HHE Neurology supplement 2018 - Page 12

Future perspectives Despite all the recent progress and the introduction of new anti-epileptic drugs, the management of TSC-related epilepsy still represents a real challenge for clinicians, with about two-thirds of patients presenting refractory seizures. 3 Neuropsychiatric comorbidity also represents a significant burden; therefore timing of treatment is crucial. Also considering that TSC can be increasingly diagnosed before or soon after birth, before any neurological symptoms appear, a preventive anti-epileptic treatment before the onset of seizures has been proposed. This was aimed to try to minimise the impact of early onset seizures; 26 however, actual evidence is still insufficient to recommend this treatment approach. Two trials are undergoing to try to solve this issue: EPISTOP (Long-term, prospective study evaluating clinical and molecular biomarkers of EPIleptogenesiS in a genetic model of epilepsy – Tuberous sclerOsis complex); and PREVeNT (Preventing Epilepsy Using Vigabatrin In Infants With Tuberous Sclerosis Complex). The EPISTOP trial – a lon ѕɴɽѥٔɅ͕Ʌ)ɽɥͭѥаɔɽ٥Ȱ)ٕѥѽȤձѥɔɽՑ)Ʌѽ̰ͥ䁅)ɽٕЁ́ݥѠQM L)́ɥ䁽ѥٔѡѥѥ)ѡձȁɭ́)ѽͥ́ѥ́ݥѠQM Q)͕䁽ѥٔ́Ѽɔѡ)Ʌѥхɐѥѥ)ɕѵЁѕȁɕ͕хѥݥѠ͕ɕ)ٕ́ɕٕѥٔɕѵЁѕȁɕɑ)ѥɴ͍ɝ́ݥѡЁ͕ɕ̸)QAIY9Pɥ́Ʌ͕ɥ(ѥаɔɽ٥ȰٕѥѽȤ)ɽՑ䁽́ݥѠQM )٥ѡٕхЁɱٕ)啐ɕѵЁݥѠ٥ɥ́ɥ)э)!