IEC 2021 | Antiseizure medication in a challenging case of refractory epilepsy with PVNH
Simona Balestrini, MD, PhD, University College London, London, UK, describes the use of antiepileptic treatment in challenging cases where there are issues with pharmacoresistance. In particular, she discusses the case of a young woman who did not tolerate a number of antiepileptic drugs, and whose only surgical option is radiofrequency-guided thermocoagulation due the presence of bilateral periventricular nodular heterotopia (PVNH). This treatment was unavailable at the time it was considered. The patient is also planning a pregnancy, and concerns about teratogenicity must be balanced with the risk of a convulsive seizure during pregnancy. Dr Balestrini says that she would like to discuss this case with the IEC 2021 audience, opening the discussion for other potential treatment suggestions. She highlights the importance of this sort of collaboration between experts. This interview took place during the 34th International Epilepsy Congress, 2021.
Transcript (edited for clarity)
I will be discussing this very challenging case. So, a physician will be addressing the issue of epilepsy treatment and we will be discussing various cases where there are issues in regards with treatment. In particular, this case is about a young woman who has pregnancy plans and who did not tolerate a number of antiseizure medication that we tried. She has a [inaudible ] abnormality in the brain and therefore we also considered surgical treatment, but unfortunately in her case, surgical treatment is not straightforward because she had a bilateral cortical malformation and there is only eventually a specific treatment which is called radiofrequency-guided thermocoagulation, which requires an intracranial EEG recording...
I will be discussing this very challenging case. So, a physician will be addressing the issue of epilepsy treatment and we will be discussing various cases where there are issues in regards with treatment. In particular, this case is about a young woman who has pregnancy plans and who did not tolerate a number of antiseizure medication that we tried. She has a [inaudible ] abnormality in the brain and therefore we also considered surgical treatment, but unfortunately in her case, surgical treatment is not straightforward because she had a bilateral cortical malformation and there is only eventually a specific treatment which is called radiofrequency-guided thermocoagulation, which requires an intracranial EEG recording. But of course, this carries a risk because it’s an invasive procedure and at the time when we considered this treatment to her, this treatment was not available in our center. So, for a series of reasons we could not consider this option. We tried a number of pharmacological options but she developed a skin rash of which most cases we consider it as an allergic reaction so we had to discontinue the drug. So, at the moment, she remains on monotherapy with the only drug that she could really tolerate but it is not effective to control her seizures. And she’s also now planning a pregnancy and of course, she was also worried about the risk of teratogenicity, but on the other hand, we also need to balance with the risk of too much seizure during pregnancy, which could be harmful for the patient and their baby.
So, that’s just a summary of what the challenges that this case presented to us and of course we would like to discuss this with the audience to see whether there might be any other suggestion or advice to treat this patient. I believe this is very important because of course, there are different experiences that can be shared. Further investigation to conduct perhaps could be suggested and perhaps colleagues from everywhere in the world may have had similar cases. So, I think definitely for such cases that prove very challenging, a good discussion and additional expertise can be very helpful.
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