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Balzekas I, Richardson JP, Lorence I, Lundstrom BN, Worrell GA, Sharp RR. Qualitative Analysis of Decision to Pursue Electrical Brain Stimulation by Patients With Drug-Resistant Epilepsy and Their Caregivers. Neurol Clin Pract 2024; 14:e200245. [PMID: 38585236 PMCID: PMC10996908 DOI: 10.1212/cpj.0000000000200245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/01/2023] [Indexed: 04/09/2024]
Abstract
Background and Objectives To understand why patients with drug-resistant epilepsy (DRE) pursue invasive electrical brain stimulation (EBS). Methods We interviewed patients with DRE (n = 20) and their caregivers about their experiences in pursuing EBS approximately 1 year post device implant. Inductive analysis was applied to identify key motivating factors. Results The cohort included participants aged from teens to 50s with deep brain stimulation, vagus nerve stimulation, responsive neurostimulation, and chronic subthreshold cortical stimulation. Patients' motivations included (1) improved quality of life (2) intolerability of antiseizure medications, (3) desperation, and (4) patient-family dynamics. Both patients and caregivers described a desire to alleviate burdens of the other. Patient apprehensions about EBS focused on invasiveness and the presence of electrodes in the brain. Previous experiences with invasive monitoring and the ability to see hardware in person during clinical visits influenced patients' comfort in proceeding with EBS. Despite realistic expectations for modest and delayed benefits, patients held out hope for an exceptionally positive outcome. Discussion Our findings describe the motivations and decision-making process for patients with DRE who pursue invasive EBS. Patients balance feelings of desperation, personal goals, frustration with medication side effects, fears about surgery, and potential pressure from concerned caregivers. These factors together with the sense that patients have exhausted therapeutic alternatives may explain the limited decisional ambivalence observed in this cohort. These themes highlight opportunities for epilepsy care teams to support patient decision-making processes.
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Affiliation(s)
- Irena Balzekas
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
| | - Jordan P Richardson
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
| | - Isabella Lorence
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
| | - Brian Nils Lundstrom
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
| | - Gregory A Worrell
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
| | - Richard R Sharp
- Bioelectronics Neurophysiology and Engineering Laboratory (IB, BNL, GAW); Biomedical Engineering and Physiology Graduate Program (IB); Department of Neurology (IB, BNL, GAW); Mayo Clinic Medical Scientist Training Program (IB); Biomedical Ethics Research Program (JPR, IL, RRS); Department of Quantitative Health Sciences (JPR, IL, RRS); Mayo Clinic Alix School of Medicine (JPR), Mayo Clinic, Rochester, MN; and Columbia University Vagelos College of Physicians and Surgeons (IL), New York, NY
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Reijneveld JC, Thijs RD, van Thuijl HF, Appelhof BA, Taphoorn MJB, Koekkoek JAF, Visser GH, Dirven L. Clinical outcome assessment in patients with epilepsy: The value of health-related quality of life measurements. Epilepsy Res 2024; 200:107310. [PMID: 38330675 DOI: 10.1016/j.eplepsyres.2024.107310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
This narrative review provides an overview of the current knowledge on health-related quality of life (HRQOL), a relevant clinical outcome in patients with epilepsy. It shows that the most important factor determining HRQOL in this patient group is seizure frequency. In particular, seizure-freedom is associated with better HRQOL scores. Many other factors may impact perceived HRQOL aspects, but their interrelation is complex and requires further research. Novel analytical approaches, such as hierarchical cluster and symptom network analyses might shed further light on this, and may result in recommendations for interventions on the most 'central' factors influencing different aspects of HRQOL in patients with epilepsy. Next, an overview of the HRQOL tools and analytical methods currently used in epilepsy care, with a focus on clinical trials, is provided. The QOLIE-31 is the most frequently applied and best validated tool. Several other questionnaires focusing on specific aspects of HRQOL (e.g., mood, social impact) are less frequently used. We show some pitfalls that should be taken into account when designing study protocols including HRQOL endpoints. This includes standardized statistical analysis approaches and predefined reporting methods for HRQOL in epilepsy populations. It has been shown in other patient groups that the lack of such standardisation negatively impacts the quality and comparability of results. We conclude with a number of recommendations for future research.
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Affiliation(s)
- Jaap C Reijneveld
- Department of Neurology, SEIN, Heemstede, the Netherlands; Department of Neurology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Roland D Thijs
- Department of Neurology, SEIN, Heemstede, the Netherlands; Department of Neurology, University College, London, United Kingdom
| | | | | | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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Scharf MT, Greenberg P, Wong S, Mani R. Sex differences in variables associated with excessive daytime sleepiness in patients with epilepsy. Epilepsy Behav 2023; 138:109015. [PMID: 36473303 DOI: 10.1016/j.yebeh.2022.109015] [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: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/21/2022] [Indexed: 12/09/2022]
Abstract
OBJECTIVE Excessive daytime sleepiness (EDS) is common in patients with epilepsy (PWE). The Epworth Sleepiness Scale (ESS) is a self-reported measure of sleepiness in widespread use. The purpose of this study was to identify contributors to the ESS score in PWE and to identify variables associated with a high score indicative of EDS. METHODS A cross-sectional study was performed on 115 PWE presenting to the epilepsy clinic. Self-reported questionnaires were administered and demographic and clinical information was gathered from the electronic medical record. Regression analyses were performed. RESULTS A high ESS score was found in nearly 20% of the cohort. Obstructive sleep apnea (OSA) risk, standardized anti-seizure drug (ASD) dose, and female sex were associated with an increased likelihood of a high ESS score. Assessment of the ESS without the use of a cutpoint showed that standardized ASD dose and OSA risk were associated with the ESS in men, but standardized ASD dose was not associated with the ESS in women. Higher use of valproic acid and oxcarbazepine in men and higher use of lamotrigine in women may be contributing factors. SIGNIFICANCE Sex is likely to be a key factor in determining contributors to EDS in PWE.
