Treatment of epilepsy existing therapies and future developments

Aiken, Simon P

doi:10.2741/a482

Cited by 14 publications

(15 citation statements)

References 162 publications

(172 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…If we increase the knowledge of seizure‐induced detrimental changes in animal models and in humans as a function of age, we will be able to design effective neuroprotective strategies for the future. The current mainstay of the treatment of seizures is administration of antiepileptic drugs (AEDs) after the condition has been established (67,68). In some cases, resective surgery is performed to eliminate the seizure focus (Engel, this volume).…”

Section: Treatment Strategiesmentioning

confidence: 99%

Temporal Lobe Epileptogenesis and Epilepsy in the Developing Brain: Bridging the Gap Between the Laboratory and the Clinic. Progression, But in What Direction?

Velı́šek

Moshé

2003

Epilepsia

View full text Add to dashboard Cite

Summary:The origins of human mesial temporal lobe epilepsy and hippocampal sclerosis are still not well understood. Hippocampal sclerosis and temporal lobe epileptogenesis involve a series of pathologies including hippocampal neuronal loss and gliosis, axonal reorganization, and maybe hippocampal neoneurogenesis. However, the causality of these events is unclear as well as their relation to the factors that may precipitate epileptogenesis. Significant differences between temporal lobe epileptogenesis in the adult and immature brain may require differential approaches. Hereditary factors also may participate in some cases of hippocampal sclerosis. The key point is to identify the significance of these age-dependent changes and to design preventive treatments. Novel strategies for the prevention and treatment of mesial temporal lobe epilepsy and hippocampal sclerosis may include rational use of neuroprotective agents, hormonotherapy, immunizations, and immunotherapy.

show abstract

Section: Treatment Strategiesmentioning

confidence: 99%

Temporal Lobe Epileptogenesis and Epilepsy in the Developing Brain: Bridging the Gap Between the Laboratory and the Clinic. Progression, But in What Direction?

Velı́šek

Moshé

2003

Epilepsia

View full text Add to dashboard Cite

show abstract

“…The damage was thought to be due to the stress associated with seizure [111]. The proposed mechanisms for the relative resistance of immature hippocampus to repeated seizures and SE-induced damage has been attributed to the fact that in immature brain there are: (1) preservation of GABA synthesis which declines with maturation [112], (2) increase in expression of GABA A receptor-1 subunit in contrast to adults [113], (3) presence of mitochondrial uncoupling protein(s) [114], (4) absence of mitochondrial oxidative stress [115], (5) absence of glia activation and cytokine production [116], (6) absence of GluR2 down-regulation or even up-regulation of GluR2 and down-regulation of GluR3 receptor subunits [117], and (7) presence of higher expression of growth factors and neurotrophins (such as BDNF) [118].…”

Section: The Neurobiology Of Epilepsy In Immature Brainsmentioning

confidence: 97%

The Rationale for Neuroprotection in Epilepsy: Steps Forward for New Therapeutic and Preventive Strategies

Hamed¹

2010

J. Integr. Neurosci.

View full text Add to dashboard Cite

The growing number of research in epilepsy provides evidences regarding the progressive neuronal damage which occur as a result of recurrent brief seizures as well as prolonged seizures. Advances in understanding the neurobiology of epilepsy indicate that initial seizure injury triggers a sequence of adaptive molecular and cellular mechanisms that interact in a highly complex manner. These changes evolve over a period of time (up to years) and involve gene alteration, channel dysfunction, impaired inhibitory/excitatory balance tipped towards excitation, mitochondrial embarrassment, homeostatic alteration of cell essential elements and exhaustion of endogenous protective mechanisms. This results in long-lasting functional and structural neurobiological reorganization at different levels that contribute to neuronal hyperexcitability, excitotoxicity, apoptotic and necrotic cell death, gliosis, persistent epileptogenesis and spontaneous seizures later in life. Importantly, seizure is only one aspect of epilepsy, however, behavioral and cognitive deficits which occur as a result of seizures or its treatment can be more detrimental to an individual's overall function. The perspectives of beneficial neuroprotection in epilepsy aim not only to improve seizure control, but also to promote compensatory processes in repairing, modifying or blocking the active changes triggered by the initial injury. Recent evidences indicate that the current AEDs have some neuroprotective potentials. However, their limited capabilities against broader range of neurotoxic insults, differential effect on the brain during various stages of development and undesirable adverse effects, trigger the inspiration of new strategies. Speculative targets may include free radical scavengers/antioxidants, modifiers of mitochondrial dysfunction, antiapoptotics, immunomodulators, hormonotherapy and neurotrophic factors. For all, assessments of therapeutic time window, long-term neuroprotective potentials and adverse consequences are mandatory.

show abstract

“…Uncontrolled studies have addressed the effectiveness of VNS in children [44,46-48,49•,50], the elderly [51], and in those with developmental delay [44,52]. Since its approval by the FDA in 1997, the Vagus Nerve Stimulator has become an important addition to the list of available treatments for many types of refractory epilepsy [53].…”

Section: Vagus Nerve Stimulationmentioning

confidence: 99%

Expanding therapeutic options: Devices and the treatment of refractory epilepsy

Karceski

Mullin

2004

Curr Neurol Neurosci Rep

View full text Add to dashboard Cite

Alternative treatments to anticonvulsants and resective surgery are needed for patients with refractory epilepsy. The renewed interest in brain stimulation and device therapy is exciting and is based on expanding human and animal research. Many important questions remain, such as where and how the stimuli should be applied. If we assume that neural networks are responsible for seizure generation and propagation, it seems reasonable to assume that seizures can be affected by electrical stimulation of more than one brain region. As research continues, we may discover that stimulation of a particular brain region is more effective for a specific type of epilepsy. In addition to finding the ideal site for treatment, the optimum stimulation parameters must be defined. We may find that different brain regions require different stimulation parameters. Presently, the Vagus Nerve Stimulator is the only alternative treatment to anticonvulsive drugs or surgery that is currently available. However, as technology advances and our understanding of epilepsy grows, we are likely to see increasingly sophisticated devices. Some of these devices may have the capacity to accurately detect seizures and to respond with the most appropriate type of stimulation.

show abstract

Treatment of epilepsy existing therapies and future developments

Cited by 14 publications

References 162 publications

Temporal Lobe Epileptogenesis and Epilepsy in the Developing Brain: Bridging the Gap Between the Laboratory and the Clinic. Progression, But in What Direction?

Temporal Lobe Epileptogenesis and Epilepsy in the Developing Brain: Bridging the Gap Between the Laboratory and the Clinic. Progression, But in What Direction?

The Rationale for Neuroprotection in Epilepsy: Steps Forward for New Therapeutic and Preventive Strategies

Expanding therapeutic options: Devices and the treatment of refractory epilepsy

Contact Info

Product

Resources

About