Pentoxifylline Potentiates Antiepileptic Activity of Diazepam on the Model of Treatment-Resistant Focal Epilepsy

Objective: To update the 2004 American Academy of Neurology (AAN) guideline for managing treatment-resistant (TR) epilepsy with second- and third-generation antiepileptic drugs (AEDs). Methods: 2004 criteria were used to systematically review literature (January 2003 to November 2015), classify pertinent studies according to the therapeutic rating scheme, and link recommendations to evidence strength. Results: Forty-two articles were included. Recommendations: The following are established as effective to reduce seizure frequency (Level A): immediate-release pregabalin and perampanel for TR adult focal epilepsy (TRAFE); vigabatrin for TRAFE (not first-line treatment; rufinamide for Lennox–Gastuat syndrome (LGS) (add-on therapy). The following should be considered to decrease seizure frequency (Level B): lacosamide, eslicarbazepine, and extended-release topiramate for TRAFE (ezogabine production discontinued); immediate- and extended-release lamotrigine for generalized epilepsy with TR generalized tonic–clonic (GTC) seizures in adults; levetiracetam (add-on therapy) for TR childhood focal epilepsy (TRCFE) (1 month to 16 years), TR GTC seizures, and TR juvenile myoclonic epilepsy; clobazam for LGS (add-on therapy); zonisamide for TRCFE (6–17 years); oxcarbazepine for TRCFE (1 month to 4 years). The text presents Level C recommendations. AED selection depends on seizure/syndrome type, patient age, concomitant medications, and AED tolerability, safety, and efficacy. This evidence-based assessment informs AED prescription guidelines for TR epilepsy and indicates seizure types and syndromes needing more evidence. A recent FDA strategy allows extrapolation of efficacy across populations; therefore, for focal epilepsy, eslicarbazepine and lacosamide (oral only for pediatric use) as add-on or monotherapy in persons ≥4 years of age and perampanel as monotherapy received FDA approval.

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Is Treatment Resistant Focal Epilepsy Less Frequent in Veterans?

Online Journal of Neurology and Brain Disorders ◽

10.32474/ojnbd.2018.01.000105 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Maria Raquel Lopez

Keyword(s):

Focal Epilepsy ◽

Treatment Resistant

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Epilepsy Treatment Stimulus Package? Deep Brain Stimulation in Treatment-Resistant Focal Epilepsy

Epilepsy Currents ◽

10.1111/j.1535-7511.2010.01384.x ◽

2010 ◽

Vol 10 (6) ◽

pp. 148-150 ◽

Cited By ~ 1

Author(s):

Chad Carlson

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Focal Epilepsy ◽

Treatment Resistant ◽

Epilepsy Treatment ◽

Deep Brain ◽

Stimulus Package

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Treating of focal epilepsy: a patent review

Pharmaceutical Patent Analyst ◽

10.4155/ppa-2021-0008 ◽

2021 ◽

Author(s):

Slobodan M Janković ◽

Nenad Marković ◽

Tanja Luković

Keyword(s):

Gene Therapy ◽

Anticonvulsant Activity ◽

Viral Vectors ◽

Focal Epilepsy ◽

Specific Gene ◽

Efficacy And Safety ◽

Treatment Resistant ◽

Patent Review ◽

Current Therapies ◽

New Compounds

Focal epilepsy is one of the most frequent specific type of epilepsies, with 30% treatment-resistant patients. There are several directions researchers can follow to improve existing treatment of focal epilepsy: synthesis of new compounds with anticonvulsant activity, repurposing drugs approved for other indications, finding drugs targeted to specific genetic and biochemical defects that underlie focal epilepsy syndromes, development of viral vectors for specific gene therapy, creation of devices and methods for suppression of seizures by electrostimulation and development of methods to increase safety of epilepsy surgery. Improvement of efficacy and safety of current therapies is necessary, as well as developing targeted treatment of genetic epilepsy syndromes that will not only suppress seizures, but stop further epileptogenesis.

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Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs II: Treatment-resistant epilepsy

Neurology ◽

10.1212/wnl.0000000000005756 ◽

2018 ◽

Vol 91 (2) ◽

pp. 82-90 ◽

Cited By ~ 27

Author(s):

Andres M. Kanner ◽

Eric Ashman ◽

David Gloss ◽

Cynthia Harden ◽

Blaise Bourgeois ◽

...

