1
|
Wang L, Gui J, Zhang X, Tian B, Meng L, Liu J, Jiang L. Disproportionality analysis of the safety profile of rufinamide in the real world: an evaluation of the FDA Adverse Event Reporting System database. Expert Opin Drug Saf 2024:1-8. [PMID: 39381902 DOI: 10.1080/14740338.2024.2412237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/30/2024] [Accepted: 09/10/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND Rufinamide (RUF) is an antiepileptic drug recently introduced for managing seizures in Lennox-Gastaut syndrome (LGS), but its adverse reactions are not well understood. This study aims to evaluate RUF's safety profile using data from the FDA Adverse Event Reporting System (FAERS). METHODS Disproportionality analysis was conducted to assess RUF-associated adverse drug events (ADEs), using reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and multi-item gamma-Poisson shrinker (MGPS). RESULTS We collected 338 ADE reports related to RUF. Nervous system disorders were the most frequently reported signals, and several new ADEs were detected, including atonic seizures, sudden unexplained death in epilepsy, seizure clusters, multi-drug resistance, and Stevens-Johnson syndrome. Nearly half of the ADEs in pediatric patients were psychological or neurological. Disproportionality analysis within 4 weeks of treatment showed high RORs for QT shortening, sudden death, and atonic seizures. CONCLUSIONS Our study revealed prospective signals of new ADEs linked to RUF as well as revealed that both prescribers and patients were more conscious of the risks involved in its clinical use.
Collapse
Affiliation(s)
- Lingman Wang
- Department of Neurology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jianxiong Gui
- Department of Neurology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaofang Zhang
- Department of Neurology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Bing Tian
- Department of Neurology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Linxue Meng
- Department of Neurology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Liu
- Department of Neurology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Neurology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
2
|
Wirrell EC, Lagae L, Scheffer IE, Cross JH, Specchio N, Strzelczyk A. Practical considerations for the use of fenfluramine to manage patients with Dravet syndrome or Lennox-Gastaut syndrome in clinical practice. Epilepsia Open 2024; 9:1643-1657. [PMID: 38962968 PMCID: PMC11450599 DOI: 10.1002/epi4.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
Fenfluramine (FFA), an antiseizure medication (ASM) with serotonergic and sigma-1 receptor activity, is used to manage patients with developmental and epileptic encephalopathies (DEEs). It is approved in the US for treating seizures associated with Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS) in patients ≥2 years old and as add-on therapy for seizures associated with DS and LGS in the EU, UK, and Japan in similarly aged patients. Consensus guidelines for treatment of DS have recommended FFA to be an early-line ASM, and it has also shown efficacy in managing seizures associated with LGS. DS and LGS are DEEs associated with a range of seizure types, developmental impairments, and multiple comorbidities. Here we provide case vignettes describing 4 patients (3 DS and 1 LGS) aged 4-29 years old in whom up to 14 ASMs had previously failed, to illustrate real-world practice issues encountered by neurologists. This review provides guidance on the use of FFA in the context of ASM polytherapy and drug-drug interactions (DDIs), behavioral issues, dose titration, and adverse events. Along with data from the clinical trial program, these case vignettes emphasize the low risk of DDIs, a generally well-tolerated safety profile, and other seizure and nonseizure benefits (eg, improved cognition and sleep) associated with the use of FFA in DS or LGS. PLAIN LANGUAGE SUMMARY: Fenfluramine is used to treat seizures in individuals with Dravet syndrome and Lennox-Gastaut syndrome, but there are a range of issues that clinicians may face when treating patients. This review highlights four patients from the authors' everyday clinical work and offers guidance and practical considerations by neurologists with expertise in managing these complex conditions related to drug interactions, dosing, and side effects associated with fenfluramine.
Collapse
Affiliation(s)
- Elaine C. Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Lieven Lagae
- Member of the European Reference Network EpiCARE, Department of Pediatric NeurologyUniversity of LeuvenLeuvenBelgium
| | - Ingrid E. Scheffer
- Austin Hospital and Royal Children’'s Hospital, Florey and Murdoch Children's Research InstitutesUniversity of MelbourneMelbourneVictoriaAustralia
| | - J. Helen Cross
- Developmental Neurosciences Research & Teaching DepartmentUCL NIHR BRC Great Ormond Street Institute of Child HealthLondonUK
- Department of NeurologyGreat Ormond Street HospitalLondonUK
| | - Nicola Specchio
- Neurology, Epilepsy and Movement Disorders UnitBambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARERomeItaly
| | - Adam Strzelczyk
- Goethe‐University Frankfurt, Epilepsy Center Frankfurt Rhine‐Main and Department of NeurologyUniversity Hospital FrankfurtFrankfurt am MainGermany
| |
Collapse
|
3
|
Ottenhoff MJ, Mous SE, Castricum J, Rietman AB, Oostenbrink R, van der Vaart T, Tulen JHM, Parra A, Ramos FJ, Legius E, Moll HA, Elgersma Y, de Wit MCY. Lamotrigine for cognitive deficits associated with neurofibromatosis type 1: A phase II randomized placebo-controlled trial. Dev Med Child Neurol 2024. [PMID: 39340758 DOI: 10.1111/dmcn.16094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 07/19/2024] [Accepted: 08/19/2024] [Indexed: 09/30/2024]
Abstract
AIM To find proof-of-principle evidence for short-term treatment with lamotrigine to improve cognitive functioning of adolescents with neurofibromatosis type 1 (NF1). METHOD This was a double-blind, parallel-group, randomized, placebo-controlled clinical trial (the NF1-EXCEL trial: Examining the Cognitive and Electrophysiological benefit of Lamotrigine in Neurofibromatosis type 1; Clinicaltrials.gov identifier NCT02256124), with the aim of enrolling 60 adolescents with NF1 aged 12 to 17 years 6 months. The short-term study intervention was 200 mg of lamotrigine taken orally for 26 weeks. The primary outcome was performance IQ tested with the Wechsler Intelligence Scale for Children, Third Edition, complemented with secondary outcomes for visuospatial learning efficacy, visual perception, visual sustained attention, fine motor coordination, attention-deficit/hyperactivity problems, and executive functioning. RESULTS We screened 402 adolescents with NF1, of whom 31 (eight females) entered the study. Complete-case analysis showed no effect of lamotrigine on either performance IQ (-0.23, 95% CI -6.90 to 6.44) or most secondary outcomes. Visual sustained attention showed a trend towards better performance in the lamotrigine group (-0.81, 95% CI -1.67 to 0.04). INTERPRETATION Lamotrigine did not improve cognitive functioning in adolescents with NF1. The small treatment effects make it unlikely that a larger sample size could have changed this conclusion.
Collapse
Affiliation(s)
- Myrthe J Ottenhoff
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sabine E Mous
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Child Brain Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jesminne Castricum
- Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - André B Rietman
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Child Brain Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rianne Oostenbrink
- Department of Pediatrics, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Thijs van der Vaart
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joke H M Tulen
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Alba Parra
- Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Federico J Ramos
- Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Eric Legius
- Center for Human Genetics, University Hospital Leuven, Leuven, Belgium
- Department of Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Henriette A Moll
- Department of Pediatrics, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ype Elgersma
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marie-Claire Y de Wit
- Erasmus MC Center of Expertise for Neurodevelopmental Disorders (ENCORE), Erasmus Medical Center, Rotterdam, the Netherlands
- Child Brain Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Pediatric Neurology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| |
Collapse
|
4
|
Vatansever Pınar Z, Sağer SG, Çimen İD, Çağ Y. The Effect of Levetiracetam and Valproic Acid Treatment on Anger and Attention Deficit Hyperactivity Disorder Clinical Features in Children and Adolescents with Epilepsy: A Prospective Study. Paediatr Drugs 2024:10.1007/s40272-024-00652-8. [PMID: 39331340 DOI: 10.1007/s40272-024-00652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Antiseizure medications (ASMs) can potentially trigger psychobehavioral adverse events associated with the onset or exacerbation of psychiatric symptoms such as irritability, aggression, and hyperactivity. The objective of this study was to evaluate the effects of levetiracetam and valproic acid on changes in clinical features of anger, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). The purpose was to furnish guidance on rational drug selection in children and adolescents with epilepsy to minimize psychiatric comorbidity in the treatment of epilepsy. METHOD This was a prospective, observational, cohort study involving treatment-naïve children aged 7-18 years with newly diagnosed generalized or focal epilepsy who were prescribed levetiracetam or valproic acid as monotherapy for a 6-month period and regularly followed up. Psychiatric assessment was conducted at the time of the new epilepsy diagnosis and at the six-month follow-up. These assessments were performed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Current and Lifetime Version (DSM-5), a structured psychiatric interview, as well as the State-Trait Anger Expression Style Inventory and Turgay DSM-IV Based Disruptive Behaviour Disorders Screening and Rating Scale. Anger subscores, ADHD symptoms, change in diagnosis, focal and generalized epilepsy groups, continuous seizures and seizure-free periods before and 6 months after treatment with valproic acid and levetiracetam were compared. RESULTS A total of 50 children, 25 in the valproic acid group and 25 in the levetiracetam group, with a mean age of 11.92 ± 3.08 years, were included in the study. There was a statistically significant increase in the ADHD subscale score post-treatment among patients receiving levetiracetam (p = 0.045) and valproic acid (p = 0.034) compared with pre-treatment. The change in both anger-in and anger-out expression scores with treatment was significantly higher in patients receiving levetiracetam (p = 0.035) compared with those receiving valproic acid (p = 0.026). Statistically, there was a significant difference in the diagnostic criteria of the levetiracetam group pre- and post-treatment (p = 0.026). The proportion of patients in whom the diagnostic criteria for ADHD+ODD were fulfilled increased from 16% before treatment to 48% after treatment, a statistically significant increase (p = 0.026). CONCLUSION This study found an increase in internalized anger features and ADHD symptom severity in children with epilepsy treated with valproic acid and levetiracetam. In those prescribed levetiracetam, there was a statistically significant rise in the proportion meeting the diagnostic criteria for ADHD + ODD. Our research is one of the first to prospectively examine the psychiatric assessment of children diagnosed with epilepsy. The remarkable results demonstrate changes in psychiatric diagnoses associated with the treatment of levetiracetam and valproic acid. Furthermore, a considerable rise in ADHD symptoms was observed in those treated with valproic acid.
