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Cerulli Irelli E, Morano A, Cocchi E, Casciato S, Fanella M, Albini M, Avorio F, Basili LM, Fisco G, Barone FA, Mascia A, D’Aniello A, Manfredi M, Fattouch J, Quarato P, Giallonardo AT, Di Gennaro G, Di Bonaventura C. Doing without valproate in women of childbearing potential with idiopathic generalized epilepsy: Implications on seizure outcome. Epilepsia 2019; 61:107-114. [DOI: 10.1111/epi.16407] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Emanuele Cerulli Irelli
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Alessandra Morano
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Enrico Cocchi
- Department of Public Health and Pediatrics University of Turin Turin Italy
| | | | - Martina Fanella
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Mariarita Albini
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Federica Avorio
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Luca M. Basili
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Giacomo Fisco
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Francesca A. Barone
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | | | | | - Mario Manfredi
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | - Jinane Fattouch
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | | | - Anna Teresa Giallonardo
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
| | | | - Carlo Di Bonaventura
- Epilepsy Unit Department of Human Neurosciences Policlinico “Umberto I”, “Sapienza” University Rome Italy
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2
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Moguilner S, García AM, Mikulan E, Del Carmen García M, Vaucheret E, Amarillo Y, Bekinschtein TA, Ibáñez A. An unaware agenda: interictal consciousness impairments in epileptic patients. Neurosci Conscious 2017; 2017:niw024. [PMID: 30042834 PMCID: PMC6007167 DOI: 10.1093/nc/niw024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/16/2016] [Accepted: 12/21/2016] [Indexed: 01/07/2023] Open
Abstract
Consciousness impairments have been described as a cornerstone of epilepsy. Generalized seizures are usually characterized by a complete loss of consciousness, whereas focal seizures have more variable degrees of responsiveness. In addition to these impairments that occur during ictal episodes, alterations of consciousness have also been repeatedly observed between seizures (i.e. during interictal periods). In this opinion article, we review evidence supporting the novel hypothesis that epilepsy produces consciousness impairments which remain present interictally. Then, we discuss therapies aimed to reduce seizure frequency, which may modulate consciousness between epileptic seizures. We conclude with a consideration of relevant pathophysiological mechanisms. In particular, the thalamocortical network seems to be involved in both seizure generation and interictal consciousness impairments, which could inaugurate a promising translational agenda for epilepsy studies.
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Affiliation(s)
- Sebastian Moguilner
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,Fundación Escuela de Medicina Nuclear (FUESMEN) and Comisión Nacional de Energía Atómica (CNEA), Buenos Aires, Argentina.,Instituto Balseiro and Facultad de Ciencias Exactas y Naturales, Universidad Nacional de Cuyo (UNCuyo), Mendoza, Argentina
| | - Adolfo M García
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Faculty of Elementary and Special Education (FEEyE), National University of Cuyo (UNCuyo), Mendoza, Argentina
| | - Ezequiel Mikulan
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Maria Del Carmen García
- Programa de Cirugía de Epilepsia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Esteban Vaucheret
- Servicio de Neurologia Infantil del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Yimy Amarillo
- Consejo Nacional de Investigaciones Científicas y Técnicas, Física Estadística e Interdisciplinaria, Centro Atómico Bariloche, San Carlos de Bariloche, Rio Negro, Argentina
| | | | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, Australia
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3
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Kjaer TW, Sorensen HBD, Groenborg S, Pedersen CR, Duun-Henriksen J. Detection of Paroxysms in Long-Term, Single-Channel EEG-Monitoring of Patients with Typical Absence Seizures. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2017; 5:2000108. [PMID: 29018634 PMCID: PMC5477700 DOI: 10.1109/jtehm.2017.2649491] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/26/2016] [Accepted: 11/27/2016] [Indexed: 11/30/2022]
Abstract
Absence seizures are associated with generalized 2.5-5 Hz spike-wave discharges in the electroencephalogram (EEG). Rarely are patients, parents, or physicians aware of the duration or incidence of seizures. Six patients were monitored with a portable EEG-device over four times 24 h to evaluate how easily outpatients are monitored and how well an automatic seizure detection algorithm can identify the absences. Based on patient-specific modeling, we achieved a sensitivity of 98.4% with only 0.23 false detections per hour. This yields a clinically satisfying performance with a positive predictive value of 87.1%. Portable EEG-recorders identifying paroxystic events in epilepsy outpatients are a promising tool for patients and physicians dealing with absence epilepsy. Albeit the small size of the EEG-device, some children still complained about the obtrusive nature of the device. We aim at developing less obtrusive though still very efficient devices, e.g., hidden in the ear canal or below the skin.
