Personalize the treatments and never lose heart the ‘rules’ of the experts; hopes for a new drug to arrive for treatment-resistant patients
“Don’t overdo the drugs, but don’t under-treat patients. And above all, do not lose heart, “said Ley Sander, director of the Department of Clinical and Experimental Epilepsy at University College London, summarized the recommendations for the treatment of resistant epilepsy during the last congress of the International League Against Epilepsy (ILAE), in Geneva (HERE THE FORUM)
The challenge of resistant epilepsy
Circa one third of patients with epilepsy have disease refractory to known drugs: in Italy the sick are about 500 thousand in total, so at least 150 thousand people do not find a solution with the treatments available. Focal epilepsy, which affects about 60 percent of patients, is the one with the greatest risk of becoming drug-resistant: seizures are no longer controlled by therapy and the quality of life drastically worsens also because, as Sander observes “For the ‘approval of drugs we believe a 50 percent reduction in seizures is adequate, but from the point of view of patients this is not enough, they need complete freedom from episodes. Resistant epilepsy is a challenge, but it must also be framed well and there are many cases of so-called pseudo-chronicity: for example, they depend on an incorrect diagnosis, which is estimated to affect up to 20 percent of cases of resistant epilepsy, or by a therapy for which the most appropriate drugs have not been chosen or, again, which is not followed well. Epilepsy is not like other diseases in which adherence that is not 100 percent can be tolerated, if you don’t take the medicine, the crises come back“. And they can be mistaken, in fact, for resistant epilepsy: a correct classification is therefore the first step, but then as Sander says “We must not give up, but always seek a solution and personalize the therapy as much as possible”.
New drugs
In this sense, the arrival in Italy of cenobamate, a new active ingredient that has been shown to have good efficacy even in cases of resistant epilepsy, is good news, according to the data discussed during the ILAE congress: three studies involving over 1900 patients led to approval thanks to a significant reduction in seizures even in the most complex patients. The drug “It has a unique mechanism of action because it is dual and complementary: on the one hand it modulates non-benzodiazepine GABA receptors, on the other hand it increases the inactivated state of voltage-gated sodium channels thus reducing excitatory neurotransmission through sodium dependent channels “, He says Oriano Mecarelli, Past President of LICE, the Italian League against Epilepsy. These pharmacological effects translate into the ability to prevent the onset and propagation of crises: the cenobamate was therefore also approved in Italy for the treatment of focal-onset seizures in adults with drug-resistant epilepsy and as concluded by Laura Tassi, president of LICE. , “Having a new drug available as a cenobamate means offering patients an additional treatment option that, through crisis control, significantly improves the quality of life, allowing them to keep symptoms under control and thus have a social activity adequate, which includes, for example, being able to drive a car “.
July 14, 2022 (change July 14, 2022 | 12:19)
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