Collapse
Affiliation(s)
- Zeynep Vatansever Pınar
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, İstanbul, Turkey.
| | - Safiye Güneş Sağer
- Department of Pediatric Neurology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - İrem Damla Çimen
- Department of Child and Adolescent Psychiatry, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Yakup Çağ
- Department of Pediatrics, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| |
Collapse
|
5
|
Schneider BM, Krapf EM, Hassara KE, Stanford LD, Pulsipher DT. Differential contributions of performance-based and parental reports of executive functioning on memory in pediatric focal and generalized epilepsies. Epilepsy Res 2024; 205:107423. [PMID: 39121693 DOI: 10.1016/j.eplepsyres.2024.107423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/20/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024]
Abstract
Children with epilepsy often experience deficits in both executive functioning (EF) and memory. However, how these two domains interact and relate to specific epilepsy types remains unclear. This study compared two groups of children: those with localization-related epilepsy (LRE) and those with genetic generalized epilepsy (GGE). We aimed to understand how performance-based and parent-reported EF differentially contribute to understanding memory function in each group. We examined neuropsychological measures assessing memory and EF in 75 children with LRE and 91 with GGE. Multiple linear regressions explored the impact of EF on memory performance. Performance-based EF scores accounted for greater variance in memory scores than parental EF reports. However, performance-based EF measures explained much more variance in visual memory for LRE than GGE and explained much more variance in verbal memory for the GGE group. Parental reports of EF contributed marginally to understanding variance. These findings suggest differential relationships between EF and memory based on epilepsy type. Performance-based EF measures appear more reliable at understanding memory variance than did parent reports. Our results have potential clinical implications for tailoring neuropsychological assessment and intervention for children with different epilepsy types.
Collapse
Affiliation(s)
- Bruna M Schneider
- Akron Children's Hospital, NeuroDevelopmental Science Center, Division of Neurobehavioral Health, 215 West Bowery Street, Suite 4400, Akron, OH 44308, United States; Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, 3333 Burnet Ave, Cincinnati, OH 45229, United States.
| | - Erica M Krapf
- Akron Children's Hospital, NeuroDevelopmental Science Center, Division of Neurobehavioral Health, 215 West Bowery Street, Suite 4400, Akron, OH 44308, United States.
| | - Kathleen E Hassara
- Akron Children's Hospital, NeuroDevelopmental Science Center, Division of Neurobehavioral Health, 215 West Bowery Street, Suite 4400, Akron, OH 44308, United States; University of Pittsburgh Medical Center, Physical Medicine and Rehabilitation, 1515 Locust Street, Suite 200, Pittsburgh, PA 15219, United States.
| | - Lisa D Stanford
- Akron Children's Hospital, NeuroDevelopmental Science Center, Division of Neurobehavioral Health, 215 West Bowery Street, Suite 4400, Akron, OH 44308, United States; University of Pittsburgh Medical Center, Physical Medicine and Rehabilitation, 1515 Locust Street, Suite 200, Pittsburgh, PA 15219, United States.
| | - Dalin T Pulsipher
- Akron Children's Hospital, NeuroDevelopmental Science Center, Division of Neurobehavioral Health, 215 West Bowery Street, Suite 4400, Akron, OH 44308, United States; University of Utah Pediatric Behavioral Health, Primary Children's Hospital, 81 N Mario Capecchi Dr, Salt Lake City, UT 84113, United States.
| |
Collapse
|
6
|
Mannini E, Misirocchi F, Lazzari S, Balella G, Bottignole D, Frapporti M, Zinno L, Florindo I, Parrino L, Mutti C. Off-label use of cannabidiol in genetic epileptic and developmental encephalopathies: A case report. Epilepsy Behav Rep 2024; 27:100687. [PMID: 39040437 PMCID: PMC11261414 DOI: 10.1016/j.ebr.2024.100687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
Developmental Epileptic encephalopathies (DEEs) are severe neurological conditions where cognitive functions appear modulated by both seizure and interictal epileptiform activity. Cannabidiol (CBD) has been shown to be highly effective in the treatment of drug-resistant seizures in patients with DEEs. Along with its antiseizure effects, CBD demonstrated clinical beneficial effects in patients' quality of life, sleep and numerous adaptive behaviors. However, based on the available phase III studies, the indications for this treatment have so far been restricted to Lennox-Gastaut syndrome (LGS), Dravet syndrome (DS) and tuberous sclerosis complex (TSC) by regulatory authorities. We present the case of a 30-year-old girl with a rare genetic DEE, experiencing relevant seizure frequency reduction together with striking improvement in sleep quality, mood, behavior, language and motor skills after introducing off-label CBD.
Collapse
Affiliation(s)
- Elisa Mannini
- Neurology Unit, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
| | - Francesco Misirocchi
- Neurology Unit, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
| | - Stefania Lazzari
- Neurology Unit, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
| | - Giulia Balella
- Neurology Unit, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
| | - Dario Bottignole
- Neurology Unit, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
| | - Maddalena Frapporti
- Neurology Unit, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
| | - Lucia Zinno
- Neurology Unit, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
- Interdepartmental Centre for Sleep Medicine, University of Parma, Italy
| | - Irene Florindo
- Neurology Unit, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
- Interdepartmental Centre for Sleep Medicine, University of Parma, Italy
| | - Liborio Parrino
- Neurology Unit, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
- Sleep Disorders Center, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
- Interdepartmental Centre for Sleep Medicine, University of Parma, Italy
| | - Carlotta Mutti
- Neurology Unit, Department of General and Specialized Medicine, Parma University Hospital, Parma, Italy
- Sleep Disorders Center, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
- Interdepartmental Centre for Sleep Medicine, University of Parma, Italy
| |
Collapse
|
7
|
D'Onofrio G, Roberti R, Riva A, Russo E, Verrotti A, Striano P, Belcastro V. Pharmacodynamic rationale for the choice of antiseizure medications in the paediatric population. Neurotherapeutics 2024; 21:e00344. [PMID: 38521667 PMCID: PMC11070715 DOI: 10.1016/j.neurot.2024.e00344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
In the landscape of paediatric epilepsy treatment, over 20 anti-seizure medications (ASMs) have gained approval from Drug Regulatory Agencies, each delineating clear indications. However, the complexity of managing drug-resistant epilepsy often necessitates the concurrent use of multiple medications. This therapeutic challenge highlights a notable gap: the absence of standardized guidelines, compelling clinicians to rely on empirical clinical experience when selecting combination therapies. This comprehensive review aims to explore current evidence elucidating the preferential utilization of specific ASMs or their combinations, with a primary emphasis on pharmacodynamic considerations. The fundamental objective underlying rational polytherapy is the strategic combination of medications, harnessing diverse mechanisms of action to optimize efficacy while mitigating shared side effects. Moreover, the intricate interplay between epilepsy and comorbidities partly may influence the treatment selection process. Despite advancements, unresolved queries persist, notably concerning the mechanisms underpinning drug resistance and the paradoxical exacerbation of seizures. By synthesizing existing evidence and addressing pertinent unresolved issues, this review aims to contribute to the evolving landscape of paediatric epilepsy treatment strategies, paving the way for more informed and efficacious therapeutic interventions.
Collapse
Affiliation(s)
- Gianluca D'Onofrio
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Roberta Roberti
- Science of Health Department, Magna Græcia University, Catanzaro, Italy
| | - Antonella Riva
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Emilio Russo
- Science of Health Department, Magna Græcia University, Catanzaro, Italy
| | | | - Pasquale Striano
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | | |
Collapse
|
8
|
Zanaboni MP, Pasca L, Bergamoni S, Bova SM, Celario M, Freri E, Grumi S, Filippini M, Leonardi V, Micheletti S, Operto FF, Papa A, Pastorino GMG, Peruzzi C, Pruna D, Ragona F, Raviglione F, Totaro M, Varesio C, De Giorgis V. The effect of executive function on health related quality of life in children with self-limited epilepsy with centrotemporal spikes. Epilepsy Behav 2024; 152:109607. [PMID: 38277852 DOI: 10.1016/j.yebeh.2023.109607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/11/2023] [Accepted: 12/21/2023] [Indexed: 01/28/2024]
Abstract
AIM The current study aims to investigate the effect of Executive Functions (EFs) on Health Related Quality of Life (HRQoL) in a cohort of children with self-limited epilepsy with centrotemporal spikes (SeLECTS) and to identify possible factors that impact HRQoL specifically related to epilepsy-related variables and EFs skills. MATERIAL AND METHOD The Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) and The Behavior Rating Inventory of Executive Function (BRIEF-2 and BRIEF-P) were completed by the parents of 129 patients with SeLECTS. Demographic variables and epilepsy-related variables were collected. RESULTS Our sample performed in the average range across all the subscales and summary scores of the PedsQL and performed in the normal range of the BRIEF questionnaire. We observed that a lower functioning in EFs was associated with lower overall HRQoL scores. We explored the relationship between epilepsy characteristics and scores on the PedsQL. We found that the use of antiseizure medications (ASMs), longer duration of the treatment, and a higher seizure frequency were associated with a lower HRQoL. Moreover, we observed that executive dysfunction was a significant predictor of reduced HRQoL. CONCLUSION Our results suggest the importance of the identification of patients with SeLECTS with a high level of risk for a poor HRQoL. We may now add executive dysfunction to the list of known risk factors for poor HRQoL in children with SeLECTS, along with such factors as seizure frequency, recent seizures, use of ASMs and longer duration of therapy. The early identification of children with SeLECTS at risk of a poor HRQoL could allow the activation of adequate interventions.
Collapse
Affiliation(s)
| | - Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Stefania Bergamoni
- Childhood and Adolescence Neurology and Psychiatry Unit, ASST GOM Niguarda, Milan, Italy
| | | | - Massimiliano Celario
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Serena Grumi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Valeria Leonardi
- Department of Biomedical and Clinical Sciences "L.Sacco", University of Milan, Italy
| | - Serena Micheletti
- Unit of Child Neurology and Psychiatry, ASST-Spedali Civili of Brescia, Brescia, Italy
| | | | - Amanda Papa
- Department of Child Neuropsychiatry, University Hospital Maggiore della Carità, Novara, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Cinzia Peruzzi
- Child and Adolescent Neuropsychiatry Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Dario Pruna
- Pediatric Neurology and Epileptology Unit, Pediatric Department, ARNAS Brotzu, Cagliari, Italy
| | - Francesca Ragona
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | | | - Martina Totaro
- Hospital Neuropsychiatry Service, ASST Rhodense, Rho, Milan, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
9
|
Gidal BE, Resnick T, Smith MC, Wheless JW. Zonisamide: A Comprehensive, Updated Review for the Clinician. Neurol Clin Pract 2024; 14:e200210. [PMID: 38170117 PMCID: PMC10759004 DOI: 10.1212/cpj.0000000000200210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/15/2023] [Indexed: 01/05/2024]
Abstract
Purpose of Review Zonisamide (ZNS) was first approved in the United States in 2000 for the adjunctive treatment of patients aged 16 years or older with partial (focal) seizures. Although ZNS has been proven to treat multiple seizure types, it has been largely underutilized in US clinical practice. Recent Findings Published literature demonstrated that antiseizure medications (ASMs) acting on Na+ and Ca2+ channels may add beneficial effects in many seizure types by reducing seizure frequency and leading to overall improvements. In addition, effects of ZNS may lead to clinical improvements in Parkinson disease, alcohol and sleep disorders, pain, and migraine. ZNS is available in multiple formulations and is a safe and effective, broad spectrum ASM. Summary The purpose of this review was to provide an update to what is known about the efficacy of ZNS and where it shows benefits in the treatment of patients with epilepsy and other CNS disorders through its many unique mechanisms of action.
