A role for inflammation in status epilepticus is revealed by a review of current therapeutic approaches

Authors

  • Damir Janigro,

    Corresponding author
    1. Cerebrovascular Research, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
    2. Kent State University School of Biomedical Sciences, Kent, Ohio, U.S.A
    • Departments of Neurological Surgery, Cellular and Molecular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
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  • Philip H. Iffland II,

    1. Departments of Neurological Surgery, Cellular and Molecular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
    2. Kent State University School of Biomedical Sciences, Kent, Ohio, U.S.A
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  • Nicola Marchi,

    1. Cerebrovascular Research, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
    2. Kent State University School of Biomedical Sciences, Kent, Ohio, U.S.A
    3. Institute of Functional Genomics, CNRS UMR 5203, INSERM U661, UM1-UM2, Montpellier, France
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  • Tiziana Granata

    1. Department of Pediatric Neurology, Carlo Besta Institute, Milan, Italy
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Address correspondence to Damir Janigro, Professor of Molecular Medicine and Director of Cerebrovascular Research, Cleveland Clinic Foundation, Department of Cellular and Molecular Medicine, 9500 Euclid Ave., NB-20, Cleveland, OH 44195, U.S.A. E-mail: janigrd@ccf.org

Summary

A significant number of patients with epilepsy fail to respond to currently available antiepileptic drugs. This suggests a need for alternative approaches to reduce the occurrence of seizures in these patients. Recent data have shown that in addition to well-known neuronal mechanism, seizures may be a consequence of misguided inflammatory response and blood–brain barrier disruption. Both peripheral and brain proinflammatory events have been demonstrated to govern the onset of status epilepticus. Evidence deriving from the experimental and clinical realms supports the notion that a role for proinflammatory and cerebrovascular events in seizure disorders is broader than previously suspected. As a result, methods to pharmacologically reduce blood–brain barrier permeability and reduce inflammation have emerged as means to reduce seizure burden. For instance, corticosteroids have been shown to be beneficial and the same agents may be able to further reduce seizure burden in conjunction with currently prescribed antiepileptic drugs.

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