METHODS OF TREATMENT OF EPILEPSY IN CHILDREN WITH TUBEROUS SCLEROSIS. LITERATURE REVIEW.
Relevance: Tuberous sclerosis – a genetic disease with autosomal dominant inheritance pattern with the characteristic of damage of the nervous system, skin and existence of benign tumors (hamartomas) clinical picture. The most frequent manifestation of the disease is epilepsy debuting in the first month of life, which find in 96% of patients. Prevalence, severity of epilepsy associated with tuberous sclerosis, as well as resistance in ongoing therapy and a small number of articles on this issue implies studying of treatment in greater depth and defines the relevance of our literature review.
Aim: to carry out the literary review on treatment of epilepsy associated with tuberous sclerosis in children.
Search strategy:: scientific search was conducted in PubMed, Elibrary, Google Scholar databases. Search depth accounts for 12 years. Key words: tuberous sclerosis, epilepsy, treatment. Inclusion criteria: sources from 2007-2018, full-text publications, the age of a research participant is under 18 years old, having convulsive syndrome in the debut of tuberous sclerosis, the diagnosis of Tuberous sclerosis is consistent with international criteria and Clinical Protocols of the Republic of Kazakhstan. Exclusion criteria were: abstracts that do not have a full-text article, duplicate publications, articles on tuberous sclerosis, but do not reveal the treatment of epilepsy in this disease and, therefore, are not appropriate in subject, as well as experimental work on animals.
Due to the fact that tuberous sclerosis is a rare disease, 523 articles were found in the databases we used. However, only 10 sources on this topic met the inclusion criteria.
Results: the prospective and retrospective studies of the effective application of Vigabatrin (4-amino-5-hexenoic acid, France, Sanofi) for infantile spasms and focal epilepsy treatment were found during the literature search. The randomized, placebo-controlled researches of effective targeted therapy with Everolimus (Novartis Pharma, Switzerland) for epilepsy associated with subependymal giant cell astrocytomas in tuberous sclerosis were found. Surgical treatment of pharmacoresistant epilepsy in children with tuberous sclerosis presented in 4 studies.
Conclusion: according to the results of the conducted literature review, vigabatrin is more effective for treatment of infantile spasms and focal epilepsy in children with tuberous sclerosis and everolimus is more preferable for treatment of epilepsy associated with subependymal giant cell astrocytomas in tuberous sclerosis. For pharmacoresistant epilepsy surgical treatment is applied at this disease.
Shynar B. Akhmetkalyieva 1, https://orcid.org/0000-0003-1207-1415
Tatyana V. Kaimak 1, https://orcid.org/0000-0002-9948-9533
Talgat N. Кhaibullin 1, https://orcid.org/0000-0003-1886-0538
Zarina R. Bektemirova 2, https://orcid.org/0000-0002-2072-5733
1 Department of neurology and neurophysiology, Semey State Medical University;
2 Semey Ambulance Hospital; Semey, Republic of Kazakhstan.
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40. Riikonen R.S. Recent advances in the pharmacotherapy of infantile spasms. CNS Drugs, 28 (4), 279-290, 2014.
41. Roach E., Sparagana S. Diagnosis of tuberous sclerosis complex // Journal of Child Neurology. 2004; 19 (9): 643-649
42. Shehata H.S. et al. Clinical patterns and outcomes of status epilepticus in patients with tuberous sclerosis complex // Журнал. 2017. Т. 13. С. 779–785.
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29. Kingswood J.C. et al. TuberOus SClerosis registry to increase disease Awareness (TOSCA) - baseline data on 2093 patients. Orphanet J. Rare Dis. 2017. T. 12. № 1. pp. 2.
30. Kossoff E.H. et al. Tuberous Sclerosis Complex and the Ketogenic Diet. Epilepsia. 2006. T. 46. № 10. pp. 1684–1686.
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34. Liang S., Li A., Zhao M. et al. Epilepsy surgery in tuberous sclerosis complex: Emphasis on surgical candidate and neuropsychology. Epilepsia 2010;51:2316–21.
35. Ma T.S., Elliott R.E., Ruppe V. et al. Electrocorticographic evidence of perituberal cortex epileptogenicity in tuberous sclerosis complex. J Neurosurg Pediatr. 2012;10(5): 376–82.
36. Moshel Y.A. i dr. Do tubers contain function? Resection of epileptogenic foci in perirolandic cortex in children with tuberous sclerosis complex. Epilepsia. 2010. T. 51. № 7. S. 1242–1251.
37. Mordovtsev V.N., Mordovtseva V.V., Mordovtseva V.V. Genetic diseases and malformations of the skin: Atlas. Moscow: Nauka; 2004: 40–2.
38. Overwater I.E., Bindels-de Heus K., Rietman A.B. et al. Epilepsy in children with tuberous sclerosis complex: Chance of remission and response to antiepileptic drugs. Journal of Child Neurology. 2015; 10 (5):55-57.
39. Qin W., Chan J. A., Vinters H. V.et al. Analysis of TSC cortical tubers by deep sequencing of TSC1, TSC2 and KRAS demonstrates that small second-hit mutations in these genes are rare events. Brain Pathol. 2010. Vol. 20, N. 6. P. 1096–1105.
40. Riikonen R.S. Recent advances in the pharmacotherapy of infantile spasms. CNS Drugs, 2014. 28 (4), 279-290,
41. 41. Roach E., Sparagana S. Diagnosis of tuberous sclerosis complex. Journal of Child Neurology. 2004; 19 (9): 643-649.
42. Shehata H.S. et al. Clinical patterns and outcomes of status epilepticus in patients with tuberous sclerosis complex. Therapeutics and clinical Risk management, 2017. T. 13. pp. 779–785.
43. Staley B. A., Vail E. A., Thiele E. A. Tuberous Sclerosis Complex: Diagnostic Challenges, Presenting Symptoms, and Commonly Missed Signs. Pediatrics. 2011. Vol. 127. P. 117–125.
44. Van Eeghen A. M., Black M. E., Pulsifer M. B. et al. Genotype and cognitive phenotype of patients with tuberous sclerosis complex. Eur. J. Hum. Genet. 2012.Vol. 20 N. 5. P. 510–515.
45. Vazhbin L.B., Belova N.I., Lezvinskaya E.M., Stribuk P.V. Tuberous sclerosis. Rossiyskiy zhurnal kozhnykh i venericheskikh bolezney. 2013;1: 5–9. (in Russian).
46. Vignoli A., La Briola F., Turner K. et al. Epilepsy in TSC: certain etiology does not mean certain prognosis. Epilepsia. 2013; 54 (12): 2134-2142.
47. Weiner H.L. Tuberous Sclerosis and Multiple Tubers: Localizing the Epileptogenic Zone. Epilepsia. 2004. T. 45. № s4. S. 41–42.
48. Welin K.O. et al. Epilepsy in tuberous sclerosis patients in Sweden – Healthcare utilization, treatment, morbidity, and mortality using national register data. Seizure. 2017. T. 53. pp. 4–9.
49. Wong M., Crino P.B. Tuberous sclerosis and epilepsy: Role of astrocytes. Glia. 2012. T. 60. № 8. S. 1244–1250.
50. Wu J.Y., Salamon N., Kirsch H.E. et al. Noninvasive testing, early surgery and seizure freedom in tuberous sclerosis complex. Neurology. 2010;74(5):392–8.
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