Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies

Guéry, Déborah; Rheims, Sylvain

doi:10.2147/ndt.s256699

Cited by 56 publications

(44 citation statements)

References 152 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although is not fully understood, some risk factors favor the possibility of developing DRE, including age of onset, symptomatic epilepsy, abnormal EEG (with both slow wave and epileptiform discharges), status epilepticus, multiple seizure types, febrile seizure, abnormal neurologic image, intellectual disability, neurologic abnormality, status epilepticus, and psychiatric comorbidities [ 23 , 24 ].…”

Section: Reviewmentioning

confidence: 99%

Epilepsy and Deep Brain Stimulation of Anterior Thalamic Nucleus

Perez-Malagon¹,

López-González²

2021

Cureus

View full text Add to dashboard Cite

Presently, at least 60 million people are suffering from epilepsy worldwide. Although multiple pharmacological options for treatment exist, about 30% to 40% of these patients are estimated to have drug-resistant epilepsy (DRE), which is associated with severe disability and morbidity. The surgical treatment options are restricted to either open surgical procedures or laser ablations. When a resective option is not favorable, then neuromodulation options such as vagal nerve stimulation and deep brain stimulation are considered. A relatively recent and more commonly used clinical application is the deep brain stimulation (DBS) of the anterior thalamic nucleus, FDA approval for which was obtained in 2018. Furthermore, new technological advances in DBS technology are expected to positively impact the treatment options of these patients.

show abstract

Section: Reviewmentioning

confidence: 99%

Epilepsy and Deep Brain Stimulation of Anterior Thalamic Nucleus

Perez-Malagon¹,

López-González²

2021

Cureus

View full text Add to dashboard Cite

show abstract

“…The most severe forms of treatment-resistant epilepsy usually begin in childhood (Patel 2016). In patients with epilepsy related to a genetic etiology, drug resistance is particularly frequent, especially in those with severe developmental and epileptic encephalopathies (Guery 2021).…”

Section: Introductionmentioning

confidence: 99%

Detection of Deregulated miRNAs in Childhood Epileptic Encephalopathies

et al. 2022

View full text Add to dashboard Cite

The term "epileptic encephalopathy" is used to describe a possible relationship between epilepsy and developmental delay. The pathogenesis of developmental encephalopathies, independent of epilepsy, can be de ned by genetic control mechanisms. The aim of this study was to investigate the use of miRNAs as serum biomarkers for the determination and discrimination of epileptic encephalopathies. MethodsWhole blood samples obtained from 54 individuals in 2 groups designated as epileptic encephalopathy patients group (n=24) and healthy controls (n=30) were included in this study. The expression levels of 10 miRNAs were determined using qRT-PCR. After the determination of expression levels the correlation of upregulated miRNA levels and Ki67 index was calculated using Pearson correlation test. ResultsThe comparison of epileptic encephalopathy patients group with healthy controls revealed the upregulation of one miRNAs (hsa-miR-324-5p) and downregulation of three miRNAs (hsa-miR-146a-5p, hsa-miR-138-5p, hsa-miR-187-3p). ConclusionIt has been determined that miRNAs with altered expression are an important factor in the formation of epileptic seizures and seizure-induced neuronal death. The fact that processes that play a key role in epiloptogenesis are under the control of miRNAs causes miRNAs to become metacontrollers of gene expression in the brain. We thouhgt that further studies are needed to prove that especially, hsa-miR-146a-5p, hsa-miR-138-5p and hsa-miR-187-3p can be used as epileptic encephalopathy biomarkers. Detection of disease-speci c miRNAs could contribute to the development of presicion treatments.

show abstract

“…It is well known that frontal dysfunction characterized people with JME however, it is exacerbated in people with drug-resistant JME ( 5 , 7 – 9 ). To date, despite several attempts to find a marker for DRE ( 10 – 12 ), there are no biomarkers for drug resistance in people with JME, and the poor response to medications is identified retrospectively.…”

Section: Introductionmentioning

confidence: 99%

Limited Ability to Adjust N2 Amplitude During Dual Task Walking in People With Drug-Resistant Juvenile Myoclonic Epilepsy

et al. 2022

View full text Add to dashboard Cite

Juvenile myoclonic epilepsy (JME) is one of the most common epileptic syndromes; it is estimated to affect 1 in 1,000 people worldwide. Most people with JME respond well to medication, but up to 30% of them are drug-resistant. To date, there are no biomarkers for drug resistance in JME, and the poor response to medications is identified in retrospect. People with JME have frontal dysfunction manifested as impaired attention and difficulties in inhibiting habitual responses and these dysfunctions are more pronounced in drug-resistant individuals. Frontal networks play an important role in walking and therefore, gait can be used to overload the neural system and expose subtle changes between people with drug-responsive and drug-resistant JME. Electroencephalogram (EEG) is a promising tool to explore neural changes during real-time functions that combine a cognitive task while walking (dual tasking, DT). This exploratory study aimed to examine the alteration in electrical brain activity during DT in people with drug-responsive and drug-resistant JME. A total of 32 subjects (14 males and 18 females) participated: 11 drug-responsive (ages: 31.50 ± 1.50) and 8 drug-resistant (27.27 ± 2.30) people with JME, and 13 healthy controls (29.46 ± 0.69). The participants underwent EEG examination during the performance of the visual Go/NoGo (vGNG) task while sitting and while walking on a treadmill. We measured latencies and amplitudes of N2 and P3 event-related potentials, and the cognitive performance was assessed by accuracy rate and response time of Go/NoGo events. The results demonstrated that healthy controls had earlier N2 and P3 latencies than both JME groups (N2: p = 0.034 and P3: p = 0.011), however, a limited ability to adjust the N2 amplitude during walking was noticeable in the drug-resistant compared to drug-responsive. The two JME groups had lower success rates (drug-responsive p < 0.001, drug-resistant p = 0.004) than healthy controls, but the drug-resistant showed longer reaction times compared to both healthy controls (p = 0.033) and drug-responsive (p = 0.013). This study provides the first evidence that people with drug-resistant JME have changes in brain activity during highly demanding tasks that combine cognitive and motor functions compared to people with drug-responsive JME. Further research is needed to determine whether these alterations can be used as biomarkers to drug response in JME.

show abstract

Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies

Cited by 56 publications

References 152 publications

Epilepsy and Deep Brain Stimulation of Anterior Thalamic Nucleus

Epilepsy and Deep Brain Stimulation of Anterior Thalamic Nucleus

Detection of Deregulated miRNAs in Childhood Epileptic Encephalopathies

Limited Ability to Adjust N2 Amplitude During Dual Task Walking in People With Drug-Resistant Juvenile Myoclonic Epilepsy

Contact Info

Product

Resources

About