Innovative Therapeutic Strategies for Drug-Resistant Epilepsy

Srikanya Laxmi^*
*Correspondence: Srikanya Laxmi, Department of Biomedical Sciences, Osmania University, Hyderabad, Telangana, India, Email:

Keywords

Neurological disorder • Epilepsy • Drugs

Introduction

Surgical intervention has long been an option for certain cases of drugresistant epilepsy. The most common form, resective surgery, involves removing the part of the brain where seizures originate. However, this isn't suitable for everyone, and risks and benefits must be carefully weighed.

In recent years, less invasive surgical procedures have emerged. Laser interstitial thermal therapy (LITT) uses laser energy to ablate seizure foci with minimal damage to surrounding tissues. Stereotactic radiosurgery, a non-invasive technique, employs focused radiation to target and lesion the epileptogenic zone [1,2].

Neuromodulation therapies

Neuromodulation, or the alteration of nerve activity through targeted delivery of a stimulus, is a rapidly growing field for drug-resistant epilepsy management.

Vagus Nerve Stimulation (VNS): This involves implanting a device that sends regular, mild pulses of electrical energy to the brain via the vagus nerve. It's been used for several years and can reduce seizure frequency by more than 50% in some patients.

Responsive Neurostimulation (RNS): The RNS system continually monitors brain waves, detects abnormal electrical activity, and delivers electrical stimulation to prevent seizures before they start.

Deep Brain Stimulation (DBS): In DBS, electrodes are implanted in specific brain areas, delivering electrical impulses that regulate abnormal impulses [3].

Description

Dietary therapies

Dietary therapies, such as the ketogenic diet, low glycemic index treatment, and the modified Atkins diet, can be beneficial for some individuals. These high-fat, low-carbohydrate diets are believed to work by altering energy metabolism in the brain. However, they require careful supervision and are not suitable for everyone [4].

Cannabidiol (CBD)

CBD, a non-psychoactive compound derived from the cannabis plant, has gained attention for its potential antiepileptic effects. In 2018, the US FDA approved Epidiolex, a purified CBD product, for the treatment of two severe pediatric epilepsy syndromes. Clinical trials have shown significant seizure reduction with CBD treatment in some cases of refractory epilepsy.

Gene therapy

Gene therapy offers an exciting and potentially curative approach for certain genetic forms of epilepsy. It involves introducing, removing, or changing genetic material to alter the function of cells and treat or potentially cure disease. While this is still an emerging field, preclinical studies and early-stage clinical trials have shown promise.

In the face of drug-resistant epilepsy, the therapeutic landscape is rapidly expanding, offering hope for patients who have struggled to achieve seizure control. These innovative strategies reflect the multidimensional approach needed to manage complex conditions like epilepsy effectively. As we continue to explore these promising frontiers, it is crucial to ensure these advancements are accessible to all those who need them, regardless of geography, income, or social status. Drug-resistant epilepsy is a challenging journey, but with scientific progress, we move closer to a world where every person with epilepsy has the opportunity for a seizure-free life [5].

MicroRNA therapies

microRNAs (miRNAs) are small non-coding RNA molecules that play a critical role in regulating gene expression. There is growing evidence that dysregulation of certain miRNAs is involved in the pathogenesis of epilepsy. Therapies that target these miRNAs could potentially modify disease progression. While still in the early stages, miRNA-based therapies represent a new frontier in the treatment of drug-resistant epilepsy.

Stem cell therapy

Stem cell therapy is another emerging approach for drug-resistant epilepsy. Stem cells could potentially be used to repair or replace damaged neuronal tissue, reduce inflammation, and promote the brain's own repair mechanisms. Animal studies have shown promise, but translating these findings to effective human therapies will require careful consideration of the many technical and ethical issues involved in stem cell research and therapy.

Immunomodulatory therapies

Recent research suggests that inflammation and autoimmune processes may play a role in some cases of epilepsy. This has led to interest in immunomodulatory therapies for drug-resistant epilepsy. Treatments such as steroids, intravenous immunoglobulins, and certain biologic agents have shown promise in some cases, particularly in individuals with signs of autoimmune epilepsy.

Pharmacogenomics

Pharmacogenomics, the study of how genes influence an individual’s response to drugs, holds promise for improving treatment outcomes in drugresistant epilepsy. By identifying genetic markers associated with response to certain AEDs, clinicians may be able to predict which patients are likely to respond to specific treatments, helping to personalize epilepsy treatment [6].

Conclusion

The landscape of therapeutic strategies for drug-resistant epilepsy is evolving rapidly. From advanced surgical techniques and neuro-modulation to breakthroughs in gene therapy and pharmacogenomics, these innovative approaches are expanding the options available for patients with refractory epilepsy. While promising, these new therapies also present challenges. They often require specialized facilities and trained personnel, and their cost may limit accessibility. Moreover, more research is needed to determine long-term outcomes and potential side effects. Nevertheless, these advancements bring hope that more effective, personalized treatments for drug-resistant epilepsy are on the horizon. In the end, the goal remains to improve the quality of life and functional outcomes for all individuals living with epilepsy.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Dalic, Linda and Mark J Cook. "Managing drug-resistant epilepsy: Challenges and solutions." Neuropsychiat Dis Treat (2016): 2605-2616.

Google Scholar, Crossref, Indexed at

2. Kalilani, Linda, Xuezheng Sun, Barbara Pelgrims and Matthias Noack‐Rink, et al. "The epidemiology of drug‐resistant epilepsy: A systematic review and meta‐analysis." Epilepsia 59 (2018): 2179-2193.

Google Scholar, Crossref, Indexed at

3. Kwan, Patrick, Alexis Arzimanoglou, Anne T Berg and Martin J Brodie, et al. "Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE commission on therapeutic strategies." (2010).

Google Scholar, Crossref

4. Tang, Fei, Anika MS Hartz and Björn Bauer. "Drug-resistant epilepsy: Multiple hypotheses, few answers." Front Neurol 8 (2017): 301.

Google Scholar, Crossref, Indexed at

5. Téllez‐Zenteno, Jose F., Lizbeth Hernández‐Ronquillo, Samantha Buckley and Ricardo Zahagun, et al. "A validation of the new definition of drug‐resistant epilepsy by the international league against epilepsy." Epilepsia 55 (2014): 829-834.

Google Scholar, Crossref, Indexed at

6. Li, Michael CH and Mark J Cook. "Deep brain stimulation for drug‐resistant epilepsy." Epilepsia 59 (2018): 273-290.

Google Scholar, Crossref