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Su HW, Chen HT, Kao CL, Hung KC, Lin YT, Liu PH, Lin CM, Chen IW. Efficacy and safety of herbal medicine combined with acupuncture in pediatric epilepsy treatment: A meta-analysis of randomized controlled trials. PLoS One 2024; 19:e0303201. [PMID: 38723054 PMCID: PMC11081325 DOI: 10.1371/journal.pone.0303201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of herbal medicine and acupuncture combination for pediatric epilepsy treatment. METHODS Databases were searched from their interception until October 2023 to identify randomized controlled trials focusing on the therapeutic efficacy of herbal medicine-acupuncture combination (intervention group) for pediatric epilepsy. The primary outcome was the risk of treatment failure, whereas the secondary outcomes included the risk of post-treatment electroencephalogram (EEG) abnormalities and adverse events. Subgroup analyses were conducted based on the type of herbal compound formulas. Meta-regression analysis was conducted to examine the influence of patient demographics and clinical history on the therapeutic efficacy of herbal medicine-acupuncture combination for pediatric epilepsy. To assess the cumulative evidence, trial sequential analysis (TSA) was performed. RESULTS The analysis included 10 trials involving a total of 882 pediatric patients. Meta-analysis revealed that the intervention group had a lower risk of treatment failure than the control group (risk ratio [RR] = 0.3, 95% confidence interval [CI]: 0.19-0.47, P<0.00001, I2 = 0%, 10 trials). Subgroup analyses showed that therapeutic efficacy was consistent among the different herbal compound formulas. Meta-regression analysis revealed that the efficacy of the treatments did not significantly vary with patient age, male sex, and duration of seizure history. TSA suggested that herbal medicine-acupuncture combination exerted a robust and conclusive effect on seizure treatment. Although the combined used of herbal medicine and acupuncture was not associated with a lower risk of post-treatment EEG abnormalities (RR = 0.82, 95%CI:0.6-1.11, P = 0.2, 3 trials), the risk of adverse events was reduced (RR = 0.27, 95%CI:0.18-0.41, P<0.00001, 4 trials). CONCLUSION The meta-analysis suggested that combined use of herbal medicine and acupuncture is a promising and safe clinical approach for pediatric epilepsy treatment. Further large-scale studies are necessary to conclusively determine the efficacy and safety of herbal medicine and acupuncture in pediatric epilepsy treatment.
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Affiliation(s)
- Hong-Wen Su
- Department of Chinese Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Hsiao-Tien Chen
- Department of Chinese Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chia-Li Kao
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yao-Tsung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ping-Hsin Liu
- Department of Anesthesiology, E-Da Dachang Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Chien-Ming Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
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Lee WT, Chan DWS, Gulati S, Likasitwattanakul S, Lim BC, Okumura A, Sanchez-Gan B, Wang Y, Liu KT. Role of Perampanel in the Management of Pediatric Epilepsies in Asia: Expert Opinion. Pediatr Neurol 2024; 151:5-16. [PMID: 38041905 DOI: 10.1016/j.pediatrneurol.2023.09.023] [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: 04/27/2023] [Revised: 09/08/2023] [Accepted: 09/29/2023] [Indexed: 12/04/2023]
Abstract
Management of pediatric epilepsies poses unique challenges around diagnosis, treatment options, comorbidities, and the potential for these factors to interact with processes in the developing brain. In pediatric patients, broad-spectrum antiseizure medications (ASMs) with minimal potential for adverse events (AEs) and limited impact on cognition and behavior are preferred. Perampanel is a first-in-class ASM with broad-spectrum efficacy, a tolerable safety profile, minimal negative impact on cognitive function, and other features that make it a viable treatment option in this patient population. However, evidence and experience of its use in pediatric patients are less extensive than in adult patients. Experts in pediatric epilepsy across the region convened at a series of meetings to discuss the use of perampanel in pediatric patients, including dose optimization, AE prevention and management, and considerations in particular groups. This article summarizes key evidence for perampanel in the pediatric population and consolidates the experts' recommendations for using the ASM in managing pediatric epilepsies.
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Affiliation(s)
- Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | | | - Sheffali Gulati
- Center of Excellence and Advanced Research on Childhood Neurodevelopmental Disorders, Child Neurology Division, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Surachai Likasitwattanakul
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Benilda Sanchez-Gan
- Division of Pediatric Neurology, Departments of Pediatrics and Neurosciences, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Kam Tim Liu
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital and Queen Mary Hospital, Hong Kong SAR, China.
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Nguyen QA, Klein PM, Xie C, Benthall KN, Iafrati J, Homidan J, Bendor JT, Dudok B, Farrell JS, Gschwind T, Porter CL, Keravala A, Dodson GS, Soltesz I. Acetylcholine receptor based chemogenetics engineered for neuronal inhibition and seizure control assessed in mice. Nat Commun 2024; 15:601. [PMID: 38238329 PMCID: PMC10796428 DOI: 10.1038/s41467-024-44853-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
Epilepsy is a prevalent disorder involving neuronal network hyperexcitability, yet existing therapeutic strategies often fail to provide optimal patient outcomes. Chemogenetic approaches, where exogenous receptors are expressed in defined brain areas and specifically activated by selective agonists, are appealing methods to constrain overactive neuronal activity. We developed BARNI (Bradanicline- and Acetylcholine-activated Receptor for Neuronal Inhibition), an engineered channel comprised of the α7 nicotinic acetylcholine receptor ligand-binding domain coupled to an α1 glycine receptor anion pore domain. Here we demonstrate that BARNI activation by the clinical stage α7 nicotinic acetylcholine receptor-selective agonist bradanicline effectively suppressed targeted neuronal activity, and controlled both acute and chronic seizures in male mice. Our results provide evidence for the use of an inhibitory acetylcholine-based engineered channel activatable by both exogenous and endogenous agonists as a potential therapeutic approach to treating epilepsy.
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Affiliation(s)
- Quynh-Anh Nguyen
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA.
| | - Peter M Klein
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA.
| | - Cheng Xie
- CODA Biotherapeutics, 240 East Grand Ave., South San Francisco, CA, 94080, USA
| | - Katelyn N Benthall
- CODA Biotherapeutics, 240 East Grand Ave., South San Francisco, CA, 94080, USA
| | - Jillian Iafrati
- CODA Biotherapeutics, 240 East Grand Ave., South San Francisco, CA, 94080, USA
| | - Jesslyn Homidan
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA
| | - Jacob T Bendor
- CODA Biotherapeutics, 240 East Grand Ave., South San Francisco, CA, 94080, USA
| | - Barna Dudok
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jordan S Farrell
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA
| | - Tilo Gschwind
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA
| | - Charlotte L Porter
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA
| | - Annahita Keravala
- CODA Biotherapeutics, 240 East Grand Ave., South San Francisco, CA, 94080, USA
| | - G Steven Dodson
- CODA Biotherapeutics, 240 East Grand Ave., South San Francisco, CA, 94080, USA
| | - Ivan Soltesz
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA
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Bogut L, Andersen K, Grejsen J, Gimenez-Rico MJM, Debes NMM. Decreased Cognitive Function in Danish Children with Epilepsy. Neuropediatrics 2023; 54:328-334. [PMID: 37607574 DOI: 10.1055/s-0043-1772191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Children with epilepsy have a significantly increased risk of cognitive impairment. EpiTrack Junior is a screening tool developed for fast assessment of cognitive function in children with epilepsy. The tool is validated for German children. This cohort study aims to investigate the differences in cognitive function between healthy Danish children and Danish children diagnosed with epilepsy METHODS: The cognitive function of 204 healthy controls and 90 children and adolescents diagnosed with epilepsy was examined using EpiTrack Junior. The participants of the control group were aged 6 to 16 years. The patients were aged 6 to 20 years. Statistical analyses were performed with the use of SPSS Statistics. RESULTS The control group showed significantly higher scores than the patient group in three of six subtests and total test scores (p-values ranging from 0.033 to <0.001). When grouped according to the EpiTrack Junior guidelines, more patients showed scores "below average" or "poor" compared to the control group. The age-corrected total score was not associated with antiepileptic drug treatment (p-value of 0.732) nor with a history of focal seizures (p-value of 0.215). A history of generalized tonic-clonic seizures (GTCS) was associated with a higher EpiTrack Junior score (p-value of 0.035). CONCLUSION The patient group showed statistically significant lower test scores compared to the control group confirming the relationship between impaired cognitive function and childhood epilepsy. Furthermore, a correlation between a higher EpiTrack Junior score and the presence of GTCS was found. Focal seizures and antiepileptic drug treatment were not associated with the EpiTrack Junior score.
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Affiliation(s)
- Laura Bogut
- Department of Neuropediatrics, Herlev University Hospital, Herlev, Denmark
| | - Kaja Andersen
- Department of Neuropediatrics, Herlev University Hospital, Herlev, Denmark
| | - Judy Grejsen
- Department of Neuropediatrics, Herlev University Hospital, Herlev, Denmark
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Li Y, Ran Y, Chen Q. Abnormal static and dynamic functional network connectivity of the whole-brain in children with generalized tonic-clonic seizures. Front Neurosci 2023; 17:1236696. [PMID: 37670842 PMCID: PMC10475552 DOI: 10.3389/fnins.2023.1236696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Generalized tonic-clonic seizures (GTCS) are a subtype of generalized seizures exhibiting bursts of bilaterally synchronous generalized spike-wave discharges. Numerous neuroimaging studies have reported aberrant functional activity and topological organization of brain network in epilepsy patients with GTCS, but most studies have focused on adults. However, the effect of GTCS on the spatial and temporal properties of brain function in children remains unclear. The present study aimed to explore whole-brain static (sFC) and dynamic functional connectivity (dFC) in children with GTCS. Methods Twenty-three children with GTCS and 32 matched healthy controls (HCs) were recruited for the present study. Resting-state functional magnetic resonance imaging (MRI) data were collected for each subject. The group independent component analysis method was used to obtain independent components (ICs). Then, sFC and dFC methods were applied and the differences in functional connectivity (FC) were compared between the children with GTCS and the HCs. Additionally, we investigated the correlations between the dFC indicators and epilepsy duration. Results Compared to HCs, GTCS patients exhibited a significant decrease in sFC strengths among most networks. The K-means clustering method was implemented for dFC analysis, and the optimal number of clusters was estimated: two discrete connectivity configurations, State 1 (strong connection) and State 2 (weak connection). The decreased dFC mainly occurred in State 1, especially the dFC between the visual network (VIS) and somatomotor network (SMN); but the increased dFC mainly occurred in State 2 among most networks in GTCS children. In addition, GTCS children showed significantly shorter mean dwell time and lower fractional windows in stronger connected State 1, while GTCS children showed significantly longer mean dwell time in weaker connected State 2. In addition, the dFC properties, including mean dwell time and fractional windows, were significantly correlated with epilepsy duration. Conclusion Our results indicated that GTCS epilepsy not only alters the connectivity strength but also changes the temporal properties of connectivity in networks in the whole brain. These findings also emphasized the differences in sFC and dFC in children with GTCS. Combining sFC and dFC methods may provide more comprehensive understanding of the abnormal changes in brain architecture in children with GTCS.
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Affiliation(s)
- Yongxin Li
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Yun Ran
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Qian Chen
- Department of Pediatric Neurosurgery, Shenzhen Children’s Hospital, Shenzhen, China
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Montagner PSS, Medeiros W, da Silva LCR, Borges CN, Brasil-Neto J, de Deus Silva Barbosa V, Caixeta FV, Malcher-Lopes R. Individually tailored dosage regimen of full-spectrum Cannabis extracts for autistic core and comorbid symptoms: a real-life report of multi-symptomatic benefits. Front Psychiatry 2023; 14:1210155. [PMID: 37671290 PMCID: PMC10475955 DOI: 10.3389/fpsyt.2023.1210155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2023] Open
Abstract
Autism Spectrum Disorders (ASD) may significantly impact the well-being of patients and their families. The therapeutic use of cannabis for ASD has gained interest due to its promising results and low side effects, but a consensus on treatment guidelines is lacking. In this study, we conducted a retrospective analysis of 20 patients with autistic symptoms who were treated with full-spectrum cannabis extracts (FCEs) in a response-based, individually-tailored dosage regimen. The daily dosage and relative proportions of cannabidiol (CBD) and tetrahydrocannabinol (THC) were adjusted based on treatment results following periodic clinical evaluation. Most patients (80%) were treated for a minimum of 6 months. We have used a novel, detailed online patient- or caregiver-reported outcome survey that inquired about core and comorbid symptoms, and quality of life. We also reviewed patients' clinical files, and no individual condition within the autistic spectrum was excluded. This real-life approach enabled us to gain a clearer appraisal of the ample scope of benefits that FCEs can provide for ASD patients and their families. Eighteen patients started with a CBD-rich FCE titrating protocol, and in three of them, the CBD-rich (CBD-dominant) FCE was gradually complemented with low doses of a THC-rich (THC-dominant) FCE based on observed effects. Two other patients have used throughout treatment a blend of two FCEs, one CBD-rich and the other THC-rich. The outcomes were mainly positive for most symptoms, and only one patient from each of the two above-mentioned situations displayed important side effects one who has used only CBD-rich FCE throughout the treatment, and another who has used a blend of CBD-Rich and THC-rich FCEs. Therefore, after FCE treatment, 18 out of 20 patients showed improvement in most core and comorbid symptoms of autism, and in quality of life for patients and their families. For them, side effects were mild and infrequent. Additionally, we show, for the first time, that allotriophagy (Pica) can be treated by FCEs. Other medications were reduced or completely discontinued in most cases. Based on our findings, we propose guidelines for individually tailored dosage regimens that may be adapted to locally available qualified FCEs and guide further clinical trials.
