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Zhao GX, Zhang Z, Cai WK, Shen ML, Wang P, He GH. Associations between CYP3A4, CYP3A5 and SCN1A polymorphisms and carbamazepine metabolism in epilepsy: A meta-analysis. Epilepsy Res 2021; 173:106615. [PMID: 33756436 DOI: 10.1016/j.eplepsyres.2021.106615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVE CYP3A4 (rs2242480), CYP3A5 (rs776746) and SCN1A (rs3812718 and rs2298771) gene polymorphisms were previously indicated to be associated with carbamazepine (CBZ) metabolism and resistance in epilepsy. However, previous studies regarding the effects of these polymorphisms still remain controversial. Therefore, we performed a meta-analysis to evaluate whether the four polymorphisms are associated with CBZ metabolism and resistance. METHODS The PubMed, EMBASE, Cochrane library, Chinese National Knowledge Infrastructure, Chinese Science and Technique Journals Database, China Biology Medicine disc and Wan Fang Database were searched up to January 2021 for appropriate studies regarding the association of rs2242480, rs776746, rs3812718 and rs2234922 polymorphisms with CBZ metabolism and resistance. The meta-analysis was conducted by Review Manager 5.3 software. RESULTS Eighteen studies involving 2546 related epilepsy patients were included. We found that the G allele of CYP3A4 rs2242480 markedly decreased the plasma CBZ concentration in epilepsy. For CYP3A5 rs776746 polymorphism, the GG genotype (homozygote codominant model: GG vs. AA) and GG + GA genotype (dominant model: GG + GA vs. AA and recessive model: GG vs. GA + AA) were respectively found to be significantly associated with increased CBZ plasma concentration. Additionally, it was also found that the SCN1A rs3812718 A allele was significantly associated with decreased CBZ plasma concentration and increased CBZ resistance. However, no association was observed between SCN1A rs2298771 polymorphism and CBZ metabolism and resistance. CONCLUSION The CYP3A4 rs2242480, CYP3A5 rs776746 and SCN1A rs3812718 polymorphisms may play important roles in CBZ metabolism and resistance, while SCN1A rs2298771 polymorphism is not associated with CBZ in epilepsy. These findings would improve the individualized therapy of epileptic patients in clinics.
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Affiliation(s)
- Gui-Xin Zhao
- Department of Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, 650032, China; Kunming Medical University, Kunming, 650500, China; Research Center of Clinical Pharmacology, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, 650021, China
| | - Zheng Zhang
- Medical Engineering Section, The 306th Hospital of PLA, Beijing, 100101, China
| | - Wen-Ke Cai
- Department of Cardio-Thoracic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, 650032, China
| | - Ming-Li Shen
- Department of Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, 650032, China
| | - Ping Wang
- Department of Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, 650032, China
| | - Gong-Hao He
- Department of Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, 650032, China; Research Center of Clinical Pharmacology, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, 650021, China.
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Poniatowski ŁA, Cudna A, Kurczych K, Bronisz E, Kurkowska-Jastrzębska I. Kinetics of serum brain-derived neurotrophic factor (BDNF) concentration levels in epileptic patients after generalized tonic-clonic seizures. Epilepsy Res 2021; 173:106612. [PMID: 33774427 DOI: 10.1016/j.eplepsyres.2021.106612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Epilepsy is a chronic neurological disorder characterized by the periodic and unpredictable occurrence of seizures. The serum level of brain-derived neurotrophic factor (BDNF) has been suggested to be a potential biomarker that could detect differences in epilepsy patients. Although there is considerable neurobiological evidence linking BDNF to epilepsy, only a small number of studies investigated the relationship between BDNF serum levels and epilepsy, and these studies obtained inconsistent results. The aim of this study was to elucidate BDNF serum levels in epilepsy cases. METHODS Collectively, group of 143 patients (n = 143) were included in this study and subsequently divided into two groups consisting of individuals after singular generalized tonic-clonic seizures (n = 50) and patients with chronic epilepsy (n = 93). The samples from patients with acute epilepsy were collected 1-3 hours and 72 h after seizure, and a single collection was performed from patients with chronic epilepsy. These samples were compared to the control group (n = 48) using ELISA. RESULTS In the present study, we observed a significant decrease of BDNF serum levels in patients after generalized tonic-clonic seizures compared to the control group. Furthermore, the observed decrease of BDNF levels in this group was sustained at 1 and 72 h after seizure insult. We did not show the relationship between BDNF levels and age, etiology of epilepsy and the duration of illness. SIGNIFICANCE Our results and the findings of previous studies indicate that the serum BDNF level significantly decreases after seizures and should be considered when measuring BDNF in patients with chronic epilepsy. It might be also influenced by neurodegenerative processes, which may be involved in the etiopathogenesis of particular epilepsy syndromes.
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Affiliation(s)
- Łukasz A Poniatowski
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland; Department of Neurosurgery, Maria Skłodowska-Curie National Research Institute of Oncology, W. K. Roentgena 5, 02-781, Warsaw, Poland.
| | - Agnieszka Cudna
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland.
| | - Katarzyna Kurczych
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland.
| | - Elżbieta Bronisz
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957, Warsaw, Poland.
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Zhang M, Yang H, Chen Z, Hu X, Wu T, Liu W. Long Noncoding RNA X-Inactive-Specific Transcript Promotes the Secretion of Inflammatory Cytokines in LPS Stimulated Astrocyte Cell Via Sponging miR-29c-3p and Regulating Nuclear Factor of Activated T cell 5 Expression. Front Endocrinol (Lausanne) 2021; 12:573143. [PMID: 33776905 PMCID: PMC7995889 DOI: 10.3389/fendo.2021.573143] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Astrocyte activation promotes glutamate accumulation and secretion of inflammatory factors, mainly responsible for epilepsy. Long noncoding RNA (lncRNA) X-inactive-specific transcript (XIST) regulates inflammation; however, the biological role and regulatory mechanism of XIST during astrocyte activation remain unclear. METHODS In the present study, rat epilepsy model and lipopolysaccharide (LPS)-treated CTX-TNA2 were established. XIST and miR-29c-3p expression were evaluated using quantitative real-time polymerase chain reaction. Nuclear factor of activated T cells 5 (NFAT5) was measured using western blot analysis. Interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and L-glutamate levels in the culture supernatants were assessed using enzyme-linked immunosorbent assay. The binding between XIST and miR-29c-3p and between miR-29c-3p and the 3'-UTR of NFAT5 was analyzed using dual-luciferase reporter, RNA-binding protein immunoprecipitation (RIP), and Biotin pull-down assay. The proliferation and apoptosis were evaluated using CCK8 and flow cytometry, respectively. RESULTS XIST expression and NFAT5 protein level was increased, whereas miR-29c-3p expression was decreased in the epilepsy rat model and LPS-treated CTX-TNA2 cells. Silenced XIST expression, miR-29c-3p overexpression, or silenced NFAT5 expression inhibited the secretion of IL-1β, IL-6, and TNF-α and promoted glutamate transport in LPS-treated CTX-TNA2 cells. miR-29c-3p was the potential miRNA sponged by XIST. NFAT5 acted as a direct binding target of miR-29c-3p. Silenced miR-29c-3p expression or NFAT5 overexpression reversed the effect of silenced XIST expression on LPS-treated CTX-TNA2.XIST and miR-29c-3p treatment does not affect NFAT5 mRNA expression, but affects NFAT5 protein level. Furthermore, underexpressed XIST or overexpressed miR-29c-3p in LPS-stimulated CTX-TNA2 can attenuate neuronal apoptosis induced by LPS-stimulated CTX-TNA2. CONCLUSION LncRNA XIST promotes the secretion of inflammatory cytokines in LPS- treated CTX-TNA2 via sponging miR-29c-3p and regulating NFAT5 expression.
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Muglia P, Hannestad J, Brandt C, DeBruyn S, Germani M, Lacroix B, Majoie M, Otoul C, Sciberras D, Steinhoff BJ, Van Laere K, Van Paesschen W, Webster E, Kaminski RM, Werhahn KJ, Toledo M. Padsevonil randomized Phase IIa trial in treatment-resistant focal epilepsy: a translational approach. Brain Commun 2020; 2:fcaa183. [PMID: 33241213 PMCID: PMC7677606 DOI: 10.1093/braincomms/fcaa183] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 11/13/2022] Open
Abstract
Therapeutic options for patients with treatment-resistant epilepsy represent an important unmet need. Addressing this unmet need was the main factor driving the drug discovery program that led to the synthesis of padsevonil, a first-in-class antiepileptic drug candidate that interacts with two therapeutic targets: synaptic vesicle protein 2 and GABAA receptors. Two PET imaging studies were conducted in healthy volunteers to identify optimal padsevonil target occupancy corresponding to levels associated with effective antiseizure activity in rodent models. Optimal padsevonil occupancy associated with non-clinical efficacy was translatable to humans for both molecular targets: high (>90%), sustained synaptic vesicle protein 2A occupancy and 10-15% transient GABAA receptor occupancy. Rational dose selection enabled clinical evaluation of padsevonil in a Phase IIa proof-of-concept trial (NCT02495844), with a single-dose arm (400 mg bid). Adults with highly treatment-resistant epilepsy, who were experiencing ≥4 focal seizures/week, and had failed to respond to ≥4 antiepileptic drugs, were randomized to receive placebo or padsevonil as add-on to their stable regimen. After a 3-week inpatient double-blind period, all patients received padsevonil during an 8-week outpatient open-label period. The primary endpoint was ≥75% reduction in seizure frequency. Of 55 patients randomized, 50 completed the trial (placebo n = 26; padsevonil n = 24). Their median age was 36 years (range 18-60), and they had been living with epilepsy for an average of 25 years. They were experiencing a median of 10 seizures/week and 75% had failed ≥8 antiepileptic drugs. At the end of the inpatient period, 30.8% of patients on padsevonil and 11.1% on placebo were ≥75% responders (odds ratio 4.14; P = 0.067). Reduction in median weekly seizure frequency was 53.7% and 12.5% with padsevonil and placebo, respectively (unadjusted P = 0.026). At the end of the outpatient period, 31.4% were ≥75% responders and reduction in median seizure frequency was 55.2% (all patients). During the inpatient period, 63.0% of patients on placebo and 85.7% on padsevonil reported treatment-emergent adverse events. Overall, 50 (90.9%) patients who received padsevonil reported treatment-emergent adverse events, most frequently somnolence (45.5%), dizziness (43.6%) and headache (25.5%); only one patient discontinued due to a treatment-emergent adverse event. Padsevonil was associated with a favourable safety profile and displayed clinically meaningful efficacy in patients with treatment-resistant epilepsy. The novel translational approach and the innovative proof-of-concept trial design maximized signal detection in a small patient population in a short duration, expediting antiepileptic drug development for the population with the greatest unmet need in epilepsy.
