Sanjeev Kumar, Reena Mittal, Sweety  , Depp Chand Jain

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Department of Physics, Central Medical Physics Research Laboratory, D.A.V. (P.G.) College, Muzaffarnagar, India.
Department of Mathematics, Shri.K.K.JAIN. College, Khatauli, India.
Department of Neurology, Safdarganj Hospital, New Delhi, India.
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Abstract: Muscular dystrophies are myopathies and tend to progressive, with ongoing degeneration and regeneration of muscle fibers. Spinal muscular atrophy (SMA), amyotrophic lateral sclerosis (ALS) and polio myelitis are essentially diseases of the anterior horn cells of the spine. It has been reported in literature that humoral immunity is manifested by the antibodies production. These are special chemical substances that react against foreign body. Antibodies are serum proteins, which are immunoglobulins and possess antibody activity and are classified according to antigens and stimulate their production such as IgA, JgG, IgM, IgD and IgE. All the immunological parameters such as of C3, C4, IgG, IgM and IgA, which are measured in Duchenne muscular dystrophy go down in comparison to healthy subjects. Complement C3 and Complement C4 go down about 44.3% and 78.57% respectively from the normal values. The serum IgG, IgM and IgA levels were also go down about 65%, 84% and 99.56% respectively in comparison to healthy subjects. A trend between all the immunoglobulins has been set up and it is rAG.M > rMA.G. > rGM.A, while we have a trend in DMD cases is rMA.G. > rAG.M > rGM.A We are in a position to say that our data have a relevance of high authenticity and reliability to accept that there is a deficit in immunity in DMD cases. The deficit in immunity may be a cause to damage muscle for abnormal functioning.

Keywords: Complements, Immunoglobulins, Duchenne Muscular Dystrophy, Regression Coefficients, Multiple Correlation Coefficients

Cite this paper: Kumar, S. , Mittal, R. ,  , S. and Jain, D. (2014) Role of Complements and Immunoglobulins in Duchenne Muscular Dystrophy. Open Journal of Applied Sciences, 4, 323-346. doi: 10.4236/ojapps.2014.46030.

References

[1]   Petrof, B., Shrager, J., Stedman, H., Kelley, A. and Sweeney, H. (1993) Dystrophin Protects the Sarcolemma from Stresses Developed during Muscle Contraction. Proceedings of the National Academy of Sciences of the United States of America, 90, 3710-3714.
http://www.pnas.org/content/90/8/3710.full.pdf

[2]   Emery, A.E. (2002) The Muscular Dystrophies. The Lancet, 359, 687-695.
http://dx.doi.org/10.1016/S0140-6736(02)07815-7

[3]   Bach, R.J. (1999) Introduction In Guide to the Evaluation and Management of Neuro Muscular Disease. Hanley & Belfus Inc., Philadelphia, 1-4.

[4]   Meryon, E. (1852) On Grannular and Fatty Degeneration of the Voluntary Muscles. Medico-Chirurgical Transactions, 35, 72-84.

[5]   Duchenne, G.B.A. (1868) Researches Sur la paralysic musculaire pseudo hypertrophic or paralysie myo-sclero sique. Archives of General Psychiatry, 11, 5-25.

[6]   Moser, H. (1984) Duchenne Muscular Dystrophy: Pathogenetic Aspects and Genetic Prevention. Human Genetics, 66, 17-40.
http://dx.doi.org/10.1007/BF00275183

[7]   Emery, A.E. (1991) Population Frequencies of Inherited Neuro-muscular Disease—A World Survey. Neuromuscular Disorders, 1, 19-29.
http://dx.doi.org/10.1016/0960-8966(91)90039-U

[8]   Abood, E.A. and Jones, M.M. (1991) Macrophages in Developing Mammalian Skeletal Muscle: Evidence for Muscle Fiber Death as a Normal Developmental Event. Acta Anatomica, 140, 201-212.
http://dx.doi.org/10.1159/000147059

[9]   Simonds, A.K., Muntani, F., Heather, S. and Fielding, S. (1998) Impact of Nasal Ventilation on Survival in Hypercapnic Duchenne Muscular Dystrophy. Therax, 53, 949-952.
http://dx.doi.org/10.1136/thx.53.11.949

[10]   Somer, H., Donner, M., Murros, J. and Konttinen, A. (1973) A Serum Isoenzyme Study in Muscular Dystrophy. Particular Reference to Creatine Kinase, Aspartate Aminotransferase, and Lactic Acid Dehydrogenase Isozymes. Archives of Neurology, 29, 343-345.