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Affiliation(s)
| | - Wesley Medeiros
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasília, Brazil
| | - Leandro Cruz Ramires da Silva
- Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Brazilian Association of Medical Cannabis Patients, Ama-Me, Belo Horizonte, Brazil
| | - Clarissa Nogueira Borges
- Specialized Educational Care Division for Gifted Students of the Department of Education of the Federal District, Brasília, Brazil
| | | | - Vinícius de Deus Silva Barbosa
- Medical Cannabis Center–Syrian-Lebanese Hospital, São Paulo, Brazil
- National Association for Inclusion of the Autistic People, São Paulo, Brazil
| | - Fabio V. Caixeta
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasília, Brazil
| | - Renato Malcher-Lopes
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasília, Brazil
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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.
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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
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Nazarinia D, Karimpour S, Hashemi P, Dolatshahi M. Neuroprotective effects of Royal Jelly (RJ) against pentylenetetrazole (PTZ)-induced seizures in rats by targeting inflammation and oxidative stress. J Chem Neuroanat 2023; 129:102255. [PMID: 36878412 DOI: 10.1016/j.jchemneu.2023.102255] [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: 01/06/2023] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
Epilepsy is a chronic neurological condition in which inflammation and oxidative stress play a key role in the pathogenesis. Recently, several studies have suggested that Royal Jelly (RJ) has antioxidant effects. Nevertheless, there is no evidence of its effectiveness against epilepsy. Here, we evaluated its neuroprotective effects at different doses (100 and 200 mg/kg) against pentylenetetrazole (PTZ)-induced seizures. Fifty male Wistar rats were randomly divided into five groups: control, PTZ, RJ100 + PTZ, RJ200 + PTZ and RJ100. In order to establish epilepsy model, 45 mg/kg of PTZ was injected intraperitoneally for 10 consecutive days. Seizure parameters were graded based on Racine's 7-point classification. Elevated-plus maze, Y maze and shuttle box tests were carried out to assess anxiety-like behavior, short-term memory, and passive avoidance memory, respectively. We used ELISA technique to measure the expression of the pro-inflammatory cytokines and oxidative stress factors. Also, neuronal loss in the hippocampal CA3 region was determined using Nissl staining. Our findings showed that PTZ-treated rats had more seizure intensity, anxiety-like behavior, memory dysfunction, higher levels of TNF-α, IL-1β, and oxidative markers. RJ could allay seizure severity and duration. It also improved memory function as well as anxiety level. In terms of biochemical assessment, RJ gave rise to a significant decrease in the level of IL-1β, TNF-α and MDA and it restored the activities of GPX and SOD enzymes. Hence, our study shows that RJ contains anti-inflammatory and antioxidative effects which contribute to less neuronal damage in the PTZ-induced epilepsy model.
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Affiliation(s)
- Donya Nazarinia
- Department of Physiology, School of Paramedical Sciences, Dezful University of Medical Sciences, Dezful, Iran.
| | - Sepideh Karimpour
- Department of Physiology, School of Paramedical Sciences, Dezful University of Medical Sciences, Dezful, Iran
| | - Paria Hashemi
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mojtaba Dolatshahi
- Department of Physiology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
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Fox HC, Milivojevic V, Sinha R. Therapeutics for Substance-Using Women: The Need to Elucidate Sex-Specific Targets for Better-Tailored Treatments. Handb Exp Pharmacol 2023; 282:127-161. [PMID: 37592081 DOI: 10.1007/164_2023_687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
In the last decade, alcohol consumption in the US has risen by 84% in women compared with 35% in men. Furthermore, research has shown that sex- and gender-related differences may disadvantage women in terms of developing a range of psychological, cognitive, and medical problems considerably earlier in their drinking history than men, and despite consuming a similar quantity of substances. While this "telescoping" process has been acknowledged in the literature, a concomitant understanding of the underlying biobehavioral mechanisms, and an increase in the development of specific treatments tailored to women, has not occurred. In the current chapter we focus on understanding why the need for personalized, sex-specific medications is imperative, and highlight some of the potential sex-specific gonadal and stress-related adaptations underpinning the accelerated progress from controlled to compulsive drug and alcohol seeking in women. We additionally discuss the efficacy of these mechanisms as novel targets for medications development, using exogenous progesterone and guanfacine as examples. Finally, we assess some of the challenges faced and progress made in terms of developing innovative medications in women. We suggest that agents such as exogenous progesterone and adrenergic medications, such as guanfacine, may provide some efficacy in terms of attenuating stress-induced craving for several substances, as well as improving the ability to emotionally regulate in the face of stress, preferentially in women. However, to fully leverage the potential of these therapeutics in substance-using women, greater focus needs to the placed on reducing barriers to treatment and research by encouraging women into clinical trials.
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Affiliation(s)
- Helen C Fox
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA.
| | - Verica Milivojevic
- The Yale Stress Center, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rajita Sinha
- The Yale Stress Center, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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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.
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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
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Operto FF, Pastorino GMG, Viggiano A, Dell’Isola GB, Dini G, Verrotti A, Coppola G. Epilepsy and Cognitive Impairment in Childhood and Adolescence: A Mini-Review. Curr Neuropharmacol 2023; 21:1646-1665. [PMID: 35794776 PMCID: PMC10514538 DOI: 10.2174/1570159x20666220706102708] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/28/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
Managing epilepsy in people with an intellectual disability remains a therapeutic challenge and must take into account additional issues such as diagnostic difficulties and frequent drug resistance. Advances in genomic technologies improved our understanding of epilepsy and raised the possibility to develop patients-tailored treatments acting on the key molecular mechanisms involved in the development of the disease. In addition to conventional antiseizure medications (ASMs), ketogenic diet, hormone therapy and epilepsy surgery play an important role, especially in cases of drugresistance. This review aims to provide a comprehensive overview of the mainfactors influencing cognition in children and adolescents with epilepsy and the main therapeutic options available for the epilepsies associated with intellectual disability.
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Affiliation(s)
- Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
| | - Andrea Viggiano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Baronissi, SA, Italy
| | | | - Gianluca Dini
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of Perugia, Giorgio Menghini Square, 06129 Perugia, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, SA, Italy
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12
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Auvin S. Paediatric epilepsy and cognition. Dev Med Child Neurol 2022; 64:1444-1452. [PMID: 35801543 DOI: 10.1111/dmcn.15337] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 01/31/2023]
Abstract
Cognitive comorbidities are more frequent in children with epilepsy than in the general population. The cognitive function of children with epilepsy should be appropriately screened, and when there is an impairment, it must be diagnosed and managed. Several factors contribute to the occurrence of this comorbidity. The underlying aetiology and epilepsy syndrome are the major risk factors. Other factors also play a role, such as seizure recurrence, antiseizure medication, and interictal abnormalities. Recent evidence also suggested that cognitive involvement is an ongoing process that interacts with the normal maturation of cognitive function in children with epilepsy. Furthermore, some patients experience rapid cognitive deterioration related to epileptic activity, resulting in epileptic encephalopathy. Further research is needed to better understand how to prevent or modify factors that affect cognitive function in children with epilepsy. WHAT THIS PAPER ADDS: Cognitive comorbidities are more frequent in children with epilepsy than in the general population. The risk factors for cognitive impairment are the underlying aetiology/syndrome, seizure recurrence, antiseizure medication, and interictal abnormalities. Advanced genetic and neuroimaging studies are useful tools to better understand cognitive impairment in children with epilepsy.
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Affiliation(s)
- Stéphane Auvin
- Assistance Publique-Hôpitaux de Paris, Service de Neurologie Pédiatrique, Hôpital Robert Debré, Paris, France.,Université Paris-Cité, Institut National de la Santé et de la Recherche Médicale NeuroDiderot, Paris, France.,Institut Universitaire de France, Paris, France
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13
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Devadasa Acharya S, Ullal SD, Blossom V, Parida A, Noushida N. Levetiracetam exposure during prenatal and postnatal period induces cognitive decline in rat offsprings, not completely prevented by Bacopa monnieri. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2022; 19:897-903. [PMID: 34284529 DOI: 10.1515/jcim-2020-0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Levetiracetam (LEV) is an antiepileptic recommended during pregnancy. Bacopa monneri is a medicinal herb used in Ayurveda for improvement of cognition. Data on effects of LEV and Bacopa on cognition is inadequate. The study evaluated the cognitive effects of LEV on rat offspring of dams exposed to LEV and whether pretreatment with Bacopa monnieri, inhibits the potential cognitive decline by LEV. METHODS Pregnant rats were allocated into four groups of three rats each. Groups 1, 2, 3 and 4 received 2% gum acacia, LEV 270 mg/kg, LEV 270 mg/kg + Bacopa 100 mg/kg and LEV 270 mg/kg + Bacopa 200 mg/kg respectively during pregnancy and lactation. Three pups from all dams were chosen at random and exposed to passive avoidance, Hebb-Williams and Morris water maze tests to check for their cognition and relevant histopathology was done. RESULTS In the passive avoidance model groups 3 and 4, showed an increase in escape latency compared with group 2, demonstrating an improved learning (p=0.05). In Hebb-Williams maze, the time taken to reach reward chamber by group 2 increased compared to group 1, p=0.006, showing cognitive decline. Neuronal count in hippocampus and prefrontal cortex decreased significantly in group 2, which improved in group 3 & 4 however there was distortion of architecture in group 4. CONCLUSIONS LEV exposure in intrauterine and neonatal period induced cognitive decline in rat offsprings and Bacopa 100 mg/kg prevented LEV induced cognitive decline. However safety of exposure to Bacopa during the gestation period has to be evaluated.
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Affiliation(s)
- Sahana Devadasa Acharya
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 575001 Karnataka, India
| | - Sheetal D Ullal
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 575001 Karnataka, India
| | - Vandana Blossom
- Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Amrita Parida
- Department of Pharmacology, Kasturba Medical College, Manipal, Manipal Academy of higher Education, Manipal, Karnataka, India
| | - Nadira Noushida
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, 575001 Karnataka, India
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Clinical Utility of Eye Tracking in Assessing Distractibility in Children with Neurological Disorders or ADHD: A Cross-Sectional Study. Brain Sci 2022; 12:brainsci12101369. [PMID: 36291303 PMCID: PMC9599566 DOI: 10.3390/brainsci12101369] [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: 09/05/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
This study aims to investigate distractibility quantified by recording and analyzing eye movements during task-irrelevant distraction in children with and without ADHD and in children with and without neurological disorders. Gaze behavior data and press latencies of 141 participants aged 6−17 that were collected during a computerized distraction paradigm with task-irrelevant stimuli (IDistrack) were analyzed. Children using attention-regulating medication were excluded from participation. Data were analyzed for subgroups that were formed based on the presence of neurological disorders and the presence of ADHD separately. Participants with ADHD and participants with neurological disorders spent less time fixating on the target stimuli compared to their peers without ADHD (p = 0.025) or their peers without neurological disorders (p < 0.001). Participants with and without ADHD had equal press latencies (p = 0.79). Participants with neurological disorders had a greater press latency compared to their typically developing peers (p < 0.001). Target fixation duration shows a significant association with parent-reported attention problems (r = −0.39, p < 0.001). We conclude that eye tracking during a distraction task reveals potentially valid clinical information that may contribute to the assessment of dysfunctional attentional processes. Further research on the validity and reliability of this paradigm is recommended.
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15
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Li Y, Qin B, Chen Q, Chen J. Altered dynamic functional network connectivity within default mode network of epileptic children with generalized tonic-clonic seizures. Epilepsy Res 2022; 184:106969. [PMID: 35738202 DOI: 10.1016/j.eplepsyres.2022.106969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/13/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Generalized tonic-clonic seizures (GTCS) is a group of epileptic disorders characterized by widespread generalized spike-and-waves discharges along with unresponsiveness and convulsions. Abnormal connectivity in the DMN is the common findings in children with generalized epilepsy. However, the neural mechanisms underlying the altered brain connectivity of DMN in children with GTCS remain unclear. The aim of the current study was to explore the temporal properties of functional connectivity states by dynamic functional connectivity (dFC) within the DMN of GTCS children. METHODS We collected resting-state functional MRI data from 22 GTCS children and 29 age-matched healthy controls. Sliding window approach and k-mean clustering analysis were applied to analyze the dFC and identify transient states of the DMN. Furthermore, the relationship between the dynamic properties and clinical features was assessed. RESULTS The dFC analyses identified two reoccurring states: a more frequent and weak connected state (State 1) and a less frequent and strong connected state (State 2). Relative to the normal control, GTCS children spent more time in State 1 showing weak connections and spent less time in State 2 showing strong connections. Dynamic functional network connectivity strength within the DMN showed both increase and decrease in patient group. In addition, the changes of dynamic metric were found to be correlated with epilepsy duration. SIGNIFICANT Our findings imply abnormal interactions and the state dynamics in DMN of the children with GTCS. These disruptions of temporal dynamic in DMN may provide significance for understanding the neural mechanism underlying the GTCS in children and suggest that dFC method can be considered as a valuable tool in children with epilepsy.