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Affiliation(s)
| | | | - Christian Brandt
- Department of General Epileptology, Bethel Epilepsy Centre, Mara Hospital, Bielefeld, Germany
| | | | | | | | - Marian Majoie
- Department of Neurology, Academic Center of Epileptology Kempenhaeghe, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | - Koen Van Laere
- Department of Imaging and Pathology, KU, Leuven, Belgium
| | | | | | | | | | - Manuel Toledo
- Epilepsy Unit, Department of Neurology, Vall d'Hebron Hospital, Barcelona, Spain
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Mesraoua B, Deleu D, Hassan AH, Gayane M, Lubna A, Ali MA, Tomson T, Khalil BA, Cross JH, Asadi-Pooya AA. Dramatic outcomes in epilepsy: depression, suicide, injuries, and mortality. Curr Med Res Opin 2020; 36:1473-1480. [PMID: 32476500 DOI: 10.1080/03007995.2020.1776234] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In this narrative review, we will discuss some of the significant risks and dramatic consequences that are associated with epilepsy: depression, suicide, seizure-related injuries, and mortality, both in adults and in children. Considering the high prevalence of depression among people with epilepsy (PWE), routine and periodic screening of all PWE for early detection and appropriate management of depression is recommended. PWE should be screened for suicidal ideation regularly and when needed, patients should be referred for a psychiatric evaluation and treatment. When starting an antiepileptic drug (AED) or switching from one to another AED, patients should be advised to report to their treating physician any change in their mood and existence of suicidal ideation. The risk of injuries for the general epilepsy population is increased only moderately. The risk is higher in selected populations attending epilepsy clinics and referral centers. This being said, there are PWE that may suffer frequent, severe, and sometimes even life-threatening seizure-related injuries. The most obvious way to reduce risk is to strive for improved seizure control. Finally, PWE have a 2-3 times higher mortality rate than the general population. Deaths in PWE may relate to the underlying cause of epilepsy, to seizures (including sudden unexpected death in epilepsy [SUDEP] and seizure related injuries) and to status epilepticus, as well as to other conditions that do not appear directly related to epilepsy. Improving seizure control and patient education may be the most important measures to reduce epilepsy related mortality in general and SUDEP in particular.
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Affiliation(s)
- Boulenouar Mesraoua
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Dirk Deleu
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Al Hail Hassan
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Melykian Gayane
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
- Neurology Epilepsy, Weill Cornell Medical College, Doha, Qatar
| | - Alsheikh Lubna
- Neurology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Torbjorn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Bassel Abou Khalil
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Helen Cross
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ali A Asadi-Pooya
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
- Epilepsy Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Strzelczyk A, Mann C, Willems LM, Rosenow F, Bauer S. Cenobamate for the treatment of focal epilepsies. Expert Opin Pharmacother 2020; 21:2215-2223. [PMID: 32812825 DOI: 10.1080/14656566.2020.1803830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Antiseizure drugs (ASDs) play a central and crucial role in the treatment of epilepsy patients because the majority require anticonvulsant treatment for an extended period of time. Due to the fact that 30% of patients are refractory to medical treatment, new therapeutic options are necessary. Cenobamate is the latest approved antiepileptic drug in focal epilepsy, and its mode of action is thought to be mediated by blocking voltage-gated sodium channels and interaction with the GABAergic system. AREAS COVERED This article reviews animal studies, pharmacokinetics, pharmacodynamics, and the phase 1 to 3 trials and open-label extension data on cenobamate. EXPERT OPINION Cenobamate has the potential to perform as an important ASD because trial data are indicative of remarkable responder and seizure freedom rates so far not seen with other ASDs. Cenobamate demonstrated significant efficacy at a dosage between 100 and 400 mg per day. The side-effect profile of this drug is comparable to other ASDs and is mainly CNS related; in particular, somnolence, dizziness, headache, diplopia, and nystagmus. However, slow titration is mandatory to decrease the risk of drug rash with eosinophilia and systemic symptoms (DRESS) that was observed in several patients with fast uptitration schemes.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt , Frankfurt Am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (Cepter), Goethe-University Frankfurt , Frankfurt Am Main, Germany
| | - Catrin Mann
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt , Frankfurt Am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (Cepter), Goethe-University Frankfurt , Frankfurt Am Main, Germany
| | - Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt , Frankfurt Am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (Cepter), Goethe-University Frankfurt , Frankfurt Am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt , Frankfurt Am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (Cepter), Goethe-University Frankfurt , Frankfurt Am Main, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt , Frankfurt Am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research (Cepter), Goethe-University Frankfurt , Frankfurt Am Main, Germany
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Frey K, Zöllner JP, Knake S, Oganian Y, Kay L, Mahr K, Keil F, Willems LM, Menzler K, Bauer S, Schubert-Bast S, Rosenow F, Strzelczyk A. Risk incidence of fractures and injuries: a multicenter video-EEG study of 626 generalized convulsive seizures. J Neurol 2020; 267:3632-3642. [PMID: 32651672 PMCID: PMC7674387 DOI: 10.1007/s00415-020-10065-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the incidence and risk factors of generalized convulsive seizure (GCS)-related fractures and injuries during video-EEG monitoring. METHODS We analyzed all GCSs in patients undergoing video-EEG-monitoring between 2007 and 2019 at epilepsy centers in Frankfurt and Marburg in relation to injuries, falls and accidents associated with GCSs. Data were gathered using video material, EEG material, and a standardized reporting form. RESULTS A total of 626 GCSs from 411 patients (mean age: 33.6 years; range 3-74 years; 45.0% female) were analyzed. Severe adverse events (SAEs) such as fractures, joint luxation, corneal erosion, and teeth loosening were observed in 13 patients resulting in a risk of 2.1% per GCS (95% CI 1.2-3.4%) and 3.2% per patient (95% CI 1.8-5.2%). Except for a nasal fracture due to a fall onto the face, no SAEs were caused by falls, and all occurred in patients lying in bed without evidence of external trauma. In seven patients, vertebral body compression fractures were confirmed by imaging. This resulted in a risk of 1.1% per GCS (95% CI 0.5-2.2%) and 1.7% per patient (95% CI 0.8-3.3%). These fractures occurred within the tonic phase of a GCS and were accompanied by a characteristic cracking noise. All affected patients reported back pain spontaneously, and an increase in pain on percussion of the affected spine section. CONCLUSIONS GCSs are associated with a substantial risk of fractures and shoulder dislocations that are not associated with falls. GCSs accompanied by audible cracking, and resulting in back pain, should prompt clinical and imaging evaluations.
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Affiliation(s)
- Katharina Frey
- Center of Neurology and Neurosurgery, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Johann Philipp Zöllner
- Center of Neurology and Neurosurgery, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Knake
- LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.,Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Yulia Oganian
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Lara Kay
- Center of Neurology and Neurosurgery, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Katharina Mahr
- Center of Neurology and Neurosurgery, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Fee Keil
- Department of Neuroradiology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Laurent M Willems
- Center of Neurology and Neurosurgery, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Katja Menzler
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Sebastian Bauer
- Center of Neurology and Neurosurgery, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Center of Neurology and Neurosurgery, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.,Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Center of Neurology and Neurosurgery, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Center of Neurology and Neurosurgery, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany. .,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany. .,Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
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Impact of childhood Dravet syndrome on care givers of patients with DS, a major impact on mothers. Epilepsy Behav 2020; 108:107094. [PMID: 32375095 DOI: 10.1016/j.yebeh.2020.107094] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to understand the impact of Dravet syndrome (DS) on patients with Dravet syndrome and their families, with a focus on the social and economic impact on both mothers and fathers. METHODS A French language on-line survey was distributed (October 2014-January 2015) for completion by caregivers of patients aged <18 years with DS. The survey was hosted on the French Dravet Syndrome Alliance website, and the survey link was provided to patients and caregivers during clinics at the Necker Hospital (Paris, France). RESULTS Survey responses were available for 91 patients (median age 7.6 years; 81.6% SCN1A mutation positive). Total seizure frequency was >2 per week for 16.1% of patients, 1-8 per month for 55.2% and < 1 per month for 28.7%; tonic-clonic and myoclonic were the most frequent seizure types. Patients showed various degrees of intellectual disability and DS had a high impact on concentration and school learning in 70.1% and 80.5%. In addition, patients showed appetite disorders in 73.6%, sleep disorders in 72.4% and behavior disorders in 62.1%. Most parents were married (80.5%) with higher rates than the French general population (53.5%). Educational achievement and socio-professional categories for the parents were higher than observed in the French general population, while monthly net income was similar. Preparation of medication was generally done by the mother and father (46.0% of patients) or the mother only (37.9%). Most caregivers reported very low or no difficulty with treatment preparation and low or no risk of error. Parents typically spent <30 min per day on treatment preparation and administration and around 4 h per week for attending therapy appointments. Although most patients and parents were perceived to have good general health, mothers had a worse perception of their own general health than fathers. Compared with fathers, mothers reported a greater impact of caring for a child with DS on their social life, relationships with family and friends, time and energy, and professional life. CONCLUSION Families caring for a child with DS experience considerable social and economic impact, with an apparent greater burden of care on the mother than the father.
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Rexach J, Lee H, Martinez-Agosto JA, Németh AH, Fogel BL. Clinical application of next-generation sequencing to the practice of neurology. Lancet Neurol 2020; 18:492-503. [PMID: 30981321 DOI: 10.1016/s1474-4422(19)30033-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/21/2018] [Accepted: 01/02/2019] [Indexed: 01/05/2023]
Abstract
Next-generation sequencing technologies allow for rapid and inexpensive large-scale genomic analysis, creating unprecedented opportunities to integrate genomic data into the clinical diagnosis and management of neurological disorders. However, the scale and complexity of these data make them difficult to interpret and require the use of sophisticated bioinformatics applied to extensive datasets, including whole exome and genome sequences. Detailed analysis of genetic data has shown that accurate phenotype information is essential for correct interpretation of genetic variants and might necessitate re-evaluation of the patient in some cases. A multidisciplinary approach that incorporates bioinformatics, clinical evaluation, and human genetics can help to address these challenges. However, despite numerous studies that show the efficacy of next-generation sequencing in establishing molecular diagnoses, pathogenic mutations are generally identified in fewer than half of all patients with genetic neurological disorders, exposing considerable gaps in the understanding of the human genome and providing opportunities to focus research on improving the usefulness of genomics in clinical practice. Looking forward, the emergence of precision health in neurological care will increasingly apply genomic data analysis to pharmacogenetics, preventive medicine, and patient-targeted therapies.
