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Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
There are a number of decisions that must be taken regarding the use of antiepileptic drugs: when to start a drug?which drug and in what dose?when to change the drug?when to add a second drug (and which one)?when to seek a specialist opinion?when to stop the drug?when to measure blood levels of the drug?when to consider epilepsy surgery?
Developmental Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James H. Tonsgard, Nikolas Mata-Machado
Aggressive control of seizures is needed. Radiologic studies suggest that seizures are associated with ischemic injury to the cortex underlying the leptomeningeal angioma because of abnormal regulation of blood flow in these vessels. This leads to laminar necrosis. The goal is to minimize seizures. Epilepsy surgery should be discussed in some patients with intractable seizures. This is controversial, because of the variable clinical course. It also is important to realize that epilepsy can be difficult in the first one or two years of life but often is less difficult thereafter. Teenagers and adults can be seizure free, even without seizure medicine.
Indications for Epilepsy Surgery Evaluation
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
It is estimated that 25% of all epileptic patients have an intractable seizure disorder (1). In this population of drug-resistant epileptics, between 12.5 and 25% of patients are suitable candidates for epilepsy surgery (2). There are approximately 75,000 patients with medically intractable epilepsy in the United States who may benefit from epilepsy surgery (3). In the last two decades, there have been major advancements in intensive video-EEG monitoring, neuroimaging, andneuropharmacology. This, combined with increased awareness among physicians as well as in patients and their families regarding the role of epilepsy surgery, has led to an increase in the number of patients being referred to centers specializing in epilepsy surgery. There is compelling evidence indicating that patients with intractable epilepsy may be identified within 2 to 4 years (1, 4–6) instead of 10 to 20 years, which has been the norm until now. It is believed that early resolution of seizures may lead to improved intellectual, social, and economic outcome (7,8).
Ketogenic diet: overview, types, and possible anti-seizure mechanisms
Published in Nutritional Neuroscience, 2021
Mohammad Barzegar, Mohammadreza Afghan, Vahid Tarmahi, Meysam Behtari, Soroor Rahimi Khamaneh, Sina Raeisi
Epilepsy is a common neurological disease which affects about 1% of the world’s population [1]. It can be recognized by seizures caused by excessive electrical activity in the brain. Frequent seizures in this disease may lead to progressive neural damage [2]. There are a variety of anticonvulsant medications which are usually used as the primary therapeutic approach in epilepsy patients [3]. However, it has been revealed that about 20–40% of the patients suffer from drug-resistant epilepsy (DRE) that their seizures are unyielding to treatments with two or more of these drugs [2,4]. This form of the disease is challenging to manage and can cause serious clinical problems such as disability, mortality, comorbidities, as well as socioeconomic and psychological costs [2]. Currently, surgical methods and diet therapies are the most prevalent and useful approaches to manage DRE [5]. Epilepsy surgery is a procedure which aims to eliminate or reduce the seizure by excising the brain epileptic zone or limit the spread of seizure activity without causing any loss of normal brain function. Although epilepsy surgery can be highly effective, it is not always appropriate, and due to the complicated etiology and indistinct pathogenesis of DRE, surgery alone is hard to achieve a certain effect and therefore needs to be replaced with other treatments such as diet therapy [5,6].
Contemporary surgical management of drug-resistant focal epilepsy
Published in Expert Review of Neurotherapeutics, 2020
Jasmina R. Milovanović, Slobodan M. Janković, Dragan Milovanović, Dejana Ružić Zečević, Marko Folić, Marina Kostić, Goran Ranković, Srđan Stefanović
Epilepsy surgery is an intensely developing treatment modality reserved for patients with focal drug-resistant seizures and small probability of major neurological deficit after surgery. Recent development of sophisticated diagnostic methods nowadays offers much more precise localization of epileptogenic focus and detailed planning of surgical procedure which will make minimal damage of neural pathways and structures essential for movements, speech, cognition, and emotions. Together with advent of perioperative care, improved diagnostics and surgical techniques resulted with significant drop in rates of postoperative complications, long-term neurological deficit, and mortality in the last decade, while seizure freedom and good quality of life became achievable in majority of operated patients. If longer postoperative horizon is taken into account, epilepsy surgery is cost/effective treatment option of focal drug-resistant epilepsy in comparison to continuation of drug therapy, as its ICER falls within the acceptable range (less than $30.000 per QALY gained) and net monetary benefit is positive.
Neuromodulation beyond neurostimulation for epilepsy: scope for focused ultrasound
Published in Expert Review of Neurotherapeutics, 2019
Manish Ranjan, Alexandre Boutet, Sanjiv Bhatia, Angus Wilfong, Walter Hader, Mark R Lee, Ali R Rezai, P. David Adelson
Epilepsy is one of the leading neurological diseases in both adults and children with significant psychosocial and neurologic morbidity [1,2], increased risk of mortality [3] including the potential for sudden unexplained death in epilepsy (SUDEP) [4]. Besides medical and psychosocial issues, medical care for epilepsy (both direct and indirect) carries a high economic cost [5,6]. Approximately 20–30% of the cases remain refractory to available medical management [7], and they have a higher risk of morbidity and mortality. Currently, in pharmacoresistant cases, treatment options include surgical resection of the epileptogenic zone after localization of a seizure focus/epileptogenic zone. This intervention, whenever possible, offers the best possible chance of seizure freedom and improve quality of life (QOL) in patients with refractory epilepsy. However, there is still a large proportion of patients who are not suitable for resective epilepsy surgery due to seizures originating from an eloquent brain region or because the seizures may be multifocal, diffuse, or bi-hemispheric in onset.