Curative and palliative MRI-guided laser ablation for drug-resistant epilepsy

2017 ◽  
Vol 89 (4) ◽  
pp. 425-433 ◽  
Author(s):  
Mesha-Gay Brown ◽  
Cornelia Drees ◽  
Lidia M Nagae ◽  
John A Thompson ◽  
Steven Ojemann ◽  
...  
Keyword(s):  
Adult Population ◽  
Surgical Approaches ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Seizure Reduction ◽  
The Us ◽  
Reduction Measure ◽  
Mri Guided ◽  
Drug Resistant Epilepsy ◽  
Traditional Approaches

Epilepsy is a common neurological disorder occurring in 3% of the US adult population. It is characterised by seizures resulting from aberrant hypersynchronous neural activity. Approximately one-third of newly diagnosed epilepsy cases fail to become seizure-free in response to antiseizure drugs. Optimal seizure control, in cases of drug-resistant epilepsy, often requires neurosurgical intervention targeting seizure foci, such as the temporal lobe. Advances in minimally invasive ablative surgical approaches have led to the development of MRI-guided laser interstitial thermal therapy (LITT). For refractory epilepsy, this surgical intervention offers many advantages over traditional approaches, including real-time lesion monitoring, reduced morbidity, and in some reports increased preservation of cognitive and language processes. We review the use of LITT for epileptic indications in the context of its application as a curative (seizure freedom) or palliative (seizure reduction) measure for both lesional and non-lesional forms of epilepsy. Furthermore, we address the use of LITT for a variety of extratemporal lobe epilepsies. Finally, we describe clinical outcomes, limitations and future applications of LITT for epilepsy.

Real-World Preliminary Experience With Responsive Neurostimulation in Pediatric Epilepsy: A Multicenter Retrospective Observational Study

Neurosurgery ◽  
2021 ◽  
Author(s):  
Yasunori Nagahama ◽  
Thomas M Zervos ◽  
Kristina K Murata ◽  
Lynette Holman ◽  
Torin Karsonovich ◽  
...  
Keyword(s):  
Young Adults ◽  
Real World ◽  
Pediatric Epilepsy ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Efficacy And Safety ◽  
Seizure Reduction ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Drug Resistant Epilepsy

Abstract BACKGROUND Despite the well-documented utility of responsive neurostimulation (RNS, NeuroPace) in adult epilepsy patients, literature on the use of RNS in children is limited. OBJECTIVE To determine the real-world efficacy and safety of RNS in pediatric epilepsy patients. METHODS Patients with childhood-onset drug-resistant epilepsy treated with RNS were retrospectively identified at 5 pediatric centers. Reduction of disabling seizures and complications were evaluated for children (<18 yr) and young adults (>18 yr) and compared with prior literature pertaining to adult patients. RESULTS Of 35 patients identified, 17 were <18 yr at the time of RNS implantation, including a 3-yr-old patient. Four patients (11%) had concurrent resection. Three complications, requiring additional surgical interventions, were noted in young adults (2 infections [6%] and 1 lead fracture [3%]). No complications were noted in children. Among the 32 patients with continued therapy, 2 (6%) achieved seizure freedom, 4 (13%) achieved ≥90% seizure reduction, 13 (41%) had ≥50% reduction, 8 (25%) had <50% reduction, and 5 (16%) experienced no improvement. The average follow-up duration was 1.7 yr (median 1.8 yr, range 0.3-4.8 yr). There was no statistically significant difference for seizure reduction and complications between children and young adults in our cohort or between our cohort and the adult literature. CONCLUSION These preliminary data suggest that RNS is well tolerated and an effective off-label surgical treatment of drug-resistant epilepsy in carefully selected pediatric patients as young as 3 yr of age. Data regarding long-term efficacy and safety in children will be critical to optimize patient selection.

Surgical outcomes between temporal, extratemporal epilepsies and hypothalamic hamartoma: systematic review and meta-analysis of MRI-guided laser interstitial thermal therapy for drug-resistant epilepsy

2021 ◽  
pp. jnnp-2021-326185
Author(s):  
Niravkumar Barot ◽  
Kavita Batra ◽  
Jerry Zhang ◽  
Mary Lou Klem ◽  
James Castellano ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Thermal Therapy ◽  
Class I ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Mri Guided ◽  
Drug Resistant Epilepsy

