9th Congress of the European Academy of Neurology
Bioethical considerations in Drug-Resistant Epilepsy (DRE) Cibele Keiti Rech1, Mariane Okamoto Ferreira1, Victor Pereira da Silva1, Izabele Ferreira de Araujo1, Beatriz Boufleur Marcon1, Carlos Frederico de Almeida Rodrigues1. 1Universidade Estadual do Oeste do Paraná – UNIOESTE, campus de Francisco Beltrão, Paraná, Brazil. Introduction: Drug-Resistant Epilepsy (DRE) is an epileptic condition in which there is a failure of adequate trials of two appropriately and tolerated antiepileptic drug (AEDs) regimens used to achieve sustained freedom from seizures. It's a highly prevalent disorder that drastically compromises the patient's life. According to Beauchamp and Childress’s concepts, this article evaluated the bioethical aspects of the leading drug and surgical treatments available for DRE. Methods: This is a review of articles published in the UpToDate, SciELO and PubMed databases, between 2018-2023, about DRE that address epidemiology and treatments. The ethical principles of Beauchamp and Childress applied were Justice, Beneficence, Non-Maleficence and Autonomy. Results: Eleven articles related to DRE were selected, addressing treatment with AEDs and surgical techniques, with emphasis on resection and neurostimulation. Evidence suggests AEDs as the first therapy for DRE, and surgical treatment in the second choice. Conclusion: DRE is a bioethical challenge because it is a severe clinical condition without effective treatment. Although ethical implications are present in all research found, these considerations should be frequently reviewed in patient management, as therapeutic advances occur constantly. Therefore, in order to improve bioethical principles in the management of patients with DRE, more efforts are needed to provide scientific substrate on the potential benefits and harms of available treatments and patient autonomy. Disclosures: The authors declare that the research was conducted without any commercial or financial relationships that could be interpreted as a potential conflict of interest. Keywords: bioethics, epidemiology, refractory epilepsy, drug-resistant epilepsy. REFERENCES Sultana B, Panzini MA, Veilleux Carpentier A, Comtois J, Rioux B, Gore G, Bauer PR, Kwon CS, Jetté N, Josephson CB, Keezer MR. Incidence and Prevalence of Drug-Resistant Epilepsy: A Systematic Review and Meta-analysis. Neurology. 2021 Apr 27;96(17):805-817. doi: 10.1212/WNL.0000000000011839. Epub 2021 Mar 15. PMID: 33722992. Kalilani L, Sun X, Pelgrims B, Noack-Rink M, Villanueva V. The epidemiology of drug-resistant epilepsy: A systematic review and meta-analysis. Epilepsia. 2018 Dec;59(12):2179-2193. doi: 10.1111/epi.14596. Epub 2018 Nov 13. PMID: 30426482. Löscher W, Potschka H, Sisodiya SM, Vezzani A. Drug Resistance in Epilepsy: Clinical Impact, Potential Mechanisms, and New Innovative Treatment Options. Pharmacol Rev. 2020 Jul;72(3):606-638. doi: 10.1124/pr.120.019539. PMID: 32540959; PMCID: PMC7300324. Rheims S, Sperling MR, Ryvlin P. Drug-resistant epilepsy and mortality-Why and when do neuromodulation and epilepsy surgery reduce overall mortality. Epilepsia. 2022 Dec;63(12):3020-3036. doi: 10.1111/epi.17413. Epub 2022 Oct 20. PMID: 36114753. Meneses, MS, Rocha, SF, Simão, CA, Santos, HL, Pereira, CO, & Kowacs, PA. Vagus nerve stimulation may be a sound therapeutic option in the treatment of refractory epilepsy. ABNEURO - Arquivos de neuro-psiquiatria 2013, 71 (1), 25-30 . doi: 10.1590/S0004-282X2013000100006. Liu JT, Liu B, Zhang H. Surgical versus medical treatment of drug-resistant epilepsy: A systematic review and meta-analysis. Epilepsy Behav. 2018 May;82:179-188. doi: 10.1016/j.yebeh.2017.11.012. Epub 2018 Mar 23. PMID: 29576434. Cascino, GD, Garcia, P, Dashe, JF. Surgical treatment of epilepsy in adults. UpToDate. 2022, Nov. Retrieved January 04, 2023. From: https://www.uptodate.com/contents/surgical-treatment-of-epilepsy-in-adults?sour ce=related_link Costa, L, Brandão, E, Segundo, L. Atualização em epilepsia: revisão de literatura. Revista de Medicina, São Paulo, v. 99, n. 2, p. 170-181, 2020. Sirven, J, Garcia, P, Dashe, JF. Evaluation and management of drug-resistant epilepsy. UpToDate. 2022, Dec. Retrieved January, 04, 2023. From: https://www.uptodate.com/contents/evaluation-and-management-of-drug-resistan t-epilepsy Pellinen, J. Treatment gaps in epilepsy. Frontiers in Epidemiology. 2022. 2:976039. doi: 10.3389/fepid.2022.976039 Beauchamp, T. L., and J. F. Childress. 2013. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press.
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