Advances in the Treatment of Drug-Resistant Pediatric Epilepsy

González-Giraldo, Ernesto; Sullivan, Joseph

doi:10.1055/s-0040-1702941

Cited by 22 publications

(15 citation statements)

References 46 publications

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“…A recent meta-analysis provides evidence for the therapeutic efficacy of high content CBD treatments ( Pamplona et al., 2018 ). Overall, the studies on CBD-enriched oils indicate a 50% reduction in seizures in roughly 30–40% of patients ( Gonzalez-Giraldo and Sullivan, 2020 ). However, it should be emphasized that these are uncontrolled studies with heterogeneous CBD preparations, the CBD content of which varied significantly and should be underlined the need for appropriately controlled studies.…”

Section: Historical Review Of the Use Of Cannabis To Treat Pediatric mentioning

confidence: 99%

Cannabidiol Treatment for Refractory Epilepsies in Pediatrics

et al. 2020

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Cannabis extracts in oil are becoming increasingly available, and, during the last years, there has been growing public and scientific interest about therapeutic properties of these compounds for the treatment of several neurologic diseases, not just epilepsy. The discovered role of the endocannabinoid system in epileptogenesis has provided the basis to investigate the pharmacological use of exogenously produced cannabinoids, to treat epilepsy. Although, physicians show reluctance to recommend Cannabis extracts given the lack of high-quality safety available data, from literature data cannabidiol (CBD) results to be a promising and safe anticonvulsant drug with low side-effect. In particular, according to early studies, CBD can reduce the frequency of seizures and lead to improvements in quality of life in children affected by refractory epilepsy. So, for these reasons, the detailed study of the interactions between CBD and anticonvulsant drugs (AEDs) administered simultaneously in polytherapy, is arousing increasing interest, to clarify and to assess the incidence of adverse effects and the relation between dose escalation and quality of life measures. To date, in pediatric age, CBD efficacy and safety is not supported by well-designed trials and strong scientific evidence are not available. These studies are either retrospective or small-scale observational and only during the last years Class I evidence data for a pure form of CBD have been available, as demonstrated in placebo-controlled RCTs for patients affected by Lennox-Gastaut syndrome and Dravet syndrome. It is necessary to investigate CBD safety, pharmacokinetics and interaction with other AEDs alongside performing double-blinded placebo-controlled trials to obtain conclusive data on its efficacy and safety in the most frequent epilepsies in children, not just in the epileptic encephalopathy. This review was aimed to revise the available data to describe the scientific evidence for CBD in Pediatric Epilepsies.

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Section: Historical Review Of the Use Of Cannabis To Treat Pediatric mentioning

confidence: 99%

Cannabidiol Treatment for Refractory Epilepsies in Pediatrics

et al. 2020

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“…In addition, central nervous system infections, parasites, and genetic metabolic diseases may also lead to epilepsy (8). While pathogenesis of epilepsy is unclear, possible mechanisms involving ion channels and abnormal brain neural networks have been suggested (9,10).…”

Section: Introductionmentioning

confidence: 99%

The efficacy of lamotrigine after failure of the first administration of valproate in treating epilepsy: a systematic review and meta-analysis

