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This is the first real documentation of up-regulated activated NMDA receptors in human epilepsy.
Refractory seizures lead to a variety of changes in neuronal receptors and transport mechanisms across the blood–brain barrier (BBB).1 As seizures remain uncontrolled, these particular changes can lead to pharmacoresistance patterns commonly seen in resistant epilepsy, status epilepticus (SE), refractory SE (RSE) and super-refractory SE (SRSE). First, γ aminobutyric acid type-A (GABAA) receptor downregulation, followed by subunit changes can lead to resistance to GABA mediated antiepileptic drugs (AEDs). Second, upregulation of the p-glycoprotein BBB transporter can lead to exportation of phenytoin and phenobarbital molecules, resulting in decreased efficacy of these medications. Finally, N-methyl-d-aspartate (NMDA) receptor upregulation has …