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Originating from the abnormal physiological state that causes epilepsy, breakage of the BBB loop leads to changes in permeability that can ultimately lead to abnormal entry of substances from small molecules to intact cells (17, 65), which is in turn evidence of microvascular dysfunction in epilepsy (66, 67)

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Notably, the observed variability in efficacy between agents, particularly in the early phases of treatment, emphasizes the importance of individualized therapeutic strategies, tailored to specific clinical goals, baseline metabolic profiles, and patient preferences

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