الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Epilepsy imposes an immense socioeconomic burden on individuals, families, and societies. It has been identified as an important cause of disability. This is mostly attributed to its effect, not only on the epilepsy patients’ quality of life (QoL), but additionally on their families’ life, as well.
Despite the better understanding of epilepsy pathogenesis and the development of a wide range of antiepileptic drugs (AEDs) covering the main targets involved in epileptogenesis, still a third of patients with epilepsy do not respond to the available therapies. These patients are considered an important challenge needing immediate attention. This condition is referred to as the drug resistant epilepsy (DRE), or medically intractable/refractory epilepsy.
Management of patients with DRE is challenging, not only because of the difficulty in producing seizure free condition, but also the associated increase in adverse reactions with heavy drug loads represents an obstacle that leads to loss of patient’s compliance and eventually treatment failure. The economic burden produced by combination therapy is another problem. Overall, this condition leads to a real disappointment of physicians, patients, and care providers and it also has an important impact on patients’ QoL.
Several hypotheses have been proposed regarding the pathogenesis of DRE, the most cited of which is the transporter hypothesis. This hypothesis denotes that excessive expression of certain efflux transporters can pump the AEDs out of the brain cells, which causes a reduction in their local concentration at their target site of action. P-glycoprotein (known as ABCB1 or MDR1) is one of most important transporters linked to this hypothesis. Targeting P-gp transporter has been suggested as a novel approach in DRE management. Inhibiting or modulating P-gp transporter can down regulate the blood brain barrier (BBB) efflux of AEDs with a subsequent better brain availability.