[11]   Mokri, B. and Engel, A.G. (1975) Duchenne Dystrophy: Electron Microscopic Findings Pointing to a Basic or Early Abnormality in the Plasma Membrane of Muscle Fiber. Neurology, 25, 1111-1120.
http://dx.doi.org/10.1212/WNL.25.12.1111

[12]   Engel, J., Furthmayr, H., Odermatt, E., von der Mark, H., Aumailley, M., Fleischmajer, R. and Timpl, R. (1985) Structure and Macromolecular Organization of Type VI Collagen. Annals of the New York Academy of Sciences, 460, 25-37.

[13]   Gillis, J.M. (1999) Understanding Dystrophinopathies: An Inventory of the Structural and Functional Consequences of the Absence of Dystrophin in Muscles of the Mdx Mouse. Journal of Muscle Research & Cell Motility, 20, 605-625.
http://dx.doi.org/10.1023/A:1005545325254

[14]   Sandri, M., Minetti, C., Pedemonte, M. and Carraro, U. (1998) Apoptotic Myonuclei in Human Duchenne Muscular Dystrophy. Laboratory Investigation, 78, 1005-1016.

[15]   Tidball, J.G., Albrecht, D.E., Lokensgard, B.E. and Spencer, M.J. (1995) Apptasis Precedes Necrosis of Dystrophin-Deficient Muscle. Journal of Cell Science, 108, 2197-2204.

[16]   Matsuda, R., Nishikawa, A. and Tanaka, H. (1995) Visualization of Dystrophic Muscle Fibers in Mdx Mouse by Vital Staining with Evans Blue: Evidence of Apoptosis in Dystrophin-Deficient Mouscle. The Journal of Biochemistry, 118, 959-963.
http://dx.doi.org/10.1093/jb/118.5.959

[17]   Spencer, M.J., Walsh, C.M., Dorshkind, K.A., Rodriguez, E.M. and Tidball, J.G. (1997) Myonuclear Apoptosis in Dystrophic Mdx Muscles Occurs by Perforin-Mediated Cytotoxicity. Journal of Clinical Investigation, 99, 2745-2751.
http://dx.doi.org/10.1172/JCI119464

[18]   Bradley, W.G., Hudgson, P., Larson, P.F., Papapetropoulas, T.A. and Jenkison, M. (1972) Structural Changes in the Early Stages of Duchenne Muscular Dystrophy. Journal of Neurology, Neurosurgery & Psychiatry, 35, 451-455.
http://dx.doi.org/10.1136/jnnp.35.4.451

[19]   Bowman, W. (1840) On the Minute Structure and Movements of Voluntary Muscle. The Philosophical Transactions of the Royal Society, 130, 457-501.

[20]   Murphy, D.L., Mendell, J.R. and Engel, W.K. (1973) Serotonin and Platelet Function in Duchenne’s Muscular Dystrophy. Archives of Neurology, 28, 239-242.
http://dx.doi.org/10.1001/archneur.1973.00490220047006

[21]   Paulsan, O.F., Engel, A.G. and Gomez, M.R. (1974) Muscle Blood Flow in Duchenne Type Muscular Dystrophy, Limb-Gridle Dystrophy, Polymyositis and in Normal Controls. Journal of Neurology, Neurosurgery & Psychiatry, 37, 685-690.
http://dx.doi.org/10.1136/jnnp.37.6.685

