Immunosorbent blood tests for assessing paroxysmal cerebral discharges
Immunosorbents, kits and compositions for diagnosing a central nervous system disorder, particularly paroxysmal cerebral discharges and epilepsy, comprising measuring the concentration of GluR1 or fragment thereof and/or GluR1 antibodies in a biological sample from a human subject. The method is particularly useful for identifying individuals that are at risk for brain related seizures and epilepsy, for distinguishing epilepsy from pseudo-epilepsy and epilepsy-like disorders, for following up after anticonvulsive treatment, and for the adjustment of adequate therapy and doses.
1. A method for determining whether paroxysmal activity is the origin of seizures in patients diagnosed as having paroxysmal discharges, thereby distinguishing between epileptic and pseudo-epileptic seizures, and treating patients suffering from seizures of paroxysmal origin, comprising directly measuring the presence and quantity of GluR1 by assaying a biological fluid in said patients for GluR1 and GluR1 fragments, correlating greater than a predetermined amount of GluR1 and GluR1 fragments with paroxysmal origin of said seizures and, when said origin is paroxysmal, further comprising:
a) treating said patient with an initial dose of anticonvulsive drug therapy;
b) directly assaying said biological fluid for the presence and quantity of GluR1;
c) increasing the dose, changing the drug, or treating with multiple drugs, if the quantity of GluR1 fails to fall below the predetermined amount of GluR1 and GluR1 fragments; and
d) employing, as a control or calibrator, the GluR1 fragment of SEQ ID NO: 5 or 6 wherein the predetermined amount is at least 50 pg/ml.
2. The method of claim 1 , wherein the predetermined amount is 75 pg/ml.
3. The method of claim 1 , wherein the predetermined amount is 100 pg/ml.
4. The method of claim 1 wherein said origin is paroxysmal or non-paroxysmal.
5. The method of claim 1 wherein said biological fluid is blood, urine, blood plasma, blood serum, cerebrospinal fluid, saliva, or perspiration, or a derivative thereof.
6. The method of claim 1 wherein said seizures are associated with pseudo-epileptic loss of consciousness, fainting, migraine, brain trauma, stroke, psychogenic activity, narcolepsy, Tourette syndrome, cardiac arrythmia, drug abuse or stroke.
7. The method of claim 1 further comprising comparing said quantity of GluR1 to a baseline level of GluR1 selected from population norms and prior levels measured in said patient.
8. The method of claim 1 wherein for a child under three years of age, a concentration of free GluR1 or fragment thereof in blood of greater than 50 pg/ml indicates a paroxysmal origin of said seizures, and a GluR1 concentration in blood of less than 50 pg/ml indicates a non-paroxysmal origin of said seizures.
9. The method of claim 1 wherein:
a) said biological fluid is assayed for the presence and quantity of GluR1,
b) said method is carried out using a diagnostic kit, and
c) said kit comprises an antibody standard comprising a specific fraction of immunoglobulins G purified from human blood, optionally immunoglobulins of 95% purity that specifically bind the GluR1 peptide without significant cross-reaction with other glutamate receptor fragments or other neuroreceptors.
10. The method of claim 1 further comprising:
a) analyzing said patient for paroxysmal spiking on EEG;
b) clinically evaluating said patient for intractable epilepsy;
c) performing neurosurgery on said patient based upon the presence of paroxysmal spiking, intractable epilepsy, and abnormally high profiles of concentrations of GluR1 or fragment thereof.
11. The method of claim 1 further comprising correlating changes in the presence or quantity of GluR1 to alterations in paroxysmal spiking activity as measured by EEG.
12. The method of claim 1 wherein the quantitating of GluR1 and GluR1 fragments is performed by direct ELISA, RIA, immunodot, immunoblot, latex agglutination, lateral flow, fluorescence polarization assay, or microarray.
13. The method of claim 1 , comprising:
a) contacting said biological sample with a solid phase comprising antibodies to GluR1 or a fragment thereof, for a time sufficient to form a complex between said antibodies and, if present in the biological sample, GluR1 or fragment thereof;
b) contacting said complex with an indicator reagent attached to a signal-generating compound; and
c) measuring the signal generated; wherein the amount of signal detected correlates to the amount of said GluR1 or fragment thereof present in said sample.
14. The method of claim 13 , wherein said indicator reagent comprises chicken anti-human IgG attached to horseradish peroxidase.
15. The method of claim 1 , wherein the biological sample is plasma or serum diluted to a ratio of about 1:50.
16. A method for determining whether paroxysmal activity is the origin of seizures in a patient diagnosed as having paroxysmal discharges, and thereby distinguishing between epileptic and pseudo-epileptic seizures, comprising:
a) contacting a biological sample from said patient with immunosorbent substrate particles upon which are immobilized antibodies to GluR1 or a fragment thereof, wherein said contacting of said biological sample is for 10 minutes or less to form an agglutination complex between said antibodies and GluR1 or fragment thereof;
b) reading a signal generated from the agglutination; wherein a signal that corresponds to a quantity of GluR1 and fragments thereof above a predetermined amount correlates to paroxysmal origin for said seizures; and
c) employing, as a control or calibrator, the GluR1 fragment of SEQ ID NO: 5 or 6 wherein the predetermined amount is 50 pg/ml.
17. The method of claim 16 , wherein the predetermined amount is 75 pg/ml.
18. The method of claim 16 , wherein the predetermined amount is 100 pg/ml.
19. A method for determining whether paroxysmal activity is the origin of seizures in patients diagnosed as having paroxysmal discharges and distinguishing between epileptic and pseudo-epileptic seizures, comprising directly measuring the presence and quantity of GluR1 in a biological fluid from a patient suffering from seizures by assaying said biological fluid, further comprising employing, as a control or calibrator, the GluR1 fragment of SEQ ID NO: 5 or 6 wherein a finding that at least 50 pg/ml of GluR1 is present in the biological fluid indicates that the patient has paroxysmal origin of the seizures.
20. The method of claim 19 , wherein a finding that at least 75 pg/ml of GluR1 is present in the biological fluid indicates that the patient has paroxysmal origin of the seizures.
21. The method of claim 19 , wherein a finding that at least 100 pg/ml of GluR1 is present in the biological fluid indicates that the patient has paroxysmal origin of the seizures.