1. Updated clinical recommendations for the management of tuberous sclerosis complex associated epilepsy.
- Author
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Specchio, Nicola, Nabbout, Rima, Aronica, Eleonora, Auvin, Stephane, Benvenuto, Arianna, de Palma, Luca, Feucht, Martha, Jansen, Floor, Kotulska, Katarzyna, Sarnat, Harvey, Lagae, Lieven, Jozwiak, Sergiusz, and Curatolo, Paolo
- Subjects
EPILEPSY ,TUBEROUS sclerosis ,SEIZURES (Medicine) ,AUTISM spectrum disorders ,DEVELOPMENTAL neurobiology ,EPILEPTIFORM discharges - Abstract
Children with tuberous sclerosis complex (TSC), may experience a variety of seizure types in the first year of life, most often focal seizure sand epileptic spasms. Drug resistance is seen early in many patients, and the management of TSC associated epilepsy remain a major challenge for clinicians. In 2018 clinical recommendations for the management of TSC associated epilepsy were published by a panel of European experts. In the last five years considerable progress has been made in understanding the neurobiology of epileptogenesis and three interventional randomized controlled trials have changed the therapeutic approach for the management of TSC associated epilepsy. Pre-symptomatic treatment with vigabatrin may delay seizure onset, may reduce seizure severity and reduce the risk of epileptic encephalopathy. The efficacy of mTOR inhibition with adjunctive everolimus was documented in patients with TSC associated refractory seizures and cannabidiol could be another therapeutic option. Epilepsy surgery has significantly improved seizure outcome in selected patients and should be considered early in all patients with drug resistant epilepsy. There is a need to identify patients who may have a higher risk of developing epilepsy and autism spectrum disorder (ASD). In the recent years significant progress has been made owing to the early identification of risk factors for the development of drug-resistant epilepsy. Better understanding of the mechanism underlying epileptogenesis may improve the management for TSC-related epilepsy. Developmental neurobiology and neuropathology give opportunities for the implementation of concepts related to clinical findings, and an early genetic diagnosis and use of EEG and MRI biomarkers may improve the development of pre-symptomatic and disease-modifying strategies. • Three interventional RCTs have changed the therapeutic approach in patients with TSC. • Early identification of risk factors of (drug resistant) epilepsy is critical for an optimal management of TSC patients. • Pre-symptomatic treatment with vigabatrin is recommended as early as possible when epileptiform EEG activity is recorded. • Epilepsy surgery should be considered early in all TSC patients with drug resistant epilepsy. • Clinical, EEG, MRI and genetic predictors of drug resistant epilepsy guides treatment choices. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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