Management of the patient with medically refractory epilepsy

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.

Keywords::

• combination therapy steroids
• dexamethasone
• epileptic seizures
• multiple drug resistance
• neurological surgery

Acknowledgements

The authors would like to acknowledge the contributions of Vincent Fazio for the extensive assistance he provided in editing and compiling of this manuscript for publication.

Financial & competing interests disclosure

This work was supported by NIH-RO1 NS43284, NIH-RO1 NS38195, NIH-R21 HD057256 to Damir Janigro. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.