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Affiliation(s)
- Yongxin Li
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China.
| | - Bing Qin
- Epilepsy Center and Department of Neurosurgery, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Qian Chen
- Department of Pediatric Neurosurgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Jiaxu Chen
- Guangzhou Key Laboratory of Formula-Pattern of Traditional Chinese Medicine, Formula-pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China.
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16
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Li Y, Qin B, Chen Q, Chen J. Impaired Functional Homotopy and Topological Properties Within the Default Mode Network of Children With Generalized Tonic-Clonic Seizures: A Resting-State fMRI Study. Front Neurosci 2022; 16:833837. [PMID: 35720710 PMCID: PMC9201640 DOI: 10.3389/fnins.2022.833837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/27/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction The aim of the present study was to examine interhemispheric functional connectivity (FC) and topological organization within the default-mode network (DMN) in children with generalized tonic-clonic seizures (GTCS). Methods Resting-state functional MRI was collected in 24 children with GTCS and 34 age-matched typically developing children (TDC). Between-group differences in interhemispheric FC were examined by an automated voxel-mirrored homotopic connectivity (VMHC) method. The topological properties within the DMN were also analyzed using graph theoretical approaches. Consistent results were detected and the VMHC values were extracted as features in machine learning for subject classification. Results Children with GTCS showed a significant decrease in VMHC in the DMN, including the hippocampal formation (HF), lateral temporal cortex (LTC), and angular and middle frontal gyrus. Although the patients exhibited efficient small-world properties of the DMN similar to the TDC, significant changes in regional topological organization were found in the patients, involving the areas of the bilateral temporal parietal junction, bilateral LTC, left temporal pole, and HF. Within the DMN, disrupted interhemispheric FC was found between the bilateral HF and LTC, which was consistent with the VMHC results. The VMHC values in bilateral HF and LTC were significantly correlated with clinical information in patients. Support vector machine analysis using average VMHC information in the bilateral HF and LTC as features achieved a correct classification rate of 89.34% for the classification. Conclusion These results indicate that decreased homotopic coordination in the DMN can be used as an effective biomarker to reflect seizure effects and to distinguish children with GTCSs from TDC.
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Affiliation(s)
- Yongxin Li
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
- *Correspondence: Yongxin Li,
| | - Bing Qin
- Department of Neurosurgery, Epilepsy Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Qian Chen
- Department of Pediatric Neurosurgery, Shenzhen Children’s Hospital, Shenzhen, China
- Qian Chen,
| | - Jiaxu Chen
- Formula-Pattern Research Center, School of Traditional Chinese Medicine, Jinan University, Guangzhou, China
- Jiaxu Chen,
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17
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Sharma P, Dhiman P, Singh D. Dietary flavonoids-rich Citrus reticulata peel extract interacts with CREB signaling to suppress seizures and linked neurobehavioral impairments in a kindling mouse model. Nutr Neurosci 2022; 26:582-593. [PMID: 35535580 DOI: 10.1080/1028415x.2022.2071807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives: The citrus fruits peel contains a variety of bioactive metabolites that have shown multiple therapeutic effects. However, despite having substantial ethnomedicinal value, citrus peels remained underexplored and regarded as bio-waste. This present study was planned to investigate the effect of a characterized peel extract of Citrus reticulata c.v. (CRE) in pentylenetetrazole (PTZ)-induced kindling and associated cognitive and behavioral impairments in a mouse model.Methods: The kindled animals were treated daily with CRE (100 and 200 mg/kg) and challenged with a sub-effective dose of PTZ every 5th day to record the severity of seizures. In the end, different tests were performed to record behavioral and cognitive performance.Results: CRE-treated kindled animals showed a significant suppression in seizure severity following 20 days of the treatment. In the T-maze test, the extract treatment resulted in a marked increase in the spontaneous alternations, whereas it showed no change in anxiety behavior of kindled animals in the elevated plus-maze test. In both forced swim and tail suspension tests, CRE treatment demonstrated a considerable reduction in immobility time. However, no change in overall locomotion was observed in the open field test among all the groups. An increase in the hippocampal Creb and Bdnf expression and decreased glutamate-to-GABA ratio were observed in the CRE-treated kindled animals.Discussion: The results showed that CRE treatment suppresses epileptic seizures and associated cognitive deficits and depression-like behavior in kindled mice. The gene expression findings supported that the observed protective effects of CRE be due to its interaction with CREB signaling.
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Affiliation(s)
- Pallavi Sharma
- Pharmacology and Toxicology Laboratory, Dietetics and Nutrition Technology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Poonam Dhiman
- Pharmacology and Toxicology Laboratory, Dietetics and Nutrition Technology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Damanpreet Singh
- Pharmacology and Toxicology Laboratory, Dietetics and Nutrition Technology Division, CSIR-Institute of Himalayan Bioresource Technology, Palampur, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
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18
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The Discordance between Network Excitability and Cognitive Performance Following Vigabatrin Treatment during Epileptogenesis. Life (Basel) 2021; 11:life11111213. [PMID: 34833089 PMCID: PMC8618433 DOI: 10.3390/life11111213] [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: 10/05/2021] [Revised: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Vigabatrin (VGB), a potent selective γ-aminobutyric acid transaminase (GABA-T) inhibitor, is an approved non-traditional anti-seizure drug for patients with intractable epilepsy. Nevertheless, its effect on epileptogenesis, and whether this effect is correlated with post-epileptogenic cognitive function remain unclear. Based on lithium-pilocarpine-induced seizure modeling, we evaluated the effect of VGB on epileptogenesis and neuronal damage following status epilepticus in Sprague-Dawley rats. Cognitive evaluations were performed with the aid of inhibitory avoidance testing. We found that VGB could interrupt epileptogenesis by reducing spontaneous recurrent seizures, hippocampal neuronal damage, and chronic mossy fiber sprouting. Nevertheless, VGB did not help with the retention of cognitive performance. Our findings suggest that further research into the role of VGB in epileptogenesis and the treatment of epilepsy in clinical practice is warranted.
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Moon JU, Han JY. Comparative Efficacy of Levetiracetam for Epilepsy in School-Aged Children with Intellectual Disability and Normal Intelligence. Brain Sci 2021; 11:brainsci11111452. [PMID: 34827451 PMCID: PMC8615484 DOI: 10.3390/brainsci11111452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Choosing optimal anti-seizure medication (ASM) is very important in pediatric patients with epilepsy who attend school, especially children with an intellectual disability (ID). Levetiracetam (LEV) has proven to be an effective, safe, generally well-tolerated, broad-spectrum ASM in children. In the context of increasing use of LEV in school-aged children with epilepsy and ID, we evaluate relevant clinical data, including efficacy, safety, and tolerability in children with epilepsy and an intellectual disability (ID) or normal intelligence (NI). We performed a retrospective chart review of children and included 298 pediatric patients with epilepsy who were treated with LEV with NI (147) and ID (151). After 6 months, 96% of NI and 83% of ID subjects had a seizure reduction rate greater than 50% (p = 0.031). The tolerability of LEV was generally good, with 75% retention rates at 2 years in both groups and only minor side effects (under 15%). The retention rates of patients with NI and ID were 76% and 74%, respectively (p = 0.597). Thus, LEV showed considerable efficacy with minimal side effects and high retention rates and is an easily maintained and safe treatment option for pediatric epilepsy with ID. However, better-designed research studies are needed to clearly elucidate the efficacy and safety of LEV in children with epilepsy and ID.
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Affiliation(s)
- Ja Un Moon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Pediatrics, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Ji Yoon Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea
- Correspondence: ; Tel.: +82-42-220-9246
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20
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Gignac F, Solé C, Barrera-Gómez J, Persavento C, Tena È, López-Vicente M, Júlvez J, Sunyer J, Couso D, Basagaña X. Identifying Factors Influencing Attention in Adolescents with a Co-Created Questionnaire: A Citizen Science Approach with Secondary Students in Barcelona, Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8221. [PMID: 34360520 PMCID: PMC8345951 DOI: 10.3390/ijerph18158221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/12/2022]
Abstract
Studies on factors that can influence attention in healthy adolescents are recent and focus on recurrent topics. Students' contribution to public health research often revolves around collecting data but rarely around creating data collection instruments. The ATENC!Ó project reunited secondary students and scientists to create a questionnaire including factors that students thought could affect their attention. We conducted a cross-sectional study to assess whether the factors included in this questionnaire had an effect on attention in adolescents. A total of 1667 students (13-16 years old) from 28 schools in Barcelona performed a validated attention test and answered the questionnaire. The response speed consistency (attentiveness), expressed as hit reaction time standard error (HRT-SE, in ms), was used as the primary outcome. Analyses were conducted using conditional linear regression with school as strata, adjusted for sociodemographic characteristics and further stratified by gender and maternal social class. Some factors showed a negative influence on attention, including taking medication and not reading regularly. We found a significant 14.3% (95% confidence interval: 3.4%, 25.3%) higher median of HRT-SE (increase inattentiveness) among students who reported not having a good relationship with classmates. Students' input into research is relevant for advancing the knowledge production in public health.
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Affiliation(s)
- Florence Gignac
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain; (F.G.); (J.B.-G.); (C.P.); (J.S.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- CIBER Epidemiología y Salud Pública, 28009 Madrid, Spain
| | - Caterina Solé
- Departament de Didactica de les Ciencies, Facultat d’Educacio, Edifici G5, Campus de la UAB, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (C.S.); (È.T.); (D.C.)
| | - Jose Barrera-Gómez
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain; (F.G.); (J.B.-G.); (C.P.); (J.S.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- CIBER Epidemiología y Salud Pública, 28009 Madrid, Spain
| | - Cecilia Persavento
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain; (F.G.); (J.B.-G.); (C.P.); (J.S.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- CIBER Epidemiología y Salud Pública, 28009 Madrid, Spain
| | - Èlia Tena
- Departament de Didactica de les Ciencies, Facultat d’Educacio, Edifici G5, Campus de la UAB, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (C.S.); (È.T.); (D.C.)
| | - Mónica López-Vicente
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands;
| | - Jordi Júlvez
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain;
| | - Jordi Sunyer
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain; (F.G.); (J.B.-G.); (C.P.); (J.S.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- CIBER Epidemiología y Salud Pública, 28009 Madrid, Spain
| | - Digna Couso
- Departament de Didactica de les Ciencies, Facultat d’Educacio, Edifici G5, Campus de la UAB, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (C.S.); (È.T.); (D.C.)
| | - Xavier Basagaña
- Barcelona Institute for Global Health (ISGlobal), Barcelona Biomedical Research Park (PRBB), 08003 Barcelona, Spain; (F.G.); (J.B.-G.); (C.P.); (J.S.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- CIBER Epidemiología y Salud Pública, 28009 Madrid, Spain
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21
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Pan L, Guo D, Wang J, Hao Y, Zhang L, Qin X, Song Y. Alterations in neural oscillations related to working memory deficit in temporal lobe epilepsy. Epilepsy Behav 2021; 121:108063. [PMID: 34052633 DOI: 10.1016/j.yebeh.2021.108063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/21/2021] [Accepted: 05/10/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Working memory (WM) is critical for higher level cognition, but the underlying neural mechanisms are not fully understood. Impaired WM affects routine daily activities and is observed in patients with temporal lobe epilepsy (TLE). This study investigated neural oscillations associated with different WM phases, to determine the specific neural activity linked with the phases of WM impairment. METHODS Patients with TLE (n = 52) and healthy volunteers (n = 35) completed a WM task, during which 34-channel electroencephalogram signals were recorded. Characteristic neural oscillation patterns during each WM phase were compared between the 2 groups. RESULTS Patients with TLE showed decreased theta power during the encoding phase of WM, which was associated with reduced accuracy in the WM task. Altered theta power in the frontal region of the brain during the encoding phase was associated with a longer reaction time. CONCLUSIONS Alterations in theta oscillation are related to WM impairment in patients with TLE and may serve as an early marker for evaluating WM deficits. SIGNIFICANCE This study provides an early marker for evaluating WM deficits in TLE.
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Affiliation(s)
- Liping Pan
- General Medicine Department, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Neurological Institute, Tianjin 300052, China
| | - Dandan Guo
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jiajing Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China; Second Clinical Medical College of Tianjin Medical University, Tianjin 300211, China
| | - Yuhan Hao
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Lulin Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xiao Qin
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yijun Song
- General Medicine Department, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Neurological Institute, Tianjin 300052, China.
