First clinical experiences with perampanel in adult patients with drug-resistant epilepsy and cognitive impairment

OBJECTIVEEpilepsy surgery is effective for lesional epilepsy, but it can be associated with significant morbidity when seizures originate from eloquent cortex that is resected. Here, the objective was to describe chronic subthreshold cortical stimulation and evaluate its early surgical safety profile in adult patients with epilepsy originating from seizure foci in cortex that is not amenable to resection.METHODSAdult patients with focal drug-resistant epilepsy underwent intracranial electroencephalography monitoring for evaluation of resection. Those with seizure foci in eloquent cortex were not candidates for resection and were offered a short therapeutic trial of continuous subthreshold cortical stimulation via intracranial monitoring electrodes. After a successful trial, electrodes were explanted and permanent stimulation hardware was implanted.RESULTSTen patients (6 males) who underwent chronic subthreshold cortical stimulation between 2014 and 2016 were included. Based on radiographic imaging, intracranial pathologies included cortical dysplasia (n = 3), encephalomalacia (n = 3), cortical tubers (n = 1), Rasmussen encephalitis (n = 1), and linear migrational anomaly (n = 1). The duration of intracranial monitoring ranged from 3 to 20 days. All patients experienced an uneventful postoperative course and were discharged home with a median length of stay of 10 days. No postoperative surgical complications developed (median follow-up length 7.7 months). Seizure severity and seizure frequency improved in all patients.CONCLUSIONSThe authors’ institutional experience with this small group shows that chronic subthreshold cortical stimulation can be safely and effectively performed in appropriately selected patients without postoperative complications. Future investigation will provide further insight to recently published results regarding mechanism and efficacy of this novel and promising intervention.

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Retention rate of pregabalin in drug-resistant epilepsy: 1-year follow-up, single-centre observation in 105 consecutive, adult patients

Seizure ◽

10.1016/j.seizure.2009.07.005 ◽

2009 ◽

Vol 18 (9) ◽

pp. 634-638 ◽

Cited By ~ 10

Author(s):

Christian Brandt ◽

Theodor W. May ◽

Bernd Pohlmann-Eden ◽

Esther Nieder ◽

Heike Elsner ◽

...

Keyword(s):

Retention Rate ◽

Adult Patients ◽

Drug Resistant ◽

Single Centre ◽

Drug Resistant Epilepsy

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Impact of epilepsy duration, seizure control and EEG abnormalities on cognitive impairment in drug-resistant epilepsy patients

Acta Neurologica Belgica ◽

10.1007/s13760-019-01090-x ◽

2019 ◽

Vol 119 (3) ◽

pp. 403-410 ◽

Cited By ~ 5

Author(s):

Aleksandar Gavrilovic ◽

Gordana Toncev ◽

Tatjana Boskovic Matic ◽

Katarina Vesic ◽

Jelena Ilic Zivojinovic ◽

...

Keyword(s):

Cognitive Impairment ◽

Seizure Control ◽

Drug Resistant ◽

Eeg Abnormalities ◽

Drug Resistant Epilepsy

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A comparison of the gut microbiota among adult patients with drug-responsive and drug-resistant epilepsy: An exploratory study

Epilepsy Research ◽

10.1016/j.eplepsyres.2021.106601 ◽

2021 ◽

Vol 172 ◽

pp. 106601

Author(s):

Hyemi Lee ◽

Sunghee Lee ◽

Dong-Hoon Lee ◽

Dong Wook Kim

Keyword(s):

Gut Microbiota ◽

Exploratory Study ◽

Adult Patients ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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Cognitive Impairment and Mossy Fiber Sprouting in a Rat Model of Drug-Resistant Epilepsy Induced by Lithium–Pilocarpine

Current Neurovascular Research ◽

10.2174/1567202618666210917155408 ◽

2021 ◽

Vol 18 ◽

Author(s):

Jing Wu ◽

Likun Wang ◽

Yuanxin Huang ◽

Qian Wu ◽

Xingmei Luo ◽

...

