Book contents
- Seizure and Epilepsy Care
- Seizure and Epilepsy Care
- Copyright page
- Contents
- 1 How Do I Evaluate a First-Time Seizure?
- 2 How Do I Make an Epilepsy Diagnosis?
- 3 Which Antiseizure Medicines Treat Epilepsy and How Do I Pick?
- 4 How Can I Best Use EEG for Treating Epilepsy Patients?
- 5 What Are Common Epilepsy Imaging Findings in New Onset and Chronic Epilepsy Care?
- 6 How Do I Care for Patients in the Emergency Department and Inpatient Settings?
- 7 How Do I Manage Epilepsy Emergencies Like Status Epilepticus?
- 8 What Is the Best Long-Term Treatment Plan for Epilepsy Patients as an Outpatient?
- 9 What to Do When Your Patient Fails Two Antiseizure Medicines
- 10 Nonepileptic Events and General Psychiatric Care for Epilepsy Patients
- 11 What Are Essential Pediatric Epilepsy Clinical Diagnoses and Treatment Plans?
- Index
- References
9 - What to Do When Your Patient Fails Two Antiseizure Medicines
Managing Drug-Resistant Epilepsy as an Outpatient
Published online by Cambridge University Press: 28 January 2023
Book contents
- Seizure and Epilepsy Care
- Seizure and Epilepsy Care
- Copyright page
- Contents
- 1 How Do I Evaluate a First-Time Seizure?
- 2 How Do I Make an Epilepsy Diagnosis?
- 3 Which Antiseizure Medicines Treat Epilepsy and How Do I Pick?
- 4 How Can I Best Use EEG for Treating Epilepsy Patients?
- 5 What Are Common Epilepsy Imaging Findings in New Onset and Chronic Epilepsy Care?
- 6 How Do I Care for Patients in the Emergency Department and Inpatient Settings?
- 7 How Do I Manage Epilepsy Emergencies Like Status Epilepticus?
- 8 What Is the Best Long-Term Treatment Plan for Epilepsy Patients as an Outpatient?
- 9 What to Do When Your Patient Fails Two Antiseizure Medicines
- 10 Nonepileptic Events and General Psychiatric Care for Epilepsy Patients
- 11 What Are Essential Pediatric Epilepsy Clinical Diagnoses and Treatment Plans?
- Index
- References
Summary
Around a third of patients have drug-resistant epilepsy (DRE). This is crucially and easily determined if a patient continues to have seizures after being on two adequately dosed and appropriately selected antiseizure medicines (ASMs). For these patients, your initial efforts to make a specific and localized diagnosis will inform next treatment decisions. If a patient presents suddenly with DRE, it is key to assess for a possible autoimmune cause, as a separate treatment pathway should be considered. Otherwise, consider epilepsy surgery as an effective treatment. These treatments include brain resections and neuromodulation. Minimally invasive techniques have recently become more common, including laser surgery as well as stereotactically placed depth electrodes. Given the prevalence of neurostimulators, consideration for obtaining MRIs in patients with these devices is addressed, as pathways exist for all of these patients to safely undergo MRI testing.
