Table 3.
Systematic review of anti-IL-6 agents in epilepsy.
| References | Disease |
PTS N Age |
Study design | Intervention | Timing | Efficacy | Safety |
|---|---|---|---|---|---|---|---|
| Magro et al. (117) | CNS disease and DRE associated with LSCS. | 1 (22 years old) |
Case Report | Tocilizumab 162 mg S.C. once a week | Start: 6 months after | Noticeable improvement in cognitive and affective symptoms with decrease in seizure frequency. Resolution of many of the enhancing lesions on brain MRI |
No adverse effects |
| Stredny et al. (114) | FIRES | 1 (6 years old) |
Case Report | Tocilizumab 12 mg/kg S.C. every 2 weeks | Start: Day 20 Stop: Day 76 |
Reduction of seizure | No adverse effects |
| Donnelly et al. (118) | NORSE | 1 (26 years old) |
Case Report | Tocilizumab 300 mg IV. for two times | First dose: 9 weeks after the beginning of treatment Second dose: 12 weeks after the beginning of treatment |
Stop seizures after 48 h | No adverse effects |
| Osminina et al. (119) | CNS disease and DRE associated with LSCS. | 1 (2 years 10 months) |
Case Report | Tocilizumab 10 mg/kg IV. once in 4 weeks | Start: 16 months after the beginning of symptoms Stop: 26 months after first infusion of Tz. |
Reduction of periventricular focus; stop seizures. | No adverse effects |
| Jaafar et al. (120) | SRSE | 1 (8 years old) |
Case Report | Tocilizumab, 8 mg/kg/day S.C. divided in two doses 1 week apart | Start: 10 days after admission to hospital | Stops seizure 24 h after | No adverse effects |
| Cantarín-Extremera et al. (121) | NORSE | 2 Pt 1: 1.9 years old Pt 2: 2.7 years old |
Case Report | Pt 1 Tocilizumab 4 mg/kg once a week |
Start: Day 21 Stop: Day 28 |
Seizures decrease in frequency, in VEEG critical patterns had disappeared. | No adverse effects |
| Pt 2 Tocilizumab 4 mg/kg for 2 times |
Start: Day 30 and 40 | 48–72 h after the first dose, the seizures began to decrease progressively in frequency and intensity, there was global neurological improvement, recovering normality in terms of language, level of consciousness, and motor capacity, but persisting hyperactivity. | No adverse effects | ||||
| Jun et al. (124) | NORSE | 7 [median 25 years old (22–64)] |
Prospective | Tocilizumab 4 mg/kg for 2 cycles in 1-week intervals, a monthly dose (8 mg/kg) was added if needed | Start: Median day 25 (6–73) | Resolution of status epilepticus in 6/7 patients 3/6 of the survived patients showed improvement on the mRS |
2/7 (2.9%) leukopenia 1/7 (1.4%) diarrhea 1/7 (1.4%) pneumonia 1/7 (1.4%) sepsis |
| Benucci et al. (122) | Limbic Encephalitis with Anti-CASPR2 Antibodies | 1 (64 years old) |
Case Report | Tocilizumab 8 mg/kg IV. once a month for 6 months, then 162 mg every week s.c | Start: 2–3 months after admission. | Full seizure control Resolution of behavioral changes and seizures Improvement in mRS |
No adverse effects |
| Vallecoccia et al. (123) | SRSE | 1 (34 years old) |
Case Report | 2 doses of tocilizumab 4 mg/kg at a 1-week interval | Start: day 24 | Partial recovery after 7–10 days from the first administration. Resolution of the clinical picture after 1 month (*ketamine and ketogenic diet added) | Sepsis by drug-resistant pathogen |
CNS, Central nervous system; DRE: drug-resistant epilepsy; FIRES, Febrile infection-related epilepsy syndrome; LSCS, Linear scleroderma “en coup de sabre;” mRS, modified Rankin scale; NORSE, New-onset refractory status epilepticus; RSE, refractory status epilepticus; SRSE, Super-refractory status epilepticus.