Collapse
Affiliation(s)
- Barry E Gidal
- Pharmacy Practice & Translational Research (BEG), University of Wisconsin-Madison; Department of Neurology (TR), Nicklaus Children Hospital; Department of Neurology, Florida International University, Miami, FL; Department of Neurological Sciences (MCS), Rush Medical College; Rush University Medical Center, Chicago, IL; and Pediatric Neurology (JWW), University of Tennessee Health Science Center; Neuroscience Institute & Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN
| | - Trevor Resnick
- Pharmacy Practice & Translational Research (BEG), University of Wisconsin-Madison; Department of Neurology (TR), Nicklaus Children Hospital; Department of Neurology, Florida International University, Miami, FL; Department of Neurological Sciences (MCS), Rush Medical College; Rush University Medical Center, Chicago, IL; and Pediatric Neurology (JWW), University of Tennessee Health Science Center; Neuroscience Institute & Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN
| | - Michael C Smith
- Pharmacy Practice & Translational Research (BEG), University of Wisconsin-Madison; Department of Neurology (TR), Nicklaus Children Hospital; Department of Neurology, Florida International University, Miami, FL; Department of Neurological Sciences (MCS), Rush Medical College; Rush University Medical Center, Chicago, IL; and Pediatric Neurology (JWW), University of Tennessee Health Science Center; Neuroscience Institute & Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN
| | - James W Wheless
- Pharmacy Practice & Translational Research (BEG), University of Wisconsin-Madison; Department of Neurology (TR), Nicklaus Children Hospital; Department of Neurology, Florida International University, Miami, FL; Department of Neurological Sciences (MCS), Rush Medical College; Rush University Medical Center, Chicago, IL; and Pediatric Neurology (JWW), University of Tennessee Health Science Center; Neuroscience Institute & Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, Memphis, TN
| |
Collapse
|
10
|
Dreier JW, Trabjerg BB, Plana-Ripoll O, Skipper N, Agerbo E, Cotsapas C, Berg AT, Christensen J. Epilepsy in childhood and school performance: a nation-wide cohort study. Brain 2024; 147:532-541. [PMID: 38102964 DOI: 10.1093/brain/awad382] [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: 08/15/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023] Open
Abstract
Childhood epilepsy has been linked to poor academic performance, but large-scale studies are lacking. In this nation-wide study of school-aged children, we examined the association between childhood epilepsy and school performance in standardized tests according to phenotypic and treatment-related characteristics. We performed a matched register-based cohort study of children born in Denmark (1997-2009) who participated in the Danish National School Test Programme between 2010 and 2019. We used population and health registers to identify children with epilepsy and a randomly sampled sex- and age-matched reference cohort without epilepsy (ratio 1:10). Norm-based test scores from language and mathematics reflecting performance as a percentile of the nation-wide distribution of scores (scale 1-100) were used to assess academic performance. Adjusted differences in mean standardized scores between children with and without epilepsy were estimated using linear regression models. Among 582 840 children participating in the School Test Programme, we identified 4659 (0.8%) children with epilepsy (52.8% males) and 46 590 matched reference children. Median age at epilepsy onset was 7.5 years (interquartile range: 4.0-10.6). Childhood epilepsy was associated with poorer school performance overall (mean score = 48.2 versus references = 56.7; adjusted difference = -6.7, 95% CI: -7.4 to -6.0), and worse performance was found in all epilepsy subgroups, including in 3534 children with uncomplicated epilepsy (i.e. no other pre-existing neurologic or intellectual disabilities and no identified possible cause for epilepsy; adjusted difference = -6.0, 95% CI: -6.8 to -5.2). No major variation by sex, age or subject was observed, but larger score differences were seen in children using antiseizure medication at time of testing (e.g. valproate monotherapy, adjusted difference = -9.3, 95% CI: -11.5 to -7.0 and lamotrigine monotherapy, adjusted difference = -13.1, 95% CI: -15.0 to -11.3) and in children with psychiatric comorbidity, especially epilepsy with comorbid intellectual disability (adjusted difference = -27.0, 95% CI: -30.0 to -23.9) and epilepsy with comorbid attention deficit/hyperactivity disorder (adjusted difference = -15.7, 95% CI: -19.0 to -12.4). Children with epilepsy scored significantly lower than their unaffected siblings (adjusted difference = -6.2, 95% CI: -7.1 to -5.4). In conclusion, childhood epilepsy was associated with impaired academic performance throughout schooling, which suggest that there is a widespread need for educational support of children with epilepsy, even when the child has no other comorbidities and when the epilepsy appears well-managed.
Collapse
Affiliation(s)
- Julie W Dreier
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Betina B Trabjerg
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Niels Skipper
- Department of Economics and Business Economics, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Esben Agerbo
- National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Business and Social Sciences, Aarhus University, 8210 Aarhus V, Denmark
| | - Chris Cotsapas
- Department of Neurology, Yale, New Haven, CT 06510, USA
- Department of Genetics, Yale, New Haven, CT 06510, USA
| | - Anne T Berg
- Department of Neurology, Northwestern University - Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jakob Christensen
- Department of Neurology, Affiliated Member of the European Reference Network EpiCARE, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| |
Collapse
|
11
|
Shin JH, Song MJ, Kim JH. Valproate use associated with frontal and cerebellar gray matter volume reductions: A voxel-based morphometry study. Epilepsia 2024; 65:e1-e6. [PMID: 37945542 DOI: 10.1111/epi.17825] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 11/12/2023]
Abstract
Recent morphometric magnetic resonance imaging (MRI) studies suggested the possibility that valproate (VPA) use is associated with parieto-occipital cortical thinning in patients with heterogeneous epilepsy syndromes. In this study, we examined the effect of VPA on the brain volume using a large number of homogenous patients with idiopathic generalized epilepsy. Voxel-based morphometry was used to compare regional gray matter (GM) volume between 112 patients currently taking VPA (VPA+ group), 81 patients not currently taking VPA (VPA- group), and 120 healthy subjects (control group). The VPA+ group showed a significant GM volume reduction in the bilateral cerebellum, hippocampus, insula, caudate nucleus, medial frontal cortex/anterior cingulate cortex, primary motor/premotor cortex, medial occipital cortex, and anteromedial thalamus, as compared to the control group. The VPA- group showed a significant GM volume reduction in the anteromedial thalamus and right hippocampus/temporal cortex, as compared to the control group. Compared to the VPA- group, the VPA+ group had a significant GM volume reduction in the bilateral cerebellum, primary motor/premotor cortex, and medial frontal cortex/anterior cingulate cortex. We have provided evidence that VPA use could result in GM volume reductions in the frontal cortex and cerebellum. Our findings should be acknowledged as a potential confounding factor in morphometric MRI studies that include subjects taking VPA.
Collapse
Affiliation(s)
- Ji Hye Shin
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Min Ji Song
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
12
|
Schmidlechner T, Zaddach M, Heinen F, Cornell S, Ramantani G, Rémi J, Vollmar C, Kunz M, Borggraefe I. IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis. J Neurol 2024; 271:177-187. [PMID: 37770569 PMCID: PMC10770207 DOI: 10.1007/s00415-023-12002-8] [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: 08/17/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE This systematic review aimed to assess the intellectual outcome of children who underwent surgery for epilepsy. METHODS A systematic review of electronic databases was conducted on December 3, 2021, for PubMed and January 11, 2022, for Web of Science. The review was conducted according to the PRISMA guidelines. The included studies reported on intelligence quotient (IQ) or developmental quotient (DQ) before and after epilepsy surgery in children. Studies were included, if the patients had medically intractable epilepsy and if the study reported mainly on curative surgical procedures. We conducted a random-effects meta-analysis to determine the mean change of IQ/DQ. RESULTS Fifty-seven studies reporting on a total of 2593 patients met the inclusion criteria. The mean age at surgery was 9.2 years (± 3.44; range 2.4 months-19.81 years). Thirty-eight studies showed IQ/DQ improvement on a group level, 8 yielded stable IQ/DQ, and 19 showed deterioration. Pooled analysis revealed a significant mean gain in FSIQ of + 2.52 FSIQ points (95% CI 1.12-3.91). The pooled mean difference in DQ was + 1.47 (95% CI - 6.5 to 9.5). The pooled mean difference in IQ/DQ was 0.73 (95% CI - 4.8 to 6.2). Mean FSIQ gain was significantly higher in patients who reached seizure freedom (+ 5.58 ± 8.27) than in patients who did not (+ 0.23 ± 5.65). It was also significantly higher in patients who stopped ASM after surgery (+ 6.37 ± 3.80) than in patients who did not (+ 2.01 ± 2.41). Controlled studies showed a better outcome in the surgery group compared to the non-surgery group. There was no correlation between FSIQ change and age at surgery, epilepsy duration to surgery, and preoperative FSIQ. SIGNIFICANCE The present review indicates that there is a mean gain in FSIQ and DQ in children with medically intractable epilepsy after surgery. The mean gain of 2.52 FSIQ points reflects more likely sustainability of intellectual function rather than improvement after surgery. Seizure-free and ASM-free patients reach higher FSIQ gains. More research is needed to evaluate individual changes after specific surgery types and their effect on long-term follow-up.
Collapse
Affiliation(s)
- Tristan Schmidlechner
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Malin Zaddach
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Florian Heinen
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Sonia Cornell
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Jan Rémi
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany.
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
| |
Collapse
|
13
|
Dusanter C, Houot M, Mere M, Denos M, Samson S, Herlin B, Navarro V, Dupont S. Cognitive effect of antiseizure medications in medial temporal lobe epilepsy. Eur J Neurol 2023; 30:3692-3702. [PMID: 37650365 DOI: 10.1111/ene.16050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND PURPOSE The specific effects of antiseizure medications (ASMs) on cognition are a rich field of study, with many ongoing questions. The aim of this study was to evaluate these effects in a homogeneous group of patients with epilepsy to guide clinicians to choose the most appropriate medications. METHODS We retrospectively identified 287 refractory patients with medial temporal lobe epilepsy associated with hippocampal sclerosis. Scores measuring general cognition (global, verbal and performance IQ), working memory, episodic memory, executive functions, and language abilities were correlated with ASM type, number, dosage and generation (old vs. new). We also assessed non-modifiable factors affecting cognition, such as demographics and epilepsy-related factors. RESULTS Key parameters were total number of ASMs and specific medications, especially topiramate (TPM) and sodium valproate (VPA). Four cognitive profiles of the ASMs were identified: (i) drugs with an overall detrimental effect on cognition (TPM, VPA); (ii) drugs with negative effects on specific areas: verbal memory and language skills (carbamazepine), and language functions (zonisamide); (iii) drugs affecting a single function in a specific and limited area: visual denomination (oxcarbazepine, lacosamide); and (iv) drugs without documented cognitive side effects. Non-modifiable factors such as age at testing, age at seizure onset, and history of febrile seizures also influenced cognition and were notably influenced by total number of ASMs. CONCLUSION We conclude that ASMs significantly impact cognition. Key parameters were total number of ASMs and specific medications, especially TPM and VPA. These results should lead to a reduction in the number of drugs received and the avoidance of medications with unfavorable cognitive profiles.
