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Yu X, Yang H, Lv H, Lu H, Zhao H, Xu Z. Age-Dependent Phenomena of 6-Hz Corneal Kindling Model in Mice. Mol Neurobiol 2024; 61:5601-5613. [PMID: 38214837 DOI: 10.1007/s12035-024-03934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
Although numerous studies have acknowledged disparities in epilepsy-related disease processes between young and aged animals, little is known about how epilepsy changes from young adulthood to middle age. This study investigates the impact of aging on 6-Hz corneal kindling in young-adult mice and middle-aged mice. We found that the kindling acquisition of the 6-Hz corneal kindling model was delayed in middle-aged mice when compared to young-adult mice. While the seizure stage and incidence of generalized seizures (GS) were similar between the two age groups, the duration of GS in the kindled middle-aged mice was shorter than that in the kindled young-adult mice. Besides, all kindled mice, regardless of age, were resistant to phenytoin sodium (PHT), valproate sodium (VPA), and lamotrigine (LGT), whereas middle-aged mice exhibited higher levetiracetam (LEV) resistance compared to young-adult mice. Both age groups of kindled mice displayed hyperactivity and impaired memory, which are common behavioral characteristics associated with epilepsy. Furthermore, middle-aged mice displayed more pronounced astrogliosis in the hippocampus. Additionally, the expression of Brain-Derived Neurotrophic Factor (BDNF) was lower in middle-aged mice than in young-adult mice prior to kindling. These data demonstrate that both the acquisition and expression of 6-Hz corneal kindling are attenuated in middle-aged mice, while hippocampal astrogliosis and pharmacological resistance are more pronounced in this age group. These results underscore the importance of considering age-related factors when utilizing the 6-Hz corneal kindling model in mice of varying age groups.
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Affiliation(s)
- Xiu Yu
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Han Yang
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - HongJie Lv
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haimei Lu
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huawei Zhao
- Department of Pharmacy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Zhenghao Xu
- Laboratory of Rheumatology & Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, No.548 Binwen Road, Hangzhou, Zhejiang, 310053, China.
- Key Laboratory of Chinese Medicine Rheumatology of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, College of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
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Wessel C, Candan FU, Panah PY, Karia S, Sah J, Mutchnick I, Karakas C. Efficacy of vagus nerve stimulation in managing drug-resistant absence epilepsy syndromes. Seizure 2024; 117:60-66. [PMID: 38330751 DOI: 10.1016/j.seizure.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Around 11% of patients with absence epilepsy develop drug-resistant absence epilepsy (DRAE), and are at increased risk for developing psychiatric and neurologic comorbidities. Current therapeutic options for DRAE are limited. The purpose of this study was to assess the efficacy of vagus nerve stimulation (VNS) in treating DRAE. METHODS Our institution maintains a database of patients who received VNS between 2010 and 2022. We identified DRAE patients who were <18 years of age at seizure onset, were electro-clinically diagnosed with an absence epilepsy syndrome (childhood absence, juvenile absence, or Jeavons Syndrome) by an epileptologist, and had normal brain imaging. The primary outcome measure was post-VNS absence seizure frequency. RESULTS Twenty-six patients (M/F:14/12) were identified. Median age at seizure onset was 7 years (IQR 4-10) and patients experienced seizures for 6 years (IQR 4.3-7.6) before VNS. After VNS, the median absence seizure frequency reduced to 1.5 days (IQR 0.1-3.5) per week from 7 days (IQR 7-7), a 66% reduction seizure frequency. VNS responder rate was 80%, and seven patients achieved seizure freedom. There was no significant effect on VNS efficacy between the time from DRAE diagnosis to VNS placement (p = 0.067) nor the time from first seizure onset to VNS implant (p = 0.80). The median follow-up duration was 4.1 years (IQR 2.4-6.7), without any significant association between follow-up duration and VNS efficacy (r2=0.023) CONCLUSIONS: VNS is effective in managing DRAE. The responder rate was 80%; seizure improvement was independent of age at both seizure onset and latency to VNS after meeting DRAE criteria.
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Affiliation(s)
- Caitlin Wessel
- University of Louisville School of Medicine, Louisville KY 40202, United States
| | - Feride Un Candan
- Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States
| | - Paya Yazdan Panah
- University of Louisville School of Medicine, Louisville KY 40202, United States
| | - Samir Karia
- University of Louisville School of Medicine, Louisville KY 40202, United States; Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States
| | - Jeetendra Sah
- University of Louisville School of Medicine, Louisville KY 40202, United States; Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States
| | - Ian Mutchnick
- University of Louisville School of Medicine, Louisville KY 40202, United States; University of Louisville Department of Neurosurgery, Louisville KY 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States
| | - Cemal Karakas
- University of Louisville School of Medicine, Louisville KY 40202, United States; Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville Kentucky 40202, United States; Norton Neuroscience Institute and Children's Hospital, 615 S Preston Street, 2nd floor, Louisville KY 40241, United States.
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Shanker OR, Kumar S, Banerjee J, Tripathi M, Chandra PS, Dixit AB. Role of non-receptor tyrosine kinases in epilepsy: significance and potential as therapeutic targets. Expert Opin Ther Targets 2024; 28:283-294. [PMID: 38629385 DOI: 10.1080/14728222.2024.2343952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Epilepsy is a chronic neurological condition characterized by a persistent propensity for seizure generation. About one-third of patients do not achieve seizure control with the first-line treatment options, which include >20 antiseizure medications. It is therefore imperative that new medications with novel targets and mechanisms of action are developed. AREAS COVERED Clinical studies and preclinical research increasingly implicate Non-receptor tyrosine kinases (nRTKs) in the pathogenesis of epilepsy. To date, several nRTK members have been linked to processes relevant to the development of epilepsy. Therefore, in this review, we provide insight into the molecular mechanisms by which the various nRTK subfamilies can contribute to the pathogenesis of epilepsy. We further highlight the prospective use of specific nRTK inhibitors in the treatment of epilepsy deriving evidence from existing literature providing a rationale for their use as therapeutic targets. EXPERT OPINION Specific small-molecule inhibitors of NRTKs can be employed for the targeted therapy as already seen in other diseases by examining the precise molecular pathways regulated by them contributing to the development of epilepsy. However, the evidence supporting NRTKs as therapeutic targets are limiting in nature thus, necessitating more research to fully comprehend their function in the development and propagation of seizures.
