临床儿科杂志 ›› 2022, Vol. 40 ›› Issue (4): 311-315.doi: 10.12372/jcp.2022.21e1280
田启龙(综述), 王举磊(审校)
收稿日期:
2021-09-06
出版日期:
2022-04-15
发布日期:
2022-04-07
Reviewer: TIAN Qilong, Reviser: WANG Julei
Received:
2021-09-06
Published:
2022-04-15
Online:
2022-04-07
摘要:
结节硬化症(TSC)患者癫痫发生率非常高,多始于婴儿期。mTOR信号通路的过度活化及局灶性皮质发育不良是TSC相关性癫痫重要的发生机制。癫痫样异常脑电活动能够有效预测后续癫痫的发生。脑电图是记录癫痫样异常脑电活动的主要手段。预防性应用氨己烯酸能够有效抑制TSC相关性癫痫发作,保护神经功能。抗癫痫药物、mTOR抑制剂、癫痫手术、生酮饮食、迷走神经刺激术是目前TSC相关性癫痫常用的治疗方案。文章围绕TSC相关性癫痫治疗的最新研究进展作一综述。
田启龙(综述), 王举磊(审校). 结节硬化症相关性癫痫治疗进展[J]. 临床儿科杂志, 2022, 40(4): 311-315.
Reviewer: TIAN Qilong, Reviser: WANG Julei. Research progress in the treatment of epilepsy associated with tuberous sclerosis complex[J]. Journal of Clinical Pediatrics, 2022, 40(4): 311-315.
[1] |
Nabbout R, Belousova E, Benedik MP, et al. Epilepsy in tuberous sclerosis complex: findings from the TOSCA Study[J]. Epilepsia Open, 2019, 4(1):73-84.
doi: 10.1002/epi4.12286 pmid: 30868117 |
[2] |
Northrup H, Aronow ME, Bebin EM, et al. Updated international tuberous sclerosis complex diagnostic criteria and surveillance and management recommendations[J]. Pediatr Neurol, 2021, 123:50-66.
doi: 10.1016/j.pediatrneurol.2021.07.011 pmid: 34399110 |
[3] |
Switon K, Kotulska K, Janusz-Kaminska A, et al. Molecular neurobiology of mTOR[J]. Neuroscience, 2017, 341:112-153.
doi: 10.1016/j.neuroscience.2016.11.017 |
[4] |
Peron A, Au KS, Northrup H. Genetics, genomics, and genotype-phenotype correlations of TSC: insights for clinical practice[J]. Am J Med Genet C Semin Med Genet, 2018, 178(3):281-290.
doi: 10.1002/ajmg.c.v178.3 |
[5] |
Ogorek B, Hamieh L, Hulshof HM, et al. TSC2 pathogenic variants are predictive of severe clinical manifestations in TSC infants: results of the EPISTOP study[J]. Genet Med, 2020, 22(9):1489-1497.
doi: 10.1038/s41436-020-0823-4 |
[6] | Barkovich A J, Dobyns WB, Guerrini R. Malformations of cortical development and epilepsy[J]. Cold Spring Harb Perspect Med, 2015, 5(5):a22392. |
[7] |
Blumcke I, Spreafico R, Haaker G, et al. Histopathological findings in brain tissue obtained during epilepsy surgery[J]. N Engl J Med, 2017, 377(17):1648-1656.
doi: 10.1056/NEJMoa1703784 |
[8] | Blumcke I, Cendes F, Miyata H, et al. Toward a refined genotype-phenotype classification scheme for the international consensus classification of focal cortical dysplasia[J]. Brain Pathol, 2021, 31(4):e12956. |
[9] |
Lim J S, Gopalappa R, Kim SH, et al. Somatic mutations in TSC1 and TSC2 cause focal cortical dysplasia[J]. Am J Hum Genet, 2017, 100(3):454-472.
doi: 10.1016/j.ajhg.2017.01.030 |
[10] |
Muhlebner A, Bongaarts A, Sarnat HB, et al. New insights into a spectrum of developmental malformations related to mTOR dysregulations: challenges and perspectives[J]. J Anat, 2019, 235(3):521-542.
doi: 10.1111/joa.12956 |
[11] |
Ruppe V, Dilsiz P, Reiss CS, et al. Developmental brain abnormalities in tuberous sclerosis complex: a comparative tissue analysis of cortical tubers and perituberal cortex[J]. Epilepsia, 2014, 55(4):539-550.
doi: 10.1111/epi.12545 |
[12] | Hui K K, Takashima N, Watanabe A, et al. GABARAPs dysfunction by autophagy deficiency in adolescent brain impairs GABAA receptor trafficking and social behavior[J]. Sci Adv, 2019, 5(4):u8237. |
[13] |
Abs E, Goorden S M, Schreiber J, et al. TORC1-dependent epilepsy caused by acute biallelic Tsc1 deletion in adult mice[J]. Ann Neurol, 2013, 74(4):569-579.
