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Mao J, Song Y, Cheng M, Xu C, Boca A, Dandurand A, Takahashi K. Seizure burden and healthcare resource utilization among people living with drug-resistant focal epilepsy in the United States. Curr Med Res Opin 2024:1-10. [PMID: 39171487 DOI: 10.1080/03007995.2024.2396049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/06/2024] [Accepted: 08/20/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE This study investigated clinical characteristics, burden of uncontrolled seizures, and seizure-related healthcare resource utilization (HRU) among individuals living with drug-resistant focal epilepsy (FE) in the United States (US). METHODS Medical charts of adults with drug-resistant FE who initiated third-line (3 L) anti-seizure medication were extracted from clinical practices in the US (1/1/2013-1/31/2020). The index date, defined as the date of 3 L initiation, was used to indicate the emergence of drug resistance. Individuals on cenobamate were followed for any length of time from the index date. Demographic and clinical characteristics were analyzed descriptively. Primary clinical outcomes included seizure burden (i.e. change in seizure frequency and time to the first and second seizure events) and epilepsy-related HRU. RESULTS Overall, 189 neurologists/epileptologists contributed 345 charts of individuals living with drug-resistant FE (66% male; average age 24 years at diagnosis and 32 years at index date). 66% had ≥1 neurologic/neuropsychiatric comorbidity at baseline. Average monthly seizure rate decreased from 6.1 at baseline to 3.8 at follow-up; however, nearly half of individuals experienced worse/no change or only some improvement (<50% reduction) in seizure frequency. Most individuals (91%) had ≥1 epilepsy-related outpatient visit during follow-up. Unplanned HRU included emergency department visits (43%) and hospitalizations (24%), primarily due to breakthrough seizure events. CONCLUSION Despite the availability of many anti-seizure medications in the US, people living with drug-resistant FE continue to experience multiple seizures per month and incur substantial healthcare resources. Novel pharmacotherapies may help individuals living with drug-resistant epilepsy achieve seizure freedom.
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Affiliation(s)
| | - Yan Song
- Analysis Group Inc., Boston, MA, USA
| | - Mu Cheng
- Analysis Group Inc., Boston, MA, USA
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Cuellar-Valencia L, Claros-Hulbert A, Ortegon A, Pino J, Velandia L, Correa-Morales JE. Subcutaneous Levetiracetam Administration in Latino Patients on Home Care. Am J Hosp Palliat Care 2024; 41:1029-1036. [PMID: 37907203 DOI: 10.1177/10499091231212450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Background: Levetiracetam has a favorable pharmacology profile to be used subcutaneously. However, its subcutaneous use is still considered off-label as this is beyond its license. The evidence base for its safety, tolerability, and efficacy is limited to observational studies. Objectives: To report the safety and efficacy of subcutaneous levetiracetam in Latino patients on home care. Design: Observational retrospective case series study. Subjects: Consecutive sample of Latino adults with life-limiting illnesses. Methods: A case series framework with 4 domains (selection, ascertainment, causality, and reporting) to ensure reporting quality was used. Additionally, 8 relevant outcomes established in a previous comprehensive review, were collected and reported. Adverse reactions were documented using the Common Terminology Criteria for Adverse Events. Results: Fifteen Latino patients with oncological and non-oncological diagnoses received subcutaneous levetiracetam for a mean of 21 days on home care. Levetiracetam was most frequently initiated subcutaneously due to loss of the oral route. The average dosage of subcutaneous levetiracetam was 1200 mg. Only 1 patient required a dose adjustment, and only 2 patients experienced a total of 5 seizures during the therapy trial. No adverse reactions were reported. Conclusions: Subcutaneous levetiracetam appears to be effective and safe. This case series of Latino patients in home care expands the evidence of its use in the home care setting. The preliminary data reported by now on multiple case series warrants robust trials.
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Affiliation(s)
- Laura Cuellar-Valencia
- Faculty of Medicine, Universidad de La Sabana, Bogotá DC, Colombia
- Colombian National Cancer Institute, Bogotá DC, Colombia
| | - Angelica Claros-Hulbert
- Faculty of Medicine, Universidad de La Sabana, Bogotá DC, Colombia
- Colombian National Cancer Institute, Bogotá DC, Colombia
| | - Adriana Ortegon
- Forja home care IPS, Bogotá DC, Colombia
- Faculty of Medicine, Universidad del Bosque, Bogotá DC, Colombia
| | - Juliana Pino
- Faculty of Medicine, Universidad de La Sabana, Bogotá DC, Colombia
- Forja home care IPS, Bogotá DC, Colombia
| | | | - Juan Esteban Correa-Morales
- Faculty of Medicine, Universidad de La Sabana, Bogotá DC, Colombia
- Colombian National Cancer Institute, Bogotá DC, Colombia
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Lattanzi S, Chiesa V, Di Gennaro G, Ferlazzo E, Labate A, La Neve A, Meletti S, Di Bonaventura C. Brivaracetam use in clinical practice: a Delphi consensus on its role as first add-on therapy in focal epilepsy and beyond. Neurol Sci 2024; 45:4519-4527. [PMID: 38558319 PMCID: PMC11306259 DOI: 10.1007/s10072-024-07485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Antiseizure medications remain the cornerstone of treatment for epilepsy, although a proportion of individuals with the condition will continue to experience seizures despite appropriate therapy. Treatment choices for epilepsy are based on variables related to both the individual patient and the available medications. Brivaracetam is a third-generation agent antiseizure medication. METHODS We carried out a Delphi consensus exercise to define the role of brivaracetam in clinical practice and to provide guidance about its use as first add-on ASM and in selected clinical scenarios. A total of 15 consensus statements were drafted by an expert panel following review of the literature and all were approved in the first round of voting by panelists. The consensus indicated different clinical scenarios for which brivaracetam can be a good candidate for treatment, including first add-on use. RESULTS Overall, brivaracetam was considered to have many advantageous characteristics that render it a suitable option for patients with focal epilepsy, including a fast onset of action, favorable pharmacokinetic profile with few drug-drug interactions, broad-spectrum activity, and being well tolerated across a range of doses. Brivaracetam is also associated with sustained clinical response and good tolerability in the long term. CONCLUSIONS These characteristics also make it suitable as an early add-on for the elderly and for patients with post-stroke epilepsy or status epilepticus as highlighted by the present Delphi consensus.
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Affiliation(s)
- Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy.
| | - Valentina Chiesa
- Epilepsy Center, Child Neurology Unit, ASST Santi Paolo Carlo, Milan, Italy
| | | | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Angela La Neve
- DiBraiN, University Hospital of Bari "A. Moro", Bari, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
- Neurology and neurophysiology unit - AOU Modena, Modena, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Moura L, Karakis I, Howard D. Emergency department utilization among adults with epilepsy: A multi-state cross-sectional analysis, 2010-2019. Epilepsy Res 2024; 205:107427. [PMID: 39116513 DOI: 10.1016/j.eplepsyres.2024.107427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/08/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE We described patterns and trends in ED use among adults with epilepsy in the United States. METHODS Utilizing inpatient and ED discharge data from seven states, we conducted a cross-sectional analysis to identify adult ED visits diagnosed with epilepsy or seizures from 2010 to 2019. Using ED visit counts and estimates of state-level epilepsy prevalence, we calculated ED visit rates overall and by payer, condition, and year. RESULTS Our data captured 304,935 ED visits with epilepsy as a primary or secondary diagnosis in 2019. Across the seven states, visit rates ranged between 366 and 726 per 1000 and were higher than rates for adults without epilepsy in all states but one. ED visit rates were highest among Medicare and Medicaid beneficiaries (vs commercial or self-pay). Adults with epilepsy were more likely to be admitted as inpatients. Visits for nervous system disorders were 6.3-8.2 times higher among people with epilepsy, and visits for mental health conditions were 1.2-2.6 times higher. Increases in ED visit rates from 2010 to 2019 among people with epilepsy exceeded increases among adults without by 6.0-27.3 percentage points. CONCLUSION Adults with epilepsy visit the ED frequently and visit rates have been increasing over time. These results underscore the importance of identifying factors contributing to ED use and designing tailored interventions to improve ambulatory care quality.
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Affiliation(s)
- Lidia Moura
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA.
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; University of Crete School of Medicine, Heraklion, Greece
| | - David Howard
- Department of Health Policy, Emory University School of Medicine, Atlanta, Georgia
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Münchenberg PS, Schulz RS, Wainwright K, Mayer I, Holtkamp M, Meisel C, Kurth T. Effect evaluation of outpatient long-term video EEGs for people with seizure disorders - study protocol of the ALVEEG project: a randomized controlled trial in Germany. BMC Health Serv Res 2024; 24:994. [PMID: 39192270 DOI: 10.1186/s12913-024-11076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/03/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Epilepsy and other seizure disorders account for a high disease burden in Germany. As a timely diagnosis and accurate treatment are crucial, improving the management of these disorders is important. Outside of Germany, outpatient long-term video EEGs (ALVEEGs) have demonstrated the potential to support the diagnosis and management of epilepsy and other seizure disorders. This study aims to evaluate the implementation of ALVEEGs as a new diagnostic pathway in eastern parts of Germany to diagnose epilepsy and other seizure disorders and to assess if ALVEEGs are equally effective as the current inpatient-monitoring gold standard, which is currently only available at a limited number of specialized centers in Germany. METHODS ALVEEG is a prospective, multicenter, randomized controlled equivalence trial, involving five epilepsy centers in the eastern states of Germany. Patients will be randomized into either intervention (IG) or control group (CG), using a permuted block randomization. The sample size targeted is 688 patients, continuously recruited over the trial. The IG will complete an ALVEEG in a home setting, including getting access to a smartphone app to document seizure activity. The CG will receive care as usual, i.e., inpatient long-term video-EEG monitoring. The primary outcome is the proportion of clinical questions being solved in the IG compared to the CG. Secondary outcomes include hospital stays, time until video EEG, time until diagnosis and result discussion, patients' health status, quality of life and health competence, and number and form of epilepsy-related events and epileptiform activity. Alongside the trial, a process implementation and health economic evaluation will be conducted. DISCUSSION The extensive evaluation of this study, including an implementation and health economic evaluation, will provide valuable information for health policy decision-makers to optimize future delivery of neurological care to patients affected by epilepsy and other seizure disorders and on the uptake of ALVEEG into standard care in Germany. TRIAL REGISTRATION German Clinical Trials Register (DRKS00032220), date registered: December 11, 2023.
