ArticleFrontiers in neurology
Glymphatic dysfunction as a predictor of response to lacosamide add-on therapy in drug-resistant focal epilepsy.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Drug-resistant epilepsy continues to be a major challenge, as treatment response to additional antiseizure medications is often limited, and early prediction remains crucial. The diffusion tensor image analysis along the perivascular space (DTI-ALPS) index has emerged as a noninvasive imaging method to assess glymphatic function, which plays a key role in brain waste clearance. We aimed to evaluate whether the DTI-ALPS index could serve as a valuable prognostic biomarker of treatment response in patients with drug-resistant focal epilepsy receiving lacosamide (LCM) add-on therapy. Methods: We retrospectively enrolled 155 patients with drug-resistant focal epilepsy who underwent diffusion tensor imaging (DTI) prior to initiating LCM add-on therapy and had at least 12 months of clinical follow-up. Patients were classified into LCM responders and non-responders based on seizure reduction. The DTI-ALPS index was calculated from preprocessed DTI data acquired on a 3 T magnetic resonance imaging scanner and compared between the groups. Results: Among 155 patients with drug-resistant focal epilepsy, 33 were classified into LCM responders and 122 into LCM non-responders. Non-responders had a higher number of prior antiseizure medication (ASM) burden (3 vs. 2, Conclusion: DTI-ALPS index was significantly lower in non-responders to LCM add-on therapy among patients with drug-resistant focal epilepsy, suggesting that glymphatic dysfunction may contribute to reduced ASM responsiveness and serve as a potential noninvasive biomarker to aid in treatment prediction.
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