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Griffen C, Schoeler NE, Browne R, Cameron T, Kirkpatrick M, Thowfeek S, Munn J, Champion H, Mills N, Phillips S, Air L, Devlin A, Nicol C, Macfarlane S, Bittle V, Thomas P, Cooke L, Ackril J, Allford A, Appleyard V, Szwec C, Atwal K, Hubbard GP, Stratton RJ. Tolerance, adherence, and acceptability of a ketogenic 2.5:1 ratio, nutritionally complete, medium chain triglyceride-containing liquid feed in children and adults with drug-resistant epilepsy following a ketogenic diet. Epilepsia Open 2024; 9:727-738. [PMID: 38411329 PMCID: PMC10984290 DOI: 10.1002/epi4.12910] [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: 11/17/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE To investigate incorporating a ready-to-use 2.5:1 ratio liquid feed into a ketogenic diet (KD) in children and adults with drug-resistant epilepsy. METHODS Following a three-day baseline, patients (n = 19; age: 19 years [SD 13], range: 8-46 years) followed a KD for 28 days (control period), then incorporated ≥200 mL/day of a ready-to-use liquid feed, made with a ratio of 2.5 g of fat to 1 g of protein plus carbohydrate and including medium chain triglycerides ([MCTs]; 25.6% of total fat/100 mL) for 28 days as part of their KD (intervention period). Outcome measures (control vs intervention period) included gastrointestinal (GI) tolerance, adherence to KD and intervention feed, dietary intake, blood ß-hydroxybutyrate (BHB) concentration, seizure outcomes, health-related quality of life (HRQoL), acceptability and safety. RESULTS Compared to the control period, during the intervention period, the percentage of patients reporting no GI symptoms increased (+5% [SD 5], p = 0.02); adherence to the KD prescription was similar (p = 0.92) but higher in patients (n = 5) with poor adherence (<50%) to KD during the control period (+33% [SD 26], p = 0.049); total MCT intake increased (+12.1 g/day [SD 14.0], p = 0.002), driven by increases in octanoic (C8; +8.3 g/day [SD 6.4], p < 0.001) and decanoic acid (C10; +5.4 g/day [SD 5.4], p < 0.001); KD ratio decreased (p = 0.047), driven by a nonsignificant increase in protein intake (+11 g/day [SD 44], p = 0.29); seizure outcomes were similar (p ≥ 0.63) but improved in patients (n = 6) with the worst seizure outcomes during the control period (p = 0.04); and HRQoL outcomes were similar. The intervention feed was well adhered to (96% [SD 8]) and accepted (≥88% of patients confirmed). SIGNIFICANCE These findings provide an evidence-base to support the effective management of children and adults with drug-resistant epilepsy following a KD with the use of a ready-to-use, nutritionally complete, 2.5:1 ratio feed including MCTs. PLAIN LANGUAGE SUMMARY This study examined the use of a ready-to-use, nutritionally complete, 2.5:1 ratio (2.5 g of fat to 1 g of protein plus carbohydrate) liquid feed, including medium chain triglycerides (MCTs), into a ketogenic diet (KD) in children and adults with drug-resistant epilepsy. The results show that the 2.5:1 ratio feed was well tolerated, adhered to, and accepted in these patients. Increases in MCT intake (particularly C8 and C10) and improvements in seizure outcomes (reduced seizure burden and intensity) and KD adherence also occurred with the 2.5:1 ratio feed in patients with the worst seizures and adherence, respectively.
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Affiliation(s)
| | - Natasha E. Schoeler
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for ChildrenLondonUK
| | | | - Tracy Cameron
- Tayside Children's HospitalDundeeUK
- Royal Aberdeen Children's HospitalAberdeenUK
| | | | - Seema Thowfeek
- The Barberry, Birmingham and Solihull Mental Health NHS Foundation TrustBirminghamUK
| | - Judith Munn
- The Barberry, Birmingham and Solihull Mental Health NHS Foundation TrustBirminghamUK
| | - Helena Champion
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Nicole Mills
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Siân Phillips
- Southampton Children's Hospital, Southampton General HospitalSouthamptonUK
| | - Linda Air
- Great North Children's HospitalNewcastle Upon TyneUK
| | - Anita Devlin
- Great North Children's HospitalNewcastle Upon TyneUK
| | - Claire Nicol
- Great North Children's HospitalNewcastle Upon TyneUK
| | | | | | | | - Lisa Cooke
- Bristol Royal Hospital for ChildrenBristolUK
| | - Julia Ackril
- Birmingham Women's and Children's NHS TrustBirminghamUK
| | | | | | - Clare Szwec
- Clinical Research, Nutricia Ltd.TrowbridgeUK
| | | | | | - Rebecca J. Stratton
- Clinical Research, Nutricia Ltd.TrowbridgeUK
- University of SouthamptonSouthamptonUK
