Is epilepsy a progressive disorder? Prospects for new therapeutic approaches in temporal-lobe epilepsy
Pitkänen A, Sutula TP.
Lancet Neurol. 2002 Jul;1(3):173-81.
https://doi.org/10.1016/s1474-4422(02)00073-x.
By the end of our monthly theme: early use of vagus nerve stimulation (#VNS), we would like to highlight a review by Pitkänen et al. 2002 from Lancet Neurol. This review provided an overview of preclinical and clinical evidence that#seizures can lead to #progressive alterations of the neuronal circuits in the brain. The study further aimed to identify the associated risk factors for these progressive brain alterations.
Animal experiments and human evidence demonstrated that recurring seizures could cause progressive and cumulative cellular changes such as neuronal loss and sprouting.
Human evidence showed that recurring seizures could cause and maintain the neuronal circuits remodeling in the brain. Moreover, recurring generalized seizures and the long duration of #epilepsy are linked to a severe loss of neurons in different hippocampal subfields. Noteworthy, those damages are not apparent until 20-30 years after the onset of epilepsy. The type of damage was associated with the age of seizure onset and the seizure type.
Studies also showed seizures cause a mild but consistent mental decline in patients with tonic-clonic seizures.
The study pointed out three potential practical therapy goals:
1) changing from secondarily generalized seizures to partial seizures might reduce the risk of time-dependent damage.
2) decreasing the seizure duration could reduce molecular, cellular, and network associated alterations.
3) neuroprotectants (such as glutamate receptor blockers, calcium-channel blockers, neurotrophins, and gene therapy, etc.) could potentially counteract the cognitive decline of patients where antiepileptic therapy is not effective.
This publication highlights the importance of achieving seizure control as early as possible after epilepsy onset as continual exposure to seizures leads to progressive worsening of epilepsy with potential effects on #cognition and#behavior.