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Affiliation(s)
| | | | - Kerstin Wainwright
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Imke Mayer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Meisel
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Berlin, Germany
- NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Meyer B, Betz LT, Brückner K, Holtkamp M. Enhancing quality of life in epilepsy with a digital intervention (emyna): Results of the ELAINE randomized controlled trial. Epilepsia Open 2024. [PMID: 39167060 DOI: 10.1002/epi4.13014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/23/2024] [Accepted: 06/17/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVE Despite the availability of pharmacological treatment for seizures, people with epilepsy (PwE) commonly experience impairments in quality of life (QoL). Given the limited access to psychosocial treatments for PwE, digital interventions could bridge treatment gaps and help improve QoL. The objective of this study was to examine the effectiveness of emyna, a fully automated digital intervention based on cognitive behavioral therapy (CBT) techniques, in improving health-related QoL among PwE who reported impairments in QoL. A previous trial showed that emyna was effective in improving depressive symptoms among PwE with a comorbid depressive disorder, but its effects on QoL among PwE without comorbid depression remain unknown. METHODS A pragmatic randomized controlled trial was conducted with N = 438 PwE (mean age = 37.5, 70.3% women, physician-verified diagnoses) who were assigned to the intervention group (n = 216), which used emyna alongside treatment as usual (TAU), or the control group (n = 222), which received TAU only. QoL and secondary outcomes such as general self-efficacy, medication adherence, general distress, and epilepsy-related work and social adjustment were assessed at baseline, 3 months, and 6 months. The primary outcome was QoL assessed with the Quality of Life in Epilepsy [QOLIE-31] total score at 3 months post-randomization. RESULTS Findings from the intent-to-treat analyses showed that after 3 months, participants in the intervention group experienced significant and clinically relevant improvements in health-related QoL compared to the control group (baseline-adjusted group difference = 4.5; 95% CI = [2.0, 6.9], p < 0.001; Cohen's d = 0.32). Effects on secondary outcomes did not reach statistical significance. SIGNIFICANCE This study extends previous research by demonstrating that emyna facilitates improvements in QoL in a diverse group of PwE treated in routine care settings. This CBT-based digital intervention therefore presents a convenient and cost-effective addition to healthcare providers' treatment repertoire. PLAIN LANGUAGE SUMMARY In our study, we tested a digital program called emyna, which conveys cognitive behavioral therapy (CBT) techniques to help improve the quality of life for people living with epilepsy. We found that those who used emyna alongside their usual treatments felt better about their quality of life compared to those who did not use the program. Emyna offers a new, convenient way for people with epilepsy to manage their condition, which can be used alongside currently available treatments.
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Affiliation(s)
- Björn Meyer
- Research & Development Department, GAIA Group, Hamburg, Germany
| | - Linda T Betz
- Research & Development Department, GAIA Group, Hamburg, Germany
| | - Katja Brückner
- Department of Neurology and Epileptology, Epilepsy Center Hamburg, Evangelical Hospital Alsterdorf, Hamburg, Germany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Reimers A. Pharmacotherapy for focal epilepsy: how close are we to a cure? Expert Opin Pharmacother 2024; 25:1575-1577. [PMID: 39136419 DOI: 10.1080/14656566.2024.2392879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 08/12/2024] [Indexed: 08/15/2024]
Affiliation(s)
- Arne Reimers
- Department of Clinical Chemistry and Pharmacology, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Clinical Chemistry and Pharmacology, Skåne University Hospital, Lund, Sweden
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Zhang H, Ou Z, Zhang E, Liu W, Hao N, Chen Y, Liu Y, Ye H, Zhou D, Wu X. Efficacy and safety of add-on antiseizure medications for focal epilepsy: A network meta-analysis. Epilepsia Open 2024; 9:1550-1564. [PMID: 38888005 PMCID: PMC11296132 DOI: 10.1002/epi4.12997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/26/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE Several antiseizure medications (ASMs) have been approved for the treatment of focal epilepsy. However, there is a paucity of evidence on direct comparison of ASMs. We evaluated the comparative efficacy and safety of all approved add-on ASMs for the treatment of focal epilepsy using network meta-analysis. METHODS Data through extensive literature search was retrieved from PubMed, Embase, Cochrane, and ClinicalTrial.gov databases using predefined search terms from inception through March 2023. PRISMA reporting guidelines (CRD42023403450) were followed in this study. Efficacy outcomes assessed were ≥50%, ≥75%, and 100% responder rates. Patient retention rate and safety outcomes such as overall treatment-emergent adverse events (TEAEs) and individual TEAEs were assessed. "Gemtc" 4.0.4 package was used to perform Bayesian analysis. Outcomes are reported as relative risks (RRs) and 95% confidence interval (CI). RESULTS Literature search retrieved 5807 studies of which, 75 studies were included in the analysis. All ASMs showed significantly higher ≥50% responder rate compared with placebo. Except the ≥75% seizure frequency reduction for zonisamide (2.23; 95% CI: 1.00-5.70) and 100% for rufinamide (2.03; 95% CI: 0.54-11.00), all other interventions showed significantly higher ≥75% and 100% responder rates compared with placebo. Among treatments, significantly higher 100% responder rate was observed with cenobamate compared to eslicarbazepine (10.71; 95% CI: 1.56-323.9) and zonisamide (10.63; 95% CI: 1.37-261.2). All ASMs showed a lower patient retention rate compared to placebo, with the least significant value observed for oxcarbazepine (0.77; 95% CI: 0.7-0.84). Levetiracetam showed a lower risk of incidence (1.0; 95%CI: 0.94-1.1; SUCRA: 0.885067) for overall TEAE compared with other medications. SIGNIFICANCE All approved ASMs were effective as add-on treatment for focal epilepsy. Of the ASMs included, cenobamate had the greatest likelihood of allowing patients to attain seizure freedom. PLAIN LANGUAGE SUMMARY This article compares the efficacy and safety of antiseizure medications (ASMs) currently available to neurologists in the treatment of epileptic patients. Several newer generation ASMs that have been developed may be as effective or better than the older medications. We included 75 studies in the analysis. In comparison, all drugs improved ≥50%, ≥75% and 100% responder rates compared to control, except for Zonisamide and Rufinamide in the ≥75% and 100% responder rate categories. Retention of patients undergoing treatment was lower in drugs than placebo. All drugs were tolerated, the levetiracetam showed the best tolerability. Cenobamate more likely help completely to reduce seizures.
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Affiliation(s)
- Hesheng Zhang
- Neurology DepartmentWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Zhujing Ou
- Neurology DepartmentWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Enhui Zhang
- Neurology DepartmentWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Wenyu Liu
- Neurology DepartmentWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Nanya Hao
- Neurology DepartmentWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Yujie Chen
- Neurology DepartmentWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Yutong Liu
- Ignis Therapeutics (Shanghai) LimitedShanghaiChina
| | - Hui Ye
- Ignis Therapeutics (Shanghai) LimitedShanghaiChina
| | - Dong Zhou
- Neurology DepartmentWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Xintong Wu
- Neurology DepartmentWest China Hospital of Sichuan UniversityChengduSichuanChina
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Lattanzi S, Ranzato F, Di Bonaventura C, Bonanni P, Gambardella A, Tartara E, Assenza G, Procaccini M, Falsetto N, Villano V, Camattari G, Ori A, Di Gennaro G. Effectiveness and Safety of Adjunctive Cenobamate in People with Focal-Onset Epilepsy: Evidence from the First Interim Analysis of the BLESS Study. Neurol Ther 2024; 13:1203-1217. [PMID: 38850402 PMCID: PMC11263269 DOI: 10.1007/s40120-024-00634-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/15/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION Despite new anti-seizure medications (ASMs) being introduced into clinical practice, about one-third of people with epilepsy do not reach seizure control. Cenobamate is a novel tetrazole-derived carbamate compound with a dual mechanism of action. In randomized controlled trials, adjunctive cenobamate reduced the frequency of focal seizures in people with uncontrolled epilepsy. Studies performed in real-world settings are useful to complement this evidence and better characterize the drug profile. METHODS The Italian BLESS ("Cenobamate in Adults With Focal-Onset Seizures") study is an observational cohort study aimed to evaluate the effectiveness, tolerability, and safety of adjunctive cenobamate in adults with uncontrolled focal epilepsy in the context of real-world clinical practice. The study is ongoing and conducted at 50 centers in Italy. This first interim analysis includes participants enrolled until June 2023 and with 12-week outcome data available. RESULTS Forty participants with a median age of 36.5 (interquartile range [IQR] 26.0-47.5) years were included. The median monthly seizure frequency at baseline was 6.0 (IQR 2.5-17.3) seizures and 31 (77.5%) participants had failed four or more ASMs before cenobamate. At 12 weeks from starting cenobamate, the median reduction in monthly seizure frequency was 52.8% (IQR 27.1-80.3%); 22 (55.0%) participants had a ≥ 50% reduction in baseline seizure frequency and six (15.0%) reached seizure freedom. The median number of concomitant ASMs decreased from 3 (IQR 2-3) at baseline to 2 (IQR 2-3) at 12 weeks and the proportion of patients treated with > 2 concomitant ASMs decreased from 52.5% to 40.0%. Seven (17.5%) patients reported a total of 12 adverse events, 11 of which were considered adverse drug reactions to cenobamate. CONCLUSION In adults with uncontrolled focal seizures, the treatment with adjunctive cenobamate was well tolerated and was associated with improved seizure control and a reduction of the burden of concomitant ASMs. TRIAL REGISTRATION NUMBER NCT05859854 (ClinicalTrials.gov Identifier).