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Affiliation(s)
- Jessica Rexach
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Hane Lee
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Julian A Martinez-Agosto
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of Medical Genetics, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Andrea H Németh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Oxford Centre for Genomic Medicine, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK
| | - Brent L Fogel
- Program in Neurogenetics, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Clinical Neurogenomics Research Center, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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Ghaderi Niri S, Khalaf AM, Massoud TF. The mammillothalamic tracts: Age-related conspicuity and normative morphometry on brain magnetic resonance imaging. Clin Anat 2020; 33:911-919. [PMID: 32239548 DOI: 10.1002/ca.23595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/21/2020] [Accepted: 03/25/2020] [Indexed: 01/24/2023]
Abstract
The mammillothalamic tract (MTT, bundle of Vicq d'Azyr) is a white-matter projection from each mammillary body to the anterior nucleus of the thalamus (ANT). Deep brain stimulation of the MTTs or ANTs is a treatment option for medically refractory focal epilepsy. Since the ANTs may be atrophied in epilepsy, targeting of the MTT terminations could be used as a proxy for ANT locations. However, MTT conspicuity and morphometry on MRI have not been evaluated to date. We investigated normative age- and sex-related MRI morphometrics of the MTTs in healthy individuals. We retrospectively analyzed magnified axial T2-weighted images of 80 subjects for bilateral MTT conspicuity, diameters, areas, shapes, precise locations, and symmetry. We statistically tested the effects of independent variables (sex and MTT side) on measured dependent variables using two-way ANOVA; and performed linear regressions with age as the independent variable for each of the dependent variables. Subjects were F:M = 44:36, with mean age 45.3 years. Only one (0.63%) MTT was inconspicuous. Mean MTT diameter was 1.8 mm, area was 2.0 mm2 , and distance from third ventricle was 3.1 mm. MTTs were mostly bilaterally symmetrical in shape, equally round, or ovoid. The right MTT diameter was larger than the left, and males had larger MTT areas than females. We found no statistical difference between MTT diameters and areas in young, middle-aged, and older adults. We report normative axial MRI morphometrics of the MTTs to guide neuromodulation treatments. Future detailed analyses will determine if the MTTs atrophy in proportion to the ANTs in refractory epilepsy.
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Affiliation(s)
- Sanaz Ghaderi Niri
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Alexander M Khalaf
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Tarik F Massoud
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Dignass A, Waller J, Cappelleri JC, Modesto I, Kisser A, Dietz L, DiBonaventura M, Wood R, May M, Libutzki B, Bargo D. Living with ulcerative colitis in Germany: a retrospective analysis of dose escalation, concomitant treatment use and healthcare costs. J Med Econ 2020; 23:415-427. [PMID: 31858853 DOI: 10.1080/13696998.2019.1707210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims: To investigate treatment of moderate-to-severe ulcerative colitis (UC) using real-world German health insurance claims data.Materials and methods: A retrospective, longitudinal cohort study was conducted from a German statutory health insurance database for adult patients with UC indexed on biologic therapy initiation (2013-2015). Anonymized data were evaluated for 12 months prior to (baseline) through 24 months after (follow-up) indexing. Biologic dose escalations, steroid and immunosuppressant use, healthcare resource utilization (HCRU) and direct healthcare costs were evaluated, with significant differences assessed across and between index biologics. Descriptive statistics, chi-square or Fisher's exact tests, and analysis of variance were performed.Results: The analysis included 304 patients (adalimumab, n = 125; golimumab, n = 47; infliximab, n = 114; vedolizumab, n = 18). Demographic and clinical characteristics were similar across biologics. Dose escalations occurred in 58% of patients (73% of patients receiving adalimumab), with 41% receiving subsequent de-escalation. Steroids were used during follow-up by 74% of patients; 25% received steroids >14 weeks after indexing. Overall, 41% of patients received an immunosuppressant during follow-up. Steroid and immunosuppressant use were similar across biologics. Total direct healthcare costs were higher during follow-up than baseline and differed significantly across treatments (p < .05), with highest costs for golimumab. Biologic costs contributed to a major portion of follow-up costs. HCRU and costs for most resources were higher in the first 12-month follow-up period than baseline. All resource use except gastroenterology visits returned to, or below, baseline levels 13-24 months post-index date.Limitations: There was potential for inappropriate inclusion/exclusion due to miscoding. Patients may have received biologics >12 months prior to the index date. Biologic originators and biosimilars could not be differentiated.Conclusions: These data suggest that control with current biologics is suboptimal. Further treatment options that provide sustained steroid-free remission for this patient population without the need for dose escalations or concomitant therapies may be warranted.
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Affiliation(s)
- Axel Dignass
- Agaplesion Markus Hospital, Frankfurt/Main, Germany
| | | | | | | | | | | | | | | | - Melanie May
- HGC Healthcare Consultants GmbH, Dusseldorf, Germany
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Green SF, Nguyen P, Kaalund-Hansen K, Rajakulendran S, Murphy E. Effectiveness, retention, and safety of modified ketogenic diet in adults with epilepsy at a tertiary-care centre in the UK. J Neurol 2020; 267:1171-1178. [PMID: 31925498 PMCID: PMC7109193 DOI: 10.1007/s00415-019-09658-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/24/2019] [Accepted: 11/27/2019] [Indexed: 01/25/2023]
Abstract
With the rising demand for ketogenic diet therapy in adult epilepsy, there is a need for research describing the real-life effectiveness, retention, and safety of relevant services. In this 1-year prospective cohort study we present outcomes of the first 100 referrals for modified ketogenic diet (MKD) at the UK's largest tertiary-care epilepsy centre, where patients received dietetic review up to twice per week. Of the first 100 referrals, 42 (31 females, 11 males; mean age 36.8 [SD ± 11.4 years]) commenced MKD, having used a mean of 4 (SD ± 3) previous antiepileptic drugs. Retention rates were: 60% at 3 months, 43% at 6 months, and 29% at 12 months. 60% of patients reported an improvement in seizure frequency, 38% reported a > 50% reduction, and 13% reported a period of seizure freedom; 30% reported a worsening in seizure frequency at some point during MKD therapy. The most common reasons for discontinuing MKD were side effects and diet restrictiveness. The most common side effects were weight loss, gastrointestinal symptoms and low mood. The likelihood of discontinuing MKD was significantly decreased by experiencing an improvement in seizure frequency (p ≤ 0.001). This study demonstrates that MKD can be effective in adults, although, even with regular dietetic support, retention rates remain low, and periods of worsening seizure frequency are common.
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Affiliation(s)
- S F Green
- Epilepsy Department, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - P Nguyen
- Charles Dent Metabolic Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - K Kaalund-Hansen
- Charles Dent Metabolic Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - S Rajakulendran
- Epilepsy Department, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Elaine Murphy
- Charles Dent Metabolic Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
- University College London, London, UK.
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Büyükçakır B, Elmaz F, Mutlu AY. Hilbert Vibration Decomposition-based epileptic seizure prediction with neural network. Comput Biol Med 2020; 119:103665. [DOI: 10.1016/j.compbiomed.2020.103665] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 12/31/2022]
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Lystad RP, Rapport F, Bleasel A, Herkes G, Nikpour A, Mitchell R. Hospital service utilization trajectories of individuals living with epilepsy in New South Wales, Australia, 2012-2016: A population-based study. Epilepsy Behav 2020; 105:106941. [PMID: 32062105 DOI: 10.1016/j.yebeh.2020.106941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to examine five-year trajectories of hospital service utilization among individuals living with epilepsy in New South Wales (NSW), Australia, and to identify factors predictive of trajectory group membership. METHODS This study used group-based trajectory modeling of hospital admissions over a five-year period for individuals living with epilepsy who had an epilepsy-related hospitalization during 1 January 2012 and 31 December 2012 in NSW, Australia (n = 5762). RESULTS The analysis revealed the following five distinct hospital service utilization trajectory groups: "one-off users" (Group 1; 22.9%), "low-chronic users" (Group 2; 47.1%), "moderate-declining users" (Group 3; 10.3%), "moderate-chronic users" (Group 4; 18.3%), and "high-chronic users" (Group 5; 1.5%). There were key features that defined trajectory group membership, in particular the relative proportions of group members with chronic health conditions, other comorbid conditions, refractory epilepsy, and status epilepticus. For instance, "high-chronic users" (Group 5) had higher proportions of individuals with chronic health conditions (34.8%) and refractory epilepsy (19.1%); "moderate-declining users" (Group 3) had higher proportions of individuals with chronic health conditions (35.1%) and status epilepticus (9.8%); and "low-chronic users" (Group 2) had the lowest proportion of individuals with chronic health conditions. CONCLUSION It is important to gain a better understanding of hospital service utilization among individuals living with epilepsy. This research has identified trajectory groups of hospital service utilization profiles of individuals living with epilepsy. Identification of predictors of trajectory group membership allows targeting of strategies to reduce hospital admissions, inform healthcare service delivery, and improve the health and wellbeing of individuals living with epilepsy.