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Affiliation(s)
- Ozasvi R Shanker
- Dr. B.R. Ambedkar Centre for Biomedical Research (ACBR), University of Delhi, New Delhi, India
| | - Sonali Kumar
- Dr. B.R. Ambedkar Centre for Biomedical Research (ACBR), University of Delhi, New Delhi, India
| | - Jyotirmoy Banerjee
- Department of Biophysics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Aparna Banerjee Dixit
- Dr. B.R. Ambedkar Centre for Biomedical Research (ACBR), University of Delhi, New Delhi, India
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Qiao YN, Li L, Hu SH, Yang YX, Ma ZZ, Huang L, An YP, Yuan YY, Lin Y, Xu W, Li Y, Lin PC, Cao J, Zhao JY, Zhao SM. Ketogenic diet-produced β-hydroxybutyric acid accumulates brain GABA and increases GABA/glutamate ratio to inhibit epilepsy. Cell Discov 2024; 10:17. [PMID: 38346975 PMCID: PMC10861483 DOI: 10.1038/s41421-023-00636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 12/06/2023] [Indexed: 02/15/2024] Open
Abstract
Ketogenic diet (KD) alleviates refractory epilepsy and reduces seizures in children. However, the metabolic/cell biologic mechanisms by which the KD exerts its antiepileptic efficacy remain elusive. Herein, we report that KD-produced β-hydroxybutyric acid (BHB) augments brain gamma-aminobutyric acid (GABA) and the GABA/glutamate ratio to inhibit epilepsy. The KD ameliorated pentetrazol-induced epilepsy in mice. Mechanistically, KD-produced BHB, but not other ketone bodies, inhibited HDAC1/HDAC2, increased H3K27 acetylation, and transcriptionally upregulated SIRT4 and glutamate decarboxylase 1 (GAD1). BHB-induced SIRT4 de-carbamylated and inactivated glutamate dehydrogenase to preserve glutamate for GABA synthesis, and GAD1 upregulation increased mouse brain GABA/glutamate ratio to inhibit neuron excitation. BHB administration in mice inhibited epilepsy induced by pentetrazol. BHB-mediated relief of epilepsy required high GABA level and GABA/glutamate ratio. These results identified BHB as the major antiepileptic metabolite of the KD and suggested that BHB may serve as an alternative and less toxic antiepileptic agent than KD.
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Affiliation(s)
- Ya-Nan Qiao
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Lei Li
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Song-Hua Hu
- Department of Cell Biology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Yuan-Xin Yang
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Zhen-Zhen Ma
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Lin Huang
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Yan-Peng An
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Yi-Yuan Yuan
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Yan Lin
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Wei Xu
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Yao Li
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China
| | - Peng-Cheng Lin
- Key Laboratory for Tibet Plateau Phytochemistry of Qinghai Province, College of Pharmacy, Qinghai University for Nationalities, Xining, Qinghai, China
| | - Jing Cao
- Department of Anatomy, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Jian-Yuan Zhao
- Institute for Developmental and Regenerative Cardiovascular Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shi-Min Zhao
- The Obstetrics & Gynaecology Hospital of Fudan University, State Key Laboratory of Genetic Engineering, Shanghai Key Laboratory of Metabolic Remodelling and Health, Institutes of Biomedical Sciences, and Children's Hospital of Fudan University, Fudan University, Shanghai, China.
- Department of Cell Biology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA.
- Key Laboratory for Tibet Plateau Phytochemistry of Qinghai Province, College of Pharmacy, Qinghai University for Nationalities, Xining, Qinghai, China.
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Rukhsar S, Tiwari AK. Lightweight convolution transformer for cross-patient seizure detection in multi-channel EEG signals. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 242:107856. [PMID: 37857026 DOI: 10.1016/j.cmpb.2023.107856] [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: 07/24/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Epilepsy is a neurological illness affecting the brain that makes people more likely to experience frequent, spontaneous seizures. There has to be an accurate automated method for measuring seizures frequency and severity to assess the efficacy of pharmacological therapy for epilepsy. The drug quantities are often derived from patient reports which may cause significant issues owing to inadequate or inaccurate descriptions of seizures and their frequencies. METHODS AND MATERIALS This study proposes a novel deep learning architecture-based Lightweight Convolution Transformer (LCT). The Transformer model is able to learn spatial and temporal correlated information simultaneously from the multi-channel electroencephalogram (EEG) signal to detect seizures at smaller segment lengths. In the proposed work, the lack of translation equivariance and localization of ViT is reduced using convolution tokenization, and rich information from the Transformer encoder is extracted by sequence pooling instead of the learnable class token. RESULTS Extensive experimental results demonstrate that the proposed model on cross-patient learning can effectively detect seizures from the raw EEG signals. The accuracy and F1-score of seizure detection in the cross-patient case on the CHB-MIT dataset are 96.31% and 96.32%, respectively, at 0.5 sec segment length. In addition, the performance metrics show that the inclusion of inductive biases and attention-based pooling in the model enhances the performance and reduces the number of Transformer encoder layers, which significantly reduces the computational complexity. In this research, we provide a novel approach to enhance efficiency and simplify the architecture for multi-channel automated seizure detection.
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Affiliation(s)
- Salim Rukhsar
- Department of Electrical Engineering, Indian Institute of Technology Jodhpur, Rajasthan, 342030, India.
| | - Anil Kumar Tiwari
- Department of Electrical Engineering, Indian Institute of Technology Jodhpur, Rajasthan, 342030, India
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Mir A, Jallul T, Alotaibi F, Amer F, Najjar A, Alhazmi R, Al Faraidy M, Alharbi A, Aldurayhim F, Barnawi Z, Fallatah B, Ali M, Almuhaish H, Almolani F, Suwailem A, Tuli M, Naim A, Hassan S, Hedgcock B, Bostanji G, Bashir S, AlBaradie R. Outcomes of resective surgery in pediatric patients with drug-resistant epilepsy: A single-center study from the Eastern Mediterranean Region. Epilepsia Open 2023; 8:930-945. [PMID: 37162422 PMCID: PMC10472393 DOI: 10.1002/epi4.12761] [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: 02/02/2023] [Accepted: 05/07/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE Epilepsy surgery is widely accepted as an effective therapeutic option for carefully selected patients with drug-resistant epilepsy (DRE). There is limited data on the outcome of epilepsy surgery, especially in pediatric patients from the Eastern Mediterranean region. Hence, we performed a retrospective study examining the outcomes of resective surgery in 53 pediatric patients with focal DRE. METHODS Patients with focal DRE who had undergone epilepsy surgery were included in the present study. All patients underwent a comprehensive presurgical evaluation. Postoperative seizure outcomes were classified using the Engel Epilepsy Surgery Outcome Scale. RESULTS After surgery, 33 patients (62.2%) were Class I according to the Engel classification of surgical outcomes; eight patients (15.0%) were Class II, 11 (20.7%) were Class III, and one (1.8%) was Class IV. The relationships of presurgical, surgical, and postsurgical clinical variables to seizure outcomes were compared. Older age at seizure onset, older age at the time of surgery, the presence of focal to bilateral tonic-clonic seizures, seizure duration over 2 minutes, unsuccessful treatment with three or fewer antiseizure medications, lesions confined to one lobe (as demonstrated via magnetic resonance imaging [MRI]), surgical site in the temporal lobe, and histopathology including developmental tumors were significantly linked to an Engel Class I outcome. A univariate analysis of excellent surgical outcomes showed that lateralized semiology, localized interictal and ictal electroencephalogram (EEG) discharges, lateralized single-photon emission computed tomography and positron emission tomography findings, and temporal lobe resections were significantly related to excellent seizure outcomes. SIGNIFICANCE The results of our study are encouraging and similar to those found in other centers around the world. Epilepsy surgery remains an underutilized treatment for children with DRE and should be offered early.
