PubMed · 5827090
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L Van Der Horst. 1964. [Mental epilepsy].. https://pubmed.ncbi.nlm.nih.gov/5827090/
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BACKGROUND: Everolimus, a mechanistic target of rapamycin (mTOR) inhibitor, is increasingly used in tuberous sclerosis complex (TSC)-associated epilepsy; however, long-term real-world outcomes and factors associated with favorable response remain unclear. This study aimed to evaluate the long-term seizure outcomes of adjunctive everolimus and explore clinical factors associated with treatment response. METHODS: We retrospectively recruited 21 patients with active TSC-associated epilepsy receiving adjunctive everolimus and assessed seizure outcomes during follow-up. Clinical characteristics were compared between responders and non-responders at 1 year after treatment initiation. RESULTS: Over a median treatment duration of 72 months, responder rates ranged from 53.8% to 64.7%, and seizure-free rates ranged from 33.3% to 41.2%. Responders had fewer involved organ systems at baseline (median 3 vs. 4, p = 0.020) and lower anti-seizure medication burden (median 2 vs. 4, p = 0.045). Younger age at treatment initiation showed a trend toward improved response. CONCLUSION: Adjunctive everolimus was associated with sustained long-term seizure reduction in this real-world cohort. In exploratory analyses, fewer involved organ systems and fewer baseline ASMs were associated with favorable treatment response. These findings require validation in larger prospective cohorts.
Epilepsy is the most common serious chronic neurological condition. All patients with epilepsy regardless of location should receive the highest quality of services that can be provided. In order to do this current service provision has to be reviewed and bench marked against ideal standards of service provision that cover a comprehensive range of services to meet all patient needs. By critically reviewing the relevant literature, criteria were developed for an ideal epilepsy service. The literature review generated evidence-based ideal standards for the following service areas: - The role of primary care and the interface with secondary care in the management of epilepsy; - The role of Accident and Emergency (A and E) departments in the care of epilepsy; - Epilepsy clinics; - Specialist epilepsy nurses for treating epilepsy; - The role of the general practitioner (GP) specialist; - Services for adult epileptics with learning disabilities; - Services for complex epilepsy; and - User views. Although many of the recommendations are based on evidence of a lower grade, the direction of the existing evidence obtained from several sources, suggested similar standards for an epilepsy service. The effectiveness and value of epilepsy services, particularly in relation to the changes recommended above, must be further researched.