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Affiliation(s)
- Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Andrew Bleasel
- University of Sydney, Sydney, Australia; Westmead Hospital, Sydney, Australia
| | - Geoffrey Herkes
- University of Sydney, Sydney, Australia; Royal North Shore Hospital, Sydney, Australia
| | - Armin Nikpour
- University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Sydney, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Abril Jaramillo J, Estévez María JC, Girón Úbeda JM, Vega López Ó, Calzado Rivas ME, Pérez Díaz H, García Martín G, Vila Herrero E, Chamorro-Muñoz M, Vázquez F, De la Fuente C, Redondo L, Peláez N, Santágueda P, Rodríguez Uranga JJ. Effectiveness and safety of perampanel as early add-on treatment in patients with epilepsy and focal seizures in the routine clinical practice: Spain prospective study (PERADON). Epilepsy Behav 2020; 102:106655. [PMID: 31812902 DOI: 10.1016/j.yebeh.2019.106655] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Perampanel (PER) has been shown to be effective as an adjunctive therapy for controlling refractory focal-onset seizures (FOS). However, the information as early add-on for the treatment of FOS in the clinical practice is still scarce and must be further assessed. METHODS An observational prospective study was conducted to evaluate the effectiveness of early add-on PER, assessed as 50% responders (seizure frequency reduced by at least 50% during the last 3 months as compared with baseline) rate at 6 and 12 months, in patients with FOS in the routine clinical practice of Spain. RESULTS One hundred and thirteen patients (mean age: 40.3 years, 51.3% male) with FOS received PER as early add-on (1st add-on: 37.2% and 2nd: 62.8%) for a mean exposure of 11 months (mean PER dose: 6.3 mg/day at month 12). At 6 months, 50.4% and 20.4% of the patients were responders and seizure-free (respectively) relative to baseline (3 months prior to PER initiation), and at 12 months, 68.1% and 26.5% of the patients were responders and seizure-free (respectively), relative to baseline (3 months prior to PER initiation). The retention rate at 6 and 12 months was 83.2% and 80.5%, respectively. The percentage of seizure-free patients at 12 months was significantly (p = 0.033) higher when PER was added as first vs. second add-on. The number of concomitant antiepileptic drugs (AEDs) was significantly reduced from baseline to 6 and 12 months (p = 0.001). Treatment was simplified in 23.9% of patients at the end of the observation period. Drug-related adverse events (AEs), most mild or moderate, were reported in 30.1% of patients, with irritability (8%) and dizziness (7.1%) as the most frequent ones. CONCLUSIONS This is the first observational, prospective study to evaluate efficacy and safety of early adjunctive treatment with PER in patients with focal epilepsy at 12 months. Perampanel demonstrated a good efficacy and safety profile when used at a median dose of 6 mg/day, regardless of the combination with other AEDs. Adverse events were mild or moderate, with dizziness being the most frequent one.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - F Vázquez
- Hospital de Torrecárdenas, Almería, Spain
| | | | | | - N Peláez
- Hospital Reina Sofía, Córdoba, Spain
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Efficacy and adverse event profile of cannabidiol and medicinal cannabis for treatment-resistant epilepsy: Systematic review and meta-analysis. Epilepsy Behav 2020; 102:106635. [PMID: 31731110 DOI: 10.1016/j.yebeh.2019.106635] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022]
Abstract
This paper aimed to systematically examine the efficacy and adverse event (AE) profile of cannabidiol and medicinal cannabis by analyzing qualitative and meta-analytic data. We used the terms ("Cannabidiol" OR "Cannabis") AND "Epilepsy" AND ("Treatment" OR "Therapeutics") as keywords to retrieve studies indexed on PubMed, ScienceDirect, and CENTRAL databases. The inclusion criteria were as follows: clinical studies with a longitudinal observational design and intervention using cannabinoid derivatives, especially cannabidiol and medicinal cannabis, whereby some results involved the frequency of epileptic seizures. We used Cochrane Collaboration's Review Manager software (RevMan 5.1.6) for the meta-analysis and dichotomized the articles to a confidence interval of 95%. From 236 articles, we selected 16 for descriptive analysis; we selected only 4 for the meta-analysis. According to the results, a statistically meaningful effect of cannabidiol compared with placebo was observed (p < 0.00001). When comparing treatment with cannabidiol or medicinal cannabis, significance was not found for the AE profile (p = 0.74). As AEs for cannabidiol were more common under short-term than under long-term treatment (p < 0.00001), this approach was favorable in the long term. Furthermore, cannabidiol is more effective than placebo, regardless of the etiology of epileptic syndromes and dosage. Overall, the AE profile did not differ across treatments with cannabidiol or medicinal cannabis, though it did differ favorably for long-term than for short-term treatment.
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Brain microstructural abnormalities correlate with KCC2 downregulation in refractory epilepsy. Neuroreport 2019; 30:409-414. [PMID: 30817684 DOI: 10.1097/wnr.0000000000001216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Dysregulations in the expression level of Na-K-Cl cotransporter (NKCC1) and K-Cl cotransporter (KCC2) genes have been detected in the brain tissues of patients with refractory epilepsy. Given the importance of these proteins in the determination of Cl equilibrium potential (ECl), evaluation of the expression changes of these transporters might assist in optimizing the diagnostic approaches and therapeutic strategies. The present investigation evaluates the expression level chloride transporters in polymorphonuclear cells and their correlation with microstructural abnormalities. Thirty cases of drug-resistant epilepsy (confirmed with temporal lobe epilepsy diagnosis) fulfilled the considered inclusion criteria. Cases were divided into two groups, one with a detectable MRI lesion (19 participants; right side) and another with no MRI findings (11 participants). Whole-brain voxel-based analysis was performed on diffusion tensor imaging to measure fractional anisotropy and mean diffusivity; neurite orientation dispersion and density imaging was performed to map neurite density index and orientation dispersion index. Our results indicated that fractional anisotropy and mean diffusivity changed in temporal and extratemporal parts of the brain, whereas the changes in neurite density index and orientation dispersion index were exclusively obvious in the temporal lobe. Molecular studies revealed significantly lower levels of KCC2 expression in patients with epilepsy, a finding that remarkably correlated with microstructural changes as well. Our research showed that downregulation of KCC2 and microstructural abnormalities might contribute to the observed refractoriness in temporal lobe epilepsy.
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Willems LM, Hamer HM, Knake S, Rosenow F, Reese JP, Strzelczyk A. General Trends in Prices and Prescription Patterns of Anticonvulsants in Germany between 2000 and 2017: Analysis of National and Cohort-Based Data. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:707-722. [PMID: 31161366 DOI: 10.1007/s40258-019-00487-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Our aim was to explore trends in price evolution and prescription volumes of anticonvulsants (AEDs, antiepileptic drugs) in Germany between 2000 and 2017. METHOD This study used data from annual reports on mean prescription frequency and prices of defined daily doses (DDD) of AEDs in Germany to analyze nationwide trends. Interrupted time series (ITS) analysis was employed to test for significant effects of several statutory healthcare reforms in Germany on AED price evolution. These data were compared to cohort-based prescription patterns of four German cohort studies from 2003, 2008, 2013, and 2016 that included a total of 1368 patients with focal and generalized epilepsies. RESULTS Analysis of national prescription data between 2000 and 2017 showed that mean prices per DDD of third-generation AEDs decreased by 65% and mean prices of second-generation AEDs decreased by 36%, whereas mean prices of first-generation AEDs increased by 133%. Simultaneously, mean prescription frequency of third- generation AEDs increased by 2494%, while there was a substantial decrease in the use of first- (- 55%) and second- (- 16%) generation AEDs. ITS analysis revealed that in particular the introduction of mandatory rebates on drugs in 2003 affected prices of frequently used newer AEDs. These findings are consistent with data from cohort studies of epilepsy patients showing a general decrease of prices for frequently used AEDs in monotherapy by 62% and in combination therapies by 68%. The analysis suggests that overall expenses for AEDs remained stable despite an increase in the prescription of "newer" and "non-enzyme-inducing" AEDs for epilepsy patients. CONCLUSION Between 2000 and 2017, a distinct decline in AED prices can be observed that seems predominately caused by a governmentally obtained price decline of third- and second-generation drugs. These observations seem to be the result of a German statutory cost containment policy applied across all health-care sectors. The increasing use of third-generation AEDs to the disadvantage of "old" and "enzyme-inducing" AEDs reflects the preferences of physicians and patients with epilepsy and follows national treatment guidelines.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Hajo M Hamer
- Epilepsy Center Erlangen and Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Susanne Knake
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Jens-Peter Reese
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
- Coordinating Center for Clinical Trials, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
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Slater JD, Eaddy M, Butts CM, Meltser I, Murty S. The real-world economic impact of home-based video electroencephalography: the payer perspective. J Med Econ 2019; 22:1030-1040. [PMID: 31237168 DOI: 10.1080/13696998.2019.1636382] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: Electroencephalography (EEG) is an established method to evaluate and manage epilepsy; video EEG (VEEG) has significantly improved its diagnostic value. This study compared healthcare costs and diagnostic-related outcomes associated with outpatient vs inpatient VEEG among patients with epilepsy in the US. Materials and methods: This study used Truven MarketScan Commercial and Medicare Supplemental claims databases. Patients with a VEEG between July 1, 2013 and December 31, 2016 were identified. Index event was the first VEEG claim, which was used to determine inpatient and outpatient cohorts. Continuous health plan enrollment 6 months pre- and 12 months post-index VEEG was required. Primary outcomes were costs during the index event and 12 months post index. A generalized linear model with gamma distribution and a log link was used to estimate adjusted index and post-index costs. Results: Controlling for baseline differences, epilepsy-related cost of index VEEG was significantly lower for the outpatient ($4,098) vs the inpatient cohort ($13,821; p < 0.0001). The cost differences observed at index were maintained in the post-index period. The 12-month post-index epilepsy-related costs were lower in the outpatient cohort ($6,114 vs $12,733, p < 0.0001). Time from physician referral to index VEEG was significantly shorter in the outpatient cohort (30.6 vs 42.5 days). Patients in the inpatient cohort were also more likely to undergo an additional subsequent follow-up inpatient VEEG (p < 0.0001). Limitations: Administrative claims data have limitations, including lack of data on clinical presentation, disease severity, and comprehensive health plan information. Generalizability may be limited to a US insured population of patients who met study criteria. Conclusions: Index VEEG was less costly in an outpatient vs inpatient cohort, and costs were lower during the follow-up period of 12 months, suggesting that outpatient VEEG can be provided to appropriate patients as a less costly option. There were fewer follow-up tests in the outpatient cohort with similar pre- and post-index diagnoses.
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Costs and cost-drivers of a diagnosis of depression among adults with epilepsy in the United States. Epilepsy Behav 2019; 98:96-100. [PMID: 31301456 DOI: 10.1016/j.yebeh.2019.04.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the amount of direct costs associated with occurrence of depression in people with epilepsy. METHODS The Medical Expenditure Panel Survey Household Components (MEPS-HC) served as data source to identify adults (≥18 years) with epilepsy from 2003 to 2014, using the Clinical Classification Code CCC-83. Annual unadjusted per person total healthcare expenditures and individual cost components (inpatient, outpatient, prescription, emergency room, and home health) were compared between people with epilepsy and depression vs. without depression. A two-part model estimated the adjusted incremental direct cost of depression (total and individual cost components) among adults with epilepsy. The model was adjusted for sex, race/ethnicity, education, marital status, insurance status, census region, income, Charlson Comorbidities index (CCI), and year trend. RESULTS Out of a weighted 1,942,413 US adults with epilepsy, 675,037 (34.7%) had a diagnosis of depression. Annual total unadjusted per person direct cost of depression was $5290 higher in people with epilepsy vs. without [$18,776 (95% confidence interval [CI]: 16,241-21,311) vs. $13,486 (95%CI: 9780-17,191)]. Costs for outpatient and prescriptions were higher among people with epilepsy plus depression vs. without depression, but no differences were observed for inpatient, emergency room, and home health costs. In the adjusted model, total costs [$2523 (95%CI: 62-4984)], incremental annual direct costs per person for outpatient [$1940 (95%CI: 1266-2613)], prescriptions [$1285 (95%CI: 772-1798)], and emergency room [$191 (95%CI: 20-361)] were significantly higher for people with epilepsy plus depression. Unadjusted and adjusted incremental total aggregate annual direct costs of depression for people with epilepsy were $3.5 billion and $1.7 billion respectively. CONCLUSION Costs of epilepsy with presence of depression in the US are high, and primarily driven by outpatient, prescriptions, and emergency room costs.