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Affiliation(s)
- Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
| | - Federica Ranzato
- Regional Adult Epilepsy Center, Neurology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, IRCCS Eugenio Medea, Scientific Institute, Conegliano, TV, Italy
| | | | - Elena Tartara
- Epilepsy Center, IRCCS Mondino Foundation, ERN EpiCare Full Member, Pavia, Italy
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, Rome, Italy
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Mao J, Takahashi K, Cheng M, Xu C, Boca A, Song Y, Dandurand A. Real-world anti-seizure treatment and adverse events among individuals living with drug-resistant focal epilepsy in the United States. Epilepsia Open 2024; 9:1311-1320. [PMID: 38818833 PMCID: PMC11296083 DOI: 10.1002/epi4.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/11/2024] [Accepted: 04/26/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE This study aimed to understand how people living with drug-resistant focal epilepsy (DRE) navigate through lines of antiseizure medications (ASM) and experience adverse events (AEs) in the real-world setting in the United States. METHODS A retrospective study was conducted with medical chart data from clinical practices in the United States. Eligible adults had a confirmed diagnosis of DRE and initiated a third-line ASM therapy between January 2013 and January 2020 (i.e., the index date). Subjects must have medical history data available for ≥1 year prior to (the baseline) and ≥2 years after the index date (the follow-up). Treatment patterns were captured from first to fourth lines. After the emergence of drug resistance, time to ASM discontinuation, reasons for discontinuation, AE experience and AE management were reported separately during third and fourth lines of treatment and beyond. RESULTS The study included a total of 345 individuals, with an average (standard deviation) age of 23.9 (11.9) years at first diagnosis. All individuals had at least three lines of ASMs with first and second lines during baseline, and third line during follow-up. The first line for most individuals was monotherapy. As individuals progressed through additional lines of ASM therapy, they were more likely to receive polytherapy. The regimens were more individualized after meeting drug resistance criteria. The top reasons for discontinuing were uncontrolled seizure and/or intolerance/AEs for both third and subsequent lines. More than a third of individuals experienced at least one AE. Among those with at least one AE, many individuals had to manage these AEs with dose adjustment (39.4%), discontinuation of offending ASM (37.9%), de novo pharmacotherapy (25.8%), emergency room visit (13.6%), and hospitalization (12.1%). SIGNIFICANCE This study demonstrated that individuals living with DRE experience significant AEs, and many of these AEs lead to treatment disruption and significant healthcare resource utilization. PLAIN LANGUAGE SUMMARY This study examined how individuals with focal epilepsy are treated across various clinics in United States and reported the adverse events these individuals experienced during treatment, along with the consequence associated with these adverse events. We found that as individuals progressed through additional treatments, they were more and more likely to receive more than one antiseizure medication, and a significant portion of individuals experienced at least one adverse event, often manifested as headache, somnolence, dizziness, and fatigue.
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Affiliation(s)
- Jianbin Mao
- Cerevel TherapeuticsCambridgeMassachusettsUSA
| | | | - Mu Cheng
- Analysis Group, Inc.BostonMassachusettsUSA
| | - Churong Xu
- Analysis Group, Inc.BostonMassachusettsUSA
| | - Andra Boca
- Analysis Group, Inc.BostonMassachusettsUSA
| | - Yan Song
- Analysis Group, Inc.BostonMassachusettsUSA
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Peng H, Qin Y, Zhang B, Zhao S, Tang S, Liu A, Cheng M. Risk Factors for In-Hospital Seizures of Aneurysmal Subarachnoid Hemorrhage After Endovascular Treatment: A Real-World Study. World Neurosurg 2024; 188:e480-e490. [PMID: 38815925 DOI: 10.1016/j.wneu.2024.05.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND PURPOSE The occurrence of in-hospital seizures for aneurysmal subarachnoid hemorrhage (aSAH) ranges from 3.7% to 15.2%, and seizures remain an important factor affecting patient prognosis. Therefore, the timely identification of patients at a higher risk for aSAH-associated seizures after endovascular treatment is of paramount importance. This study aims to analyze the risk factors for in-hospital seizures after endovascular treatment for aSAH. METHODS The study comprised 547 patients at 3 centers from January 2019 to September 2021. In the context of this study, 2 models were utilized: the first model involved no variable adjustment, while the second model included all potential confounders in the multivariate logistic regression analysis. Additionally, the dose-response relationship between biomarkers and seizure occurrence was assessed using restricted cubic spline. RESULTS Among these patients, 28 (5.1%) developed seizures during hospitalization. In Model 2, the modified Fisher score (adjusted odds ratio [OR]: 3.138, 95% confidence interval [CI]: 1.226-8.036), body mass index (adjusted OR: 0.852, 95% CI: 0.749-0.970), aspect ratio (adjusted OR: 0.264, 95% CI: 0.115-0.604), and aspartate transaminase (adjusted OR: 1.017, 95% CI: 1.001-1.035) were showed as factors contributing to an increased risk of aSAH-associated seizures. CONCLUSIONS Body mass index, aspartate transaminase, aspect ratio, modified Fisher scores, and Hunt-Hess scores were correlated with the formation of aSAH-associated seizures after endovascular treatment.
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Affiliation(s)
- Haiyan Peng
- Department of Psychiatry, The School of Clinical Medicine, Hunan University of Chinese Medicine, Brain Hospital of Hunan Province (The Second People's Hospital of Hunan Province), Changsha, Hunan, China
| | - Yongkai Qin
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Baorui Zhang
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Songfeng Zhao
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shenkun Tang
- Department of Neurosurgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Cheng
- Department of Psychiatry, The School of Clinical Medicine, Hunan University of Chinese Medicine, Brain Hospital of Hunan Province (The Second People's Hospital of Hunan Province), Changsha, Hunan, China.
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12
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Zabler N, Swinnen L, Biondi A, Novitskaya Y, Schütz E, Epitashvili N, Dümpelmann M, Richardson MP, Van Paesschen W, Schulze-Bonhage A, Hirsch M. High precision in epileptic seizure self-reporting with an app diary. Sci Rep 2024; 14:15823. [PMID: 38982283 PMCID: PMC11233562 DOI: 10.1038/s41598-024-66932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/05/2024] [Indexed: 07/11/2024] Open
Abstract
People with epilepsy frequently under- or inaccurately report their seizures, which poses a challenge for evaluating their treatment. The introduction of epilepsy health apps provides a novel approach that could improve seizure documentation. This study assessed the documentation performance of an app-based seizure diary and a conventional paper seizure diary. At two tertiary epilepsy centers patients were asked to use one of two offered methods to report their seizures (paper or app diary) during their stay in the epilepsy monitoring unit. The performances of both methods were assessed based on the gold standard of video-EEG annotations. In total 89 adults (54 paper and 35 app users) with focal epilepsy were included in the analysis, of which 58 (33 paper and 25 app users) experienced at least one seizure and made at least one seizure diary entry. We observed a high precision of 85.7% for the app group, whereas the paper group's precision was lower due to overreporting (66.9%). Sensitivity was similar for both methods. Our findings imply that performance of seizure self-reporting is patient-dependent but is more precise for patients who are willing to use digital apps. This may be relevant for treatment decisions and future clinical trial design.
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Affiliation(s)
- Nicolas Zabler
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Department of Microsystems Engineering (IMTEK), Faculty of Engineering, University of Freiburg, Freiburg, Germany.
| | - Lauren Swinnen
- Laboratory for Epilepsy Research, KU Leuven, Leuven, Belgium.
| | - Andrea Biondi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yulia Novitskaya
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elisa Schütz
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nino Epitashvili
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Dümpelmann
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Microsystems Engineering (IMTEK), Faculty of Engineering, University of Freiburg, Freiburg, Germany
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Wim Van Paesschen
- Laboratory for Epilepsy Research, KU Leuven, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Andreas Schulze-Bonhage
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Hirsch
- Department of Neurosurgery, Epilepsy Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Randi YM, Tedrus GMDAS, Nucci LB. Evaluation of social inclusion in Brazilian adult women with epilepsy: Perception of stigma and quality of life. Epilepsy Behav 2024; 156:109821. [PMID: 38704987 DOI: 10.1016/j.yebeh.2024.109821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024]
Abstract
Epilepsy is a chronic disease characterized by recurrent epileptic seizures that can affect the perception of stigma and compromise the quality of life of those living with it. In addition, sociodemographic factors such as employment and maintaining a job, education, and the autonomy to drive vehicles are often impaired. OBJECTIVE To assess the social inclusion of adult women with epilepsy in relation to the perception of stigma and quality of life, and the clinical aspects of the disease. METHODOLOGY Data from 70 adult Brazilian women with epilepsy regarding aspects related to their social inclusion were verified. Such data were linked to clinical aspects and scores from the questionnaires: Quality of Life in Epilepsy Inventory 31 (QOLIE-31) and the Epilepsy Stigma Scale (ESS), with a significance level of p < 0.05. RESULTS Average age of 45.5 years, 40 (57.1 %) women were divorced/single/widowed, 31 (44.3 %) women had less than 10 years of formal education, 32 (45.7 %) women had no income, and 57 (81.4 %) did not have a driver's license. The age at the time of the first seizure was 18 years, the seizures were focal in 46 (65.7 %) cases, and 26 (37.1 %) cases were seizure-free in the last year. A high number of women reported that the diagnosis of epilepsy negatively influenced aspects of autonomy such as the possession of a driver's license and going out alone. Longer duration of epilepsy was associated with lower education, not having children, and lower scores on the QOLIE-31. Higher scores on the QOLIE-31 were correlated with lower frequency of seizures and with the age at the time of the first seizure. Values in the dimension - energy and fatigue of the QOLIE-31 were significantly lower in the group with less independence compared to the other two groups with more independence, in latent class analyses (ANOVA, adjusted for age 42.1 ± 35.6 vs 57.2 ± 28.4 vs 73.9 ± 23.8, p = 0.0295). DISCUSSION Clinical aspects of epilepsy and having a partner, autonomy, and independence such as driving vehicles are factors that contribute to social inclusion and to the perception of a better quality of life for adult women with epilepsy. CONCLUSION It was observed that having a partner, autonomy, and independence such as driving vehicles are factors that contribute to social inclusion and to the perception of a better quality of life for adult women with epilepsy.