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Affiliation(s)
- Ali Mir
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Tarek Jallul
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Faisal Alotaibi
- Neuroscience CentreKing Faisal Specialist Hospital and Research CenterRiyadhSaudi Arabia
| | - Fawzia Amer
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
- Department of Pediatric Neurology and MetabolicCairo University Children HospitalCairoEgypt
| | - Ahmed Najjar
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
- Department of Surgery, College of MedicineTaibah UniversityAlmadinah AlmunawwarahSaudi Arabia
| | - Rami Alhazmi
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Mona Al Faraidy
- Anesthesia DepartmentKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Alanoud Alharbi
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Fatimah Aldurayhim
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Zakia Barnawi
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Bassam Fallatah
- Department of NeurosurgeryKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Mona Ali
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Husam Almuhaish
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Fadhel Almolani
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Abdullah Suwailem
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Mahmoud Tuli
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Abdulrahman Naim
- Department of Medical ImagingKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Suad Hassan
- Department of Mental HealthKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Brent Hedgcock
- Department of NeurophysiologyKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Ghadah Bostanji
- Department of Social WorkKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Shahid Bashir
- Neuroscience CentreKing Fahad Specialist HospitalDammamSaudi Arabia
| | - Raidah AlBaradie
- Department of Pediatric NeurologyKing Fahad Specialist HospitalDammamSaudi Arabia
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Quiroga-Padilla PJ, Briceño C, Mayor LC. Effect of the modified Atkins diet in adults with drug-resistant epilepsy: A controlled study. Epilepsy Behav 2022; 136:108936. [PMID: 36215831 DOI: 10.1016/j.yebeh.2022.108936] [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: 06/28/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 12/14/2022]
Abstract
The objective of this study was to be a proof of concept of an analysis strategy to assess the effectiveness of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy (DRE). This retrospective cohort study included participants aged >16 years with at least two failed antiseizure medications (ASMs). The variables were self-reported and gathered from medical records or phone calls. Two groups are compared: MAD adjuvant to ASM (diet group) and ASM only (control). To make both groups comparable, diet and control groups were matched (1:2) by predictors of seizure remission (PSR) in adults with DRE. A systematic review of the literature was conducted to establish PSR. A total of 127 patients were eligible. Forty-six participants (36 %) initiated the MAD, but only 28 (22 %) continued the diet after 3 months. The number of past and new ASMs, epilepsy type, and follow-up time were selected as PSR. Twelve patients were included in the diet group and 24 in the control group, matched by PSR. Compared with the control group, the diet group had 4.5 greater odds of achieving ≥50 % seizure frequency reduction at 1-3 months (OR 5.5; 90 % confidence interval 1.1-26.65). Mean seizure frequency and other secondary outcomes did not differ significantly between the groups. In summary, the MAD showed a modest effect over seizure control compared with only ASM. Matching by PSR could be an alternative analysis approach to determine the effectiveness of the ketogenic diet in controlled studies. Additional studies are required to validate the analysis proposed.
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Affiliation(s)
- Pedro J Quiroga-Padilla
- Diabetes, Lipids and Metabolism Laboratory, Faculty of Medicine, Universidad de los Andes, Bogotá D.C. 111021, Colombia.
| | - Claudia Briceño
- Department of Nutrition, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá D.C. 110111, Colombia
| | - Luis C Mayor
- Epilepsy Clinic, Department of Neurology, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá D.C. 110111, Colombia; Faculty of Medicine, Universidad de los Andes, Bogotá D.C. 111021, Colombia.
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Kapar O, Gurkan ZM, Dolgun M, Sencer A, Gürses C, Bilgic B. Focal cortical dysplasia pathology: diagnostic difficulty, classification, and utility for pathogenesis. Neurosurg Focus 2022; 53:E6. [DOI: 10.3171/2022.7.focus21731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 07/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE
In the histopathological examination of treatment-resistant epilepsy, focal cortical dysplasia (FCD) is the most common diagnosis in the pediatric group. FCD is classified histopathologically according to the International League Against Epilepsy (ILAE) classification. In the last decade since the ILAE classification has been released, molecular genetic studies have revealed mTOR pathway–related mutations as a major etiology. The objective of this study was to determine the incidence of FCD in treatment-resistant epilepsy patients, explore histomorphological and immunohistochemical features, examine clinicopathological correlation, demonstrate mTOR pathway activation using a pS6 antibody immunohistochemically, and try to introduce a candidate for possible targeted therapies.
METHODS
Paraffin blocks and slides of tissue from patients with treatment-resistant epilepsy were reexamined retrospectively. Histopathological subtypes of FCD were determined according to the ILAE classification. NeuN and neurofilament H (NF-H) staining were performed, and additionally a pS6 antibody was used to demonstrate mTOR pathway activation.
RESULTS
In 32 cases diagnosed with FCD, or 17.5% of 183 surgical epilepsy materials, there were no significant differences in the statistical analysis of clinical variables between the ILAE FCD subtypes. Recommended antibody NeuN revealed microcolumnar alignment in the FCD type Ia and IIIa groups and the loss of lamination in the type Ib group. Another recommended antibody, NF-H, was not found to be useful in discriminating between normal and dysmorphic neurons. pS6 expression, showing mTOR pathway activation, was observed in dysmorphic neurons and balloon cells in all FCD type II cases.
CONCLUSIONS
Significant pS6 expression in FCD type II represents the genomic nature of the disease noted in the literature. Nevertheless, the known MTOR gene and mTOR pathway–related mutations remain behind proportionally to explain the mTOR pathway activation in all FCD type II cases. Clinicopathologically and genetically integrated classification and usage of mTOR pathway inhibitors in treatment are expected as a recent evolution.
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Affiliation(s)
- Ozge Kapar
- Department of Pathology, Istanbul University
| | - Zahide Mail Gurkan
- Department of Neurology and Clinical Neurophysiology, Istanbul University
| | - Muge Dolgun
- Department of Neurosurgery, Sultangazi Haseki Training and Research Hospital
| | - Altay Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University; and
| | - Candan Gürses
- Department of Neurology, Koc University, Istanbul, Turkey
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Lescrauwaet E, Vonck K, Sprengers M, Raedt R, Klooster D, Carrette E, Boon P. Recent Advances in the Use of Focused Ultrasound as a Treatment for Epilepsy. Front Neurosci 2022; 16:886584. [PMID: 35794951 PMCID: PMC9251412 DOI: 10.3389/fnins.2022.886584] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
Epilepsy affects about 1% of the population. Approximately one third of patients with epilepsy are drug-resistant (DRE). Resective surgery is an effective treatment for DRE, yet invasive, and not all DRE patients are suitable resective surgery candidates. Focused ultrasound, a novel non-invasive neurointerventional method is currently under investigation as a treatment alternative for DRE. By emitting one or more ultrasound waves, FUS can target structures in the brain at millimeter resolution. High intensity focused ultrasound (HIFU) leads to ablation of tissue and could therefore serve as a non-invasive alternative for resective surgery. It is currently under investigation in clinical trials following the approval of HIFU for essential tremor and Parkinson’s disease. Low intensity focused ultrasound (LIFU) can modulate neuronal activity and could be used to lower cortical neuronal hyper-excitability in epilepsy patients in a non-invasive manner. The seizure-suppressive effect of LIFU has been studied in several preclinical trials, showing promising results. Further investigations are required to demonstrate translation of preclinical results to human subjects.