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Affiliation(s)
- Troels W. Kjaer
- Center of NeurophysiologyDepartment of NeurologyZealand University
HospitalRoskildeDenmark
| | - Helge B. D. Sorensen
- Department of Electrical
EngineeringTechnical University of
DenmarkKgs. LyngbyDenmark
| | - Sabine Groenborg
- Juliane Marie CentreRigshospitalet University
HospitalCopenhagenDenmark
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4
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Liu F, Wang Y, Li M, Wang W, Li R, Zhang Z, Lu G, Chen H. Dynamic functional network connectivity in idiopathic generalized epilepsy with generalized tonic-clonic seizure. Hum Brain Mapp 2016; 38:957-973. [PMID: 27726245 DOI: 10.1002/hbm.23430] [Citation(s) in RCA: 251] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/23/2022] Open
Abstract
Idiopathic generalized epilepsy (IGE) has been linked with disrupted intra-network connectivity of multiple resting-state networks (RSNs); however, whether impairment is present in inter-network interactions between RSNs, remains largely unclear. Here, 50 patients with IGE characterized by generalized tonic-clonic seizures (GTCS) and 50 demographically matched healthy controls underwent resting-state fMRI scans. A dynamic method was implemented to investigate functional network connectivity (FNC) in patients with IGE-GTCS. Specifically, independent component analysis was first carried out to extract RSNs, and then sliding window correlation approach was employed to obtain dynamic FNC patterns. Finally, k-mean clustering was performed to characterize six discrete functional connectivity states, and state analysis was conducted to explore the potential alterations in FNC and other dynamic metrics. Our results revealed that state-specific FNC disruptions were observed in IGE-GTCS and the majority of aberrant functional connectivity manifested itself in default mode network. In addition, temporal metrics derived from state transition vectors were altered in patients including the total number of transitions across states and the mean dwell time, the fraction of time spent and the number of subjects in specific FNC state. Furthermore, the alterations were significantly correlated with disease duration and seizure frequency. It was also found that dynamic FNC could distinguish patients with IGE-GTCS from controls with an accuracy of 77.91% (P < 0.001). Taken together, this study not only provided novel insights into the pathophysiological mechanisms of IGE-GTCS but also suggested that the dynamic FNC analysis was a promising avenue to deepen our understanding of this disease. Hum Brain Mapp 38:957-973, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Feng Liu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology and Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610054, People's Republic of China.,Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Yifeng Wang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology and Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610054, People's Republic of China
| | - Meiling Li
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology and Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610054, People's Republic of China
| | - Wenqin Wang
- School of Sciences, Tianjin Polytechnic University, Tianjin, 300130, People's Republic of China
| | - Rong Li
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology and Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610054, People's Republic of China
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China
| | - Huafu Chen
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology and Center for Information in BioMedicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, 610054, People's Republic of China
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5
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Stewart E, Catroppa C, Lah S. Theory of Mind in Patients with Epilepsy: a Systematic Review and Meta-analysis. Neuropsychol Rev 2016; 26:3-24. [DOI: 10.1007/s11065-015-9313-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 12/16/2015] [Indexed: 11/30/2022]
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6