- Type
- Chapter
- Information
- Seizure and Epilepsy CareThe Pocket Epileptologist, pp. 156 - 174Publisher: Cambridge University PressPrint publication year: 2023
References
Works Cited
Kwan, P, Arzimanoglou, A, Berg, AT et al. Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069–77.CrossRefGoogle Scholar
Chen, Z, Brodie, MJ, Liew, D, and Kwan, P. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: A 30-year longitudinal cohort study. JAMA Neurol. 2018;75(3):279–86.Google Scholar
Brodie, MJ, Barry, SJ, Bamagous, GA, Norrie, JD, and Kwan, P. Patterns of treatment response in newly diagnosed epilepsy. Neurology. 2012;78(20):1548–54.Google Scholar
St. Louis, EK. Truly “rational” polytherapy: Maximizing efficacy and minimizing drug interactions, drug load, and adverse effects. Curr Neuropharmacol. 2009;7(2):96–105.CrossRefGoogle ScholarPubMed
Dubey, D, Singh, J, Britton, JW et al. Predictive models in the diagnosis and treatment of autoimmune epilepsy. Epilepsia. 2017;58(7):1181–9.Google Scholar
Dubey, D, Kothapalli, N, McKeon, A et al. Predictors of neural-specific autoantibodies and immunotherapy response in patients with cognitive dysfunction. J Neuroimmunol. 2018;323:62–72.Google Scholar
Engel, J, Jr., Wiebe, S, French, J et al. Practice parameter: Temporal lobe and localized neocortical resections for epilepsy: Report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons. Neurology. 2003;60(4):538–47.Google Scholar
Wiebe, S, Blume, WT, Girvin, JP, and Eliasziw, M. A randomized, controlled trial of surgery for temporal-lobe epilepsy. N Engl J Med. 2001;345(5):311–18.CrossRefGoogle ScholarPubMed
Engel, J, Jr., McDermott, MP, Wiebe, S et al. Early surgical therapy for drug-resistant temporal lobe epilepsy: A randomized trial. JAMA. 2012;307(9):922–30.Google Scholar
Livanova, PLC. MRI with the VNS Therapy System. 26–0010–0300. London: Livanova, PLC. October 2019.Google Scholar
Medtronic, Inc. MRI Guidelines for Medtronic Deep Brain Stimulation Systems. M929535A074 Rev. B. Minneapolis, MN: Medtronic, Inc. January 7, 2021.Google Scholar
Neuropace, Inc. MRI Guidelines for the RNS System. DN 1017451 Rev. 6. Mountain View, CA: Neuropace, Inc. February 2020.Google Scholar
Ben-Menachem, E, Mañon-Espaillat, R, Ristanovic, R et al. Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. First International Vagus Nerve Stimulation Study Group. Epilepsia. 1994;35(3):616–26.Google Scholar
Handforth, A, DeGiorgio, CM, Schachter, SC et al. Vagus nerve stimulation therapy for partial-onset seizures: A randomized active-control trial. Neurology. 1998;51(1):48–55.CrossRefGoogle ScholarPubMed
Kawai, K, Tanaka, T, Baba, H et al. Outcome of vagus nerve stimulation for drug-resistant epilepsy: The first three years of a prospective Japanese registry. Epileptic Disord. 2017;19(3):327–38.Google Scholar
García-Pallero, MA, García-Navarrete, E, Torres, CV et al. Effectiveness of vagal nerve stimulation in medication-resistant epilepsy: Comparison between patients with and without medication changes. Acta Neurochir (Wien). 2017;159(1):131–6.CrossRefGoogle ScholarPubMed
Fisher, RS, Afra, P, Macken, M et al. Automatic vagus nerve stimulation triggered by ictal tachycardia: Clinical outcomes and device performance – The U.S. E-37 Trial. Neuromodulation. 2016;19(2):188–95.Google Scholar
Heck, C, Helmers, SL, and DeGiorgio, CM. Vagus nerve stimulation therapy, epilepsy, and device parameters: Scientific basis and recommendations for use. Neurology. 2002;59(6 suppl. 4):S31–7.Google Scholar
Helmers, SL, Begnaud, J, Cowley, A et al. Application of a computational model of vagus nerve stimulation. Acta Neurol Scand. 2012;126(5):336–43.Google Scholar
A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures: The Vagus Nerve Stimulation Study Group. Neurology. 1995;45(2):224–30.Google Scholar
