Treatment changes in a cohort of people with apparently drug-resistant epilepsy: an extended follow-up

Neligan, Aidan; Bell, Gail S.; Elsayed, Muaz; Sander, Josemir W.; Shorvon, Simon

doi:10.1136/jnnp-2011-302085

Cited by 39 publications

(36 citation statements)

References 18 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The authors of the study also noted that the remission was negatively correlated with the number of ASDs that failed in a particular patient, while relapse could not be explained by dose reductions or medication discontinuation alone. Similarly, Neligan et al (27) conducted a prospective cohort study in 139 patients with uncontrolled chronic epilepsy with a median follow-up of 6.9 years and showed that 19% of patients became seizure free and 29% of patients experienced 50–99% improvement in seizure frequency at the last follow-up. However, a substantial proportion of the patients who experienced remission subsequently relapsed (27).…”

Section: Background: Refractory Epilepsymentioning

confidence: 99%

“…Similarly, Neligan et al (27) conducted a prospective cohort study in 139 patients with uncontrolled chronic epilepsy with a median follow-up of 6.9 years and showed that 19% of patients became seizure free and 29% of patients experienced 50–99% improvement in seizure frequency at the last follow-up. However, a substantial proportion of the patients who experienced remission subsequently relapsed (27). In another study, Neligan et al (28) found that the intermittent pattern of seizures (i.e., having one or more seizure-free periods which lasted for at least 2 years) occurred in about 30% of patients with refractory epilepsy, which was found to be associated with fewer total ASDs taken and lower seizure frequency in the previous year when compared to the continuous pattern of pharmacoresistance.…”

Section: Background: Refractory Epilepsymentioning

confidence: 99%

See 1 more Smart Citation

Drug-Resistant Epilepsy: Multiple Hypotheses, Few Answers

2017

View full text Add to dashboard Cite

Epilepsy is a common neurological disorder that affects over 70 million people worldwide. Despite the recent introduction of new antiseizure drugs (ASDs), about one-third of patients with epilepsy have seizures refractory to pharmacotherapy. Early identification of patients who will become refractory to ASDs could help direct such patients to appropriate non-pharmacological treatment, but the complexity in the temporal patterns of epilepsy could make such identification difficult. The target hypothesis and transporter hypothesis are the most cited theories trying to explain refractory epilepsy, but neither theory alone fully explains the neurobiological basis of pharmacoresistance. This review summarizes evidence for and against several major theories, including the pharmacokinetic hypothesis, neural network hypothesis, intrinsic severity hypothesis, gene variant hypothesis, target hypothesis, and transporter hypothesis. The discussion is mainly focused on the transporter hypothesis, where clinical and experimental data are discussed on multidrug transporter overexpression, substrate profiles of ASDs, mechanism of transporter upregulation, polymorphisms of transporters, and the use of transporter inhibitors. Finally, future perspectives are presented for the improvement of current hypotheses and the development of treatment strategies as guided by the current understanding of refractory epilepsy.

show abstract

Section: Background: Refractory Epilepsymentioning

confidence: 99%

Section: Background: Refractory Epilepsymentioning

confidence: 99%

Drug-Resistant Epilepsy: Multiple Hypotheses, Few Answers

2017

View full text Add to dashboard Cite

show abstract

“…Risk factors for subsequent poor treatment outcome are symptomatic focal epilepsy and cognitive deficits (Chadwick et al 1996;Schmidt and Löscher 2005). Finally, 5% of those with refractory epilepsy will achieve a remission of 12 mo when medication is adjusted, although about onehalf will subsequently relapse (Neligan et al 2012).…”