[22]   Jerusalem, F., Engel, A.G. and Gomez, M.R. (1974) Duchenne Dystrophy. I. Morphometric Study of the Muscle Microvascular. Brain, 97, 115-122.
http://dx.doi.org/10.1093/brain/97.1.115

[23]   McComas, A.J., Sica, R.E.P. and Currie, S. (1971) An Electro-physiological Study of Duchenne Dystrophy. Journal of Neurology, Neurosurgery & Psychiatry, 34, 461-468.
http://dx.doi.org/10.1136/jnnp.34.4.461

[24]   Panayiotopoulos, C.P., Scarpalezos, S. and Papapetropoulos, T. (1974) Electrophysiological Estimation of Motor Units in Duchenne Muscular Dystrophy. Journal of the Neurological Sciences, 23, 89-98.
http://dx.doi.org/10.1016/0022-510X(74)90145-2

[25]   Ballantyne, J.P. and Hansen, S. (1974) New Method for Estimation of the Number of Motor Units in a Muscle. 2. Duchenne, Limb-Girdle and Facioscapulohumerol, and Myotonic Muscular Dystrophies. Journal of Neurology, Neurosurgery & Psychiatry, 37, 1195-1201.
http://dx.doi.org/10.1136/jnnp.37.11.1195

[26]   Matheson, D.M. and Howland, J.L. (1974) Erythrocyte Deformation in Human Muscular Dystrophy. Science, 184, 165-166.
http://dx.doi.org/10.1126/science.184.4133.165

[27]   Miale, T.D., Frias, J.L. and Lawson, D.L. (1975) Erythrocytes in Human Muscular Dystrophy. Science, 187, 453-454.
http://dx.doi.org/10.1126/science.1111115

[28]   Miller, S.E., Roses, A.D. and Appel, S.H. (1975) Letter: Erythrocytes in Human Muscular Dystrophy. Science, 188, 1131.
http://dx.doi.org/10.1126/science.1215993

[29]   Brown, H.D., Chattopadyay, S.K. and Patel, A.B. (1967) Erythrocyte Abnormality in Human Myopathy. Science, 157, 1577-1578.
http://dx.doi.org/10.1126/science.157.3796.1577

[30]   Peter, J.B., Worsfold, M. and Pearson, C.M. (1969) Erythrocyte Ghost Adenosine Triphosphate (AT Pase) in Duchenne Dystrophy. Journal of Laboratory and Clinical Medicine, 74, 103-108.

[31]   Roses, A.D., Herbstreith, M.H. and Appel, S.H. (1975) Membrane Protein Kinease Alteration in Duchenne Muscular Dystrophy. Nature, 254, 350-351.
http://dx.doi.org/10.1038/254350a0

[32]   Mawatari, S., Takagi, A. and Rowland, L.P. (1974) Adenyl Cyclase in Normal and Pathologic Human Muscle. Archives of Neurology, 30, 96-102.

[33]   Pearce, G.W., Pearce, J.M.S. and Walton, J.N. (1966) The Duchenne Type Muscular Dystrophy: Histopathological Studies of the Carrier State. Brain, 89, 109-120.
http://dx.doi.org/10.1001/archneur.1974.00490310098016

[34]   Roy, S. and Dubowitz, V. (1970) Carrier Detection in Duchenne Muscular Dystrophy: A Comparative Study of Electron Microscopy, Light Microscopy and Serum Enzymes. Journal of the Neurological Sciences, 11, 65-79.
http://dx.doi.org/10.1016/0022-510X(70)90041-9

[35]   Ionasescu, V., Zellweger, H. and Conway, T.W. (1971) Ribosomal Protein Synthesis in Ducheme Muscular Dystrophy. Archives of Biochemistry and Biophysics, 144, 51-58.
http://dx.doi.org/10.1016/0003-9861(71)90453-X