Keyword(s):

Antiepileptic Drugs ◽

Seizure Frequency ◽

Extended Release ◽

Focal Epilepsy ◽

Immediate Release ◽

Juvenile Myoclonic Epilepsy ◽

Review Literature ◽

Treatment Resistant ◽

New Antiepileptic Drugs ◽

Frequency Level

ObjectiveTo update the 2004 American Academy of Neurology guideline for managing treatment-resistant (TR) epilepsy with second- and third-generation antiepileptic drugs (AEDs).Methods2004 criteria were used to systemically review literature (January 2003 to November 2015), classify pertinent studies according to the therapeutic rating scheme, and link recommendations to evidence strength.ResultsForty-two articles were included.RecommendationsThe following are established as effective to reduce seizure frequency (Level A): immediate-release pregabalin and perampanel for TR adult focal epilepsy (TRAFE); vigabatrin for TRAFE (not first-line treatment); rufinamide for Lennox-Gastaut syndrome (LGS) (add-on therapy). The following should be considered to decrease seizure frequency (Level B): lacosamide, eslicarbazepine, and extended-release topiramate for TRAFE (ezogabine production discontinued); immediate- and extended-release lamotrigine for generalized epilepsy with TR generalized tonic-clonic (GTC) seizures in adults; levetiracetam (add-on therapy) for TR childhood focal epilepsy (TRCFE) (1 month–16 years), TR GTC seizures, and TR juvenile myoclonic epilepsy; clobazam for LGS (add-on therapy); zonisamide for TRCFE (6–17 years); oxcarbazepine for TRCFE (1 month–4 years). The text presents Level C recommendations. AED selection depends on seizure/syndrome type, patient age, concomitant medications, and AED tolerability, safety, and efficacy. This evidence-based assessment informs AED prescription guidelines for TR epilepsy and indicates seizure types and syndromes needing more evidence. A recent Food and Drug Administration (FDA) strategy allows extrapolation of efficacy across populations; therefore, for focal epilepsy, eslicarbazepine and lacosamide (oral only for pediatric use) as add-on or monotherapy in persons ≥4 years of age and perampanel as monotherapy received FDA approval.

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Patients with resistant focal epilepsy: what affects the quality of life?

Epilepsia and paroxyzmal conditions ◽

10.17749/2077-8333.2019.11.3.233-243 ◽

2019 ◽

Vol 11 (3) ◽

pp. 233-243

Author(s):

K. V. Firsov ◽

M. G. Amirhanyan ◽

A. S. Kotov

Keyword(s):

Quality Of Life ◽

Focal Epilepsy ◽

Brain Mri ◽

Epileptic Seizures ◽

Social Situation ◽

Psychological State ◽

Treatment Resistant ◽

History Of ◽

The Impact

The aim is to assess the impact of resistant focal epilepsy on the quality of patients' life.Materials and methods. Prospective, comparative, observational study conducted under conditions of real clinical practice. Inclusion criteria: age over 18 years; the presence of two or more epileptic seizures in history; a long history of treatment-resistant focal epileptic seizures; current AED therapy. Exclusion criteria: history of non-epileptic seizures of any etiology; inability to perform an MRI and/or EEG. The design included two patient visits, the second 3-12 months after the first ("primary" and "repeated" examinations). The examination included the medical history, analysis of seizure diary, clinical and neurological examination, routine EEG and/or EEG video monitoring, brain MRI, and laboratory tests. During the initial and repeated visits, the patients were asked to answer the QOLIE-31, NHS3, HADS questionnaires. The patients were also asked to give their own subjective assessment of their physical and psychological state, treatment results, side effects, social situation, and the quality of life. All patients had a follow-up history of at least one year.Results. In total, 120 patients with current or past treatment-resistant epileptic seizures were examined (53 men and 67 women aged 18 to 77 years). At the time of the re-examination (under continuing AED therapy), seizures stopped in 50.8% of them. The number of seizure types decreased in 65.9% of people. The effect of resistant focal epilepsy on the patient's quality of life was determined.Conclusion. The use of commonly accepted tests (QOLIE-31, HADS, etc.) in the "expertise" mode is incorrect, probably because these tests had been originally created for the "client" situation. A discrepancy was found between an objective improvement in the clinical picture as a result of successful treatment and a subjective "insignificant" improvement in the quality of life as per patients' assessments.

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