Collapse
Affiliation(s)
- Cedric Dusanter
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marion Houot
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Clinical Investigation Centre, Institut du Cerveau et de la Moelle épinière (ICM), Pitié-Salpêtrière Hospital, Paris, France
| | - Marie Mere
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marisa Denos
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Séverine Samson
- Univ. Lille, ULR 4072 - PSITEC - Psychologie: Interactions Temps Émotions Cognition, Lille, France
| | - Bastien Herlin
- CEA Neurospin, Unité Mixte de Recherche BAOBAB (Building Large Instruments for Neuroimaging: From Population Imaging to Ultra-High Magnetic Fields), Paris, France
| | - Vincent Navarro
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Neurophysiology Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Université Paris Sorbonne, Paris, France
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France
| | - Sophie Dupont
- Department of Neurology, Epileptology Unit, Reference Center for Rare Epilepsies, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Université Paris Sorbonne, Paris, France
- Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France
| |
Collapse
|
14
|
Dontaine P, Rouge C, Urbain C, Galer S, Raffoul R, Nonclercq A, Van Dyck D, Baijot S, Aeby A. How the Spreading and Intensity of Interictal Epileptic Activity Are Associated with Visuo-Spatial Skills in Children with Self-Limited Focal Epilepsy with Centro-Temporal Spikes. Brain Sci 2023; 13:1566. [PMID: 38002525 PMCID: PMC10669985 DOI: 10.3390/brainsci13111566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
This paper investigates brain-behaviour associations between interictal epileptic discharges and cognitive performance in a population of children with self-limited focal epilepsy with centro-temporal spikes (SeLECTS). Sixteen patients with SeLECTS underwent an extensive neuropsychological assessment, including verbal short-term and episodic memory, non-verbal short-term memory, attentional abilities and executive function. Two quantitative EEG indices were analysed, i.e., the Spike Wave Index (SWI) and the Spike Wave Frequency (SWF), and one qualitative EEG index, i.e., the EEG score, was used to evaluate the spreading of focal SW to other parts of the brain. We investigated associations between EEG indices and neuropsychological performance with non-parametric Spearman correlation analyses, including correction for multiple comparisons. The results showed a significant negative correlation between (i) the awake EEG score and the Block Tapping Test, a visuo-spatial short-term memory task, and (ii) the sleep SWI and the Tower of London, a visuo-spatial planning task (pcorr < 0.05). These findings suggest that, in addition to the usual quantitative EEG indices, the EEG analysis should include the qualitative EEG score evaluating the spreading of focal SW to other parts of the brain and that neuropsychological assessment should include visuo-spatial skills.
Collapse
Affiliation(s)
- Pauline Dontaine
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Coralie Rouge
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles (LN2T), UNI-ULB Neurosciences Institute, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Charline Urbain
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Laboratoire de Neuroanatomie et Neuroimagerie Translationnelles (LN2T), UNI-ULB Neurosciences Institute, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Sophie Galer
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Romain Raffoul
- BEAMS (Bio-, Electro- And Mechanical Systems), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Antoine Nonclercq
- BEAMS (Bio-, Electro- And Mechanical Systems), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Dorine Van Dyck
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Simon Baijot
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
- Department of Neuropsychology and Speech Therapy, Queen Fabiola Children’s University Hospital (HUDERF)-Hôpital Universitaire de Bruxelles (H.U.B), Université libre de Bruxelles (ULB), 1020 Brussels, Belgium
| | - Alec Aeby
- Department of Pediatric Neurology, Hopital Universitaire de Bruxelles (H.U.B.), Queen Fabiola Children’s University Hospital (HUDERF), Université Libre de Bruxelles (ULB), 1020 Brussels, Belgium
- Neuropsychology and Functional Neuroimaging Research Group (UR2NF), Center for Research in Cognition & Neurosciences (CRCN), ULB Neurosciences Institute, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| |
Collapse
|
15
|
Lagae L, Klotz KA, Fogarasi A, Floricel F, Reichel C, Elshoff JP, Fleyshman S, Kang H. Long-term safety and efficacy of adjunctive brivaracetam in pediatric patients with epilepsy: An open-label, follow-up trial. Epilepsia 2023; 64:2934-2946. [PMID: 37597326 DOI: 10.1111/epi.17754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate the long-term safety, tolerability, and efficacy of adjunctive brivaracetam (BRV) treatment in pediatric patients with epilepsy. METHODS A phase 3, open-label, multicenter, long-term follow-up trial (N01266; NCT01364597) was conducted on patients (aged 1 month to <17 years at core trial entry; direct enrollers aged 4 to <17 years) treated with BRV. Outcomes included treatment-emergent adverse events (TEAEs), behavior assessments (Achenbach Child Behavior Checklist [CBCL], Behavior Rating Inventory of Executive Function [BRIEF]/BRIEF-Preschool version [BRIEF-P]), and efficacy outcomes (percent change in focal seizure frequency, 50% responder rate for all seizure types for patient subgroups <2 years and ≥2 years of age using daily record card data). RESULTS Of 257 patients with ≥1 dose of BRV (141 [54.9%] male; mean age = 8.0 years [SD = 4.5]), 36 patients were <2 years of age, and 72.0% of patients had a history of focal seizures. Mean BRV exposure was 3.2 patient-years. At least one TEAE occurred in 93.4% patients, and 32.3% had serious TEAEs. Seven patients died during the trial; no deaths were considered treatment-related. Patients ≥2 years of age had a median decrease in 28-day adjusted focal seizure frequency of 62.9%, and 50.9% had a ≥50% response in all seizures. Patients <2 years of age had a median decrease in 28-day adjusted focal seizure frequency of 96.9%, and 68.2% had a ≥50% response in all seizures. Kaplan-Meier estimated treatment retention was 72.7%, 64.5%, 57.8%, 53.3%, 50.1%, and 44.8% at 1, 2, 3, 4, 5, and 6 years, respectively. Mean changes (baseline to last evaluation) for all Achenbach CBCL and BRIEF-P/BRIEF subscale scores were negative, reflecting stability/slight improvement. SIGNIFICANCE Long-term adjunctive BRV treatment was generally well tolerated and efficacious in reducing seizure frequency, and had high retention rates, with generally stable cognitive/behavioral scores in pediatric patients with epilepsy.
Collapse
Affiliation(s)
- Lieven Lagae
- Department of Development and Regeneration, Pediatric Neurology Section, University Hospitals Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kerstin Alexandra Klotz
- Department of Neuropediatrics and Muscle Disorders, Medical Center, University of Freiburg, Freiburg, Germany
| | - András Fogarasi
- Department of Neuropediatrics, Bethesda Children's Hospital, Budapest, Hungary
| | | | | | | | | | - Harriet Kang
- Department of Neurology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| |
Collapse
|
16
|
Bosco F, Guarnieri L, Rania V, Palma E, Citraro R, Corasaniti MT, Leo A, De Sarro G. Antiseizure Medications in Alzheimer's Disease from Preclinical to Clinical Evidence. Int J Mol Sci 2023; 24:12639. [PMID: 37628821 PMCID: PMC10454935 DOI: 10.3390/ijms241612639] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Alzheimer's disease (AD) and epilepsy are common neurological disorders in the elderly. A bi-directional link between these neurological diseases has been reported, with patients with either condition carrying almost a two-fold risk of contracting the other compared to healthy subjects. AD/epilepsy adversely affects patients' quality of life and represents a severe public health problem. Thus, identifying the relationship between epilepsy and AD represents an ongoing challenge and continuing need. Seizures in AD patients are often unrecognized because they are often nonconvulsive and sometimes mimic some behavioral symptoms of AD. Regarding this, it has been hypothesized that epileptogenesis and neurodegeneration share common underlying mechanisms. Targeted treatment to decrease epileptiform activity could represent a valuable strategy for delaying the neurodegenerative process and related cognitive impairment. Several preclinical studies have shown that some antiseizure medications (ASMs) targeting abnormal network hyperexcitability may change the natural progression of AD. However, to date, no guidelines are available for managing seizures in AD patients because of the paucity of randomized clinical trials sufficient for answering the correlated questions. Future AD clinical studies are mandatory to update clinicians about the symptomatic treatment of seizures in AD patients and recognize whether ASM therapy could change the natural progression of the disease, thereby rescuing cognitive performance.
Collapse
Affiliation(s)
- Francesca Bosco
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
| | - Lorenza Guarnieri
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
| | - Vincenzo Rania
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
| | - Ernesto Palma
- Department of Health Sciences, School of Pharmacy, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (E.P.); (M.T.C.)
| | - Rita Citraro
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
- System and Applied Pharmacology, University Magna Graecia (FAS@UMG) Research Center, Department of Health Sciences, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Maria Tiziana Corasaniti
- Department of Health Sciences, School of Pharmacy, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (E.P.); (M.T.C.)
| | - Antonio Leo
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
- System and Applied Pharmacology, University Magna Graecia (FAS@UMG) Research Center, Department of Health Sciences, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Giovambattista De Sarro
- Department of Health Sciences, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (F.B.); (L.G.); (V.R.); (R.C.); (G.D.S.)
- System and Applied Pharmacology, University Magna Graecia (FAS@UMG) Research Center, Department of Health Sciences, School of Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| |
Collapse
|
17
|
Perversi F, Costa C, Labate A, Lattanzi S, Liguori C, Maschio M, Meletti S, Nobili L, Operto FF, Romigi A, Russo E, Di Bonaventura C. The broad-spectrum activity of perampanel: state of the art and future perspective of AMPA antagonism beyond epilepsy. Front Neurol 2023; 14:1182304. [PMID: 37483446 PMCID: PMC10359664 DOI: 10.3389/fneur.2023.1182304] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/07/2023] [Indexed: 07/25/2023] Open
Abstract
Glutamate is the brain's main excitatory neurotransmitter. Glutamatergic neurons primarily compose basic neuronal networks, especially in the cortex. An imbalance of excitatory and inhibitory activities may result in epilepsy or other neurological and psychiatric conditions. Among glutamate receptors, AMPA receptors are the predominant mediator of glutamate-induced excitatory neurotransmission and dictate synaptic efficiency and plasticity by their numbers and/or properties. Therefore, they appear to be a major drug target for modulating several brain functions. Perampanel (PER) is a highly selective, noncompetitive AMPA antagonist approved in several countries worldwide for treating different types of seizures in various epileptic conditions. However, recent data show that PER can potentially address many other conditions within epilepsy and beyond. From this perspective, this review aims to examine the new preclinical and clinical studies-especially those produced from 2017 onwards-on AMPA antagonism and PER in conditions such as mesial temporal lobe epilepsy, idiopathic and genetic generalized epilepsy, brain tumor-related epilepsy, status epilepticus, rare epileptic syndromes, stroke, sleep, epilepsy-related migraine, cognitive impairment, autism, dementia, and other neurodegenerative diseases, as well as provide suggestions on future research agenda aimed at probing the possibility of treating these conditions with PER and/or other AMPA receptor antagonists.