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Kellenaers JTF, Rijkers K, van Mastrigt GAPG, Schijns OEMG, Hoogland G, Dings J, van Kuijk S, Vlooswijk MCG, Wagner LGL, Idema S, van Straaten IECW, van der Salm SMA, Majoie MHJM. Resective Epilepsy Surgery, QUality of life and Economic evaluation (RESQUE): the change in quality of life after resective epilepsy surgery-protocol for a multicentre, prospective cohort study. BMJ Open 2023; 13:e064263. [PMID: 37407053 DOI: 10.1136/bmjopen-2022-064263] [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] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Resective epilepsy surgery is often seen as a last resort when treating drug-resistant epilepsy. Positive results on quality of life (QoL) and economic benefits after surgery argue for a less restrictive attitude towards epilepsy surgery for drug-resistant epilepsy. QoL and economic benefits are country-dependent. The objective of the Resective Epilepsy Surgery, QUality of life and Economic evaluation (RESQUE) trial is to evaluate the change in QoL before and after epilepsy surgery in Dutch people with drug-resistant epilepsy. The results will form part of an economic evaluation of epilepsy surgery in people with epilepsy (PWE) in The Netherlands. METHODS AND ANALYSIS A longitudinal prospective multicentre cohort study involving 100 PWE undergoing epilepsy surgery between 2019 and 2025 is being performed in three Dutch academic hospitals. Excluded are PWE who have a lower level of intelligence (TIQ<70) or who do not master the Dutch language. Before surgery and 3, 6, 12 and 24 months after surgery, PWE receive validated online questionnaires (QOLIE-31, EQ-5D, iMCQ and iPCQ) on QoL, cost of care, expectations and satisfaction. Primary outcome is the change in QoL. Secondary outcomes are change in generic QoL, seizure reduction (International League Against Epilepsy Outcome Classification), medical consumption, productivity, the correlation between QoL and seizure reduction and expectation of and satisfaction with the surgery. ETHICS AND DISSEMINATION The study design has been approved by the Medical Ethics Review Committee (METC) of Maastricht UMC+ (2019-1134) and the Amsterdam UMC (vu). At the time of writing, UMC Utrecht is in the process of considering approval. The study will be conducted according to the Dutch Medical Research Involving Human Subjects Act and the Declaration of Helsinki. The results will be publicly disclosed and submitted for publication in international peer-reviewed scientific journals. There is no veto on publication by the involved parties. TRIAL REGISTRATION NL8278; Pre-results.
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Affiliation(s)
- Julia T F Kellenaers
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kim Rijkers
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Olaf E M G Schijns
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Govert Hoogland
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jim Dings
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sander van Kuijk
- Clinical Epidemiology and Medical Technology Assessment, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | | | | | - Sander Idema
- Department of Neurosurgery, Amsterdam UMC VUMC Site, Amsterdam, The Netherlands
| | | | - Sandra M A van der Salm
- Department of Neurology, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands
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Evans K, Stamas N, Li Q, Vincent T, Zhang L, Danielson V, Lam S, Lassagne R, Berger A. Patterns of utilization and cost of healthcare services and pharmacotherapy among patients with drug-resistant epilepsy during the two-year period before neurostimulation: A descriptive analysis of the journey to implantation based on analyses of a large United States healthcare claims database. Epilepsy Behav 2023; 145:109288. [PMID: 37348410 DOI: 10.1016/j.yebeh.2023.109288] [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: 02/27/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To conduct a descriptive assessment of patterns of utilization and cost of healthcare services and pharmacotherapies among patients with drug-resistant epilepsy (DRE) before neurostimulator implantation. METHODS Using a large United States healthcare claims database, we identified all patients with DRE who were implanted with neurostimulators between January 1, 2012, and December 31, 2019. Patients without an epilepsy diagnosis on their implantation date were excluded, as were those without (1) anti-seizure medication (ASM) dispenses within 12 months of implantation date, and (2) continuous enrollment for the 24-month period before this date. Demographic and clinical characteristics were assessed over the two-year period before implantation, as were patterns of utilization and cost of healthcare services and pharmacotherapy. Care was assessed as all-cause or epilepsy-related, with the latter defined as all medical (inpatient and outpatient) care resulting in diagnoses of epilepsy and all ASM dispenses. RESULTS Eight hundred sixty patients met all selection criteria. Among these patients, comorbidities were common, including depression (27%), anxiety (30%), and learning disabilities (25%). Fifty-nine percent of patients had ≥1 all-cause hospitalizations; 57% had ≥1 epilepsy-related admissions. Patients averaged 8.6 epilepsy-related visits to physicians' offices, including 5.1 neurologist visits. Mean all-cause and epilepsy-related healthcare costs during the pre-implantation period were $123,500 and $91,995, respectively; corresponding median values were $74,567 and $53,029. Median monthly all-cause healthcare costs increased by 138% during the 24-month period (from $1,042 to $2,481 in the month prior to implantation); median epilepsy-related costs, by 290% (from $383 to $1,492). CONCLUSIONS The two-year period before neurostimulator implantation is a long and costly journey. Estimates likely minimize the burden experienced during this period, given that seizure frequency and severity-and corresponding impacts on quality of life-were unavailable in these data. Further research is needed to understand the clinical, economic, and psychological impact of the time between DRE onset and implantation among qualifying patients.