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22
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Bishop KI, Isquith PK, Gioia GA, Gammaitoni AR, Farfel G, Galer BS, Nabbout R, Wirrell EC, Polster T, Sullivan J. Improved everyday executive functioning following profound reduction in seizure frequency with fenfluramine: Analysis from a phase 3 long-term extension study in children/young adults with Dravet syndrome. Epilepsy Behav 2021; 121:108024. [PMID: 34023810 DOI: 10.1016/j.yebeh.2021.108024] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Individuals with Dravet syndrome (DS) experience frequent pharmacoresistant seizures beginning in infancy. Most exhibit poor neurodevelopmental outcomes including motor function difficulties, behavior problems, and cognitive impairment. Cognitive deficits in children with DS have been associated with seizure frequency and antiseizure medication (ASM) use. Recent research in children and young adults with DS has begun to examine the role of executive functions (EFs), as these include higher-order cognitive functions and may mediate the relationship between risk factors and cognitive impairment. Current conceptualizations, however, of EFs involve the broader self-regulation of cognitive, behavioral, and emotional domains. We explored relationships between reduction in convulsive seizure frequency and everyday EFs in a subset of children and young adults with DS treated with adjunctive fenfluramine for 1 year. METHODS This is a post-hoc analysis of data from children and young adults with Dravet syndrome aged 5-18 years who participated in a phase 3 randomized, placebo-controlled clinical trial (core study) followed by completion of at least 1 year of fenfluramine treatment in an open-label extension (OLE) study. Eligible children and young adults started the OLE study at 0.2 mg/kg/day fenfluramine and were titrated to optimal seizure control and tolerability (maximum daily dose: 26 mg/day). Parents/caregivers documented convulsive seizure frequency per 28 days (i.e., monthly convulsive seizure frequency [MCSF]) by electronic diary. A parent/caregiver for each child also completed the Behavior Rating Inventory of Executive Function (BRIEF®) parent form, a questionnaire capturing parents'/caregivers' perceptions of everyday EF that was included as a safety measure to assess treatment-related adverse effects on EF during the trial. Ratings on BRIEF® were mapped to the current edition, the BRIEF®2 parent form, and were used to calculate T-scores for the Behavior Regulation Index (BRI), Emotion Regulation Index (ERI), Cognitive Regulation Index (CRI), and Global Executive Composite (GEC). Change in BRIEF®2 T-scores from baseline in the core study to Year 1 of the OLE study was calculated. Spearman's rho correlation coefficients assessed associations between change in BRIEF®2 indexes/composite T-scores and percentage change in MCSF. Children and young adults were divided into 2 groups based on percentage of MCSF reduction achieved from pre-randomization baseline in the core study to Year 1 of the OLE study: <50% and ≥50% MCSF reduction. Changes in the distribution of BRIEF®2 indexes/composite T-scores were compared between MCSF reduction groups using Mann-Whitney U tests. The proportions of children and young adults in these groups who showed clinically meaningful improvement in everyday EF, defined as Reliable Change Index (RCI) values ≥95% certainty relative to a reference population of neurotypically developing healthy volunteers, were then assessed by cross-tabulations and Somers' D tests (p ≤ 0.05). When there was a significant meaningful improvement in an index score, post-hoc analyses using the same statistical methods were conducted to evaluate the individual BRIEF®2 scales composing that index. Supplemental analyses examined the proportions of patients in MCSF reduction groups <25% and ≥75% who achieved clinically meaningful improvement or worsening in everyday EF using RCI values ≥95% certainty and ≥80% certainty, respectively, relative to the reference population. RESULTS At the time of analysis, 58 children and young adults (mean age: 11 ± 4 years) had reached OLE Year 1 of fenfluramine treatment with a 75% median percentage reduction in seizure frequency from pre-randomization baseline. Overall, there was a significant correlation between change in MCSF and change in BRIEF®2 T-scores for ERI (p = 0.008), but not for BRI, CRI, or GEC (p > 0.05). At OLE Year 1, 78% (n = 45) of total children/young adults had ≥50% MCSF reduction (50% [n = 29] achieved ≥75% MCSF reduction) and 22% (n = 13) of total children/young adults had <50% MCSF reduction (12% [n = 7] showed <25% MCSF reduction). The ≥50% MCSF reduction group was significantly more likely to achieve clinically meaningful improvement (RCI ≥ 95% certainty) in ERI (p = 0.002) and in CRI (p = 0.001) than the <50% MCSF reduction group. There were no significant differences in the proportions of children and young adults in the 2 MCSF reduction groups showing clinically meaningful worsening (RCI ≥ 80% certainty) on the BRIEF®2 indexes/composite. SIGNIFICANCE In children and young adults with DS, the magnitude of reduction in MCSF after long-term treatment with adjunctive fenfluramine was associated with clinically meaningful levels of improvement in everyday EF. Seventy-eight percent (78%) of children and young adults treated with adjunctive fenfluramine for 1 year in the OLE study achieved ≥50% reduction in MCSF, for a magnitude of efficacy associated with a significantly greater likelihood of experiencing clinically meaningful improvement in emotion regulation and cognitive regulation.
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Affiliation(s)
- Kim I Bishop
- Global Pharma Consultancy, LLC, PO Box 38, Muncy, PA 17756, USA
| | - Peter K Isquith
- Global Pharma Consultancy, LLC, PO Box 38, Muncy, PA 17756, USA; Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerard A Gioia
- Global Pharma Consultancy, LLC, PO Box 38, Muncy, PA 17756, USA; Children's National Health System, 111 Michigan Avenue, NW, Washington, DC 20010, USA; Departments of Pediatrics and Psychiatry, George Washington University School of Medicine, Washington, DC, USA
| | | | - Gail Farfel
- Zogenix, Inc., 5959 Horton Street, Suite 500, Emeryville, CA 94608, USA
| | - Bradley S Galer
- Zogenix, Inc., 5959 Horton Street, Suite 500, Emeryville, CA 94608, USA
| | - Rima Nabbout
- Hôpital Universitaire Necker - Enfants Malades, Inserm U1163, Institut Imagine, Université de Paris, 149 rue de Sèvres, 75743 Paris, France
| | - Elaine C Wirrell
- Mayo Clinic, Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, 200 1st Street SW, Rochester, MN 55905, USA
| | - Tilman Polster
- Department of Epileptology, Mara Hospital, Bethel Epilepsy Centre, Medical School OWL, Bielefeld University, Maraweg 21, 33617 Bielefeld, Germany
| | - Joseph Sullivan
- University of California San Francisco, Benioff Children's Hospital, 1975 4th Street, San Francisco, CA 94158, USA
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Vera J, Lippmann K. Post-stroke epileptogenesis is associated with altered intrinsic properties of hippocampal pyramidal neurons leading to increased theta resonance. Neurobiol Dis 2021; 156:105425. [PMID: 34119635 DOI: 10.1016/j.nbd.2021.105425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 01/23/2023] Open
Abstract
Brain insults like stroke, trauma or infections often lead to blood-brain barrier-dysfunction (BBBd) frequently resulting into epileptogenesis. Affected patients suffer from seizures and cognitive comorbidities that are potentially linked to altered network oscillations. It has been shown that a hippocampal BBBd in rats leads to in vivo seizures and increased power at theta (3-8 Hz), an important type of network oscillations. However, the underlying cellular mechanisms remain poorly understood. At membrane potentials close to the threshold for action potentials (APs) a subpopulation of CA1 pyramidal cells (PCs) displays intrinsic resonant properties due to an interplay of the muscarine-sensitive K+-current (IM) and the persistent Na+-current (INaP). Such resonant neurons are more excitable and generate more APs when stimulated at theta frequencies, being strong candidates for contributing to hippocampal theta oscillations during epileptogenesis. We tested this hypothesis by characterizing changes in intrinsic properties of hippocampal PCs one week after post-stroke epileptogenesis, a model associated with BBBd, using slice electrophysiology and computer modeling. We find a higher proportion of resonant neurons in BBBd compared to sham animals (47 vs. 29%), accompanied by an increase in their excitability. In contrast, BBBd non-resonant neurons showed a reduced excitability, presented with lower impedance and more positive AP threshold. We identify an increase in IM combined with either a reduction in INaP or an increase in ILeak as possible mechanisms underlying the observed changes. Our results support the hypothesis that a higher proportion of more excitable resonant neurons in the hippocampus contributes to increased theta oscillations and an increased likelihood of seizures in a model of post-stroke epileptogenesis.
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Affiliation(s)
- Jorge Vera
- Grass Laboratory, Marine Biological Laboratory, Woods Hole, MA 02543, USA; Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Kristina Lippmann
- Grass Laboratory, Marine Biological Laboratory, Woods Hole, MA 02543, USA; Carl-Ludwig-Institute for Physiology, Medical Faculty, University of Leipzig, D-04103 Leipzig, Germany.
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Evaluation of lorcaserin as an anticonvulsant in juvenile Fmr1 knockout mice. Epilepsy Res 2021; 175:106677. [PMID: 34130255 DOI: 10.1016/j.eplepsyres.2021.106677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/13/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023]
Abstract
Recent preclinical and clinical studies suggest that lorcaserin, a preferential serotonin 2C receptor (5-HT2CR) agonist that was approved for the treatment of obesity, possesses antiepileptic properties. Here, we tested whether lorcaserin (1, 3, 5.6, 10 mg/kg) is prophylactic against audiogenic seizures (AGSs) in juvenile Fmr1 knockout mice, a mouse model of fragile X syndrome (FXS). MPEP (30 mg/kg), a non-competitive mGluR5 receptor antagonist, was used as a positive control. As lorcaserin likely engages 5-HT2ARs at therapeutic doses, we pretreated one group of mice with the selective 5-HT2AR antagonist/inverse agonist, M100907 (0.03 mg/kg), alone or before administering lorcaserin (5.6 mg/kg), to discern putative contributions of 5-HT2ARs to AGSs. We also assessed lorcaserin's in vitro pharmacology at human (h) and mouse (m) 5-HT2CRs and 5-HT2ARs and its in vivo interactions at m5-HT2CRs and m5-HT2ARs. MPEP significantly decreased AGS prevalence (P = 0.011) and lethality (P = 0.038). Lorcaserin, 3 mg/kg, attenuated AGS prevalence and lethality by 14 % and 32 %, respectively, however, results were not statistically significant (P = 0.5 and P = 0.06); other doses and M100907 alone or with lorcaserin also did not significantly affect AGSs. Lorcaserin exhibited full efficacy agonist activity at h5-HT2CRs and m5-HT2CRs, and near full efficacy agonist activity at h5-HT2ARs and m5-HT2ARs; selectivity for activation of 5-HT2CRs over 5-HT2ARs was greater for human (38-fold) compared to mouse (13-fold) receptors. Lorcaserin displayed relatively low affinities at antagonist-labeled 5-HT2CRs and 5-HT2ARs, regardless of species. Lorcaserin (3 and 5.6 mg/kg) increased the 5-HT2AR-dependent head-twitch response (HTR) elicited by (±)-2,5-dimethoxy-4-iodoamphetamine (DOI) in mice (P = 0.03 and P = 0.02). At 3 mg/kg, lorcaserin alone did not elicit an HTR. If mice were treated with the selective 5-HT2CR antagonist SB 242084 (0.5 or 1 mg/kg) plus lorcaserin (3 mg/kg), a significantly increased HTR was observed, relative to vehicle (P = 0.01 and P = 0.03), however, the HTR was much lower than what was elicited by DOI or DOI plus lorcaserin. Lorcaserin, 3 mg/kg, significantly reduced locomotor activity on its own, an effect reversed by SB 242084, and lorcaserin also dose-dependently reduced locomotor activity when administered prior to DOI (Ps<0.002). These data suggest that lorcaserin may engage 5-HT2CRs as well as 5-HT2ARs in mice at doses as low as 3 mg/kg. The similar activity at m5-HT2CRs and m5-HT2ARs suggests careful dosing of lorcaserin is necessary to selectively engage 5-HT2CRs in vivo. In conclusion, lorcaserin was ineffective at preventing AGSs in Fmr1 knockout mice. Lorcaserin may not be a suitable pharmacotherapy for seizures in FXS.