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Affiliation(s)
- Yara Maria Randi
- Postgraduate Program in Health Sciences. Pontifical Catholic University of Campinas - Campus II, Brazil.
| | | | - Luciana Bertoldi Nucci
- Postgraduate Program in Health Sciences. Pontifical Catholic University of Campinas - Campus II, Brazil.
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Chen L, He XH, Li XL, Yang J, Huang H. Bibliometric analysis of research in epilepsy and comorbid depression from 2014 to 2023. World J Psychiatry 2024; 14:985-998. [PMID: 38984335 PMCID: PMC11230101 DOI: 10.5498/wjp.v14.i6.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Epilepsy and depression have complicated bidirectional relationships. Our study aimed to explore the field of epilepsy comorbid with depression in a bibliometric perspective from 2014-2023. AIM To improve our understanding of epilepsy and depression by evaluating the relationship between epilepsy and depression, bibliometric analyses were performed. METHODS Epilepsy and depression-related publications from the last decade were retrieved from the Web of Science Core Collection. We conducted bibliometric and visual analysis using VOSviewer and CiteSpace, examining authorships, countries, institutions, journals of publication, co-citations of references, connections between keywords, clusters of keywords, and keywords with citation bursts. RESULTS Over the past ten years, we collected 1045 research papers focusing on the field of epilepsy and comorbid depression. Publications on epilepsy and depression have shown a general upward trend over time, though with some fluctuations. The United States, with 287 articles, and the University of Melbourne, contributing 34 articles, were the top countries and institutions, respectively. In addition, in the field of epilepsy and depression, Professor Lee, who has published 30 articles, was the most contributing author. The hot topics pay attention to the quality of life in patients with epilepsy and depression. CONCLUSION We reported that quality of life and stigma in patients with epilepsy comorbid with depression are possible future hot topics and directions in the field of epilepsy and depression research.
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Affiliation(s)
- Ling Chen
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Xiao-Hui He
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400010, China
| | - Xia-Ling Li
- Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400010, China
| | - Juan Yang
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Hao Huang
- Department of Neurology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
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Daniłowska K, Picheta N, Żyła D, Piekarz J, Zych K, Gil-Kulik P. New Pharmacological Therapies in the Treatment of Epilepsy in the Pediatric Population. J Clin Med 2024; 13:3567. [PMID: 38930098 PMCID: PMC11204858 DOI: 10.3390/jcm13123567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Epilepsy is a disorder characterized by abnormal brain neuron activity, predisposing individuals to seizures. The International League Against Epilepsy (ILAE) categorizes epilepsy into the following groups: focal, generalized, generalized and focal, and unknown. Infants are the most vulnerable pediatric group to the condition, with the cause of epilepsy development being attributed to congenital brain developmental defects, white matter damage, intraventricular hemorrhage, perinatal hypoxic-ischemic injury, perinatal stroke, or genetic factors such as mutations in the Sodium Channel Protein Type 1 Subunit Alpha (SCN1A) gene. Due to the risks associated with this condition, we have investigated how the latest pharmacological treatments for epilepsy in children impact the reduction or complete elimination of seizures. We reviewed literature from 2018 to 2024, focusing on the age group from 1 month to 18 years old, with some studies including this age group as well as older individuals. The significance of this review is to present and compile research findings on the latest antiseizure drugs (ASDs), their effectiveness, dosing, and adverse effects in the pediatric population, which can contribute to selecting the best drug for a particular patient. The medications described in this review have shown significant efficacy and safety in the studied patient group, outweighing the observed adverse effects. The main aim of this review is to provide a comprehensive summary of the current state of knowledge regarding the newest pharmacotherapy for childhood epilepsy.
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Affiliation(s)
- Karolina Daniłowska
- Student’s Scientific Society of Clinical Genetics, Medical University of Lublin, 20-080 Lublin, Poland; (K.D.); (N.P.); (D.Ż.); (J.P.); (K.Z.)
| | - Natalia Picheta
- Student’s Scientific Society of Clinical Genetics, Medical University of Lublin, 20-080 Lublin, Poland; (K.D.); (N.P.); (D.Ż.); (J.P.); (K.Z.)
| | - Dominika Żyła
- Student’s Scientific Society of Clinical Genetics, Medical University of Lublin, 20-080 Lublin, Poland; (K.D.); (N.P.); (D.Ż.); (J.P.); (K.Z.)
| | - Julia Piekarz
- Student’s Scientific Society of Clinical Genetics, Medical University of Lublin, 20-080 Lublin, Poland; (K.D.); (N.P.); (D.Ż.); (J.P.); (K.Z.)
| | - Katarzyna Zych
- Student’s Scientific Society of Clinical Genetics, Medical University of Lublin, 20-080 Lublin, Poland; (K.D.); (N.P.); (D.Ż.); (J.P.); (K.Z.)
| | - Paulina Gil-Kulik
- Department of Clinical Genetics, Medical University of Lublin, 20-080 Lublin, Poland
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16
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Sauls RM, Buro AW, Kirby RS. Lifestyle Behavioral Interventions and Health-Related Outcomes Among People with Epilepsy: A Review of Randomized Controlled Trials. Am J Health Promot 2024; 38:720-730. [PMID: 38414186 DOI: 10.1177/08901171241235731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To gather and assess current literature on the prevalence and efficacy of lifestyle behavioral interventions (sleep, nutrition, physical activity) for health outcomes, including QOL, psychological well-being, behavioral changes, and seizure frequency, among PWE. DATA SOURCE A review was conducted of English-language articles identified from PubMed, Scopus, and Embase between January 2013 to January 2023. STUDY INCLUSION AND EXCLUSION CRITERIA Inclusion criteria were randomized controlled trials (RCT) with human subjects diagnosed with epilepsy who participated in a lifestyle behavioral intervention. DATA EXTRACTION Two researchers independently completed the title, abstract, and full-text reviews. Information extracted includes study population, duration, type of intervention, findings, and outcomes. DATA SYNTHESIS Data was narratively synthesized to show level of evidence and degree of consistency in findings. Results: 4001 studies identified, 66 full texts reviewed, and 24 included. A majority (n = 16) of studies utilized diet specific RCTs, and some focused on physical activity (n = 7) and sleep (n = 1). Diet-specific RCTs (eg, ketogenic, Modified Atkins) reported reduced seizure frequency with adverse effects, such as gastrointestinal complications. Physical activity-based interventions found that maintained levels of exercise improved QOL and psychological well-being. However, physical activity and diet-based interventions did not have lasting effects after study conclusion. Only the behavioral sleep intervention reported that sleep quality improved significantly and was maintained post-intervention. CONCLUSION Future research is needed to establish the relationship between lifestyle behavioral interventions on QOL and other health outcomes (eg, seizure frequency).