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Affiliation(s)
| | | | | | | | - Lu Zhang
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | | | - Sandi Lam
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Monteagudo-Gimeno E, Sánchez-González R, Raduà-Castaño J, Fortea-González L, Boget-Llucià T, Carreño-Martínez M, Donaire-Pedraza A, Bargalló-Alabart N, Setoain-Perego X, Rumià-Arboix J, Bulbena-Vilarrasa A, Pintor-Pérez L. Clinical relevance of interictal dysphoric disorder and its impact on quality of life in drug-resistant epilepsy. Epilepsy Behav 2023; 144:109253. [PMID: 37192579 DOI: 10.1016/j.yebeh.2023.109253] [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: 03/03/2023] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This study aims to assess the prevalence of Interictal Dysphoric Disorder (IDD) in drug-resistant epilepsy (DRE) and to describe its clinical and psychopathological profile, including personality, as well as its impact on quality of life (QOL). METHOD A retrospective cross-sectional study from an Epilepsy Unit from January 2007 to December 2017. All patients were diagnosed with DRE. Patients underwent a battery of tests (HADS, SCL-90R, PDQ-4+, QOLIE-31) and a psychiatrist assessed the presence of Axis-I disorders and IDD. Statistical procedures were carried out using R-4.0.1 software. RESULTS A total of 282 patients were included. A statistically significant association was found between IDD and mood and anxiety disorders (p < 0.001 and p < 0.05 respectively), and between IDD and higher scores in all HADS and SCL-90-R items compared to subjects without IDD (p < 0.001). A statistically significant association was also found between IDD and obsessive-compulsive, borderline and depressive personality disorder (p < 0.05). Scores in all QOLIE-31 items except for 'medication effects' were significantly lower in subjects with IDD compared with subjects without IDD (p < 0.001). CONCLUSIONS In DRE, IDD subjects show differences in the psychopathological profile and QOL scores compared to subjects without a diagnosis of IDD. An early diagnosis of IDD could facilitate prompt interventions which might positively impact QOL.
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Affiliation(s)
- E Monteagudo-Gimeno
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Benito Menni Mental HealthCare Complex, Sant Boi de Llobregat, Barcelona, Spain.
| | - R Sánchez-González
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - J Raduà-Castaño
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain; FIDMAG Research Foundation, Sant Boi de Llobregat, Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - L Fortea-González
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.
| | - T Boget-Llucià
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain.
| | - M Carreño-Martínez
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain.
| | - A Donaire-Pedraza
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain.
| | - N Bargalló-Alabart
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain.
| | - X Setoain-Perego
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain; Biomedical Imaging Group, Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain.
| | - J Rumià-Arboix
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain.
| | - A Bulbena-Vilarrasa
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain.
| | - L Pintor-Pérez
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain; Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain; Consultation-Liaison Service, Department of Psychiatry, Institut de Neurociències. Universitat de Barcelona, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.
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Kim S, Park S, Choi TG, Kim SS. Role of Short Chain Fatty Acids in Epilepsy and Potential Benefits of Probiotics and Prebiotics: Targeting “Health” of Epileptic Patients. Nutrients 2022; 14:nu14142982. [PMID: 35889939 PMCID: PMC9322917 DOI: 10.3390/nu14142982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/17/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
The WHO’s definition of health transcends the mere absence of disease, emphasizing physical, mental, and social well-being. As this perspective is being increasingly applied to the management of chronic diseases, research on gut microbiota (GM) is surging, with a focus on its potential for persistent and noninvasive dietary therapeutics. In patients with epilepsy (PWE), a chronic lack of seizure control along with often neglected psychiatric comorbidities greatly disrupt the quality of life. Evidence shows that GM-derived short chain fatty acids (SCFAs) may impact seizure susceptibility through modulating (1) excitatory/inhibitory neurotransmitters, (2) oxidative stress and neuroinflammation, and (3) psychosocial stress. These functions are also connected to shared pathologies of epilepsy and its two most common psychiatric consequences: depression and anxiety. As the enhancement of SCFA production is enabled through direct administration, as well as probiotics and prebiotics, related dietary treatments may exert antiseizure effects. This paper explores the potential roles of SCFAs in the context of seizure control and its mental comorbidities, while analyzing existing studies on the effects of pro/prebiotics on epilepsy. Based on currently available data, this study aims to interpret the role of SCFAs in epileptic treatment, extending beyond the absence of seizures to target the health of PWE.
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Affiliation(s)
- Soomin Kim
- Department of Preliminary Medicine, School of Medicine, Kyung Hee University, Seoul 02447, Korea;
| | - Siyeon Park
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston, MA 02115, USA;
| | - Tae Gyu Choi
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Korea
- Biomedical Science Institute, Kyung Hee University, Seoul 02447, Korea
- Correspondence: (T.G.C.); (S.S.K.); Tel.: +82-2-961-0287 (T.G.C.); +82-2-961-0524 (S.S.K.)
| | - Sung Soo Kim
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Korea
- Biomedical Science Institute, Kyung Hee University, Seoul 02447, Korea
- Correspondence: (T.G.C.); (S.S.K.); Tel.: +82-2-961-0287 (T.G.C.); +82-2-961-0524 (S.S.K.)
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Abstract
Drug-resistant epilepsy is associated with poor health outcomes and increased economic burden. In the last three decades, various new antiseizure medications have been developed, but the proportion of people with drug-resistant epilepsy remains relatively unchanged. Developing strategies to address drug-resistant epilepsy is essential. Here, we define drug-resistant epilepsy and emphasize its relationship to the conceptualization of epilepsy as a symptom complex, delineate clinical risk factors, and characterize mechanisms based on current knowledge. We address the importance of ruling out pseudoresistance and consider the impact of nonadherence on determining whether an individual has drug-resistant epilepsy. We then review the principles of epilepsy drug therapy and briefly touch upon newly approved and experimental antiseizure medications.