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Affiliation(s)
- Matthew T Scharf
- Sleep Center, Division of Pulmonary and Critical Care, Department of Medicine, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, United States; Department of Neurology, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
| | - Patricia Greenberg
- Biostatistics and Epidemiology Services Center, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, United States.
| | - Stephen Wong
- Department of Neurology, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
| | - Ram Mani
- Department of Neurology, Rutgers- Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
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Metcalf CS, Gagangras S, Bulaj G, White HS. Synergistic effects of the galanin analog 810-2 with the antiseizure medication levetiracetam in rodent seizure models. Epilepsia 2022; 63:3090-3099. [PMID: 36177529 DOI: 10.1111/epi.17420] [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: 07/27/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The use of many antiseizure medications (ASMs) is limited due to pharmacoresistance and dose-limiting side effects, suggesting an unmet need for novel therapeutic approaches. The neuropeptide galanin reduces seizures in several preclinical seizure and epilepsy models, but its clinical utility is limited due to rapid metabolism and poor blood-brain barrier penetration. The lead galanin analog 810-2 is systemically bioavailable and reduces seizures when administered alone. Further development of this analog, with the potential for use as an add-on therapy in patients with epilepsy, requires a better understanding of the use of this analog in combination with approved ASMs. We sought to evaluate 810-2 in combination with commonly used ASMs in rodent models of seizures. METHODS The mouse 6-Hz seizure assay was used to test efficacy of 810-2 in combination with levetiracetam (LEV), valproic acid (VPA), or lacosamide (LCM) using a 1:1 dose ratio in isobolographic studies. Further characterization was performed for the combination of 810-2 and LEV in the mouse corneal kindling and rat 6-Hz assays. RESULTS Whereas the combination of 810-2 with VPA and LCM yielded additive interactions, the combination of 810-2 with LEV demonstrated a synergistic interaction in the mouse 6-Hz assay. Supra-additive effects were also observed in the mouse corneal kindling and rat 6-Hz assays for this combination. SIGNIFICANCE The combination of 810-2 with LEV suggests the potential for this galanin analog to be further developed as an add-on therapy for patients with epilepsy, particularly when coadministered with LEV.
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Affiliation(s)
- Cameron S Metcalf
- Epilepsy Therapy Screening Program Contract Site, Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Saurabh Gagangras
- Epilepsy Therapy Screening Program Contract Site, Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA
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Zhu H, Deng X, Feng L, Lian Y, Han X, Guo Z, Gou Y, Du Y, Xie L, Yao D, Liu Y, Wu Q, Lan S, Liu K, Zhan P, Wang X, Dang J, Hou Y, Chen K, Zhu Y, Shi Y, Yu Y, Xiao B, Zhu S, Meng H. Efficacy comparison of oxcarbazepine and levetiracetam monotherapy among patients with newly diagnosed focal epilepsy in China: A multicenter, open-label, randomized study. CNS Neurosci Ther 2022; 28:1072-1080. [PMID: 35429132 PMCID: PMC9160445 DOI: 10.1111/cns.13840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
Aims This multicenter, open‐label, randomized study (Registration No. ChiCTR‐OCH‐14004528) aimed to compare the efficacy and effects of oxcarbazepine (OXC) with levetiracetam (LEV) as monotherapies on patient quality of life and mental health for patients with newly diagnosed focal epilepsy from China. Methods Patients with newly diagnosed focal epilepsy who had experienced 2 or more unprovoked seizures at greater than a 24‐h interval during the previous year were recruited. Participants were randomly assigned to the OXC group or LEV group. Efficacy, safety, quality of life, and mental health were evaluated over 12‐week and 24‐week periods. Results In total, we recruited 271 newly diagnosed patients from 23 centers. Forty‐four patients were excluded before treatment for reasons. The rate of seizure freedom of OXC was significantly superior to that of LEV at 12 weeks and 24 weeks (p < 0.05). The quality of life (except for the seizure worry subsection) and anxiety scale scores also showed significant differences from before to after treatment in the OXC and LEV groups. Conclusions OXC monotherapy may be more effective than LEV monotherapy in patients with newly diagnosed focal epilepsy. Both OXC and LEV could improve the quality of life and anxiety state in adult patients with focal epilepsy.
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Affiliation(s)
- Haoyue Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xuejun Deng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yajun Lian
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiong Han
- Department of Neurology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zhenli Guo
- Department of Neurology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan, China
| | - Yulan Gou
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Yuanmin Du
- Department of Neurology, Wuhan General Hospital of the YANGTZE River Shipping, Wuhan, China
| | - Longshan Xie
- Department of Functional Neuroscience, The First People's Hospital of Foshan, Foshan, China
| | - Dongai Yao
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yonghong Liu
- Department of Neurology, Xijing Hospital of Air Force Military Medical University, Xi'an, China
| | - Qiang Wu
- Department of Neurology, Wuhan General Hospital of PLA, Wuhan, China
| | - Song Lan
- Department of Internal Medicine-Neurology, Maoming People's Hospital of Guangdong Province, Maoming, China
| | - Kaisheng Liu
- Department of Neurology, Taihe Hospital, Shiyan, China
| | - Peiyan Zhan
- Department of Neurology, The Central Hospital of Wuhan, Wuhan, China
| | - Xiahong Wang
- Department of Neurology, Zhengzhou Second Hospital, Zhengzhou, China
| | - Jingxia Dang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yunqi Hou
- Department of Neurology, Shunde First Affiliated Hospital of Southern Medical University, Shunde, China
| | - Keqiang Chen
- Department of Neurology, Central Hospital of Jiangmen, Jiangmen, China
| | - Yulan Zhu
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuliang Shi
- Department of Neurology, People's Hospital of Meizhou, Meizhou, China
| | - Yunli Yu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongmei Meng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
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Deegbe DA, Tshabalala AM, Aziato L, Casteleijn D. Meanings of quality of life among people living with epilepsy in Ghana; a qualitative exploratory study. Epilepsy Behav 2022; 129:108527. [PMID: 35168123 DOI: 10.1016/j.yebeh.2021.108527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to explore the meanings of quality of life among people living with epilepsy (PLWE) in Ghana. METHODS An exploratory-qualitative study design was adopted. Face-to-face in-depth interviews, using a semi-structured interview guide, were conducted on 15 PLWE who were purposively selected for the study. The interviews were audio recorded and transcribed verbatim. The content analysis approach was then used to analyze the data. RESULTS Four themes - "acceptance", "support", "seizure control", and "self-reliance" emerged from the study as meanings of Quality of life (QoL). Quality of life meant unconditional acceptance from family, friends, acquaintances at home, school, and work, and by the public despite epilepsy. Receiving support in the form of protection from injury during a seizure, financial assistance to meet individual and family demands, emotional warmth, and spiritual support through prayers and encouragement, was QoL for PLWE. Achievement of control over seizures and being self-reliant in terms of selfcare and daily activities in addition to having some form of financial independence meant QoL. CONCLUSION Meanings of quality of life among PLWE is associated with being accepted and supported by family and friends as well as being in control of seizures and attaining a status of independence.