[36]   Ionasescu, V., Zellweger, H., Shirk, P. and Conway, T.W. (1973) Identification of Carriers of Duchenne Muscular Dystrophy by Muscle Protein Synthesis. Neurology, 23, 497-501.
http://dx.doi.org/10.1212/WNL.23.5.497

[37]   Roses, A.D., Roses, M.J., Miller, S.E., Hull, K.L. and Appel, S.H. (1976) Carrier Detection in Duchenne Muscular Dystrophy. New England Journal of Medicine, 294, 193-198.
http://dx.doi.org/10.1056/NEJM197601222940404

[38]   Hobbins, J.C. and Mahoney, M.J. (1974) In Utero Diagnosis of Hemoglobinopathies—Technique for Obtaining Fetal Blood. New England Journal of Medicine, 290, 1065-1067.
http://dx.doi.org/10.1056/NEJM197405092901908

[39]   Bodensteiner, J.B. and Engel, A.G. (1978) Intracellular Calcium Accumulation in Duchenne Dystrophy and Other Myopathies. A Study of 56, 7,000 Muscle Fibers in 114 Biopsies. Neurology, 28, 439-446.
http://dx.doi.org/10.1212/WNL.28.5.439

[40]   Bertorini, T.E., Bhattacharya, S.K., Palmieri, G.M.A., Chesney, C.M., Pifer, D. and Baker, B. (1982) Muscle Calcium and Magnesium Content in Duchenne Muscular Dystrophy. Neurology, 32, 1088-1092.
http://dx.doi.org/10.1212/WNL.32.10.1088

[41]   Schotland, D.L., Bonilla, E. and Wakayama, Y. (1980) Application of the Freeze Fracture Technique to the Study of Human Neuromuscular Diseases. Muscle & Nerve, 3, 21-27.
http://dx.doi.org/10.1002/mus.880030104

[42]   Schotland, D.L., Bonilla, E. and Van Meter, M. (1977) Duchenne Dystrophy: Alteration in Plasma Membrane Structure. Science, 196, 1005-1007.
http://dx.doi.org/10.1126/science.860127

[43]   Peluchretti, D., Mora, M., Protti, A. and Cornelio, F. (1985) Freeze-Fracture Analysis of the Muscle Fiber Plasma Membrane in Duchenne Dystrophy. Neurology, 35, 928-930.
http://dx.doi.org/10.1212/WNL.35.6.928

[44]   Heimann-Patterson, T.D., Bonilla, E. and Schotland, D.L. (1982) Cancanavalin A Binding of the Cell Surfac of Duchenne Muscle in Vitro. Annals of Neurology, 12, 305-307.
http://dx.doi.org/10.1002/ana.410120317

[45]   Brooke, M.H. (1986) Muscular Dystrophies. In: McSherry, N.C. and Victoria, M.V., Eds., A Clinician’s View of Neuromuscular Disease, Williams & Wilkins, Baltimore, London, Los Angles, Sytdney, 117-154.

[46]   Ionasescu, R., Kaeding, L., Feld, R., Write, D., Cancilla, P., Kaeding, L. and Stern, L.Z. (1991) Alterations in Creatine Kinase in Fresh Muscle and Cell Cultures in Duchenne Dystrophy. Annals of Neurology, 9, 394-399.
http://dx.doi.org/10.1002/ana.410090413

[47]   Thompson, E.J., Yasin, R., Van Beers, G., Nurse, K. and Al-Ani, S. (1977) Myogenic Defect in Human Muscular Dystrophy. Nature, 268, 241-243.
http://dx.doi.org/10.1038/268241a0

[48]   Rothman, S.M. and Bischoff, R. (1983) Electrophysiology of Duchenne Dystrophy Myotubes in Tissue Culture. Annals of Neurology, 13, 176-179.
http://dx.doi.org/10.1002/ana.410130212

[49]   Mawatari, S., Miranda, A. and Rowland, L.P. (1976) Adenyl Cyelase Abnormality in Duchenne Muscular Dystrophy: Muscle Cells in Culture. Neurology, 26, 1021-1026.
http://dx.doi.org/10.1212/WNL.26.11.1021