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Vincent T, Li Q, Zhang L, Stokes M, Danielson V, Murphy J, Barion F, Lam S, Lassagne R, Berger A. Comparison of utilization and cost of healthcare services and pharmacotherapy following implantation of vagus nerve stimulation vs. responsive neurostimulation or deep brain stimulation for the treatment of drug-resistant epilepsy: analyses of a large United States healthcare claims database. J Med Econ 2022; 25:1218-1230. [PMID: 36384429 DOI: 10.1080/13696998.2022.2148680] [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] [Indexed: 11/18/2022]
Abstract
AIM Vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) all are options for drug-resistant epilepsy (DRE). However, little is known about how the choice of neurostimulation impacts subsequent healthcare costs. MATERIALS AND METHODS We used a large US healthcare claims database to identify all patients with epilepsy who underwent neurostimulation between 2012 and 2019. Eligible patients were identified and stratified based on procedure received (VNS vs. RNS/DBS). VNS patients were matched by propensity scoring to RNS/DBS patients. Use and cost of healthcare resources and pharmacotherapy were ascertained over the 24-month period following neurostimulation, incorporating all-cause and epilepsy-related measures. Disease-related care was defined based on diagnoses of claims for medical care and relevant pharmacotherapies. RESULTS Seven hundred and ninety-two patients met all selection criteria. VNS patients were younger, were prescribed a higher pre-index mean number of anti-seizure medications (ASMs), and had higher pre-index levels of use and cost of epilepsy-related healthcare services. We propensity matched 148 VNS patients to an equal number of RNS/DBS patients. One year following index date (inclusive), mean total all-cause healthcare costs were 50% lower among VNS patients than RNS/DBS patients, and mean epilepsy-related costs were 55% lower; corresponding decreases at the two-year mark were 41% and 48%, respectively. LIMITATIONS Some clinical variables, such as seizure frequency and severity, quality of life, and functional status were unavailable in the database, precluding our ability to comprehensively assess differences between devices. Administrative claims data are subject to billing code errors, inaccuracies, and missing data, resulting in possible misclassification and/or unmeasured confounding. CONCLUSIONS After matching, VNS was associated with significantly lower all-cause and epilepsy-related costs for the two-year period following implantation. All-cause and epilepsy-related costs remained statistically significantly lower for VNS even after costs of implantation were excluded.
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Affiliation(s)
| | | | - Lu Zhang
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Sandi Lam
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Marital status among patients with epilepsy in Saudi Arabia. Epilepsy Behav 2022; 126:108452. [PMID: 34864382 DOI: 10.1016/j.yebeh.2021.108452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 02/01/2023]
Abstract
There are no adequate studies on Saudi Arabia regarding the effect of the social environment on marriage among people with epilepsy (PWE). To fill this gap in the literature, we investigated the marital status of PWE to determine the factors affecting their marital prospects. The subjects of the study included PWE aged 18 years or above, recruited between 1998 and 2019 from the Epilepsy Registry of King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We collected a wide range of socio-demographic data on age, gender, location, education level, employment status, and marital status. In total, 1857 PWE, comprising 1086 men (58.48%) and 771 women (41.52%), were enrolled in the study. The data analysis showed that those 'married' and those who 'had been married' comprised 46.96% of the sample, while those 'never married' comprised 53.04%; 65.37% of the sample held a 'high school diploma or less' or had 'no education', 26.85% reported ongoing university education or had already obtained a bachelor's or higher degree; 50.08% of the respondents were employed, while 47.98% were not. Of the sample, 40.28% resided in Riyadh, whereas 13.14% were from the Asir region. We found that socio-demographic factors, especially employment status, had a major influence on the marital prospects of PWE.
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McCann ZH, Szaflarski M, Szaflarski JP. A feasibility study to assess social stress and social support in patients enrolled in a cannabidiol (CBD) compassionate access program. Epilepsy Behav 2021; 124:108322. [PMID: 34600280 PMCID: PMC8960472 DOI: 10.1016/j.yebeh.2021.108322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 01/12/2023]
Abstract
Cannabidiol (CBD) trials offer an opportunity to examine social factors that shape outcomes of patients with treatment-resistant epilepsy. Prior research of patients treated with CBD for epilepsy describes financial struggles of these patients/families and the association between socioeconomic status and patient-centered outcomes. However, social determinants of health in this population are still poorly understood, mainly due to data scarcity. This study aimed to establish feasibility of assessing social stress, social support, and religious participation and their associations with outcomes (perceived health, quality of life, and mood) in patients treated with CBD for epilepsy. Data were collected during 2015-2018 through structured face-to face interviews with patients/caregivers in a CBD compassionate access/research program in the southern United States. Adult (ages 19-63; n = 65) and pediatric (ages 8-19; n = 46) patients or their caregivers were interviewed at the time of enrollment in the study. Social stress was assessed with stressful life events, perceived stress, epilepsy-related discrimination, and economic stressors; social support with the Interpersonal Support Evaluation List [ISEL]-12; and religious participation with frequency of religious attendance. The results showed economic stressors to be associated with poor overall health, but no associations were noted between stress, support, and religious participation measures and quality of life or mood. Despite a robust data collection plan, completeness of the data was mixed. We discuss lessons learned and directions for future research and identify potential refinements to social data collection in people with treatment-resistant epilepsy during clinical trials.