Collapse
Affiliation(s)
| | - Cinzia Costa
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Neurological Clinic, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome ‘Tor Vergata”, Rome, Italy
- Epilepsy Center, Neurology Unit, University Hospital “Tor Vergata”, Rome, Italy
| | - Marta Maschio
- Center for Tumor-Related Epilepsy, UOSD Neuro-Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Meletti
- Neurology Department, University Hospital of Modena, Modena, Italy
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genova, Genova, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Andrea Romigi
- Sleep Medicine Center, Neurological Mediterranean Institute IRCCS Neuromed, Pozzilli, Italy
- Psychology Faculty, International Telematic University Uninettuno, Rome, Italy
| | - Emilio Russo
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
18
|
Pisani F, Spagnoli C. What are the considerations when initiating treatment for epilepsy in children? Expert Rev Neurother 2023; 23:1081-1096. [PMID: 38032395 DOI: 10.1080/14737175.2023.2288107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION There is a very wide spectrum of epilepsies and developmental and epileptic encephalopathies that affect children, from self-limited forms, not necessarily requiring treatment, to severe drug-resistant ones. AREAS COVERED In this perspective, the authors discuss the main factors to consider before drug prescription in children, considering the most recent clinical research, including age, seizure type, epilepsy syndrome, etiology, efficacy and safety profile, comorbidities, gender, available formulations, costs and drug coverage, and regulatory issues. The literature search was conducted through a PubMed search on antiseizure medications for patients aged 0-18, with respect to each of the aforementioned factors, and by checking the reference lists of relevant papers. EXPERT OPINION The most expanding field of research and innovation for clinical practice is precision medicine, which addresses the holistic treatment of genetic epilepsies and developmental and epileptic encephalopathies. It achieves this by addressing their detrimental effects on synapses, neurotransmission, and cellular signaling pathways with the double aim to treat seizures and to rescue neurodevelopmental trajectories, but also the issue of adverse events and drug resistance through pharmacogenomics.
Collapse
Affiliation(s)
- Francesco Pisani
- Human Neurosciences Department, Sapienza University of Rome, Rome, Italy
| | - Carlotta Spagnoli
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
19
|
Wirrell EC, Riney K, Specchio N, Zuberi SM. How have the recent updated epilepsy classifications impacted on diagnosis and treatment? Expert Rev Neurother 2023; 23:969-980. [PMID: 37676056 DOI: 10.1080/14737175.2023.2254937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Epilepsies are a diverse group of disorders which differ regarding prognosis for seizure control and associated comorbidities. Accurate classification is critical to choose the highest yield investigations and best therapeutic options and to provide the most accurate prognoses regarding the expected degree of seizure control, possible remission, and risk of associated comorbidities to patients and their families. This article reviews the recent updates in epilepsy classification to illustrate how accurate classification impacts care for persons with epilepsy. AREAS COVERED The authors discuss the ILAE 2017 Classification of the Epilepsies along with the modification of the classification for neonatal seizures and epilepsies. They also discuss the ILAE position papers on Epilepsy syndromes in neonates and infants and children of variable age and the Idiopathic Generalized Epilepsies. EXPERT OPINION Accurate epilepsy classification allows selection of the highest yield investigations, choice of optimal therapies, and accurate prognostication of seizures (likelihood of response to antiseizure treatments and likelihood of remission with age), as well as comorbidities (likelihood, type, and severity). As we move into the era of disease modifying therapy, early accurate identification of underlying causes with timely introduction of specific treatments will be crucial to lessen the severity of epilepsy, with improved seizure control and attenuation of associated comorbidities.
Collapse
Affiliation(s)
- Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, Australia and Faculty of Medicine, University of St Lucia, Brisbane, Queensland, Australia
| | - Nicola Specchio
- Clinical and Experimental Neurology, Bambino Gesu Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies (EpiCARE), Rome, Italy
| | - Sameer M Zuberi
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Royal Hospital for Children, Glasgow, UK
| |
Collapse
|
20
|
Liu P, Zhang Y, Xu X, Zhou M, Fei Y, Zhang L. Mining and analysis of adverse drug reactions associated with perampanel based on FAERS database. Epilepsy Behav 2023; 145:109283. [PMID: 37315406 DOI: 10.1016/j.yebeh.2023.109283] [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: 03/02/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Perampanel (PER) is a non-competitive AMPA glutamate receptor antagonist used as an anti-seizure medication. Large post-marketing databases are still lacking for safety analysis of the new generation of anti-seizure medications. Based on the FDA's adverse event reporting system (FAERS) database, this study aimed to investigate, assess, and offer evidence for the safety of PER to support clinical decision-making. METHODS Perampanel-related adverse reaction signals were mined using the reporting odds ratio (ROR), medicines and healthcare products regulatory agency (MHRA), and Bayesian confidence propagation neural network (BCPNN). The rate and occurrence of reported adverse responses were examined. RESULTS With the three methodologies used in combination, 83 signals mostly related to psychosis and different nervous system disorders were detected. Among them, suicide behavior, respiratory depression, hepatotoxicity, cognitive impairment, and other possible novel signals warranted consideration. Further examination of the age and gender differences in the detected signals revealed that elderly patients should be closely monitored for any change in consciousness and the occurrence of movement disorders; male patients should be observed for negative mental reactions like a personal attack and homicidal ideation; and female patients should be watched for the occurrence of negative reactions in memory, weight, vision, liver function, and other specific areas. CONCLUSIONS This study found that PER had the risk of causing suicide behavior, respiratory depression, hepatotoxicity, and cognitive impairment among other adverse effects. When used clinically, PER should be closely monitored for the occurrence of adverse effects on mental health and behavior. However, these results should be interpreted with caution.
Collapse
Affiliation(s)
- Pengcheng Liu
- China Pharmaceutical University School of International Pharmaceutical Business, Nanjing 211198, China.
| | - Yuwei Zhang
- China Pharmaceutical University School of International Pharmaceutical Business, Nanjing 211198, China
| | - Xiaoli Xu
- China Pharmaceutical University School of International Pharmaceutical Business, Nanjing 211198, China
| | - Ming Zhou
- China Pharmaceutical University School of International Pharmaceutical Business, Nanjing 211198, China
| | - Yi Fei
- China Pharmaceutical University School of Science, Nanjing 211198, China
| | - Liming Zhang
- The First Affiliated Hospital of Harbin Medical University Department of Neurology, Harbin 150007, China.
| |
Collapse
|
21
|
Ramirez JM, Carroll MS, Burgraff N, Rand CM, Weese-Mayer DE. A narrative review of the mechanisms and consequences of intermittent hypoxia and the role of advanced analytic techniques in pediatric autonomic disorders. Clin Auton Res 2023; 33:287-300. [PMID: 37326924 DOI: 10.1007/s10286-023-00958-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
Disorders of autonomic functions are typically characterized by disturbances in multiple organ systems. These disturbances are often comorbidities of common and rare diseases, such as epilepsy, sleep apnea, Rett syndrome, congenital heart disease or mitochondrial diseases. Characteristic of many autonomic disorders is the association with intermittent hypoxia and oxidative stress, which can cause or exaggerate a variety of other autonomic dysfunctions, making the treatment and management of these syndromes very complex. In this review we discuss the cellular mechanisms by which intermittent hypoxia can trigger a cascade of molecular, cellular and network events that result in the dysregulation of multiple organ systems. We also describe the importance of computational approaches, artificial intelligence and the analysis of big data to better characterize and recognize the interconnectedness of the various autonomic and non-autonomic symptoms. These techniques can lead to a better understanding of the progression of autonomic disorders, ultimately resulting in better care and management.
Collapse
Affiliation(s)
- Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, 1900 Ninth Avenue, Seattle, WA, 98101, USA.
- Departments of Neurological Surgery and Pediatrics, University of Washington School of Medicine, 1900 Ninth Avenue, Seattle, WA, 98101, USA.
| | - Michael S Carroll
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Autonomic Medicine, Stanley Manne Children's Research Institute at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Nicholas Burgraff
- Center for Integrative Brain Research, Seattle Children's Research Institute, 1900 Ninth Avenue, Seattle, WA, 98101, USA
| | - Casey M Rand
- Division of Autonomic Medicine, Stanley Manne Children's Research Institute at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Debra E Weese-Mayer
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Autonomic Medicine, Stanley Manne Children's Research Institute at Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| |
Collapse
|
22
|
Stefanos-Yakoub I, Wingeier K, Cserpan D, Gennari AG, Latal B, Reuner G, Ramantani G. Lesion Extent Negatively Impacts Intellectual Skills in Pediatric Focal Epilepsy. Pediatr Neurol 2023; 145:67-73. [PMID: 37285765 DOI: 10.1016/j.pediatrneurol.2023.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/08/2023] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cognitive development in children and adolescents with focal lesional epilepsy is determined by the underlying epileptogenic lesion, in addition to epilepsy itself. However, the impact of lesion-related variables on intelligence quotient (IQ) and developmental quotient (DQ) remains largely unexplored. Here, we aimed to determine the effect of lesion-related predictors and their relation with epilepsy-related predictors of intellectual functioning. METHODS We retrospectively analyzed data from children with focal lesional epilepsy who underwent standardized cognitive evaluation yielding IQ/DQ in our institution. RESULTS We included 50 consecutive patients aged 0.5 to 17.5 years (mean, 9.3; S.D., 4.9) at cognitive assessment. Epilepsy duration was 0 to 15.5 years (mean, 3.8; S.D., 4.1). Of the total cohort, 30 (60%) patients had unilobar lesions, seven (14%) multilobar, 10 (20%) hemispheric, and three (6%) bilateral. Etiology was congenital in 32 (64%) cases, acquired in 14 (28%), and progressive in four (8%). For patients with unilobar lesions, the mean IQ/DQ was 97.1 ± 15.7, for multilobar 98.9 ± 20.2, for hemispheric 76.1 ± 20.5, and for bilateral 76.3 ± 4.5. Larger lesion extent, earlier epilepsy onset, and longer epilepsy duration correlated with lower IQ/DQ in the univariate analysis, whereas only lesion extent and epilepsy duration contributed significantly to the explanatory model in the multivariable analysis. CONCLUSIONS The present study demonstrates that lesion extent and epilepsy duration are important risk factors for intellectual impairment in pediatric patients with focal lesional epilepsy. These findings are useful for family counseling and the early consideration of interventions that may limit the duration of epilepsy.
