Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Intravenous immunoglobulins for epilepsy

This is not the most recent version

Information

DOI:
https://doi.org/10.1002/14651858.CD008557.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 04 July 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Epilepsy Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Article metrics

Altmetric:

Cited by:

Cited 0 times via Crossref Cited-by Linking

Collapse

Authors

  • JinSong Geng

    Evidence‐based Medicine Center, Medical School of Nantong University, Nantong, China

  • JianCheng Dong

    Correspondence to: Evidence‐based Medicine Center, Medical School of Nantong University, Nantong, China

    [email protected]

  • Youping Li

    Chinese Cochrane Centre, Chinese Evidence‐Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, China

  • Hengjian Ni

    Evidence‐based Medicine Center, Medical School of Nantong University, Nantong, China

  • Kui Jiang

    Evidence‐based Medicine Center, Medical School of Nantong University, Nantong, China

  • Li Li Shi

    Evidence‐based Medicine Center, Medical School of Nantong University, Nantong, China

  • GuoHua Wang

    Institute of Nautical Medicine, Nantong University, Nantong, China

Contributions of authors

Geng JS ‐ all correspondence; drafting protocol and review versions; searching for trials; selection of trials for inclusion and exclusion; extraction of data; interpretation of data analyses; updating review.

Dong JC ‐ arbiter of selection of trials for inclusion and exclusion; drafting review versions; extracting data; updating review.

Li YP ‐ methodology expert.

Ni HJ ‐ obtaining copies of trial reports.

Jiang K ‐ search for trials; updating review.

Shi LL ‐ selection of trials for inclusion and exclusion.

Wang GH ‐ conduct of analyses; data entry.

Sources of support

Internal sources

  • Project of Humanities and Social Sciences (Project No. 14YJCZH035), Ministry of Education in China, China.

  • National Natural Science Foundation of China (Project No. 71603138), China.

External sources

  • National Institute for Health Research (NIHR), UK.

    This review was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to the Epilepsy Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Declarations of interest

JG: none known
JD: none known
YL: none known
HN: none known
LS: none known
GW: none known

Acknowledgements

We are grateful for technical assistance from the Cochrane Epilepsy Group. We sincerely thank Professor Sridharan Ramaratnam (editorial mentor) for important advice on how to write and revise the protocol. We acknowledge the contribution of Rachael Kelly (Managing Editor), Markus Reuber (subject expert), Ann Johnston (subject expert), Karla Hemming (statistician) and Keven Hearn (consumer). We thank Professor Marcel Delire for providing us with additional information about the included trial. We thank Professor Taixiang Wu and Professor GuanJian Liu at the Chinese Cochrane Center and Chinese Evidence‐based Medicine Center for guidance on how to teach and carry out research in evidence‐based medicine. We acknowledge the help of the teachers at the Chinese Cochrane Center and Chinese Evidence‐based Medicine Center, West China Hospital and Department of Medical informatics, Medical School of Nantong University.

Version history

Published

Title

Stage

Authors

Version

2019 Dec 02

Intravenous immunoglobulins for epilepsy

Review

JinSong Geng, JianCheng Dong, Youping Li, HengJian Ni, Kui Jiang, Li Li Shi, GuoHua Wang

https://doi.org/10.1002/14651858.CD008557.pub4

2017 Jul 04

Intravenous immunoglobulins for epilepsy

Review

JinSong Geng, JianCheng Dong, Youping Li, Hengjian Ni, Kui Jiang, Li Li Shi, GuoHua Wang

https://doi.org/10.1002/14651858.CD008557.pub3

2011 Jan 19

Intravenous immunoglobulins for epilepsy

Review

JinSong Geng, JianCheng Dong, Youping Li, HengJian Ni, Kui Jiang, Li Li Shi, GuoHua Wang

https://doi.org/10.1002/14651858.CD008557.pub2

2010 Jun 16

Intravenous immunoglobulins for epilepsy

Protocol

JinSong Geng, JianCheng Dong, Youping Li, HengJian Ni, Kui Jiang, Li Li Shi, GuoHua Wang

https://doi.org/10.1002/14651858.CD008557

Differences between protocol and review

Although 'global assessment' was not stated in the review protocol, it was reported as an important outcome in the included study. The global assessment was considered to integrate several clinical aspects including reduction in the number and severity of seizures, evolution of EEG, interictal status, and perception of the participants and caregivers.

Keywords

MeSH

Medical Subject Headings Check Words

Humans;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Comparison 1 IVIg versus placebo, Outcome 1 50% or greater reduction in seizure frequency for refractory epilepsy, ITT analysis.
Figures and Tables -
Analysis 1.1

Comparison 1 IVIg versus placebo, Outcome 1 50% or greater reduction in seizure frequency for refractory epilepsy, ITT analysis.

Comparison 1 IVIg versus placebo, Outcome 2 50% or greater reduction in seizure frequency for refractory epilepsy, per‐protocol.
Figures and Tables -
Analysis 1.2

Comparison 1 IVIg versus placebo, Outcome 2 50% or greater reduction in seizure frequency for refractory epilepsy, per‐protocol.