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Affiliation(s)
- David Atsu Deegbe
- Department of Mental Health Nursing, School of Nursing and Midwifery, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana.
| | - Amme Mardulate Tshabalala
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.
| | - Lydia Aziato
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, P.O. Box LG 43, Legon, Accra, Ghana.
| | - Daleen Casteleijn
- Department of Occupational Therapy, School of Therapeutic Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.
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Beh HC, Tan HJ, Hod R, Khoo CS, Mohamad K. Prevalence and Factors Influencing Visual Memory Dysfunction among Epilepsy Patients-A Single-Center Study. Neurol India 2021; 68:581-585. [PMID: 32643667 DOI: 10.4103/0028-3886.289011] [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] [Indexed: 11/04/2022]
Abstract
Background Epilepsy is associated with cognitive impairment due to the disease itself or side-effects of antiepileptic drugs. Objective We aimed to study the prevalence of visual memory dysfunction among epilepsy patients and identify the predictors that could contribute to the impairment. Materials and Methods This was a cross-sectional study. We analyzed 250 patients with epilepsy from neurology clinic at our tertiary center. Assessment of visual memory was done using Wechsler Memory Scale-IV (WMS-IV) with scores from subsets of visual reproduction I, II and designs I, II contributing to visual memory index (VMI) score. The correlation between continuous variables was analyzed using Pearson correlation; whereas the VMI scores of different factors were analyzed via a 1-way ANOVA test. The statistical significance was set at P < 0.05. Results The prevalence of visual memory dysfunction in our epilepsy population was 37.2%. Analysis of individual predictors showed that older patients, lower educational level, combined generalized and focal types of epilepsy, longer duration of epilepsy, greater number of antiepileptic drugs (AEDs) used, and abnormal neuroimaging contributed to poor visual memory. Multiple logistic regression analysis showed that educational level, types of epilepsy, and the number of AEDs used were significant predictors for visual memory impairment. Conclusion Visual memory dysfunction in patients with epilepsy was due to manifold confounding factors. Our findings enabled us to identify patients with visual memory dysfunction and modifiable factors that contribute to it. WMS-IV is a suitable assessment tool to determine visual memory function, which can help clinicians to optimize the patients' treatment.
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Affiliation(s)
- Hui-Chien Beh
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hui-Jan Tan
- Department of Medicine; Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Rozita Hod
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ching-Soong Khoo
- Department of Medicine; Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Khairiyah Mohamad
- Department of Medicine; Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Ferreira ACFM, Eveloff RJ, Freire M, Santos MTBR. The Impact of Oral-Gut Inflammation in Cerebral Palsy. Front Immunol 2021; 12:619262. [PMID: 33717115 PMCID: PMC7953843 DOI: 10.3389/fimmu.2021.619262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Oral-gut inflammation has an impact on overall health, placing subjects at risk to acquire chronic conditions and infections. Due to neuromotor disturbances, and medication intake, cerebral palsy (CP) subjects present intestinal constipation, impacting their quality of life (QOL). We aimed to investigate how oral inflammatory levels predicted gut phenotypes and response to therapy. Methods: A total of 93 subjects aging from 5 to 17 years were included in the study, and assigned into one of the 4 groups: CP with constipation (G1, n = 30), CP without constipation (G2, n = 33), and controls without CP with constipation (G3, n = 07) and without CP and without constipation (G4, n = 23). In addition to characterizing subjects' clinical demographics, medication intake, disease severity levels, salivary cytokine levels [TNF-α, interleukin (IL)-1β, IL-6, IL-8, IL-10], and Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). Statistical significance was evaluated by Shapiro-Wilks, Student's T-Test, ANOVA, and ANCOVA analysis. Results: Salivary proinflammatory cytokines were highly correlated with the severe form of gut constipation in G1 (P < 0.001), and out of all cytokines IL-1β levels demonstrated highest correlation with all gut constipation (P < 0.05). A significant relationship was found between the type of medication, in which subjects taking Gamma-Aminobutyric Acid (GABA) and GABA+ (GABA in association with other medication) were more likely to be constipated than the other groups (P < 0.01). Cleary salivary inflammatory levels and gut constipation were correlated, and impacted QOL of CP subjects. G1 presented a lower QOL mean score of CPCHILD (49.0 ± 13.1) compared to G2 (71.5 ± 16.7), when compared to G3 (88.9 ± 7.5), and G4 (95.5 ± 5.0) (P < 0.01). We accounted for gingival bleeding as a cofounder of oral inflammation, and here were no differences among groups regarding gender (P = 0.332) and age (P = 0.292). Conclusions: Collectively, the results suggest that saliva inflammatory levels were linked to gut constipation, and that the clinical impact of medications that controlled gut was reliably monitored via oral cytokine levels, providing reliable and non-invasive information in precision diagnostics.