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Affiliation(s)
- Zachary H McCann
- Department of Sociology, University of Alabama at Birmingham, USA.
| | | | - Jerzy P Szaflarski
- UAB Epilepsy Center and Departments of Neurology, Neurosurgery, and Neurobiology, USA
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Moos TAO, Rydahl-Hansen S. 'Everything is as before, but nothing is as it was'-A phenomenological-hermeneutic study of meaningfulness in adult patients with refractory epilepsy after interdisciplinary epilepsy rehabilitation. Epilepsy Behav 2021; 122:108168. [PMID: 34271324 DOI: 10.1016/j.yebeh.2021.108168] [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: 02/15/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Interdisciplinary Rehabilitation aimed at adults with refractory epilepsy (RE) establishes scientific evidence of higher health-related QoL, including improved self-worth and increased self-awareness as outcomes. Yet, there is very little research-based knowledge of how life transforms itself after the rehabilitation program from patients' perspectives. AIM The aim of this study was to identify and describe how - from the patient perspectives - life transforms itself after rehabilitation among adults with RE, focusing on the meaningfulness of interdisciplinary rehabilitation. METHOD Nine patients, who all completed an Interdisciplinary Rehabilitation Program in an Adult Epilepsy Clinic, were interviewed between six months and two years after rehabilitation. Nine interviews were recorded, transcribed verbatim, and analyzed as described by the phenomenological method 'Reflective Lifeworld Research' (RLR). FINDINGS The essence of the phenomenon was revealed as life as a struggle for a dignified existence with RE as a navigating life companion. Through the clusters of meaning, four constituents emerged from the phenomenon: 1) to accept the limitations of body and mind; 2) to be on a journey toward your inner self; 3) to be quietly understood; 4) to fight for renewed hope and recognition during transition. CONCLUSION The patients consider it significant to know their own bodies with the constraints that this involves. This knowledge helps them make decisions that not only have a positive effect on their epilepsy, but also raise their self-esteem and give them renewed hope and courage to face life. However, the struggle for a dignified life is continuously hard, and it comes to a head in patients' transition from 'patient to citizen', where asymmetries arise. These asymmetries leave considerable marks on the patients' worlds and challenge their renewed hope for a dignified existence.
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Affiliation(s)
- Trine Arnam Olsen Moos
- Department of Adult Epileptology and PNES, The Danish National Epilepsy Center, Filadelfia, Kolonivej 2 A, 1. Sal, 4293 Dianalund, Denmark.
| | - Susan Rydahl-Hansen
- Research Unit of Nursing and Healthcare, Institute of Public Health Health, Aarhus University, Department of Public Health - Department of Science in Nursing, Campus Emdrup, Tuborgvej 164, bygning B8, 1. sal, 2400 Copenhagen NV, Denmark.
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Lanzone J, Boscarino M, Ricci L, Insola A, Tombini M, Di Lazzaro V, Assenza G. Effects of the noncompetitive AMPA receptor antagonist perampanel on thalamo-cortical excitability: A study of high-frequency oscillations in somatosensory evoked potentials. Clin Neurophysiol 2021; 132:1049-1056. [PMID: 33743300 DOI: 10.1016/j.clinph.2020.12.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Wedesignedalongitudinalcohortstudyon People with Epilepsy (PwE) with the aimofassessingthe effect of Perampanel (PER) oncortico-subcortical networks, as measured by high-frequency oscillations of somatosensory evoked potentials (SEP-HFOs). SEP-HFOs measure the excitability of both thalamo-corticalprojections(early HFOs) and intracortical GABAergic synapses (late HFOs), thus they could be used to study the anti-glutamatergic action of PER, a selective antagonist of the AMPA receptor. METHODS 15 PwE eligible for PER add-on therapy, were enrolled prospectively. Subjects underwent SEPs recording from the dominant hand at two times: PwET0 (baseline, before PER titration) and PwET1 (therapeutic dose of 4 mg). HFOs were obtained by filtering N20 scalp response in the 400-800 Hz range. Patients were compared with a normative population of 15 healthy controls (HC) matched for age and sex. RESULTS We found a significant reduction ofTotal HFOs and mostly early HFOs area between PwET0 and PwET1 (p = 0.05 and p = 0.045 respectively) and between HC and PwET1 (p = 0.01). Furthermore, we found a significant reduction of P24/N24 Amplitude between PwET0 and HC and between PwET0 and PwET1 (p = 0.006 and p = 0.032, respectively). CONCLUSIONS Introduction of PER as add-on therapy reduced the area of total HFOs, acting mainly on the early burst, related to thalamo-cortical pathways. Furthermore P24/N24 amplitude, which seems to reflect a form of cortico-subcortical integration, resulted increased in PwE at T0 and normalized at T1. SIGNIFICANCE Our findings suggest that PER acts on cortico-subcortical excitability. This could explain the broad spectrum of PER and its success in forms of epilepsy characterized by thalamo-cortical hyperexcitability.
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Affiliation(s)
- Jacopo Lanzone
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Marilisa Boscarino
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Lorenzo Ricci
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Mario Tombini
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giovanni Assenza
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
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Serum transferrin as a biomarker of hepatocyte nuclear factor 4 alpha activity and hepatocyte function in liver diseases. BMC Med 2021; 19:39. [PMID: 33593348 PMCID: PMC7887823 DOI: 10.1186/s12916-021-01917-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/18/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Serum transferrin levels represent an independent predictor of mortality in patients with liver failure. Hepatocyte nuclear factor 4 alpha (HNF4α) is a master regulator of hepatocyte functions. The aim of this study was to explore whether serum transferrin reflects HNF4α activity. METHODS Factors regulating transferrin expression in alcoholic hepatitis (AH) were assessed via transcriptomic/methylomic analysis as well as chromatin immunoprecipitation coupled to DNA sequencing. The findings were corroborated in primary hepatocytes. Serum and liver samples from 40 patients with advanced liver disease of multiple etiologies were also studied. RESULTS In patients with advanced liver disease, serum transferrin levels correlated with hepatic transferrin expression (r = 0.51, p = 0.01). Immunohistochemical and biochemical tests confirmed reduced HNF4α and transferrin protein levels in individuals with cirrhosis. In AH, hepatic gene-gene correlation analysis in liver transcriptome revealed an enrichment of HNF4α signature in transferrin-correlated transcriptome while transforming growth factor beta 1 (TGFβ1), tumor necrosis factor α (TNFα), interleukin 1 beta (IL-1β), and interleukin 6 (IL-6) negatively associated with transferrin signature. A key regulatory region in transferrin promoter was hypermethylated in patients with AH. In primary hepatocytes, treatment with TGFβ1 or the HNF4α inhibitor BI6015 suppressed transferrin production, while exposure to TNFα, IL-1β, and IL-6 had no effect. The correlation between hepatic HNF4A and transferrin mRNA levels was also seen in advanced liver disease. CONCLUSIONS Serum transferrin levels constitute a prognostic and mechanistic biomarker. Consequently, they may serve as a surrogate of impaired hepatic HNF4α signaling and liver failure.