Collapse
Affiliation(s)
- Ilona Stefanos-Yakoub
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Kevin Wingeier
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Dorottya Cserpan
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Antonio Giulio Gennari
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland; MR Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Gitta Reuner
- Faculty of Behavioral and Cultural Studies, Institute of Education Studies, University of Heidelberg, Heidelberg, Germany
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
| |
Collapse
|
23
|
Leppien EE, Doughty BJ, Hurd KL, Strong KN, Piper BJ, McCall KL. Newer Antiseizure Medications and Suicidality: Analysis of the Food and Drug Administration Adverse Event Reporting System (FAERS) Database. Clin Drug Investig 2023:10.1007/s40261-023-01272-9. [PMID: 37184612 DOI: 10.1007/s40261-023-01272-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The association between antiseizure medications (ASMs) and suicidality remains controversial. Analyses of additional datasets are needed to further elucidate the complex relationship between antiseizure medications and suicidality. OBJECTIVE The aim of this study was to compare the safety profile of newer ASMs with older ASMs through an analysis of the US Food and Drug Administration Adverse Event Reporting System (FAERS) database, with a focus on suicidality. METHODS We queried over 17 million reports in the FAERS database from 2012 to 2021 and identified cases involving ASMs. After removing incomplete and duplicate reports, the study cohort consisted of lacosamide (n = 7593), perampanel (n = 1813), clobazam (n = 3827), brivaracetam (n = 1166), and vigabatrin (n = 5293) compared with a control group of older ASMs (topiramate, lamotrigine, valproic acid, carbamazepine, levetiracetam; n = 71,535). Cases of suicidality (completed suicide, suicidal ideation, attempted suicide, suicidal behavior, suicidal depression) were identified in each group. Adjusted (age and sex) odds ratios (aOR) and associated 95% confidence intervals (CI) were calculated using logistic regression analysis for each new drug when compared with the control group of older ASM drugs. RESULTS A total of 6309 cases of suicidality were identified among reports with ASMs. Most reports were sourced from healthcare professionals (5516, 87.4%). The proportion of reports involving suicidality were 210/7593 (2.8%) for lacosamide, 185/1813 (10.2%) for perampanel, 108/3827 (2.8%) for clobazam, 57/1166 (4.9%) for brivaracetam, 14/5293 (0.3%) for vigabatrin, and 5735/71,535 (8.0%) for older ASMs. Compared with older ASMs, the aOR for suicidality was 0.33 (95% CI 0.28-0.38) for lacosamide, 1.34 (95% CI 1.15-1.56) for perampanel, 0.35 (95% CI 0.29-0.43) for clobazam, 0.60 (95% CI 0.45-0.77) for brivaracetam, and 0.03 (95% CI 0.02-0.05) for vigabatrin. CONCLUSION When compared with older ASMs, four newer ASMs (lacosamide, clobazam, brivaracetam, and vigabatrin) were found to have significantly lower odds of suicidality, while perampanel was found to significantly increase the odds of suicidality. Pronounced variability (greater than 30 fold) in the proportion of FAERS reports associated with suicidality among the drugs studied was identified. The results of this case control study of FDA adverse event reports spanning 10 years and 6309 cases of suicidality expand our understanding of the safety profile of newer ASMs.
Collapse
Affiliation(s)
- Emily E Leppien
- Department of Pharmacy Practice, Binghamton University School of Pharmacy & Pharmaceutical Sciences, Johnson City, NY, 13790, USA
| | - Bennett J Doughty
- Department of Pharmacy Practice, Binghamton University School of Pharmacy & Pharmaceutical Sciences, Johnson City, NY, 13790, USA
| | - Karyssa L Hurd
- Binghamton University School of Pharmacy & Pharmaceutical Sciences, 96 Corliss Avenue, Johnson City, NY, 13790, USA
| | - Keira N Strong
- Binghamton University School of Pharmacy & Pharmaceutical Sciences, 96 Corliss Avenue, Johnson City, NY, 13790, USA
| | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, 18510, USA
- Geisinger Center for Pharmacy Innovation and Outcomes, Daville, PA, 17821, USA
| | - Kenneth L McCall
- Department of Pharmacy Practice, Binghamton University School of Pharmacy & Pharmaceutical Sciences, Johnson City, NY, 13790, USA.
| |
Collapse
|
24
|
Sourbron J, Lagae L. Fenfluramine: a plethora of mechanisms? Front Pharmacol 2023; 14:1192022. [PMID: 37251322 PMCID: PMC10213522 DOI: 10.3389/fphar.2023.1192022] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 05/31/2023] Open
Abstract
Developmental and epileptic encephalopathies are rare, treatment-resistant epilepsies with high seizure burden and non-seizure comorbidities. The antiseizure medication (ASM) fenfluramine is an effective treatment for reducing seizure frequency, ameliorating comorbidities, and potentially reducing risk of sudden unexpected death in epilepsy (SUDEP) in patients with Dravet syndrome and Lennox-Gastaut syndrome, among other rare epilepsies. Fenfluramine has a unique mechanism of action (MOA) among ASMs. Its primary MOA is currently described as dual-action sigma-1 receptor and serotonergic activity; however, other mechanisms may be involved. Here, we conduct an extensive review of the literature to identify all previously described mechanisms for fenfluramine. We also consider how these mechanisms may play a role in the reports of clinical benefit in non-seizure outcomes, including SUDEP and everyday executive function. Our review highlights the importance of serotonin and sigma-1 receptor mechanisms in maintaining a balance between excitatory (glutamatergic) and inhibitory (γ-aminobutyric acid [GABA]-ergic) neural networks, and suggests that these mechanisms may represent primary pharmacological MOAs in seizures, non-seizure comorbidities, and SUDEP. We also describe ancillary roles for GABA neurotransmission, noradrenergic neurotransmission, and the endocrine system (especially such progesterone derivatives as neuroactive steroids). Dopaminergic activity underlies appetite reduction, a common side effect with fenfluramine treatment, but any involvement in seizure reduction remains speculative. Further research is underway to evaluate promising new biological pathways for fenfluramine. A better understanding of the pharmacological mechanisms for fenfluramine in reducing seizure burden and non-seizure comorbidities may allow for rational drug design and/or improved clinical decision-making when prescribing multi-ASM regimens.
Collapse
|
25
|
Sinanoglu B, Ozdemir F. Evaluation of functional mobility, balance, and executive functions in children with epilepsy. Epilepsy Behav 2023; 143:109230. [PMID: 37146465 DOI: 10.1016/j.yebeh.2023.109230] [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: 11/25/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE It is known that motor skills and executive functions are interrelated in healthy children. The study aims to evaluate the functional mobility, balance and executive functions in children who are diagnosed with epilepsy and to determine whether they are related to each other. METHODS The study included 21 children who were diagnosed with epilepsy and have no additional comorbidities and 21 healthy children who had similar age and sex to those diagnosed with epilepsy. Their demographic data were collected using a descriptive information form. In addition, the Timed Up and Go Test (TUG) and the Stair Climb Test (SCT) were used to evaluate their functional mobility, the Pediatric Berg Balance Scale (PBSS) to evaluate their balance, and the Behavior Evaluation Inventory for Executive Functions Parent Form (BRIEF-P) to evaluate their executive functions. RESULTS Our study found a statistically significant difference between the children with epilepsy and their healthy peers in terms of functional mobility and executive functions (p < 0.05). However, there was no statistically significant difference between them in terms of balance parameters (p > 0.05). In addition, a statistically significant difference was found between the executive functions and functional mobility in children with epilepsy (p < 0.05). The coefficient of determinations (R2) indicating how differences in T and SCT scores explained by executive function domains were found as 0.718 and 0.725, respectively. CONCLUSIONS Epilepsy can negatively affect several aspects of functional mobility and executive functions in childhood. According to the results of our study, it is important to recognize the motor skills and executive functions problems of children with epilepsy who do not have additional comorbidities, and to direct them to appropriate healthcare programs. Our results support the need to raise awareness in both health professionals and families to encourage children with epilepsy to be more active.
Collapse
Affiliation(s)
- Bercem Sinanoglu
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Inonu University, Malatya, Turkey.
| | - Filiz Ozdemir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Inonu University, Malatya, Turkey.
| |
Collapse
|
26
|
Makridis KL, Hoyer S, Elger CE, Kaindl AM. Is There a Cognitive Decline in Pediatric Patients Following Epilepsy Surgery? Pediatr Neurol 2023; 144:44-49. [PMID: 37146539 DOI: 10.1016/j.pediatrneurol.2023.03.020] [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: 05/15/2022] [Revised: 03/13/2023] [Accepted: 03/30/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Epilepsy surgery is currently the only way to cure drug-resistant epilepsy (DRE). The loss of epileptic activity or its propagation in the developing brain may not only result in seizure freedom but also be associated with further positive effects. Here, we analyzed the cognitive development of children and adolescents with DRE after epilepsy surgery. METHODS We evaluated retrospectively the cognitive development of children and adolescents before and after epilepsy surgery. RESULTS Fifty-three children and adolescents underwent epilepsy surgery at a median age of 7.62 years. Overall seizure freedom was 86.8% at a current median observation period of 20 months. Presurgically, 81.1% had the clinical diagnosis of cognitive impairment, which was confirmed by standardized tests in 43 of 53 patients (76.7%). Further 10 patients had severe cognitive impairment rendering a standardized test impossible. The median intelligence quotient (IQ)/development quotient value was 74. After surgery, caretakers reported developmental progress in all patients, whereas the median IQ decreased slightly (P = 0.404). In eight patients the IQ points decreased after surgery; however, their individual raw scores increased in line with their reported increase in cognitive abilities. CONCLUSIONS We did not detect any cognitive deterioration in children following epilepsy surgery. A loss of IQ points did not correspond to a real loss of cognitive abilities. These patients developed more slowly than age-matched peers with an average development speed but profited individually as seen in their raw scores. Therefore, an individual analysis of raw scores is relevant to assess the cognitive development after surgery.