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Affiliation(s)
| | - Ryan J Eveloff
- Department of Genomic Medicine and Infectious Diseases, J. Craig Venter Institute, La Jolla, CA, United States
| | - Marcelo Freire
- Department of Genomic Medicine and Infectious Diseases, J. Craig Venter Institute, La Jolla, CA, United States.,Department of Infectious Diseases, School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Maria Teresa Botti Rodrigues Santos
- Postgraduate Program in Dentistry, Department of Individuals With Special Needs, Cruzeiro do Sul University, São Paulo, Brazil.,Department of Dentistry, Association for Assistance to Disabled Children, São Paulo, Brazil
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9
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Tombini M, Assenza G, Quintiliani L, Ricci L, Lanzone J, Di Lazzaro V. Epilepsy and quality of life: what does really matter? Neurol Sci 2021; 42:3757-3765. [PMID: 33449244 DOI: 10.1007/s10072-020-04990-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/11/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess quality of life (QoL) in adult people with epilepsy (PWE) and identify the main factors affecting it. METHODS We enrolled consecutively 122 PWE. They were interviewed for a careful collection of demographic and clinical data. Patients completed dedicated questionnaires for the assessment of the quality of life (Quality of Life in Epilepsy Scale-31) (Q31) as well as psychosocial features: depressive symptoms (DS) (Beck Depression Inventory-II/BDI-II), difficulties of emotion regulation (Difficulties of Emotion Regulation Scale/DERS), and stigma related to epilepsy (Stigma Scale of Epilepsy/SSE and Jacoby's Stigma Scale/JSS). The results of Q31 and their subscales were correlated with clinical details of PWE, as well as the other scores. A stepwise multiple regression analysis was applied to identify the main factors affecting QoL. RESULTS Quality of life is inversely correlated mostly with psychosocial features, as DS, emotion dysregulation, and stigma perception, as well as with epilepsy-related factors, as the seizure frequency and number of antiseizure medications (ASMs). The combination of DS, perceived stigma, and number of ASMs best explained the QoL. Worse features of QoL were detected in females and in patients with age of epilepsy onset in adulthood. CONCLUSION Quality of life in adult PWE is predominantly affected by psychosocial factors more than epilepsy-related ones. These findings suggest that effective epilepsy management requires more than seizure control, and early detection of psychological dysfunction and tailored interventions to improve the QoL should be considered.
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Affiliation(s)
- Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy.
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Livia Quintiliani
- Psicologia Clinica, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Jacopo Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
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Gutiérrez-Viedma Á, Sanz-Graciani I, Romeral-Jiménez M, Parejo-Carbonell B, Serrano-García I, Cuadrado ML, Aledo-Serrano Á, Gil-Nagel A, Toledano R, Pérez-De-Heredia-Torres M, Santamarina E, García-Morales I. Epidaily, a scale for comprehensive functional assessment of patients with epilepsy. Epilepsy Behav 2021; 114:107570. [PMID: 33234457 DOI: 10.1016/j.yebeh.2020.107570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop and validate an epilepsy-specific scale for comprehensive functional assessment of patients with epilepsy, named Epidaily. METHODS The multidisciplinary research group created through brainstorming a list of 47 items to explore the cognitive, social, basic and instrumental functionality of the patient. A group of epilepsy experts independent of the research group evaluated the suitability of all the items, which then were selected and reviewed by the research group to conform the Epidaily scale. On a sample of 102 patients, a reliability analysis was performed, as well as a validation one using as reference scale the score on the Activities of Daily Living Questionnaire (ADLQ), which evaluates basic and instrumental functionality. RESULTS Epidaily consisted of 10 items distributed in four dimensions, with a possible score from 0 to 100 (perfect functionality). Inter-observer reliability was excellent, with an intraclass correlation coefficient of 0.98 (95% confidence interval 0.97-0.99). Criterion validity was demonstrated by the high positive correlation of the Epidaily score with the ADLQ score (Spearman's rho coefficient 0.85, p < 0.001). Significant relation was found between ADLQ and Epidaily in the linear regression analysis (p < 001), which reported that Epidaily explains 85.5% of the variability of ADLQ (R-squared 0.85). Discriminant validity was also proved, as Epidaily allowed to classify epilepsy severity based on Cramer et al epilepsy severity classification. The median time to obtain the Epidaily score was 5 min (interquartile range 4-6). SIGNIFICANCE Epidaily is a brief and versatile scale, with excellent inter-observer reliability, which has been validated for comprehensive functional assessment of patients with epilepsy.
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Affiliation(s)
- Álvaro Gutiérrez-Viedma
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Servicio de Neurología, Hospital Universitario Fundación Jiménez Díaz, Avenida de los Reyes Católicos 2, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain.
| | - Isabel Sanz-Graciani
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - María Romeral-Jiménez
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Beatriz Parejo-Carbonell
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Irene Serrano-García
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Unidad de Metodología de Investigación y Epidemiología Clínica, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - María-Luz Cuadrado
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Ángel Aledo-Serrano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Antonio Gil-Nagel
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Rafael Toledano
- Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Unidad de Epilepsia, Servicio de Neurología, Hospital Ramón y Cajal, Carretera de Colmenar Viejo 100, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Marta Pérez-De-Heredia-Torres
- Unidad de Epilepsia, Servicio de Neurología, Hospital Ramón y Cajal, Carretera de Colmenar Viejo 100, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Estevo Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Vall D́Hebrón, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
| | - Irene García-Morales
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal s/n, 28040 Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain; Programa de Epilepsia, Servicio de Neurología, Hospital Ruber Internacional, Calle La Masó 38, 28034 Madrid, Spain; Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina física, Facultad de Ciencias de la Salud , Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
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Acteoside Isolated from Colebrookea oppositifolia Smith Attenuates Epilepsy in Mice Via Modulation of Gamma-Aminobutyric Acid Pathways. Neurotox Res 2020; 38:1010-1023. [PMID: 32803629 DOI: 10.1007/s12640-020-00267-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/13/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022]
Abstract
The present study was aimed to evaluate the anticonvulsant activity of acteoside and explore its mechanism of action. Initially, the acteoside was evaluated in maximal electroshock (MES) and pentylenetetrazole (PTZ)-induced convulsions, and later it was evaluated against N-methyl-D-aspartic acid (NMDA)-induced mortality in Swiss albino mice. Based on the response in these models, further evaluations were performed to explore the mechanism of action. In the results, the acteoside (10, 25, and 50 mg/kg) has shown significant anticonvulsant activity in the PTZ model (p < 0.01 for all doses); however, there was no protection observed in MES and NMDA models. Therefore, further mechanism-based studies were performed on the PTZ model, and the outcomes have revealed that there was a significant reduction in GABA (p < 0.01 for both regions) and elevation of glutamate (p < 0.01 for both regions) in the cortex and hippocampus regions of PTZ-treated animals. Further, the antioxidant levels (SOD, catalase, GPx, GR, GSH, LPO) were altered significantly (p < 0.01 for all parameters), with reduced GABAA mRNA levels (p < 0.01) in the PTZ control compared with the normal control. Interestingly, co-administration of acteoside (25 mg/kg) (p < 0.01 for all parameters) has restored all the PTZ-induced alterations compared to PTZ-control. Moreover, the anti-PTZ action of acteoside was completely blocked in the presence of flumazenil, and thus confirmed the GABAergic mechanism behind the anticonvulsant activity of acteoside. Besides, actophotometer and rotarod tests have confirmed that the acteoside is free from central side effects like motor incoordination and locomotor deficits.