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Alqadi K, Alghamdi O, Babtain F, Ba'arma H, Bajammal S, Albalawi M, Alfadhel A, Jawhari M, Abu-Jabber A, Madani N, Al-Said Y, Baz S, Kayyali H. Effects of fasting during Ramadan on seizure control and quality of life in patients with epilepsy. Epilepsy Behav 2020; 112:107440. [PMID: 32906015 DOI: 10.1016/j.yebeh.2020.107440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND During Ramadan, the ninth month of the lunar Islamic calendar, adult Muslims are obliged to fast, which involves refraining from taking any food, beverages, or oral medications from dawn to sunset. Fasting's effect on seizure control is not fully understood, and a few observational studies have provided inconclusive results. This study aimed to investigate the effect of fasting during Ramadan on seizure control and quality of life in adult patients with epilepsy. METHODS This was a prospective observational study over a 3-month period (one month before fasting, the fasting month, and one month after fasting). We recruited adult patients with active epilepsy who were able to fast during the month of Ramadan. The primary outcome measures were as follows: 1) seizure control and 2) quality of life score using the Arabic version of the Ferrans and Powers Quality of Life Index (QLI). Changes in anticonvulsant medications were not allowed during the study period. We used a seizure log provided to participants to record the number of seizures during the 3-month period. Quality of life was scored at the end of each month of the study period. RESULTS Thirty-seven patients were studied (59% males). The mean age was 30 years (range, 14-51 years), and mean age at epilepsy onset was 13 years (range, 0.5-35 years). On average, patients were on three antiepileptic medications at baseline (range: 2-5). A total of 1576 seizures were reported during the 3-month follow-up, where seizures prior to fasting represented 35.5% of all seizures. Multilinear regression analysis revealed a significant decline of seizures by 21% during the fasting month compared with baseline (adjusted coefficient = 0.79, p < 0.01, 95% confidence interval (CI); 0.61-0.98, R2 = 0.81) and by 29% during post fasting compared with baseline (adjusted coefficient = 0.71, p < 0.01, 95% CI; 0.53-0.90, R2 = 0.79). No significant change was found in the QLI scores calculated during the three months of the study period. CONCLUSION Fasting during Ramadan might have a positive impact on seizure control in patients with epilepsy, which continued during the month following fasting, whereas the quality of life scores were not affected by fasting.
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Affiliation(s)
- Khalid Alqadi
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
| | - Omar Alghamdi
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Taif Children's Hospital, Taif, Saudi Arabia
| | - Fawzi Babtain
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Hanan Ba'arma
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Somaya Bajammal
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Department of Internal Medicine, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Miad Albalawi
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | | | - Amal Abu-Jabber
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nadia Madani
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Youssef Al-Said
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Salah Baz
- Alfaisal University, Riyadh, Saudi Arabia
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Taskiran E, Matur Z, Gül G, Bebek N, Baykan B, Gökyigit A, Gürses C. The Impact of Affective State on Quality of Life in Focal Epilepsy in Turkey. J Neurosci Rural Pract 2019; 10:267-272. [PMID: 31001016 PMCID: PMC6454954 DOI: 10.4103/jnrp.jnrp_324_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: Seizures and accompanying situations including social, medical, and psychiatric problems threaten the quality of life (QOL) in patients with epilepsy. The World Health Organization defines health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. Aims: This study examines the prevalence of both depression and anxiety symptoms and also impact of the affective state on QOL in patients with focal epilepsy in Turkey. Settings and Design: One hundred and five patients with focal epilepsy over 18 years old were included in this study. The patients were classified into four groups according to the presence of AS and seizure control. Subjects and Methods: Patients’ affective symptoms (AS) and QOL were examined using the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and QOL in Epilepsy Inventory-31 (QOLIE-31). Statistical Analysis Used: We used descriptive statistics, Chi-square test, independent samples t-test, one-way analysis of variance, Mann–Whitney U-test, Kruskal–Wallis H-test, and also Pearson's and Spearman's correlation test for correlations. Results: There were positive correlations between total QOLIE-31 score and epilepsy surgery, employment, and seizure freedom, whereas negative correlations were found with antiepileptic drug use, anxiety, and depression. Statistically significant differences were found in QOLIE-31 totals and subscores between Groups 3 and 4 (P < 0.05). Conclusions: The presence of AS has a negative impact on QOL in patients with focal epilepsy. Physicians should be aware that psychiatric comorbidities in epilepsy have a severe impact and epilepsy treatment requires comprehensive management.