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Lee C, Kim SM, Jung YJ, Im CH, Kim DW, Jung KY. Causal influence of epileptic network during spike-and-wave discharge in juvenile myoclonic epilepsy. Epilepsy Res 2014; 108:257-66. [DOI: 10.1016/j.eplepsyres.2013.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 10/07/2013] [Accepted: 11/03/2013] [Indexed: 11/16/2022]
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7
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Tosun D, Dabbs K, Caplan R, Siddarth P, Toga A, Seidenberg M, Hermann B. Deformation-based morphometry of prospective neurodevelopmental changes in new onset paediatric epilepsy. Brain 2011; 134:1003-14. [PMID: 21398377 DOI: 10.1093/brain/awr027] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Epilepsy is a prevalent childhood neurological disorder, but there are few prospective quantitative magnetic resonance imaging studies examining patterns of brain development compared to healthy controls. Controlled prospective investigations initiated at or near epilepsy onset would best characterize the nature, timing and course of neuroimaging abnormalities in paediatric epilepsy. In this study, we report the results of a deformation-based morphometry technique to examine baseline and 2-year prospective neurodevelopmental brain changes in children with new and recent onset localization-related epilepsies (n = 24) and idiopathic generalized epilepsies (n = 20) compared to healthy controls (n = 36). Children with epilepsy demonstrated differences from controls in baseline grey and white matter volumes suggesting antecedent anomalies in brain development, as well as abnormal patterns of prospective brain development that involved not only slowed white matter expansion, but also abnormalities of cortical grey matter development involving both greater and lesser volume changes compared to controls. Furthermore, abnormal neurodevelopmental changes extended outside the cortex affecting several subcortical structures including thalamus, cerebellum, brainstem and pons. Finally, there were significant differences between the epilepsy syndromes (localization-related epilepsies and idiopathic generalized epilepsies) with the idiopathic generalized epilepsies group showing a more disrupted pattern of brain structure both at baseline and over the 2-year interval.
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Affiliation(s)
- Duygu Tosun
- Centre for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Centre, San Francisco, CA, USA.
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8
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Pulsipher DT, Dabbs K, Tuchsherer V, Sheth RD, Koehn MA, Hermann BP, Seidenberg M. Thalamofrontal neurodevelopment in new-onset pediatric idiopathic generalized epilepsy. Neurology 2011; 76:28-33. [PMID: 21205692 DOI: 10.1212/wnl.0b013e318203e8f3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Quantitative MRI techniques have demonstrated thalamocortical abnormalities in idiopathic generalized epilepsy (IGE). However, there are few studies examining IGE early in its course and the neurodevelopmental course of this region is not adequately defined. OBJECTIVE We examined the 2-year developmental course of the thalamus and frontal lobes in pediatric new-onset IGE (i.e., within 12 months of diagnosis). METHODS We performed whole-brain MRI in 22 patients with new-onset IGE and 36 age-matched healthy controls. MRI was repeated 24 months after baseline MRI. Quantitative volumetrics were used to examine thalamic and frontal lobe volumes. RESULTS The IGE group showed significant differences in thalamic volume within 1 year of seizure onset (baseline) and went on to show thalamic volume loss at a significantly faster rate than healthy control children over the 2-year interval. The control group also showed a significantly greater increase in frontal white matter expansion than the IGE group. In contrast, frontal lobe gray matter volume differences were moderate at baseline and persisted over time, indicating similar developmental trajectories with differences early in the disease process that are maintained. CONCLUSIONS Brain tissue abnormalities in thalamic and frontal regions can be identified very early in the course of IGE and an abnormal trajectory of growth continues over a 2-year interval.
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Affiliation(s)
- D T Pulsipher
- Rosalind Franklin University of Medicine & Science, Department of Psychology, 3333 Green Bay Road, North Chicago, IL 60064, USA.