[50]   Cerri, C.A., Willner, J.H. and Miranda, A.F. (1982) Adenylate Cyclase in Duchenne Fibroblasts. Journal of the Neurological Sciences, 53, 181-185.
http://dx.doi.org/10.1016/0022-510X(82)90004-1

[51]   Rowland, L.P. (1980) Biochemistry of Muscle Membranes in Duchenne Dystrophy. Muscle & Nerve, 3, 3-20.
http://dx.doi.org/10.1002/mus.880030103

[52]   Falk, R.S., Campion, D., Guthrie, B., Sparkes, R.S. and Fox, C.F. (1979) Phospharylation of the Red-Cell Membrane Proteins in Duchenne Muscular Dystrophy. New England Journal of Medicine, 300, 258-259.
http://dx.doi.org/10.1056/NEJM197902013000514

[53]   Fischer, S., Tortolero, M., Piau, J.P., Delaunay, J. and Schapira, G. (1978) Protein Kinase and Adanylate Kinase of Erythrocyte Membrane from Patients with Duchenne Dystrophy. Clinica Chimica Acta, 88, 437-440.
http://dx.doi.org/10.1016/0009-8981(78)90278-4

[54]   Roses, A.D., Mabry, M.E., Herbstreith, M.H., Shile, E.V. and Balakrishnan, O.V. (1982) Increased [32P]-Phospharylation of Spectrin Peptides in Duchenne Muscular Dystrophy. In: Schotland, D.L., Ed., Disorders of the Motor Unit, John Wiley & Sons, New York, 413-420.

[55]   Mabry, M.E. and Roses, A.D. (1981) Increased 32P-Phoshorylase of Triptic Peptides of Erythrocytes Spectrin in Duchenne Muscular Dystrophy. Muscle & Nerve, 4, 489-493.
http://dx.doi.org/10.1002/mus.880040605

[56]   Roses, A.D., Shile, P.E., Herbstreith, M.H. and Balakrishnan, C.V. (1981) Identification of Abnormality [32P]-Phoshorylated Cyanogen Bromide Cleavage Product of Erythrocyte Membrane Spectrin in Duchenne Muscular Dystrophy. Neurology, 31, 1026-1030.
http://dx.doi.org/10.1212/WNL.31.8.1026

[57]   Arthur, H., de Niese, M., Jeffrey, P.L. and Austin, L. (1983) Plasma Lipoprotein in Duchenne Muscular Dystrophy. Biochemistry International, 6, 307-313.

[58]   Ehrlich, P. (1885) Das sauerstufbudurfnis des organismus, in Eine Farbenanalytische Studies. Hirschwald, Berlin, pp. 167.

[59]   Murphy, J.B. and Sturm, E. (1923) Conditions Determining the Transplantability of Tissues in the Brain. The Journal of Experimental Medicine, 39, 183-197.
http://dx.doi.org/10.1084/jem.38.2.183

[60]   Sabin, F.R. (1916) The Origin and Development of the Lymphatic System. Johns Hopkins Hospital Reports, Johns Hopkins Press, Baltimore, 347-440.

[61]   Ediden, M. (1972) Transplantation Antigens. Academic Press, New York, 125-140.

[62]   Blalock, J.E. (1984) The Immune System as a Sensory Organ. The Journal of Immunology, 132, 1067-1070.

