Everolimus treatment of refractory epilepsy in tuberous sclerosis complex
Version of Record online: 10 SEP 2013
© 2013 American Neurological Association
Annals of Neurology
Volume 74, Issue 5, pages 679–687, November 2013
How to Cite
Krueger, D. A., Wilfong, A. A., Holland-Bouley, K., Anderson, A. E., Agricola, K., Tudor, C., Mays, M., Lopez, C. M., Kim, M.-O. and Franz, D. N. (2013), Everolimus treatment of refractory epilepsy in tuberous sclerosis complex. Ann Neurol., 74: 679–687. doi: 10.1002/ana.23960
- Issue online: 18 DEC 2013
- Version of Record online: 10 SEP 2013
- Accepted manuscript online: 24 JUN 2013 10:18AM EST
- Manuscript Accepted: 7 JUN 2013
- Manuscript Revised: 28 MAY 2013
- Manuscript Received: 5 FEB 2013
Epilepsy is a major manifestation of tuberous sclerosis complex (TSC). Everolimus is an mammalian target of rapamycin complex 1 inhibitor with demonstrated benefit in several aspects of TSC. We report the first prospective human clinical trial to directly assess whether everolimus will also benefit epilepsy in TSC patients.
The effect of everolimus on seizure control was assessed using a prospective, multicenter, open-label, phase I/II clinical trial. Patients ≥2 years of age with confirmed diagnosis of TSC and medically refractory epilepsy were treated for a total of 12 weeks. The primary endpoint was percentage of patients with a ≥50% reduction in seizure frequency over a 4-week period before and after treatment. Secondary endpoints assessed impact on electroencephalography (EEG), behavior, and quality of life.
Twenty-three patients were enrolled, and 20 patients were treated with everolimus. Seizure frequency was reduced by ≥50% in 12 of 20 subjects. Overall, seizures were reduced in 17 of the 20 by a median reduction of 73% (p < 0.001). Seizure frequency was also reduced during 23-hour EEG monitoring (p = 0.007). Significant reductions in seizure duration and improvement in parent-reported behavior and quality of life were also observed. There were 83 reported adverse events that were thought to be treatment-related, all of which were mild or moderate in severity.
Seizure control improved in the majority of TSC patients with medically refractory epilepsy following treatment with everolimus. Everolimus demonstrated additional benefits on behavior and quality of life. Treatment was safe and well tolerated. Everolimus may be a therapeutic option for refractory epilepsy in this population. Ann Neurol 2013;74:679–687