doi: 10.1002/ana.v74.4 |
[14] |
Jozwiak S, Slowinska M, Borkowska J, et al. Preventive antiepileptic treatment in tuberous sclerosis complex: a long-term, prospective trial[J]. Pediatr Neurol, 2019, 101:18-25.
doi: 10.1016/j.pediatrneurol.2019.07.008 |
[15] |
Wu JY, Peters JM, Goyal M, et al. Clinical Electro encephalographic biomarker for impending epilepsy in asymptomatic tuberous sclerosis complex infants[J]. Pediatric Neurology, 2016, 54:29-34.
doi: 10.1016/j.pediatrneurol.2015.09.013 |
[16] |
De Ridder J, Lavanga M, Verhelle B, et al. Prediction of neurodevelopment in infants with tuberous sclerosis complex using early EEG characteristics[J]. Front Neurol, 2020, 11:582891.
doi: 10.3389/fneur.2020.582891 |
[17] |
Kotulska K, Kwiatkowski DJ, Curatolo P, et al. Prevention of epilepsy in infants with tuberous sclerosis complex in the EPISTOP trial[J]. Ann Neurol, 2021, 89(2):304-314.
doi: 10.1002/ana.v89.2 |
[18] |
Slowinska M, Kotulska K, Szymanska S, et al. Approach to preventive epilepsy treatment in tuberous sclerosis complex and current clinical practice in 23 countries[J]. Pediatr Neurol, 2021, 115:21-27.
doi: 10.1016/j.pediatrneurol.2020.11.003 |
[19] |
Hussain SA, Schmid E, Peters JM, et al. High vigabatrin dosage is associated with lower risk of infantile spasms relapse among children with tuberous sclerosis complex[J]. Epilepsy Res, 2018, 148:1-7.
doi: S0920-1211(18)30351-6 pmid: 30296632 |
[20] |
Overwater IE, Bindels-De H K, Rietman AB, et al. Epilepsy in children with tuberous sclerosis complex: chance of remission and response to antiepileptic drugs[J]. Epilepsia, 2015, 56(8):1239-1245.
doi: 10.1111/epi.13050 pmid: 26046563 |
[21] |
Riikonen R, Rener-Primec Z, Carmant L, et al. Does vigabatrin treatment for infantile spasms cause visual field defects? An international multicentre study[J]. Dev Med Child Neurol, 2015, 57(1):60-67.
doi: 10.1111/dmcn.12573 pmid: 25145415 |
[22] |
Thiele EA, Bebin EM, Bhathal H, et al. Add-on Cannabidiol treatment for drug-resistant seizures in tuberous sclerosis complex: a placebo-controlled randomized clinical trial[J]. JAMA Neurol, 2021, 78(3):285-292.
doi: 10.1001/jamaneurol.2020.4607 |
[23] |
Hess EJ, Moody KA, Geffrey AL, et al. Cannabidiol as a new treatment for drug-resistant epilepsy in tuberous sclerosis complex[J]. Epilepsia, 2016, 57(10):1617-1624.
doi: 10.1111/epi.13499 |
[24] |
Ebrahimi-Fakhari D, Agricola KD, Tudor C, et al. Cannabidiol elevates mechanistic target of rapamycin inhibitor levels in patients with tuberous sclerosis complex[J]. Pediatr Neurol, 2020, 105:59-61.
doi: S0887-8994(19)30955-5 pmid: 31924480 |
[25] |
Russo E, Citraro R, Mula M. The preclinical discovery and development of brivaracetam for the treatment of focal epilepsy[J]. Expert Opin Drug Discov, 2017, 12(11):1169-1178.
doi: 10.1080/17460441.2017.1366985 |
[26] |
Willems LM, Bertsche A, Bosebeck F, et al. Efficacy, retention, and tolerability of brivaracetam in patients with epileptic encephalopathies: a multicenter cohort study from germany[J]. Front Neurol, 2018, 9:569.
doi: 10.3389/fneur.2018.00569 |
[27] |
Villanueva V, Lopez-Gonzalez FJ, Mauri JA, et al. BRIVA-LIFE-A multicenter retrospective study of the long-term use of brivaracetam in clinical practice[J]. Acta Neurol Scand, 2019, 139(4):360-368.
doi: 10.1111/ane.13059 pmid: 30506559 |
[28] |
French JA, Lawson JA, Yapici Z, et al. Adjunctive evero limus therapy for treatment-resistant focal-onset seizures associated with tuberous sclerosis (EXIST-3): a phase 3, randomised, double-blind, placebo-controlled study[J]. Lancet, 2016, 388(10056):2153-2163.
doi: 10.1016/S0140-6736(16)31419-2 |
[29] |
Franz DN, Lawson J A, Yapici Z, et al. Everolimus dosing recommendations for tuberous sclerosis complex-associated refractory seizures[J]. Epilepsia, 2018, 59(6):1188-1197.