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Biton V, Di Memmo J, Shukla R, Lee YY, Poverennova I, Demchenko V, Saiers J, Adams B, Hammer A, Vuong A, Messenheimer J. Adjunctive lamotrigine XR for primary generalized tonic-clonic seizures in a randomized, placebo-controlled study. Epilepsy Behav 2010; 19:352-8. [PMID: 20937567 DOI: 10.1016/j.yebeh.2010.07.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/22/2010] [Accepted: 07/24/2010] [Indexed: 10/19/2022]
Abstract
Efficacy and tolerability of once-daily adjunctive lamotrigine extended-release (XR) for primary generalized tonic-clonic (PGTC) seizures in epilepsy were evaluated. Patients (n = 153) ≥ 13 years old diagnosed with epilepsy with PGTC seizures were randomized to once-daily adjunctive lamotrigine XR or placebo in a double-blind, parallel-group trial comprising a baseline phase, a 7-week double-blind escalation phase, and a 12-week double-blind maintenance phase. Lamotrigine XR was more effective than placebo with respect to median percentage reduction from baseline in weekly PGTC seizure frequency (primary endpoint-19-week treatment phase: 75.4% vs 32.1%, P<0.0001; escalation phase: 61.9% vs 30.6%, P = 0.0016; maintenance phase: 89.7% vs 33.3%, P<0.0001). Lamotrigine XR was more effective than placebo with respect to the percentage of patients with ≥50% reduction in PGTC seizure frequency. Significant separation from placebo for ≥50% reduction in PGTC seizures was observed beginning on treatment day 8. The most common adverse event was headache (lamotrigine XR 14%, placebo 16%).
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Affiliation(s)
- Victor Biton
- Arkansas Epilepsy Program, Little Rock, AR 72205, USA.
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10
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Montouris G, Abou-Khalil B. The first line of therapy in a girl with juvenile myoclonic epilepsy: Should it be valproate or a new agent? Epilepsia 2009; 50 Suppl 8:16-20. [DOI: 10.1111/j.1528-1167.2009.02230.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
More than half of patients with newly diagnosed epilepsy achieve complete seizure control without major side-effects. Patients who continue to have seizures after initial medical therapy should have an early and detailed assessment to confirm the diagnosis, to determine the underlying cause and epilepsy syndrome, and to choose an adequate treatment strategy. The risks and potential benefits of surgical procedures or experimental therapy have to be weighed against the chance of improvement and the potential side-effects of additional medical therapy. Surgery for temporal lobe epilepsy, the most common cause of focal epilepsy, can control seizures and improve quality of life in appropriately selected patients. However, around 20-30% of patients do not respond to medical or surgical treatment. The management of chronic intractable epilepsy requires comprehensive care to address the adverse events of medical treatment, quality of life issues, and comorbid disorders. Much research focuses on the experimental treatment options that offer hope of seizure reduction or cure.
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Affiliation(s)
- Stephan U Schuele
- Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
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12
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Specchio N, Boero G, Michelucci R, Gambardella A, Giallonardo AT, Fattouch J, Di Bonaventura C, de Palo A, Ladogana M, Lamberti P, Vigevano F, La Neve A, Specchio LM. Effects of levetiracetam on EEG abnormalities in juvenile myoclonic epilepsy. Epilepsia 2008; 49:663-9. [PMID: 18266754 DOI: 10.1111/j.1528-1167.2007.01523.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE A multicenter, prospective, long-term, open-label study to evaluate the effects of levetiracetam on electroencephalogram (EEG) abnormalities and photoparoxysmal response (PPR) of patients affected by juvenile myoclonic epilepsy (JME). METHODS Forty-eight patients with newly diagnosed JME (10) or resistant/intolerant (38) to previous antiepileptic drugs (AEDs) were enrolled. After an 8-week baseline period, levetiracetam was titrated in 2 weeks to 500 mg b.i.d. and then increased to up to 3,000 mg/day. Efficacy parameters were based on the comparison and analysis of EEG interictal abnormalities classified as spikes-and-waves, polyspikes-and-waves, and presence of PPR. Secondary end point was evaluation of EEG and PPR changes as predictive factors of 12-month seizure freedom. RESULTS Overall, mean dose of levetiracetam was 2,208 mg/day. Mean study period was 19.3 +/- 11.5 months (range 0.3-38). During the baseline period, interictal EEG abnormalities were detected in 44/48 patients (91.6%) and PPR was determined in 17/48 (35.4%) of patients. After levetiracetam treatment, 27/48 (56.2%) of patients compared to 4/48 (8.3%) in the baseline period (p < 0.0001) had a normal EEG. Thirteen of 17 (76.4%) (p < 0.0003) patients showed suppression of PPR. Cumulative probability of days with myoclonia (DWM) 12-month remission was significantly higher (p < 0.05) in patients with a normal (normalized) EEG after levetiracetam treatment compared to those with an unchanged EEG. CONCLUSIONS Levetiracetam appeared to be effective in decreasing epileptiform EEG abnormalities, and suppressing the PPR in JME patients. This effect, along with a good efficacy and tolerability profile in this population further supports a first-line role for levetiracetam in the treatment of JME.