He¹,

Wu²,

Dong³

2022

Ann Palliat Med

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Background: Epilepsy is a long-term recurrent chronic brain disease that can cause significant emotional burden to the patient and their family, as well as huge economic costs to society. Timely and accurate diagnosis of epilepsy, together with early and standardized treatments can effectively control seizures and restore the patient's quality of life and reduce the economic burden. This meta-analysis examined the efficacy of lamotrigine administration in patients with epilepsy.Methods: A literature search was performed in the PubMed, Embase, and OVID-Medline databases to identify articles related to epilepsy and lamotrigine that were published from the establishment of the database to April 2021. The keywords used for the literature search included "epilepsy", "sodium valproate", "lamotrigine", "effectiveness", and "therapeutic effect". It uses Cochrane review manual 5.3 to evaluate the quality of the included literature and review manager 5.3 software for meta-analysis.Results: A total of 9 studies involving 1,864 patients with epilepsy were included in this meta-analysis.The results revealed that, after treatment failure with the first drug of valproic acid, the total effective rate of lamotrigine treatment had an odds ratio (OR) of 2.21 with a 95% confidence interval (CI) of 1.15 to 4.27 (Z=2.37; P=0.02). The total adverse reaction rate (OR =0.70; 95% CI: 0.55 to 0.88; Z=2.98; P=0.003) and the improvement rate of epilepsy associated with lamotrigine treatment (OR =4.22; 95% CI: 1.00 to 17.84; Z=1.96; P=0.05) were all significantly higher than that of other drug treatments.Discussion: A total of 9 articles were included in this meta-analysis to examine the efficacy of lamotrigine in the treatment of epilepsy. The clinical efficacy of lamotrigine addition therapy was found to be superior to lamotrigine replacement therapy, and the incidence of adverse reactions was lower than that of lamotrigine replacement therapy. However, due to the low methodological quality of the included literatures, this conclusion should be further verified using large sample and high-quality randomized double-blinded experiments.

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“…The technologies available for neuromodulation include vagus nerve stimulation (VNS), deep brain stimulation, or responsive neurostimulation (RNS). 6 RNS is a closed-loop system that is designed to detect abnormal electrical signals from the suspected seizure onset zone (SOZ) by using digital signal analysis of electroencephalography (EEG) through a predefined seizure detection algorithm, and delivering a stimulus to arrest the seizure. 7,8 RNS is an FDA-approved system for the management of DRE in adults 8,9 but has only been used off label in children when no other treatment options are available.…”

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confidence: 99%

Responsive neurostimulation in pediatric patients with drug-resistant epilepsy

Falls

Arango

Adelson

2022

Neurosurgical Focus

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OBJECTIVE Medically refractory epilepsy remains a therapeutic challenge when resective surgery is not a practical option and indirect neurostimulation efficacy may be limited. In these instances responsive neurostimulation (RNS) has been used in adults, with good outcomes in most patients. However, the utility of RNS in children and young adults has not been systematically explored. In this study, the authors present a single institution’s experience with RNS in pediatric patients. METHODS A single-center retrospective chart review of patients who underwent RNS implantation at Phoenix Children’s Hospital during the 4-year period between January 2018 and December 2021 was performed. RESULTS Following evaluation for epilepsy surgery, 22 patients underwent RNS implantation using different anatomical targets depending on the predetermined epileptic focus/network. In the cohort, 59% of patients were male, the mean age at implantation was 16.4 years (range 6–22 years), and the mean follow-up time was 2.7 years (range 1.0–4.3 years). All patients had a preoperative noninvasive evaluation that included MRI, video-electroencephalography, and resting-state functional MRI. Additionally, 13 patients underwent invasive monitoring with stereo-electroencephalography to help determine RNS targets. All patients had variable positive responses with reduction of seizure frequency and/or intensity. Overall, seizure frequency reduction of > 50% was seen in the majority (86%) of patients. There were two complications: one patient experienced transitory weakness and one generator failed, requiring replacement. A patient died of sudden unexpected death in epilepsy 3 years after implantation despite being seizure free during the previous year. CONCLUSIONS RNS used in children with medically refractory epilepsy improved seizure control after implantation, with decreases in seizure frequency > 50% from preoperative baseline in the majority of patients. Preliminary findings indicate that functional MRI and stereo-electroencephalography were helpful for RNS targeting and that RNS can be used safely even in young children.

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Advances in the Treatment of Drug-Resistant Pediatric Epilepsy

Cited by 22 publications

References 46 publications

Cannabidiol Treatment for Refractory Epilepsies in Pediatrics

Cannabidiol Treatment for Refractory Epilepsies in Pediatrics

The efficacy of lamotrigine after failure of the first administration of valproate in treating epilepsy: a systematic review and meta-analysis

Responsive neurostimulation in pediatric patients with drug-resistant epilepsy

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