P12.10 Treatment of pharmacoresistent epilepsy by combining stereotactic destruction and authologous mesenchymal stem cells

Abstract

Abstract BACKGROUND Existing anti-epileptic drugs (AED) have limited efficiency in many patients, necessitating the search for alternative approaches such as stereotactic radiosurgery (SRS) and followed by stem cell therapy to improve results of previous treatment. MATERIAL AND METHODS From 2016 to 2017, a prospective study included 6 patients with a combined pathology, a median of 56 years of age, in the past TBI - 3 patients, a solitary metastatic focus in the brain (GM) - 2 patients. The indications for stereotactic intervention were both the presence of a metastatic lesion of the GM, and the bitemporal epilepsy with generalized convulsive, complex and simple partial attacks, regardless of the presence of an organic focus on CT or MRI GM. SRS was undertaken in patients undergoing a course of anticonvulsant drug therapy in combination with other types of symptomatic therapy in the absence of therapeutic effect. The frequency of generalized convulsive seizures ranged from 2–3 to 7–10 per month, complex partial from daily to 2–3 per month. SRS was performed on a stereotactic irradiation system with conical “BrainLab” collimators mounted on a linear CLINAC accelerator and allowing the session of SRS arc arches. Total dose was 12–30 Gy in isocenter, 1 fraction. After 2–3 monthes from SRS the patients received AED supplemented with single intravenous administration of undifferentiated autologous MSC (target dose of 1 × 106 cells/kg), followed by a single intrathecal injection of neurally induced autologous MSC (target dose of 0.1 × 106 cells/kg). RESULTS duration of epilepsy at the time of surgery ranged from 3 to 42 years. Cessation of attacks after 2–3 months after SRS with followed MSC therapy in 2 out of 6 patients was achieved remission (no seizures for one year and more), and 3 patients became responders to AEDs additionally, reduction of the pathological EEG pattern (disappearance of beta focusing, reduction of theta2-index to 23.6). Persistent clinical onco- and neurological remission 18 months. Reduction of the dose of enkorata-chrono - 3 patients, complete abolition of anticonvulsant therapy - 2 patients. MSC injections were well tolerated and did not cause any severe adverse effects. CONCLUSION MSC possess unique immunomodulatory properties and are a safe and promising candidate for cell therapy in AED resistant epilepsy patients in the frame of combined treatment.