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Rampp S, Stefan H, Wu X, Kaltenhäuser M, Maess B, Schmitt FC, Wolters CH, Hamer H, Kasper BS, Schwab S, Doerfler A, Blümcke I, Rössler K, Buchfelder M. Magnetoencephalography for epileptic focus localization in a series of 1000 cases. Brain 2019; 142:3059-3071. [PMID: 31373622 DOI: 10.1093/brain/awz231] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 02/05/2023] Open
Abstract
Abstract
The aim of epilepsy surgery in patients with focal, pharmacoresistant epilepsies is to remove the complete epileptogenic zone to achieve long-term seizure freedom. In addition to a spectrum of diagnostic methods, magnetoencephalography focus localization is used for planning of epilepsy surgery. We present results from a retrospective observational cohort study of 1000 patients, evaluated using magnetoencephalography at the University Hospital Erlangen over the time span of 28 years. One thousand consecutive cases were included in the study, evaluated at the University Hospital Erlangen between 1990 and 2018. All patients underwent magnetoencephalography as part of clinical workup for epilepsy surgery. Of these, 405 underwent epilepsy surgery after magnetoencephalography, with postsurgical follow-ups of up to 20 years. Sensitivity for interictal epileptic activity was evaluated, in addition to concordance of localization with the consensus of presurgical workup on a lobar level. We evaluate magnetoencephalography characteristics of patients who underwent epilepsy surgery versus patients who did not proceed to surgery. In operated patients, resection of magnetoencephalography localizations were related to postsurgical seizure outcomes, including long-term results after several years. In comparison, association of lesionectomy with seizure outcomes was analysed. Measures of diagnostic accuracy were calculated for magnetoencephalography resection and lesionectomy. Sensitivity for interictal epileptic activity was 72% with significant differences between temporal and extra-temporal lobe epilepsy. Magnetoencephalography was concordant with the presurgical consensus in 51% and showed additional or more focal involvement in an additional 32%. Patients who proceeded to surgery showed a significantly higher percentage of monofocal magnetoencephalography results. Complete magnetoencephalography resection was associated with significantly higher chances to achieve seizure freedom in the short and long-term. Diagnostic accuracy was significant in temporal and extra-temporal lobe cases, but was significantly higher in extra-temporal lobe epilepsy (diagnostic odds ratios of 4.4 and 41.6). Odds ratios were also higher in non-lesional versus lesional cases (42.0 versus 6.2). The results show that magnetoencephalography provides non-redundant information, which significantly contributes to patient selection, focus localization and ultimately long-term seizure freedom after epilepsy surgery. Specifically in extra-temporal lobe epilepsy and non-lesional cases, magnetoencephalography provides excellent accuracy.
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Affiliation(s)
- Stefan Rampp
- Department of Neurosurgery, University Hospital Erlangen, Germany
- Department of Neurosurgery, University Hospital Halle (Saale), Germany
| | - Hermann Stefan
- Department of Neurology, University Hospital Erlangen, Germany
| | - Xintong Wu
- Department of Neurosurgery, University Hospital Erlangen, Germany
- Department of Neurology, West China Hospital, Sichuan University, Sichuan, China
| | | | - Burkhard Maess
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Carsten H Wolters
- Institute for Biomagnetism and Biosignalanalysis, University Münster, Germany
| | - Hajo Hamer
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Germany
| | - Burkhard S Kasper
- Department of Neurology, Epilepsy Center, University Hospital Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University Hospital Erlangen, Germany
| | - Arndt Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Germany
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Germany
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Wang X, Zhang W, Li J, Yu M, Dong M, Meng H. Collapsin Response Mediator Protein 2, a Potential Therapeutic Target in Temporal Lobe Epilepsy. NEUROCHEM J+ 2019. [DOI: 10.1134/s1819712419020144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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73
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Long S, Zhou H, Li S, Wang T, Ma Y, Li C, Zhou Y, Zhou S, Wu B, Wang Y. The Clinical and Genetic Features of Co-occurring Epilepsy and Autism Spectrum Disorder in Chinese Children. Front Neurol 2019; 10:505. [PMID: 31139143 PMCID: PMC6527735 DOI: 10.3389/fneur.2019.00505] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/26/2019] [Indexed: 12/18/2022] Open
Abstract
There is still no comprehensive description of the general population regarding clinical features and genetic etiology for co-occurring epilepsy and autism spectrum disorder (ASD) in Chinese children. This study was a retrospective study of children diagnosed with epilepsy and ASD from January 1st, 2015, to May 1st, 2018, at the Children's Hospital of Fudan University. A total of 117 patients met the inclusion criteria, and 103 subjects were eligible. Among them, 88 underwent genetic testing, and 47 children (53.4%) were identified as having pathogenic or likely pathogenic variants: 39 had single gene mutations (83.0%, 39/47), and eight had copy number variants (17.0%, 8/47), with SCN1A (14.9%, 7/47) and MECP2 (10.6%, 5/47) gene mutations being the most common. Mutations in other genes encoding voltage-gated ion channels including SCN2A, CACNA1A, CACNA1H, CACNA1D, and KCNQ2 were also common, but the number of individual cases for each gene was small. Epilepsy syndrome and epilepsy-associated syndrome were more common (P = 0.014), and higher rates of poly-therapy (P = 0.01) were used in the positive genetic test group than in the negative group. There were no statistically significant differences in drug-refractory epilepsy, ASD severity, or intellectual disability between the positive genetic test group and the negative genetic group. These data strongly indicate the need for ASD screening in children with epilepsy with voltage-gated ion channel gene variants for better diagnosis and early intervention.
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Affiliation(s)
- Shasha Long
- Department of Neurology, Epilepsy Center, Children's Hospital of Fudan University, Shanghai, China
| | - Hao Zhou
- Department of Neurology, Epilepsy Center, Children's Hospital of Fudan University, Shanghai, China.,Department of Neurology, Guizhou Provincial People's Hospital, Medical College of Guizhou University, Guizhou, China
| | - Shuang Li
- Department of Neurology, Epilepsy Center, Children's Hospital of Fudan University, Shanghai, China
| | - Tianqi Wang
- Department of Neurology, Epilepsy Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yu Ma
- Department of Neurology, Epilepsy Center, Children's Hospital of Fudan University, Shanghai, China
| | - Chunpei Li
- Department of Neurology, Epilepsy Center, Children's Hospital of Fudan University, Shanghai, China
| | - Yuanfeng Zhou
- Department of Neurology, Epilepsy Center, Children's Hospital of Fudan University, Shanghai, China
| | - Shuizhen Zhou
- Department of Neurology, Epilepsy Center, Children's Hospital of Fudan University, Shanghai, China
| | - Bingbing Wu
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, Epilepsy Center, Children's Hospital of Fudan University, Shanghai, China
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Reaven NL, Funk SE, Lyons PD, Story TJ. The direct cost of seizure events in severe childhood-onset epilepsies: A retrospective claims-based analysis. Epilepsy Behav 2019; 93:65-72. [PMID: 30831405 DOI: 10.1016/j.yebeh.2019.01.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/17/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The objective of the study was to assess the direct cost of medically treated seizure events in severe childhood-onset epilepsies. Lennox-Gastaut syndrome (LGS), Dravet syndrome (DS), and tuberous sclerosis complex (TSC) are representative conditions associated with frequent intractable seizures. METHODS Commercial and Medicaid insurance claims from 2010 to 2015 were queried to identify patients with possible LGS, possible DS, or TSC, having ≥2 years of continuous insurance from the date of first epilepsy/seizure diagnosis or antiepileptic drug (AED) fill (index date). Utilization and cost data in patients with and without seizure events requiring acute treatment were evaluated for two years postindex. Medically treated seizure events resulting in minor, moderate, severe, and no injury were included. Average costs were normalized to 2017 dollars at 3% per annum and reported for each cohort, by insurance type and degree of injury. RESULTS Among 9754 patients, 55.4-58.8% of LGS, 47.7-55.8% of DS, and 13.7-28.0% of TSC cohorts had ≥1 medically treated seizure event, depending on insurance type. Events during two-year postindex averaged 2.8-3.3 in LGS, 3.1-3.3 in DS, and 1.9-2.2 in TSC; cost per event averaged $8147-$14,759 in LGS, $4637-$8751 in DS, and $5335-$9672 in TSC. In patients with events, average all-cause costs per-patient-per-year (PPPY) were $71,512-$84,939 in LGS; $31,278-$43,758 in DS; and $42,997-$48,330 in TSC. CONCLUSIONS Patients with intractable seizures having at least one medically treated seizure event incur substantial all-cause costs. Our results can be used to inform cost effectiveness and budget impact models to estimate the value of existing and future treatments for these and similar conditions.