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Protective effects of lamotrigine and vitamin B12 on pentylenetetrazole-induced epileptogenesis in rats. Epilepsy Behav 2021; 118:107915. [PMID: 33743341 DOI: 10.1016/j.yebeh.2021.107915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 12/26/2022]
Abstract
Epileptogenesis is a process that includes molecular and cellular events that foster the establishment of hyperexcitable neuronal networks in the brain. Pentylenetetrazole (PTZ)-induced kindling model in rodents has added new information to the knowledge about the pathogenesis of epilepsy and potential targets of novel antiepileptic agents. Evidence from animal and human studies suggests that oxidative and inflammatory events may play important roles in the initiation and maintaining seizure activities. Vitamin B12 has beneficial effects on the nervous system and presents pleiotropic effects with antioxidant and anti-inflammatory aspects. In the present study, we aimed to test the hypothesis that vitamin B12 and their combination with lamotrigine prevents behavioral deficits, hippocampal damage, oxidation, and proinflammatory state during epileptogenesis. Male rats were subjected to PTZ-induced epileptogenesis and pretreated with vitamin B12 (50 µg/kg) or Lamotrigine (LTG) (25 mg/kg) or B12 (50 µg/kg) + LTG (25 mg/kg). Vitamin B12 and its combination with LTG suppressed epileptogenesis and improved the performance of rats in the passive avoidance test. In addition, Vitamin B12 and its combination with LTG decreased levels of total oxidative status (TOS), oxidative stress index (OSI), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and increased total antioxidant status (TAS) levels in the hippocampus and cerebral cortex. Furthermore, it reduced hippocampal neuronal damage. Current findings support the beneficial actions of vitamin B12 due to its antioxidative and anti-inflammatory properties during the course of disease.
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Efficacy of Phytocannabinoids in Epilepsy Treatment: Novel Approaches and Recent Advances. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083993. [PMID: 33920188 PMCID: PMC8070313 DOI: 10.3390/ijerph18083993] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
Epilepsy is a neurological disorder mainly characterised by recurrent seizures that affect the entire population diagnosed with the condition. Currently, there is no cure for the disease and a significant proportion of patients have been deemed to have treatment-resistant epilepsy (TRE). A patient is deemed to have TRE if two or more antiepileptic drugs (AEDs) fail to bring about seizure remission. This inefficacy of traditional AEDs, coupled with their undesirable side effect profile, has led to researchers considering alternative forms of treatment. Phytocannabinoids have long served as therapeutics with delta-9-THC (Δ9-THC) receiving extensive focus to determine its therapeutic potential. This focus on Δ9-THC has been to the detriment of analysing the plethora of other phytocannabinoids found in the cannabis plant. The overall aim of this review is to explore other novel phytocannabinoids and their place in epilepsy treatment. The current review intends to achieve this aim via an exploration of the molecular targets underlying the anticonvulsant capabilities of cannabidiol (CBD), cannabidavarin (CBDV), delta-9-tetrahydrocannabivarin (Δ9-THCV) and cannabigerol (CBG). Further, this review will provide an exploration of current pre-clinical and clinical data as it relates to the aforementioned phytocannabinoids and the treatment of epilepsy symptoms. With specific reference to epilepsy in young adult and adolescent populations, the exploration of CBD, CBDV, Δ9-THCV and CBG in both preclinical and clinical environments can guide future research and aid in the further understanding of the role of phytocannabinoids in epilepsy treatment. Currently, much more research is warranted in this area to be conclusive.
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27
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Pisani F, Spagnoli C, Falsaperla R, Nagarajan L, Ramantani G. Seizures in the neonate: A review of etiologies and outcomes. Seizure 2021; 85:48-56. [PMID: 33418166 DOI: 10.1016/j.seizure.2020.12.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 12/21/2022] Open
Abstract
Neonatal seizures occur in their majority in close temporal relation to an acute brain injury or systemic insult, and are accordingly defined as acute symptomatic or provoked seizures. However less frequently, unprovoked seizures may also present in the neonatal period as secondary to structural brain abnormalities, thus corresponding to structural epilepsies, or to genetic conditions, thus corresponding to genetic epilepsies. Unprovoked neonatal seizures should be thus considered as the clinical manifestation of early onset structural or genetic epilepsies that often have the characteristics of early onset epileptic encephalopathies. In this review, we address the conundrum of neonatal seizures including acute symptomatic, remote symptomatic, provoked, and unprovoked seizures, evolving to post-neonatal epilepsies, and neonatal onset epilepsies. The different clinical scenarios involving neonatal seizures, each with their distinct post-neonatal evolution are presented. The structural and functional impact of neonatal seizures on brain development and the concept of secondary epileptogenesis, with or without a following latent period after the acute seizures, are addressed. Finally, we underline the need for an early differential diagnosis between an acute symptomatic seizure and an unprovoked seizure, since it is associated with fundamental differences in clinical evolution. These are crucial aspects for neonatal management, counselling and prognostication. In view of the above aspects, we provide an outlook on future strategies and potential lines of research in this field.
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Affiliation(s)
- Francesco Pisani
- Child Neuropsychiatry Unit, Medicine and Surgery Department, University of Parma, Italy
| | - Carlotta Spagnoli
- Child Neurology Unit, Department of Pediatrics, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit, University-Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Lakshmi Nagarajan
- Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Australia
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, Switzerland.
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28
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Abstract
There is increasing recognition that epilepsy can be associated with a broad spectrum of comorbidities. While epileptic seizures are an essential element of epilepsy in children, there is a spectrum of neurological, mental health and cognitive disorders that add to the disease burden of childhood epilepsy resulting in a decreased quality of life. The most common comorbid conditions in childhood epilepsy include depression, anxiety, autism spectrum disorders, sleep disorders, attention deficits, cognitive impairment, and migraine. While epilepsy can result in comorbidities, many of the comorbidities of childhood have a bi-directional association, with the comorbid condition increasing risk for epilepsy and epilepsy increasing the risk for the comorbid condition. The bidirectional feature of epilepsy and the comorbidities suggest a common underlying pathological basis for both the seizures and comorbid condition. While recognition of the comorbid conditions of pediatric epilepsies is increasing, there has been a lag in the development of effective therapies partly out of concern that drugs used to treat the comorbid conditions could increase seizure susceptibility. There is now some evidence that most drugs used for comorbid conditions are safe and do not lower seizure threshold. Unfortunately, the evidence showing drugs are effective in treating many of the childhood comorbidities of epilepsy is quite limited. There is a great need for randomized, placebo-controlled drug trials for efficacy and safety in the treatment of comorbidities of childhood epilepsy.
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Affiliation(s)
- Gregory L Holmes
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Stafford Hall, 118C, Burlington, VT, 05405, USA.
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29
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Effects of antiepileptic drugs on electroencephalography (EEG): Insights and applicability. Epilepsy Behav 2020; 110:107161. [PMID: 32512368 DOI: 10.1016/j.yebeh.2020.107161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of the study was to assess the effects of antiepileptic drugs (AEDs) on posterior alpha rhythm and determine whether they produce pathological slow waves in patients with epilepsy. METHODS Outpatient electroencephalographs (EEGs) in alert patients were selected. The three compared groups include 1) patients with an interested AED (monotherapy or combined with other AEDs); 2) patients with AEDs other than the interested AED; and 3) patients who did not take AEDs. Outcomes were frequency of posterior alpha rhythm and presence of generalized continuous (CSWs) and generalized intermittent slow waves (ISWs). Analysis of variance was used to assess which AED was associated with slower posterior alpha rhythm. Chi-square and logistic regression were employed to assess association and odds ratio (OR) with 95% confidence interval (CI) between pathological generalized slow waves and each AED. RESULTS Among 1050 EEG tracings, 638 EEGs met our criteria. Electroencephalographs requested because of cognitive decline and psychiatric symptoms were excluded, leaving 616 EEGs for analysis. Four hundred thirty-seven patients received at least one AED, whereas the remaining 179 patients did not take AED. Conventional AEDs [carbamazepine (CBZ), p = 0.024; phenobarbital (PB), p = 0.013; phenytoin (PHT), p = 0.001] except valproic acid (VPA) were associated with slower alpha frequency. Carbamazepine [adjusted OR: 5.74 (95% CI: 2.07, 15.94)] and PB [adjusted OR: 2.58 (95% CI: 1.15, 5.78)] were significantly associated with generalized ISWs. None were associated with generalized CSWs. CONCLUSIONS Phenytoin, CBZ, and PB are associated with slower posterior alpha frequency. The latter 2 AEDs also produced pathological generalized ISWs. Valproic acid, benzodiazepines, and new-generation AEDs are not associated with either outcome. The presence of generalized ISWs in patients taking CBZ or PB should be cautiously interpreted since there can be drug effects. Association with cognitive side effects of these slow waves should be further studied.
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30
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Fonseca Wald ELA, Debeij-Van Hall MHJA, De Jong E, Aldenkamp AP, Vermeulen RJ, Vles JSH, Klinkenberg S, Hendriksen JGM. Neurocognitive and behavioural profile in Panayiotopoulos syndrome. Dev Med Child Neurol 2020; 62:985-992. [PMID: 32608507 DOI: 10.1111/dmcn.14417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2019] [Indexed: 11/30/2022]
Abstract
AIM To determine neurocognitive performance and behavioural problems in children with Panayiotopoulos syndrome. METHOD All 18 children (10 females, 8 males; mean age 4y 7mo; SD 1y 10mo) diagnosed with Panayiotopoulos syndrome at the Kempenhaeghe Epilepsy Center in the Netherlands between 2010 and 2017 were analysed retrospectively. All underwent a neuropsychological/behavioural assessment, an academic assessment, and a 24-hour electroencephalogram. RESULTS Mean full-scale IQ (93.5; range 76-123; p=0.04) and performance IQ (93.2; range 76-126; p=0.04) were within the normal range, although significantly lower compared to the normative mean. Verbal IQ (96.3; range 76-118) and processing speed (96.1; range 74-114) were not significantly lower. Simple auditory/visual reaction times, visual attention, visual-motor integration, and verbal memory were significantly lower compared to normative values. On average, patients with Panayiotopoulos syndrome were 8 months behind in arithmetic speed and 11 months behind in reading speed for the number of months in school. Behavioural questionnaires revealed significantly higher scores on reported internalizing behavioural problems. INTERPRETATION Children with Panayiotopoulos syndrome demonstrated diffuse cognitive dysfunction in full-scale IQ, performance IQ, visual attention, visual-motor integration, and verbal memory. A high incidence of internalizing behavioural problems was reported. This strongly suggests neuropsychological and behavioural comorbidity in children with Panayiotopoulos syndrome. WHAT THIS PAPER ADDS Children with Panayiotopoulos syndrome are at risk for cognitive deficits in various cognitive domains. Children with Panayiotopoulos syndrome are also prone to internalizing behavioural problems. Mild-to-severe academic underachievement was present in more than half of the children with Panayiotopoulos syndrome.
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Affiliation(s)
- Eric L A Fonseca Wald
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,Kempenhaeghe Epilepsy Center, Heeze, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | | | - Eline De Jong
- Kempenhaeghe Epilepsy Center, Heeze, the Netherlands
| | - Albert P Aldenkamp
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,Kempenhaeghe Epilepsy Center, Heeze, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands
| | - R Jeroen Vermeulen
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Johan S H Vles
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Sylvia Klinkenberg
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Jos G M Hendriksen
- Department of Neurology, Maastricht University Medical Center+, Maastricht, the Netherlands.,Kempenhaeghe Epilepsy Center, Heeze, the Netherlands
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31
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Fukuyama K, Ueda Y, Okada M. Effects of Carbamazepine, Lacosamide and Zonisamide on Gliotransmitter Release Associated with Activated Astroglial Hemichannels. Pharmaceuticals (Basel) 2020; 13:ph13060117. [PMID: 32516974 PMCID: PMC7345221 DOI: 10.3390/ph13060117] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/23/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
Recent studies using the genetic partial epilepsy model have demonstrated that hyperfunction of astroglial hemichannels contributes to pathomechanism of epileptic seizure. Therefore, to explore the novel anticonvulsive mechanisms, the present study determined the effects of voltage-dependent Na+ channel (VDSC)-inhibiting anticonvulsants, carbamazepine (CBZ), lacosamide (LCM), and zonisamide (ZNS) on the astroglial release of l-glutamate and adenosine triphosphate (ATP). The effects of subchronic administration of therapeutic-relevant dose of three anticonvulsants on the release of l-glutamate and ATP in the orbitofrontal cortex (OFC) were determined using microdialysis. The concentration-dependent effects of acute and subchronic administrations of anticonvulsants on astroglial gliotransmitter release were determined using primary cultured astrocytes. The concentration-dependent effects of subchronic administrations of anticonvulsants on connexin43 (Cx43) expression in the plasma membrane of primary cultured astrocytes were determined using the Simple Western system. An increase in the levels of extracellular K+ resulted in a concentration-dependent increase in the astroglial release of l-glutamate and ATP. The depleted levels of extracellular Ca2+ alone did not affect astroglial gliotransmitter release but did accelerate K+-evoked gliotransmitter release via activation of astroglial hemichannels. Both non-selective hemichannel inhibitor carbenoxolone (CBX) and selective Cx43 inhibitor GAP19 prevented both gliotransmitter release through activated astroglial hemichannels and the hemichannel-activating process induced by elevation of the levels of extracellular K+ with depletion of the levels of extracellular Ca2+. ZNS subchronically decreased Cx43 expression and acutely/subchronically inhibited Cx43 hemichannel activity. LCM acutely inhibited hemichannel activity but did not subchronically affect Cx43 expression. Therapeutic-relevant concentration of CBZ did not affect hemichannel activity or Cx43 expression, but supratherapeutic concentration of CBZ decreased Cx43 expression and hemichannel activity. Therefore, the present study demonstrated the distinct effects of CBZ, LCM, and ZNS on gliotransmitter release via modulation of astroglial hemichannel function. The different features of the effects of three VDSC-inhibiting anticonvulsants on astroglial transmission associated with hemichannels, at least partially, possibly contributing to the formation of the properties of these three anticonvulsants, including the antiepileptic spectrum and adverse effects regarding mood and cognitive disturbance.