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Affiliation(s)
- Emma Lescrauwaet
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
- *Correspondence: Emma Lescrauwaet,
| | - Kristl Vonck
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Mathieu Sprengers
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Robrecht Raedt
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Debby Klooster
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Evelien Carrette
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Paul Boon
- 4Brain Lab, Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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10
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Dini G, Tulli E, Dell’Isola GB, Mencaroni E, Di Cara G, Striano P, Verrotti A. Improving Therapy of Pharmacoresistant Epilepsies: The Role of Fenfluramine. Front Pharmacol 2022; 13:832929. [PMID: 35668937 PMCID: PMC9164301 DOI: 10.3389/fphar.2022.832929] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/29/2022] [Indexed: 01/24/2023] Open
Abstract
Epilepsy is among the most common neurological chronic disorders, with a prevalence of 0.5-1%. Despite the introduction of new antiepileptic drugs during recent years, about one third of the epileptic population remain drug-resistant. Hence, especially in the pediatric population limited by different pharmacokinetics and pharmacodynamics and by ethical and regulatory issues it is needed to identify new therapeutic resources. New molecules initially used with other therapeutic indications, such as fenfluramine, are being considered for the treatment of pharmacoresistant epilepsies, including Dravet Syndrome (DS) and Lennox-Gastaut Syndrome (LGS). Drug-refractory seizures are a hallmark of both these conditions and their treatment remains a major challenge. Fenfluramine is an amphetamine derivative that was previously approved as a weight loss drug and later withdrawn when major cardiac adverse events were reported. However, a new role of fenfluramine has emerged in recent years. Indeed, fenfluramine has proved to be a promising antiepileptic drug with a favorable risk-benefit profile for the treatment of DS, LGS and possibly other drug-resistant epileptic syndromes. The mechanism by which fenfluramine provide an antiepileptic action is not fully understood but it seems to go beyond its pro-serotoninergic activity. This review aims to provide a comprehensive analysis of the literature, including ongoing trials, regarding the efficacy and safety of fenfluramine as adjunctive treatment of pharmacoresistant epilepsies.
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Affiliation(s)
- Gianluca Dini
- Department of Pediatrics, University of Perugia, Genoa, Italy,*Correspondence: Gianluca Dini,
| | - Eleonora Tulli
- Department of Pediatrics, University of Perugia, Genoa, Italy
| | | | | | | | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS “G. Gaslini” Institute, Genoa, Italy,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
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11
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Singh A. Cenobamate for treatment-resistant focal seizures: current evidence and place in therapy. J Cent Nerv Syst Dis 2022; 14:11795735211070209. [PMID: 35282314 PMCID: PMC8905054 DOI: 10.1177/11795735211070209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background Cenobamate is newly approved for partial-onset seizures in adults, albeit the mechanism of its action remain poorly understood. Methods This article aims to review the efficacy, safety, and tolerability of cenobamate in treating partial-onset seizures. Data Collection: The English language articles were searched in the National Institute of Health clinical trials registry, PubMed, and the Cochrane library between 2010 and June 2021 using the keywords cenobamate, YKP 3089, and seizure, and filter “trial” was applied. Results: A total of 31 articles were retrieved. Eventually, two randomized, double-blind, multicenter clinical trials involving 659 patients were analyzed. Cenobamate has shown significant reduction in seizure frequency compared to placebo. In cenobamate group, a greater number of participants showed ≥50% reduction in seizure frequency, adverse effects, and drug discontinuation compared to placebo. Multiple drug-drug interactions with other anti-seizure drugs were also observed. Conclusions Based on the findings of these trials, cenobamate seems to be an attractive option for treatment-resistant partial-onset seizures; however, multiple treatment-related adverse effects and drug-drug interactions are the areas of concern.
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Affiliation(s)
- Alok Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, India
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12
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Mikellides G, Michael P, Gregoriou A, Schuhmann T, Sack AT. Bilateral Orbitofrontal Repetitive Transcranial Magnetic Stimulation in Frontal Lobe Epilepsy: A Case Report. Case Rep Neurol 2021; 13:729-737. [PMID: 34950012 PMCID: PMC8647097 DOI: 10.1159/000520257] [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: 07/09/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022] Open
Abstract
Epilepsy is a common and severe neurological disorder affecting millions of people worldwide. Nowadays, antiseizure medications (ASMs) are the main treatment for most epilepsy patients, although many of them do not respond to ASMs and suffer from drug-resistant epilepsy (DRE). Alternative and novel treatment methods have been offered nowadays, showing promising results for the treatment of DRE. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method that has become increasingly popular in the last decades. This article reports a patient with frontal lobe epilepsy. We aimed to investigate whether bilateral orbitofrontal (OFC) low-frequency rTMS (LF-rTMS) is feasible and tolerable, safe, and potentially clinically effective in treating epileptic seizures. The patient's satisfaction with rTMS therapy was self-reported to be high, as rTMS helped in reducing the frequency of the focal attacks and completely abolished the preceding feeling of fear and panic. Therefore, bilateral OFC rTMS treatment can be well tolerated in patients with frontal epilepsy although the findings of the present case report with regard to clinical efficacy warrant further investigation.