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Affiliation(s)
| | | | - Paul D Lyons
- Virginia Comprehensive Epilepsy Program, Winchester, VA, USA
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Willems LM, Kondziela JM, Knake S, Schulz J, Neif B, Schade B, Gerlinger S, Neubauer BA, Brunst B, Schubert-Bast S, Fuchs S, Staab-Kupke H, Kniess T, Rosenow F, Strzelczyk A. Counseling and social work for people with epilepsy in Germany: A cross-sectional multicenter study on demand, frequent content, patient satisfaction, and burden-of-disease. Epilepsy Behav 2019; 92:114-120. [PMID: 30654230 DOI: 10.1016/j.yebeh.2018.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The diagnosis of epilepsy is accompanied by relevant personal, interpersonal, and professional restrictions for patients and their caregivers. Specialized epilepsy counseling services (ECS) have been introduced to inform, advise, and support patients with disease-related problems. AIM AND SCOPE The objective of this cross-sectional, multicenter study was to determine the demand, typical content, and outcomes of ECS in children, adolescents, and adults in two adjacent German regions of Hessen and Lower Franconia. All ECS sites in these regions participated in 2014 and 2015, offering a total population of 7.5 million inhabitants. RESULTS A total number of 435 patients [323 adults (74.3%), 51.7% female, mean age: 40.3 ± 14.7 years and 112 children/adolescents (25.7%), 52.7% female, mean age: 9.4 ± 4.6 years] were enrolled at six ECS sites. The most common reasons for counseling were general information needs (n = 304; 69.9%), administrative help (n = 208; 47.8%), problems with education or work (n = 176; 40.5%), and recreational activities (n = 119; 27.3%). In addition, 6.2% reported epilepsy-related questions on family planning as a specific reason for desiring counseling. Recommendation by the treating physicians was the most frequent reason for receiving counseling through ECS (62.5%), and most patients preferred to receive a personal consultation (73.1%). Patient satisfaction as measured by the ZUF-8 client satisfaction score was high with a mean of 29.7 points (standard deviation: ±2.7 points, median: 29.9 points), and 83.9% of patients said they would recommend ECS. Disease-related job loss or change in school was avoided in 72% of 82 patients. Suggestions for improvement of ECS included an extension of service hours (58.6%) and a better availability of more sites located nearby (32.8%). CONCLUSION Epilepsy counseling services are necessary, valued, and effective institutions for people with epilepsy complementing outpatient and inpatient care. To improve the care for people with epilepsy, access to and availability of ECS should be improved.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Jacqueline M Kondziela
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Juliane Schulz
- Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Birgit Neif
- Department of Neurology, Hephata-Klinik, Schwalmstadt-Treysa, Germany
| | - Bernd Schade
- Department of Neurology, Hephata-Klinik, Schwalmstadt-Treysa, Germany
| | - Stefan Gerlinger
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernd A Neubauer
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernhard Brunst
- Epilepsy Counseling Diakonisches Werk Hochtaunus, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Simone Fuchs
- Epilepsy Counseling Unterfranken, Stiftung Juliusspital, Würzburg, Germany
| | | | - Tobias Kniess
- Department of Neurology, Campus Rhön Klinikum AG, Bad Neustadt a.d. Saale, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany.
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Mumford V, Rapport F, Shih P, Mitchell R, Bleasel A, Nikpour A, Herkes G, MacRae A, Bartley M, Vagholkar S, Braithwaite J. Promoting faster pathways to surgery: a clinical audit of patients with refractory epilepsy. BMC Neurol 2019; 19:29. [PMID: 30782132 PMCID: PMC6381714 DOI: 10.1186/s12883-019-1255-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/07/2019] [Indexed: 11/17/2022] Open
Abstract
Background Individuals with epilepsy who cannot be adequately controlled with anti-epileptic drugs, refractory epilepsy, may be suitable for surgical treatment following detailed assessment. This is a complex process and there are concerns over delays in referring refractory epilepsy patients for surgery and subsequent treatment. The aim of this study was to explore the different patient pathways, referral and surgical timeframes, and surgical and medical treatment options for refractory epilepsy patients referred to two Tertiary Epilepsy Clinics in New South Wales, Australia. Methods Clinical records were reviewed for 50 patients attending the two clinics, in two large teaching hospitals (25 in Clinic 1; 25 in Clinic 2. A purpose-designed audit tool collected detailed aspects of outpatient consultations and treatment. Patients with refractory epilepsy with their first appointment in 2014 were reviewed for up to six visits until the end of 2016. Data collection included: patient demographics, type of epilepsy, drug management, and assessment for surgery. Outcomes included: decisions regarding surgical and/or medical management, and seizure status following surgery. Patient-reported outcome measures to assess anxiety and depression were collected in Clinic 1 only. Results Patient mean age was 38.3 years (SD 13.4), the mean years since diagnosis was 17.3 years (SD 9.8), and 88.0% of patients had a main diagnosis of focal epilepsy. Patients were taking an average of 2.3 (SD 0.9) anti-epileptic drugs at the first clinic visit. A total of 17 (34.0%) patients were referred to the surgical team and 11 (22.0%) underwent a neuro-surgical procedure. The average waiting time between visit 1 to surgical referral was 38.8 weeks (SD 25.1), and between visit 1 and the first post-operative visit was 55.8 weeks (SD 25.0). Conclusion The findings confirm international data showing significant waiting times between diagnosis of epilepsy and referral to specialist clinics for surgical assessment and highlight different approaches in each clinic in terms of visit numbers and recorded activities. A standardised pathway and data collection, including patient-reported outcome measures, would provide better evidence for whether promoting earlier referral and assessment for surgery improves the lives of this disease group. Electronic supplementary material The online version of this article (10.1186/s12883-019-1255-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Virginia Mumford
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
| | - Frances Rapport
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Patti Shih
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Andrew Bleasel
- University of Sydney, Sydney, Australia.,Westmead Hospital, Westmead, Australia
| | - Armin Nikpour
- University of Sydney, Sydney, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - Geoffrey Herkes
- University of Sydney, Sydney, Australia.,Royal North Shore Hospital, Sydney, Australia
| | - Amy MacRae
- Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Sanjyot Vagholkar
- Primary Care & Wellbeing, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Willems LM, Reif PS, Knake S, Hamer HM, Willems C, Krämer G, Rosenow F, Strzelczyk A. Noncompliance of patients with driving restrictions due to uncontrolled epilepsy. Epilepsy Behav 2019; 91:86-89. [PMID: 29752000 DOI: 10.1016/j.yebeh.2018.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 03/31/2018] [Accepted: 04/13/2018] [Indexed: 11/26/2022]
Abstract
Epilepsies are a common and chronic neurological disorder characterized by sustained risk of recurrent seizures. Because of paroxysmal and often unpredictable occurrence of seizures, patients with uncontrolled epilepsy are subject to disease-specific restrictions in daily life, such as their career choice or specific work limitations. According to German law and many other European and international guidelines, driving is strictly prohibited in patients with uncontrolled epilepsy so as to increase active and passive safety in public road traffic. Nevertheless, a significant percentage of patients probably do not comply with these legal restrictions and drive on a regular basis. For this study, we analyzed a representative German cohort with 302 patients (mean age: 45.0 years ± 16.4; 48% male) with established epilepsy to identify the number of patients driving without permission. Overall, 58.6% (n = 177) of patients had a driving license, 71.1% (n = 69/97) of patients were in seizure remission, and 52.7% (n = 108/205) of patients had uncontrolled epilepsy. Among patients in seizure remission, 54.6% (n = 53/97) reported regular driving while, among patients with uncontrolled epilepsy, 15.1% (n = 31/205) reported driving on a regular basis. No patient in the cohort stated driving without a valid license. Permanent employment, freelance work, the absence of a relevant disability, and living alone were identified as significant risk factors, which underlines the already existing evidence for the importance of a possible restricted access to the labor market as motive for disregarding legal driving restrictions. In our opinion, specialized and generally available social counseling with a special focus on vocational and career guidance is urgently needed to improve compliance with epilepsy-caused driving restrictions and the underlying reasons for violating these rules. In addition, more effort has to be spent on improving diagnostics and treatment of epilepsy to reduce the number of patients with uncontrolled seizures. Comprehensive introduction of self-driving vehicles may also help to improve mobility of patients with refractory epilepsy.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Hajo M Hamer
- Epilepsy Center Erlangen and Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | | | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
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Willems LM, Reif PS, Spyrantis A, Cattani A, Freiman TM, Seifert V, Wagner M, You SJ, Schubert-Bast S, Bauer S, Klein KM, Rosenow F, Strzelczyk A. Invasive EEG-electrodes in presurgical evaluation of epilepsies: Systematic analysis of implantation-, video-EEG-monitoring- and explantation-related complications, and review of literature. Epilepsy Behav 2019; 91:30-37. [PMID: 29907526 DOI: 10.1016/j.yebeh.2018.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stereoelectroencephalography (sEEG) is a diagnostic procedure for patients with refractory focal epilepsies that is performed to localize and define the epileptogenic zone. In contrast to grid electrodes, sEEG electrodes are implanted using minimal invasive operation techniques without large craniotomies. Previous studies provided good evidence that sEEG implantation is a safe and effective procedure; however, complications in asymptomatic patients after explantation may be underreported. The aim of this analysis was to systematically analyze clinical and imaging data following implantation and explantation. RESULTS We analyzed 18 consecutive patients (mean age: 30.5 years, range: 12-46; 61% female) undergoing invasive presurgical video-EEG monitoring via sEEG electrodes (n = 167 implanted electrodes) over a period of 2.5 years with robot-assisted implantation. There were no neurological deficits reported after implantation or explantation in any of the enrolled patients. Postimplantation imaging showed a minimal subclinical subarachnoid hemorrhage in one patient and further workup revealed a previously unknown factor VII deficiency. No injuries or status epilepticus occurred during video-EEG monitoring. In one patient, a seizure-related asymptomatic cross break of two fixation screws was found and led to revision surgery. Unspecific symptoms like headaches or low-grade fever were present in 10 of 18 (56%) patients during the first days of video-EEG monitoring and were transient. Postexplantation imaging showed asymptomatic and small bleedings close to four electrodes (2.8%). CONCLUSION Overall, sEEG is a safe and well-tolerated procedure. Systematic imaging after implantation and explantation helps to identify clinically silent complications of sEEG. In the literature, complication rates of up to 4.4% in sEEG and in 49.9% of subdural EEG are reported; however, systematic imaging after explantation was not performed throughout the studies, which may have led to underreporting of associated complications.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany.