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Affiliation(s)
- Rachel M Sauls
- Department of Non-Therapeutic Research Operations, H. Lee Moffitt Cancer Center, Tampa, FL, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Acadia W Buro
- College of Population Health, University of New Mexico, Albuquerque, NM, USA
| | - Russell S Kirby
- College of Public Health, University of South Florida, Tampa, FL, USA
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17
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Lappe L, Hertzberg C, Knake S, Knuf M, von Podewils F, Willems LM, Kovac S, Zöllner JP, Sauter M, Kurlemann G, Mayer T, Bertsche A, Marquard K, Meyer S, Schäfer H, Thiels C, Zukunft B, Schubert-Bast S, Reese JP, Rosenow F, Strzelczyk A. A multicenter, matched case-control analysis comparing burden of illness among patients with tuberous sclerosis complex related epilepsy, generalized idiopathic epilepsy, and focal epilepsy in Germany. Neurol Res Pract 2024; 6:29. [PMID: 38812055 PMCID: PMC11138101 DOI: 10.1186/s42466-024-00323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/15/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Depending on the underlying etiology and epilepsy type, the burden of disease for patients with seizures can vary significantly. This analysis aimed to compare direct and indirect costs and quality of life (QoL) among adults with tuberous sclerosis complex (TSC) related with epilepsy, idiopathic generalized epilepsy (IGE), and focal epilepsy (FE) in Germany. METHODS Questionnaire responses from 92 patients with TSC and epilepsy were matched by age and gender, with responses from 92 patients with IGE and 92 patients with FE collected in independent studies. Comparisons were made across the main QoL components, direct costs (patient visits, medication usage, medical equipment, diagnostic procedures, ancillary treatments, and transport costs), indirect costs (employment, reduced working hours, missed days), and care level costs. RESULTS Across all three cohorts, mean total direct costs (TSC: €7602 [median €2620]; IGE: €1919 [median €446], P < 0.001; FE: €2598 [median €892], P < 0.001) and mean total indirect costs due to lost productivity over 3 months (TSC: €7185 [median €11,925]; IGE: €3599 [median €0], P < 0.001; FE: €5082 [median €2981], P = 0.03) were highest among patients with TSC. The proportion of patients with TSC who were unemployed (60%) was significantly larger than the proportions of patients with IGE (23%, P < 0.001) or FE (34%, P = P < 0.001) who were unemployed. Index scores for the EuroQuol Scale with 5 dimensions and 3 levels were significantly lower for patients with TSC (time-trade-off [TTO]: 0.705, visual analog scale [VAS]: 0.577) than for patients with IGE (TTO: 0.897, VAS: 0.813; P < 0.001) or FE (TTO: 0.879, VAS: 0.769; P < 0.001). Revised Epilepsy Stigma Scale scores were also significantly higher for patients with TSC (3.97) than for patients with IGE (1.48, P < 0.001) or FE (2.45, P < 0.001). Overall Quality of Life in Epilepsy Inventory-31 items scores was significantly lower among patients with TSC (57.7) and FE (57.6) than among patients with IGE (66.6, P = 0.004 in both comparisons). Significant differences between patients with TSC and IGE were also determined for Neurological Disorder Depression Inventory for Epilepsy (TSC: 13.1; IGE: 11.2, P = 0.009) and Liverpool Adverse Events Profile scores (TSC: 42.7; IGE: 37.5, P = 0.017) with higher score and worse results for TSC patients in both questionnaires. CONCLUSIONS This study is the first to compare patients with TSC, IGE, and FE in Germany and underlines the excessive QoL burden and both direct and indirect cost burdens experienced by patients with TSC.
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Affiliation(s)
- Lisa Lappe
- Goethe-University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Markus Knuf
- Department of Pediatrics, Klinikum Worms, Worms, Germany
- Department of Pediatrics, University Medicine Mainz, Mainz, Germany
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Greifswald, Germany
| | - Laurent M Willems
- Goethe-University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Stjepana Kovac
- Department of Neurology with Institute of Translational Neurology, University Münster, Münster, Germany
| | - Johann Philipp Zöllner
- Goethe-University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Matthias Sauter
- Klinikum Kempten, Klinikverbund Allgäu, Kempten/Allgäu, Germany
| | | | | | - Astrid Bertsche
- Department of Neuropediatrics, University Hospital for Children and Adolescents, Greifswald, Germany
| | - Klaus Marquard
- Department of Pediatric Neurology, Psychosomatics and Pain Management, Klinikum Stuttgart, Stuttgart, Germany
| | - Sascha Meyer
- Department of General Pediatrics and Neonatology, Franz-Lust Klinik für Kinder und Jugendliche, Karlsruhe, Germany
| | - Hannah Schäfer
- Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Charlotte Thiels
- Division of Nephrology, Medizinische Klinik und Poliklinik IV, Klinikum der LMU München - Innenstadt, Munich, Germany
- Department of Neuropediatrics and Pediatric Epileptology, University Hospital of Ruhr University Bochum, Bochum, Germany
| | - Bianca Zukunft
- Department of Nephrology and Internal Intensive Care, Charité - University Medicine Berlin, Berlin, Germany
| | - Susanne Schubert-Bast
- Goethe-University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
- Goethe-University Frankfurt, Department of Neuropediatrics, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Felix Rosenow
- Goethe-University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
- Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Goethe-University Frankfurt, Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
- 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, Germany.
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Viola V, Bisulli F, Cornaggia CM, Ferri L, Licchetta L, Muccioli L, Mostacci B. Personality disorders in people with epilepsy: a review. Front Psychiatry 2024; 15:1404856. [PMID: 38800062 PMCID: PMC11116589 DOI: 10.3389/fpsyt.2024.1404856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Epileptologists and psychiatrists have long observed a correlation between epilepsy and personality disorders (PDs) in their clinical practice. We conducted a comprehensive PubMed search looking for evidence on PDs in people with epilepsy (PwE). Out of over 600 results obtained without applying any time restriction, we selected only relevant studies (both analytical and descriptive) limited to English, Italian, French and Spanish languages, with a specific focus on PDs, rather than traits or symptoms, thus narrowing our search down to 23 eligible studies. PDs have been investigated in focal epilepsy (predominantly temporal lobe epilepsy - TLE), juvenile myoclonic epilepsy (JME) and psychogenic non-epileptic seizures (PNES), with heterogeneous methodology. Prevalence rates of PDs in focal epilepsy ranged from 18 to 42% in surgical candidates or post-surgical individuals, with Cluster C personality disorders or related traits and symptoms being most common. In JME, prevalence rates ranged from 8 to 23%, with no strong correlation with any specific PDs subtype. In PNES, prevalence rates ranged from 30 to 60%, with a notable association with Cluster B personality disorders, particularly borderline personality disorder. The presence of a PD in PwE, irrespective of subtype, complicates treatment management. However, substantial gaps of knowledge exist concerning the neurobiological substrate, effects of antiseizure medications and epilepsy surgery on concomitant PDs, all of which are indeed potential paths for future research.
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Affiliation(s)
- Veronica Viola
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Bisulli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | | | - Lorenzo Ferri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Laura Licchetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Lorenzo Muccioli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epilepsy Center (full member of the European Reference Network EpiCARE), Bologna, Italy
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Fareed A, Sohail A, Siddiqui W, Asif MI, Fadlalla Ahmed TK. XEN1101, a novel potassium channel opener: hope or hype for adults with focal seizure. Ann Med Surg (Lond) 2024; 86:2417-2419. [PMID: 38694370 PMCID: PMC11060254 DOI: 10.1097/ms9.0000000000002029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 05/04/2024] Open
Affiliation(s)
- Areeba Fareed
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Afra Sohail
- Karachi Medical and Dental College, Karachi, Pakistan
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Lu M, Speri E, Lauks A, Leibson C, Rao SC. Understanding Health Care Provider Burnout When Caring for Patients With Refractory Epilepsy in the United States. Neurol Clin Pract 2024; 14:e200260. [PMID: 38585442 PMCID: PMC10996904 DOI: 10.1212/cpj.0000000000200260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/20/2023] [Indexed: 04/09/2024]
Abstract
Background and Objectives Among health care providers (HCPs), neurologists have one of the highest rates of burnout in the United States, compromising the quality and accessibility of patient care. Patients with refractory epilepsy are especially challenging to treat. This study aims to understand the burnout level in neurologists treating patients with refractory epilepsy and identify key contributing factors. Methods US board-certified pediatric/adult neurologists who devote ≥50% of their time to clinical practice and treat ≥10 unique patients with refractory epilepsy annually were invited to take a noninterventional quantitative survey, designed to capture key elements of the HCP's background, burnout level, current practice, burden domains, and satisfaction with current antiseizure medications (ASMs). Burnout in 3 domains (emotional exhaustion, depersonalization, and personal accomplishment) was assessed by the validated Maslach Burnout Inventory-Human Services Survey. Results From March 11, 2022, to April 10, 2022, a total of 138 neurology-specialist HCPs participated in the survey, divided between adult epileptologists (n = 44), adult neurologists (n = 41), pediatric epileptologists (n = 36), and pediatric neurologists (n = 17). Of participating HCPs, 61% experienced at least some burnout (≥1 of 3 burnout domains categorized as high), and 4% experienced high burnout (3 of 3 burnout domains categorized as high). High burnout levels were driven by high pediatric and inpatient caseloads and unexpected pediatric patient reluctance to transition to adult care. HCPs with high burnout had a higher yearly caseload of patients with refractory epilepsy. Most HCPs (approximately 90%) indicated that patients with refractory epilepsy were more difficult to manage than those with nonrefractory epilepsy. The proportion of HCPs satisfied or extremely satisfied with ASMs was lower for patients with refractory epilepsy (20%) than that for patients with nonrefractory epilepsy (73%). Dissatisfaction was mostly due to workload and latency of the insurance approval process, out-of-pocket costs, and poor efficacy, safety, and tolerability. For 32% of HCPs, stopping practicing or moving to another practice within 5 years was probable or very probable. Discussion Some burnout is common among HCPs who treat patients with refractory epilepsy. However, management of refractory epilepsy is challenging, and satisfaction with available ASMs is low. Thus, addressing these contributing factors may help to alleviate HCP burnout.