Keyword(s):

Drug Resistance ◽

Cognitive Impairment ◽

Spatial Memory ◽

Seizure Frequency ◽

Rat Model ◽

Memory Impairment ◽

Mossy Fiber ◽

Drug Resistant ◽

Spontaneous Seizures ◽

Drug Resistant Epilepsy

Background: The mossy fiber sprouting (MFS) in the dentate gyrus is a common pathological change of epilepsy. Previous studies suggested that it is associated with drug-resistant epilepsy, and mossy cells control spontaneous seizures and spatial memory. Methods: We investigated the correlations among cognitive impairment, MFS, seizure frequency and drug resistance in a rat model of epilepsy induced by lithium–pilocarpine. Phenytoin and phenobarbital were used to screen drug resistance. Cognitive function and MFS were detected through the novel object recognition (NOR) test, Morris water maze (MWM) test and Timm staining. Results: The results showed that object memory and spatial memory functions were both significantly impaired in rats with epilepsy, and only spatial memory impairment was more severe in rats with drug-resistant epilepsy. More frequent spontaneous seizures and more obvious MFS were observed in the drug-resistant rats. The seizure frequency was significantly associated with the MWM performance but not with the NOR performance in rats with epilepsy. The degree of MFS was significantly associated with seizure frequency and spatial memory function. Conclusion: Taken together, these correlations among drug resistance, seizure frequency, spatial memory impairment and MFS suggested the possibility of a common pathological mechanism. More studies are needed to clarify the underlying mechanism behind these correlations and the detailed role of MFS in epilepsy. The mechanism of mossy cell change may be an important target for the treatment of seizures, drug resistance and cognitive dysfunction in patients with epilepsy.

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Survey on Antiepileptic Drug Therapy in Patients with Drug Resistant Epilepsy

Journal of Epilepsy Research ◽

10.14581/jer.21010 ◽

2021 ◽

Vol 11 (1) ◽

pp. 72-82

Author(s):

Jun-Sang Sunwoo ◽

Hyunjin Jo ◽

Kyung Wook Kang ◽

Keun Tae Kim ◽

Daeyoung Kim ◽

...

Keyword(s):

Expert Opinion ◽

Mechanism Of Action ◽

Mail Survey ◽

Drug Resistant ◽

Clinical Experiences ◽

Positive Effects ◽

Anti Epileptic Drug ◽

Drug Resistant Epilepsy ◽

E Mail ◽

Research Period

Background and Purpose: Individualized anti-epileptic drug (AED) selection in patient with epilepsy is crucial. However, there is no unified opinion in treating patients with drug resistant epilepsy (DRE). This survey aimed to make a consolidate consensus with epileptologists’ perspectives of the treatment for Korean DRE patients by survey responses.Methods: The survey was conducted with Korean epilepsy experts who have experience prescribing AEDs via e-mail. Survey questionnaires consisted of six items regarding prescription patterns and practical questions in treating patients with DRE in Korea. The research period was from February 2021 to March 2021.Results: The survey response rate was 83.3% (90/108). Most (77.8%) of the responders are neurologists. The proportion of patients whose seizures were not controlled by the second AED was 26.9%. The proportion of patients who had taken five or more AEDs is 13.9%, and those who are currently taking five or more AEDs are 7.3%, of which 54.5% and 37.9% reported positive effects on additional AED, respectively. The majority (91.1%) of respondents answered that the mechanism of action was the top priority factor when adding AED. Regarding data priority, responders considered that expert opinion should have the top priority, followed by clinical experiences, reimbursement guidelines and clinical evidence. Responders gave 64.9 points (range from 0 to 100) about overall satisfaction on reimbursement system of Health Insurance Review and Assessment Service for AED.Conclusions: This study on AED therapy for DRE patients is the first nationwide trial in Korean epilepsy experts. In five drug failure, the top priorities on AED selection are mechanism of action and expert opinion. These findings might help to achieve consensus and recognize the insight on optimal therapy of AED in DRE.

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