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.

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.

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.

Epileptic Spasms Predict Poor Epilepsy Outcomes After Perinatal Stroke

2019 ◽  
Vol 34 (13) ◽  
pp. 830-836
Author(s):  
Jason P. Lockrow ◽  
Jason N. Wright ◽  
Russell P. Saneto ◽  
Catherine Amlie-Lefond
Keyword(s):  
Initial Response ◽  
Response To Treatment ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Perinatal Stroke ◽  
Epileptic Spasms ◽  
Venous Infarct ◽  
Structural Lesion ◽  
Drug Resistant Epilepsy ◽  
Severe Epilepsy

Perinatal stroke is a significant cause of severe epilepsy, including epileptic spasms. Although epileptic spasms due to underlying structural lesion often respond poorly to treatment and evolve into drug-resistant epilepsy, outcomes are not uniformly poor, and predictors of outcomes are not well described. We performed a single-institution retrospective review of epileptic spasms following perinatal stroke to determine if outcome depended on vascular subtype. We identified 24 children with epileptic spasms due to perinatal ischemic stroke: 11 cases of perinatal arterial stroke and 13 cases of perinatal venous infarct. Initial response to treatment was similar between groups; however, although children with perinatal arterial stroke who responded to epileptic spasms therapy had high rates of seizure freedom, many children with perinatal venous infarct, regardless of initial response, had residual drug-resistant epilepsy. We consider whether the mechanism for epileptogenesis may be different between arterial and venous strokes, and whether these 2 groups should be monitored for epileptic spasms, and subsequent epilepsy, differently.

scholarly journals Role of high-density EEG (hdEEG) in pre-surgical epilepsy evaluation in children: case report and review of the literature

2021 ◽  
Vol 37 (5) ◽  
pp. 1429-1437
Author(s):  
Michela Quintiliani ◽  
Federico Bianchi ◽  
Filomena Fuggetta ◽  
Daniela Pia Rosaria Chieffo ◽  
Antonia Ramaglia ◽  
...  
Keyword(s):  
Case Report ◽  
Low Cost ◽  
Previous History ◽  
Accurate Method ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Source Imaging ◽  
Left Hand ◽  
Negative Myoclonus ◽  
Drug Resistant Epilepsy

Abstract Introduction Electrical source imaging (ESI) and especially hdEEG represent a noninvasive, low cost and accurate method of localizing epileptic zone (EZ). Such capability can greatly increase seizure freedom rate in surgically treated drug resistant epilepsy cases. Furthermore, ESI might be important in intracranial record planning. Case report We report the case of a 15 years old boy suffering from drug resistant epilepsy with a previous history of DNET removal. The patient suffered from heterogeneous seizure semiology characterized by anesthesia and loss of tone in the left arm, twisting of the jaw to the left and dysarthria accompanied by daze; lightheadedness sometimes associated with headache and dizziness and at a relatively short time distance negative myoclonus involving the left hand. Clinical evidence poorly match scalp and video EEG monitoring thus requiring hdEEG recording followed by SEEG to define surgical target. Surgery was also guided by ECoG and obtained seizure freedom. Discussion ESI offers an excellent estimate of EZ, being hdEEG and intracranial recordings especially important in defining it. We analyzed our results together with the data from the literature showing how in children hdEEG might be even more crucial than in adults due to the heterogeneity in seizures phenomenology. The complexity of each case and the technical difficulties in dealing with children, stress even more the importance of a noninvasive tool for diagnosis. In fact, hdEEG not only guided in the presented case SEEG planning but may also in the future offer the possibility to replace it.

scholarly journals Keto-on-the-Clock: A Survey of Dietetic Care Contact Time Taken to Provide Ketogenic Diets for Drug-Resistant Epilepsy in the UK

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2484
Author(s):  
Bridget Lambert ◽  
Kathryn Lightfoot ◽  
Rachel Meskell ◽  
Victoria J. Whiteley ◽  
Kirsty J. Martin-McGill ◽  
...  
Keyword(s):  
Contact Time ◽  
Online Survey ◽  
Treatment Options ◽  
Oral Intake ◽  
Drug Resistant ◽  
Patient Journey ◽  
Ketogenic Diets ◽  
Language Difficulties ◽  
Drug Resistant Epilepsy ◽  
The Uk

Medical ketogenic diets (KDs) are effective yet resource-intensive treatment options for drug-resistant epilepsy (DRE). We investigated dietetic care contact time, as no recent data exist. An online survey was circulated to ketogenic dietitians in the UK and Ireland. Data were collected considering feeding route, KD variant and type of ketogenic enteral feed (KEF), and the estimated number of hours spent on patient-related activities during the patient journey. Fifteen dietitians representing nine KD centres responded. Of 335 patients, 267 (80%) were 18 years old or under. Dietitians spent a median of 162 h (IQR 54) of care contact time per patient of which a median of 48% (IQR 6) was direct contact. Most time was required for the classical KD taken orally (median 193 h; IQR 213) as a combined tube and oral intake (median 211 h; IQR 172) or a blended food KEF (median 189 h; IQR 148). Care contact time per month was higher for all KDs during the three-month initial trial compared to the two-year follow-up stage. Patients and caregivers with characteristics such as learning or language difficulties were identified as taking longer. Twelve out of fifteen (80%) respondents managed patients following the KD for more than two years, requiring an estimated median contact care time of 2 h (IQR 2) per patient per month. Ten out of fifteen (67%) reported insufficient official hours for dietetic activities. Our small survey gives insight into estimated dietetic care contact time, with potential application for KD provision and service delivery

scholarly journals CLINICAL AND NEUROLOGICAL MANIFESTATIONS OF DRUG-RESISTANT EPILEPSY AND OPTIMIZATION OF PATIENT TREATMENT

