Open AccessDrug-resistant epilepsy: modern concepts, integrative mechanisms, and therapeutic advances
Author(s) -
Vitalie Chiosa,
Dumitru Ciolac,
Viorica Chelban,
Alexandru Gasnas,
A. Vataman,
Munteanu Cristina,
Stanislav Groppa
Publication year - 2021
Publication title -
the moldovan medical journal
Language(s) - English
Resource type - Journals
eISSN - 2537-6381
pISSN - 2537-6373
DOI - 10.52418/moldovan-med-j.64-4.21.14
Subject(s) - epilepsy , drug resistant epilepsy , medicine , vagus nerve stimulation , neurostimulation , clinical trial , randomized controlled trial , bioinformatics , psychiatry , biology , stimulation , vagus nerve
Background: Drug-resistant epilepsy is the cause of severe disability. Multiple questions remain unanswered both in terms of pathogenesis and therapeutic management. For this narrative review, PubMed database and Infomedica library were searched by using “drug-resistance in epilepsy” and “treatment of drug-resistant epilepsy” as key words. The following filters were applied: “Clinical Trial”, “Meta-analysis”, “Multicenter Study”, and “Randomized Controlled Trial”, covering the period of 01.01.2005–06.01.2021.Several hypotheses have been proposed, i.e., pharmacokinetic, intrinsic severity, gene, target, transporter, and neural network hypotheses. Many controlled trials showed different results in terms of seizure control after combined methods of therapies. Immunotherapy, palliative epilepsy surgery alone or associated with neurostimulation procedures including vagus nerve, trigeminal nerve, or deep brain stimulation may be efficient, however, seizure freedom is not always achieved. Genetic epilepsies might benefit from gene and exosome therapy; however, further studies are needed to verify their safety. Conclusions: Neuroscience of drug-resistant epilepsy faces many challenges. Inflammatory mediators, biomarkers, and genes might allow the identification of new treatment targets, contribute to an earlier diagnosis, and assess the clinical outcomes.