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Affiliation(s)
- Georgios Mikellides
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Cyprus rTMS Centre, Larnaca, Cyprus
| | | | - Angelos Gregoriou
- Consultant Neurologist and Epileptologist, Aretaeio Private Hospital, Nicosia, Cyprus
| | - Teresa Schuhmann
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Alexander T Sack
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain+Nerve Centre, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
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13
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Limotai C, Jirasakuldej S. Perampanel treatment in highly drug-resistant epilepsies including nonsurgical candidates and failed surgery. Epilepsy Behav 2021; 121:108073. [PMID: 34058494 DOI: 10.1016/j.yebeh.2021.108073] [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: 02/04/2021] [Revised: 04/19/2021] [Accepted: 05/11/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and tolerability of perampanel (PER) treatment for patients with highly drug-resistant epilepsies (HDRE) including nonsurgical candidates and failed surgery in real-world setting. METHODS All patients who were treated with PER during June 2015 to August 2019 were selected. Primary outcomes were percentage of seizure reduction, responder rate, and seizure freedom rate. Seizure frequency after taking PER at 3 and 12 months were compared with baseline seizure frequency within the same time period prior to starting PER. Secondary outcomes were retention rate, side effects, and predictors for a response to PER. Descriptive statistics and the Kernel regression model were employed. RESULTS Forty-one patients received PER treatment during the study period. Six patients who had no baseline seizure frequency recordings were excluded, for a total of 35 patients included for analysis. Mean age was 40.06 years (SD 12.34). All were highly resistant to several antiseizure drugs (ASDs) with a median number of previously failed ASDs of 8 items. Eleven, 16, 5, and 3 patients were lesional, nonlesional focal epilepsy, nonsurgical candidate, and failed surgery, respectively. At 3 months after PER treatment, the median percentage of seizure reduction was 20 % (-35.71, 100), the responder rate was 22.86 % (8/35), and the seizure freedom rate was 17.14% (6/35). At 12 months after PER treatment, the corresponding outcomes were 25% (-20.57, 91.60), 22.58% (7/31), and 9.68% (3/31), respectively. Retention rates at 3 and 12 months were 100% and 91.43% (32/35), respectively. Nineteen patients (54.29%) experienced side effects from PER. Side effects were somnolence (6/35), dizziness (3/35), irritability (2/35), and ataxia (2/35), and one each for weight loss, nausea, headache, insomnia, verbal aggressivity, and depression. Median duration for 2-mg dose increment was 2.2 months. CONCLUSIONS In real-world practice, slow-titration PER regimen is well-tolerable and shows benefit in helping control seizures in patients with very difficult-to-treat HDRE.
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Affiliation(s)
- Chusak Limotai
- Chulalongkorn Comprehensive Epilepsy Center of Excellence (CCEC), King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand; Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Suda Jirasakuldej
- Chulalongkorn Comprehensive Epilepsy Center of Excellence (CCEC), King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand; Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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14
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Fattorusso A, Matricardi S, Mencaroni E, Dell'Isola GB, Di Cara G, Striano P, Verrotti A. The Pharmacoresistant Epilepsy: An Overview on Existent and New Emerging Therapies. Front Neurol 2021; 12:674483. [PMID: 34239494 PMCID: PMC8258148 DOI: 10.3389/fneur.2021.674483] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/27/2021] [Indexed: 12/21/2022] Open
Abstract
Epilepsy is one of the most common neurological chronic disorders, with an estimated prevalence of 0. 5 - 1%. Currently, treatment options for epilepsy are predominantly based on the administration of symptomatic therapy. Most patients are able to achieve seizure freedom by the first two appropriate drug trials. Thus, patients who cannot reach a satisfactory response after that are defined as pharmacoresistant. However, despite the availability of more than 20 antiseizure medications (ASMs), about one-third of epilepsies remain drug-resistant. The heterogeneity of seizures and epilepsies, the coexistence of comorbidities, and the broad spectrum of efficacy, safety, and tolerability related to the ASMs, make the management of these patients actually challenging. In this review, we analyze the most relevant clinical and pathogenetic issues related to drug-resistant epilepsy, and then we discuss the current evidence about the use of available ASMs and the alternative non-pharmacological approaches.
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Affiliation(s)
- Antonella Fattorusso
- Department of Medicine and Surgery, Pediatric Clinic, University of Perugia, Perugia, Italy
| | - Sara Matricardi
- Child Neurology and Psychiatry Unit, Children's Hospital “G. Salesi”, Ospedali Riuniti Ancona, Ancona, Italy
| | - Elisabetta Mencaroni
- Department of Medicine and Surgery, Pediatric Clinic, University of Perugia, Perugia, Italy
| | | | - Giuseppe Di Cara
- Department of Medicine and Surgery, Pediatric Clinic, University of Perugia, Perugia, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS “G. Gaslini” Institute, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Alberto Verrotti
- Department of Medicine and Surgery, Pediatric Clinic, University of Perugia, Perugia, Italy
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15
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Sadanandan N, Saft M, Gonzales-Portillo B, Borlongan CV. Multipronged Attack of Stem Cell Therapy in Treating the Neurological and Neuropsychiatric Symptoms of Epilepsy. Front Pharmacol 2021; 12:596287. [PMID: 33815100 PMCID: PMC8010689 DOI: 10.3389/fphar.2021.596287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
Epilepsy stands as a life-threatening disease that is characterized by unprovoked seizures. However, an important characteristic of epilepsy that needs to be examined is the neuropsychiatric aspect. Epileptic patients endure aggression, depression, and other psychiatric illnesses. Therapies for epilepsy can be divided into two categories: antiepileptic medications and surgical resection. Antiepileptic drugs are used to attenuate heightened neuronal firing and to lessen seizure frequency. Alternatively, surgery can also be conducted to physically cut out the area of the brain that is assumed to be the root cause for the anomalous firing that triggers seizures. While both treatments serve as viable approaches that aim to regulate seizures and ameliorate the neurological detriments spurred by epilepsy, they do not serve to directly counteract epilepsy's neuropsychiatric traits. To address this concern, a potential new treatment involves the use of stem cells. Stem cell therapy has been employed in experimental models of neurological maladies, such as Parkinson's disease, and neuropsychiatric illnesses like depression. Cell-based treatments for epilepsy utilizing stem cells such as neural stem cells (NSCs), mesenchymal stem cells (MSCs), and interneuron grafts have been explored in preclinical and clinical settings, highlighting both the acute and chronic stages of epilepsy. However, it is difficult to create an animal model to capitalize on all the components of epilepsy due to the challenges in delineating the neuropsychiatric aspect. Therefore, further preclinical investigation into the safety and efficacy of stem cell therapy in addressing both the neurological and the neuropsychiatric components of epilepsy is warranted in order to optimize cell dosage, delivery, and timing of cell transplantation.
