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Case Reports
. 2022 Sep 15;61(18):2785-2787.
doi: 10.2169/internalmedicine.9036-21. Epub 2022 Feb 8.

Complete Relief of Painful Tonic Seizures in Neuromyelitis Optica Spectrum Disorder by Satralizumab Treatment

Akiyuki Uzawa  1 , Masahiro Mori  1 , Yuta Iwai  2 , Hiroki Masuda  1 , Satoshi Kuwabara  1
Affiliations
Case Reports

Complete Relief of Painful Tonic Seizures in Neuromyelitis Optica Spectrum Disorder by Satralizumab Treatment

Akiyuki Uzawa et al. Intern Med. .

Abstract

Satralizumab, a monoclonal antibody against interleukin-6 receptors, has been approved for the treatment of neuromyelitis optica spectrum disorder (NMOSD). Several reports have described the effectiveness of satralizumab against neuropathic pain in patients with NMOSD, but its effects on painful tonic seizures have not yet been reported. We herein report a Japanese woman with anti-aquaporin-4 antibody-positive NMOSD whose painful tonic seizures completely resolved after six months of satralizumab treatment. In conclusion, interleukin-6 blocking may be effective against painful tonic seizures. This effect may be due to suppression of microglial activation and the resultant neuronal hyperexcitability.

Keywords: IL-6; neuromyelitis optica; painful tonic seizures; satralizumab.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Spinal cord magnetic resonance imaging at the inflammatory episode of cervical myelitis. Sagittal (A) and axial (B, C) images on T2-weighted imaging of the cervical spinal cord showed a C2-3 lesion. The C2 lesion involved the dorsal column of the spinal cord (left side dominant).
Figure 2.
Figure 2.
Time course of painful tonic seizures after satralizumab treatment. Her painful tonic seizure started approximately one month after the onset of myelitis. The patient suffered painful tonic seizures for eight months. Treatment with carbamazepine (CBZ), clonazepam (CZP), and gabapentin (GBP) failed to suppress painful tonic seizures. Before satralizumab treatment, painful tonic seizures occurred once an hour [visual analog scale (VAS) 10]. After one month of treatment, the seizures were reduced to once a week (VAS 7.5). After three months of treatment, seizures were reduced to once a month (VAS 5.5). After six months of satralizumab treatment, the seizures disappeared.
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