Pharmacoresistance with newer anti-epileptic drugs in mesial temporal lobe epilepsy with hippocampal sclerosis

Abstract

This study aims to evaluate the overall prognosis, prognostic factors, and efficacy of treatment in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) who have access to third generation anti-epileptic drugs but not to epilepsy surgery. Eighty-five MTLE-HS patients were retrospectively placed into a seizure-free (seizure-free for >1 year) or drug-resistant group, and the two groups were compared on the basis of age, sex, age at onset of seizures, duration of epilepsy, side of lesion, handedness, EEG findings, history of CNS infection, history of febrile convulsions, history of head trauma, history of cognitive impairment, family history of seizures, number of current anti-epileptic drugs (AEDs), total number of AED trials, and presence of individual AEDs. Only 24.7% of MTLE-HS patients had achieved seizure freedom for >1 year. Poor prognosis and drug-resistance were associated with younger age at onset of seizures (p=0.002), longer duration of epilepsy (p=0.018), greater number of current AEDs (p<0.001), and greater total number of AED trials (p<0.001). In addition, regimens with newer AEDs had no greater efficacy than regimens with older AEDs. Most medically managed MTLE-HS patients do not achieve seizure freedom despite multiple AED trials, and treatment with third generation AEDs should not preclude evaluation for epilepsy surgery.

Hemispheric Regional Based Analysis of Diffusion Tensor Imaging and Diffusion Tensor Tractography in Patients with Temporal Lobe Epilepsy and Correlation with Patient outcomes

“…TLE is typically managed medically at the onset of the disease with various antiepileptic medications, but for those patients with intractable seizures failing to respond to numerous antiepileptic agents, surgery such as anterior temporal lobectomy (ATL) or selective laser amygdalohippocampectomy (SLAH) may be considered 2 . As previously mentioned, there are numerous causes that may lead to TLE, but the most frequent disease etiology that is refractory to medical management and responsive to surgical management is mesial temporal sclerosis (MTS), also commonly known as hippocampal sclerosis (HS) 3 .…”

A modern epilepsy surgery treatment algorithm: Incorporating traditional and emerging technologies

“…Epilepsy patients who continue to have seizures despite treatment trials with two well-tolerated AEDs or drug combinations should be referred to a comprehensive epilepsy center for noninvasive presurgical evaluation. It is well recognized that individuals who fail two AEDs are unlikely to achieve seizure freedom with additional medication trials – a reality that has not changed substantially with the recent introduction of newer AEDs [4, 5]. This recommendation is consistent with consensus guidelines by the American Academy of Neurology and several other North American and international organizations [6–8].…”

Layer-By-Layer: The Case for 3D Bioprinting Neurons to Create Patient-Specific Epilepsy Models

“…There are a variety of epileptiform disorders with differing causes such as genetic predisposition, brain injury, stroke or tumours. However, epilepsy is idiopathic in one third of patients [7,8,9,10].…”

“…Treatment can involve dietary changes, surgical intervention or antiepileptic drugs (AEDs). AEDs can be used as monotherapies or in combination with other treatments including other AEDs [7,9,10]. Health care providers prescribe AEDs based on AEDs they have had success with in other patients, however this is an inefficient approach typically based on trial and error [11].…”