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Sakthong P, Suriyapakorn B. Medication-Related Quality of Life in Thai Epilepsy Patients. J Epilepsy Res 2020; 9:139-146. [PMID: 32509550 PMCID: PMC7251341 DOI: 10.14581/jer.19016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/02/2020] [Accepted: 01/31/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Purpose This study aimed to assess medication-related quality of life in Thai patients with epilepsy. The second objective was to evaluate the associations between the medication therapy-related quality of life and patient characteristics. Methods This was a cross-sectional study. A convenience sample of 173 outpatients with epilepsy was recruited from a university hospital in Bangkok, Thailand. Inclusion criteria were aged 18 or over who were continuously taking an epileptic drug for at least 3 months, understanding Thai language, and willing to participate in the study. The Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) was utilized to measure the medication therapy-related quality of life. Pearson’s correlation coefficients and stepwise multiple linear regressions were employed to assess the relationships between eight PROMPT-QoL domain scores and patient demographic and clinical characteristics. Results Mean age was 36.4±9.5 years and approximately 57% were female. Among eight domains of the PROMPT-QoL, the therapeutic relationships with health care providers and psychological impacts of medication use domains yielded the highest (77.9) and lowest (61.9) mean scores, respectively. Seven out of eight PROMPT-QoL domain scores were considered as moderate-to-good. Age, gender, duration of epilepsy, seizure frequency, and treatment preference were significantly associated with PROMPT-QoL domain scores in multivariate linear regression analyses. Conclusions This study showed that Thai patients with epilepsy had moderate-to-good medication therapy-related quality of life. Healthcare providers should pay more attention to patients’ psychological impacts of antiepileptic drugs and those with characteristics related to lower medication therapy-related quality of life.
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Affiliation(s)
- Phantipa Sakthong
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Bavornpat Suriyapakorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
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van Dijk RM, Koska I, Bleich A, Tolba R, Seiffert I, Möller C, Di Liberto V, Talbot SR, Potschka H. Design of composite measure schemes for comparative severity assessment in animal-based neuroscience research: A case study focussed on rat epilepsy models. PLoS One 2020; 15:e0230141. [PMID: 32413036 PMCID: PMC7228039 DOI: 10.1371/journal.pone.0230141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/23/2020] [Indexed: 12/18/2022] Open
Abstract
Comparative severity assessment of animal models and experimental interventions is of utmost relevance for harm-benefit analysis during ethical evaluation, an animal welfare-based model prioritization as well as the validation of refinement measures. Unfortunately, there is a lack of evidence-based approaches to grade an animal's burden in a sensitive, robust, precise, and objective manner. Particular challenges need to be considered in the context of animal-based neuroscientific research because models of neurological disorders can be characterized by relevant changes in the affective state of an animal. Here, we report about an approach for parameter selection and development of a composite measure scheme designed for precise analysis of the distress of animals in a specific model category. Data sets from the analysis of several behavioral and biochemical parameters in three different epilepsy models were subjected to a principal component analysis to select the most informative parameters. The top-ranking parameters included burrowing, open field locomotion, social interaction, and saccharin preference. These were combined to create a composite measure scheme (CMS). CMS data were subjected to cluster analysis enabling the allocation of severity levels to individual animals. The results provided information for a direct comparison between models indicating a comparable severity of the electrical and chemical post-status epilepticus models, and a lower severity of the kindling model. The new CMS can be directly applied for comparison of other rat models with seizure activity or for assessment of novel refinement approaches in the respective research field. The respective online tool for direct application of the CMS or for creating a new CMS based on other parameters from different models is available at https://github.com/mytalbot/cms. However, the robustness and generalizability needs to be further assessed in future studies. More importantly, our concept of parameter selection can serve as a practice example providing the basis for comparable approaches applicable to the development and validation of CMS for all kinds of disease models or interventions.
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Affiliation(s)
- Roelof Maarten van Dijk
- Institute of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximilians-University, Munich, Germany
| | - Ines Koska
- Institute of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximilians-University, Munich, Germany
| | - Andre Bleich
- Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, Hannover, Germany
| | - Rene Tolba
- Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, Hannover, Germany
| | - Isabel Seiffert
- Institute of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximilians-University, Munich, Germany
| | - Christina Möller
- Institute of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximilians-University, Munich, Germany
| | - Valentina Di Liberto
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Steven Roger Talbot
- Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, Hannover, Germany
| | - Heidrun Potschka
- Institute of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximilians-University, Munich, Germany
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Assessment of Quality of Life of Epileptic Patients in Ethiopia. Int J Chronic Dis 2020; 2020:8714768. [PMID: 31976314 PMCID: PMC6961609 DOI: 10.1155/2020/8714768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/26/2019] [Accepted: 10/10/2019] [Indexed: 01/26/2023] Open
Abstract
Background Patients with epilepsy are at an increased risk of poor quality of life. Purpose We aimed at assessing the quality of life and its determinants among epileptic patients at University of Gondar Referral Hospital (UoGRH), Ethiopia. Methods Institution based cross-sectional study was conducted on epileptic patients on follow up at UoGRH from January 15 to April 15, 2017. Information including socio-demographic profile and diagnosis was extracted from medical records and patients. Quality Of Life In Epilepsy-10 (QOLIE-10) tool was used to measure the quality of life. Independent t-test and one-way analysis of variance were used to look for factors associated with quality of life. The level of statistical significance was declared at P-value ≤ 0.05. Results A total of 354 patients were included in the study and mean age was 29.1 ± 11.7 years. The mean QOLIE-10 score was 19.85. One hundred ninety-four (54.8%) of participants had a good quality of life. Being illiterate, unemployment, and presence of co-morbid medical condition were associated with poorer quality of life. Conclusion Nearly half of the participants had a poor quality of life. Patients with co-morbidity, illiteracy, and unemployment should be given special emphasis in order to improve their quality of life.
