scholarly journals Recommendations for the treatment of epilepsy in adult and pediatric patients in Belgium: 2020 update

2020 ◽  
Author(s):  
Paul Boon ◽  
Susana Ferrao Santos ◽  
Anna C. Jansen ◽  
Lieven Lagae ◽  
Benjamin Legros ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Generic Substitution ◽  
Pediatric Patients ◽  
Relevant Literature ◽  
New Drugs ◽  
Drug Resistant ◽  
Early Referral ◽  
Pharmacokinetic Properties ◽  
Adults And Children ◽  
Drug Resistant Epilepsy

Abstract To guide health care professionals in Belgium in selecting the appropriate antiepileptic drugs (AEDs) for their epilepsy patients, a group of Belgian epilepsy experts developed recommendations for AED treatment in adults and children (initial recommendations in 2008, updated in 2012). As new drugs have become available, others have been withdrawn, new indications have been approved and recommendations for pregnant women have changed, a new update was pertinent. A group of Belgian epilepsy experts (partly overlapping with the group in charge of the 2008/2012 recommendations) evaluated the most recent international guidelines and relevant literature for their applicability to the Belgian situation (registration status, reimbursement, clinical practice) and updated the recommendations for initial monotherapy in adults and children and add-on treatment in adults. Recommendations for add-on treatment in children were also included (not covered in the 2008/2012 publications). Like the 2008/2012 publications, the current update also covers other important aspects related to the management of epilepsy, including the importance of early referral in drug-resistant epilepsy, pharmacokinetic properties and tolerability of AEDs, comorbidities, specific considerations in elderly and pregnant patients, generic substitution and the rapidly evolving field of precision medicine.

scholarly journals Vagus nerve stimulation for pediatric patients with drug-resistant epilepsy caused by genetic mutations: Two cases

2020 ◽  
Vol 8 (3) ◽  
pp. 138-148
Author(s):  
Xiaoya Qin
Keyword(s):  
Vagus Nerve ◽  
Empirical Evidence ◽  
Therapeutic Effect ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Pediatric Patients ◽  
Genetic Mutations ◽  
Drug Resistant ◽  
Therapeutic Impact ◽  
Drug Resistant Epilepsy

Vagus nerve stimulation (VNS) is a neuromodulation therapy increasingly used for treating drug-resistant epilepsy. However, it remains to be determined which patients are best suited for the treatment, and it is difficult to predict the therapeutic effect before the implantation. Mutations in some genes could lead to epilepsy. Here we report two cases of pediatric patients with drug-resistant epilepsy treated by VNS therapy: Patient 1 with ARX mutation achieved good outcomes; Patient 2 with the CDKL5 mutation did not show improvement. Additionally, the therapeutic impact of VNS on brain networks was investigated, hoping to provide some empirical evidence for a better understanding of the mechanism of VNS treatment.

scholarly journals Neuroradiological and pathomorphological features of epilepsy associated brain tumors

2021 ◽  
Vol 12 (2) ◽  
pp. 7-21
Author(s):  
V. S. Khalilov ◽  
A. A. Kholin ◽  
A. N. Kisyakov ◽  
N. A. Medvedeva ◽  
B. R. Bakaeva
Keyword(s):  
Brain Tumors ◽  
Multimodal Imaging ◽  
Pediatric Patients ◽  
Drug Resistant ◽  
Distinctive Features ◽  
Imaging Approach ◽  
Neoplastic Process ◽  
Common Etiology ◽  
Neuroradiological Examination ◽  
Drug Resistant Epilepsy

Brain tumors are the second most common etiology in pediatric patients with focal seizures undergoing surgery for drug-resistant epilepsy. These neoplasms have a number of distinctive features from those found in adult patients, one of which is a wide polymorphism of structural architectonics during neuroradiological examination. Given the tremendous biological stability of these tumors, not in all cases of pre-surgical examination it is possible to verify the presence of a neoplastic process in the structure of the epileptogenic substrate using routine neuroimaging methods. In some complex diagnostic cases, a multimodal imaging approach and in-depth complex examination are required for reliable diagnosis and success of the results of epileptic surgery.

scholarly journals Safety of responsive neurostimulation in pediatric patients with medically refractory epilepsy

2020 ◽  
Vol 26 (5) ◽  
pp. 525-532 ◽  
Author(s):  
Fedor Panov ◽  
Sara Ganaha ◽  
Jennifer Haskell ◽  
Madeline Fields ◽  
Maite La Vega-Talbott ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Complete Removal ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Invasive Treatment ◽  
Single Center Study ◽  
Drug Resistant Epilepsy ◽  
Main Complication

OBJECTIVEApproximately 75% of pediatric patients who suffer from epilepsy are successfully treated with antiepileptic drugs, while the disease is drug resistant in the remaining patients, who continue to have seizures. Patients with drug-resistant epilepsy (DRE) may have options to undergo invasive treatment such as resection, laser ablation of the epileptogenic focus, or vagus nerve stimulation. To date, treatment with responsive neurostimulation (RNS) has not been sufficiently studied in the pediatric population because the FDA has not approved the RNS device for patients younger than 18 years of age. Here, the authors sought to investigate the safety of RNS in pediatric patients.METHODSThe authors performed a retrospective single-center study of consecutive patients with DRE who had undergone RNS system implantation from September 2015 to December 2019. Patients were followed up postoperatively to evaluate seizure freedom and complications.RESULTSOf the 27 patients studied, 3 developed infections and were treated with antibiotics. Of these 3 patients, one required partial removal and salvaging of a functioning system, and one required complete removal of the RNS device. No other complications, such as intracranial hemorrhage, stroke, or device malfunction, were seen. The average follow-up period was 22 months. All patients showed improvement in seizure frequency.CONCLUSIONSThe authors demonstrated the safety and efficacy of RNS in pediatric patients, with infections being the main complication.

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