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Affiliation(s)
- Mei Lu
- Takeda Pharmaceuticals USA, Inc. (ML, SCR), Lexington, MA; and IQVIA (ES, AL, CL), Cambridge, MA
| | - Enrico Speri
- Takeda Pharmaceuticals USA, Inc. (ML, SCR), Lexington, MA; and IQVIA (ES, AL, CL), Cambridge, MA
| | - A Lauks
- Takeda Pharmaceuticals USA, Inc. (ML, SCR), Lexington, MA; and IQVIA (ES, AL, CL), Cambridge, MA
| | - Charles Leibson
- Takeda Pharmaceuticals USA, Inc. (ML, SCR), Lexington, MA; and IQVIA (ES, AL, CL), Cambridge, MA
| | - Satish C Rao
- Takeda Pharmaceuticals USA, Inc. (ML, SCR), Lexington, MA; and IQVIA (ES, AL, CL), Cambridge, MA
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Farjoud Kouhanjani M, Hosseini SA, Asadi-Pooya AA, Heydari M, Hosseini SMH, Farjoudi Kouhanjani HK. Historical roots of the stigma of epilepsy: A review of the classic Iranian literature. Epilepsy Behav 2024; 152:109644. [PMID: 38280255 DOI: 10.1016/j.yebeh.2024.109644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND The stigma toward epilepsy is a daily challenge for people with epilepsy (PWE) and can influence the well-being and prognosis of these individuals. However, the cultural origins of such stigma have sparsely been examined. In this study, we aimed to investigate the classic Persian literature to gain insight into the historical and cultural beliefs and opinions regarding epilepsy as a determinant in developing stigma towards PWE. METHODS In this narrative review of the classic Persian literature, we investigated the opinions and beliefs regarding epilepsy and PWE. In February 2023, we searched https://ganjoor.net (an open-access database of Iranian literature) for the relevant literary materials (poem and prose) using the Persian translation of the terms epilepsy (Sar'e) and epileptic (Masroo'e). Two clinical researchers went through the results and extracted the related materials under the supervision of two experts in Persian literature. A bilingual academic translated the included literary materials from Persian to English. RESULTS Our search yielded 57 literature materials by 31 poets and writers from the 4th to 14th Hijri centuries, roughly coinciding with the past Gregorian millennium (1000-2000 AC). We classified the literary concepts related to epilepsy stigma into five subgroups: (i) a simile for pain and suffering; (ii) an atonement for blasphemous beliefs or a disease caused by supernatural power; (iii) a sign of madness, insanity, and lack of wisdom; (iv) a celestial observation; and (v) a subject for jokes. CONCLUSIONS Classic Persian literature considered epilepsy as a simile for suffering and a sign of insanity that is caused by blasphemous beliefs or celestial objects, with PWE classified as insane and unwise. While such depictions became less prevalent after the 14th century CE, they can give rise to misconceptions and negative stigma toward PWE and should be addressed in modern culture. Each society should critically investigate its socio-cultural origins of stigma and rectify such misbeliefs.
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Affiliation(s)
| | - Seyed Ali Hosseini
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA.
| | - Mojtaba Heydari
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Seyed Mohammad Hadi Hosseini
- Department of Education of Fars, Shiraz, Fars Province, Iran; Farhangian University, Shiraz, Fars Province, Iran; Qatar University, Qatar.
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22
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Fan D, Qi L, Hou S, Wang Q, Baier G. The seizure classification of focal epilepsy based on the network motif analysis. Brain Res Bull 2024; 207:110879. [PMID: 38237873 DOI: 10.1016/j.brainresbull.2024.110879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/10/2023] [Accepted: 01/13/2024] [Indexed: 01/23/2024]
Abstract
Due to the complexity of focal epilepsy and its risk for transiting to the generalized epilepsy, the development of reliable classification methods to accurately predict and classify focal and generalized seizures is critical for the clinical management of patients with epilepsy. In order to holistically understand the seizure propagation behavior of focal epilepsy, we propose a three-node motif reduced network by respectively simplifying the focal region, surrounding healthy region and their critical regions as the single node. Because three-node motif can richly characterize information evolutions, the motif analysis method could comprehensively investigate the seizure behavior of focal epilepsy. Firstly, we define a new seizure propagation marker value to capture the seizure onsets and intensity. Based on the three-node motif analysis, it is shown that the focal seizure and spreading can be categorized as inhibitory seizure, focal seizure, focal-critical seizure and generalized seizures, respectively. The four types of seizures correspond to specific modal types respectively, reflecting the strong correlation between seizure behavior and information flow evolution. In addition, it is found that the intensity difference of outflow and inflow information from the critical node (connection heterogeneity) and the excitability of the critical node significantly affected the distribution and transition of the four seizure types. In particular, the method of local linear stability analysis also verifies the effectiveness of four types of seizures classification. In sum, this paper computationally confirms the complex dynamic behavior of focal seizures, and the study of criticality is helpful to propose novel seizure control strategies.
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Affiliation(s)
- Denggui Fan
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China
| | - Lixue Qi
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing 100083, China
| | - Songan Hou
- Department of Dynamics and Control, Beihang University, Beijing 100191, China
| | - Qingyun Wang
- Department of Dynamics and Control, Beihang University, Beijing 100191, China.
| | - Gerold Baier
- Cell and Developmental Biology, University College London, London WC1E 6BT, United Kingdom
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Koay JM, Sabsevitz DS, Ritaccio A, Feyissa AM, Tatum W, Blackmon K. Is preserved consciousness during seizures associated with quality of life among patients with drug-resistant epilepsy? Epilepsy Behav 2024; 150:109585. [PMID: 38096662 DOI: 10.1016/j.yebeh.2023.109585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 01/14/2024]
Abstract
Drug-resistant epilepsy is associated with reduced quality of life (QoL) due to a myriad of disease-related and psychosocial factors. Although consciousness during seizures is a core feature of seizure classification, its impact on QoL in people with epilepsy (PWE) is not well understood. This study aimed to address this gap by comparing QoL between PWE with focal aware (FA) versus impaired awareness (FIA) seizures. Sixty-nine adults with epilepsy completed the Quality of Life in Epilepsy-31 (QoLIE-31) inventory as part of their pre-surgical neuropsychological evaluation (FA: n = 26, FIA: n = 43). There was no group difference in seizure burden as defined by the proportion of comorbid focal to bilateral tonic-clonic seizures (FA:65.4 %; FIA: 79.1 %). People with FA seizures reported lower overall QoL than people with FIA seizures; sub-scale analyses revealed that seizure worry drives this effect. There was no difference in QoL between people with motor and non-motor FA seizures. Results suggest that FA seizures are burdensome on the QoL of PWE. FA seizures may contribute to seizure worry due to preserved awareness of aversive peri-ictal phenomenon. Findings suggest that clinical efforts should continue to be made to optimize seizure control in people with breakthrough FA seizures. Prospective longitudinal monitoring of QoL in trials of consciousness-targeting neurostimulation therapy is needed to determine if QoL changes as a function of improved peri-ictal consciousness following treatment.
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Affiliation(s)
- Jun Min Koay
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA.
| | - David S Sabsevitz
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - William Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Karen Blackmon
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA; Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
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Yang C, Liu J, Zhang L, Huang X. Treatment access barriers and medication adherence among children with epilepsy in western China: A cross-sectional study. Epilepsy Behav 2023; 149:109511. [PMID: 37944284 DOI: 10.1016/j.yebeh.2023.109511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE This study aimed to evaluate treatment access barriers and medication adherence among children with epilepsy and explore the influencing factors. METHODS This cross-sectional study consecutively sampled children with epilepsy from pediatric neurology clinics at West China Second Hospital of Sichuan University from October 2022 to April 2023. The scale used to assess treatment access barriers was self-designed and medication adherence was assessed with the Morisky Medication Adherence Scale. Multivariate linear or logistic regression analyses were used to determine influencing factors. RESULTS This study included 1,847 children with epilepsy. The majority of caregivers of participating children had treatment access barriers, especially for making appointments, obtaining diagnosis and examination results, and response from the care team (scores > 3). Younger age of children, difficulty paying medical expenses, comorbidities, higher frequency of seizures in the past month, and attitude toward seizures were associated with high treatment access barriers scores. Poor medication adherence was observed in 38 % (702/1,847) of the sample. Age, being an only child, place of residence, annual medical expense, being newly diagnosed, and comorbidities were associated with medication adherence. CONCLUSIONS Among children with epilepsy, there is high demand for disease treatment but medication adherence is relatively low, and there are a range of influencing factors. We suggest medical personnel strengthen health education and regular follow-ups to improve medication adherence and meet treatment needs in this population.
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Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Jianing Liu
- West China School of pharmacy, Sichuan University, China
| | - Lingli Zhang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Sichuan University, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
| | - Xi Huang
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, China.
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Jarzyński S, Rapacz A, Dziubina A, Pękala E, Popiół J, Piska K, Wojtulewski S, Rudolf B. Mechanochemical synthesis and anticonvulsant activity of 3-aminopyrrolidine-2,5-dione derivatives. Biomed Pharmacother 2023; 168:115749. [PMID: 37879208 DOI: 10.1016/j.biopha.2023.115749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023] Open
Abstract
A series of 3-aminopyrrolidine-2,5-dione derivatives was synthesized and tested for anticonvulsant activity. Succinimide derivatives were obtained from a simple solvent-based reaction and a mechanochemical aza-Michael reaction of maleimide or its N-substituted derivatives with selected amines. The structure of the compounds was confirmed by spectroscopic methods (NMR, FT-IR, HPLC, ESI-MS, EA and XRD for four compounds). The cytotoxic activity of the succinimide derivatives was evaluated using HepG2 cells for hepatocytotoxicity and SH-SY5Y cells for neurocytotoxicity. None of the studied compounds showed hepatocytotoxicity and two showed neurocytotoxicity. Initial anticonvulsant screening was performed in mice using the psychomotor seizure test (6 Hz, 32 mA). The selected compounds were evaluated in the following acute models of epilepsy: the maximal electroshock test, psychomotor seizure test (6 Hz, 44 mA), subcutaneous pentylenetetrazole seizure test, and acute neurotoxicity (rotarod test). The most active compound 3-((4-chlorophenyl)amino)pyrrolidine-2,5-dione revealed antiseizure activity in all seizure models (including pharmacoresistant seizures) and showed better median effective doses (ED50) and protective index values than the reference compound, ethosuximide. Furthermore, 3-(benzylamino)pyrrolidine-2,5-dione and 3-(phenylamino)pyrrolidine-2,5-dione exhibited antiseizure activity in the 6 Hz and MES tests, and 3-(butylamino)-1-phenylpyrrolidine-2,5-dione and 3-(benzylamino)-1-phenylpyrrolidine-2,5-dione exhibited antiseizure activity in the 6 Hz test. All active compounds demonstrated low in vivo neurotoxicity in the rotarod test and yielded favourable protective indices.
