Neurotherapeutics

, Volume 6, Issue 2, pp 344–351

Convection-enhanced delivery in the treatment of epilepsy

Theme 4: Novel Delivery Approach

DOI: 10.1016/j.nurt.2009.01.017

Cite this article as:
Rogawski, M.A. Neurotherapeutics (2009) 6: 344. doi:10.1016/j.nurt.2009.01.017

Summary

Convection-enhanced delivery (CED) is a novel drug-delivery technique that uses positive hydrostatic pressure to deliver a fluid containing a therapeutic substance by bulk flow directly into the interstitial space within a localized region of the brain parenchyma. CED circumvents the blood-brain barrier and provides a wider, more homogenous distribution than bolus deposition (focal injection) or other diffusion-based delivery approaches. A potential use of CED is for the local delivery of antiseizure agents, which would provide an epilepsy treatment approach that avoids the systemic toxicities of orally administered antiepileptic drugs and bystander effects on non-epileptic brain regions. Recent studies have demonstrated that brief CED infusions of nondiffusible peptides that inhibit the release of excitatory neurotransmitters, including ω-conotoxins and botulinum neurotoxins, can produce long-lasting (weeks to months) seizure protection in the rat amygdala-kindling model. Seizure protection is obtainable without detectable neurological or behavioral side effects. Although conventional diffusible antiepileptic drugs do confer seizure protection when administered locally by CED, the effect is transitory. CED is a potential approach for seizure protection that could represent an alternative to resective surgery in the treatment of focal epilepsies that are resistant to orally-administered antiepileptic drugs. The prolonged duration of action of nondiffusible toxins would allow seizure protection to be maintained chronically with infrequent reinfusions.

Key Words

Convection-enhanced deliverydrug deliveryω-conotoxinbotulinum neurotoxinkindlingantiepileptic drugepilepsyseizure
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Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2009

Authors and Affiliations

  1. 1.Department of Neurology, School of MedicineUniversity of California, DavisSacramento