Epilepsia resistente a fármacos. Concepto y alternativas terapéuticas

González, Francisco Sánchez-Montes; Osorio, Xiana Rodríguez; Rein, Antonio Gil-Nagel; Martinez, M.; Fernández, J. Serratosa; Haba, V. Villanueva; Pedraza, Alexandra; Cerdá, J.M. Mercadé

doi:10.1016/j.nrl.2014.04.012

Cited by 51 publications

(18 citation statements)

References 51 publications

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“… 70 When polytherapy using multiple AEDs fails to reduce epileptic symptoms, alternative and surgical treatment options should be discussed following the diagnosis of drug-resistant epilepsy. 73 …”

Section: Treatments: the Old And The Newmentioning

confidence: 99%

“…Alternative treatment options for epilepsy include surgical resection of the epileptic brain area, ketogenic diet, and neurostimulation devices such as deep brain stimulators and vagus nerve stimulators. 73 It is becoming common practice to provide neurosurgical consultation to drug-resistant epilepsy patients after failure of ~2 AED regimens. 20 Earlier surgical consultation results in overall increased quality of life and decreased medical cost for patients.…”

Section: Treatments: the Old And The Newmentioning

confidence: 99%

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Contemplating stem cell therapy for epilepsy-induced neuropsychiatric symptoms

Rao

Mashkouri

Aum

et al. 2017

NDT

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Epilepsy is a debilitating disease that impacts millions of people worldwide. While unprovoked seizures characterize its cardinal symptom, an important aspect of epilepsy that remains to be addressed is the neuropsychiatric component. It has been documented for millennia in paintings and literature that those with epilepsy can suffer from bouts of aggression, depression, and other psychiatric ailments. Current treatments for epilepsy include the use of antiepileptic drugs and surgical resection. Antiepileptic drugs reduce the overall firing of the brain to mitigate the rate of seizure occurrence. Surgery aims to remove a portion of the brain that is suspected to be the source of aberrant firing that leads to seizures. Both options treat the seizure-generating neurological aspect of epilepsy, but fail to directly address the neuropsychiatric components. A promising new treatment for epilepsy is the use of stem cells to treat both the biological and psychiatric components. Stem cell therapy has been shown efficacious in treating experimental models of neurological disorders, including Parkinson’s disease, and neuropsychiatric diseases, such as depression. Additional research is necessary to see if stem cells can treat both neurological and neuropsychiatric aspects of epilepsy. Currently, there is no animal model that recapitulates all the clinical hallmarks of epilepsy. This could be due to difficulty in characterizing the neuropsychiatric component of the disease. In advancing stem cell therapy for treating epilepsy, experimental testing of the safety and efficacy of allogeneic and autologous transplantation will require the optimization of cell dosage, delivery, and timing of transplantation in a clinically relevant model of epilepsy with both neurological and neuropsychiatric symptoms of the disease as the primary outcome measures.

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Section: Treatments: the Old And The Newmentioning

confidence: 99%

Section: Treatments: the Old And The Newmentioning

confidence: 99%

Contemplating stem cell therapy for epilepsy-induced neuropsychiatric symptoms

Rao

Mashkouri

Aum

et al. 2017

NDT

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“…The International League Against Epilepsy (ILAE) describes drug-resistant epilepsy (DRE) as the failure of adequate trials of two tolerated and appropriately chosen and used AED schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom [ 4 ]. Sustained seizure freedom occurs when the patient is seizure-free for more than one year or has sporadic seizures separated by a period three times the maximum interval between seizures before the treatment, whichever is longer [ 4 ]. About 7% to 20% of children have DRE, while 30% to 40% of adult patients remain refractory to pharmacological treatment [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Cannabis, More Than the Euphoria: Its Therapeutic Use in Drug-Resistant Epilepsy

Buchanan-Peart

Oribhabor

Khokale

et al. 2020

Cureus

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A significant number of epilepsy patients are refractory to conventional antiepileptic drugs. These patients experience considerable neurocognitive impairments that impact their quality of life and ability to function independently. This need for alternative treatment has generated increased interest in cannabis use as a therapeutic option in these patients. This review seeks to analyze data presented on the pharmacology, safety, and efficacy of cannabis use in patients with drug-resistant epilepsy (DRE) and to propose any future recommendations regarding its use. PubMed was used to retrieve all published studies and articles which evaluated the use of cannabis in epilepsy. The two foremost phytocannabinoids of cannabis showing anticonvulsant properties are tetrahydrocannabinol (THC) and cannabidiol (CBD). Due to the psychoactive properties of THC, most studies focused on CBD use in these patients. The use of CBD as an adjunct resulted in decreased seizure frequency, and secondary benefits observed included improvement in mood, alertness and sleep. Adverse events (AEs) reported were drowsiness, diarrhea, increased transaminases and worsening of seizures. It can safely be concluded that there is a significant benefit in DRE patients using CBD as adjunctive therapy. However, further controlled and adequately powered studies are needed to assess the pharmacokinetics and impact of the long-term use of cannabis.

