Therapeutic approaches targeting seizure networks.

Frontiers in network physiology Pub Date : 2024-08-07 eCollection Date: 2024-01-01 DOI:10.3389/fnetp.2024.1441983
Jenna Langbein, Ujwal Boddeti, Matthew Kreinbrink, Ziam Khan, Ihika Rampalli, Muzna Bachani, Alexander Ksendzovsky
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Abstract

Epilepsy is one of the most common neurological disorders, affecting over 65 million people worldwide. Despite medical management with anti-seizure medications (ASMs), many patients fail to achieve seizure freedom, with over one-third of patients having drug-resistant epilepsy (DRE). Even with surgical management through resective surgery and/or neuromodulatory interventions, over 50 % of patients continue to experience refractory seizures within a year of surgery. Over the past 2 decades, studies have increasingly suggested that treatment failure is likely driven by untreated components of a pathological seizure network, a shift in the classical understanding of epilepsy as a focal disorder. However, this shift in thinking has yet to translate to improved treatments and seizure outcomes in patients. Here, we present a narrative review discussing the process of surgical epilepsy management. We explore current surgical interventions and hypothesized mechanisms behind treatment failure, highlighting evidence of pathologic seizure networks. Finally, we conclude by discussing how the network theory may inform surgical management, guiding the identification and targeting of more appropriate surgical regions. Ultimately, we believe that adapting current surgical practices and neuromodulatory interventions towards targeting seizure networks offers new therapeutic strategies that may improve seizure outcomes in patients suffering from DRE.

针对癫痫发作网络的治疗方法。
癫痫是最常见的神经系统疾病之一,影响着全球 6500 多万人。尽管使用抗癫痫药物(ASMs)进行内科治疗,但许多患者仍无法摆脱癫痫发作,超过三分之一的患者患有耐药性癫痫(DRE)。即使通过切除手术和/或神经调节干预进行手术治疗,50% 以上的患者在术后一年内仍会出现难治性癫痫发作。在过去的 20 年中,越来越多的研究表明,治疗失败很可能是由病理发作网络中未经治疗的成分导致的,这改变了人们对癫痫是一种局灶性疾病的传统认识。然而,这种思维方式的转变尚未转化为治疗方法的改进和患者发作结果的改善。在此,我们将对癫痫外科治疗过程进行叙述性回顾。我们探讨了当前的手术干预措施和治疗失败背后的假设机制,并强调了病理发作网络的证据。最后,我们讨论了网络理论如何为手术管理提供信息,指导识别和定位更合适的手术区域。最终,我们认为,调整当前的手术方法和神经调节干预措施,以癫痫发作网络为目标,可提供新的治疗策略,从而改善 DRE 患者的癫痫发作预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
2.70
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