title: Everolimus in tuberous sclerosis patients with intractable epilepsy: a treatment option?
abstract: BACKGROUND
  Tuberous Sclerosis Complex (TSC) is an often severe neurodevelopmental disorder caused by overactivation of the mTOR pathway due to mutations in either the TSC1 or TSC2 genes. Seizures are the primary cause of neurologic morbidity and often refractory. The mTOR inhibitor everolimus was recently approved for the treatment of giant cell astrocytomas and renal angiomyolipomas in TSC. Whether everolimus has any direct effect on epilepsy in TSC is not known.
  
  
  METHODS
  Within the framework of a compassionate use trial, we evaluated the safety and efficacy of everolimus in seven patients with TSC and intractable epilepsy. We evaluated seizure frequency, seizure-free days and adverse effects including standard laboratory parameters. Seizure frequency was analysed in each patient using a non-parametric test for trend and using a Generalized Estimating Equations Model in the total patient group. The observation period was continued for nine months.
  
  
  RESULTS
  One patient discontinued the medication at the beginning of the observation period due to side effects (flushing). In the remaining 6 patients, we observed a reduction of seizures in 4/6 patients with a reduction of 25-100%. In addition, the percentage of seizure-free days increased in 3/4 of these patients. In 2/6 patients, no alteration of seizure frequency was noted. We observed an increase of mild infections and an increase of triglycerides and various liver function tests. We did not encounter life-threatening infections or other side effects of everolimus.
  
  
  CONCLUSIONS
  In some patients with TSC, everolimus may have an anticonvulsant effect with a reduction in seizure frequency and increase of seizure-free days. Everolimus was well tolerated, with adverse effects similar to those reported in previous studies.
authors.affiliation: Department of Neuropediatrics, University Medical Center Schleswig-Holstein (UKSH, Campus Kiel), Arnold-Heller-Str. 3, Haus 9, 24105 Kiel, Germany. Electronic address: wiegand@pedneuro.uni-kiel.de.
authors.forename: Gert
authors.initials: G
authors.lastname: Wiegand
authors.forename: Theodor W
authors.initials: TW
authors.lastname: May
authors.forename: Philipp
authors.initials: P
authors.lastname: Ostertag
authors.forename: Rainer
authors.initials: R
authors.lastname: Boor
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stephani
authors.forename: David Neal
authors.initials: DN
authors.lastname: Franz
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000150:complications* / Q000188:drug therapy; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D014402:Tuberous Sclerosis / Q000150:complications* / Q000188:drug therapy* / Q000235:genetics; D000077005:Tuberous Sclerosis Complex 2 Protein; D025521:Tumor Suppressor Proteins / Q000235:genetics
chemical_list: D000927:Anticonvulsants; D007166:Immunosuppressive Agents; C000624653:TSC2 protein, human; D000077005:Tuberous Sclerosis Complex 2 Protein; D025521:Tumor Suppressor Proteins; D000068338:Everolimus; D020123:Sirolimus
keywords: Everolimus; Intractable epilepsy; Refractory seizures; Tuberous sclerosis; mTOR