New study breakthrough emphasizes the association between inflammation and drug resistant epilepsy

New study breakthrough emphasizes the association between inflammation and drug resistant epilepsy. This finding implies that an approach for the treatment of epilepsy could involve the use of an anti-inflammatory agent.

What is the definition of drug-resistant epilepsy?

Drug-resistant epilepsy is defined as a failure of adequate trials of two (or more) tolerated, appropriately chosen, and appropriately used antiepileptic drug regimens (whether administered as monotherapy or in combination) to achieve freedom from seizures. This definition is based on the observation that if complete seizure control is not achieved with trials of two appropriate antiepileptic drugs, the likelihood of success with subsequent regimens is much reduced.

 What are the most common causes of pseudo resistant epilepsy?

Pseudo resistance, in which seizures persist because epilepsy has not been correctly diagnosed or appropriately treated, must be excluded or corrected before drug treatment can be considered to have failed. This phenomenon may arise in a number of situations, of which misdiagnosis of epilepsy is probably the most common. Conditions that frequently mimic epileptic seizures include vasovagal syncope, cardiac arrhythmias, metabolic disturbances, and other neurologic disorders with episodic manifestations (e.g., transient ischemic attacks and migraine). Psychogenic, nonepileptic seizures are estimated to account for more than 25% of adult cases of apparently drug-resistant epilepsy.

Q: What are the criteria for surgical treatment of drug-resistant epilepsy?

A: Patients who meet the criteria for having drug-resistant epilepsy should be evaluated early for surgical treatment, particularly if they have a surgically remedial syndrome, such as unilateral hippocampal sclerosis or other resectable lesions. Other potentially curative procedures include resection of structural lesions such as glial tumors and vascular malformations.

Q: What dietary approach has shown promise for the management of drug-resistant epilepsy in children?

A: The ketogenic diet (a high-fat, low-protein, low-carbohydrate diet) is used in children with drug-resistant epilepsy. A randomized, controlled trial showed that the number of seizures fell by more than 50% in approximately half of children after 1 year on the diet (class II evidence). The diet seems to be effective for all seizure types. The major problem is adherence to the restrictive (and unpleasant) dietary regimen.

New research- Marker of Inflammation May be Elevated with Certain Seizure Types

Marker of Inflammation May be Elevated with Certain Seizure Types. In recent studies presented in the May issue of the journal Epilepsia, Doctors Alapirtti and colleagues from the department of Neuroscience and Rehabilitation, Tampere University Hospital in Tampere, Finland and the departments of Virology and Neurology at the University of Turku and Clinical Neurophysiology Pirkanmaa Hospital District detailed an analysis

looking at a marker of inflammation known as C-reactive protein (CRP) and its relationship to specific seizures. The investigators looked at 31 patients who had drug

resistant epilepsy of partial onset who were admitted for a video EEG monitoring unit at the Tampere University Hospital. All of these patients underwent continuous monitoring for four days with the idea of recording seizures as part of their clinical evaluation for potential epilepsy surgery. They drew blood samples at the beginning of the four day recording at various points in the admission and in relationship to their recorded seizures.

Their goal?

To see whether there was a change in the CRP level after seizures in patients who had refractory epilepsy, and to look at the difference in baseline CRP levels in healthy patients versus those with epilepsy. They also assessed elevated CRP levels and if the CRP levels varied with epilepsy syndrome, cause of epilepsy, length of epilepsy, seizure duration, seizure frequency, and the current use of enzyme inducing antiepileptic drugs.

The results?

The investigators found that CRP was significantly higher in patients who had refractory partial epilepsy as compared to patients without epilepsy. All five patients with an elevated CRP level had temporal lobe epilepsy versus other epilepsy types. They noted that the most important predictor of an increase in the CRP level was having a secondary generalized tonic-clonic seizure. They concluded that the higher baseline level in patients with epilepsy compared with healthy controls show that CRP concentrations are effected in patients with drug resistant epilepsy. It also suggests that a single generalized tonic-clonic seizure stimulates CRP production. These results emphasize the association between inflammation and drug resistant epilepsy.

And what does this mean?

This study is important for two reasons:

1. It shows there is clearly an elevation of the markers of inflammation in patients with drug resistant epilepsy and;

2. It also shows that single seizures can significantly increase CRP. This finding implies that an approach for the treatment of epilepsy could involve the use of an anti-inflammatory agent. This idea if translated to therapy could change the way we treat seizures.

Much more research needs to be done in order to understand the full meaning of this study, but early signs are very positive.

(Source-Journal Epilepsia)