Comparison 1 IVIg versus placebo, Outcome 3 50% or greater reduction in seizure frequency for refractory epilepsy, best‐case.
Figures and Tables -
Analysis 1.3

Comparison 1 IVIg versus placebo, Outcome 3 50% or greater reduction in seizure frequency for refractory epilepsy, best‐case.

Comparison 1 IVIg versus placebo, Outcome 4 50% or greater reduction in seizure frequency for refractory partial epilepsy, ITT analysis.
Figures and Tables -
Analysis 1.4

Comparison 1 IVIg versus placebo, Outcome 4 50% or greater reduction in seizure frequency for refractory partial epilepsy, ITT analysis.

Comparison 1 IVIg versus placebo, Outcome 5 50% or greater reduction in seizure frequency for refractory partial epilepsy, per‐protocol.
Figures and Tables -
Analysis 1.5

Comparison 1 IVIg versus placebo, Outcome 5 50% or greater reduction in seizure frequency for refractory partial epilepsy, per‐protocol.

Comparison 1 IVIg versus placebo, Outcome 6 50% or greater reduction in seizure frequency for refractory partial epilepsy, best‐case.
Figures and Tables -
Analysis 1.6

Comparison 1 IVIg versus placebo, Outcome 6 50% or greater reduction in seizure frequency for refractory partial epilepsy, best‐case.

Comparison 1 IVIg versus placebo, Outcome 7 Global assessment for refractory epilepsy, ITT analysis.
Figures and Tables -
Analysis 1.7

Comparison 1 IVIg versus placebo, Outcome 7 Global assessment for refractory epilepsy, ITT analysis.

Comparison 1 IVIg versus placebo, Outcome 8 Global assessment for refractory epilepsy, per‐protocol.
Figures and Tables -
Analysis 1.8

Comparison 1 IVIg versus placebo, Outcome 8 Global assessment for refractory epilepsy, per‐protocol.

Comparison 1 IVIg versus placebo, Outcome 9 Global assessment for refractory epilepsy, best‐case.
Figures and Tables -
Analysis 1.9

Comparison 1 IVIg versus placebo, Outcome 9 Global assessment for refractory epilepsy, best‐case.

Summary of findings for the main comparison. IVIg compared to placebo for refractory epilepsy

IVIg compared to placebo for refractory epilepsy

Patient or population: patients with refractory epilepsy
Settings: three participating hospitals‐Ottignies (Belgium), Zurich (Switzerland) and Kehl‐Kork (Germany)
Intervention: IVIg
Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo

IVIg

Seizure freedom

Not reported

Satisfactory seizure control
50% or greater reduction in seizure frequency for refractory epilepsy

278 per 1000

525 per 1000
(236 to 1000)

RR 1.89
(0.85 to 4.21)

58
(1 study)

⊕⊕⊝⊝
low1,2

Incidence of adverse or harmful effects

Not reported

Global assessment

167 per 1000

548 per 1000
(188 to 1000)

RR 3.29
(1.13 to 9.57)

60
(1 study)

⊕⊕⊝⊝
low1,2

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Unclear risk of selection bias: no information was obtained on generation of the random sequence or concealment of allocation of the randomisation.
2 More trials and patients are needed to allow more precise estimation of the treatment effects of IVIg.

Figures and Tables -
Summary of findings for the main comparison. IVIg compared to placebo for refractory epilepsy
Comparison 1. IVIg versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 50% or greater reduction in seizure frequency for refractory epilepsy, ITT analysis Show forest plot

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

1.76 [0.79, 3.93]

2 50% or greater reduction in seizure frequency for refractory epilepsy, per‐protocol Show forest plot

1

58

Risk Ratio (M‐H, Fixed, 95% CI)

1.89 [0.85, 4.21]

3 50% or greater reduction in seizure frequency for refractory epilepsy, best‐case Show forest plot

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

2.01 [0.91, 4.43]

4 50% or greater reduction in seizure frequency for refractory partial epilepsy, ITT analysis Show forest plot

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

3.08 [0.84, 11.34]

5 50% or greater reduction in seizure frequency for refractory partial epilepsy, per‐protocol Show forest plot

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

3.35 [0.91, 12.30]

6 50% or greater reduction in seizure frequency for refractory partial epilepsy, best‐case Show forest plot

1

49

Risk Ratio (M‐H, Fixed, 95% CI)

3.57 [0.98, 13.00]

7 Global assessment for refractory epilepsy, ITT analysis Show forest plot

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

3.21 [1.10, 9.36]

8 Global assessment for refractory epilepsy, per‐protocol Show forest plot

1

60

Risk Ratio (M‐H, Fixed, 95% CI)

3.29 [1.13, 9.57]

9 Global assessment for refractory epilepsy, best‐case Show forest plot

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

3.35 [1.15, 9.73]

Figures and Tables -
Comparison 1. IVIg versus placebo