Ramsay, RE, Uthman, BM, Augustinsson, LE et al. Vagus nerve stimulation for treatment of partial seizures: 2. Safety, side effects, and tolerability. First International Vagus Nerve Stimulation Study Group. Epilepsia. 1994;35(3):627–36.CrossRefGoogle ScholarPubMed
Aaronson, ST, Carpenter, LL, Conway, CR et al. Vagus nerve stimulation therapy randomized to different amounts of electrical charge for treatment-resistant depression: Acute and chronic effects. Brain Stimul. 2013;6(4):631–40.Google Scholar
Malow, BA, Edwards, J, Marzec, M, Sagher, O, and Fromes, G. Effects of vagus nerve stimulation on respiration during sleep: A pilot study. Neurology. 2000;55(10):1450–4.Google Scholar
Marzec, M, Edwards, J, Sagher, O, Fromes, G, and Malow, BA. Effects of vagus nerve stimulation on sleep-related breathing in epilepsy patients. Epilepsia. 2003;44(7):930–5.Google Scholar
Hsieh, T, Chen, M, McAfee, A, and Kifle, Y. Sleep-related breathing disorder in children with vagal nerve stimulators. Pediatr Neurol. 2008;38(2):99–103.Google Scholar
Fisher, R, Salanova, V, Witt, T et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. Epilepsia. 2010;51(5):899–908.Google Scholar
Salanova, V, Witt, T, Worth, R et al. Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy. Neurology. 2015;84(10):1017–25.CrossRefGoogle ScholarPubMed
Morrell, MJ. Responsive cortical stimulation for the treatment of medically intractable partial epilepsy. Neurology. 2011;77(13):1295–304.CrossRefGoogle ScholarPubMed
Nair, DR, Laxer, KD, Weber, PB et al. Nine-year prospective efficacy and safety of brain-responsive neurostimulation for focal epilepsy. Neurology. 2020;95(9):e1244–56.Google Scholar
Nagahama, Y, Schmitt, AJ, Nakagawa, D et al. Intracranial EEG for seizure focus localization: Evolving techniques, outcomes, complications, and utility of combining surface and depth electrodes. J Neurosurg. 2018;130(4):1–13.Google Scholar
Englot, DJ. A modern epilepsy surgery treatment algorithm: Incorporating traditional and emerging technologies. Epilepsy Behav. 2018;80:68–74.Google Scholar
Katz, JS and Abel, TJ. Stereoelectroencephalography versus subdural electrodes for localization of the epileptogenic zone: What is the evidence? Neurotherapeutics. 2019;16(1):59–66.Google Scholar
Gonzalez-Martinez, JA. The stereo-electroencephalography: The epileptogenic zone. J Clin Neurophysiol. 2016;33(6):522–9.Google Scholar
Mullin, JP, Shriver, M, Alomar, S et al. Is SEEG safe? A systematic review and meta-analysis of stereo-electroencephalography-related complications. Epilepsia. 2016;57(3):386–401.CrossRefGoogle Scholar
Arya, R, Mangano, FT, Horn, PS et al. Adverse events related to extraoperative invasive EEG monitoring with subdural grid electrodes: A systematic review and meta-analysis. Epilepsia. 2013;54(5):828–39.Google Scholar
Miller, C, Schatmeyer, B, Landazuri, P et al. sEEG for expansion of a surgical epilepsy program: Safety and efficacy in 152 consecutive cases. Epilepsia Open. 2021;6(4):694–702.Google Scholar
Kohlhase, K, Zöllner, JP, Tandon, N, Strzelczyk, A, and Rosenow, F. Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta-analysis of outcomes. Epilepsia. 2021;62(4):831–45.Google Scholar
Willie, JT, Laxpati, NG, Drane, DL et al. Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery. 2014;74(6):569–84; discussion 84–5.Google Scholar
Sharma, M, Ball, T, Alhourani, A et al. Inverse national trends of laser interstitial thermal therapy and open surgical procedures for refractory epilepsy: A nationwide inpatient sample-based propensity score matching analysis. Neurosurg Focus. 2020;48(4):E11.Google Scholar
Landazuri, P, Shih, J, Leuthardt, E et al. A prospective multicenter study of laser ablation for drug resistant epilepsy: One year outcomes. Epilepsy Res. 2020;167:106473.Google Scholar
Wu, C, Jermakowicz, WJ, Chakravorti, S et al. Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients. Epilepsia. 2019;60(6):1171–83.Google Scholar
Gross, RE, Stern, MA, Willie, JT et al. Stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Ann Neurol. 2018;83(3):575–87.Google Scholar