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Kim H, Yoo S, Jeon Y, Yi S, Kim S, Choi SA, Hwang H, Kim KJ. Characterization of Anti-seizure Medication Treatment Pathways in Pediatric Epilepsy Using the Electronic Health Record-Based Common Data Model. Front Neurol 2020; 11:409. [PMID: 32477256 PMCID: PMC7235379 DOI: 10.3389/fneur.2020.00409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/20/2020] [Indexed: 12/21/2022] Open
Abstract
The purpose of this pilot study was to analyze treatment pathways of pediatric epilepsy using the common data model (CDM) based on electronic health record (EHR) data. We also aimed to reveal whether CDM analysis was feasible and applicable to epilepsy research. We analyzed the treatment pathways of pediatric epilepsy patients from our institute who underwent antiseizure medication (ASM) treatment for at least 2 years, using the Observational Medical Outcomes Partnership (OMOP)-CDM. Subgroup analysis was performed for generalized or focal epilepsy, varying age of epilepsy onset, and specific epilepsy syndromes. Changes in annual prescription patterns were also analyzed to reveal the different trends. We also calculated the proportion of drug-resistant epilepsy by applying the definition of seizure persistence after application of two ASMs for a sufficient period of time (more than 6 months). We identified 1,192 patients who underwent treatment for more than 2 years (mean ± standard deviation: 6.5 ± 3.2 years). In our pediatric epilepsy cohort, we identified 313 different treatment pathways. Drug resistance, calculated as the application of more than three ASMs during the first 2 years of treatment, was 23.8%. Treatment pathways and ASM resistance differed between subgroups of generalized vs. focal epilepsy, different onset age of epilepsy, and specific epilepsy syndromes. The frequency of ASM prescription was similar between onset groups of different ages; however, phenobarbital was frequently used in children with epilepsy onset < 4 years. Ninety-one of 344 cases of generalized epilepsy and 187 of 835 cases of focal epilepsy were classified as medically intractable epilepsy. The percentage of drug resistance was markedly different depending on the specific electro-clinical epilepsy syndrome [79.0% for Lennox-Gastaut syndrome (LGS), 7.1% for childhood absence epilepsy (CAE), and 9.0% for benign epilepsy with centrotemporal spikes (BECTS)]. We could visualize the annual trend and changes of ASM prescription for pediatric epilepsy in our institute from 2004 to 2017. We revealed that CDM analysis was feasible and applicable for epilepsy research. The strengths and limitations of CDM analysis should be carefully considered when planning the analysis, result extraction, and interpretation of results.
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Affiliation(s)
- Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yonghoon Jeon
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Soyoung Yi
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seok Kim
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sun Ah Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Pediatrics, Ewha Woman's University Medical Center, Seoul, South Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ki Joong Kim
- Department of Pediatric, Seoul National University Children's Hospital, Seoul, South Korea
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Abstract
This article reviews common and clinically important neuropsychiatric aspects of epilepsy. Comorbidities are common, underdiagnosed, and powerfully impact clinical outcomes. Biological, psychological, and social factors contribute to the associations between epilepsy and neuropsychiatric disorders. Epidemiologic studies point to a bidirectional relationships between epilepsy and neuropsychiatric disorders. People with epilepsy are more likely to develop certain neuropsychiatric disorders, and those with these disorders are more likely to develop epilepsy. This relationship suggests the possibility of shared underlying pathophysiologies. We review the neuropsychiatric impact of antiseizure medications and therapeutic options for treatment. Diagnosis and treatment involve close collaboration among a multidisciplinary team.
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Affiliation(s)
- Benjamin Tolchin
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA; Epilepsy Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA
| | - William Curt LaFrance
- Brown University, Rhode Island Hospital, Potter 3, 593 Eddy Street, Providence, RI 02903, USA
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Conde-Guzón PA, Soria-Martín C, Cancho-Candela R, Quirós-Expósito P, Conde-Bartolomé P, Bulteau C. Parental report of quality of life in children with epilepsy: A Spanish/French comparison. Epilepsy Behav 2020; 105:106968. [PMID: 32092458 DOI: 10.1016/j.yebeh.2020.106968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Epilepsy is a chronic neurological condition that affects the quality of life (QoL) of patients and their families. In this study, we compare two sets of reports on QoL that were completed by two samples of parents whose children have epilepsy. METHOD Parents of children with various types of epilepsy from Spain (N = 196) and France (N = 219) completed the same QoL questionnaire. Medical variables were recorded from the referred specialist doctor for each patient. RESULTS The factors associated with parental reports on QoL were similar in both countries. Parents of children with nonidiopathic generalized or unclassified epilepsy reported poorer QoL and the highest proportion of learning and behavioral problems. However, the intensity of difficulties varied between the two samples. CONCLUSIONS This questionnaire made it possible to detect comorbidities and daily life difficulties in children with epilepsy and their families. The type of epilepsy had the same influence on Spanish and French families' ratings of QoL. Families shared the same comorbidities in terms of hyperactivity/attention/sociability problems. Nevertheless, the intensity of reported difficulties varied in both countries, possibly because of differences in cultural and educational environments. This aspect should be further explored in future research.
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Affiliation(s)
- Pablo-A Conde-Guzón
- Department of Psychology, University of León, Spain, Campus de Vegazana, 24071 León, Spain.
| | - Carmen Soria-Martín
- Clinica PCH: Neurological and Neuropsychological Rehabilitation, Madrid, Spain; University Cardenal Cisneros, Faculty of Psychology, Avda. Jesuitas, 34, 28806 Alcalá de Henares, Spain
| | - Ramón Cancho-Candela
- Pediatric Neurology Unit, Pediatrics Department, Hospital Universitario Rio Hortega, C/ Dulzaina, 2, 47012 Valladolid, Spain.
| | - Pilar Quirós-Expósito
- Faculty of Psychology, Department of Basic Psychology, UNED, C/ Juan del Rosal, 10, 24040 Madrid, Spain.
| | - Pablo Conde-Bartolomé
- Faculty of Medicine, University of Salamanca, CM. San Bartolomé, C/Henry Collet, 37, 37007 Salamanca, Spain
| | - Christine Bulteau
- Rothschild Foundation Hospital, Pediatric Neurosurgery Department, 27, Rue Manin, 75019 Paris, France; Memory, Brain and Cognition (MC2Lab, EA 7536), Paris Descartes University, Paris, France.
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Le Daré B, Triquet L, Degremont A, Charbonnel H, Default A, Osmont MN, Picard S, Gentilhomme G, Bellissant E, Scailteux LM, Polard E. [Pitch perception modification due to antiepileptics: A literature and pharmacovigilance databases review]. Therapie 2020; 75:599-604. [PMID: 32204934 DOI: 10.1016/j.therap.2020.02.017] [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: 08/05/2019] [Revised: 12/09/2019] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
Pitch perception modifications are among the little-known adverse effects observed with antiepileptics, mainly affecting patients treated with carbamazepine (CBZ). Here, we describe an original French case of pitch perception modification due to CBZ resulting in perfect pitch loss. We also reviewed the literature as well as French and world health organisation global pharmacovigilance database. The case report concerns a 22-year-old patient with perfect pitch with untreated left temporal partial epilepsy. Following a generalized seizure, the introduction of CBZ prolonged release (200mg twice a day) is decided. As soon as CBZ is introduced, the patient notices a change in pitch perception, about a semitone lower. This adverse effect persisted despite a gradual decrease in doses. The patient reported a total recovery of his perfect pitch when CBZ stopped completely 11 years later. In the French pharmacovigilance database, only one other case of pitch perception modification under CBZ was recorded (no cases were found with oxcarbazepine, lacosamide, sodium valproate, lamotrigine, levetiracetam, phenobarbital, phenytoin, primidone, ethosuximide, vigabatrine, felbamate, gabapentin, tiagabine and topiramate). In the literature, 27 cases of pitch perception modification have been published with CBZ, 1 case with oxcarbazepine and 1 case with lacosamide. Pitch perception modification is a very rare adverse effect of CBZ, oxcarbazepine and lacosamide, identified in the literature mainly in the Japanese population, in experienced musicians. A rapid onset after the introduction of treatment, a complete resolution of symptoms, in most cases upon discontinuation of treatment, is observed, with no sequelae reported. Due to the impact on quality of life, especially in patients whose profession is related to music, knowledge of this adverse event seems important to evoke this diagnosis.
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Affiliation(s)
- Brendan Le Daré
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, hôpital universitaire de Rennes, CHU de Rennes, 2, rue Henri-Le Guilloux, 35000 Rennes, France.
| | - Louise Triquet
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, hôpital universitaire de Rennes, CHU de Rennes, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - Adeline Degremont
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, hôpital universitaire de Rennes, CHU de Rennes, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | | | - Anne Default
- Centre régional de pharmacovigilance Marseille-Provence-Corse, hôpital Sainte-Marguerite, Assistance publique-Hôpitaux de Marseille, 130005 Marseille, France
| | - Marie-Noëlle Osmont
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, hôpital universitaire de Rennes, CHU de Rennes, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - Sylvie Picard
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, hôpital universitaire de Rennes, CHU de Rennes, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - Guillaume Gentilhomme
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, hôpital universitaire de Rennes, CHU de Rennes, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - Eric Bellissant
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, hôpital universitaire de Rennes, CHU de Rennes, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - Lucie-Marie Scailteux
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, hôpital universitaire de Rennes, CHU de Rennes, 2, rue Henri-Le Guilloux, 35000 Rennes, France
| | - Elisabeth Polard
- Centre régional de pharmacovigilance, pharmacoépidémiologie et information sur le médicament, hôpital universitaire de Rennes, CHU de Rennes, 2, rue Henri-Le Guilloux, 35000 Rennes, France
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Lee SH, Kim SJ. Effects of Lamotrigine on Problem-Solving Abilities in Newly Diagnosed Pediatric Patients with Epilepsy. J Clin Neurol 2020; 16:46-52. [PMID: 31942757 PMCID: PMC6974838 DOI: 10.3988/jcn.2020.16.1.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose This study aimed to determine the effects of lamotrigine (LTG) on language unction, including problem-solving abilities, in newly diagnosed pediatric epileptic patients. Methods This study included 112 newly diagnosed epileptic patients treated with LTG [69 males and 43 females aged 9.6±2.7 years (mean±SD)]. Repeated neurologic examinations, electroencephalography, neuroimaging studies, and standard language tests including the Test of Problem Solving (TOPS), mean length of utterance in words (MLU-w), Receptive and Expressive Vocabulary Test (REVT), and Urimal Test of Articulation and Phonology were performed before and after initiating LTG treatment. The starting LTG dosage was 1 mg/kg/day (maximum: 25 mg/day) for the first 14 days, which was increased to 2 mg/kg/day for the subsequent 14 days and then up to 7 mg/kg/day (or 200 mg/day) for maintenance. Results Problem-solving skills as assessed by TOPS scores significantly improved after initiating LTG treatment (33.5±14.5 vs. 35.7±14.25, p<0.01). Scores in the “determining causes” category (11.9±4.7 vs. 12.9±4.8, p<0.01), “making inferences” category (12.9±6.2 vs. 13.6±6.0, p<0.05), and “predicting” category (8.9±5.4 vs. 9.7±5.6, p<0.01) significantly improved after LTG treatment. The MLU-w score did not decrease after LTG treatment (4.7±1.9 vs. 5.0±2.1). There was a significant improvement in receptive language function as assessed using the REVT score (9.4±3.4 years vs. 9.9±3.3 years, p<0.01). Precise articulation also improved after initiating LTG treatment (97.8% vs. 98.5%). Conclusions Language function including problem-solving skills improved after LTG treatment, suggesting that LTG can be administered without causing significant negative effects on language function in pediatric patients.
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Affiliation(s)
- Soo Hyun Lee
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Sun Jun Kim
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.
