Results of treatment changes in patients with apparently drug‐resistant chronic epilepsy

Luciano, A L; Shorvon, Simon

doi:10.1002/ana.21064

Cited by 306 publications

(228 citation statements)

References 26 publications

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“…It has been shown that about 15 % of pharmacoresistant patients become seizure-free after responding to the third, fourth, or later AED that is tried in the course of systematic treatment. This observation was independent of the AED used [39,40]. Thus, there are clearly late responders to specific AEDs, as has been also shown in phase III trials designed to license new AEDs.…”

Section: Genetic Biomarkers For Pharmacoresponsesupporting

confidence: 58%

Genetic Biomarkers in Epilepsy

et al. 2014

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The identification of valid biomarkers for outcome prediction of diseases and improvement of drug response, as well as avoidance of side effects is an emerging field of interest in medicine. The concept of individualized therapy is becoming increasingly important in the treatment of patients with epilepsy, as predictive markers for disease prognosis and treatment outcome are still limited. Currently, the clinical decision process for selection of an antiepileptic drug (AED) is predominately based on the patient's epileptic syndrome and side effect profiles of the AEDs, but not on effectiveness data. Although standard dosages of AEDs are used, supplemented, in part, by therapeutic monitoring, the response of an individual patient to a specific AED is generally unpredictable, and the standard care of patients in antiepileptic treatment is more or less based on trial and error. Therefore, there is an urgent need for valid predictive biomarkers to guide patient-tailored individualized treatment strategies in epilepsy, a research area that is still in its infancy. This review focuses on genomic factors as part of an individual concept for AED therapy summarizing examples that influence the prognosis of the disease and the response to AEDs, including side effects.

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Section: Genetic Biomarkers For Pharmacoresponsesupporting

confidence: 58%

Genetic Biomarkers in Epilepsy

et al. 2014

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“…It is true that no large‐scale study has been carried out that confirms or refutes this proposition, but with the large number of new therapies made available in recent years, and the indisputable advances in the science of epileptology, including surgery and neuroimaging, it would be surprising if the medical prognosis has not improved. Even if individual drugs result in seizure control in only a small percentage of patients, the additive effect of a number of these drugs tried in turn results in a markedly improved overall prognosis 28. Furthermore, there is plenty of anecdotal evidence that prognosis has been transformed.…”

Section: Today's Theories and Practices Which May Not Withstand The Tmentioning

confidence: 99%

The right and the wrong with epilepsy and her science

Shorvon

Schmidt²

2016

Epilepsia Open

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SummaryThis is a commentary and an opinion paper attempting a critical reassessment of the methods and practices of epilepsy research as we see it. The enormous progress in the field of epilepsy in recent years is a cause of celebration. Advances have been made on most fronts, and the position of patients with epilepsy in society has greatly improved. However, there have also been culs‐de‐sac and dead ends of modern science and clinical practice which are also intriguing. It may be true that we can learn more from our mistakes than from our successes. In this opinion paper, we have listed some of the successes and some of the failures of past epilepsy practice, and also areas of current practice and theory which we feel are likely to prove mistaken. The underlying reasons for misdirected practices and theories include, in our view, the influence of fashion, bad science, and the bureaucracies of practice and academic medicine. As a result, some findings are far from objective. Recognition is the first step to remediation, and hopefully future research will minimize some of the pitfalls mentioned in this article and bring the “End of Epilepsy,” as defined and predicted by Oswei Temkin, closer than it is today.

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“…There are of course costs well beyond monetary values. Observational studies have demonstrated that some patients who have not responded to several anti-epileptic drugs in the past, and might therefore be expected to continue to have seizures despite trials of further anti-epileptic drugs [2], might in fact occasionally respond to a new anti-epileptic drug [3,4].…”

Section: Sanjay Sisodiyamentioning

confidence: 99%

Genomics of drug resistance: moving ahead

Sisodiya¹

2010

E&S

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Results of treatment changes in patients with apparently drug‐resistant chronic epilepsy

Cited by 306 publications

References 26 publications

Genetic Biomarkers in Epilepsy

Genetic Biomarkers in Epilepsy

The right and the wrong with epilepsy and her science

Genomics of drug resistance: moving ahead

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