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Affiliation(s)
- Nicola Specchio
- Division of Neurology, Bambino Gesù Children's Hospital, Roma, Italy.
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Vendrame M, Khurana DS, Cruz M, Melvin J, Valencia I, Legido A, Kothare SV. Aggravation of Seizures and/or EEG Features in Children Treated with Oxcarbazepine Monotherapy. Epilepsia 2007; 48:2116-20. [PMID: 17645535 DOI: 10.1111/j.1528-1167.2007.01210.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Exacerbation of epilepsy may occur following initiation of therapy with antiepileptic drugs (AEDs). The aim of this study is to analyze the clinical and EEG characteristics of a group of pediatric patients with worsening of seizures and/or EEG deterioration while on oxcarbazepine (OXC). METHODS A retrospective analysis of a clinical database was performed to identify patients with epilepsy treated with OXC over the past 3 years. History, neurological examination, and EEG findings were reviewed to identify any who had developed exacerbation of seizures or new abnormalities on EEG. RESULTS Of 290 patients on OXC, we identified 12 patients with new onset seizures, all with initial normal neurological exam and normal EEG, who developed either worsening of preexisting seizures, new seizure types, and/or EEG deterioration following introduction of OXC monotherapy. EEG changes were primarily characterized by new onset of generalized epileptiform activity not reported on the initial baseline EEG. Following substitution of OXC with a broad spectrum AED, significant improvement of seizure control and improvement in the EEG was observed. CONCLUSIONS These findings suggest that OXC can aggravate seizures and/or worsen EEG features in children. Following initiation of therapy with OXC, monitoring of patients with follow-up EEGs may be important, especially in patients who do not show adequate response to therapy.
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Affiliation(s)
- Martina Vendrame
- Department of Pediatrics, Division of Neurology, St. Christopher's Hospital for Children, Drexel University College of Medicine, Erie Avenue at Front Street, Philadelphia, PA 19134, U.S.A
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14
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15
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Restuccia D, Valeriani M, Della Marca G. Giant subcortical high-frequency SEPs in idiopathic generalized epilepsy: a protective mechanism against seizures? Clin Neurophysiol 2006; 118:60-8. [PMID: 17097917 DOI: 10.1016/j.clinph.2006.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 09/06/2006] [Accepted: 09/08/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Recently, we found that high-frequency somatosensory evoked potentials (HF-SEPs), which are modulated by arousal-related structures, were abnormally enhanced during N-REM sleep in two seizure-free IGE patients [Restuccia D, Rubino M, Valeriani M, Della Marca G. Increase of brainstem high-frequency SEP subcomponents during light sleep in seizure-free epileptic patients. Clin Neurophysiol 2005; 116: 1774-1778]. Here, we aimed at verifying whether similar HF-SEP abnormalities were significantly correlated to the clinical outcome in a larger population of untreated IGE patients. METHODS Patients were classified as Juvenile Myoclonic epilepsy (JME; six patients) and Childhood or Juvenile Absence epilepsy (CAE and JAE, six patients). They were untreated because newly diagnosed, or because seizure-free. HF-SEPs from patients were compared with those obtained from 21 healthy volunteers. RESULTS HF-SEPs were abnormally enhanced in all seizure-free CAE-JAE patients, whereas they were normal in all JME patients and in CAE-JAE patients with frequent seizures. Not only scalp distribution, but also dipolar source analysis suggested a subcortical origin for these enhanced subcomponents, possibly in the brainstem. CONCLUSIONS The enhancement of HF-SEPs might reflect the hyperactivity of arousal-related brainstem structures; such an enhancement was found in all seizure-free CAE-JAE patients, while it was never observed in JME patients. SIGNIFICANCE We speculate that the hyperactivity of arousal-related brainstem structures might account for the different clinical outcome among IGE subsyndromes.