BackgroundApproximately 1/3 of patients with epilepsy have drug-resistant epilepsy (DRE) and require surgical interventions. This meta-analysis aimed to review the effectiveness of MRI-guided laser interstitial thermal therapy (MRgLITT) in DRE.MethodsThe Population, Intervention, Comparator and Outcome approach and Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. PubMed, MEDLINE and EMBASE databases were systematically searched for English language publications from 2012 to Nov 2020. Data on the prevalence outcome using the Engel Epilepsy Surgery Outcome Scale (Class I–IV), and postoperative complications were analysed with 95% CIs.ResultsTwenty-eight studies that included a total of 559 patients with DRE were identified. The overall prevalence of Engel class I outcome was 56% (95% CI 0.52% to 0.60%). Hypothalamic hamartomas (HH) patients had the highest seizure freedom rate of 67% (95% CI 0.57% to 0.76%) and outcome was overall comparable between mesial temporal lobe epilepsy (mTLE) (56%, 95% CI 0.50% to 0.61%) and extratemporal epilepsy (50% 95% CI 0.40% to 0.59%). The mTLE cases with mesial temporal sclerosis had better outcome vs non-lesional cases of mTLE. The prevalence of postoperative adverse events was 19% (95% CI 0.14% to 0.25%) and the most common adverse event was visual field deficits. The reoperation rate was 9% (95% CI 0.05% to 0.14%), which included repeat ablation and open resection.ConclusionMRgLITT is an effective and safe intervention for DRE with different disease aetiologies. The seizure freedom outcome is overall comparable in between extratemporal and temporal lobe epilepsy; and highest with HH.Trail registration numberThe study protocol was registered with the National Institute for Health Research (CRD42019126365), which serves as a prospective register of systematic reviews. It is an international database of prospectively registered systematic reviews with a focus on health-related outcomes. Details about the protocol can be found at https://wwwcrdyorkacuk/PROSPERO/.

Update and Overview of the International League Against Epilepsy Consensus Definition of Drug-resistant Epilepsy

2011 ◽  
Vol 6 (1) ◽  
pp. 57 ◽  
Author(s):  
Xiao-Ting Hao ◽  
Patrick Kwan ◽  
◽  
Keyword(s):  
Improve Patient Care ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Consensus Definition ◽  
International League Against Epilepsy ◽  
Clinical Challenge ◽  
Drug Resistant Epilepsy ◽  
Definition Of ◽  
Improve Patient ◽  
International League

Drug-resistant epilepsy remains a major clinical challenge. Diverse criteria have been used to define drug resistance by different researchers, making it difficult or even impossible to compare the results across different studies. To improve patient care and facilitate clinical research, the International League Against Epilepsy (ILAE) recently proposed a consensus definition to define drug-resistant epilepsy. This is the failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom. This article outlines the framework of the consensus definition, explains how to apply it in practice and discusses the future development of its use.

Treating Drug-resistant Epilepsy – Why are we Waiting?

2015 ◽  
Vol 10 (2) ◽  
pp. 171
Author(s):  
Paul Boon ◽  
Philippe Ryvlin ◽  
James W Wheless ◽  
Kensuke Kawai ◽  
◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychiatric Disease ◽  
Drug Resistant ◽  
Treatment Gap ◽  
Health Service Provision ◽  
Adequate Treatment ◽  
Seizure Reduction ◽  
Number Of Patients ◽  
Drug Resistant Epilepsy

Drug-resistant epilepsy (DRE) has been defined by the ad hoc Task Force of the International League Against Epilepsy (ILAE) Commission on Therapeutic Strategies as the failure of two appropriately chosen and tolerated anti-epileptic drugs (AEDs) (whether as monotherapy or in combination) to control seizures when used for an adequate period of time. The difference between the number of patients with DRE and the number of these patients who do not get access to adequate treatment is defined as the ‘treatment gap’, which is considered to be substantial. There are multiple possible causes that underlie the treatment gap in DRE: economic costs, natural history of epilepsy, deficiencies in health service provision, social stigma and other as yet unidentified causes. Factors affecting quality of life in DRE include depression and anxiety, raised risk of mortality and morbidity, increased healthcare utilisation and increased risk of adverse events with long- term use of AEDs, cognitive and memory impairment, seizure-related injuries, impaired ability to achieve educational and vocational goals, to drive, establish families and benefit from social relationships. Among the reasons for the greater risk of premature death are the raised risk of suicide in those patients with comorbid psychiatric disease and the increased incidence of sudden unexpected death among those with epilepsy. Managing epilepsy well involves more than just seizure reduction and when freedom from seizures cannot be achieved, addressing quality of life is likely to be more beneficial than interventions aimed at seizure reduction alone. Options exist for patients with DRE who are not candidates for epilepsy surgery, including dietary treatments, further attempts with AEDs and non-pharmacological interventions with devices. Further, non-invasive modalities are emerging, creating a more hopeful picture that the treatment gap for patients with DRE may be narrowed or even closed.

scholarly journals The Pharmacoresistant Epilepsy: An Overview on Existant and New Emerging Therapies

2021 ◽  
Vol 12 ◽  
Author(s):  
Antonella Fattorusso ◽  
Sara Matricardi ◽  
Elisabetta Mencaroni ◽  
Giovanni Battista Dell'Isola ◽  
Giuseppe Di Cara ◽  
...  
Keyword(s):  
Treatment Options ◽  
Current Evidence ◽  
Seizure Freedom ◽  
Symptomatic Therapy ◽  
Drug Resistant ◽  
Drug Trials ◽  
Pharmacoresistant Epilepsy ◽  
Emerging Therapies ◽  
Chronic Disorders ◽  
Drug Resistant Epilepsy