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Andrea Spyrantis
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe-University, Frankfurt am Main, Germany
| | - Marlies Wagner
- Department of Neuroradiology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Se-Jong You
- Department of Neuroradiology, Goethe-University, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Karl Martin Klein
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany
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Long-Term, Targeted Delivery of GDNF from Encapsulated Cells Is Neuroprotective and Reduces Seizures in the Pilocarpine Model of Epilepsy. J Neurosci 2019; 39:2144-2156. [PMID: 30665947 DOI: 10.1523/jneurosci.0435-18.2018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 11/14/2018] [Accepted: 12/14/2018] [Indexed: 12/19/2022] Open
Abstract
Neurotrophic factors are candidates for treating epilepsy, but their development has been hampered by difficulties in achieving stable and targeted delivery of efficacious concentrations within the desired brain region. We have developed an encapsulated cell technology that overcomes these obstacles by providing a targeted, continuous, de novo synthesized source of high levels of neurotrophic molecules from human clonal ARPE-19 cells encapsulated into hollow fiber membranes. Here we illustrate the potential of this approach for delivering glial cell line-derived neurotrophic factor (GDNF) directly to the hippocampus of epileptic rats. In vivo studies demonstrated that bilateral intrahippocampal implants continued to secrete GDNF that produced high hippocampal GDNF tissue levels in a long-term manner. Identical implants robustly reduced seizure frequency in the pilocarpine model. Seizures were reduced rapidly, and this effect increased in magnitude over 3 months, ultimately leading to a reduction of seizures by 93%. This effect persisted even after device removal, suggesting potential disease-modifying benefits. Importantly, seizure reduction was associated with normalized changes in anxiety and improved cognitive performance. Immunohistochemical analyses revealed that the neurological benefits of GDNF were associated with the normalization of anatomical alterations accompanying chronic epilepsy, including hippocampal atrophy, cell degeneration, loss of parvalbumin-positive interneurons, and abnormal neurogenesis. These effects were associated with the activation of GDNF receptors. All in all, these results support the concept that the implantation of encapsulated GDNF-secreting cells can deliver GDNF in a sustained, targeted, and efficacious manner, paving the way for continuing preclinical evaluation and eventual clinical translation of this approach for epilepsy.SIGNIFICANCE STATEMENT Epilepsy is one of the most common neurological conditions, affecting millions of individuals of all ages. These patients experience debilitating seizures that frequently increase over time and can associate with significant cognitive decline and psychiatric disorders that are generally poorly controlled by pharmacotherapy. We have developed a clinically validated, implantable cell encapsulation system that delivers high and consistent levels of GDNF directly to the brain. In epileptic animals, this system produced a progressive and permanent reduction (>90%) in seizure frequency. These benefits were accompanied by improvements in cognitive and anxiolytic behavior and the normalization of changes in CNS anatomy that underlie chronic epilepsy. Together, these data suggest a novel means of tackling the frequently intractable neurological consequences of this devastating disorder.
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Prevalence, risk factors and therapeutic aspects of injuries and accidents in women with epilepsy. Eur J Trauma Emerg Surg 2018; 45:375-381. [DOI: 10.1007/s00068-018-1030-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/08/2018] [Indexed: 11/26/2022]
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Mela A, Staniszewska A, Wrona W, Poniatowski ŁA, Jaroszyński J, Niewada M. The direct and indirect costs of epilepsy in Poland estimates for 2014-2016 years. Expert Rev Pharmacoecon Outcomes Res 2018; 19:353-362. [PMID: 30293466 DOI: 10.1080/14737167.2019.1533817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND According to the current data, around 1% of the Poland population have epilepsy, which comprises about 400,000 people. This group of patients requires life-long therapy including both drug therapy and hospitalization. The character of the epilepsy has a significant impact on the expenses borne by individual patients, and the prevalence of the disease has a significant impact on the health care system. METHODS This article aims to measure the direct and indirect costs of epilepsy in Poland estimates for the years 2014-2016 (top-down approach). We use a modified human capital approach and a unique dataset provided by the number of Polish institutions including National Health Fund, Social Insurance Institution, and Central Statistical Office. RESULTS Epilepsy burden in Poland is significant. In the years 2014-2016, the total direct cost of epilepsy amounted to, respectively, 355 mln PLN (84 mln EUR), 368 mln PLN (87 mln EUR), and 373 mln PLN (88 mln EUR), but the total indirect cost amounted to 1 bn PLN (239 mln EUR), 949 mln PLN (224 mln EUR), and 848 mln PLN (200 mln EUR). CONCLUSIONS Direct and indirect costs of epilepsy can be a useful input for health technology analyses of drugs or economic impact assessments of public health programs.
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Affiliation(s)
- Aneta Mela
- a Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT) , Medical University of Warsaw , Warsaw , Poland
| | - Anna Staniszewska
- a Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT) , Medical University of Warsaw , Warsaw , Poland
| | | | - Łukasz A Poniatowski
- a Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT) , Medical University of Warsaw , Warsaw , Poland.,c Department of Neurosurgery , Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology , Warsaw , Poland
| | - Janusz Jaroszyński
- d Department of Public Health, 2nd Faculty of Medicine , Medical University of Lublin , Lublin , Poland
| | - Maciej Niewada
- a Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT) , Medical University of Warsaw , Warsaw , Poland
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Willems LM, Kay L, Rosenow F, Strzelczyk A. Krankheitskosten und Outcome: Versorgungsrealität des Status epilepticus. ZEITSCHRIFT FUR EPILEPTOLOGIE 2018. [DOI: 10.1007/s10309-018-0205-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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83
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Baumgartner C, Koren JP, Rothmayer M. Automatic Computer-Based Detection of Epileptic Seizures. Front Neurol 2018; 9:639. [PMID: 30140254 PMCID: PMC6095028 DOI: 10.3389/fneur.2018.00639] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/17/2018] [Indexed: 11/28/2022] Open
Abstract
Automatic computer-based seizure detection and warning devices are important for objective seizure documentation, for SUDEP prevention, to avoid seizure related injuries and social embarrassments as a consequence of seizures, and to develop on demand epilepsy therapies. Automatic seizure detection systems can be based on direct analysis of epileptiform discharges on scalp-EEG or intracranial EEG, on the detection of motor manifestations of epileptic seizures using surface electromyography (sEMG), accelerometry (ACM), video detection systems and mattress sensors and finally on the assessment of changes of physiologic parameters accompanying epileptic seizures measured by electrocardiography (ECG), respiratory monitors, pulse oximetry, surface temperature sensors, and electrodermal activity. Here we review automatic seizure detection based on scalp-EEG, ECG, and sEMG. Different seizure types affect preferentially different measurement parameters. While EEG changes accompany all types of seizures, sEMG and ACM are suitable mainly for detection of seizures with major motor manifestations. Therefore, seizure detection can be optimized by multimodal systems combining several measurement parameters. While most systems provide sensitivities over 70%, specificity expressed as false alarm rates still needs to be improved. Patients' acceptance and comfort of a specific device are of critical importance for its long-term application in a meaningful clinical way.
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Affiliation(s)
- Christoph Baumgartner
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Johannes P Koren
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Michaela Rothmayer
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
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84
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Willems LM, Bertsche A, Bösebeck F, Hornemann F, Immisch I, Klein KM, Knake S, Kunz R, Kurlemann G, Langenbruch L, Möddel G, Müller-Schlüter K, von Podewils F, Reif PS, Steinhoff BJ, Steinig I, Rosenow F, Schubert-Bast S, Strzelczyk A. Efficacy, Retention, and Tolerability of Brivaracetam in Patients With Epileptic Encephalopathies: A Multicenter Cohort Study From Germany. Front Neurol 2018; 9:569. [PMID: 30083127 PMCID: PMC6064736 DOI: 10.3389/fneur.2018.00569] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/25/2018] [Indexed: 01/10/2023] Open
Abstract
Objective: To evaluate the efficacy and tolerability of brivaracetam (BRV) in a severely drug refractory cohort of patients with epileptic encephalopathies (EE). Method: A multicenter, retrospective cohort study recruiting all patients treated with EE who began treatment with BRV in an enrolling epilepsy center between 2016 and 2017. Results: Forty-four patients (27 male [61%], mean age 29 years, range 6 to 62) were treated with BRV. The retention rate was 65% at 3 months, 52% at 6 months and 41% at 12 months. A mean retention time of 5 months resulted in a cumulative exposure to BRV of 310 months. Three patients were seizure free during the baseline. At 3 months, 20 (45%, 20/44 as per intention-to-treat analysis considering all patients that started BRV including three who were seizure free during baseline) were either seizure free (n = 4; 9%, three of them already seizure-free at baseline) or reported at least 25% (n = 4; 9%) or 50% (n = 12; 27%) reduction in seizures. An increase in seizure frequency was reported in two (5%) patients, while there was no change in the seizure frequency of the other patients. A 50% long-term responder rate was apparent in 19 patients (43%), with two (5%) free from seizures for more than six months and in nine patients (20%, with one [2 %] free from seizures) for more than 12 months. Treatment-emergent adverse events were predominantly of psychobehavioural nature and were observed in 16%. Significance: In this retrospective analysis the rate of patients with a 50% seizure reduction under BRV proofed to be similar to those seen in regulatory trials for focal epilepsies. BRV appears to be safe and relatively well tolerated in EE and might be considered in patients with psychobehavioral adverse events while on levetiracetam.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Astrid Bertsche
- Department of Neuropediatrics, University of Rostock, Rostock, Germany.,Centre of Pediatric Research, Hospital for Children and Adolescents, Leipzig, Germany
| | - Frank Bösebeck
- Epilepsy Center Rotenburg, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - Frauke Hornemann
- Centre of Pediatric Research, Hospital for Children and Adolescents, Leipzig, Germany
| | - Ilka Immisch
- Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Karl M Klein
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Rhina Kunz
- Epilepsy Center Greifswald and Department of Neurology, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Gerhard Kurlemann
- Department of Neuropediatrics, Westfälische Wilhelms-University, Münster, Germany
| | - Lisa Langenbruch
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology - Epileptology, Westfälische Wilhelms-University, Münster, Germany
| | - Gabriel Möddel
- Epilepsy Center Münster-Osnabrück, Department of Neurology with Institute of Translational Neurology - Epileptology, Westfälische Wilhelms-University, Münster, Germany
| | - Karen Müller-Schlüter
- Epilepsy Center for Children, University Hospital Neuruppin, Brandenburg Medical School, Neuruppin, Germany
| | - Felix von Podewils
- Epilepsy Center Greifswald and Department of Neurology, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | | | - Isabel Steinig
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neuropediatrics, Goethe University Frankfurt, Frankfurt, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
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85