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Copmans D, Kildgaard S, Rasmussen SA, Ślęzak M, Dirkx N, Partoens M, Esguerra CV, Crawford AD, Larsen TO, de Witte PAM. Zebrafish-Based Discovery of Antiseizure Compounds from the North Sea: Isoquinoline Alkaloids TMC-120A and TMC-120B. Mar Drugs 2019; 17:md17110607. [PMID: 31731399 PMCID: PMC6891649 DOI: 10.3390/md17110607] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 12/14/2022] Open
Abstract
There is a high need for the development of new and improved antiseizure drugs (ASDs) to treat epilepsy. Despite the potential of marine natural products (MNPs), the EU marine biodiscovery consortium PharmaSea has made the only effort to date to perform ASD discovery based on large-scale screening of MNPs. To this end, the embryonic zebrafish photomotor response assay and the larval zebrafish pentylenetetrazole (PTZ) model were used to screen MNP extracts for neuroactivity and antiseizure activity, respectively. Here we report the identification of the two known isoquinoline alkaloids TMC-120A and TMC-120B as novel antiseizure compounds, which were isolated by bioactivity-guided purification from the marine-derived fungus Aspergillus insuetus. TMC-120A and TMC-120B were observed to significantly lower PTZ-induced seizures and epileptiform brain activity in the larval zebrafish PTZ seizure model. In addition, their structural analogues TMC-120C, penicisochroman G, and ustusorane B were isolated and also significantly lowered PTZ-induced seizures. Finally, TMC-120A and TMC-120B were investigated in a mouse model of drug-resistant focal seizures. Compound treatment significantly shortened the seizure duration, thereby confirming their antiseizure activity. These data underscore the possibility to translate findings in zebrafish to mice in the field of epilepsy and the potential of the marine environment for ASD discovery.
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Affiliation(s)
- Daniëlle Copmans
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49 box 824, 3000 Leuven, Belgium; (D.C.); (M.Ś.); (N.D.); (M.P.); (C.V.E.); (A.D.C.)
| | - Sara Kildgaard
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Søltofts Plads, Building 221, 2800 Kgs. Lyngby, Denmark; (S.K.); (S.A.R.)
| | - Silas A. Rasmussen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Søltofts Plads, Building 221, 2800 Kgs. Lyngby, Denmark; (S.K.); (S.A.R.)
| | - Monika Ślęzak
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49 box 824, 3000 Leuven, Belgium; (D.C.); (M.Ś.); (N.D.); (M.P.); (C.V.E.); (A.D.C.)
| | - Nina Dirkx
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49 box 824, 3000 Leuven, Belgium; (D.C.); (M.Ś.); (N.D.); (M.P.); (C.V.E.); (A.D.C.)
| | - Michèle Partoens
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49 box 824, 3000 Leuven, Belgium; (D.C.); (M.Ś.); (N.D.); (M.P.); (C.V.E.); (A.D.C.)
| | - Camila V. Esguerra
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49 box 824, 3000 Leuven, Belgium; (D.C.); (M.Ś.); (N.D.); (M.P.); (C.V.E.); (A.D.C.)
- Current affiliation: Centre for Molecular Medicine Norway, Faculty of Medicine, University of Oslo, Gaustadalléen 21, 0349 Oslo, Norway
| | - Alexander D. Crawford
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49 box 824, 3000 Leuven, Belgium; (D.C.); (M.Ś.); (N.D.); (M.P.); (C.V.E.); (A.D.C.)
- Current affiliation: Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ullevålsveien 72, 0454 Oslo, Norway
| | - Thomas O. Larsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Søltofts Plads, Building 221, 2800 Kgs. Lyngby, Denmark; (S.K.); (S.A.R.)
- Correspondence: (T.O.L.); (P.A.M.-d.W.); Tel.: +45-4525-2632 (T.O.L.); +32-16-32-34-32 (P.A.M.-d.W.)
| | - Peter A. M. de Witte
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49 box 824, 3000 Leuven, Belgium; (D.C.); (M.Ś.); (N.D.); (M.P.); (C.V.E.); (A.D.C.)
- Correspondence: (T.O.L.); (P.A.M.-d.W.); Tel.: +45-4525-2632 (T.O.L.); +32-16-32-34-32 (P.A.M.-d.W.)
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Wang M, Ding D, Zhang Q, Zhu G, Ge Y, Yang B, Wang T, Kwan P, Wang W, Hong Z, Sander JW. Oral health and dental status in people with epilepsy in rural China. Seizure 2019; 65:42-47. [PMID: 30611009 DOI: 10.1016/j.seizure.2018.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/13/2018] [Accepted: 12/24/2018] [Indexed: 01/24/2023] Open
Abstract
PURPOSE We evaluated the oral health and dental status of people with epilepsy, and their relationship to seizure frequency, in a community cohort in rural China. METHODS A cross-sectional study of people with epilepsy was carried out in areas in Henan, Shanxi and Ningxia provinces of China. All participants underwent a specially designed "Oral health and Dental status Questionnaire". Univariate and multivariate analyses were used to explore the relationships between seizure frequency and oral health and dental status. RESULTS A total of 875 people participated. Almost two thirds (65.8%) reported brushing their teeth at least once a day but 634 (73.0%) brushed their teeth for less than 3 min each time. Only 80 (9.1%) had visited a dental clinic in the previous year. Multivariate logistic regression analysis showed that having 1-4 seizures/month (OR 0.60, 95%CI 0.40-0.90) or >4 seizures/month (OR 0.38, 95%CI 0.22-0.66) was associated with decreased odds of brushing teeth at least once a day, and higher seizure frequency was associated with increased odds of dental injury due to seizures (OR 2.07, 95%CI 1.22-3.50 for <1 seizure/month; OR 2.12, 95%CI 1.25-3.58 for 1-4 seizures/month; OR 3.09, 95%CI 1.57-6.07 for >4 seizures/month). CONCLUSION Seizure frequency was significantly associated with seizure-related dental injury, and with the lack of good oral health practice. Improvement in the oral health of people with epilepsy in resource-poor areas should be encouraged.
