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Review
. 2009 Dec;9(12):1791-802.
doi: 10.1586/ern.09.114.

Management of the patient with medically refractory epilepsy

Tiziana Granata  1 , Nicola Marchi, Erin Carlton, Chaitali Ghosh, Jorge Gonzalez-Martinez, Andreas V Alexopoulos, Damir Janigro
Affiliations
Review

Management of the patient with medically refractory epilepsy

Tiziana Granata et al. Expert Rev Neurother. 2009 Dec.

Abstract

Epilepsy imposes a significant clinical, epidemiologic and economic burden on societies throughout the world. Despite the development of more than ten new antiepileptic drugs over the past 15 years, approximately a third of patients with epilepsy remain resistant to pharmacotherapy. Individuals who fail to respond, or respond only partially, continue to have incapacitating seizures. Managing patients with medically refractory epilepsy is challenging and requires a structured multidisciplinary approach in specialized clinics. If the problems related to drug resistance could be resolved, even in part, by improving the pharmacokinetic profile of existing drugs, the economic savings would be remarkable and the time required to design drugs that achieve seizure control would be shorter than the discovery of new targets and molecules was required. A promising approach is the use of corticosteroids that may have a dual beneficial effect. Resective brain surgery remains the ultimate and highly successful approach to multiple drug resistance in epileptic patients.

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Figures

Figure 1
Figure 1. To cut or not to cut? The decision-making process for resective surgery
AED: Antiepileptic drug.
Figure 2
Figure 2. Is drug-resistant epilepsy a dual disease?
MRPs: Multidrug resistance-associated proteins.
See this image and copyright information in PMC

References

    1. Picot MC, Baldy-Moulinier M, Daures JP, Dujols P, Crespel A. The prevalence of epilepsy and pharmacoresistant epilepsy in adults: a population-based study in a Western European country. Epilepsia. 2008;49(7):1230–1238. - PubMed
    1. Kwan P, Brodie MJ. Epilepsy after the first drug fails: substitution or add-on? Seizure. 2000;9(7):464–468. - PubMed
    1. Arts WF, Brouwer OF, Peters AC, et al. Course and prognosis of childhood epilepsy: 5-year follow-up of the Dutch study of epilepsy in childhood. Brain. 2004;127:1774–1784. - PubMed
    1. Sillanpaa M, Schmidt D. Natural history of treated childhood-onset epilepsy: prospective, long-term population-based study. Brain. 2006;129:617–624. - PubMed
    1. Callaghan BC, Anand K, Hesdorffer D, Hauser WA, French JA. Likelihood of seizure remission in an adult population with refractory epilepsy. Ann Neurol. 2007;62(4):382–389. - PubMed

Websites

    1. Evaluating the transporter protein inhibitor probenecid in patients with epilepsy. http://clinicaltrials.gov/ct2/show/NCT00610532?term=epilepsy&recr=Open&r....
    1. P-Glycoprotein Inhibition as Adjunct Treatment for Medically Refractory Epilepsy. http://clinicaltrials.gov/ct2/show/NCT00524134.
    1. Verapamil and Catamenial Epilepsy. http://clinicaltrials.gov/ct2/show/NCT00559169?term=epilepsy&recr=Open&r....

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