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Affiliation(s)
| | | | | | - Cesar V. Borlongan
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, United States
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16
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Liu YT, Chen GT, Huang YC, Ho JT, Lee CC, Tsai CC, Chang CN. Effectiveness of dose-escalated topiramate monotherapy and add-on therapy in neurosurgery-related epilepsy: A prospective study. Medicine (Baltimore) 2020; 99:e23771. [PMID: 33350762 PMCID: PMC7769361 DOI: 10.1097/md.0000000000023771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Lesional and symptomatic causes of epilepsy are the most common neurological disorders of the brain. Topiramate effectively controls newly diagnosed epilepsy and refractory focal seizures, but high-dose topiramate does not improve seizure control. This study aimed to evaluate the clinical efficacy and safety of dose-escalated topiramate as first-line monotherapy and add-on therapy in patients with neurosurgery-related epilepsy. MATERIAL AND METHODS A total of 55 neurosurgical patients with epilepsy were divided into monotherapy and add-on therapy groups and both groups received topiramate via the dose-escalation method. The primary efficacy outcomes were seizure-free rate and seizure response rate. Adverse events and seizure frequency were recorded. RESULTS The seizure response rate in the first month of monotherapy was significantly better than that of add-on therapy (89% vs 65%, P < .05), but no significant differences were found in seizure response rates between the 2 groups after 2 months of treatment. Both monotherapy and add-on therapy were effective in controlling seizures, with mean seizure frequency of 0.725 vs 0.536 and seizure-free rate of 88% vs 78.6%. Both treatments showed good improvement of seizure frequency in patients without tumor. The efficacy of monotherapy was better than that of add-on therapy (80% vs 29.2%) in patients with body mass index (BMI) ≤24. However, add-on therapy was better than monotherapy (76.7% vs 21.4%) in patients with BMI > 24. Dizziness (25.5%) and headache (16.4%) were the most common adverse events. No severe adverse event such as cognitive impairment was observed. CONCLUSIONS Dose-escalated topiramate monotherapy and add-on therapy demonstrate good efficacy and safety, with fewer adverse events in seizure control in neurosurgical patients.
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Affiliation(s)
- Yu-Tse Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch and school of medicine
| | - Guo-Tai Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi Branch and school of medicine, Chang Gung University, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch and school of medicine
| | - Jih-Tsun Ho
- Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Branch and school of medicine
| | - Cheng-Chi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch and school of medicine
| | - Cheng-Chia Tsai
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi Branch and school of medicine, Chang Gung University, Taiwan
| | - Chen-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi Branch and school of medicine, Chang Gung University, Taiwan
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17
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Neves GS, Lunardi MS, Lin K, Rieger DK, Ribeiro LC, Moreira JD. Ketogenic diet, seizure control, and cardiometabolic risk in adult patients with pharmacoresistant epilepsy: a review. Nutr Rev 2020; 79:931-944. [PMID: 33230563 DOI: 10.1093/nutrit/nuaa112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pharmacoresistant epilepsy causes serious deleterious effects on the patient's health and quality of life. For this condition, a ketogenic diet (KD) is a treatment option. The KD is a general term for a set of diets that contain high amounts of fat and low content of carbohydrates. The most prominent KD treatments are classical KD (4:1 ratio of fat to carbohydrate), modified Atkins diet (2:1 to 1:1 ratio), medium-chain triglycerides KD (with medium-chain triglyceride as a part of the fat content), and low glycemic index KD (using low glycemic carbohydrates). KD has been widely prescribed for children with epilepsy but not for adult patients. One of the main concerns about adult use of KD is its cardiovascular risk associated with high-fat and cholesterol intake. Therefore, this narrative review provides comprehensive information of the current literature on the effects of KD on lipid profile, glycemic-control biomarkers, and other cardiometabolic risk factors in adult patients with pharmacoresistant epilepsy.
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Affiliation(s)
- Gabriela S Neves
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Mariana S Lunardi
- Postgraduate Program in Medical Sciences, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Katia Lin
- Postgraduate Program in Medical Sciences, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Débora Kurrle Rieger
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Letícia C Ribeiro
- Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
| | - Júlia D Moreira
- Postgraduate Program in Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Department of Nutrition, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.,Translational Nutrition Neuroscience Working Group, CNPq Directory of Research Groups, Florianópolis, Santa Catarina, Brazil
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18
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Sadowska M, Sarecka-Hujar B, Kopyta I. Evaluation of Risk Factors for Epilepsy in Pediatric Patients with Cerebral Palsy. Brain Sci 2020; 10:brainsci10080481. [PMID: 32722475 PMCID: PMC7463548 DOI: 10.3390/brainsci10080481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 01/14/2023] Open
Abstract
Cerebral palsy (CP) is a set of etiologically diverse symptoms that change with the child's age. It is one of the most frequent causes of motor disability in children. CP occurs at a frequency of 1.5 to 3.0 per 1000 live-born children. CP often coexists with epilepsy, which is drug-resistant in a high number of cases. The aim of the present study was to analyze the associations between preconception, prenatal, perinatal, neonatal, and infancy risk factors for epilepsy in a group of pediatric patients with CP. We retrospectively analyzed 181 children with CP (aged 4-17 years at diagnosis), hospitalized at the Department of Pediatrics and Developmental Age Neurology in Katowice in the years 2008-2016. Division into particular types of CP was based on Ingram's classification. Data were analyzed using STATISTICA 13.0 (STATSOFT; Statistica, Tulsa, OK, USA). Epilepsy was diagnosed in 102 children (56.35%), of whom 44 (43%) had drug-resistant epilepsy; only in 15 cases (14.71%) was epilepsy susceptible to treatment. The incidence of epilepsy varied between the types of CP. It occurred significantly more often in children with tetraplegia (75%), ataxic form (83%), and mixed form (80%) in comparison to diplegia (32%) and hemiplegia (38%). Maternal hypertension was found to be a risk factor for epilepsy in CP patients (OR = 12.46, p < 0.001) as well as for drug-resistant epilepsy (the odds ratio (OR) = 9.86, p = 0.040). Delivery by cesarean section increased the risk of epilepsy in the CP patients over two-fold (OR = 2.17, p = 0.012). We observed also that neonatal convulsions significantly increased the risk for epilepsy (OR = 3.04, p = 0.011) as well as drug-resistant epilepsy (OR = 4.02, p = 0.002). In conclusion, maternal hypertension, neonatal convulsions, and delivery by cesarean section were the most important factors increasing the risk of epilepsy as well as drug-resistant epilepsy in the analyzed group of patients with CP.
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Affiliation(s)
- Małgorzata Sadowska
- Department of Pediatrics and Developmental Age Neurology, Upper Silesian Center for Child’s Health, 40-752 Katowice, Poland;
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Sosnowiec, Poland
- Correspondence: or ; Tel.: +48-322-699-830
| | - Ilona Kopyta
- Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
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19
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Buchanan-Peart KAR, Oribhabor GI, Khokale RV, Nelson ML, Cancarevic I. Cannabis, More Than the Euphoria: Its Therapeutic Use in Drug-Resistant Epilepsy. Cureus 2020; 12:e9299. [PMID: 32832296 PMCID: PMC7437102 DOI: 10.7759/cureus.9299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A significant number of epilepsy patients are refractory to conventional antiepileptic drugs. These patients experience considerable neurocognitive impairments that impact their quality of life and ability to function independently. This need for alternative treatment has generated increased interest in cannabis use as a therapeutic option in these patients. This review seeks to analyze data presented on the pharmacology, safety, and efficacy of cannabis use in patients with drug-resistant epilepsy (DRE) and to propose any future recommendations regarding its use. PubMed was used to retrieve all published studies and articles which evaluated the use of cannabis in epilepsy. The two foremost phytocannabinoids of cannabis showing anticonvulsant properties are tetrahydrocannabinol (THC) and cannabidiol (CBD). Due to the psychoactive properties of THC, most studies focused on CBD use in these patients. The use of CBD as an adjunct resulted in decreased seizure frequency, and secondary benefits observed included improvement in mood, alertness and sleep. Adverse events (AEs) reported were drowsiness, diarrhea, increased transaminases and worsening of seizures. It can safely be concluded that there is a significant benefit in DRE patients using CBD as adjunctive therapy. However, further controlled and adequately powered studies are needed to assess the pharmacokinetics and impact of the long-term use of cannabis.
