Managing drug-resistant epilepsy: challenges and solutions

Linda Dalic,1 Mark J Cook2,3 1Department of Neurology, Austin Health, 2St Vincent’s Hospital, Centre for Clinical Neurosciences and Neurological Research, 3Department of Medicine, The University of Melbourne, Melbourne, Australia Abstract: Despite the development of new antiepileptic dru...

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Autores principales:	Dalic L, Cook MJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Drug-resistant epilepsy pharmacoresistant management review. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/cc54fa326bb94e6798f81a8e41b80461
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spelling	oai:doaj.org-article:cc54fa326bb94e6798f81a8e41b804612021-12-02T05:55:30ZManaging drug-resistant epilepsy: challenges and solutions1178-2021https://doaj.org/article/cc54fa326bb94e6798f81a8e41b804612016-10-01T00:00:00Zhttps://www.dovepress.com/managing-drug-resistant-epilepsy-challenges-and-solutions-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Linda Dalic,1 Mark J Cook2,3 1Department of Neurology, Austin Health, 2St Vincent’s Hospital, Centre for Clinical Neurosciences and Neurological Research, 3Department of Medicine, The University of Melbourne, Melbourne, Australia Abstract: Despite the development of new antiepileptic drugs (AEDs), ~20%–30% of people with epilepsy remain refractory to treatment and are said to have drug-resistant epilepsy (DRE). This multifaceted condition comprises intractable seizures, neurobiochemical changes, cognitive decline, and psychosocial dysfunction. An ongoing challenge to both researchers and clinicians alike, DRE management is complicated by the heterogeneity among this patient group. The underlying mechanism of DRE is not completely understood. Many hypotheses exist, and relate to both the intrinsic characteristics of the particular epilepsy (associated syndrome/lesion, initial response to AED, and the number and type of seizures prior to diagnosis) and other pharmacological mechanisms of resistance. The four current hypotheses behind pharmacological resistance are the “transporter”, “target”, “network”, and “intrinsic severity” hypotheses, and these are reviewed in this paper. Of equal challenge is managing patients with DRE, and this requires a multidisciplinary approach, involving physicians, surgeons, psychiatrists, neuropsychologists, pharmacists, dietitians, and specialist nurses. Attention to comorbid psychiatric and other diseases is paramount, given the higher prevalence in this cohort and associated poorer health outcomes. Treatment options need to consider the economic burden to the patient and the likelihood of AED compliance and tolerability. Most importantly, higher mortality rates, due to comorbidities, suicide, and sudden death, emphasize the importance of seizure control in reducing this risk. Overall, resective surgery offers the best rates of seizure control. It is not an option for all patients, and there is often a significant delay in referring to epilepsy surgery centers. Optimization of AEDs, identification and treatment of comorbidities, patient education to promote adherence to treatment, and avoidance of triggers should be periodically performed until further insights regarding causative pathology can guide better therapies. Keywords: drug-resistant epilepsy, pharmacoresistant, management, review Dalic LCook MJDove Medical PressarticleDrug-resistant epilepsypharmacoresistantmanagementreview.Neurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 12, Pp 2605-2616 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Drug-resistant epilepsy pharmacoresistant management review. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Drug-resistant epilepsy pharmacoresistant management review. Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Dalic L Cook MJ Managing drug-resistant epilepsy: challenges and solutions
description	Linda Dalic,1 Mark J Cook2,3 1Department of Neurology, Austin Health, 2St Vincent’s Hospital, Centre for Clinical Neurosciences and Neurological Research, 3Department of Medicine, The University of Melbourne, Melbourne, Australia Abstract: Despite the development of new antiepileptic drugs (AEDs), ~20%–30% of people with epilepsy remain refractory to treatment and are said to have drug-resistant epilepsy (DRE). This multifaceted condition comprises intractable seizures, neurobiochemical changes, cognitive decline, and psychosocial dysfunction. An ongoing challenge to both researchers and clinicians alike, DRE management is complicated by the heterogeneity among this patient group. The underlying mechanism of DRE is not completely understood. Many hypotheses exist, and relate to both the intrinsic characteristics of the particular epilepsy (associated syndrome/lesion, initial response to AED, and the number and type of seizures prior to diagnosis) and other pharmacological mechanisms of resistance. The four current hypotheses behind pharmacological resistance are the “transporter”, “target”, “network”, and “intrinsic severity” hypotheses, and these are reviewed in this paper. Of equal challenge is managing patients with DRE, and this requires a multidisciplinary approach, involving physicians, surgeons, psychiatrists, neuropsychologists, pharmacists, dietitians, and specialist nurses. Attention to comorbid psychiatric and other diseases is paramount, given the higher prevalence in this cohort and associated poorer health outcomes. Treatment options need to consider the economic burden to the patient and the likelihood of AED compliance and tolerability. Most importantly, higher mortality rates, due to comorbidities, suicide, and sudden death, emphasize the importance of seizure control in reducing this risk. Overall, resective surgery offers the best rates of seizure control. It is not an option for all patients, and there is often a significant delay in referring to epilepsy surgery centers. Optimization of AEDs, identification and treatment of comorbidities, patient education to promote adherence to treatment, and avoidance of triggers should be periodically performed until further insights regarding causative pathology can guide better therapies. Keywords: drug-resistant epilepsy, pharmacoresistant, management, review
format	article
author	Dalic L Cook MJ
author_facet	Dalic L Cook MJ
author_sort	Dalic L
title	Managing drug-resistant epilepsy: challenges and solutions
title_short	Managing drug-resistant epilepsy: challenges and solutions
title_full	Managing drug-resistant epilepsy: challenges and solutions
title_fullStr	Managing drug-resistant epilepsy: challenges and solutions
title_full_unstemmed	Managing drug-resistant epilepsy: challenges and solutions
title_sort	managing drug-resistant epilepsy: challenges and solutions
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/cc54fa326bb94e6798f81a8e41b80461
work_keys_str_mv	AT dalicl managingdrugresistantepilepsychallengesandsolutions AT cookmj managingdrugresistantepilepsychallengesandsolutions
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Managing drug-resistant epilepsy: challenges and solutions

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