doi: 10.1111/epi.2018.59.issue-6 |
[30] |
Curatolo P, Franz DN, Lawson JA, et al. Adjunctive everolimus for children and adolescents with treatment-refractory seizures associated with tuberous sclerosis complex: post-hoc analysis of the phase 3 EXIST-3 trial[J]. Lancet Child Adolesc Health, 2018, 2(7):495-504.
doi: S2352-4642(18)30099-3 pmid: 30169322 |
[31] |
Combes FP, Baneyx G, Coello N, et al. Population phar macokinetics-pharmacodynamics of oral everolimus in patients with seizures associated with tuberous sclerosis complex[J]. J Pharmacokinet Pharmacodyn, 2018, 45(5):707-719.
doi: 10.1007/s10928-018-9600-2 |
[32] |
Bialer M, Johannessen SI, Levy RH, et al. Progress report on new antiepileptic drugs: a summary of the Thirteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XIII)[J]. Epilepsia, 2017, 58(2):181-221.
doi: 10.1111/epi.13634 pmid: 28111749 |
[33] |
Krueger DA, Wilfong AA, Mays M, et al. Long-term treatment of epilepsy with everolimus in tuberous sclerosis[J]. Neurology, 2016, 87(23):2408-2415.
pmid: 27815402 |
[34] |
Mingarelli A, Vignoli A, La Briola F, et al. Dramatic relapse of seizures after everolimus withdrawal[J]. Eur J Paediatr Neurol, 2018, 22(1):203-206.
doi: 10.1016/j.ejpn.2017.07.018 |
[35] |
Liu S, Yu T, Guan Y, et al. Resective epilepsy surgery in tuberous sclerosis complex: a nationwide multicentre retrospective study from China[J]. Brain, 2020, 143(2):570-581.
doi: 10.1093/brain/awz411 |
[36] |
Fohlen M, Taussig D, Ferrand-Sorbets S, et al. Refractory epilepsy in preschool children with tuberous sclerosis complex: Early surgical treatment and outcome[J]. Seizure, 2018, 60:71-79.
doi: 10.1016/j.seizure.2018.06.005 |
[37] |
Rosenow F, Bast T, Czech T, et al. Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment[J]. Epilepsia, 2016, 57(8):1215-1220.
doi: 10.1111/epi.13449 pmid: 27354263 |
[38] |
Stellon MA, Cobourn K, Whitehead MT, et al. "Laser and the Tuber": thermal dynamic and volumetric factors influencing seizure outcomes in pediatric subjects with tuberous sclerosis undergoing stereoencephalography-directed laser ablation of tubers[J]. Childs Nerv Syst, 2019, 35(8):1333-1340.
doi: 10.1007/s00381-019-04255-4 |
[39] |
Hooten KG, Werner K, Mikati MA, et al. MRI-guided laser interstitial thermal therapy in an infant with tuberous sclerosis: technical case report[J]. J Neurosurg Pediatr, 2018, 23(1):92-97.
doi: 10.3171/2018.6.PEDS1828 |
[40] |
Kossoff EH, Zupec-Kania BA, Auvin S, et al. Optimal clinical management of children receiving dietary therapies for epilepsy: updated recommendations of the International Ketogenic Diet Study Group[J]. Epilepsia Open, 2018, 3(2):175-192.
doi: 10.1002/epi4.12225 pmid: 29881797 |
[41] |
Youn S E, Park S, Kim SH, et al. Long-term outcomes of ketogenic diet in patients with tuberous sclerosis complex-derived epilepsy[J]. Epilepsy Res, 2020, 164:106348.
doi: 10.1016/j.eplepsyres.2020.106348 |
[42] |
van der Louw E, van den Hurk D, Neal E, et al. Ketogenic diet guidelines for infants with refractory epilepsy[J]. Eur J Paediatr Neurol, 2016, 20(6):798-809.
doi: 10.1016/j.ejpn.2016.07.009 |
[43] |
Dressler A, Hafele C, Giordano V, et al. The ketogenic diet including breast milk for treatment of infants with severe childhood epilepsy: feasibility, safety, and effectiveness[J]. Breastfeed Med, 2020, 15(2):72-78.
doi: 10.1089/bfm.2019.0190 |
[44] |
Warren EC, Dooves S, Lugara E, et al. Decanoic acid inhibits mTORC1 activity independent of glucose and insulin signaling[J]. Proc Natl Acad Sci U S A, 2020, 117(38):23617-23625.
doi: 10.1073/pnas.2008980117 |
[45] |
Dressler A, Benninger F, Trimmel-Schwahofer P, et al. Efficacy and tolerability of the ketogenic diet versus high-dose adrenocorticotropic hormone for infantile spasms: a single-center parallel-cohort randomized controlled trial[J]. Epilepsia, 2019, 60(3):441-451.
doi: 10.1111/epi.2019.60.issue-3 |
[46] |
Orosz I, Mccormick D, Zamponi N, et al. Vagus nerve stimulation for drug-resistant epilepsy: a European long-term study up to 24 months in 347 children[J]. Epilepsia, 2014, 55(10):1576-1584.
doi: 10.1111/epi.12762 pmid: 25231724 |
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