Epilepsy is one of the most common neurological chronic disorders characterized by unpredictable recurrent seizures, which leads to brain dysfunction, cognitive, psychological, and social disorders. Various treatment options for epilepsy are: antiepileptic drugs, surgery, neuromodulation, gene therapy and ketogenic diet. However, definitions, diagnosis and treatment of epilepsy are still challenging issues for clinicians and researchers.
Antiepileptic drugs play a central and crucial role in the treatment of epilepsy patients. Brivaracetam Cannabidiol (CBD), Cenobamate, Everolimus and Fenfluramine are the five novel anticonvulsant drugs during the last 5 years. Brivaracetam anticonvulsant effects are due to its highly selective affinity for synaptic vesicle protein 2A (SV2A) in the brain. It is act as an SV2A ligand. Among these drugs Cannabidiol is one of the prominent phytocannabinoids derived from the cannabis sativa. The anticonvulsant mechanisms of action of CBD including antagonism of G protein-coupled receptor 55 (GPR55), desensitization of transient receptor potential vanilloid type 1 (TRPV1) channels, and potentiation of adenosine-mediated signaling through inhibition of the equilibrative nucleoside transporter 1 (ENT-1) and enhancement of GABAergic transmission. The mechanisms of the antiseizure effect of Cenobamate are: increasing the inactivated state of voltage-gated sodium channels, and acting as a positive allosteric modulator of the GABA-A receptors by binding at a non-benzodiazepine site. Everolimus is a mammalian target of rapamycin (mTOR) inhibitor. Fenfluramine is able to enhance extracellular serotonin levels, modulate serotonergic and other neurologic receptors. Nevertheless, the exact mechanism of action of most of these drugs is unknown.
At least 30% of people with epilepsy have drug-resistant epilepsy (DRE), therefore, non-pharmacological treatments have been considered. the Vagus Nerve Stimulation (VNS), Trigeminal Nerve Stimulation (TNS), Transcranial Direct Current Stimulation (tDCS), Transcranial Magnetic Stimulation (TMS) are the most common neuromodulation-based approaches.
Also, in recent years, a new field of GABA-, adenosine-, galanin-, and neuropeptide Y- based cell and gene therapies for refractory epilepsy has emerged.
In spite of these advances, significant gaps in knowledge still remain. In particular, the mechanisms underlying epilepsy, including status epilepticus, drug and surgical treatments are still not well elucidated. Novel insights on pathophysiological mechanisms of epilepsy and new treatment options prompted us to collect the most recent publications on pharmacological and non-pharmacological treatments of epilepsy.
So, in this Research Topic, we will focus on the advances in the field of treatment in epilepsy, the pathophysiology and molecular aspects of seizure attacks and novel antiseizure medications.
Epilepsy is one of the most common neurological chronic disorders characterized by unpredictable recurrent seizures, which leads to brain dysfunction, cognitive, psychological, and social disorders. Various treatment options for epilepsy are: antiepileptic drugs, surgery, neuromodulation, gene therapy and ketogenic diet. However, definitions, diagnosis and treatment of epilepsy are still challenging issues for clinicians and researchers.
Antiepileptic drugs play a central and crucial role in the treatment of epilepsy patients. Brivaracetam Cannabidiol (CBD), Cenobamate, Everolimus and Fenfluramine are the five novel anticonvulsant drugs during the last 5 years. Brivaracetam anticonvulsant effects are due to its highly selective affinity for synaptic vesicle protein 2A (SV2A) in the brain. It is act as an SV2A ligand. Among these drugs Cannabidiol is one of the prominent phytocannabinoids derived from the cannabis sativa. The anticonvulsant mechanisms of action of CBD including antagonism of G protein-coupled receptor 55 (GPR55), desensitization of transient receptor potential vanilloid type 1 (TRPV1) channels, and potentiation of adenosine-mediated signaling through inhibition of the equilibrative nucleoside transporter 1 (ENT-1) and enhancement of GABAergic transmission. The mechanisms of the antiseizure effect of Cenobamate are: increasing the inactivated state of voltage-gated sodium channels, and acting as a positive allosteric modulator of the GABA-A receptors by binding at a non-benzodiazepine site. Everolimus is a mammalian target of rapamycin (mTOR) inhibitor. Fenfluramine is able to enhance extracellular serotonin levels, modulate serotonergic and other neurologic receptors. Nevertheless, the exact mechanism of action of most of these drugs is unknown.
At least 30% of people with epilepsy have drug-resistant epilepsy (DRE), therefore, non-pharmacological treatments have been considered. the Vagus Nerve Stimulation (VNS), Trigeminal Nerve Stimulation (TNS), Transcranial Direct Current Stimulation (tDCS), Transcranial Magnetic Stimulation (TMS) are the most common neuromodulation-based approaches.
Also, in recent years, a new field of GABA-, adenosine-, galanin-, and neuropeptide Y- based cell and gene therapies for refractory epilepsy has emerged.
In spite of these advances, significant gaps in knowledge still remain. In particular, the mechanisms underlying epilepsy, including status epilepticus, drug and surgical treatments are still not well elucidated. Novel insights on pathophysiological mechanisms of epilepsy and new treatment options prompted us to collect the most recent publications on pharmacological and non-pharmacological treatments of epilepsy.
So, in this Research Topic, we will focus on the advances in the field of treatment in epilepsy, the pathophysiology and molecular aspects of seizure attacks and novel antiseizure medications.