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Affiliation(s)
- Szymon Jarzyński
- Faculty of Chemistry, Department of Organic Chemistry, University of Lodz, Tamka 12, 91-403 Lodz, Poland
| | - Anna Rapacz
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 St., 30-688 Krakow, Poland
| | - Anna Dziubina
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 St., 30-688 Krakow, Poland
| | - Elżbieta Pękala
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 St., 30-688 Krakow, Poland
| | - Justyna Popiół
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 St., 30-688 Krakow, Poland
| | - Kamil Piska
- Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 St., 30-688 Krakow, Poland
| | - Sławomir Wojtulewski
- Department of Structural Chemistry, Faculty of Chemistry, University of Bialystok, Ciołkowskiego 1K, 15-245 Bialystok, Poland
| | - Bogna Rudolf
- Faculty of Chemistry, Department of Organic Chemistry, University of Lodz, Tamka 12, 91-403 Lodz, Poland.
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26
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Benoist C, Boccaletti S, Leach JP, Cattaneo A, Chaplin A, Antunes L, Heiman F, Sander JW. Characterising people with focal drug-resistant epilepsy: A retrospective cohort study. Epilepsy Behav 2023; 149:109540. [PMID: 38006844 DOI: 10.1016/j.yebeh.2023.109540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVES To describe the demographics, clinical characteristics, drug treatment outcomes, healthcare resource utilization, and injuries among people with focal drug-resistant epilepsy (F-DRE) analysed separately for six European countries. METHODS We used electronic medical record data from six European (Belgium, Spain, Italy, France, UK and Germany) primary care/specialist care databases to identify antiseizure medication (ASM) treatment-naïve people (aged ≥ 18 years at F-DRE diagnosis). They were followed from their epilepsy diagnosis until death, the date of last record available, or study end. We used descriptive analyses to characterise the F-DRE cohort, and results were reported by country. RESULTS One-thousand-seventy individuals with F-DRE were included (mean age 52.5 years; 55.4 % female). The median follow-up time from the first diagnosis to the end of the follow-up was 95.5 months across all countries. The frequency of F-DRE diagnosis in 2021 ranged from 8.8 % in Italy to 18.2 % in Germany. Psychiatric disorders were the most common comorbidity across all countries. Frequently reported psychiatric disorders were depression (26.7 %) and anxiety (11.8 %). The median time from epilepsy diagnosis to the first ASM failure ranged from 5.9 (4.2-10.2) months in France to 12.6 (5.8-20.4) months in Spain. Levetiracetam and lamotrigine were the most commonly used ASM monotherapies in all countries. Consultation with a general practitioner is sought more frequently after F-DRE diagnosis than after epilepsy diagnosis, except in the UK. SIGNIFICANCE No one ASM is optimal for all people with F-DRE, and the risks and benefits of the ASM must be considered. Comorbidities must be an integral part of the management strategy and drive the choice of drugs.
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Affiliation(s)
| | | | | | | | - Anna Chaplin
- IQVIA Solutions; Via Fabio Filzi 29, 20124 Milano; Italy
| | - Luis Antunes
- IQVIA Solutions; Via Fabio Filzi 29, 20124 Milano; Italy
| | - Franca Heiman
- IQVIA Solutions; Via Fabio Filzi 29, 20124 Milano; Italy.
| | - Josemir W Sander
- UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, the Netherlands; Neurology Department, West of China Hospital, Sichuan University, Chengdu 61004, China
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27
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Ben-Menachem E, Schmitz B, Kälviäinen R, Thomas RH, Klein P. The burden of chronic drug-refractory focal onset epilepsy: Can it be prevented? Epilepsy Behav 2023; 148:109435. [PMID: 37748414 DOI: 10.1016/j.yebeh.2023.109435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023]
Abstract
Despite the many therapeutic options for epilepsy available today, a third of patients still have poorly controlled epilepsy. Over the years, their transition through lines of treatment exposes them to increased risk of disease progression, mortality, morbidity, mental distress, and not least significantly impaired quality of life (QoL). The present review explores the multiple factors contributing to the impairment of health-related QoL in PWE-including both seizure-related and non seizure-related. The analysis aims to identify potential areas of intervention and strategies for a more holistic approach to epilepsy care and inform policy-makers and healthcare providers in their approach to this condition.
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Affiliation(s)
| | - Bettina Schmitz
- Neurology/Center for Epilepsy, Stroke Unit and Neurological Rehabilitation, Vivantes Humboldt Hospital, Berlin, Germany.
| | | | - Rhys H Thomas
- Department of Neurology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle-Upon-Tyne NE1 4LP, United Kingdom; Translational and Clinical Research Institute, Henry Wellcome Building, Framlington Place, Newcastle-Upon-Tyne NE2 4HH, United Kingdom.
| | - Pavel Klein
- Department of Neurology, George Washington University, Boston, United States.
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Villanueva V, Santos‐Carrasco D, Cabezudo‐García P, Gómez‐Ibáñez A, Garcés M, Serrano‐Castro P, Castro‐Vilanova MD, Sayas D, Lopez‐Gonzalez FJ, Rodríguez‐Osorio X, Torres‐Gaona G, Saiz‐Diaz RA, Hampel KG, Martinez‐Ferri M, Aguilar‐Amat MJ, Mercedes‐Alvarez B, García‐Morales V, del Villar‐Igea A, Massot‐Tarrús A, Rodríguez‐Uranga JJ. Real-world safety and effectiveness of cenobamate in patients with focal onset seizures: Outcomes from an Expanded Access Program. Epilepsia Open 2023; 8:918-929. [PMID: 37149853 PMCID: PMC10472366 DOI: 10.1002/epi4.12757] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/03/2023] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVE This study investigated early, real-world outcomes with cenobamate (CNB) in a large series of patients with highly drug-resistant epilepsy within a Spanish Expanded Access Program (EAP). METHOD This was a multicenter, retrospective, observational study in 14 hospitals. Inclusion criteria were age ≥18 years, focal seizures, and EAP authorization. Data were sourced from patient clinical records. Primary effectiveness endpoints included reductions (100%, ≥90%, ≥75%, and ≥50%) or worsening in seizure frequency at 3-, 6-, and 12-month visits and at the last visit. Safety endpoints included rates of adverse events (AEs) and AEs leading to discontinuation. RESULTS The study included 170 patients. At baseline, median epilepsy duration was 26 years and median number of seizures/month was 11.3. The median number of prior antiseizure medications (ASMs) and concomitant ASMs were 12 and 3, respectively. Mean CNB dosages/day were 176 mg, 200 mg, and 250 mg at 3, 6, and 12 months. Retention rates were 98.2%, 94.5%, and 87% at 3, 6, and 12 months. At last available visit, the rate of seizure freedom was 13.3%; ≥90%, ≥75%, and ≥50% responder rates were 27.9%, 45.5%, and 63%, respectively. There was a significant reduction in the number of seizures per month (mean: 44.6%; median: 66.7%) between baseline and the last visit (P < 0.001). Responses were maintained regardless of the number of prior or concomitant ASMs. The number of concomitant ASMs was reduced in 44.7% of patients. The cumulative percentage of patients with AEs and AEs leading to discontinuation were 68.2% and 3.5% at 3 months, 74.1% and 4.1% at 6 months, and 74.1% and 4.1% at 12 months. The most frequent AEs were somnolence and dizziness. SIGNIFICANCE In this highly refractory population, CNB showed a high response regardless of prior and concomitant ASMs. AEs were frequent but mostly mild-to-moderate, and few led to discontinuation.
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Affiliation(s)
- Vicente Villanueva
- Hospital Universitario y Politécnico La Fe, Member of EPICAREValenciaSpain
| | - Daniel Santos‐Carrasco
- Centro Neurología AvanzadaSevillaSpain
- Departamento de Psicología ExperimentalUniversidad de SevillaSevillaSpain
| | | | | | - Mercedes Garcés
- Hospital Universitario y Politécnico La Fe, Member of EPICAREValenciaSpain
| | | | | | - Débora Sayas
- Hospital Universitario y Politécnico La Fe, Member of EPICAREValenciaSpain
| | | | | | | | | | - Kevin G. Hampel
- Hospital Universitario y Politécnico La Fe, Member of EPICAREValenciaSpain
| | | | - Maria J. Aguilar‐Amat
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz—IdiPAZMadridSpain
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Annick-Mélanie M, Daniel GM, Laure MM, Ghislaine M, Christian E, Eric-Lamou GB, Callixte KT. Beliefs and attitudes of traditional healers regarding epilepsy in Cameroon. Epilepsy Behav 2023; 145:109300. [PMID: 37336130 DOI: 10.1016/j.yebeh.2023.109300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/24/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION People living with epilepsy suffer from stigmatization, overprotection, or exclusion, thus, part of these population in developing countries uses traditional medicine as a first resort. METHODS We prospectively conducted a study to determine the knowledge, attitudes, and practices (KAP) of traditional healers (THs) concerning epilepsy. Over a 9-month period, we included 208 THs practicing in the Littoral, Center and West regions of Cameroon who agreed to participate in the study. The THs were interviewed using a standardized questionnaire. Data were analyzed using Epi Info version 7.2 software. RESULTS Two-hundred and eight THs were recruited, with a mean age ± standard deviation (SD) of 49.9 ± 11.4 years, and 169 (81.2%) were male. Primary 77(37.0%) and secondary 67(32.2%) levels of education were the most represented, and most of the THs had more than 10 years of professional experience. One hundred and forty-one TH (68,7%) had poor knowledge about epilepsy. The independent factors associated with poor knowledge were female sex, Muslim religion, and marital status of cohabitation. One hundred and eighty-four THs (88.4%) had a good attitude and practices toward people with seizures. Factors independently associated with poor practices and attitude were rural residence, Muslim religion, and education level. CONCLUSION Our result confirmed that THs had poor knowledge about epilepsy but good attitudes and practices about epilepsy. THs were in favor of future collaboration with modern medicine in the care of people living with epilepsy.