Collapse
Affiliation(s)
- Konstantin L Makridis
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute of Cell- and Neurobiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Hoyer
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian E Elger
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany; Beta Neurologie - Kompetenzzentrum für Epilepsie, Beta Klinik GmbH, Bonn, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute of Cell- and Neurobiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
27
|
Bishop KI, Isquith PK, Gioia GA, Knupp KG, Scheffer IE, Nabbout R, Specchio N, Sullivan J, Auvin S, Helen Cross J, Guerrini R, Farfel G, Galer BS, Gammaitoni AR. Fenfluramine treatment is associated with improvement in everyday executive function in preschool-aged children (<5 years) with Dravet syndrome: A critical period for early neurodevelopment. Epilepsy Behav 2023; 138:108994. [PMID: 36463826 DOI: 10.1016/j.yebeh.2022.108994] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/29/2022] [Accepted: 11/05/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To evaluate whether fenfluramine (FFA) is associated with improvement in everyday executive function (EF)-self-regulation-in preschool-aged children with Dravet syndrome (DS). METHODS Children with DS received placebo or FFA in one of two phase III studies (first study: placebo, FFA 0.2 mg/kg/day, or FFA 0.7 mg/kg/day added to stiripentol-free standard-of-care regimens; second study: placebo or FFA 0.4 mg/kg/day added to stiripentol-inclusive regimens). Everyday EF was evaluated at baseline and Week 14-15 for children aged 2-4 years with parent ratings on the Behavior Rating Inventory of Executive Function®-Preschool (BRIEF®-P); raw scores were transformed to T-scores and summarized in Inhibitory Self-Control Index (ISCI), Flexibility Index (FI), Emergent Metacognition Index (EMI), and Global Executive Composite (GEC). Clinically meaningful improvement and worsening were defined using RCI ≥ 90% and RCI ≥ 80% certainty, respectively. The associations between placebo vs FFA combined (0.2, 0.4, and 0.7 mg/kg/day) or individual treatment groups and the likelihood of clinically meaningful change in BRIEF®-P indexes/composite T-scores were evaluated using Somers'd; pairwise comparisons were calculated by 2-sided Fisher's Exact tests (p ≤ 0.05) and Cramér's V. RESULTS Data were analyzed for 61 evaluable children of median age 3 years (placebo, n = 22; FFA 0.2 mg/kg/day, n = 15; 0.4 mg/kg/day [with stiripentol], n = 10; 0.7 mg/kg/day, n = 14 [total FFA, n = 39]). Elevated or problematic T-scores (T ≥ 65) were reported in 55% to 86% of patients at baseline for ISCI, EMI, and GEC, and in ∼33% for FI. Seventeen of the 61 children (28%) showed reliable, clinically meaningful improvement (RCI ≥ 90% certainty) in at least one BRIEF®-P index/composite, including a majority of the children in the FFA 0.7 mg/kg/day group (9/14, 64%). Only 53% of these children (9/17) also experienced clinically meaningful reduction (≥50%) in monthly convulsive seizure frequency, including 6/14 patients in the FFA 0.7 mg/kg/day group. Overall, there were positive associations between the four individual treatment groups and the likelihood of reliable, clinically meaningful improvement in all BRIEF®-P indexes/composite (ISCI, p = 0.001; FI, p = 0.005; EMI, p = 0.040; GEC, p = 0.002). The FFA 0.7 mg/kg/day group showed a greater likelihood of reliable, clinically meaningful improvement than placebo in ISCI (50% vs 5%; p = 0.003), FI (36% vs 0%; p = 0.005), and GEC (36% vs 0%; p = 0.005). For EMI, the FFA 0.7 mg/kg/day group showed a greater likelihood of reliable, clinically meaningful improvement than the FFA 0.2 mg/kg/day group (29% vs 0%; p = 0.040), but did not meet the significance threshold compared with placebo (29% vs 5%; p = 0.064). There were no significant associations between treatment and the likelihood of reliable, clinically meaningful worsening (p > 0.05). SIGNIFICANCE In this preschool-aged DS population with high baseline everyday EF impairment, FFA treatment for 14-15 weeks was associated with dose-dependent, clinically meaningful improvements in regulating behavior, emotion, cognition, and overall everyday EF. These clinically meaningful improvements in everyday EF were not entirely due to seizure frequency reduction, suggesting that FFA may have direct effects on everyday EF during the early formative years of neurodevelopment.
Collapse
Affiliation(s)
| | - Peter K Isquith
- Global Pharma Consultancy, LLC, Muncy, PA, USA; Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerard A Gioia
- Global Pharma Consultancy, LLC, Muncy, PA, USA; Children's National Health System, Rockville, MD, USA
| | | | - Ingrid E Scheffer
- University of Melbourne, Austin and Royal Children's Hospitals, Florey Institute and Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Hôpital Universitaire Necker-Enfants Malades, APHP, Member of EPICARE, Institut Imagine, Université Paris Cité, Paris, France
| | | | - Joseph Sullivan
- University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
| | - Stéphane Auvin
- Robert Debré Children's Hospital, APHP, Université de Paris, Paris, France; Institut Universitaire de France (IUF), Paris, France
| | - J Helen Cross
- UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Renzo Guerrini
- Anna Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Gail Farfel
- Formerly Zogenix, Inc., now a part of UCB, Emeryville, CA, USA
| | - Bradley S Galer
- Formerly Zogenix, Inc., now a part of UCB, Emeryville, CA, USA
| | | |
Collapse
|
28
|
Knupp KG, Scheffer IE, Ceulemans B, Sullivan J, Nickels KC, Lagae L, Guerrini R, Zuberi SM, Nabbout R, Riney K, Agarwal A, Lock M, Dai D, Farfel GM, Galer BS, Gammaitoni AR, Polega S, Davis R, Gil‐Nagel A. Fenfluramine provides clinically meaningful reduction in frequency of drop seizures in patients with Lennox-Gastaut syndrome: Interim analysis of an open-label extension study. Epilepsia 2023; 64:139-151. [PMID: 36196777 PMCID: PMC10099582 DOI: 10.1111/epi.17431] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate the long-term safety and effectiveness of fenfluramine in patients with Lennox-Gastaut syndrome (LGS). METHODS Eligible patients with LGS who completed a 14-week phase 3 randomized clinical trial enrolled in an open-label extension (OLE; NCT03355209). All patients were initially started on .2 mg/kg/day fenfluramine and after 1 month were titrated by effectiveness and tolerability, which were assessed at 3-month intervals. The protocol-specified treatment duration was 12 months, but COVID-19-related delays resulted in 142 patients completing their final visit after 12 months. RESULTS As of October 19, 2020, 247 patients were enrolled in the OLE. Mean age was 14.3 ± 7.6 years (79 [32%] adults) and median fenfluramine treatment duration was 364 days; 88.3% of patients received 2-4 concomitant antiseizure medications. Median percentage change in monthly drop seizure frequency was -28.6% over the entire OLE (n = 241) and -50.5% at Month 15 (n = 142, p < .0001); 75 of 241 patients (31.1%) experienced ≥50% reduction in drop seizure frequency. Median percentage change in nondrop seizure frequency was -45.9% (n = 192, p = .0038). Generalized tonic-clonic seizures (GTCS) and tonic seizures were most responsive to treatment, with median reductions over the entire OLE of 48.8% (p < .0001, n = 106) and 35.8% (p < .0001, n = 186), respectively. A total of 37.6% (95% confidence interval [CI] = 31.4%-44.1%, n = 237) of investigators and 35.2% of caregivers (95% CI = 29.1%-41.8%, n = 230) rated patients as Much Improved/Very Much Improved on the Clinical Global Impression of Improvement scale. The most frequent treatment-emergent adverse events were decreased appetite (16.2%) and fatigue (13.4%). No cases of valvular heart disease (VHD) or pulmonary arterial hypertension (PAH) were observed. SIGNIFICANCE Patients with LGS experienced sustained reductions in drop seizure frequency on fenfluramine treatment, with a particularly robust reduction in frequency of GTCS, the key risk factor for sudden unexpected death in epilepsy. Fenfluramine was generally well tolerated; VHD or PAH was not observed long-term. Fenfluramine may provide an important long-term treatment option for LGS.
Collapse
Affiliation(s)
- Kelly G. Knupp
- University of Colorado, Children's Hospital ColoradoAuroraColoradoUSA
| | - Ingrid E. Scheffer
- University of Melbourne, Austin Hospital and Royal Children's HospitalMelbourneVictoriaAustralia
| | - Berten Ceulemans
- Department of Pediatric NeurologyAntwerp University HospitalAntwerpBelgium
| | - Joseph Sullivan
- University of California, San Francisco Weill Institute for Neurosciences, Benioff Children's HospitalSan FranciscoCaliforniaUSA
| | | | - Lieven Lagae
- Member of the European Reference Network EpiCARE, Department of Pediatric NeurologyUniversity of LeuvenLeuvenBelgium
| | - Renzo Guerrini
- Pediatric Neurology and Neurogenetics UnitAnna Meyer Children's Hospital, University of FlorenceFlorenceItaly
- Stella Maris Foundation, Scientific Institute for Research and Health CarePisaItaly
| | - Sameer M. Zuberi
- Paediatric Neurosciences Research GroupRoyal Hospital for ChildrenGlasgowUK
| | - Rima Nabbout
- Reference Center for Rare EpilepsiesNecker–Sick Children University Hospital, Public Hospital Network of Paris, member of EpiCARE, Imagine Institute, Paris Cité UniversityParisFrance
| | - Kate Riney
- Neuroscience UnitQueensland Children's HospitalSouth BrisbaneQueenslandAustralia
- School of Clinical MedicineUniversity of QueenslandSt LuciaQueenslandAustralia
| | | | - Michael Lock
- Independent Consultant, Zogenix (now a part of UCB)HaikuHawaiiUSA
| | - David Dai
- Syneos HealthMorrisvilleNorth CarolinaUSA
| | | | | | | | | | - Ronald Davis
- Neurology and Epilepsy Research CenterOrlandoFloridaUSA
| | | |
Collapse
|
29
|
Pisani F, Pisani LR, Barbieri MA, de Leon J, Spina E. Optimization of Therapy in Patients with Epilepsy and Psychiatric Comorbidities: Key Points. Curr Neuropharmacol 2023; 21:1755-1766. [PMID: 35619263 PMCID: PMC10514544 DOI: 10.2174/1570159x20666220526144314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/24/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022] Open
Abstract
Psychiatric disorder comorbidity in patients with epilepsy (PWE) is very frequent with a mean percentage prevalence of up to 50% and even higher. Such a high frequency suggests that epilepsy and psychiatric disorders might share common pathological pathways. Various aspects contribute in making the matter very complex from a therapeutic point of view. Some antiseizure medications (ASMs), namely valproic acid, carbamazepine, and lamotrigine, have mood-stabilising effects and are routinely used for the treatment of bipolar disorder in patients who do not have epilepsy. Pregabalin and, to a lesser extent, gabapentin, exerts anxiolytic effects. However, several ASMs, in particular levetiracetam, topiramate, and perampanel, may contribute to psychiatric disorders, including depression, aggressive behaviour, and even psychosis. If these ASMs are prescribed, the patient should be monitored closely. A careful selection should be made also with psychotropic drugs. Although most of these can be safely used at therapeutic doses, bupropion, some tricyclic antidepressants, maprotiline, and clozapine may alter seizure threshold and facilitate epileptic seizures. Interactions between ASMs and psychotropic medication may make it difficult to predict individual response. Pharmacokinetic interactions can be assessed with drug monitoring and are consequently much better documented than pharmacodynamic interactions. Another aspect that needs a careful evaluation is patient adherence to treatment. Prevalence of non-adherence in PWE and psychiatric comorbidities is reported to reach values even higher than 70%. A careful evaluation of all these aspects contributes in optimizing therapy with a positive impact on seizure control, psychiatric wellbeing, and quality of life.