[63]   Reichlin, S. (1993) Neuroendocrine-Immune Interactions. New England Journal of Medicine, 329, 1246-1253.
http://dx.doi.org/10.1056/NEJM199310213291708

[64]   Sternberg, E.M., Chrousos, G.P., Wilder, R.L. and Gold, P.W. (1992) The Stress Response and the Regulation of Inflammatory Disease. Annals of Internal Medicine, 117, 854-866.
http://dx.doi.org/10.7326/0003-4819-117-10-854

[65]   Weigent, D.A. and Blalock, J.E. (1987) Interactions between the Neuroendocrine and Immune Systems: Common Hormones Receptors. Immunological Reviews, 100, 79-108.
http://dx.doi.org/10.1111/j.1600-065X.1987.tb00528.x

[66]   Tourtellotte, W. (1970) On Cerebrospinal Fluid Immunoglobulin-G (IgG) quotIents in Multiple Sclerosis and Other Disease. A Review and a New Formula to Estimate the Amount of IgG Synthesized Per Day by the Central Nervous System. Journal of the Neurological Sciences, 10, 279-304.
http://dx.doi.org/10.1016/0022-510X(70)90156-5

[67]   Oldstone, M.B. and Dixon, F.J. (1968) Immunohistochemical Study of Allergic Encephalomyelitis. American Journal of Pathology, 52, 251-263.

[68]   Miller, S.D., Vanderlugt, C.L., Begolka, W.S., Pao, W., Yauch, R.L., Neville, K.L., Katz-Levy, Y., Carrizosa, A. and Kim, B.S. (1997) Presistent Infection with Theiler’s Virus Leads to CNS Autoimmunity via Epitope Spreading. Nature Medicine, 3, 1133-1136.
http://dx.doi.org/10.1038/nm1097-1133

[69]   Agnello, V. (1978) Complement Deficiency States. Medicne, 57, 1-23.

[70]   Fearon, D.T. (1987) Structure and Functions of Compliment. In: Ataasi, M.Z., Vanoss, C.J. and Absolon, D.R., Eds., Molecular Immunology, Marcel Dekker Inc., New York, pp. 511.

[71]   Volanakis, J.E. (1975) The Human Complement System. Journal of Oral Pathology & Medicine, 4, 195-221.
http://dx.doi.org/10.1111/j.1600-0714.1975.tb01742.x

[72]   Stein, J.H. (1987) Complement Measurement. In: Puddy, S., Ed., Internal Medicine, 2nd Edition, Little Brown and Company Boston, Toronto, pp. 1184.

[73]   Fishman, R.A. (1980) Cerebrospinal Fluid in Disorders of the Nervous System. Armarou, A., Hrtncry, M. and Shapiro, K., Eds., Sounders, Philadelphia, London, Toronto, 95-107.

[74]   Milica, T.C., Brinar, V., Pauro, M., Vogrinc, Z. and Stambuk, N. (1998) Cerebrospinal Fluid Complement Activation in Neurological Diseases. Journal of the Neurological Sciences, 154, 173-181.
http://dx.doi.org/10.1016/S0022-510X(97)00225-6

[75]   Isenberg, D.A. (1982) Immunoglobulin Deposition in Skeletal Muscle in Primary Muscle Disease. QJM: An International Journal of Medicine, 52, 297-310.

[76]   Spulre, S. and Engel, A.G (1988) Unexpected Sarcolemental Complement on Membrane Attack Complex Deposits on Nonnecrotic Muscle Fibers in Muscular Dystrophies. Neurology, 50, 41-46.
http://dx.doi.org/10.1212/WNL.50.1.41

[77]   Engel, A.G. and Biesecker, G. (1982) Complement Activation in Muscle Fiber Necrosis Demonstration of the Membrane Attack Complex of Complement in Necrotic Fibers. Annals of Neurology, 12, 289-296.

[78]   Niebrój-Dobosz, I., Lukasiuk, M. and Niebrój-Dobosz, I. (1995) Immunoblot Analysis of Sarcoplasmic Calcium Binding Proteins in Duchenne Muscular Dystrophy. Journal of Neurology, 242, 82-86.
http://dx.doi.org/10.1007/BF00887821

[79]   Minetti, C., Tanjii, K. and Bonilla, E. (1992) Immunologic Study of Vinculin in Duchenne Muscular Dystrophy. Neurology, 42, 1751-1754.
http://dx.doi.org/10.1212/WNL.42.9.1751