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Affiliation(s)
- Domenico Restuccia
- Scientific Institute E. MEDEA, Polo Friuli Venezia Giulia, Udine, Italy.
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Maiga Y, Nogues B, Guillon B. Accentuation des crises tonico-cloniques sous lamotrigine dans l’épilepsie myoclonique juvénile. Rev Neurol (Paris) 2006; 162:1125-7. [PMID: 17086150 DOI: 10.1016/s0035-3787(06)75126-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Lamotrigine is an anti-epileptic drug considered as a first-line therapy in idiopathic generalised epilepsy. Lamotrigine is well-tolerated and secondary aggravation of epileptic syndromes has rarely been reported. CASE REPORT We report the case of a 19 year-old man with juvenile myoclonic epilepsy in whom lamotrigine lead to the exacerbation of generalised tonico-clonic seizures, reversible when lamotrigine was stopped and substituted by valproic acid. CONCLUSION Lamotrogine may induce exacerbation of generalised tonico-clonic seizures and myoclonic jerks in juvenile myoclonic epilepsy.
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Affiliation(s)
- Y Maiga
- Clinique Neurologique, Hôpital Laënnec, Nantes
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17
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Aldenkamp A, Vigevano F, Arzimanoglou A, Covanis A. Role of valproate across the ages. Treatment of epilepsy in children. Acta Neurol Scand 2006; 184:1-13. [PMID: 16776492 DOI: 10.1111/j.1600-0404.2006.00666.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In June 2005 a team of experts participated in a workshop with the objective of reaching agreement on the place of valproate use in the treatment of paediatric epilepsy patients. A general "consensus of the meeting" was that the initiation of antiepileptic drug (AED) treatment should be based on a seizure-syndromic approach in children. Participants of the meeting also agreed that valproate is currently the AED with the broadest spectrum across all types of seizures and syndromes. Its superiority has been shown over almost 40 years of clinical experience. The best results are seen in idiopathic generalized epilepsy with or without photosensitivity, idiopathic focal and symptomatic generalized tonic-clonic seizures (GTCS). Evidence supports the use of valproate, ethosuximide and lamotrigine in absence epilepsies and the use of carbamazepine, lamotrigine, oxcarbazepine, phenytoin, topiramate, valproate and phenobarbital for primary GTCS. For new AEDs trials have been undertaken to define their therapeutic role but studies comparing their role to 'old' broad-spectrum drugs in specific syndromes are missing. Experts concluded that intravenous (i.v.) valproate is a useful agent in the treatment of non-convulsive status epilepticus (SE). There is an easy transition to oral treatment following i.v. valproate use. The discussion also concluded that, despite the lack of studies, valproate is an interesting, underutilized alternative in convulsive SE but more controlled studies are needed. The side effects of valproate use are well documented. Its effect on cognition and behaviour is more favourable than many of the other AEDs which is an important consideration in children. Overall, the clinical consensus of the meeting was that valproate's well established therapeutic properties far outweigh the negative side effects. Contraindication or withdrawal should be assessed individually.
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Affiliation(s)
- A Aldenkamp
- Epilepsy Centre Kempenhaeghe, PO Box 21, 5590 AB Heeze, The Netherlands.
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Specchio LM, Gambardella A, Giallonardo AT, Michelucci R, Specchio N, Boero G, La Neve A. Open label, long-term, pragmatic study on levetiracetam in the treatment of juvenile myoclonic epilepsy. Epilepsy Res 2006; 71:32-9. [PMID: 16814521 DOI: 10.1016/j.eplepsyres.2006.05.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 05/13/2006] [Accepted: 05/14/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE Patients with juvenile myoclonic epilepsy (JME) may be resistant or show adverse effects to valproate. We present a multicenter, prospective, long-term, open-label study evaluating the efficacy and safety of levetiracetam in JME. METHODS Patients with newly diagnosed (10) or resistant/intolerant to previous AEDs JME (38) were enrolled. After a 8 week baseline period, levetiracetam was titrated in 2 weeks to 500 mg b.i.d. and then increased up to 3000 mg/day according to the patient's response. Efficacy parameters were: number of seizure-free patients, number of days with myoclonus (DWM), and monthly frequency of generalised tonic-clonic (GTC) seizures. Adverse events were recorded. RESULTS The overall mean dose of levetiracetam was 2208 mg/day. The mean study period was 19 (range 0.3-38) months. Five patients dropped out. 11/38 (28.9%) patients with add-on treatment and 5/10 (50%) newly diagnosed patients were seizure-free for a mean period of 17.2 (+/-8.8) months. Eighteen patients (37.5%) were without myoclonia, and 35 (72.9%) had no GTC seizures over the study period. The mean monthly frequency of DWM and of GTC seizures in the entire group was significantly reduced after levetiracetam. Five patients complained of side effects. CONCLUSIONS This open-label study suggests levetiracetam may be effective and well tolerated in resistant cases of JME or may become a reasonable alternative to valproate in newly diagnosed patients.
