Surgery for Drug-Resistant Epilepsy in Children

Shanterra Grable, Mercer University College of Pharmacy

Epilepsy affects 65 million people worldwide. Of those, 3.4 million are in the United States. One third of the people with epilepsy are thought to be resistant to available treatments and live with uncontrolled seizures. [1]

If seizures persist after two trials of the appropriate medication at the proper dose, they are considered to be “drug resistant”. [2] Surgery is an option if patients do not respond to medication therapy alone. These surgeries have been performed for over a century, and their use has seen a significant increase in the 1980s and 1990s. However, evidence suggests that success cannot be guaranteed; therefore, risk versus benefits of these procedures should be carefully weighed. [3]

It has been suggested that the earlier surgery is performed, the better patient outcomes are.  Despite the evidence, the Epilepsy Foundation recommends to consider surgery as a last resort. [3] Previously, a retrospective analysis of 142 children showed that 79.3% were free from seizures post surgery with an average follow up of four years. This study was performed as a follow up on to the aforementioned trial in order to compare outcomes of surgery to medical therapy alone. [4]

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Could Cannabidiol be Effective for Seizures?

Reem Gebrekidan, Mercer University College of Pharmacy

Dravet Syndrome is a genetic epileptic encephalopathy beginning in infancy that is characterized by febrile, prolonged, and lateralized seizures.[1] Epilepsy guidelines consider sodium valproate or topiramate as first-line treatment in children with Dravet syndrome while clobazam or stiripentol are supported as adjunctive therapy. Medications such as carbamazepine, gabapentin, lamotrigine, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin were advised to be avoided. [2]
The U.S. Food and Drug Administration (FDA) has approved two synthetic cannabinoids based on a substance present in marijuana and a substance acting similarly to another compound in marijuana. Attempting to use components of marijuana is considered to be in the public’s best interest; however, safe and effective use has not been determined. [3] Continue reading