Treatment Strategy for the Patient with Hippocampal Sclerosis Who Failed to the First Antiepileptic Drug

Abstract

Despite many epilepsy patients respond to antiepileptic drugs (AED) successfully, more than 30% of patients continue to have seizures on multiple AEDs. The refractory epilepsy increases the risk of cognitive deterioration, psychosocial dysfunction, and sudden unexpected death of epilepsy patients (SUDEP). It is important to identify refractory epilepsy early and make the goal of epilepsy treatment as the prevention of decline in social, vocational, and cognitive performances and minimizing the risk of accident or SUDEP. The syndrome of medial temporal lobe epilepsy with hippocampal sclerosis (MTLE with HS) is often resistant to AEDs, and surgically remediable. Initially well-controlled seizures often become intractable to AEDs. There are progressive behavioral changes including increasing memory deficit. Surgical outcome is also worse with longer duration of epilepsy or increasing age at surgery, which suggests that MTLE is a progressive disorder. Some emphasized the ultimate intractability of MTLE in which intractability of MTLE could be evident only after some years following initial diagnosis.However, when patients considered to have intractable epilepsy were followed up for a long period of

Different patterns of epileptiform-like activity are generated in the sclerotic hippocampus from patients with drug-resistant temporal lobe epilepsy

“…Hippocampal sclerosis (HS) is the most frequent histopathological finding in refractory TLE 2 , 3 . Temporal lobe epilepsy associated with HS is often progressive with worsening of seizures, impairment of cognitive function, psychiatric disorders and is accompanied by significant morbidity and mortality 4 – 6 . In this scenario, resective surgery has been recognized as an effective treatment for pharmacoresistant TLE/HS 7 – 10 .…”

Chemokines as new inflammatory players in the pathogenesis of epilepsy

“…Mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis is a typical example of drugresistant epilepsy. For many MTLE patients, the surgical removal of the epileptic focus remains the only option to achieve an acceptable seizure control (Kwan et al, 2011;Lee, 2014). Thus, it is urgent to find alternative and less invasive approaches for drug-resistant epilepsy treatment.…”

Resin-acid derivatives as potent electrostatic openers of voltage-gated K channels and suppressors of neuronal excitability

“…Unfortunately, not all of these diseases are entirely controlled by currently available pharmaceuticals. For instance, one third of the patients with epilepsy do not respond satisfactorily 2 3 4 to existing treatment; therefore there is a need for new therapies. For all these conditions, voltage-gated ion channels, responsible for the generation and propagation of neuronal and cardiac action potentials, are obvious targets.…”