2019 ◽  
Vol 11 (1) ◽  
pp. 46-52
Author(s):  
Yo. N. Madjidova ◽  
A. A. Solikhzoda ◽  
Kh. N. Maksudova
Keyword(s):  
Short Term Memory ◽  
Combined Therapy ◽  
Anticonvulsant Therapy ◽  
Biologically Active ◽  
Patient Treatment ◽  
Drug Resistant ◽  
Neurological Manifestations ◽  
Pharmacoresistant Epilepsy ◽  
Student’S T ◽  
Drug Resistant Epilepsy

Aim – to study the clinical and neurological manifestations in patients with drug-resistant epilepsy and optimize the therapy. Materials and methods. Fifty patients with drug-resistant epilepsy were examined. Of these, 28 were females and 22 were males; their average age was 32.6±11.4 years. All patients had true pharmacoresistant epilepsy, i. e., the seizures occurred on the background of adequate polytherapy with anticonvulsants; the use of anticonvulsants had no effect on the course of the disease. All patients underwent clinical and neurological examination. The patients were blindly divided into two therapeutic groups: the main group consisted of 25 patients who were prescribed with the combined therapy, which included a biologically active polypeptide at a dose of 10 mg/day for 20 days with a subsequent transition to hopantenic acid (500 mg twice a day for 2 months). The second group did not receive these drugs. For the anticonvulsant therapy, both groups received the combinations of valproic acid (30 mg/kg at two daily doses) and carbamazepine (5 mg/kg at three daily doses). The significance of differences was determined by the paired and unpaired Student’s t-test. The differences were considered statistically significant at p <0.05. Results. The data on the occurrence of subjective and focal neurological symptoms indicated the prevalence of complaints characteristic of general cerebral symptoms in the form of headaches, dizziness, as well as subjective symptoms of cerebral asthenia. In addition, some patients complained of short-term memory impairments. In most cases, drug-resistant epilepsy developed on the background of organic brain damage. In 87.2±6.9% of cases, we encountered a Chvostek sign indicating an increased excitability of the nervous system. Both groups of patients showed positive yet different clinical dynamics: the number of seizures decreased in 40% of patients taking the polypeptide regulator and hopantenic acid, and in 28% of patients in the comparison group (p<0.05). Conclusion. In order to optimize the anticonvulsant therapy, it is recommended to prescribe a combination of valproate and carbamazepine; to increase the efficacy of the combined therapy it is recommended to add the polypeptide regulator and hopantenic acid.

scholarly journals A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood

2019 ◽  
Vol 23 (3) ◽  
pp. 274-284 ◽  
Author(s):  
Han Yan ◽  
Eric Toyota ◽  
Melanie Anderson ◽  
Taylor J. Abel ◽  
Elizabeth Donner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Zona Incerta ◽  
Electrode Placement ◽  
Patient Specific ◽  
Seizure Freedom ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
Deep Brain

OBJECTIVEDrug-resistant epilepsy (DRE) presents a therapeutic challenge in children, necessitating the consideration of multiple treatment options. Although deep brain stimulation (DBS) has been studied in adults with DRE, little evidence is available to guide clinicians regarding the application of this potentially valuable tool in children. Here, the authors present the first systematic review aimed at understanding the safety and efficacy of DBS for DRE in pediatric populations, emphasizing patient selection, device placement and programming, and seizure outcomes.METHODSThe systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations. Relevant articles were identified from 3 electronic databases (MEDLINE, Embase, and Cochrane CENTRAL) from their inception to November 17, 2017. Inclusion criteria of individual studies were 1) diagnosis of DRE; 2) treatment with DBS; 3) inclusion of at least 1 pediatric patient (age ≤ 18 years); and 4) patient-specific data. Exclusion criteria for the systematic review included 1) missing data for age, DBS target, or seizure freedom; 2) nonhuman subjects; and 3) editorials, abstracts, review articles, and dissertations.RESULTSThis review identified 21 studies and 40 unique pediatric patients (ages 4–18 years) who received DBS treatment for epilepsy. There were 18 patients with electrodes placed in the bilateral or unilateral centromedian nucleus of the thalamus (CM) electrodes, 8 patients with bilateral anterior thalamic nucleus (ATN) electrodes, 5 patients with bilateral and unilateral hippocampal electrodes, 3 patients with bilateral subthalamic nucleus (STN) and 1 patient with unilateral STN electrodes, 2 patients with bilateral posteromedial hypothalamus electrodes, 2 patients with unilateral mammillothalamic tract electrodes, and 1 patient with caudal zona incerta electrode placement. Overall, 5 of the 40 (12.5%) patients had an International League Against Epilepsy class I (i.e., seizure-free) outcome, and 34 of the 40 (85%) patients had seizure reduction with DBS stimulation.CONCLUSIONSDBS is an alternative or adjuvant treatment for children with DRE. Prospective registries and future clinical trials are needed to identify the optimal DBS target, although favorable outcomes are reported with both CM and ATN in children.

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