Jermakowicz, WJ, Kanner, AM, Sur, S et al. Laser thermal ablation for mesiotemporal epilepsy: Analysis of ablation volumes and trajectories. Epilepsia. 2017;58(5):801–10.CrossRefGoogle ScholarPubMed
Le, S, Ho, AL, Fisher, RS et al. Laser interstitial thermal therapy (LITT): Seizure outcomes for refractory mesial temporal lobe epilepsy. Epilepsy Behav. 2018;89:37–41.Google Scholar
Donos, C, Breier, J, Friedman, E et al. Laser ablation for mesial temporal lobe epilepsy: Surgical and cognitive outcomes with and without mesial temporal sclerosis. Epilepsia. 2018;59(7):1421–32.Google Scholar
Kang, JY, Wu, C, Tracy, J et al. Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy. Epilepsia. 2016;57(2):325–34.Google Scholar
Youngerman, BE, Oh, JY, Anbarasan, D et al. Laser ablation is effective for temporal lobe epilepsy with and without mesial temporal sclerosis if hippocampal seizure onsets are localized by stereoelectroencephalography. Epilepsia. 2018;59(3):595–606.Google Scholar
Gupta, K, Cabaniss, B, Kheder, A et al. Stereotactic MRI-guided laser interstitial thermal therapy for extratemporal lobe epilepsy. Epilepsia. 2020;61(8):1723–34.Google Scholar
Lewis, EC, Weil, AG, Duchowny, M et al. MR-guided laser interstitial thermal therapy for pediatric drug-resistant lesional epilepsy. Epilepsia. 2015;56(10):1590–8.Google Scholar
Voges, J, Büntjen, L, and Schmitt, FC. Radiofrequency-thermoablation: General principle, historical overview and modern applications for epilepsy. Epilepsy Res. 2018;142:113–16.Google Scholar
Bourdillon, P, Isnard, J, Catenoix, H et al. Stereo electroencephalography-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in drug-resistant focal epilepsy: Results from a 10-year experience. Epilepsia. 2017;58(1):85–93.Google Scholar
Cossu, M, Fuschillo, D, Casaceli, G et al. Stereoelectroencephalography-guided radiofrequency thermocoagulation in the epileptogenic zone: A retrospective study on 89 cases. J Neurosurg. 2015;123(6):1358–67.Google Scholar
Catenoix, H, Bourdillon, P, Guénot, M, and Isnard, J. The combination of stereo-EEG and radiofrequency ablation. Epilepsy Res. 2018;142:117–20.CrossRefGoogle ScholarPubMed
Catenoix, H, Mauguière, F, Guénot, M et al. SEEG-guided thermocoagulations: A palliative treatment of nonoperable partial epilepsies. Neurology. 2008;71(21):1719–26.CrossRefGoogle ScholarPubMed
Barbaro, NM, Quigg, M, Ward, MM et al. Radiosurgery versus open surgery for mesial temporal lobe epilepsy: The randomized, controlled ROSE trial. Epilepsia. 2018;59(6):1198–207.Google Scholar
Quigg, M, Broshek, DK, Barbaro, NM et al. Neuropsychological outcomes after Gamma Knife radiosurgery for mesial temporal lobe epilepsy: A prospective multicenter study. Epilepsia. 2011;52(5):909–16.CrossRefGoogle ScholarPubMed
Liu, H, Yang, Y, Wang, Y et al. Ketogenic diet for treatment of intractable epilepsy in adults: A meta-analysis of observational studies. Epilepsia Open. 2018;3(1):9–17.Google Scholar
Kossoff, EH, Zupec-Kania, BA, Auvin, S et al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018;3(2):175–92.CrossRefGoogle ScholarPubMed
Groesbeck, DK, Bluml, RM, and Kossoff, EH. Long-term use of the ketogenic diet in the treatment of epilepsy. Dev Med Child Neurol. 2006;48(12):978–81.Google Scholar
Bank, IM, Shemie, SD, Rosenblatt, B, Bernard, C, and Mackie, AS. Sudden cardiac death in association with the ketogenic diet. Pediatr Neurol. 2008;39(6):429–31.Google Scholar
Best, TH, Franz, DN, Gilbert, DL, Nelson, DP, and Epstein, MR. Cardiac complications in pediatric patients on the ketogenic diet. Neurology. 2000;54(12):2328–30.Google Scholar
Sharma, S and Gulati, S. The ketogenic diet and the QT interval. J Clin Neurosci. 2012;19(1):181–2.Google Scholar
Cervenka, MC and Kossoff, EH. Dietary treatment of intractable epilepsy. Continuum (Minneapolis, Minn). 2013;19(3 Epilepsy):756–66.Google Scholar