The ILAE definition of drug resistant epilepsy and its clinical applicability compared with “older” established definitions

SUMMARY Background. Early identification of potential epilepsy surgery candidates is essential to the treatment process. Aim. To evaluate the clinical applicability of the ILAE definition of drug resistant epilepsy and its potential in identifying surgical candidates earlier compared to three established “older” definitions of drug resistant epilepsy. Material and Methods. Retrospective analysis of 174 patients who underwent epilepsy surgery between 1998 and 2009. Clinical factors and course of disease were extracted from patients' charts. Drug resistant epilepsy was classified according to four definitions and the time until fulfillment of criteria compared. Results. Mean time to fulfillment of criteria of drug resistant epilepsy ranged from 11.8 (standard deviation (SD) 9.8) to 15.6 years (SD 11.3). Time to drug resistance was significantly longer applying the only definition, requiring failure of three antiepileptic drugs (AEDs) (Canada definition), whereas time to fulfillment of all other definitions did not differ. Fifty percent of all patients experienced a seizure free period of ≥1 year prior to being classified as drug resistant, 13% entered another 1-year remission after fulfilling any criteria for drug resistance. Conclusion. We conclude that the ILAE definition identifies drug resistant epilepsy, with similar latency like two of three formerly used definitions. It is an easy applicable tool to minimize the delay of referral to a specialized center. Intermittent remissions delay assessment of drug resistance for all definitions and 13% of patients enter a remission despite established drug resistance.

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Mechanisms of Drug Resistance in the Pathogenesis of Epilepsy: Role of Neuroinflammation. A Literature Review

Brain Sciences ◽

10.3390/brainsci11050663 ◽

2021 ◽

Vol 11 (5) ◽

pp. 663

Author(s):

Elena D. Bazhanova ◽

Alexander A. Kozlov ◽

Anastasia V. Litovchenko

Keyword(s):

Drug Resistance ◽

Premature Death ◽

Resistance Mechanisms ◽

Biomedical Literature ◽

Drug Resistant ◽

Psychological Consequences ◽

Text Documents ◽

Neural Connections ◽

Inflammatory Processes ◽

Drug Resistant Epilepsy

Epilepsy is a chronic neurological disorder characterized by recurring spontaneous seizures. Drug resistance appears in 30% of patients and it can lead to premature death, brain damage or a reduced quality of life. The purpose of the study was to analyze the drug resistance mechanisms, especially neuroinflammation, in the epileptogenesis. The information bases of biomedical literature Scopus, PubMed, Google Scholar and SciVerse were used. To obtain full-text documents, electronic resources of PubMed Central and Research Gate were used. The article examines the recent research of the mechanisms of drug resistance in epilepsy and discusses the hypotheses of drug resistance development (genetic, epigenetic, target hypothesis, etc.). Drug-resistant epilepsy is associated with neuroinflammatory, autoimmune and neurodegenerative processes. Neuroinflammation causes immune, pathophysiological, biochemical and psychological consequences. Focal or systemic unregulated inflammatory processes lead to the formation of aberrant neural connections and hyperexcitable neural networks. Inflammatory mediators affect the endothelium of cerebral vessels, destroy contacts between endothelial cells and induce abnormal angiogenesis (the formation of “leaky” vessels), thereby affecting the blood–brain barrier permeability. Thus, the analysis of pro-inflammatory and other components of epileptogenesis can contribute to the further development of the therapeutic treatment of drug-resistant epilepsy.

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Seizure frequency and social outcome in drug resistant epilepsy patients who do not undergo epilepsy surgery

Seizure ◽

10.1016/j.seizure.2011.04.010 ◽

2011 ◽

Vol 20 (7) ◽

pp. 580-582 ◽

Cited By ~ 8

Author(s):

Mar Carreño ◽

Juan Luis Becerra ◽

Joaquín Castillo ◽

Iratxe Maestro ◽

Antonio Donaire ◽

...

Keyword(s):

Seizure Frequency ◽

Epilepsy Surgery ◽

Drug Resistant ◽

Social Outcome ◽

Drug Resistant Epilepsy

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Selection of children with drug resistant epilepsy who are candidates for epilepsy surgery: pre and post-operative evaluation

QJM ◽

10.1093/qjmed/hcab113.056 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Osama Salah Mohamed El Sharkawy ◽

Zeinab Anwar El kabbany ◽

Neveen Tawakol Younis ◽

Khaled Aboulfotouh Ahmad ◽

Ahmed Darwish Mahmoud ◽

...