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“…[5] Refrakter epilepsili hastalarda; antiepileptik ilaç tedavisinin yanı sıra epilepsi cerrahisi, vagal sinir stimülasyonu (VNS), nörostimülasyon ve ketojenik diyette önemli tedavi yöntemleridir. [6] Dünyada VNS ilk olarak 1988 yılında, ülkemizde de ilk uygulama 1998 yılında yapılmıştır. [7,8] VNS, sekonder jeneralizasyon görülsün veya görülmesin tedaviye dirençli, rezektif cerrahi adayı olmayacak, olup da fayda görmeyen fokal epilepsi hastalarında ek tedavi olarak onay almıştır.…”

Section: Introductionunclassified

Efficacy of Vagal Nerve Stimulation in Adult Patients; Experience of a Young Epilepsy Outpatient Clinic

Erdal¹,

Genç²,

Türk³

et al. 2019

Epilepsi

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Objectives: Antiepileptic drugs are the most commonly used treatments in epilepsy. However, in a group of about one-third of all epilepsy patients who have not been able to control seizures with antiepileptic drugs called drug-resistant epilepsy, epilepsy surgery, VNS (vagal nerve stimulation), neurostimulation, and the ketogenic diet are important treatment modalities. In this study, the patients who had refractory epilepsy and had VNS were reviewed retrospectively, and the results were evaluated. Methods: Patients who were followed-up with VNS in our clinic between July 2014 and January 2019 were evaluated in this study. Demographic and clinical features of the patients and seizure outcome after VNS were reviewed. Results: Seventeen patients who underwent vagal nerve stimulation were enrolled in this study. Three of these patients were VNS in the external centers and the patients we followed in our clinic. Eight (47.1%) of the patients were male, and nine (52.9%) were female; average age 32±8.40 years; (minimum 19 years, maximum 52 years). The mean age of VNS was 28.06±8.37 years, and the mean follow-up period after VNS was 38.82±14.67 months. The seizure of 52.9% of the patients degreased by more than 50%, 11.8% had no change in seizure frequency, 35.3% less than 50% improved. Cognitive improvement was observed in 47.1% of the patients. Conclusion: VNS is an important treatment modality in this group of patients to alleviate the frequency and the severity of the seizures, and to provide cognitive and behavioral improvement in drug-resistant epilepsy patients. ÖzetAmaç: Epilepside antiepileptik ilaçlar en sık kullanılan tedavilerdir. Ancak ilaca dirençli epilepsi dediğimiz antiepileptik ilaçlarla nöbet kontrolü tam sağlanamayan yaklaşık tüm epilepsi hastalarının üçte birini oluşturan-grupta epilepsi cerrahisi, vagal sinir stimülasyonu (VNS), nörostimülasyon ve ketojenik diyet önemli tedavi yöntemleridir. Bu çalışmada, ilaç tedavisine dirençli refrakter epilepsisi bulunan ve VNS uygulanan kliniğimizin hastaları geriye dönük olarak gözden geçirilerek sonuçlar değerlendirildi. Gereç ve Yöntem: Temmuz 2014 yılından, Ocak 2019 tarihine kadar kliniğimizde takipli VNS uygulanmış hastalar değerlendirildi. Hastaların demografik, klinik özellikleri ve VNS sonrası nöbet sonlanımları gözden geçirildi. Bulgular: Vagal sinir stimülasyonu ile takibi yapılan 17 hasta çalışmaya alındı. Bu hastalardan üç tanesi dış merkezde VNS takılıp, kliniğimizde takip ettiğimiz hastalardı. Hastaların 8'i (%47.1) erkek, 9'u (%52.9) kadındı; ortalama yaş 32±8.40 yıl; (minimum 19 yaş, maksimum 52 yaş) idi. Çalışmaya alınan hastaların ortalama VNS takılma yaşı 28.06±8.37 yıl, VNS uygulanması sonrası ortalama takip süresi 38.82±14.67 aydı. Hastaların %52.9'unun nöbetleri %50'den fazla azalmıştı, %11.8'inde nöbet sıklığı ve şiddetinde değişiklik yoktu, %35.3'ünde ise %50'den az düzelme görüldü. Hastaların %47.1'inde kognitif olarak iyileşme görüldü. Sonuç: Vagal sinir stimülasyonu, ilaca dirençli epilepsi hastalarında, epilepsi cerrahisi kadar etk...

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Epilepsia resistente a fármacos. Concepto y alternativas terapéuticas

Cited by 51 publications

References 51 publications

Contemplating stem cell therapy for epilepsy-induced neuropsychiatric symptoms

Contemplating stem cell therapy for epilepsy-induced neuropsychiatric symptoms

Cannabis, More Than the Euphoria: Its Therapeutic Use in Drug-Resistant Epilepsy

Efficacy of Vagal Nerve Stimulation in Adult Patients; Experience of a Young Epilepsy Outpatient Clinic

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