ձѡɕձ́ѡ͔Ց́ݥ)ɽ٥ͽɅѥѥ́Ѽ՝Ёѡ)ѥѼѥєɕѵЁѼՅɅѕ)ѥɕѵЁɽȁ́ݥѠ)ɔѽѥͥ́QM )ٕɽ́͡ݕɕՍѥ͕ɔ)ɕՕ䃊&)ѡɵɔɕЁͥɔ)Ց䁕ɽԁѥ́չȁѡ)啅́չɕȁɅєȼԤ)ݥѠѥܼ̀Ȥ͕ɔɕ́Aͥѥٔ)ɕձ́ٔͼхɅ͕)ɽɥمՅѥ䁽ٕɽ)́ɕݥѠԔѡ͡ݥ&)ɕՍѥ͕ɔɕՕ一)A͔%%$Չɽ)Ց䀡ᅵٕɽ́MՑ䁽)QՉɽ́Mɽͥ́ a%MP̤ɕ)ѡ䁅ͅ䁽ݼͥɕ)ٕɽٕ́́ѥ)ݥѠQM ɕɅѽ䁙一ԁQ)Ց䁥Ցѥݕ͕) ͕ѡͥѥٔɕձ́ѡ)ɥѡɽ ͥ)ɽٕٕɽ́́)չѥٔɕѵЁȁѥ)ݥѠɕɅѽѥ͕)͕ɕ́ͽѕݥѠQM )ٕȁѡݼ啅)͔ݕ䁅ݕɔ͔)ݕѕ͔ͥɥѡɔ͔)ݥѠ؁ѥ́ɽɕѕȁɕՍѥ)͕ɔɕՕ݅́хݥѠѡݼ)хɝѕɔɅٕ́ɽ̀ϊLݹ)LչɥͽݥѠQ)ɕ͔Ʌє͕́ɔɕՕ)ɕՍѥ&݅̀ԸĔѡɽ(Ȕѡܵɔٕɽ́ɽ(ѡɔٕɽ́ɽ)ٕɽ̵ɕѕٕ͔ٕ́ݕɔեє)Ё͕ѡͥѥٔɕձ́ѡ)ɥѡɽ ͥɽٕ)ٕɽ́́չѥٔɕѵЁ)ѥ́ݥѠɕɅѽѥ͕Ё͕ɕ)ͽѕݥѠQM ٕȁѡݼ啅̸)Iɕ(ā Ʌѽ@ ɑɤH))ݥLQՉɽ͍́ɽ̸ͥ)1ЀȠߊL(ȁ Ʌѽ@5ٕɼH)Yɥ́A(9ɽ)ɽ卡ɥ́)Չɽ͍́ɽͥ́)1Ё9ɽРܤ(ϊLԸ(́ ԵMɔ (ЁQɅ)ѽ䁽䁥Չɽ)͍ɽͥ́กͥ(ĠܤۊLĸ(ЁAɅݼLЁхɅ)ͥ́Չɽ͍́ɽͥ)Q=I āѥمѥ)ѥ ɅAѡ(̠Ĥ׊L(ԁ ɥA5ձ)ѡͥ́Չȁɵѥ)Չɽ͍́ɽͥ́)( 9ɽۊLԸ(؁ Ʌѽ@5ѥхɝ)Ʌ卥Q=HՉɽ)͍ɽͥ́൅ͽѕ)丁Aȁ9ɽ(Ƞ̤NJL(܁ Ʌѽ@ЁQ=H)ɕձѥՉɽ)͍ɽ̵ͥɕѕ)ЁI؁9ɽѡȀ(̤׊Lĸ(]Ёͥѕͽ)ѥ́́)ɵɥݡєѕ)ݥѡѡѽ齹)Չɽ͍́ɽͥ́)Ì(ȴ̤ۊL̸(5ٕɼHЁ]єѕ)ѥ́ͽѕݥѠ)ͥѕЁ͕ɕ́Չɽ)͍ɽͥ́ก) ؀ϊLܸ( ɽ ЁI镐)ɥɥ٥ɥ)ɽѥͽѥ)͵́ՔѼՉɽ)͍ɽ̸ͥI(ؠȤLԸ(ā ɑɤHЁɱ)ɽ͕ɕ́ɽٕ)ѕɴэɕ)ݥѠՉɽ͍́ɽͥ)กȁ(Aȁ9ɽ(ۊL(ȁ ͵HЁ1ѕɴ)ɽэɕ)ݥѠɱ䵽͕Ё)ͽѕݥѠՉɽ)͍ɽ̸ͥ (ȠФ׊L(́iЁYɥ)͕́ɕ́Q=H)ѡ݅䁅ѥمѥ͔)Չɽ͍́ɽͥ)กA1L=Ȥ)Ը(Ё Ʌѽ@Ё5)䁅ͽѕݥѠ)Չɽ͍́ɽͥ́(QM 聍ɕѥ̸)ȁ(Aȁ9ɽ(ؠؤˊLظ(ԁ]ԁ)dЁ9مͥٔ)ѕѥɱɝ䰁͕ɔ)ɕՉɽ͍́ɽͥ)ก9ɽРԤˊL(؁i8ЁY)ٔѥձѥȁɕɅѽ)䁥Չɽ͍́ɽ̸ͥ)Aȁ9ɽ̠ĤLи(܁5MLЁQ)ѽЁ́ѡ)хɝЁɅ卥(Q=Hѡ݅丁ͥ()!!хѡɔ(Ƞ̤ߊLĸ(-ͽ ЁQՉɽ)͍ɽͥ́ѡ)ѽиͥ(ؠӊLظ(-ՕȁЁٕɽ)ɕѵЁɕɅѽ䁕)Չɽ͍́ɽͥ́)9ɽРԤLܸ(-ՕȁЁ1ѕɴ)ɕѵЁݥѠ)ٕɽ́Չɽ͍́ɽ̸ͥ)9ɽܠ̤LԸ(ā]Ёٕɽ)Չɽ͍́ɽͥ́ѥ)ݥѠɅх)ɕѵЁѥȁ()Aȁ9ɽܠؤ(NJL(ȁ ɑ4Ё)5хɝЁɅ卥)ѽ́ȁɅх)Չ嵅Ё)ɽѽ́Չɽ)͍ɽͥ́ก(A(РԤ׊L(́MՕLЁ)ͅ䁽ٕɽ́)ɕݥѠQM ͽѕ)䃊LAЁфɽ)ͥѕȁɽѥٔ)Ց丁=Ё(Iɔ(ĠĤԸ(Ё=ٕ݅ѕȁ%ЁMɽ)ȁ 䁥ɕݥѠ)Չɽ͍́ɽͥ́)Ʌ镐ɽɥ)9ɽܠNJL(ԁɕ)Ёչѥٔ)ٕɽ́ѡɅ䁙)ɕѵеɕͥхЁ)͕Ё͕ɕ́ͽѕݥѠ)Չɽ͍́ɽͥ̀a%MP̤)͔̰Ʌ͕Չ)ɽՑ)1Ѐؤ(ϊL̸(؁)ݥLЁѥѥ)ɕѵЁɔѡ͕)͕ɕ́ɕՍ́)͕ٕɥ䁅ɥͬх)ɕхɑѥ́ݥѠ)Չɽ͍́ɽͥ́ก)(Aȁ9ɽԠԤ(ӊLĸ