Collapse
Affiliation(s)
- Francesco Pisani
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | | | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA and Psychiatry and Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| |
Collapse
|
30
|
Han MJ, Min JH, Kim SJ. Effect of Oxcarbazepine on Language Function in Patients With Newly Diagnosed Pediatric Epilepsy. J Clin Neurol 2023; 19:76-82. [PMID: 36606649 PMCID: PMC9833875 DOI: 10.3988/jcn.2023.19.1.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to determine the effects of oxcarbazepine (OXC) on the language function of patients with pediatric epilepsy. METHODS We assessed the language abilities of patients aged 5-17 years with newly diagnosed focal epilepsy and the same number of age-matched healthy children using the Test of Problem Solving (TOPS) and the Receptive and Expressive Vocabulary Test-Receptive (REVT-R). The Mean Length of Utterance-words (MLU-w) was used to estimate linguistic productivity before and after OXC initiation. All patients received OXC monotherapy with a starting dosage of 10 mg/kg/day for 1 week, which in some cases was increased to 30 mg/kg/day (or 1,200 mg/day). RESULTS The study finally included 41 pediatric patients (22 males and 19 females; age 9.9±3.0 years, mean±standard deviation). All language parameters of the TOPS improved significantly after initiating OXC (determining cause, 12.5±4.8-13.7±4.1 [p=0.016]; making inference, 15.6±5.6-17.4±6.4 [p<0.001]; and predicting, 9.8±5.0-11.6±4.5 [p=0.001]). However, patients who received OXC did not exhibit a significantly extended MLU-w (determining cause, p=0.493; making inference, p=0.386; and predicting, p=0.341). Receptive language scores also significantly increased after taking OXC (REVT-R: 121.0±43.1-129.4±43.8, p=0.002), but the percentage of development age to chronological age did not vary (REVT-developmental quotient: p=0.075). CONCLUSIONS Our results suggest that OXC is safe and preserves language function in patients with pediatric epilepsy.
Collapse
Affiliation(s)
- Min Jeong Han
- Department of Pediatrics, Jeonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Jeonbuk National University Medical School, Jeonju, Korea
| | - Ju Hong Min
- Clinical Speech Pathology of Jeonbuk National University, Jeonju, Korea
| | - Sun Jun Kim
- Department of Pediatrics, Jeonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Jeonbuk National University Medical School, Jeonju, Korea
| |
Collapse
|
31
|
Ying Y, Gong L, Tao X, Ding J, Chen N, Yao Y, Liu J, Chen C, Zhu T, Jiang P. Genetic Knockout of TRPM2 Increases Neuronal Excitability of Hippocampal Neurons by Inhibiting Kv7 Channel in Epilepsy. Mol Neurobiol 2022; 59:6918-6933. [PMID: 36053438 DOI: 10.1007/s12035-022-02993-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
Epilepsy is a chronic brain disease that makes serious cognitive and motor retardation. Ion channels affect the occurrence of epilepsy in various ways, but the mechanisms have not yet been fully elucidated. Transient receptor potential melastain2 (TRPM2) ion channel is a non-selective cationic channel that can permeate Ca2+ and critical for epilepsy. Here, TRPM2 gene knockout mice were used to generate a chronic kindling epilepsy model by PTZ administration in mice. We found that TRPM2 knockout mice were more susceptible to epilepsy than WT mice. Furthermore, the neuronal excitability in the hippocampal CA1 region of TRPM2 knockout mice was significantly increased. Compared with WT group, there were no significant differences in the input resistance and after hyperpolarization of CA1 neurons in TRPM2 knockout mice. Firing adaptation rate of hippocampal CA1 pyramidal neurons of TRPM2 knockout mice was lower than that of WT mice. We also found that activation of Kv7 channel by retigabine reduced the firing frequency of action potential in the hippocampal pyramidal neurons of TRPM2 knockout mice. However, inhibiting Kv7 channel increased the firing frequency of action potential in hippocampal pyramidal neurons of WT mice. The data suggest that activation of Kv7 channel can effectively reduce epileptic seizures in TRPM2 knockout mice. We conclude that genetic knockout of TRPM2 in hippocampal CA1 pyramidal neurons may increase neuronal excitability by inhibiting Kv7 channel, affecting the susceptibility to epilepsy. These findings may provide a potential therapeutic target for epilepsy.
Collapse
Affiliation(s)
- Yingchao Ying
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Lifen Gong
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaohan Tao
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Junchao Ding
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Department of Pediatrics, Yiwu Maternal and Child Health Care Hospital, Yiwu, China
| | - Nannan Chen
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yinping Yao
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- Department of Pediatrics, Shaoxing People's Hospital, Shaoxing, China
| | - Jiajing Liu
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chen Chen
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Tao Zhu
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| | - Peifang Jiang
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| |
Collapse
|
32
|
Strzelczyk A, Schubert-Bast S. Psychobehavioural and Cognitive Adverse Events of Anti-Seizure Medications for the Treatment of Developmental and Epileptic Encephalopathies. CNS Drugs 2022; 36:1079-1111. [PMID: 36194365 PMCID: PMC9531646 DOI: 10.1007/s40263-022-00955-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 02/06/2023]
Abstract
The developmental and epileptic encephalopathies encompass a group of rare syndromes characterised by severe drug-resistant epilepsy with onset in childhood and significant neurodevelopmental comorbidities. The latter include intellectual disability, developmental delay, behavioural problems including attention-deficit hyperactivity disorder and autism spectrum disorder, psychiatric problems including anxiety and depression, speech impairment and sleep problems. Classical examples of developmental and epileptic encephalopathies include Dravet syndrome, Lennox-Gastaut syndrome and tuberous sclerosis complex. The mainstay of treatment is with multiple anti-seizure medications (ASMs); however, the ASMs themselves can be associated with psychobehavioural adverse events, and effects (negative or positive) on cognition and sleep. We have performed a targeted literature review of ASMs commonly used in the treatment of developmental and epileptic encephalopathies to discuss the latest evidence on their effects on behaviour, mood, cognition, sedation and sleep. The ASMs include valproate (VPA), clobazam, topiramate (TPM), cannabidiol (CBD), fenfluramine (FFA), levetiracetam (LEV), brivaracetam (BRV), zonisamide (ZNS), perampanel (PER), ethosuximide, stiripentol, lamotrigine (LTG), rufinamide, vigabatrin, lacosamide (LCM) and everolimus. Bromide, felbamate and other sodium channel ASMs are discussed briefly. Overall, the current evidence suggest that LEV, PER and to a lesser extent BRV are associated with psychobehavioural adverse events including aggressiveness and irritability; TPM and to a lesser extent ZNS are associated with language impairment and cognitive dulling/memory problems. Patients with a history of behavioural and psychiatric comorbidities may be more at risk of developing psychobehavioural adverse events. Topiramate and ZNS may be associated with negative effects in some aspects of cognition; CBD, FFA, LEV, BRV and LTG may have some positive effects, while the remaining ASMs do not appear to have a detrimental effect. All the ASMs are associated with sedation to a certain extent, which is pronounced during uptitration. Cannabidiol, PER and pregabalin may be associated with improvements in sleep, LTG is associated with insomnia, while VPA, TPM, LEV, ZNS and LCM do not appear to have detrimental effects. There was variability in the extent of evidence for each ASM: for many first-generation and some second-generation ASMs, there is scant documented evidence; however, their extensive use suggests favourable tolerability and safety (e.g. VPA); second-generation and some third-generation ASMs tend to have the most robust evidence documented over several years of use (TPM, LEV, PER, ZNS, BRV), while evidence is still being generated for newer ASMs such as CBD and FFA. Finally, we discuss how a variety of factors can affect mood, behaviour and cognition, and untangling the associations between the effects of the underlying syndrome and those of the ASMs can be challenging. In particular, there is enormous heterogeneity in cognitive, behavioural and developmental impairments that is complex and can change naturally over time; there is a lack of standardised instruments for evaluating these outcomes in developmental and epileptic encephalopathies, with a reliance on subjective evaluations by proxy (caregivers); and treatment regimes are complex involving multiple ASMs as well as other drugs.
Collapse
Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany. .,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.,LOEWE Center for Personalized and Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.,Department of Neuropediatrics, Goethe-University and University Hospital Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
33
|
Kolaski K. Are anti-seizure medications effective and safe treatments for Lennox-Gastaut syndrome? A Cochrane Review summary with commentary. Dev Med Child Neurol 2022; 64:678-680. [PMID: 35322410 DOI: 10.1111/dmcn.15208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Kat Kolaski
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
34
|
Bai YF, Zeng C, Jia M, Xiao B. Molecular mechanisms of topiramate and its clinical value in epilepsy. Seizure 2022; 98:51-56. [DOI: 10.1016/j.seizure.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022] Open
|
35
|
Makridis KL, Atalay DA, Thomale UW, Tietze A, Elger CE, Kaindl AM. Epilepsy surgery in the first six months of life: A systematic review and meta-analysis. Seizure 2022; 96:109-117. [DOI: 10.1016/j.seizure.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 11/16/2022] Open
|
36
|
Sun Y, Zhao J, Zhao P, Zhang H, Zhong J, Pan P, Wang G, Yi Z, Xie L. Social cognition in children and adolescents with epilepsy: A meta-analysis. Front Psychiatry 2022; 13:983565. [PMID: 36186867 PMCID: PMC9520261 DOI: 10.3389/fpsyt.2022.983565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Many studies have investigated impairments in two key domains of social cognition (theory of mind [ToM] and facial emotion recognition [FER]) in children and adolescents with epilepsy. However, inconsistent conclusions were found. Our objective was to characterize social cognition performance of children and adolescents with epilepsy. A literature search was conducted using Web of Science, PubMed, and Embase databases. The article retrieval, screening, quality assessment (Newcastle-Ottawa-Scale), and data extraction were performed independently by two investigators. A random-effects model was used to examine estimates. The meta-analysis included 19 studies, with a combined sample of 623 children and adolescents with epilepsy (mean [SD] age, 12.13 [2.62] years; 46.1% female) and 677 healthy controls [HCs]) (mean [SD] age, 11.48 [2.71] years; 50.7% female). The results revealed that relative to HCs, children and adolescents with epilepsy exhibited deficits in ToM (g = -1.08, 95% CI [-1.38, -0.78], p < 0.001, the number of studies [k] = 13), FER (g = -0.98, 95% CI [-1.33, -0.64], p < 0.001, k = 12), and ToM subcomponents (cognitive ToM: g = -1.04, 95% CI [-1.35, -0.72], p < 0.001, k = 12] and affective ToM: g = -0.73, 95% CI [-1.12, -0.34], p < 0.001, k = 8). In addition, there were no statistically significant differences in social cognition deficits between children and adolescents with focal epilepsy and generalized epilepsy. Meta-regressions confirmed the robustness of the results. These quantitative results further deepen our understanding of the two core domains of social cognition in children and adolescents with epilepsy and may assist in the development of cognitive interventions for this patient population. Systematic review registration: https://inplasy.com/inplasy-2022-3-0011/, identifier INPLASY202230011.
Collapse
Affiliation(s)
- Yang Sun
- Department of Clinical Laboratory, The Fourth Affiliated Hospital of Nantong University, The First People's Hospital of Yancheng, Yancheng, Jiangsu, China
| | - Jing Zhao
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - PanWen Zhao
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - Hui Zhang
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - JianGuo Zhong
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - PingLei Pan
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, Jiangsu, China.,Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - GenDi Wang
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - ZhongQuan Yi
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - LiLi Xie
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| |
Collapse
|