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Affiliation(s)
- Emine Taskiran
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Zeliha Matur
- Department of Neurology, Istanbul Bilim University Faculty of Medicine, Istanbul, Turkey
| | - Günay Gül
- Department of Neurology, Neurology Clinic, Bakirkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Istanbul, Turkey
| | - Nerses Bebek
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayşen Gökyigit
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Candan Gürses
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Roehl K, Falco-Walter J, Ouyang B, Balabanov A. Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life. Epilepsy Behav 2019; 93:113-118. [PMID: 30867113 DOI: 10.1016/j.yebeh.2018.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study evaluates the efficacy of a modified ketogenic diet (MKD) on seizure frequency, severity, and quality of life (QOL), as well as potential complications of MKD therapy among adults with drug-resistant epilepsy (DRE). METHODS Changes in seizure frequency, severity, QOL, and side effects were retrospectively examined among adults, ≥17 years of age, with DRE (≥2 antiepileptic drugs [AEDs]), after 3 months of MKD therapy. Attention was paid to medication or vagus nerve stimulator (VNS) changes as well to evaluate potential confounders. RESULTS A total of 60% (n = 33) of the 55 individuals reported ≥50% seizure frequency improvement, 42 (76%) reported improvement in seizure severity, and 48 (87%) reported improvement in QOL. More patients following a modified ketogenic diet - 15 g net carbohydrate daily (MKD-15) (95%) compared with a MKD-50 (69%) reported improvement in QOL (p = 0.02). Weight among the entire sample declined from 77.5 (20) kg to 73.9 (19.0) kg (p < 0.0001), and total cholesterol (TC), low density lipoprotein (LDL), and total cholesterol:high density lipoprotein (TC:HDL) increased significantly (p = 0.03, p = 0.04, and p = 0.02, respectively). Free carnitine values were available for a select number of patients, 26 (47%) at baseline, and 7 (13%) at follow-up, of which 8 (31%) at baseline, and 2 (29%) at follow-up had carnitine deficiency (<25 nmol/mL). Constipation was noted in 5 patients (9%), and no kidney stones were reported during the study period. There were no statistical differences in number or dose changes for AED or VNS during the study period. SIGNIFICANCE Modified ketogenic diet therapies reduce seizure frequency and severity and improve QOL among adults with DRE with few side effects outside of weight loss, a desired outcome among many adults with DRE. More restrictive MKDs may offer improved seizure severity and QOL. Modified ketogenic diet therapy increases LDL cholesterol, which may be cardioprotective if related to an increase in LDL particle size with high saturated fat intake; however, more research is needed examining LDL particle size changes among those receiving MKD therapy.
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Affiliation(s)
- Kelly Roehl
- Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, United States of America.
| | - Jessica Falco-Walter
- Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, United States of America; Stanford University, 213 Quarry Road, 4th Floor, Palo Alto, CA 94304, United States of America.
| | - Bichun Ouyang
- Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, United States of America.
| | - Antoaneta Balabanov
- Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, United States of America.
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Cano-López I, Hampel KG, Garcés M, Villanueva V, González-Bono E. Quality of life in drug-resistant epilepsy: relationships with negative affectivity, memory, somatic symptoms and social support. J Psychosom Res 2018; 114:31-37. [PMID: 30314576 DOI: 10.1016/j.jpsychores.2018.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the relative contribution of factors non-directly related to seizures such as negative affectivity, social support, somatic symptoms and memory performance on quality of life (QOL) in patients with drug-resistant epilepsy. METHODS This is a cross-sectional study. Seventy patients with drug-resistant epilepsy were consecutively recruited from the inpatient Epilepsy Unit, Hospital Universitario y Politécnico La Fe, between April 2015 and October 2017. Medical history provided demographic characteristics of the patients (sex, age, and educational level), and clinical data (age at epilepsy onset, duration of epilepsy in years, frequency of seizures per month, type of seizures and number of AEDs). Pre-surgical assessment included diagnosis of the type of epilepsy and the lateralization of the epileptogenic area. All the patients underwent a neuropsychological assessment in which QOL (QOLIE-31), negative affectivity, social support, somatic symptoms, and memory were evaluated. RESULTS Negative affectivity (including anxiety-trait and depression), social support, neurosensory symptoms, and long-term verbal memory were significantly related to QOL composite score (for all, p < .009), subscales of QOL showing different sensitivities to them. Even after controlling for negative affectivity, neurosensory symptoms and long-term verbal memory significantly contribute to QOL composite score (p = .0001). CONCLUSION Results suggest that clinical management of patients with drug-resistant epilepsy should consider the treatment of verbal memory impairments at an early stage. Recognition of negative affectivity, poor social support and high somatic symptoms would also lead health professionals to develop different strategies to improve the QOL of patients with drug-resistant epilepsy.
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Affiliation(s)
- Irene Cano-López
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010 Valencia, Spain.