Keyword(s):

Epilepsy Surgery ◽

Preoperative Evaluation ◽

Drug Resistant ◽

Surgery Outcome ◽

Class 1 ◽

Operative Evaluation ◽

Drug Resistant Epilepsy ◽

Stage 1 ◽

International League ◽

Selection Of

Abstract Objective To select patients with drug resistant epilepsy following up in Pediatrics Neurology Outpatient Clinic of Children's Hospital, Ain Shams University who are candidates for epilepsy surgery and to detect outcome of epilepsy surgery in such children as regards seizures control. Methods This prospective study was conducted over a period of 36 months and comprises of 3 stages. Stage 1 includes selection of candidates for epilepsy surgery and preoperative evaluation. Evaluation included clinical assessment, video EEG, MRI epilepsy protocol. Stage 2 include surgery phase where decision of surgery was made by a multidisciplinary team. Stage 3 includes post-operative evaluation as regards Seizures frequency, Seizures Severity using Chalfont score, Engel Epilepsy Surgery Outcome Scale and the International League Against Epilepsy (ILAE) outcome classification. Data was tabulated and analyzed with SSPS package for windows. Results 17 patients underwent epilepsy surgery. Results revealed significant decrease in seizures frequency and severity at 6 and 12 months after surgery. As regards Engel Epilepsy Surgery Outcome Scale 11 (64.7%) patients were class I at 12 months. As regards the ILAE outcome classification 10 (58.8%) patients are class 1 at 12 months. Conclusions epilepsy surgery can be a hope for patients with drug resistant epilepsy who are well selected and evaluated preoperatively. New studies on larger number and for longer duration are recommended.

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Fifteen-minute consultation: When medicines don’t work—the child with poorly controlled seizures

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2018-316035 ◽

2018 ◽

Vol 104 (3) ◽

pp. 135-140

Author(s):

Pooja Harijan ◽

Arnab Kumar Seal ◽

Manish Prasad ◽

William P Whitehouse

Keyword(s):

Quality Of Life ◽

Epilepsy Surgery ◽

Drug Resistant ◽

Algorithmic Approach ◽

Life Management ◽

Drug Resistant Epilepsy

Drug-resistant epilepsy (DRE) occurs in 20%–30% of children with epilepsy with significant impact on their quality of life. Management of this group of children has greatly improved in the recent years with streamlining of epilepsy surgery services and associated quaternary multimodal evaluation. This article provides a review of DRE in children and management based on recent evidence and published opinion. We have also presented an algorithmic approach to the child with possible DRE.

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Does epilepsy surgery lower the mortality of drug-resistant epilepsy?

Epilepsy Research ◽

10.1016/j.eplepsyres.2003.10.001 ◽

2003 ◽

Vol 56 (2-3) ◽

pp. 105-120 ◽

Cited By ~ 36

Author(s):

P Ryvlin ◽

P Kahane

Keyword(s):

Epilepsy Surgery ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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Medically resistant pediatric insular-opercular/perisylvian epilepsy. Part 1: invasive monitoring using the parasagittal transinsular apex depth electrode

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.4.peds15636 ◽

2016 ◽

Vol 18 (5) ◽

pp. 511-522 ◽

Cited By ~ 13

Author(s):

Alexander G. Weil ◽

Aria Fallah ◽

Evan C. Lewis ◽

Sanjiv Bhatia

Keyword(s):

Epilepsy Surgery ◽

Electrode Placement ◽

Epileptogenic Zone ◽

Drug Resistant ◽

Depth Electrodes ◽

Depth Electrode ◽

Age At Surgery ◽

Feasible Alternative ◽

The Mean ◽

Drug Resistant Epilepsy

OBJECTIVE Insular lobe epilepsy (ILE) is an under-recognized cause of extratemporal epilepsy and explains some epilepsy surgery failures in children with drug-resistant epilepsy. The diagnosis of ILE usually requires invasive investigation with insular sampling; however, the location of the insula below the opercula and the dense middle cerebral artery vasculature renders its sampling challenging. Several techniques have been described, ranging from open direct placement of orthogonal subpial depth and strip electrodes through a craniotomy to frame-based stereotactic placement of orthogonal or oblique electrodes using stereo-electroencephalography principles. The authors describe an alternative method for sampling the insula, which involves placing insular depth electrodes along the long axis of the insula through the insular apex following dissection of the sylvian fissure in conjunction with subdural electrodes over the lateral hemispheric/opercular region. The authors report the feasibility, advantages, disadvantages, and role of this approach in investigating pediatric insular-opercular refractory epilepsy. METHODS The authors performed a retrospective analysis of all children (< 18 years old) who underwent invasive intracranial studies involving the insula between 2002 and 2015. RESULTS Eleven patients were included in the study (5 boys). The mean age at surgery was 7.6 years (range 0.5–16 years). All patients had drug-resistant epilepsy as defined by the International League Against Epilepsy and underwent comprehensive noninvasive epilepsy surgery workup. Intracranial monitoring was performed in all patients using 1 parasagittal insular electrode (1 patient had 2 electrodes) in addition to subdural grids and strips tailored to the suspected epileptogenic zone. In 10 patients, extraoperative monitoring was used; in 1 patient, intraoperative electrocorticography was used alone without extraoperative monitoring. The mean number of insular contacts was 6.8 (range 4–8), and the mean number of fronto-parieto-temporal hemispheric contacts was 61.7 (range 40–92). There were no complications related to placement of these depth electrodes. All 11 patients underwent subsequent resective surgery involving the insula. CONCLUSIONS Parasagittal transinsular apex depth electrode placement is a feasible alternative to orthogonally placed open or oblique-placed stereotactic methodologies. This method is safe and best suited for suspected unilateral cases with a possible extensive insular-opercular epileptogenic zone.

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