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Affiliation(s)
- Luigi Maria Specchio
- Department of Medical and Occupational Sciences, Clinic of the Nervous System Diseases, University of Foggia, Italy.
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D'Arcangelo G, D'Antuono M, Tancredi V, Avoli M. Neocortical hyperexcitability in a genetic model of absence seizures and its reduction by levetiracetam. Epilepsia 2006; 47:1144-52. [PMID: 16886977 DOI: 10.1111/j.1528-1167.2006.00588.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To study the effect of the antiepileptic drug levetiracetam (LEV) on the patterns of intrinsic optical signals (IOSs) generated by slices of the somatosensory cortex obtained from 3- and 6-month-old WAG/Rij and age-matched, nonepileptic control (NEC) rats. METHODS WAG/Rij and NEC animals were anesthetized with enfluorane and decapitated. Brains were quickly removed, and neocortical slices were cut coronally with a vibratome, transferred to a submerged tissue chamber, and superfused with oxygenated artificial cerebrospinal fluid (aCSF). Slices were illuminated with a dark-field condensor and examined with a x2.5 objective; images were processed with a real time digital video image-enhancement system. Images were acquired before (background) and during electrical stimulation with a temporal resolution of 10 images/s and were displayed in pseudocolors. Extracellular stimuli (200 micros; <4 V) were delivered through bipolar stainless steel electrodes placed in the white matter. RESULTS IOSs recorded in NEC slices bathed in control aCSF became less intense and of reduced size with age (p < 0.05); this trend was not seen in WAG/Rij slices. Age-dependent decreases in IOS intensity and area size were also seen in NEC slices superfused with aCSF containing the convulsant 4-aminopyridine (4-AP, 5 microM); in contrast, significant increases in both parameters occurred with age in 4-AP-treated WAG/Rij slices (p < 0.05). Under any of these conditions, the IOS intensity and area size slices were larger in WAG/Rij than in NEC slices. LEV (50-500 microM) application to WAG/Rij slices caused dose-dependent IOS reductions that were evident both in control and in 4-AP-containing aCSF and were more pronounced in 6-month-old tissue. CONCLUSIONS These data demonstrate age-dependent IOS modifications in NEC and WAG/Rij rat slices and identify a clear pattern of hyperexcitability that occurs in 6-month-old WAG/Rij neocortical tissue, an age when absence seizures occur in all animals. The ability of LEV to reduce these patterns of network hyperexcitability supports the potential use of this new antiepileptic drug in primary generalized epileptic disorders.
