F J López González1, X Rodríguez Osorio2, A Gil-Nagel Rein3, M Carreño Martínez4, J Serratosa Fernández5, V Villanueva Haba6, A J Donaire Pedraza4, J M Mercadé Cerdá7. 1. Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España. Electronic address: javieritol@yahoo.com. 2. Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España. 3. Hospital Rúber Internacional, Madrid, España. 4. Hospital Clínic, Barcelona, España. 5. Hospital Universitario Fundación Jiménez Díaz, Madrid, España. 6. Hospital Universitario La Fe, Valencia, España. 7. Hospital Regional Universitario Carlos Haya, Málaga, España.
Abstract
INTRODUCTION: Drug-resistant epilepsy affects 25% of all epileptic patients, and quality of life decreases in these patients due to their seizures. Early detection is crucial in order to establish potential treatment alternatives and determine if the patient is a surgical candidate. DEVELOPMENT: PubMed search for articles, recommendations published by major medical societies, and clinical practice guidelines for drug-resistant epilepsy and its medical and surgical treatment options. Evidence and recommendations are classified according to the criteria of the Oxford Centre for Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic actions. CONCLUSIONS: Identifying patients with drug-resistant epilepsy is important for optimising drug therapy. Experts recommend rational polytherapy with antiepileptic drugs to find more effective combinations with fewer adverse effects. When adequate seizure control is not achieved, a presurgical evaluation in an epilepsy referral centre is recommended. These evaluations explore how to resect the epileptogenic zone without causing functional deficits in cases in which this is feasible. If resective surgery is not achievable, palliative surgery or neurostimulation systems (including vagus nerve, trigeminal nerve, or deep brain stimulation) may be an option. Other treatment alternatives such as ketogenic diet may also be considered in selected patients.
INTRODUCTION: Drug-resistant epilepsy affects 25% of all epilepticpatients, and quality of life decreases in these patients due to their seizures. Early detection is crucial in order to establish potential treatment alternatives and determine if the patient is a surgical candidate. DEVELOPMENT: PubMed search for articles, recommendations published by major medical societies, and clinical practice guidelines for drug-resistant epilepsy and its medical and surgical treatment options. Evidence and recommendations are classified according to the criteria of the Oxford Centre for Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic actions. CONCLUSIONS: Identifying patients with drug-resistant epilepsy is important for optimising drug therapy. Experts recommend rational polytherapy with antiepileptic drugs to find more effective combinations with fewer adverse effects. When adequate seizure control is not achieved, a presurgical evaluation in an epilepsy referral centre is recommended. These evaluations explore how to resect the epileptogenic zone without causing functional deficits in cases in which this is feasible. If resective surgery is not achievable, palliative surgery or neurostimulation systems (including vagus nerve, trigeminal nerve, or deep brain stimulation) may be an option. Other treatment alternatives such as ketogenic diet may also be considered in selected patients.
Authors: Gianluca Dini; Eleonora Tulli; Giovanni Battista Dell'Isola; Elisabetta Mencaroni; Giuseppe Di Cara; Pasquale Striano; Alberto Verrotti Journal: Front Pharmacol Date: 2022-05-20 Impact factor: 5.988