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20
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González-Castillo Z, Solórzano Gómez E, Torres-Gómez A, Venta Sobero J, Gutiérrez Moctezuma J. Intravenous immunoglobulin G as adjuvant treatment in drug-resistant childhood epilepsy. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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21
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Hamdy MM, Elfatatry AM, Mekky JF, Hamdy E. Rapid eye movement (REM) sleep and seizure control in idiopathic generalized epilepsy. Epilepsy Behav 2020; 107:107064. [PMID: 32320932 DOI: 10.1016/j.yebeh.2020.107064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/01/2020] [Accepted: 03/19/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sleep and epilepsy are bedfellows, and they affect each other reciprocally. Despite the well-known relationship between sleep and epilepsy, data about the impact of sleep on seizure control and responsiveness to therapy are scarce. OBJECTIVE The aim of this work was to study the impact of sleep architecture in drug-naïve patients with idiopathic generalized epilepsy (IGE) on seizure control and responsiveness to treatment. METHODS This is a prospective cohort study conducted on thirty newly diagnosed patients with IGE attending the epilepsy clinic in Alexandria University Hospital in Egypt and thirty healthy controls. All recruited subjects had a baseline overnight polysomnographic study, then patients were given sodium valproate in therapeutic doses and followed up for six months for assessment of seizure control. After follow-up, they were classified into fully controlled and inadequately controlled patients, and a comparison between them was made. RESULTS Of the recruited patients, 13 were fully controlled. Rapid eye movement (REM) sleep % was significantly lower among inadequately controlled patients (9.01 ± 6.23) than fully controlled group (19.6 ± 9.01) and controls (18.17 ± 4.85) (p = 0.002), and the REM sleep latency was significantly longer among the inadequately controlled patients (115.7 ± 72.8 min) than fully controlled patients (54.6 ± 77.3 min) and controls (68.75 ± 37.95 min) (p = 011). On univariate regression analysis, the Odd's ratio (OR) for REM sleep percentage was 3.04 (p = 0.001). CONCLUSION Rapid eye movement sleep percentage and latency can contribute to seizure control in IGE.
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Affiliation(s)
- Mohamed M Hamdy
- Department of Neurology, Faculty of Medicine, Alexandria University, Egypt
| | - Amr M Elfatatry
- Department of Neurology, Faculty of Medicine, Alexandria University, Egypt
| | - Jaidaa F Mekky
- Department of Neurology, Faculty of Medicine, Alexandria University, Egypt
| | - Eman Hamdy
- Department of Neurology, Faculty of Medicine, Alexandria University, Egypt.
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22
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Mercadé Cerdá J, López Gonzalez F, Serrano Castro P, Castro Vilanova M, Campos Blanco D, Querol Pascual M. Observational multicentre study into the use of antiepileptic drugs in Spanish neurology consultations. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Cárdenas-Rodríguez N, Carmona-Aparicio L, Pérez-Lozano DL, Ortega-Cuellar D, Gómez-Manzo S, Ignacio-Mejía I. Genetic variations associated with pharmacoresistant epilepsy (Review). Mol Med Rep 2020; 21:1685-1701. [PMID: 32319641 PMCID: PMC7057824 DOI: 10.3892/mmr.2020.10999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022] Open
Abstract
Epilepsy is a common, serious neurological disorder worldwide. Although this disease can be successfully treated in most cases, not all patients respond favorably to medical treatments, which can lead to pharmacoresistant epilepsy. Drug-resistant epilepsy can be caused by a number of mechanisms that may involve environmental and genetic factors, as well as disease- and drug-related factors. In recent years, numerous studies have demonstrated that genetic variation is involved in the drug resistance of epilepsy, especially genetic variations found in drug resistance-related genes, including the voltage-dependent sodium and potassium channels genes, and the metabolizer of endogenous and xenobiotic substances genes. The present review aimed to highlight the genetic variants that are involved in the regulation of drug resistance in epilepsy; a comprehensive understanding of the role of genetic variation in drug resistance will help us develop improved strategies to regulate drug resistance efficiently and determine the pathophysiological processes that underlie this common human neurological disease.
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Affiliation(s)
- Noemí Cárdenas-Rodríguez
- Laboratory of Neuroscience, National Institute of Pediatrics, Ministry of Health, Coyoacán, Mexico City 04530, Mexico
| | - Liliana Carmona-Aparicio
- Laboratory of Neuroscience, National Institute of Pediatrics, Ministry of Health, Coyoacán, Mexico City 04530, Mexico
| | - Diana L Pérez-Lozano
- Laboratory of Neuroscience, National Institute of Pediatrics, Ministry of Health, Coyoacán, Mexico City 04530, Mexico
| | - Daniel Ortega-Cuellar
- Laboratory of Experimental Nutrition, National Institute of Pediatrics, Ministry of Health, Coyoacán, Mexico City 04530, Mexico
| | - Saúl Gómez-Manzo
- Laboratory of Genetic Biochemistry, National Institute of Pediatrics, Ministry of Health, Coyoacán, Mexico City 04530, Mexico
| | - Iván Ignacio-Mejía
- Laboratory of Translational Medicine, Military School of Health Graduates, Lomas de Sotelo, Militar, Mexico City 11200, Mexico
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Verrotti A, Tambucci R, Di Francesco L, Pavone P, Iapadre G, Altobelli E, Matricardi S, Farello G, Belcastro V. The role of polytherapy in the management of epilepsy: suggestions for rational antiepileptic drug selection. Expert Rev Neurother 2019; 20:167-173. [PMID: 31855066 DOI: 10.1080/14737175.2020.1707668] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Antiepileptic polytherapy may be indicated in patients experiencing drug-resistant epilepsy. To date, there are no evidence-based criteria on how to combine different antiepileptic drugs (AEDs) together, in order to obtain the best therapeutic response.Areas covered: This paper reviews the available data about the various associations of AEDs in patients undergoing polytherapy, focusing on the most effective and well-tolerated polytherapies. Moreover, some controversial aspects of this topic are addressed.Expert opinion: Nowadays, there are no guidelines on polytherapy in patients with epilepsy; thus, the management of pharmacoresistant epilepsy is still uncertain, except for valproate/lamotrigine combination, which seems to be the only one recommended. Data regarding mechanism of action, pharmacokinetics, tolerability, and, more importantly, the analysis of the valuable clinical studies of drug combinations can help physicians to choose the best and most effective AED association for each patient.
