Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies

Deborah Guery,1 Sylvain Rheims1– 3 1Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France; 2Lyon’s Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France; 3Epilepsy Institute, Lyon, FranceCorrespondence: Sylvain RheimsDepart...

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Autores principales:	Guery D, Rheims S
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	drug resistant epilepsy epilepsy surgery antiseizure drugs comprehensive care Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/1ee8b34853774d1d826ebc774b8615cc
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spelling	oai:doaj.org-article:1ee8b34853774d1d826ebc774b8615cc2021-12-02T16:39:55ZClinical Management of Drug Resistant Epilepsy: A Review on Current Strategies1178-2021https://doaj.org/article/1ee8b34853774d1d826ebc774b8615cc2021-07-01T00:00:00Zhttps://www.dovepress.com/clinical-management-of-drug-resistant-epilepsy-a-review-on-current-str-peer-reviewed-fulltext-article-NDThttps://doaj.org/toc/1178-2021Deborah Guery,1 Sylvain Rheims1– 3 1Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France; 2Lyon’s Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France; 3Epilepsy Institute, Lyon, FranceCorrespondence: Sylvain RheimsDepartment of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, 59 Boulevard Pinel, Bron Cedex, 69677, FranceTel +33 4 72 35 79 00Email sylvain.rheims@chu-lyon.frAbstract: Drug resistant epilepsy (DRE) is defined as the persistence of seizures despite at least two syndrome-adapted antiseizure drugs (ASD) used at efficacious daily dose. Despite the increasing number of available ASD, about a third of patients with epilepsy still suffer from drug resistance. Several factors are associated with the risk of evolution to DRE in patients with newly diagnosed epilepsy, including epilepsy onset in the infancy, intellectual disability, symptomatic epilepsy and abnormal neurological exam. Pharmacological management often consists in ASD polytherapy. However, because quality of life is driven by several factors in patients with DRE, including the tolerability of the treatment, ASD management should try to optimize efficacy while anticipating the risks of drug-related adverse events. All patients with DRE should be evaluated at least once in a tertiary epilepsy center, especially to discuss eligibility for non-pharmacological therapies. This is of paramount importance in patients with drug resistant focal epilepsy in whom epilepsy surgery can result in long-term seizure freedom. Vagus nerve stimulation, deep brain stimulation or cortical stimulation can also improve seizure control. Lastly, considering the effect of DRE on psychologic status and social integration, comprehensive care adaptations are always needed in order to improve patients’ quality of life.Keywords: drug resistant epilepsy, epilepsy surgery, antiseizure drugs, comprehensive careGuery DRheims SDove Medical Pressarticledrug resistant epilepsyepilepsy surgeryantiseizure drugscomprehensive careNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 17, Pp 2229-2242 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	drug resistant epilepsy epilepsy surgery antiseizure drugs comprehensive care Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	drug resistant epilepsy epilepsy surgery antiseizure drugs comprehensive care Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Guery D Rheims S Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies
description	Deborah Guery,1 Sylvain Rheims1– 3 1Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France; 2Lyon’s Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France; 3Epilepsy Institute, Lyon, FranceCorrespondence: Sylvain RheimsDepartment of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, 59 Boulevard Pinel, Bron Cedex, 69677, FranceTel +33 4 72 35 79 00Email sylvain.rheims@chu-lyon.frAbstract: Drug resistant epilepsy (DRE) is defined as the persistence of seizures despite at least two syndrome-adapted antiseizure drugs (ASD) used at efficacious daily dose. Despite the increasing number of available ASD, about a third of patients with epilepsy still suffer from drug resistance. Several factors are associated with the risk of evolution to DRE in patients with newly diagnosed epilepsy, including epilepsy onset in the infancy, intellectual disability, symptomatic epilepsy and abnormal neurological exam. Pharmacological management often consists in ASD polytherapy. However, because quality of life is driven by several factors in patients with DRE, including the tolerability of the treatment, ASD management should try to optimize efficacy while anticipating the risks of drug-related adverse events. All patients with DRE should be evaluated at least once in a tertiary epilepsy center, especially to discuss eligibility for non-pharmacological therapies. This is of paramount importance in patients with drug resistant focal epilepsy in whom epilepsy surgery can result in long-term seizure freedom. Vagus nerve stimulation, deep brain stimulation or cortical stimulation can also improve seizure control. Lastly, considering the effect of DRE on psychologic status and social integration, comprehensive care adaptations are always needed in order to improve patients’ quality of life.Keywords: drug resistant epilepsy, epilepsy surgery, antiseizure drugs, comprehensive care
format	article
author	Guery D Rheims S
author_facet	Guery D Rheims S
author_sort	Guery D
title	Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies
title_short	Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies
title_full	Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies
title_fullStr	Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies
title_full_unstemmed	Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies
title_sort	clinical management of drug resistant epilepsy: a review on current strategies
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/1ee8b34853774d1d826ebc774b8615cc
work_keys_str_mv	AT gueryd clinicalmanagementofdrugresistantepilepsyareviewoncurrentstrategies AT rheimss clinicalmanagementofdrugresistantepilepsyareviewoncurrentstrategies
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Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies

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