scholarly journals Survey on Antiepileptic Drug Therapy in Patients with Drug Resistant Epilepsy

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.

Vagus nerve stimulation

2009 ◽  
Vol 27 (3) ◽  
pp. E5 ◽  
Author(s):  
Dzenan Lulic ◽  
Amir Ahmadian ◽  
Ali A. Baaj ◽  
Selim R. Benbadis ◽  
Fernando L. Vale
Keyword(s):  
Vagus Nerve ◽  
Mechanism Of Action ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Drug Resistant ◽  
Nonpharmacological Treatment ◽  
History Of ◽  
Drug Resistant Epilepsy ◽  
Medically Refractory Epilepsy

Vagus nerve stimulation (VNS) is a key tool in the treatment of patients with medically refractory epilepsy. Although the mechanism of action of VNS remains poorly understood, this modality is now the most widely used nonpharmacological treatment for drug-resistant epilepsy. The goal of this work is to review the history of VNS and provide information on recent advances and applications of this technology.

The Ketogenic Diet in the Treatment of Childhood Epilepsy

2010 ◽  
Vol 5 (1) ◽  
pp. 88
Author(s):  
J Helen Cross ◽  
Keyword(s):  
Ketogenic Diet ◽  
Evidence Base ◽  
Drug Resistant ◽  
Older Children ◽  
Efficacy Evaluation ◽  
Anti Epileptic Drug ◽  
Drug Resistant Epilepsy ◽  
Randomised Controlled

The ketogenic diet has been used for the treatment of drug-resistant epilepsy in childhood for almost 100 years. This aside, it is only over the past decade that renewed interest has led to a further evidence base for efficacy, evaluation of optimal implementation and wider discussion of possible mechanisms of action. Randomised controlled data have now demonstrated the diet to be as effective as any newer anti-epileptic drug (AED) in drug-resistant epilepsy. Implementation can be challenging, and is resource-intensive, but successful use can lead to improved quality of life with most immediate side effects alleviated by dietary manipulation. However, data are still required on the choice of optimal candidates and the role of alternative diets in older children.

scholarly journals Refractory Epilepsy: Mechanisms of Pharmacoresistance

2021 ◽  
pp. 99-110
Author(s):  
Ariel Le ◽  
Makenzie Thomas ◽  
Brady Stallman ◽  
Kathryn Meadows ◽  
Vidya Bhargava
Keyword(s):  
Blood Brain Barrier ◽  
Refractory Epilepsy ◽  
Treatment Options ◽  
Brain Barrier ◽  
Drug Resistant ◽  
Blood Brain ◽  
Anti Epileptic Drug ◽  
Drug Resistant Epilepsy ◽  
Protein Transporters

Refractory or drug-resistant epilepsy is a complex and debilitating disorder that impacts over one-third of people diagnosed with epilepsy. Many studies have suggested a variety of possible hypotheses for drug-resistant epilepsy, including the degeneration of neural networks, alterations of anti-epileptic drug (AED) targets, intrinsic severity/frequency of seizures, and genetic predisposition to pharmacoresistance. However, extensive research suggests that the overexpression of efflux protein transporters in brain tissue is the most viable hypothesis. Specifically, the overexpression of P-glycoproteins (P-gps) at the blood brain barrier proves the most compelling mechanism to discuss further. Studying the mechanisms of these transporters provides critical insight for new ways to combat pharmacoresistance. Thus, this review evaluates the co-administration of P-gp inhibitors with AEDs as a promising, yet relatively unexplored, treatment option for refractory epilepsy. This review specifically considers Tariquidar (TQD) the most promising P-gp inhibitor for refractory epilepsy treatment. This work aims to evaluate the role of P-gp overexpression in refractory epilepsy, consolidate current research about potential treatment options, and identify discrepancies or gaps in the literature related to P-gp inhibitory treatments for refractory epilepsy. It was concluded that, as a result of increased drug efflux processes at the blood brain barrier, overexpression of P-gp is the leading cause of pharmacoresistance. By inhibiting the activity of these proteins with the drug Tariquidar, an effective treatment for refractory epilepsy may become a reality.

scholarly journals European Expert Opinion on ANT-DBS therapy for patients with drug-resistant epilepsy (a Delphi consensus)

Seizure ◽  
2020 ◽  
Vol 81 ◽  
pp. 201-209 ◽  
Author(s):  
Elisabeth Kaufmann ◽  
Fabrice Bartolomei ◽  
Paul Boon ◽  
Stéphan Chabardes ◽  
Albert J. Colon ◽  
...  
Keyword(s):  
Expert Opinion ◽  
Drug Resistant ◽  
Delphi Consensus ◽  
Drug Resistant Epilepsy

Long-term use of the ketogenic diet in drug resistant epilepsy syndromes during childhood: Differences between responders and non-responders in seizure types, EEG, and outcome

2008 ◽  
Vol 39 (05) ◽  
Author(s):  
A Dressler ◽  
E Reithofer ◽  
B Stöcklin ◽  
F Benninger ◽  
M Freilinger ◽  
...  
Keyword(s):  
Ketogenic Diet ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy

Diacylfuroxans Are Masked Nitrile Oxides That Inhibit GPX4 Covalently

2019 ◽  
Author(s):  
John Eaton ◽  
Richard A. Ruberto ◽  
Anneke Kramm ◽  
Vasanthi S. Viswanathan ◽  
Stuart Schreiber
Keyword(s):  
Molecular Mechanism ◽  
Mechanism Of Action ◽  
Therapeutic Target ◽  
Biologically Active ◽  
Drug Resistant ◽  
Nitrile Oxides ◽  
Molecular Mechanism Of Action

<div><div><div><p>GPX4 represents a promising yet difficult-to-drug therapeutic target for the treatment of, among others, drug-resistant cancers. While most GPX4 inhibitors rely on a chloroacetamide moiety to modify covalently the protein’s catalytic selenocysteine residue, the discovery and mechanistic elucidation of structurally diverse GPX4-inhibiting molecules has uncovered novel electrophilic warheads that bind and inhibit GPX4. Here we report our discovery that diacylfuroxans can act as masked nitrile oxides that inhibit GPX4 covalently. These observations illuminate a novel molecular mechanism of action for biologically active furoxans and also suggest that nitrile oxides may be uniquely suited to targeting GPX4.</p></div></div></div>

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