Mechanisms of epileptogenesis and potential treatment targets

A Pitkänen, K Lukasiuk - The Lancet Neurology, 2011 - thelancet.com
A Pitkänen, K Lukasiuk
The Lancet Neurology, 2011thelancet.com
Prevention of epileptogenesis after brain trauma is an unmet medical challenge. Recent
molecular profiling studies have provided an insight into molecular changes that contribute
to formation of ictogenic neuronal networks, including genes regulating synaptic or neuronal
plasticity, cell death, proliferation, and inflammatory or immune responses. These
mechanisms have been targeted to prevent epileptogenesis in animal models. Favourable
effects have been obtained using immunosuppressants, antibodies blocking adhesion of …
Summary
Prevention of epileptogenesis after brain trauma is an unmet medical challenge. Recent molecular profiling studies have provided an insight into molecular changes that contribute to formation of ictogenic neuronal networks, including genes regulating synaptic or neuronal plasticity, cell death, proliferation, and inflammatory or immune responses. These mechanisms have been targeted to prevent epileptogenesis in animal models. Favourable effects have been obtained using immunosuppressants, antibodies blocking adhesion of leucocytes to endothelial cells, gene therapy driving expression of neurotrophic factors, pharmacological neurostimulation, or even with conventional antiepileptic drugs by administering them before the appearance of genetic epilepsy. Further studies are needed to clarify the optimum time window and aetiological specificity of treatments. Questions related to adverse events also need further consideration. Encouragingly, the recent experimental studies emphasise that the complicated process of epileptogenesis can be favourably modified, and that antiepileptogenesis as a treatment indication might not be an impossible mission.
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