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Affiliation(s)
- Mengjie Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ding Ding
- Institute of Neurology, WHO Collaborating Center for Research and Training in Neurosciences, Huashan Hospital, Fudan University, Shanghai, China.
| | - Qing Zhang
- Department of Neurology, Ningxia Medical University Affiliated Hospital, Yinchuan, China.
| | - Guoxing Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Yan Ge
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Yang
- Jiaozuo People's Hospital, Jiaozuo, Henan, China
| | - Taiping Wang
- Jincheng Emergency Center, Shanxi Province, China
| | - Patrick Kwan
- Department of Neuroscience, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - Wenzhi Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhen Hong
- Institute of Neurology, WHO Collaborating Center for Research and Training in Neurosciences, Huashan Hospital, Fudan University, Shanghai, China
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, Heemstede, 2103 SW, the Netherlands
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Desai VR, Gadgil N, Saad S, Raskin JS, Lam SK. Measures of Health-Related Quality of Life Outcomes in Pediatric Neurosurgery: Literature Review. World Neurosurg 2018; 122:252-265. [PMID: 30399472 DOI: 10.1016/j.wneu.2018.10.194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/25/2018] [Accepted: 10/27/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Improving value in healthcare means optimizing outcomes and minimizing costs. The emerging pay-for-performance era requires understanding of the effect of healthcare services on health-related quality of life (HRQoL). Pediatric and surgical subspecialties have yet to fully integrate HRQoL measures into practice. The present study reviewed and characterized the HRQoL outcome measures across various pediatric neurosurgical diagnoses. METHODS A literature review was performed by searching PubMed and Google Scholar with search terms such as "health-related quality of life" and "pediatric neurosurgery" and then including the specific pathologies for which a HRQoL instrument was found (e.g., "health-related quality of life" plus "epilepsy"). Each measurement was evaluated by content and purpose, relative strengths and weaknesses, and validity. RESULTS We reviewed 68 reports. Epilepsy, brain tumor, cerebral palsy, spina bifida, hydrocephalus, and scoliosis were diagnoses found in reported studies that had used disease-specific HRQoL instruments. Information using general HRQoL instruments was also reported. Internal, test-retest, and/or interrater reliability varied across the instruments, as did face, content, concurrent, and/or construct validity. Few instruments were tested enough for robust reliability and validity. Significant variability was found in the usage of these instruments in clinical studies within pediatric neurosurgery. CONCLUSIONS The HRQoL instruments used in pediatric neurosurgery are currently without standardized guidelines and thus exhibit high variability in use. Clinicians should support the development and application of these methods to optimize these instruments, promote standardization of research, improve performance measures to reflect clinically modifiable and meaningful outcomes, and, ultimately, lead the national discussion in healthcare quality and patient-centered care.
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Affiliation(s)
- Virendra R Desai
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
| | - Nisha Gadgil
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Shahbaz Saad
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jeffrey S Raskin
- Division of Pediatric Neurosurgery, Riley Hospital for Children, Indianapolis, Indiana, USA; Department of Neurosurgery, Goodman Campbell Brain and Spine, Indiana University, Indianapolis, Indiana, USA
| | - Sandi K Lam
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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Raffin EP, Penniston KL, Antonelli JA, Viprakasit DP, Averch TD, Bird VG, Chew BH, Sivalingam S, Sur RL, Nakada SY, Pais VM. The Effect of Thiazide and Potassium Citrate Use on the Health Related Quality of Life of Patients with Urolithiasis. J Urol 2018; 200:1290-1294. [PMID: 29913138 DOI: 10.1016/j.juro.2018.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To our knowledge it is unknown whether the benefits of medical management of urolithiasis outweigh the potential side effects of the medications used, including potassium citrate and thiazide diuretics. Therefore, we evaluated the relationship between potassium citrate or thiazides and overall stone related health related quality of life. MATERIALS AND METHODS Cross-sectional data were obtained on stone forming enrollees in the North American Stone Quality of Life Consortium. We used the WISQOL (Wisconsin Stone Quality of Life) questionnaire to compare health related quality of life between patients treated and not treated with potassium citrate or thiazide type diuretics. Additionally, the likelihood of gastrointestinal complaints was compared between those prescribed and not prescribed potassium citrate. The likelihood of fatigue and sexual complaints was also compared in those prescribed and not prescribed thiazides. RESULTS Of the 1,511 subjects, including 787 males and 724 females, 279 were on potassium citrate and 238 were on thiazides at study enrollment. Patients prescribed potassium citrate had higher health related quality of life in each domain vs those not prescribed potassium citrate (p <0.001). Patients prescribed thiazides had higher health related quality of life in each domain compared to those not prescribed thiazide (all p <0.01). Those prescribed potassium citrate were less likely than those not prescribed potassium citrate to report nausea, stomach upset or cramps (OR 0.57, p <0.001). Patients prescribed thiazides were less likely than those not prescribed thiazides to report fatigue (OR 0.63, p = 0.004) or reduced sexual interest and/or activity (OR 0.64, p = 0.005). CONCLUSIONS Among stone formers the use of potassium citrate and thiazides was associated with better health related quality of life across all WISQOL domains without an increased likelihood of gastrointestinal complaints and fatigue or sexual complaints, respectively. These findings may be useful when counseling patients regarding the initiation of potassium citrate or thiazides for medical management of nephrolithiasis.
