PubMed · 2392246
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1990. Pseudoseizures.. https://doi.org/10.1212/wnl.40.9.1478
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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.
Many people with epilepsy experience the need for more information concerning their condition and some people require, at times, greater access to rehabilitation services than has previously been available. Information and support may also be required by the family, friends and work colleagues of the patient. Research indicates that rehabilitation needs, for the patient, can arise in relation to poor self-esteem, overprotection as a child, low expectations, reduced cognitive abilities and stigma perceived or experienced in the family, in society, and at work. Successful rehabilitation is individualistic and should therefore be based on an assessment of the individual's needs. Only on the basis of this can realistic goals be identified. In the cases where intensive multidisciplinary rehabilitation is required a thorough medical assessment will also be needed in order to formulate realistic goals. Achievement of these goals may involve input from psychological, neuropsychological, pedagogical, social, employment and family orientated perspectives. Specialists in these areas must be included within, or co-ordinated by, the epilepsy team or rehabilitation service. In Sweden hospital based epilepsy-teams have added psycho-social rehabilitation aspects in their responsibilities and other rehabilitation services have recently begun to focus on the needs of people with epilepsy. This has led to a range of different rehabilitation models being available. The need to develop improved epilepsy rehabilitation services was identified in the 1970s and has recently received short-term funding support to develop new services and build up expertise. It is hoped that in the future these services will continue to find support at both the county and national levels.
Samuel-Auguste Tissot (1728-1797), general practitioner in the Swiss city of Lausanne, was one of the great physicians of the eighteenth century (the Age of Enlightenment), one of the founders of rational medicine and a firm foe of quackery. He was renowned for his popular book "Avis au peuple sur sa santé" (published in 1761), which furthered the understanding of sanitary principles, dietetics and prevention among ordinary people and gave advice on self-treatment for inhabitants of remote areas. His most significant scientific book was the "Traité de l'épilepsie", published in 1770. There, Tissot describes the symptomatology of nearly every form of epileptic seizures and expresses his views on the pathogenesis, course and prognosis of epilepsy. The book remains one of the cornerstones of modern epileptology.