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Dlugos DJ, Buono RJ, Ferraro TN. Defining the clinical role of pharmacogenetics in antiepileptic drug therapy. THE PHARMACOGENOMICS JOURNAL 2006; 6:357-9. [PMID: 16505830 DOI: 10.1038/sj.tpj.6500379] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- D J Dlugos
- Divison of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-3403, USA
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Ferraro TN, Dlugos DJ, Buono RJ. Challenges and opportunities in the application of pharmacogenetics to antiepileptic drug therapy. Pharmacogenomics 2006; 7:89-103. [PMID: 16354127 DOI: 10.2217/14622416.7.1.89] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The recent surge of interest in pharmacogenetics has provoked considerable thought regarding its relevance to antiepileptic drug (AED) therapy. Initial studies have focused on genes whose products play a putatively important role in AED pharmacology, particularly drug transporter proteins, drug metabolizing enzymes and ion channel subunits. However, there is a lack of good correspondence between results from different laboratories, and more recent findings are awaiting attempts at confirmation. Thus, there are currently no AED treatment guidelines that are informed by pharmacogenetic data. In order to begin to have clinical impact, standards specific to the conduct of future AED studies must be established. Of particular importance are the need for accurate epilepsy classification, appropriate AED selection and clear and objective assessment outcome measures. In addition, general standards for analysis and interpretation of genetic association data must be better codified and applied consistently across studies. Finally, extensive clinical research networks must be formulated and large numbers of well characterized patients must be recruited. Further development of these critical factors will optimize chances for overcoming current challenges posed by AED pharmacogenetic research and ultimately allow the realization of improved, more rational therapeutic strategies.
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Affiliation(s)
- Thomas N Ferraro
- University of Pennsylvania, Center for Neurobiology and Behavior, Room 2209, Translational Research Laboratories, and The Children's Hospital of Philadelphia, Department of Pediatrics, Philadelphia, PA 19104, USA. TNF-@mail.med.upenn.edu
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Abstract
The idiopathic generalized epilepsies (IGE) are a group of epilepsies that are genetically determined, have no structural or anatomic cause, and usually begin early in life. Neurologic examination, intelligence, and imaging studies are normal, and EEG shows only epileptiform abnormalities (i.e., no abnormal slow activity or evidence for diffuse encephalopathy). In some IGE, the genetic substrate has been identified, whereas in most, it remains unknown. Depending on the age at onset and predominant seizure type, individual subtypes of IGE (syndromes) are defined. However, overall, there are more similarities than there are differences among the various subtypes, and the IGE are best viewed as a spectrum or continuum of conditions. In general, IGE respond to treatment, with 80-90% becoming fully controlled. However, not all antiepileptic drugs (AED) are equally effective in IGE. Some AED are ill advised because they either do not work or exacerbate seizure types other than generalized tonic-clonic (GTC) seizures, that is, absence and myoclonic seizures. These include carbamazepine, oxcarbazepine, phenytoin, gabapentin, and tiagabine. Their use is the main cause of "pseudo-intractability," and at least in the United States where PHT and CBZ are the most commonly used AEDs, patients with IGE are often on inadequate medications. For patients with clear IGE, the drug of choice is generally valproic acid because it effectively controls absence myoclonic seizures and GTC seizures. Second-line drugs (when first-line drugs fail or are not tolerated) may include benzodiazepines, but the use of second-line drugs is evolving rapidly. Some of the newer AEDs are considered broad spectrum, meaning that they work in IGE and focal epilepsies, although the evidence is largely preliminary at this point. These newer AEDs include lamotrigine, topiramate, levetiracetam, and zonisamide.
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Affiliation(s)
- Selim R Benbadis
- Department of Neurology , University of South Florida, Tampa General Hospital, Tampa, Florida 33606, USA.
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Abstract
Selecting the optimal antiepileptic drug (AED) begins with accurate epilepsy classification, including seizure type and epilepsy syndrome if possible. Based on the available data, children with focal epilepsy, with or without secondary generalization, can be treated with a traditional or newer narrow-spectrum or broad-spectrum AED. Children with generalized convulsive epilepsy, mixed epilepsy, or seizures of an unknown type are best treated with a broad-spectrum AED. Children with childhood absence epilepsy can be treated with ethosuximide, valproate, or lamotrigine. In all cases, the best choice among the various AED options requires consideration of factors such as seizure frequency, seizure severity, AED adverse event profile, AED titration schedule, patient comorbidities, prescription plan coverage, and cost. Most children with epilepsy achieve the goal of "no seizures and no side effects" and most children eventually become seizure free without AEDs. If accurate epilepsy classification is made, clear differences in efficacy are not evident among the multiple available AEDs. Better comparative data emphasizing adverse event profiles, comorbidities and longer-term outcome are needed between the traditional and newer AEDs.
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Affiliation(s)
- Joseph E Sullivan
- Division of Neurology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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