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37
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Operto FF, Pastorino GMG, Mazza R, Carotenuto M, Roccella M, Marotta R, di Bonaventura C, Verrotti A. Effects on executive functions of antiepileptic monotherapy in pediatric age. Epilepsy Behav 2020; 102:106648. [PMID: 31715510 DOI: 10.1016/j.yebeh.2019.106648] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Cognitive abilities and executive functions in children and adolescents are important indicators of quality of life as well as academic and social achievements. Cognitive and executive functioning are often impaired in patients with epilepsy and can be exacerbated by seizures and antiseizure drugs. The aim of our observational retrospective study was to assess executive functioning in patients with pediatric epilepsy, currently taking a single antiseizure medication. MATERIALS AND METHODS Records of 172 children and adolescents aged between 6 and 18 years (mean age = 12 ± 3.4 years) with newly diagnosed epilepsy who had not yet commenced an antiepileptic treatment were included in the study. Longitudinal changes in executive functioning were assessed using the EpiTrack Junior test at baseline, before the introduction of antiepileptic monotherapy, and at 3-month, 6-month, and 9-month follow-up visits. All patients commenced a single antiepileptic treatment (levetiracetam n = 54; valproic acid n = 52; ethosuximide n = 20; oxcarbazepine n = 22; carbamazepine n = 24). Age, sex, seizure types, and seizure baseline frequency were also recorded. RESULTS Relative to baseline, Epitrack Junior mean scores deteriorated at the 9-month follow-up visit for patients taking valproic acid, ethosuximide, and carbamazepine, but this was only statistically significant for patients taking carbamazepine. In contrast, mean scores improved for subjects taking levetiracetam and oxcarbazepine at the 9-month follow-up visit relative to baseline, but this was only statistically significant for patients taking levetiracetam. CONCLUSIONS Levetiracetam was the only antiseizure medication that led to slight improvements in executive functioning; whereas carbamazepine led to deteriorations in cognitive functioning. Further research using double-blinded, placebo-controlled trials are needed to confirm these results.
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Affiliation(s)
- Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
| | - Grazia Maria Giovanna Pastorino
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy; Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Università degli Studi della Campania L. Vanvitelli, Napoli, Italy
| | - Roberta Mazza
- Child and Adolescent Neuropsychiatry, Department of Basic Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Università degli Studi della Campania L. Vanvitelli, Napoli, Italy
| | - Michele Roccella
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Palermo, Italy
| | - Rosa Marotta
- Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Carlo di Bonaventura
- Epilepsy Unit, Department of Neurosciences/Mental Health, "Sapienza" University, Rome, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
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Micronized resveratrol shows promising effects in a seizure model in zebrafish and signalizes an important advance in epilepsy treatment. Epilepsy Res 2019; 159:106243. [PMID: 31786493 DOI: 10.1016/j.eplepsyres.2019.106243] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/25/2019] [Accepted: 11/22/2019] [Indexed: 01/05/2023]
Abstract
Resveratrol is a natural non-flavonoid polyphenolic that has been emerging in epilepsy treatment. Despite its pharmacological properties, the poor bioavailability of resveratrol has been an important barrier that hinders its application as an anticonvulsant. The aim of this work was to improve resveratrol's anticonvulsant effects by micronizing this compound through supercritical fluid micronization technology, which promotes an increase of the particles' surface area and allows significantly reduced particle size to be obtained. We obtained commercial and micronized resveratrol and investigated the anticonvulsant effects of resveratrol as commercially found and micronized resveratrol in a pentylenetetrazole-induced seizure model in zebrafish (Danio rerio) larvae. Diazepam was used as the positive control. Also, animals had their locomotor and exploratory activity analyzed 24 h after the seizure occurrence. The occurrence of the tonic-clonic seizure stage was only prevented by diazepam and micronized resveratrol, unlike the non-processed compound. The seizure development was significantly slowed by diazepam and micronized resveratrol, while non-micronized resveratrol was not able to increase the latency of seizure stages. In addition, diazepam and micronized resveratrol prevented the deleterious effects of pentylenetetrazole-induced seizures on animals' locomotor and exploratory behaviour. Obtained data demonstrates that the micronization process potentiates the anticonvulsant effect of resveratrol. Micronized resveratrol achieved a similar effect to the classical drug diazepam, with the benefit that it may be a safe drug candidate to be used during the neurodevelopmental stage.
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Fleury-Teixeira P, Caixeta FV, Ramires da Silva LC, Brasil-Neto JP, Malcher-Lopes R. Effects of CBD-Enriched Cannabis sativa Extract on Autism Spectrum Disorder Symptoms: An Observational Study of 18 Participants Undergoing Compassionate Use. Front Neurol 2019; 10:1145. [PMID: 31736860 PMCID: PMC6834767 DOI: 10.3389/fneur.2019.01145] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/14/2019] [Indexed: 12/17/2022] Open
Abstract
Autism Spectrum Disorders comprise conditions that may affect cognitive development, motor skills, social interaction, communication, and behavior. This set of functional deficits often results in lack of independence for the diagnosed individuals, and severe distress for patients, families, and caregivers. There is a mounting body of evidence indicating the effectiveness of pure cannabidiol (CBD) and CBD-enriched Cannabis sativa extract (CE) for the treatment of autistic symptoms in refractory epilepsy patients. There is also increasing data support for the hypothesis that non-epileptic autism shares underlying etiological mechanisms with epilepsy. Here we report an observational study with a cohort of 18 autistic patients undergoing treatment with compassionate use of standardized CBD-enriched CE (with a CBD to THC ratio of 75/1). Among the 15 patients who adhered to the treatment (10 non-epileptic and five epileptic) only one patient showed lack of improvement in autistic symptoms. Due to adverse effects, three patients discontinued CE use before 1 month. After 6-9 months of treatment, most patients, including epileptic and non-epileptic, showed some level of improvement in more than one of the eight symptom categories evaluated: Attention Deficit/Hyperactivity Disorder; Behavioral Disorders; Motor Deficits; Autonomy Deficits; Communication and Social Interaction Deficits; Cognitive Deficits; Sleep Disorders and Seizures, with very infrequent and mild adverse effects. The strongest improvements were reported for Seizures, Attention Deficit/Hyperactivity Disorder, Sleep Disorders, and Communication and Social Interaction Deficits. This was especially true for the 10 non-epileptic patients, nine of which presented improvement equal to or above 30% in at least one of the eight categories, six presented improvement of 30% or more in at least two categories and four presented improvement equal to or above 30% in at least four symptom categories. Ten out of the 15 patients were using other medicines, and nine of these were able to keep the improvements even after reducing or withdrawing other medications. The results reported here are very promising and indicate that CBD-enriched CE may ameliorate multiple ASD symptoms even in non-epileptic patients, with substantial increase in life quality for both ASD patients and caretakers.
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Affiliation(s)
| | | | - Leandro Cruz Ramires da Silva
- Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Associação Brasileira de Pacientes de Cannabis Medicinal, Belo Horizonte, Brazil
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Assessing evidence quality in research reporting neurocognitive outcomes following paediatric temporal lobe surgery for epilepsy. Epilepsy Res 2019; 154:116-123. [DOI: 10.1016/j.eplepsyres.2019.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/17/2018] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
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Association of Child Neurology-Indian Epilepsy Society Consensus Document on Parental Counseling of Children with Epilepsy. Indian J Pediatr 2019; 86:608-616. [PMID: 31177510 DOI: 10.1007/s12098-019-02946-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
Abstract
When a child is diagnosed with epilepsy, counseling regarding the same is done by the treating doctor. Most parents are frightened and have poor knowledge about epilepsy. Therapeutic advice including drug dosage, administration and side effects takes up the major part of physician's time, thereby neglecting important issues like home seizure management, follow up and others. These lacunae in knowledge require systematic patient and family education. To address these issues, an expert group meeting of pediatric neurologists and epileptologists in India along with social workers/epilepsy educators, legal experts, parents, and teachers was held. The various aspects regarding parental counseling in children with epilepsy were discussed and a consensus document was formulated. Here authors present the group consensus statement on counseling parents and caregivers of children with epilepsy. This document is intended to help physicians and pediatricians counsel the families when a child is diagnosed with epilepsy.
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Helmstaedter C, Witt JA, Hoppe C. Evaluating the mediating role of executive functions for antiepileptic drugs' effects on IQ in children and adolescents with epilepsy. Epilepsy Behav 2019; 96:98-103. [PMID: 31121514 DOI: 10.1016/j.yebeh.2019.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/02/2019] [Accepted: 04/06/2019] [Indexed: 10/26/2022]
Abstract
Several studies suggest that antiepileptic drug (AED) treatment may permanently or reversibly affect intelligence (intelligence quotient [IQ]) in children and adolescents with epilepsy. Since AED treatment preferentially affects attention and executive functions, we evaluated the potentially mediating effect of executive functions in regard to the adverse effects of drug treatment on intelligence. In a retrospective observational study, 178 children and adolescents with refractory and mostly localization-related epilepsies were evaluated in regard to the interrelation of IQ (Wechsler Intelligence Scale for Children [WISC III] short-form), executive functions (EpiTrack-Junior®, a cognitive AED screening test), and drug treatment (drug load). The results indicate that a low IQ was evident in 23%, impaired executive functions in 59% of the patients. Executive functions correlated to IQ (r = 0.60) and the symbol digits and picture arrangement subtests (R2 = 0.46) in particular. Odds ratios for impaired executive functions compared to being off drug (33% impaired) increased from 2.0 with one drug (53% impaired) to 9.5 (83% impaired) with at least three drugs. A mediation analysis revealed that drug dependent differences in executive functions mediate the negative effect of the AED load on intelligence. Hence, executive functions appear to link adverse cognitive side effects of AED treatment to intelligence. Considering Catell's two factor model of intelligence, AEDs preferentially affect the aspects of fluid intelligence. The overall impact of AED on intelligence appears mild. It may become relevant, however, when drug-induced impairments persist over longer time intervals during sensitive developmental phases. This issue needs to be addressed in future longitudinal studies.
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Affiliation(s)
| | - Juri-Alexander Witt
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Christian Hoppe
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
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Colliva C, Ferrari M, Benatti C, Guerra A, Tascedda F, Blom JMC. Executive functioning in children with epilepsy: Genes matter. Epilepsy Behav 2019; 95:137-147. [PMID: 31054523 DOI: 10.1016/j.yebeh.2019.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 02/02/2023]
Abstract
Pediatric epilepsy has emerged as a chronic medical disease with a characteristic behavioral and cognitive phenotype, which includes compromised executive functioning (EF) and attention-related deficits. However, considerable interindividual variability exists; children often display very different or even opposite outcomes, and some children are more likely than others to develop neurocognitive problems in the face of similar individual and disease-related problems. The factors responsible for this interindividual variability are still largely unknown, but we do know that some genetic factors render the developing brain more susceptible to damage or traumatic experiences than others. Dopamine availability has a neuromodulatory function in the prefrontal cortex (PFC) and especially affects EF. Dopamine availability relates to polymorphisms in the gene encoding catechol-O-methyltransferase (COMT Val158Met), which in turn is affected by the methylation state of its promoter. Allelic variation of the methylenetetrahydrofolate reductase (MTHFR C677T) gene, alters methylation and may influence the methylation state of the COMT promoter. Given this, we tested the hypothesis that these polymorphisms interact in children with epilepsy, and that variability in allelic expression is associated with variability in cognitive phenotype. Executive function was tested directly and indirectly (parent-rated) in 42 children between 5 and 12 years of age. The MTHFR T allele carriers performed worse than MTHFR homozygous CC carriers on indirect EF, and a significant decline was observed when T allele carriers had at least one met allele of the COMT gene, especially on Working Memory. Direct EF was significantly compromised in COMT Val/Val carriers where reduced dopamine availability seems to confer a higher risk in a test that requests a high degree of executive attention and planning. This finding suggests that in children with epilepsy, genes that influence methylation and dopamine availability affect PFC-related EF. Therefore, we should consider genetic vulnerability as a polygenic risk, which might predispose for a particular phenotype and include specific genetic signatures as part of each patient's behavioral and cognitive profile from the moment that we start to take care of the child.
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Affiliation(s)
- Chiara Colliva
- Dept. of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Cristina Benatti
- Dept. of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy; Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Azzurra Guerra
- Dept. of Medical and Surgical science, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Tascedda
- Dept. of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy; Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Joan M C Blom
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Dept. of Education and Human Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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Taipale H, Lampela P, Koponen M, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen AM. Antiepileptic Drug Use Is Associated with an Increased Risk of Pneumonia Among Community-Dwelling Persons with Alzheimer's Disease-Matched Cohort Study. J Alzheimers Dis 2019; 68:127-136. [PMID: 30775987 PMCID: PMC6484268 DOI: 10.3233/jad-180912] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Antiepileptic drugs (AEDs) have sedative properties which may lead to an increased risk of pneumonia. Objectives: To investigate whether incident AED use is associated with an increased risk of pneumonia among community-dwelling persons with Alzheimer’s disease (AD). In addition, we determined the risk according to duration of AED use and specific AEDs. Methods: Persons with AD were identified from the MEDALZ dataset which includes all community-dwelling persons who received a clinically verified diagnosis of AD during 2005-2011 in Finland (N=70,718). New AED users were identified with one-year washout period. A matched cohort (1 : 1, N=5,769, matching criteria age, gender, and time since AD diagnoses) of nonusers was formed. Data from nationwide registers included dispensed medications which were modelled with PRE2DUP method, hospitalizations, and causes of death. The association between AED use and hospital admission or death due to pneumonia was analyzed with Cox proportional hazard models. Results: AED use was associated with an increased risk of pneumonia (adjusted HR 1.92, 95% CI 1.63-2.26; incidence rate per 100 person-years 12.58, 95% CI 12.49-12.66 during AED use and 6.41, 95% CI 6.37-6.45 during nonuse). The highest risk was observed during the first month of use (aHR 3.59, 95% CI 2.29-5.61) and the risk remained elevated until two years of use. Of specific drug substances, phenytoin, carbamazepine, valproic acid, and pregabalin were associated with an increased risk. Conclusion: Antiepileptic drug use may increase the risk of pneumonia which is concerning as persons with AD have elevated risk of pneumonia.
