Seizure Frequency and RE

Several hypotheses have been formulated on the involvement of drug transporters in 

Marson et al., however, found no significant difference between deferred treatment (patients experienced multiple seizures before treatment onset) and immediate antiepileptic drug treatment [44]. Accordingly, patients from an underdeveloped region from northern Ecuador with a long history of seizures and no prior AED treatment showed RE incidences comparable to those who had experienced only one or two seizures prior to treatment [45[. 

In concordance with these findings, animal models showed that ABCBl is transiently increased shortly after a seizure, and drops back to normal levels within 

1-2 days [47, 48[, indicating that an isolated seizure event cannot affect RE. It is, however, conceivable that multiple events occurring within a short time frame may lead to a reinforcement ofthe otherwise transient increase in efflux pump expression and may render the patient permanently refractory to treatment with anticonvulsants. Alternatively, a hitherto uninvestigated efflux pump may be upregulated as a result of prolonged and repetitive seizure activity. 

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