Section: Prognosismentioning

confidence: 99%

Seizures and Epilepsy: An Overview for Neuroscientists

Stafstrom

Carmant²

2015

Cold Spring Harbor Perspectives in Medicine

613

421

View full text Add to dashboard Cite

Epilepsy is one of the most common and disabling neurologic conditions, yet we have an incomplete understanding of the detailed pathophysiology and, thus, treatment rationale for much of epilepsy. This article reviews the clinical aspects of seizures and epilepsy with the goal of providing neuroscientists an introduction to aspects that might be amenable to scientific investigation. Seizures and epilepsy are defined, diagnostic methods are reviewed, various clinical syndromes are discussed, and aspects of differential diagnosis, treatment, and prognosis are considered to enable neuroscientists to formulate basic and translational research questions.T his article provides an overview of seizures and epilepsy for neuroscientists. We focus on broad concepts, rather than clinical details, and raise questions related to mechanisms, epileptogenesis, and therapeutic approaches that might generate interest among basic researchers. Further information about differential diagnosis, drug doses, and clinical management are available from numerous resources (Engel and Pedley 2008;Duchowny et al. 2012;Engel 2013).We first define seizures and epilepsy and summarize their classification, pathophysiology, and genetics. Diagnostic methods are then considered, including the importance of an accurate historical description of an event suspected to be a seizure and the appropriate use of ancillary/confirmative tests, such as electroencephalogram (EEG), neuroimaging, and genetic studies. These modalities enable the clinician to differentiate epilepsy from numerous clinical conditions that mimic seizures, but have a nonepileptic pathophysiological basis. Examples of epilepsy syndromes are then described, selected based on their frequency in the population or because they embody scientific questions that warrant elucidation. Finally, we provide an overview of treatment options and prognosis, including a consideration of conditions that accompany epilepsy (comorbidities) and complicate the daily lives of people with epilepsy. Subsequent articles in this collection explore the scientific basis of many of the clinical concepts introduced here. DEFINITIONS AND EPIDEMIOLOGYA "seizure" is a paroxysmal alteration of neurologic function caused by the excessive, hyper-

show abstract

“…16 A systematic review and meta-analysis of the efficacy of all novel AEDs as adjunctive treatment for drug-resistant epilepsy found total control over ES in about 6% of all patients and a reduction in critical frequency in 21% 17 (LE I). Population studies in patients with drug-resistant epilepsy describe long remission periods thanks to successive changes in medication (8%-28%) 18,19 (LE III). Fig.…”

Section: Number Of Antiepileptic Drugs To Try In Cases Of Drug-resistmentioning

confidence: 99%

Drug-resistant epilepsy: Definition and treatment alternatives

González

Osorio

Rein

et al. 2015

Neurología (English Edition)

View full text Add to dashboard Cite

Introduction: Drug-resistant epilepsy affects 25% of all epileptic patients, and quality of life decreases in these patients due to their seizures. Early detection is crucial in order to establish potential treatment alternatives and determine if the patient is a surgical candidate. Development: PubMed search for articles, recommendations published by major medical societies, and clinical practice guidelines for drug-resistant epilepsy and its medical and surgical treatment options. Evidence and recommendations are classified according to the criteria of the Oxford Centre for Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic actions.Conclusions: Identifying patients with drug-resistant epilepsy is important for optimising drug therapy. Experts recommend rational polytherapy with antiepileptic drugs to find more effective combinations with fewer adverse effects. When adequate seizure control is not achieved, a presurgical evaluation in an epilepsy referral centre is recommended. These evaluations explore how to resect the epileptogenic zone without causing functional deficits in cases in which this is feasible. If resective surgery is not achievable, palliative surgery or neurostimulation systems (including vagus nerve, trigeminal nerve, or deep brain stimulation) may be an option. Other treatment alternatives such as ketogenic diet may also be considered in selected patients. Epilepsia resistente a fármacos. Concepto y alternativas terapéuticas ResumenIntroducción: La epilepsia resistente al tratamiento médico afecta a una cuarta parte de los pacientes con epilepsia. Como consecuencia de las crisis estos pacientes presentan una peor calidad de vida, por lo que es fundamental su diagnóstico para establecer posibles alternativas terapéuticas e iniciar una valoración prequirúrgica.Desarrollo: Búsqueda de artículos en PubMed y recomendaciones de las Guías de Práctica Clínica (GPC) y Sociedades Científicas más relevantes, referentes a epilepsia refractaria y al tratamiento médico y quirúrgico. Se clasifican las evidencias y recomendaciones según los criterios pronósticos del Oxford Centre for Evidence Based Medicine (2001) y de la European Federation of Neurological Societies (2004) para actuaciones terapéuticas.Conclusiones: La identificación de los pacientes con epilepsia refractaria es importante para optimizar el tratamiento farmacológico. Se recomienda el empleo de una politerapia racional de fármacos antiepilépticos, buscando combinaciones que aumenten la eficacia y minimicen los efectos adversos. Cuando no se consigue el control adecuado de las crisis es necesario realizar una valoración prequirúrgica en un centro especializado, con el fin de resecar la zona epileptógena sin producir déficits al paciente en los casos en los que sea posible. En caso contrario se recurrirá a procedimientos de cirugía paliativa o sistemas de neuroestimulación (vagal, trigeminal o cerebral). Otras alternativas, como la dieta cetógena, también pueden considerarse en pacientes...

show abstract

Treatment changes in a cohort of people with apparently drug-resistant epilepsy: an extended follow-up

Cited by 39 publications

References 18 publications

Drug-Resistant Epilepsy: Multiple Hypotheses, Few Answers

Drug-Resistant Epilepsy: Multiple Hypotheses, Few Answers

Seizures and Epilepsy: An Overview for Neuroscientists

Drug-resistant epilepsy: Definition and treatment alternatives

Contact Info

Product

Resources

About