Introduction to Refractory Epilepsies

What is/are Refractory Epilepsies?

Refractory Epilepsies - The therapeutic applications of Δ9-THC are limited, whereas cannabidiol (CBD), another phytocannabinoid, induces antiepileptic effects in experimental animals and in patients with refractory epilepsies. ^[1] They account for a significant proportion of the refractory epilepsies and are usually associated with poor outcome. ^[2] The obtained data suggest that food allergy may play a role in triggering refractory epilepsies and their adequate response to treatment. ^[3] To assess the long‐term efficacy and tolerability of stiripentol (STP) as an adjunctive treatment in different forms of refractory epilepsies. ^[4] Especially during the pre-surgical work-up of children with pharmaco-refractory epilepsies, however, diagnosing homonymous visual field defects (HVFDs) can be crucial for planning surgical strategies. ^[5] Genetic malformations of cortical development (MCDs), such as mild MCDs (mMCD), focal cortical dysplasia (FCD), and hemimegalencephaly (HME), are major causes of severe pediatric refractory epilepsies subjected to neurosurgery. ^[6] Thus, 68-70 were promising candidates for developing into anti-epileptic drugs, especially for treatment of refractory epilepsies such as Dravet syndrome. ^[7] Its role in the treatment of other refractory epilepsies requires further study. ^[8] Although tackling epilepsy's seizure-prone feature, by tonically modifying overall circuit excitability and/or connectivity, the last 50 years of drug development has not seen a substantial improvement in seizure suppression of refractory epilepsies. ^[9] BACKGROUND Mild malformation of cortical development with oligodendroglial hyperplasia and epilepsy (MOGHE) is a newly described, rare histopathologic entity detected in resected brain tissue of patients with refractory epilepsies. ^[10] Effectiveness and tolerability of perampanel in children and adolescents with refractory epilepsies: first experiences. ^[11] Most previous studies in stereotactic-EEG have been directed toward temporal lobe epilepsy, which does not represent the whole spectrum of drug-refractory epilepsies. ^[12] Malformations of cortical development (MCDs) are an important cause of treatment refractory epilepsies. ^[13] Although baseline variables differed considerably, with most elderly patients with tumor-related and vascular etiologies in the mono group and most patients with refractory epilepsies with pronounced use of concomitant sodium channel blockers (SCBs) in the ≥2+ group, retention as a measure of real-life effectiveness turned out not to be substantially different and favorable in all groups. ^[14] Topiramate is a cheap, easily administrable, broad spectrum anti-epileptic, with multiple mechanisms of action and proven efficacy in many refractory epilepsies. ^[15] An elevated suspicion of sleep disorders in epileptic patients is needed to perform an adequate diagnosis and treatment, in order to achieve a better seizures control, especially in refractory epilepsies. ^[16] Vagus nerve stimulation (VNS) is a neuromodulation therapy, approved in Europe (1994), USA (1997) and Brazil (2000) as adjunctive for treatment for refractory epilepsies, which an electrical stimulus is applied in the cervical vagus nerve. ^[17] In a randomized, double-blind placebo-controlled cross-over design, we tried to demonstrate the efficacy of a mixture of Nigella sativa and Thymus vulgaris extracts (Epistop) on seizures in a group of children with refractory epilepsies. ^[18] Methods: To this end, we analyzed 820 seizures from 252 consecutive patients explored by stereoelectroencephalography (total of 2148 electrodes), including various forms of focal refractory epilepsies. ^[19] Our approach demonstrates that two-stage phenotype-based screening in a zebrafish model of DS successfully identifies synthetic cannabinoids with anti-seizure activity, and supports further investigation of SCs for refractory epilepsies. ^[20]