Epilepsy is one of the most common neurological chronic disorders, with an estimated prevalence of 0. 5 – 1%. Currently, treatment options for epilepsy are predominantly based on the administration of symptomatic therapy. Most patients are able to achieve seizure freedom by the first two appropriate drug trials. Thus, patients who cannot reach a satisfactory response after that are defined as pharmacoresistant. However, despite the availability of more than 20 antiseizure medications (ASMs), about one-third of epilepsies remain drug-resistant. The heterogeneity of seizures and epilepsies, the coexistence of comorbidities, and the broad spectrum of efficacy, safety, and tolerability related to the ASMs, make the management of these patients actually challenging. In this review, we analyze the most relevant clinical and pathogenetic issues related to drug-resistant epilepsy, and then we discuss the current evidence about the use of available ASMs and the alternative non-pharmacological approaches.

scholarly journals Drug Resistant Epilepsy Among Patients Attended The Neurosciences Hospital

2019 ◽  
Vol 13 (1) ◽  
pp. 108-115
Author(s):  
Nael Husain Zaer
Keyword(s):  
Drug Resistance ◽  
Medical History ◽  
Refractory Epilepsy ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Past Medical History ◽  
Number Of Patients ◽  
Drug Resistant Epilepsy ◽  
Patients With Epilepsy

Background: Drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules to achieve sustained seizure freedom. Up to 30% of patients referred to clinics with a diagnosis of pharmaco-resistant epilepsy may have been misdiagnosed, and many can be helped by optimizing their treatment.Pseudoresistance, in which seizures persist because the underlying disorder has not been adequately or appropriately treated, must be ruled out or corrected before drug treatment can be considered to have failed. Objectives: The objectives of this study were to determine the causes of drug failure in patients with epilepsy and to differentiate between drug resistant epilepsy and pseudoresistant epilepsy. Type of the study: This is a retrospective study. Method: It is conducted in Baghdad governorate at the epilepsy clinic in the neurosciences hospital during the period from the 1st of February through July 2013. Two hundred patients with refractory epilepsy were involved. These patients attended the epilepsy clinic during 2011 and 2012. The data was collected from the files of the patients including age, gender, weight, history of presenting illness, type of seizure, drugs used, duration of disease, EEG and imaging findings, compliance and follow up. Results: Drug resistance epilepsy constituted a prevalence of 24% (128) as the total number of patients with epilepsy attending the hospital during the same period was 527.The mean age of patients with refractory epilepsy was 25 years. Male were 56.5% (113/200) and urban residents were 70.5% (141/200). The study revealed that 64% (128/200) of refractory epilepsy was attributed to drug resistance; while the remaining proportion was pseudoresistance 36% (72/200). The main cause of pseudoresistance was poor compliance 36.1% (26/72).The most common type of seizure in the sampled patients was generalized tonic clonic seizures in 51.5% (103/200).Compliance was found to be statistically associated with abnormal EEG finding, past medical history (hypertension, cardiac diseases, encephalitis, diabetes mellitus and any significant history) and quality of follow up. The follow-up was found to be statistically associated with the family history, past medical history( encephalitis and hypertension) and compliance of patient. Conclusion:A considerable number of patientsdiagnosed as cases of drug resistant epilepsy had another explanation causing drug failure.The study recommends the application of consensus definition for drug resistant epilepsy and periodic evaluation of patients with drug resistant epilepsy to exclude pseudoresistance.

scholarly journals Current approaches to neurosurgical treatment for drug-resistant focal epilepsy in adults

2018 ◽  
Vol 10 (1S) ◽  
pp. 81-88
Author(s):  
E. A. Narodova ◽  
A. A. Narodov ◽  
N. A. Shnayder ◽  
D. V. Dmitrenko ◽  
I. G. Strotskaya
Keyword(s):  
Focal Epilepsy ◽  
Rapid Development ◽  
Adult Population ◽  
Infectious Complications ◽  
High Rate ◽  
Drug Resistant ◽  
Postoperative Rehabilitation ◽  
Foreign Countries ◽  
Neurosurgical Treatment ◽  
Drug Resistant Epilepsy

The review is dedicated to the problems of current neurosurgical treatment for drug-resistant epilepsy in the adult population of Russia and foreign countries. The literature published in the period  2010–2017 was sought in Russian and foreign databases. This  review included 58 only full-text publications. The search results  have shown that despite advances in neurosurgery for drug-resistant epilepsy and the development of new surgical procedures, the  problem of this disease has not yet been fully resolved today. This is  evidenced by fairly high global prevalence rates in patients with  postoperative epilepsy resistant to antiepileptic therapy. The  literature analysis has revealed that the mean prevalence of postoperative epilepsy is 69%. This indicator may vary according  to the type of an epileptogenic structural lesion and its location in  the brain. However, despite the rapid development of epilepsy  surgery, currently there is still a low surgical activity in the treatment  of patients with drugresistant epilepsy. Of importance is  also the presence of postoperative complications, including various  infectious complications and neurological deficit. Taking into account  the high rate of postoperative epilepsy, it is concluded that it is  appropriate to develop postoperative rehabilitation methods for patients with drug-resistant epilepsy.

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