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Strzelczyk A, Kay L, Bauer S, Immisch I, Klein KM, Knake S, Kowski A, Kunz R, Kurlemann G, Langenbruch L, Möddel G, Müller-Schlüter K, Reif PS, Schubert-Bast S, Steinhoff BJ, Steinig I, Willems LM, von Podewils F, Rosenow F. Use of brivaracetam in genetic generalized epilepsies and for acute, intravenous treatment of absence status epilepticus. Epilepsia 2018; 59:1549-1556. [PMID: 29943451 DOI: 10.1111/epi.14476] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate effectiveness, retention, and tolerability of brivaracetam (BRV) in genetic generalized epilepsies (GGE) in clinical practice. METHODS A multicenter, retrospective cohort study recruiting all patients that started BRV in 2016 and 2017. RESULTS A total of 61 patients (mean age = 29.8, range = 9-90 years, 41 female [67%]) were treated with BRV. They were difficult to control, with 2.4 failed antiepileptic drugs (AEDs) in the past, taking 1.9 AEDs on average at baseline. The length of exposure to BRV ranged from 7 days to 24 months, with a mean retention time of 7.9 months, resulting in a total exposure time to BRV of 483 months. The retention rate was 82% at 3 months and 69% at 6 months. Efficacy at 3 months was 36% (50% responder rate), with 25% seizure-free for 3 months. Patients with juvenile myoclonic epilepsy showed a responder rate of 60%, with 40% being free of any seizures. Long-term 50% responder rate was present in 17 patients (28%; 11 seizure-free [18%]) for >6 months and in 14 patients (23%; 10 seizure-free [16%]) for >12 months. Treatment-emergent adverse events were observed in 26% of the patients, with the most common being somnolence, ataxia, and psychobehavioral adverse events. Use of intravenous BRV with bolus injection of 200-300 mg in two females with absence status epilepticus was well tolerated, but did not result in cessation of status epilepticus. SIGNIFICANCE Use of BRV in GGE is well tolerated, and 50% responder rates are similar to those observed in the regulatory trials for focal epilepsies. An immediate switch from levetiracetam (LEV) to BRV at a ratio of 15:1 is feasible. The occurrence of psychobehavioral adverse events seems less prominent than under LEV, and a switch to BRV can be considered in patients with LEV-induced adverse events.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Epilepsy Center Hessen and Department of Neurology, Philipps University, Marburg, Germany
| | - Lara Kay
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Ilka Immisch
- Epilepsy Center Hessen and Department of Neurology, Philipps University, Marburg, Germany
| | - Karl Martin Klein
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Epilepsy Center Hessen and Department of Neurology, Philipps University, Marburg, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps University, Marburg, Germany
| | - Alexander Kowski
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Rhina Kunz
- Epilepsy Center Greifswald and Department of Neurology, Ernst Moritz Arndt University, Greifswald, Germany
| | - Gerhard Kurlemann
- Department of Neuropediatrics, Westfälische Wilhelms University, Münster, Germany
| | - Lisa Langenbruch
- Epilepsy Center Münster-Osnabrück, Department of Neurology, Westfälische Wilhelms University, Münster, Germany
| | - Gabriel Möddel
- Epilepsy Center Münster-Osnabrück, Department of Neurology, Westfälische Wilhelms University, Münster, Germany
| | - Karen Müller-Schlüter
- Epilepsy Center for Children, University Hospital Neuruppin, Brandenburg Medical School, Neuruppin, Germany
| | - Philipp S Reif
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Department of Neuropediatrics, Goethe University, Frankfurt am Main, Germany
| | | | - Isabel Steinig
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Felix von Podewils
- Epilepsy Center Greifswald and Department of Neurology, Ernst Moritz Arndt University, Greifswald, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Epilepsy Center Hessen and Department of Neurology, Philipps University, Marburg, Germany
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86
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Willems LM, Watermann N, Richter S, Kay L, Hermsen AM, Knake S, Rosenow F, Strzelczyk A. Incidence, Risk Factors and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single Center Study. Front Neurol 2018; 9:414. [PMID: 29963000 PMCID: PMC6013746 DOI: 10.3389/fneur.2018.00414] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/18/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction: This study was designed to evaluate risk factors and incidence of epilepsy-related injuries and accidents (ERIA) at an outpatient clinic of a German epilepsy center providing healthcare to a mixed urban and rural population of over one million inhabitants. Methods: Data acquisition was performed between 10/2013 and 09/2014 using a validated patient questionnaire on socioeconomic status, course of epilepsy, quality of life (QoL), depression, injuries and accidents associated with seizures or inadequate periictal patterns of behavior concerning a period of 3 months. Univariate analysis, multiple testing and regression analysis were performed to identify possible variables associated with ERIA. Results: A total of 292 patients (mean age 40.8 years, range 18-86; 55% female) were enrolled and analyzed. Focal epilepsy was diagnosed in 75% of the patients. The majority was on an antiepileptic drug (AEDs) polytherapy (mean number of AEDs: 1.65). Overall, 41 patients (14.0%) suffered from epilepsy-related injuries and accidents in a 3-month period. Besides lacerations (n = 18, 6.2%), abrasions and bruises (n = 9, 3.1%), fractures (n = 6, 2.2%) and burns (n = 3, 1.0%), 17 mild injuries (5.8%) were reported. In 20 (6.8% of the total cohort) cases, urgent medical treatment with hospitalization was necessary. Epilepsy-related injuries and accidents were related to active epilepsy, occurrence of generalized tonic-clonic seizures (GTCS) and drug-refractory course as well as reported ictal falls, ictal loss of consciousness and abnormal peri-ictal behavior in the medical history. In addition, patients with ERIA had significantly higher depression rates and lower QoL. Conclusion: ERIA and their consequences should be given more attention and standardized assessment for ERIA should be performed in every outpatient visit.
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Affiliation(s)
- Laurent M Willems
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Nina Watermann
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Saskia Richter
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Lara Kay
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Anke M Hermsen
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Susanne Knake
- Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, Philipps University of Marburg, Marburg, Germany
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87
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Willems LM, Richter S, Watermann N, Bauer S, Klein KM, Reese JP, Schöffski O, Hamer HM, Knake S, Rosenow F, Strzelczyk A. Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany from 2003 to 2013 - A ten-year overview. Epilepsy Behav 2018; 83:28-35. [PMID: 29649671 DOI: 10.1016/j.yebeh.2018.03.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022]
Abstract
This study evaluated trends in resource use and prescription patterns in patients with active epilepsy over a 10-year period at the same outpatient clinic of a German epilepsy center. We analyzed a cross-sectional patient sample of consecutive adults with active epilepsy over a 3-month period in 2013 and compared them with equally acquired data from the years 2003 and 2008. Using validated patient questionnaires, data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded. A total of 198 patients (mean age: 39.6±15.0years, 49.5% male) were enrolled and compared with our previous assessments in 2003 (n=101) and 2008 (n=151). In the 2013 cohort, 75.8% of the patients had focal epilepsy, and the majority were taking antiepileptic drugs (AEDs) (39.9% monotherapy, 59.1% polytherapy). We calculated epilepsy-specific costs of €3674 per three months per patient. Direct medical costs were mainly due to anticonvulsants (20.9% of total direct costs) and to hospitalization (20.8% of total direct costs). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2013. Indirect costs of €1795 in 2013 were mainly due to early retirement (55.0% of total indirect costs), unemployment (26.5%), and days off due to seizures (18.2%). In contrast to our previous findings from 2003 and 2008, our data show a stagnating cost increase with slightly reduced total costs and balanced direct and indirect costs in patients with active epilepsy. These findings are accompanied by an ongoing cost-neutral increase in the prescription of 'newer' and non-enzyme-inducing AEDs. However, the number and distribution of indirect cost components remained unchanged.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Saskia Richter
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Nina Watermann
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Karl Martin Klein
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Jens-Peter Reese
- Coordinating Center for Clinical Trials, Philipps-University, Marburg, Germany
| | - Oliver Schöffski
- Department of Health Management, Friedrich-Alexander-University, Nuremberg, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, Friedrich-Alexander-University, Erlangen, Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany.
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88
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Page R, Shankar R, McLean BN, Hanna J, Newman C. Digital Care in Epilepsy: A Conceptual Framework for Technological Therapies. Front Neurol 2018; 9:99. [PMID: 29551988 PMCID: PMC5841122 DOI: 10.3389/fneur.2018.00099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/12/2018] [Indexed: 11/13/2022] Open
Abstract
Epilepsy is associated with a significant increase in morbidity and mortality. The likelihood is significantly greater for those patients with specific risk factors. Identifying those at greatest risk of injury and providing expert management from the earliest opportunity is made more challenging by the circumstances in which many such patients present. Despite increasing recognition of the importance of earlier identification of those at risk, there is little or no improvement in outcomes over more than 30 years. Despite ever increasing sophistication of drug development and delivery, there has been no meaningful improvement in 1-year seizure freedom rates over this time. However, in the last few years, there has been an increase in patient-triggered interventions based on automated monitoring of indicators and risk factors facilitated by technological advances. The opportunities such approaches provide will only be realized if accompanied by current working practice changes. Replacing traditional follow-up appointments at arbitrary intervals with dynamic interventions, remotely and at the point and place of need provides a better chance of a substantial reduction in seizures for people with epilepsy. Properly implemented, electronic platforms can offer new opportunities to provide expert advice and management from first presentation thus improving outcomes. This perspective paper provides and proposes an informed critical opinion built on current evidence base of an outline techno-therapeutic approach to harnesses these technologies. This conceptual framework is generic, rather than tied to a specific product or solution, and the same generalized approach could be beneficially applied to other long-term conditions.
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Affiliation(s)
- Rupert Page
- Dorset Epilepsy Service, Poole Hospital NHS Foundation Trust, Poole, United Kingdom
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, United Kingdom.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, United Kingdom
| | | | | | - Craig Newman
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom
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89
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Willems LM, Zöllner JP, Paule E, Schubert-Bast S, Rosenow F, Strzelczyk A. Eslicarbazepine acetate in epilepsies with focal and secondary generalised seizures: systematic review of current evidence. Expert Rev Clin Pharmacol 2017; 11:309-324. [PMID: 29285947 DOI: 10.1080/17512433.2018.1421066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Eslicarbazepine acetate (ESL) is a third-generation antiepileptic drug (AED) approved for adjunctive treatment in adults, children, and adolescents with focal-onset seizures. Recently ESL was approved for initial monotherapy in adults. The intention of this article is to review current evidence for ESL and to summarise its pharmacological profile in comparison to other AEDs of the dibenzazepine group. Areas covered: We performed a systematic literature search in electronic databases (MEDLINE database, Cochrane Central Register of Controlled Trials, Excerpta Medica dataBASE) using a combined search strategy including the following keywords: eslicarbazepine, epilepsy and seizure. The search was performed from 2000 until December 2017. Using a standardised assessment form, information on the study design, methodological framework, data sources and efficacy and adverse events attributed to ESL were extracted from each publication and systematically reported. Expert commentary: ESL is an effective, safe and well tolerated third-generation AED for the treatment of focal epilepsies. During therapy, especially serum sodium levels and possible interactions with other substances have to be monitored. As of yet, long-term experience is still needed to make severe late-occurring adverse events unlikely and to obtain data regarding its use in pregnancy.
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Affiliation(s)
- Laurent M Willems
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany
| | - Johann Philipp Zöllner
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany
| | - Esther Paule
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany
| | - Susanne Schubert-Bast
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany.,c Department of Neuropediatrics , Goethe-University , Frankfurt am Main , Germany
| | - Felix Rosenow
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany.,b Epilepsy Center Hessen and Department of Neurology , Philipps-University , Marburg , Germany
| | - Adam Strzelczyk
- a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany.,b Epilepsy Center Hessen and Department of Neurology , Philipps-University , Marburg , Germany
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