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Published on: May 16, 2019
In vivo P-glycoprotein function before and after epilepsy surgery
Martin Bauer1, Rudolf Karch1, Markus Zeitlinger1
1From the Departments of Clinical Pharmacology (M.B., M.Z., M. Müller, O.L.) and Neurology (E.P.), Center for Medical Statistics, Informatics, and Intelligent Systems (R.K.), Institute of Neurology (J.A.H.), and Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine (W.W., M. Mitterhauser), Medical University of Vienna, Austria; Department of Clinical and Experimental Epilepsy (J.L., M.J.K., S.M.S.), UCL Institute of Neurology, London; Epilepsy Society (M.J.K., S.M.S.), Chalfont St Peter, Buckinghamshire; Institute for Population Health Wolfson Molecular Imaging Centre (M.-C.A.), University of Manchester, MAHSC, UK; and Health and Environment Department (O.L.), AIT Austrian Institute of Technology GmbH, Seibersdorf, Austria.
P-glycoprotein (Pgp) overactivity in temporal lobe epilepsy patients is dynamic. Seizure freedom after surgery correlates with reduced Pgp function, suggesting Pgp activity reversal is key for optimal epilepsy treatment.
Area of Science:
- Neuroscience
- Pharmacology
- Medical Imaging
Background:
- Temporal lobe epilepsy (TLE) is often drug-resistant.
- P-glycoprotein (Pgp) is a key efflux transporter at the blood-brain barrier.
- Pgp function may influence drug efficacy and seizure control in TLE.
Purpose of the Study:
- To investigate P-glycoprotein (Pgp) function at the blood-brain barrier in TLE patients.
- To assess changes in Pgp activity before and after temporal lobe surgery.
- To correlate Pgp function changes with seizure frequency and antiepileptic drug load post-surgery.
Main Methods:
- Positron emission tomography (PET) using (R)-[(11)C]verapamil (VPM) was performed pre- and post-surgery in seven TLE patients.
- Patients were followed for a median of 6 years.
- Pgp immunoreactivity was assessed in resected hippocampal tissue via immunohistochemistry.
Main Results:
- Optimal surgical outcomes (seizure freedom, drug withdrawal) were linked to higher pre-surgery Pgp function and Pgp staining in resected tissue.
- A reduction in global Pgp function was observed postoperatively in patients with optimal outcomes.
- Non-optimal surgical outcomes showed different Pgp activity patterns.
Conclusions:
- Pgp overactivity in epilepsy appears to be dynamic and reversible.
- Complete seizure control and cessation of antiepileptic drugs correlate with Pgp overactivity reversal.
- Further validation in larger cohorts is needed to confirm these pilot study findings.
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