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Affiliation(s)
- Heidi Taipale
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Pasi Lampela
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,Impact Assessment Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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45
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Huang C, Li Y, Feng X, Li D, Li X, Ouyang Q, Dai W, Wu G, Zhou Q, Wang P, Zhou K, Xu X, Li S, Peng Y. Distinct Gut Microbiota Composition and Functional Category in Children With Cerebral Palsy and Epilepsy. Front Pediatr 2019; 7:394. [PMID: 31646147 PMCID: PMC6779726 DOI: 10.3389/fped.2019.00394] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022] Open
Abstract
Cerebral palsy (CP) and epilepsy are two interactive neurological diseases, and their clinical treatment can cause severe side-effects in children's development, especially when it involves long-term administration of antiepileptic drugs. Accumulating studies on the gut-brain axis indicated that the gut microbiota (GM), which participates in various neurological diseases, would provide a harmless therapeutic target for the treatment of CP and epilepsy. To explore the GM characteristics in children with both CP and epilepsy (CPE), we collected fecal samples from 25 CPE patients (CPE group) and 21 healthy children (Healthy group) for 16S rDNA sequencing. In this study, we discovered significantly higher microbial diversity in the CPE group compared to healthy group (P < 0.001). After selecting the top 15 most abundant genera in each group, we found significantly enriched Bifidobacterium, Streptococcus, Akkermansia, Enterococcus, Prevotella, Veillonella, Rothia, and Clostridium IV in the CPE group, and noticeably reduced Bacteroides, Faecalibacterium, Blautia, Ruminococcus, Roseburia, Anaerostipes, and Parasutterella. A GM co-occurrence network was also constructed, and negative correlations were discovered between Bacteroides and Lactobacillus (r = -0.768, P < 0.001, FDR < 0.001), as well as Intestinibacter and Bifidobacterium (r = -0.726, P < 0.001, FDR < 0.001). After KEGG annotation and functional enrichment, 24 functional categories exhibited different enrichment levels between the CPE and Healthy groups. The functions, associated with xenobiotics metabolism, immune system diseases, and neurodegenerative diseases, were enriched in the CPE group. Conversely, the functional categories related to the biosynthesis of secondary metabolites were reduced. Furthermore, the neurodegenerative diseases were mainly attributed to Streptococcus, while an increased risk of immune system diseases was associated with enriched Akkermansia in the CPE patients. Generally, this study characterized the GM in CPE patients, illustrated the microbial co-occurrence relationships, and detected the functional distributions of the bacteria.
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Affiliation(s)
- Congfu Huang
- Department of Pediatrics, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | - Yinhu Li
- Department of Computer Science, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Xin Feng
- Department of Microbial Research, WeHealthGene Institute, Shenzhen, China
| | - Dongfang Li
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuyun Li
- Department of Pediatrics, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | - Qiuxing Ouyang
- Department of Pediatrics, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | - Wenkui Dai
- Department of Computer Science, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Genfeng Wu
- Department of Pediatrics, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | - Qian Zhou
- Department of Computer Science, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Peiqin Wang
- Department of Pediatrics, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, China
| | - Ke Zhou
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Ximing Xu
- School of Statistics and Data Science, NanKai University, Tianjin, China
| | - Shuaicheng Li
- Department of Computer Science, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Yuanping Peng
- Department of Healthcare, Longgang District Social Welfare Center, Shenzhen, China
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46
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Karlsson Lind L, Wide K, Wettermark B, von Euler M. Utilization of Antiepileptic Medicines in Swedish Children and Adolescents with Different Diagnoses. Basic Clin Pharmacol Toxicol 2018; 123:94-100. [DOI: 10.1111/bcpt.12981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/31/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Linnéa Karlsson Lind
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- The Health and Medical Care Administration; Stockholm County Council; Stockholm Sweden
| | - Katarina Wide
- Department of Pediatrics; CLINTEC; Karolinska Institutet; Stockholm Sweden
| | - Björn Wettermark
- The Health and Medical Care Administration; Stockholm County Council; Stockholm Sweden
- Centre for Pharmacoepidemiology (CPE); Department of Medicine; Clinical Epidemiology Unit Solna; Karolinska Institutet; Stockholm Sweden
| | - Mia von Euler
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
- Division of Clinical Pharmacology; Karolinska University Hospital Solna; Stockholm Sweden
- Karolinska Institutet Stroke Research Network at Södersjukhuset; Stockholm Sweden
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47
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Taipale H, Gomm W, Broich K, Maier W, Tolppanen AM, Tanskanen A, Tiihonen J, Hartikainen S, Haenisch B. Use of Antiepileptic Drugs and Dementia Risk-an Analysis of Finnish Health Register and German Health Insurance Data. J Am Geriatr Soc 2018; 66:1123-1129. [DOI: 10.1111/jgs.15358] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Heidi Taipale
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy; University of Eastern Finland; Kuopio Finland
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Willy Gomm
- German Center for Neurodegenerative Diseases; Bonn Germany
| | - Karl Broich
- Federal Institute for Drugs and Medical Devices; Bonn Germany
| | - Wolfgang Maier
- German Center for Neurodegenerative Diseases; Bonn Germany
- Department of Psychiatry; University of Bonn; Bonn Germany
| | | | - Antti Tanskanen
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital; University of Eastern Finland; Kuopio Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Forensic Psychiatry, Niuvanniemi Hospital; University of Eastern Finland; Kuopio Finland
| | - Sirpa Hartikainen
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
- Kuopio Research Center for Geriatric Care, School of Pharmacy; University of Eastern Finland; Kuopio Finland
- Department of Psychiatry; Kuopio University Hospital; Kuopio Finland
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Endesfelder S, Weichelt U, Schiller C, Winter K, von Haefen C, Bührer C. Caffeine Protects Against Anticonvulsant-Induced Impaired Neurogenesis in the Developing Rat Brain. Neurotox Res 2018; 34:173-187. [PMID: 29417440 DOI: 10.1007/s12640-018-9872-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/08/2018] [Accepted: 01/23/2018] [Indexed: 02/06/2023]
Abstract
In preterm infants, phenobarbital is the first-line antiepileptic drug for neonatal seizures while caffeine is used for the treatment of apnea. Data from experimental animals suggest that phenobarbital and other anticonvulsants are toxic for the developing brain, while neuroprotective effects have been reported for caffeine both in newborn rodents and preterm human infants. To characterize the interaction of phenobarbital and caffeine in the hippocampus of the developing rodent brain, we examined the effects of both drugs given separately or together on postnatal neurogenesis after administration to neonatal rats throughout postnatal day (P) 4 to P6. Phenobarbital treatment (50 mg/kg) resulted in a significant decrease of proliferative capacity in the dentate gyrus. Phenobarbital also reduced expression of neuronal markers (doublecortin (DCX), calretinin, NeuN), neuronal transcription factors (Pax6, Sox2, Tbr1/2, Prox1), and neurotrophins (NGF, BDNF, NT-3) up to 24 h after the last administration. The phenobarbital-mediated impairment of neurogenesis was largely ameliorated by preconditioning with caffeine (10 mg/kg). In contrast, caffeine alone reduced proliferative capacity and expression of the neuronal markers DCX and NeuN at 6 h, but increased expression of neurotrophins and neuronal transcription factors at 6 and 12 h. These results indicate that administration of phenobarbital during the vulnerable phase of brain development negatively interferes with neuronal development, which can be prevented in part by co-administration of caffeine.
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Affiliation(s)
- Stefanie Endesfelder
- Department of Neonatology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Ulrike Weichelt
- Endowed Professorship of Immunotechnology, Institute of Biochemistry and Biology, University of Potsdam, Campus Golm, Karl-Liebknechtstraße 24-25, 14476, Potsdam - Golm, Germany
| | - Cornelia Schiller
- Department of Neonatology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Katja Winter
- Department of Neonatology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Clarissa von Haefen
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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49
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van Ool JS, Hurks PPM, Snoeijen-Schouwenaars FM, Tan IY, Schelhaas HJ, Klinkenberg S, Aldenkamp AP, Hendriksen JGM. Accuracy of WISC-III and WAIS-IV short forms in patients with neurological disorders. Dev Neurorehabil 2018; 21:101-107. [PMID: 28152329 DOI: 10.1080/17518423.2016.1277799] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The assessment of intellectual abilities is intensive, time-consuming, and might be considered burdensome for patients. We examined psychometric qualities of short forms (SFs) of the Wechsler Intelligence Scales for Children (WISC-third edition) and for adults (WAIS-fourth edition), in children (n = 986; Mage = 10.9) and adults (n = 324; Mage = 40.9) with neurological disorders. SF estimates were compared with Full Scale IQ (FSIQ), obtained by a complete administration, for the entire sample and for the subgroups FSIQ < 80 and FSIQ ≥ 80. The FSIQ was correctly identified within ± 7 points in 86% of children and 87% of adults. There were, however, some differences regarding the optimal SF subtest combination between subgroups. Although clinical inferences should not be made, SFs may be useful in research settings to obtain a global estimate of intelligence, and in clinical settings to screen periodically for possible intellectual deterioration.
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Affiliation(s)
- Jans S van Ool
- a Department of Residential Care , Kempenhaeghe Epilepsy Centre , Heeze , The Netherlands
| | - Petra P M Hurks
- b Faculty of Psychology and Neuroscience, Maastricht University , Maastricht , The Netherlands
| | | | - In Y Tan
- a Department of Residential Care , Kempenhaeghe Epilepsy Centre , Heeze , The Netherlands
| | - Helenius J Schelhaas
- c Department of Neurology , Academic Center for Epileptology Kempenhaeghe , Heeze , The Netherlands
| | - Sylvia Klinkenberg
- d Department of Neurology , Maastricht University Medical Centre , Maastricht , The Netherlands.,h Department of Neurological Learning Disabilities , Kempenhaeghe Epilepsy Centre , Heeze , The Netherlands
| | - Albert P Aldenkamp
- d Department of Neurology , Maastricht University Medical Centre , Maastricht , The Netherlands.,e Faculty of Electrical Engineering, University of Technology , Eindhoven , The Netherlands.,f Department of Neurology , Ghent University Hospital , Ghent, Belgium.,g Department of Behavioral Sciences , Kempenhaeghe Epilepsy Centre , Heeze , The Netherlands
| | - Jos G M Hendriksen
- d Department of Neurology , Maastricht University Medical Centre , Maastricht , The Netherlands.,g Department of Behavioral Sciences , Kempenhaeghe Epilepsy Centre , Heeze , The Netherlands.,h Department of Neurological Learning Disabilities , Kempenhaeghe Epilepsy Centre , Heeze , The Netherlands
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50
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Chen VCH, Yang YH, Lee CP, Wong J, Ponton L, Lee Y, McIntyre RS, Huang KY, Wu SI. Risks of road injuries in patients with bipolar disorder and associations with drug treatments: A population-based matched cohort study. J Affect Disord 2018; 226:124-131. [PMID: 28972929 DOI: 10.1016/j.jad.2017.09.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 07/05/2017] [Accepted: 09/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Using a nation-wide, population-based dataset, we aimed to investigate the risk of road injury among individuals with bipolar disorder (BD) compared to individuals without BD. In addition, we investigated the putative moderating effects of prescription for lithium, anticonvulsants, antidepressants, and/or first- or second-generation antipsychotic agents on the association between BD and risk of road injury. METHOD As part of an16-year longitudinal cohort study, we compared the risk of road injuries among study subjects aged 16 and above with a diagnosis of BD, with ten age- and sex-matched sample of individuals without BD. Individuals were compared on measures of incidence on road injuries using medical claims data based on the ICD-9-CM codes: E800~807, E810~817, E819~830, E840~848. Time dependent Cox regression models were used to adjust for time-varying covariates such as age, and medication uses. Hazard ratios before and after adjusting for age, sex, other comorbidities, and drug use were calculated. RESULTS 3953 people with BD were matched with 39,530 controls from general population. Adjusted hazard ratios revealed a 1.66-fold (95% CI 1.40-1.97) increase in risk of road injuries among bipolar subjects when compared to controls. Female gender, older age (i.e. over 80), residence in areas of highest levels of urbanization, and use of antidepressants were associated with a lower risk of road injuries. CONCLUSIONS In this large, national, population-based cohort, BD was associated with an elevated risk of road injuries. However, prescriptions of antidepressants might help mitigate the foregoing risk.
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Affiliation(s)
- Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital at Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan; Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, College of Public Health, Taipei, Taiwan
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | | | - Lynn Ponton
- University of California, San Francisco (UCSF), USA
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Kuo-You Huang
- Department of Speech, Language Pathology and Audiology, Chung Shan Medical University, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology, Speech, and Language Pathology, Mackay Medical College, Taipei, Taiwan.
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