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Affiliation(s)
- Magnerou Annick-Mélanie
- Department of Neurology, Laquintinie Hospital of Douala, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, Cameroon
| | | | | | - Meyo Ghislaine
- Higher Institute of Medical Technology, Nkolondom, Yaoundé, Cameroon
| | - Eyoum Christian
- Department of Neurology, Laquintinie Hospital of Douala, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, The University of Douala, Cameroon
| | | | - Kuate-Tegueu Callixte
- Department of Neurology, Laquintinie Hospital of Douala, Cameroon; Faculty of Medicine and Biomedical Sciences, The University of Yaoundé 1, Cameroon
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Busch RM, Dalton JE, Jehi L, Ferguson L, Krieger NI, Struck AF, Hermann BP. Association of Neighborhood Deprivation With Cognitive and Mood Outcomes in Adults With Pharmacoresistant Temporal Lobe Epilepsy. Neurology 2023; 100:e2350-e2359. [PMID: 37076308 PMCID: PMC10256132 DOI: 10.1212/wnl.0000000000207266] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/21/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Temporal lobe epilepsy (TLE) is the most common adult form of epilepsy and is associated with a high risk of cognitive deficits and depressed mood. However, little is known about the role of environmental factors on cognition and mood in TLE. This cross-sectional study examined the relationship between neighborhood deprivation and neuropsychological function in adults with TLE. METHODS Neuropsychological data were obtained from a clinical registry of patients with TLE and included measures of intelligence, attention, processing speed, language, executive function, visuospatial skills, verbal/visual memory, depression, and anxiety. Home addresses were used to calculate the Area Deprivation Index (ADI) for each individual, which were separated into quintiles (i.e., quintile 1 = least disadvantaged and quintile 5 = most disadvantaged). Kruskal-Wallis tests compared quintile groups on cognitive domain scores and mood and anxiety scores. Multivariable regression models, with and without ADI, were estimated for overall cognitive phenotype and for mood and anxiety scores. RESULTS A total of 800 patients (median age 38 years; 58% female) met all inclusion criteria. Effects of disadvantage (increasing ADI) were observed across nearly all measured cognitive domains and with significant increases in symptoms of depression and anxiety. Furthermore, patients in more disadvantaged ADI quintiles had increased odds of a worse cognitive phenotype (p = 0.013). Patients who self-identified as members of minoritized groups were overrepresented in the most disadvantaged ADI quintiles and were 2.91 (95% CI 1.87-4.54) times more likely to be in a severe cognitive phenotype than non-Hispanic White individuals (p < 0.001). However, accounting for ADI attenuated this relationship, suggesting neighborhood deprivation may account for some of the relationship between race/ethnicity and cognitive phenotype (ADI-adjusted proportional odds ratio 1.82, 95% CI 1.37-2.42). DISCUSSION These findings highlight the importance of environmental factors and regional characteristics in neuropsychological studies of epilepsy. There are many potential mechanisms by which neighborhood disadvantage can adversely affect cognition (e.g., fewer educational opportunities, limited access to health care, food insecurity/poor nutrition, and greater medical comorbidities). Future research will seek to investigate these potential mechanisms and determine whether structural and functional alterations in the brain moderate the relationship between ADI and cognition.
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Affiliation(s)
- Robyn M Busch
- From the Epilepsy Center (R.M.B., L.J., L.F.), Department of Neurology (R.M.B., L.J.), Neurological Institute, Department of Quantitative Health Sciences (J.E.D., N.I.K.), and Center for Computational Life Sciences (L.J.), Lerner Research Institute, Cleveland Clinic, OH; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison.
| | - Jarrod E Dalton
- From the Epilepsy Center (R.M.B., L.J., L.F.), Department of Neurology (R.M.B., L.J.), Neurological Institute, Department of Quantitative Health Sciences (J.E.D., N.I.K.), and Center for Computational Life Sciences (L.J.), Lerner Research Institute, Cleveland Clinic, OH; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Lara Jehi
- From the Epilepsy Center (R.M.B., L.J., L.F.), Department of Neurology (R.M.B., L.J.), Neurological Institute, Department of Quantitative Health Sciences (J.E.D., N.I.K.), and Center for Computational Life Sciences (L.J.), Lerner Research Institute, Cleveland Clinic, OH; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Lisa Ferguson
- From the Epilepsy Center (R.M.B., L.J., L.F.), Department of Neurology (R.M.B., L.J.), Neurological Institute, Department of Quantitative Health Sciences (J.E.D., N.I.K.), and Center for Computational Life Sciences (L.J.), Lerner Research Institute, Cleveland Clinic, OH; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Nikolas I Krieger
- From the Epilepsy Center (R.M.B., L.J., L.F.), Department of Neurology (R.M.B., L.J.), Neurological Institute, Department of Quantitative Health Sciences (J.E.D., N.I.K.), and Center for Computational Life Sciences (L.J.), Lerner Research Institute, Cleveland Clinic, OH; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Aaron F Struck
- From the Epilepsy Center (R.M.B., L.J., L.F.), Department of Neurology (R.M.B., L.J.), Neurological Institute, Department of Quantitative Health Sciences (J.E.D., N.I.K.), and Center for Computational Life Sciences (L.J.), Lerner Research Institute, Cleveland Clinic, OH; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Bruce P Hermann
- From the Epilepsy Center (R.M.B., L.J., L.F.), Department of Neurology (R.M.B., L.J.), Neurological Institute, Department of Quantitative Health Sciences (J.E.D., N.I.K.), and Center for Computational Life Sciences (L.J.), Lerner Research Institute, Cleveland Clinic, OH; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison
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Willems LM, Zöllner JP, Hamann L, Knake S, Kovac S, von Podewils F, Rosenow F, Strzelczyk A. Unemployment and early retirement among patients with epilepsy - A study on predictors, resilience factors and occupational reintegration measures. Epilepsy Behav 2023; 144:109255. [PMID: 37209554 DOI: 10.1016/j.yebeh.2023.109255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Abstract
The primary aim of this study was to identify predictors and resilience factors for unemployment and early retirement in patients with epilepsy of working age based on data from a multicenter German cohort study performed in 2020 (n = 456) by using multivariate binary logistic regression analysis. A second aim was to assess the assumed working ability of patients as well as the use of occupational reintegration measures. The unemployment rate was 8.3%, and 18% of patients had retired early due to epilepsy. Multivariate binary logistic regression analysis identified the presence of a relevant disability and frequent seizures as significant predictors of unemployment and early retirement, while seizures in remission were the only resilience factor associated with job retention. Regarding occupational incapacity, at the time of the survey, most of the patients in early retirement or unemployment were fit for work in their original or extended occupational setting. The proportion of patients with recent epilepsy-related occupational retraining (0.4%) or job changes (0.9%) was low, and only 2.4% reported an epilepsy-related reduction in work time. These findings underline the persistent disadvantage of patients with epilepsy in the professional field and the urgent need for effective, comprehensive work reintegration measures that must be made accessible for all patients.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Laura Hamann
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Stjepana Kovac
- Epilepsy Center Münster-Osnabrück, Department of Neurology, Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Felix von Podewils
- Department of Neurology, University Hospital Greifswald, Greifswald, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
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Chen J, Huang F, Fang X, Li S, Liang Y. Silencing TLR4 using an ultrasound-targeted microbubble destruction-based shRNA system reduces ischemia-induced seizures in hyperglycemic rats. Open Life Sci 2022; 17:1689-1697. [PMID: 36619717 PMCID: PMC9795576 DOI: 10.1515/biol-2022-0526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 12/28/2022] Open
Abstract
The toll-like receptor 4 (TLR4) pathway is involved in seizures. We investigated whether ultrasound-targeted microbubble destruction (UTMD)-mediated delivery of short hairpin RNA (shRNA) targeting the TLR4 gene (shRNA-TLR4) can reduce ischemia-induced seizures in rats with hyperglycemia. A total of 100 male Wistar rats were randomly assigned to five groups: (1) Sham; (2) normal saline (NS); (3) shRNA-TLR4, where rats were injected with shRNA-TLR4; (4) shRNA-TLR4 + US, where rats were injected with shRNA-TLR4 followed by ultrasound (US) irradiation; and (5) shRNA-TLR4 + microbubbles (MBs) + US, where rats were injected with shRNA-TLR4 mixed with MBs followed by US irradiation. Western blot and immunohistochemical staining were used to measure TLR4-positive cells. Half of the rats in the NS group developed tonic-clonic seizures, and TLR4 expression in the CA3 region of the hippocampus was increased in these rats. In addition, the NS group showed an increased number of TLR4-positive cells compared with the Sham group, while there was a decreased number of TLR4-positive cells in the shRNA, shRNA + US, and shRNA + MBs + US groups. Our findings indicate that the TLR4 pathway is involved in the pathogenesis of ischemia-induced seizures in hyperglycemic rats and that UTMD technology may be a promising strategy to treat brain diseases.
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Affiliation(s)
- Jia Chen
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Fami Huang
- Department of Intensive Care Unit, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511500, China
| | - Xiaobo Fang
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Siying Li
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Yanling Liang
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China,Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, 510150, China
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