[80]   Wochner, R.D., Drews, G., Strober, W. and Warren, S. (1966) Accelerated Breakdown of Immunoglobulin G (IgG) in Myotonic Dystrophy: A Hereditary Error of Immunoglobulin Catabolism. Journal of Clinical Investigation, 45, 321-329.
http://dx.doi.org/10.1172/JCI105346

[81]   Larsen, B., Johnson, G., Loghem, E., Van Marshall, W.H., Newton, R.M., Pryse-Phillips, W. and Skanes, V. (1980) Immunoglobulin Concentration and Gm Allotypes in a Family with Thirty-Three Cases of Myotonic Dystrophy. Clinical Genetics, 18, 13-19.
http://dx.doi.org/10.1111/j.1399-0004.1980.tb01358.x

[82]   Sanders, B.G., Kline, K. and Morton, C.J. (1980) Serum IgG Levels in the Storrs Strain of Hereditary Muscular Dystrophhic Chickens. Biochemical Genetics, 18, 1149-1158.

[83]   Mancini, G., Carbonara, A.O. and Heremans, J.F. (1965) Immunochemical Quantitation of Antigens by Single Radial Immunodiffusion. Immunochemistry, 2, 235-254.
http://dx.doi.org/10.1016/0019-2791(65)90004-2

[84]   Al-Hakeim, H.K. (2008) Serum Cortisol, Immunoglobulins and Some Complements among Depressed Patients. Indian Journal of Clinical Biochemistry, 23, 76-80.
http://dx.doi.org/10.1007/s12291-008-0018-2

[85]   Olsson, R., Hellner, L., Lindstedt, G., Lundberg, P.A. and Teger-Nilsson, A.C. (1983) Plasma Proteins in Patients on Long Term Anti Epileptic Treatment. Clinical Chemistry, 29, 728-730.

[86]   Riddoch, D. and Thompson, R.A. (1970) Immunoglobulin Levels in the Cerebrospinal Fluid. British Medicine Journal, 1, 396-399.
http://dx.doi.org/10.1136/bmj.1.5693.396

[87]   Gholamoli, Y.P., Izadi, S. and Ghaderi, A. (2004) Immunological Correlates of Adults Onset Idiopathic Generalised Tonic-Clanic Epilepsy before and after Sodium Valporate Treatment, Iranion. The Journal of Immunology, 1, 105-110.

[88]   Slavin, B.N., Fenton, G.M., Laundry, M. and Reynolds, E.H. (1974) Serum Immunoglobulin in Epilepsy. Journal of the Neurological Sciences, 23, 353-357.
http://dx.doi.org/10.1016/0022-510X(74)90153-1

[89]   Moustafa, S., Osama, A., Saad, A., Elseed, S. and Moustafa, N. (2006) Immunotoxicity of Chronic Phenytoin Administration in Epileptic Patients. Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 43, 435-441.

[90]   Kumar, S. (1989) Medico-Physical Studies on Epilepsy and Other Neurological Disorders. Ph. D. Thesis, University of Delhi, New Delhi.

[91]   Anderson, P. and Moseklide, L. (1977) Immunoglobulin Levels and Autoantibodies in Epileptics on Long-Term Anti-convulsant Therapy. Acta Medica Scandinavica, 201, 69-74.

[92]   Moore, T.L., Ryan Jr., R.E., Pohl, D.A., Roodman, S.T. and Ryan Sr., R.E. (1980) Immunoglobulin, Complement, and Immune Complex Levels during a Migrane Attack. Headache: The Journal of Headache and Face pain, 20, 9-12.

[93]   Lord, G.D.A. and Duchworth, J.W. (1977) Immunoglobulin and Complement Studies in Migrance. Headache: The Journal of Head and Face Pain, 17, 163-168.
http://dx.doi.org/10.1111/j.1526-4610.1977.hed1704163.x

[94]   Kumar, S., Kumar, V., Jain, D.C. and Mittal, R. (2013) Immunological Variations in Epileptic Children. Open Journal of Applied Sciences, 3, 71-91.