Novel drugs and early polypharmacotherapy in status epilepticus.
Por:
Amengual-Gual M, Sánchez Fernández B and Wainwright MS
Publicada:
1 may 2019
Ahead of Print:
7 ago 2018
Resumen:
PURPOSE: Rescue medications for status epilepticus (SE) have a relatively high rate of failure. The purpose of this review is to summarize the evidence for the efficacy of novel drugs and early polypharmacotherapy for SE. METHOD: Literature review. RESULTS: New drugs and treatment strategies aim to target the pathophysiology of SE in order to improve seizure control and outcomes. Changes at the synapse level during SE include a progressive decrease in synaptic GABA(A) receptors and increase in synaptic NMDA receptors. These changes tend to promote self-sustaining seizures. Current SE guidelines recommend a rapid stepwise treatment using benzodiazepines in monotherapy as the first-line treatment, targeting GABA(A) synaptic receptors. Novel treatment approaches target GABA(A) synaptic and extrasynaptic receptors with allopregnanolone, and NMDA receptors with ketamine. Novel rescue treatments used for SE include topiramate, brivaracetam, and perampanel, which are already marketed in epilepsy. Some available drugs not marketed for use in epilepsy have been used in the treatment of SE, and other agents are being studied for this purpose. Early polytherapy, most frequently combining a benzodiazepine with a second-line drug or an NMDA receptor antagonist, might potentially increase seizure control with relatively minor increase in side effects. Although many preclinical studies support novel drugs and early polytherapy in SE, human studies are scarce and inconclusive. Currently, evidence is lacking to recommend specific combinations of these new agents. CONCLUSIONS: Novel drugs and strategies target the underlying pathophysiology of SE with the intent to improve seizure control and outcomes.
Filiaciones:
Amengual-Gual M:
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
Pediatric Neurology Unit, Department of Pediatrics, Hospital Universitari Son Espases, Universitat de les Illes Balears, Palma, Spain
Sánchez Fernández B:
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Spain
Wainwright MS:
Department of Neurology, Division of Pediatric Neurology. University of Washington School of Medicine, Seattle, WA, USA
Open Access
|