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Affiliation(s)
- Eric P Raffin
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Kristina L Penniston
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Davis P Viprakasit
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Timothy D Averch
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Vincent G Bird
- University of Florida College of Medicine, Gainesville, Florida
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sri Sivalingam
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Roger L Sur
- University of California-San Diego School of Medicine, San Diego, California
| | - Stephen Y Nakada
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Vernon M Pais
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
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19
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Almalag HM, Alzahrani H, Al-Hussain F, Alsemari A, De Vol EB, Almarzouqi MR, AlRuthia YS. The impact of old versus new antiepileptic drugs on costs and patient reported outcomes among older adults. Geriatr Nurs 2018; 39:669-675. [PMID: 29859697 DOI: 10.1016/j.gerinurse.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/04/2018] [Indexed: 12/30/2022]
Abstract
The aim of this prospective questionnaire-based cross-sectional study was to examine whether the new generation of Antiepileptic drugs (AEDs) with higher acquisition cost generate lower adverse effects than the old AEDs among a sample of 102 Arabic-speaking older adults (60 years of age or older) with seizure disorders. The mean scores of the Arabic version of the Liverpool Adverse Events Profile (LAEP), which assessed the adverse effects of the AEDs, did not differ between patients taking the old and new generations of AEDs. Despite their 4-fold higher cost, the new generation of AEDs were not characterized by lower LAEP scores of adverse effects. However, higher LAEP scores were associated with better health literacy. In conclusion, the use of new AEDs was not associated with lower self-reported adverse effects scores among Arabic-speaking older adults with seizure disorders despite their higher acquisition costs.
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Affiliation(s)
- Haya M Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Huda Alzahrani
- Department of Pharmacy, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fawaz Al-Hussain
- Department of Medicine, Neurology Division, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alsemari
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Edward B De Vol
- Department of Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Manal Rashed Almarzouqi
- Department of Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Yazed S AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
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20
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Zhao T, Gao Y, Zhu X, Wang N, Chen Y, Zhang J, He G, Feng Y, Xu J, Han X, Zhang J. Awareness, attitudes toward epilepsy, and first aid knowledge of seizures of hospital staff in Henan, China. Epilepsy Behav 2017; 74:144-148. [PMID: 28738284 DOI: 10.1016/j.yebeh.2017.06.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study was to evaluate awareness of, attitudes toward, and first aid knowledge of seizures of hospital staff in Henan, China. METHOD Two hundred nineteen hospital staff, including doctors, nurses, medical technicians, logisticians, and executives working at tertiary hospitals in Henan, China, completed the survey from March to September in 2016. The data comprised the demographic data section, awareness of epilepsy section, attitude toward epilepsy section, and first aid knowledge of seizure attack section. RESULTS The participants obtained a mean score of 7.48±1.705 on the awareness of epilepsy section, and a mean score of 5.32±1.165 on the first aid knowledge of seizure attacks section. There were significant correlations between educational level (r=0.187, P=0.006), occupation (r=-0.244, P=0.000), and attitudes toward patients with epilepsy (r=0.351, P=0.000) with the awareness of epilepsy. There were significant correlations between age (r=0.170, P=0.014), educational status (r=0.139, P=0.040), and professional titles (r=0.197, P=0.004) with the first aid knowledge of seizures. CONCLUSION The study showed that hospital staff had a moderate level of knowledge regarding epilepsy, and they generally displayed a positive attitude. It was also determined that as the awareness of epilepsy increased, they displayed more positive attitudes toward patients with epilepsy. The study also suggests that specialists working on epilepsy should provide more lectures and educational sessions to improve the knowledge of and attitude toward epilepsy and first aid knowledge of seizures among hospital staff.
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Affiliation(s)
- Ting Zhao
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Yajuan Gao
- Department of Clinical Medicine, Zhengzhou University, Zhengzhou 450000, China
| | - Xuerui Zhu
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Na Wang
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Yanan Chen
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Jiahui Zhang
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Guinv He
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Yan Feng
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Jun Xu
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China.
| | - Jiewen Zhang
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
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21
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Beamer E, Fischer W, Engel T. The ATP-Gated P2X7 Receptor As a Target for the Treatment of Drug-Resistant Epilepsy. Front Neurosci 2017; 11:21. [PMID: 28210205 PMCID: PMC5288361 DOI: 10.3389/fnins.2017.00021] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/11/2017] [Indexed: 12/15/2022] Open
Abstract
Despite the progress made in the development of new antiepileptic drugs (AEDs), the biggest challenges that epilepsy presents to drug development have remained unchanged for the last 80 years: finding a treatment with potential for modifying disease progression and reducing the percentage of patients resistant to all pharmacological interventions. The mechanism of action of the majority of AEDs is based on blocking Na+ and/or Ca2+ channels, promotion of GABA or inhibition of glutamate signaling. In order for further progress to be made, however, a fuller picture of epilepsy will need to be considered, including changes to blood–brain barrier permeability, synaptic plasticity, network reorganization, and gliosis. In particular, brain inflammation has attracted much attention over recent years. Emerging evidence demonstrates a causal role for brain inflammation in lowering seizure thresholds and driving epileptogenesis. Consistent with this, intervening in pro-inflammatory cascades has shown promise in animal models of epilepsy, with clinical trials of anti-inflammatory agents already underway. The ATP-gated purinergic P2X7 receptor (P2X7) has been proposed as a novel drug target for a host of neurological conditions, including epilepsy. Constitutive expression of P2X7 in the CNS is mainly on microglia, but neuronal and astroglial expression has also been suggested. Its function as a gatekeeper of inflammation is most clearly understood, however, it also plays a number of other important roles pertinent to icto- and epileptogenesis: depolarization of the cell membrane, release of macromolecules, induction of apoptosis and synaptic reorganization. Changes in P2X7 expression have been reported following prolonged seizures (status epilepticus) and during chronic epilepsy in both experimental models and patients. While much of the early work focused on the study of P2X7 during status epilepticus, there is now mounting data showing involvement of this receptor during epilepsy. The present short review will discuss the most recent findings concerning P2X7 expression and function during epilepsy and the clinical potential for P2X7 antagonists as novel AEDs.
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Affiliation(s)
- Edward Beamer
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland Dublin, Ireland
| | - Wolfgang Fischer
- Medical Faculty, Rudolf-Boehm-Institute of Pharmacology and Toxicology, University of Leipzig Leipzig, Germany
| | - Tobias Engel
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland Dublin, Ireland
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