Work

Autoimmune mechanisms in drug-resistant focal epilepsy: Pathophysiology, biomarkers, and therapeutic implications

Year: 2026

Type: article

Abstract: This review explores the role of autoimmune mechanisms in drug-resistant epilepsy (DRE), with emphasis on etiology, mechanisms of drug resistance, and potential immunomodulatory interventions. A structured review of clinical and experimental studies was conducted to assess current knowledge on the interplay between molecular mechanisms and immune responses in DRE. Particular attention was given to the involvement of the mTOR pathway, blood-brain barrier (BBB) dysfunction, astrocyte activation, and overexpression of efflux transporters, as well as the presence of neuronal autoantibodies such as N-methyl-D-aspartate receptor (NMDAR) and GluR3. The available evidence suggests that, although conventional pharmacologic approaches fail in a subset of patients, immunologic diagnostics and targeted therapies - including intravenous immunoglobulin, corticosteroids, rituximab, and plasmapheresis - may provide clinical benefit. Seizure reduction has been reported in selected patients; however, therapeutic response remains heterogeneous and is limited by small study populations. In conclusion, early identification of autoimmune mechanisms in DRE may help optimize treatment strategies, improve patient outcomes, and reduce the long-term clinical and societal burden of the disease.

Source: Advances in Clinical and Experimental Medicine

DOI: 10.17219/acem/218006

Authors: Kamil Aleksander Kunecki, Edyta Dziadkowiak

Institutions: Wroclaw Medical University, University of Wrocław

Language: English

Topic: Epilepsy research and treatment

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $754