MODERN TREATMENT OPTIONS FOR DRUG-RESISTANT EPILEPSY IN CHILDREN
Abstract
Abstract: we present the experience of applying the methods of non-drug treatment drug-resistant epilepsy in children. These include surgery, ketogenic diet and chronic vagus nerve stimulation (VNS therapy). Methods. We observed 118 patients with refractory epilepsy. As a result of a comprehensive survey 46 patients became candidates for surgical treatment, VNS stimulator implanted in 17 patients, and the ketogenic diet recommended for 50 patients. Results. Surgical treatment showed the highest efficiency: the complete elimination of seizures (100%) was observed in 28 (61%) patients, reducing the number of seizures of >75% was observed in 1 (2%), >50% in 5 (11%) and <50 % in 12 (26%) patients. Efficiency of a ketogenic diet conceded to surgery: 100 % reduction of seizures observed in 9 (18%) patients, >75% in 10 (20%), >50 % in 4 (8%) and <50% in 27 (54%) patients. VNS stimulation, as well as the ketogenic diet was less effective compared with surgical treatment: 100% effect was observed in 3 (17.5%) patients, reducing the seizures of >75% in 2 (12%), >50 % in 17 (15%) and <50 % in 43 (38%) patients. Conclusions. The most effective and radical treatment of refractory epilepsy is surgery in comparing with the ketogenic diet and VNS stimulation. The overall efficiency of these treatments (seizure reducing more than 50%) was observed in 70 patients, representing 62% of the total. Thus, an integrated approach in the treatment of refractory epilepsy allows to achieve a positive effect in significant number of cases.
About the Authors
S. O. Aivazyan
Scientifically-practical centre of medical aid to children PHD of Moscow; Medical center «Neuromed», Moscow
Russian Federation
Russian Federation
E. G. Lukyanova
Scientifically-practical centre of medical aid to children PHD of Moscow
Russian Federation
Russian Federation
Yu. S. Shiryaev
Scientifically-practical centre of medical aid to children PHD of Moscow
Russian Federation
Russian Federation
References
1. Usacheva E.L., Ajvazjan S.O., Sorvacheva T.N., Pyr eva E.A., Shorina M.Ju. Primenenie ketogennoj diety v lechenii farmakorezis-tentnyh jepilepsij. Zhurnaja nevrologii i psihiatrii im. S.S. Korsakova. 2004; 7: 29-34. Alexopoulos A.V., Kotagal P., Loddenkemper T. et al. Long-term results with vagus nerve stimulation in children with pharmacore-sistant epilepsy. Seizure. 2006; 15: 491-503.
2. Amar A.P., Elder J.B., Apuzzo M.L.J. Vagal Nerve Stimulation for Seizures. Textbook of Stereotactic and Functional Neurosurgery. Ed. by A.M. Lozano, P.L. Gildenberg, R.R. Tasker. Springer. 2009; 2801-2822.
3. Benifla M., Rutka J.T., Logan W., Donner E.J. Vagal nerve stimulation for refractory epilepsy in children: indications and experience at The Hospital for Sick Children. Childs Nerv. Syst. 2006; 22: 1018-1026.
4. Ben-Menachem E., Hellstrom K., Waldton C., Augustinsson L.E: Evaluation of refractory epilepsy treated with vagus nerve stimulation for up to 5 years. Neurology. 1999; 52: 1265-1267.
5. Bough K.J., Rho Jong M. Anticonvulsant Mechanisms of the Ketogenic Diet. Epilepsia. 2007; 48 (1): 43-58.
6. Cramer J.A., Mattson R.H., Prevey M.L., Scheyer R.D., Ouellette V.L. How often is medication taken as prescribed? A novel assessment technique. Journal of American Medical Association. 1989 Jun 9; 261 (22): 3273-7.
7. Devinsky O. Patients with Refractory Seizures. New Englang Journal of Medicine 1999; 340: 1565-1570
8. Freeman J., Veggiotti P., Lanzi G., Tagliabue A., Perucca E. The ketogenic diet: from molecular mechanisms to clinical effects. Epilepsy Research. 2006; 68: 145-180.
9. French J.A. Refractory epilepsy: clinical overview. Epilepsia. 2007; 48 (1): 3-7. Review.
10. Hermanns G., Noachtar S., Tuxhorn I., Holthausen H., Ebner A., Wolf P. Systematic testing of medical intractability for carbamazepine, phenytoin, and Phenobarbital or primidone in monotherapy for patients considered for epilepsy surgery. Epilepsia. 1996 Jul; 37 (7): 675-9.
11. Kwan P., Brodie M.J. Early identification of refractory epilepsy. New Englang Journal of Medicine. 2000 Feb 3; 342 (5): 314-9.
12. Lockard J.S., Congdon W.C., DuCharme L.L. Feasibility and safety of vagal stimulation in monkey model. Epilepsia. 1990; 31: 20-26.
13. Loscher W., Potschka H. Role of drug efflux transporters in the brain for drug disposition and treatment of brain diseases. Progress in Neurobiology. 2005, 76: 22-76.
14. Morris A.A. Cerebral ketone body metabolism. Journal of Inherited Metabolic Disease. 2005; 28: 109-121.
15. Polkey C.E. Clinical outcome of epilepsy surgery. Current Opinion in Neurology. 2004 Apr; 17 (2): 173-8. Review.
16. Schmidt D., Loscher W. Drug resistance in epilepsy: putative neurobiologic and clinical mechanisms. Epilepsia. 2005; 46: 858-77.
17. Shorvon S.D. The epidemiology and treatment of chronic and refractory epilepsy. Epilepsia. 1996; 37 (2): 1-3. Review. PubMed PMID: 8641240.
18. Tate S.K., Sisodiya S.M. Multidrug resistance in epilepsy: a pharmacogenomic update. Expert Opinion on Pharmacotherapy. 2007; 8: 1441-9.
19. Vezzani A., French J., Bartfai T., Baram T.Z. The role of inflammation in epilepsy. Nature Reviews Neurology. 2011; 7 (1): 31-40.
20. Zabara J. Inhibition of experimental seizures in canines by repetitive vagal stimulation. Epilepsia. 1992; 33: 1005-1012.
Review
For citations:
Aivazyan S.O., Lukyanova E.G., Shiryaev Yu.S. MODERN TREATMENT OPTIONS FOR DRUG-RESISTANT EPILEPSY IN CHILDREN. Epilepsy and paroxysmal conditions. 2014;6(1):34-43. (In Russ.)
Views: 784
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 