| | - Kevin G Hampel
- Multidisciplinary Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026, Valencia, Spain
| | - Mercedes Garcés
- Multidisciplinary Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026, Valencia, Spain
| | - Vicente Villanueva
- Multidisciplinary Epilepsy Unit, Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevar sur, s/n Carretera de Malilla, 46026, Valencia, Spain
| | - Esperanza González-Bono
- IDOCAL/Department of Psychobiology, Psychology Center, University of Valencia, Avda. Blasco Ibañez, 21, 46010 Valencia, Spain
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Assenza G, Mecarelli O, Lanzone J, Assenza F, Tombini M, Di Lazzaro V, Pulitano P. The ROME (Retrospective Observational Multicenter study on Eslicarbazepine) study: Efficacy and behavioural effects of Eslicarbazepine acetate as adjunctive therapy for adults with partial onset seizures in real life. Seizure 2018; 58:35-40. [PMID: 29649684 DOI: 10.1016/j.seizure.2018.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Eslicarbazepine acetate (ESL) is a third-generation member of the dibenzazepine family approved in 2009 by the European Medicines Agency with the indication of adjunctive therapy in adult people with partial-onset seizures (PPOS). We aimed at assessing the ESL impact on seizure frequency and quality of life in PPOS with a particular attention to sleepiness and depression. METHODS We evaluated 50 adult PPOS (>18 years; 48 ± 14 years-old; 23 males) treated with adjunctive ESL for ≥2months with a retrospective multi-centric design. Clinical files of the last 2 years were reviewed checking for monthly seizure frequency, treatment retention rate, adverse drug reactions (ADRs), concomitant anti-epileptic drugs and behavioural scales for sleepiness (Stanford Sleepiness Scale, SSS, and Epworth Sleepiness Scale, ESS), depression (Beck Depression Inventory-II, BDI) and overall quality of life (QOLIE-31). RESULTS At the end of 96 ± 28 days of ESL treatment, the mean seizure reduction was 56%; 60% of patients had seizure reduction above 50%, with a 31% of the whole population becoming seizure free. We reported 16 ADRs with 4 hyponatremia. Retention rate was 76%. Patient reported less sleepiness after ESL (SSS, p = 0.031; ESS, p = 0.0000002). Before ESL, 38% of patients had pathologic BDI scores, which normalized in most of them (73%) after ESL (BDI improvement, p = 0.000012). These scores resulted in an amelioration of quality of life (QOLIE-31, p = 0.000002). CONCLUSIONS ESL is a safe and effective anti-epileptic drug in a real life scenario, with an excellent behavioural profile for the overall quality of life and, in particular, for sleepiness and depression.
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Affiliation(s)
- G Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - O Mecarelli
- Department of Neurology and Psychiatry, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - J Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - F Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - M Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - V Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - P Pulitano
- Department of Neurology and Psychiatry, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
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Mukherjee J, Chakraborty DP, Guha G, Bose B, Saha SP. Recent Drug Resistant Epilepsy Spectrum in Eastern India. J Epilepsy Res 2017; 7:39-44. [PMID: 28775954 PMCID: PMC5540689 DOI: 10.14581/jer.17007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/04/2017] [Indexed: 11/05/2022] Open
Abstract
Background and Purpose The Magnitude of Drug-resistant Epilepsy (DRE) in India, being unknown, takes a heavy toll on the patients and society in the form of prolonged dependence, unemployment, morbidity and mortality. We tried to explore the clinical, electro-physiological, neuro-imaging and drug-response spectrum of DRE patients in Eastern India in our study. Methods During the period of January 2014 to December 2015, epilepsy patients were treated and DRE patients were identified according to International League Against Epilepsy criteria. We isolated those patients and studied them in a special clinic. Results Among 2,153 patients treated in Neurology out-patient department, 243 (11.3%) patients were drug-resistant. Among the DRE patients, 63% were male. Age-wise 40%, 30.5% & 18.1% patients were presented in their first, second and third decades respectively. Males were more affected in 0–5 years age group while females in 6–10 years age group. Various seizures types were found alone or in combination. Males were mostly affected by generalized tonic clonic seizure and myoclonus and females by complex partial seizure. Positive family history was higher in partial seizure group. Electroencephalographic (EEG) abnormalities were common with structural lesions in brain. EEG findings in different etiologies were varied with a large number of DRE patients who were found to have normal EEG. Females were higher medicine non-compliant. Conclusions The spectrum was pointed towards gender predilection for specific age group and also for seizure types. Idiopathic cases were most common in DRE, pointing towards the need of newer investigations. Normal EEG could be found even in a DRE patient. Non-compliance was more in females.
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Affiliation(s)
- Joydeep Mukherjee
- Department of Neurology, NRS Medical College Hospital, Kolkata, India
| | | | - Gautam Guha
- Department of Neurology, NRS Medical College Hospital, Kolkata, India
| | - Biman Bose
- Department of Neurology, NRS Medical College Hospital, Kolkata, India
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Diagnosing and treating depression in epilepsy. Seizure 2016; 44:184-193. [PMID: 27836391 DOI: 10.1016/j.seizure.2016.10.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 01/24/2023] Open
Abstract
At least one third of patients with active epilepsy suffer from significant impairment of their emotional well-being. A targeted examination for possible depression (irrespective of any social, financial or personal burdens) can identify patients who may benefit from medical attention and therapeutic support. Reliable screening instruments such as the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) are suitable for the timely identification of patients needing help. Neurologists should be capable of managing mild to moderate comorbid depression but referral to mental health specialists is mandatory in severe and difficult-to-treat depression, or if the patient is acutely suicidal. In terms of the therapeutic approach, it is essential first to optimize seizure control and minimize unwanted antiepileptic drug-related side effects. Psychotherapy for depression in epilepsy (including online self-treatment programs) is underutilized although it has proven effective in ten well-controlled trials. In contrast, the effectiveness of antidepressant drugs for depression in epilepsy is unknown. However, if modern antidepressants are used (e.g. SSRI, SNRI, NaSSA), concerns about an aggravation of seizures and or problematic interactions with antiepileptic drugs seem unwarranted. Epilepsy-related stress ("burden of epilepsy") explains depression in many patients but acute and temporary seizure-related states of depression or suicidality have also been reported. Limbic encephalitits may cause isolated mood alteration without any recognizable psychoetiological background indicating a possible role of neuroinflammation. This review will argue that, overall, a bio-psycho-social model best captures the currently available evidence relating to the etiology and treatment of depression as a comorbidity of epilepsy.
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