PEDIATRIC-NEUROLOGY-FEBRILE SEZURES&NEUROPROTECTION

FEBRILE SEIZURES & NEUROPROTECTION


Neuroprotection: Preventing Epilepsy?
Traditionally, pharmacological neuroprotection is a concept primarily
associated with acute neurodegeneration due to cerebral ischemia or traumatic
brain injury. The goal of drug therapy in these settings is to restore the
normal biochemical environment and protect neurons from the cytotoxic
effects of inflammation and hyperexcitability. Anti-thrombotic, thrombolytic,
and anti-inflammatory agents are used in stroke and head injury to prevent
the sequelae of such insults to the brain. Recent studies of anticoagulation
with unfractionated heparin following ischemia and brain trauma in animal
models show a decrease in lesion size and improvement in motor and cognitive
deficits. Unfractionated heparin is believed to have not only anti-coagulant,
but anti-oxidant, anti-inflammatory, anti-excitatory, and neurotrophic effects that
may act synergistically to provide neuroprotection in acute brain insult. After
traumatic brain injury, neuroprotective therapy generally focuses on prevention
of secondary brain injury. Many pharmacotherapeutic agents are being investigated and a variety of promising therapeutic options have emerged,including glutamate receptor antagonists, calcium channel antagonists, and free radical scavengers.

A common theme in neuroprotection is prevention of seizures in patients who
are at increased risk for developing epilepsy. Potential causes of epilepsy include
cerebrovascular disease, perinatal hypoxia or ischemia, infection, febrile seizures,
tumors, congenital malformations, trauma, and status epilepticus. Underlying
genetic factors may also have a role in determining seizure susceptibility after an
insult. The ability of the anti-epileptic drugs to prevent epileptogenesis in at-risk
patients is largely unknown.

Clinical studies of phenytoin, phenobarbital, carbamazepine, and valproate
have failed to show a protective effect in the development of epilepsy after head
injury. Studies in animal models, though, have shown that valproate may be
effective in preventing epilepsy. These findings emphasize the complex multifactorial
nature of seizure development and emphasize the need for multifaceted
treatment strategies in epilepsy. Identifying the fundamental mechanisms of
epileptogenesis may allow us to develop therapies that target the underlying
disease process and effectively alter the development or progression of epilepsy.

There is undoubtedly a cascade of disparate events that occurs in the
development of epilepsy. A primary insult in the setting of genetic susceptibility
may lead to fundamental structural or biochemical changes that result in
spontaneous seizures and epilepsy. Pharmacotherapeutic strategies that can alter
the sequelae of brain injury, influence the process of epileptogenesis, prevent
or terminate seizure activity, modify underlying pathology, or interfere with
multidrug resistance mechanisms do have an essential role in the successful
treatment of patients with epilepsy.(Leonardo Oloan Agusta Sitanggang-FK.UNRI)
Terimakasih buat temen-temen yang udah mau baca&diharapkan komentar ny y....