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Affiliation(s)
- Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Renato Tambucci
- Pediatric Unit, University of L'Aquila, L'Aquila, Italy.,Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Piero Pavone
- Department of Pediatrics, University of Catania, Catania, Italy
| | - Giulia Iapadre
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Emma Altobelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Sara Matricardi
- Department of Child Neuropsychiatry, Salesi Hospital Ancona, Italy
| | - Giovanni Farello
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Vincenzo Belcastro
- Child Neuropsychiatry Unit, Department of Mental Health, ASST-LARIANA, COMO
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Borsato GS, Siegel JL, Rose MQ, Ojard M, Feyissa AM, Quinones-Hinojosa A, Jackson DA, Rogers ER, Freeman WD. Ketamine in seizure management and future pharmacogenomic considerations. THE PHARMACOGENOMICS JOURNAL 2019; 20:351-354. [PMID: 31772310 DOI: 10.1038/s41397-019-0120-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 11/09/2022]
Abstract
Ketamine is a noncompetitive N-methyl-D-aspartate antagonist with emerging evidence for use in medically refractory epilepsy. We describe the novel use of low-dose intravenous (IV) ketamine transitioning to enteral formulation in a patient with drug-resistant localization-related refractory epilepsy. We performed a National Library of Medicine (NLM) literature review using search terms "ketamine", "low dose", and "seizure" for similar cases, followed by an illustrative clinical case. Our NLM search engine methodology yielded 24 hits, none of which described use of low-dose ketamine for seizures. Anesthetic doses are used for status epilepticus, but we show that in a patient with postoperative worsening of his chronic seizure burden, low-dose IV ketamine can be used to avoid oversedation and intubation. We demonstrate that IV ketamine can be transitioned to oral regimen to shorten length of stay in the intensive care unit and hospital and has future CYP2B6 pharmacogenomic considerations for further dose individualization.
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Affiliation(s)
- Giovanna Soldatelli Borsato
- Pontifical Catholic University of Parana, R. Imaculada Conceição, 1155, Prado Velho, Curitiba - PR, 80215-901, Brazil
| | - Jason L Siegel
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA.,Department of Neurology, Mayo Clinic, Jacksonville, FL, USA.,Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Mariah Q Rose
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Michelle Ojard
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Alfredo Quinones-Hinojosa
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL, USA.,Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | | | - Emily R Rogers
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - William D Freeman
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA. .,Department of Neurology, Mayo Clinic, Jacksonville, FL, USA. .,Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.
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Chen NN, Zhao DJ, Sun YX, Wang DD, Ni H. Long-Term Effects of Zinc Deficiency and Zinc Supplementation on Developmental Seizure-Induced Brain Damage and the Underlying GPR39/ZnT-3 and MBP Expression in the Hippocampus. Front Neurosci 2019; 13:920. [PMID: 31551684 PMCID: PMC6737275 DOI: 10.3389/fnins.2019.00920] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/16/2019] [Indexed: 01/17/2023] Open
Abstract
We previously illustrated that long-term upregulated expression of ZnT-3 in the hippocampus of rats that underwent neonatal seizures was restored by pretreatment with a ketogenic diet. It was recently demonstrated that upregulated expression of ZnT-3 was associated with increased concentrations of intracellular free zinc ions in an in vitro model of glutamate-induced hippocampal neuronal excitotoxic damage. However, there is still a lack of research on the effects of different concentrations of zinc in the diet on developmental convulsive brain injury. The aim of this study was to investigate the effects of different zinc concentrations in the diet on long-term neurobehavioral and seizure thresholds following lithium chloride-pilocarpine-induced developmental seizures. Sprague-Dawley rats (postnatal day 27, P27) were randomly assigned to one of six dietary groups for 4 weeks: normal zinc control group (Control group, 44 mg/kg Zn), Zn-deficient control group (ZD group, 2.7 mg/kg Zn), Zn supplemented control group (ZS group, 246 mg/kg Zn), pilocarpine-induced seizure plus regular zinc diet group (SE group, 44 mg/kg Zn), seizure plus low-zinc diet group (SE + ZD group, 2.7 mg/kg Zn), and seizure plus high-zinc diet group (SE + ZS group, 246 mg/kg Zn). Novel object recognition and passive avoidance tests were performed on rats at P42 and P56. After routine seizure threshold detection and Timm staining procedures at P57, expression of GPR39, ZnT-3, and MBP were detected in the hippocampus by Western blot analysis. The results revealed that the Zinc-deficient diet for 4 weeks aggravated the long-term adverse effects of developmental seizures, evidenced by weight, cognition, seizure threshold and serum zinc concentrations, which were paralleled by expression changes in hippocampal GPR39 and ZnT-3. In contrast, zinc supplementation for 4 weeks significantly improved damage-related changes described above and rescued the abnormal expression of GPR39, ZnT-3, and MBP in the hippocampus. Similar alterations between the expression pattern of MBP and aberrant sprouting of mossy fibers in the hippocampus may indicate that sprouting is a secondary pathological change caused by developmental brain damage rather than the cause of epileptogenesis. Up-regulation of MBP protein levels in the high zinc diet-treated seizure group as well as the corresponding improvement of cognitive impairment and reduced hippocampal mossy fiber regenerative sprouting, may represent a compensatory mechanism for neuronal membrane damage and repair.
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Affiliation(s)
- Ni-Na Chen
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Dong-Jing Zhao
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Yu-Xiao Sun
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Dan-Dan Wang
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Hong Ni
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
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Gogou M, Pavlou E. Efficacy of antiepileptic drugs in the era of pharmacogenomics: A focus on childhood. Eur J Paediatr Neurol 2019; 23:674-684. [PMID: 31280948 DOI: 10.1016/j.ejpn.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/23/2019] [Accepted: 06/24/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND In recent years advances in the field of pharmacogenomics have expanded the concept for more individualized treatments. Our aim is to provide literature data about the relationship between genetic polymorphisms and efficacy of antiepileptic drugs in children. METHODS Pubmed was used as the main medical database source. Only original research papers were considered. No year-of-publication restriction was placed. Quality of evidence was assessed according to American Academy of Neurology guidelines. RESULTS A total of 12 cross-sectional and case-control studies fulfilled our selection criteria. ABCB1 gene was associated with drug responsiveness in 2 out of 6 studies and ABCC2 gene in 1 out of 1 studies. SCN1A gene was also associated with seizure control in 4 out of 5 studies. Cytochrome P450 genes were found to significantly affect drug responsiveness in 2 out of 4 studies, while polymorphisms of uridinediphosphateglucuronosyltransferaseUGT2B7 gene predisposed to drug-resistance in 1 out of 2 studies. CONCLUSION Variability in genes coding for sodium channels, drug transporters and cytochrome P450 enzymes can have a significant impact on response to antiepileptic drugs. Larger prospective studies with better stratification of samples are needed to shed light on these associations.
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Affiliation(s)
- Maria Gogou
- 2nd Department of Pediatrics, University General Hospital AHEPA, Thessaloniki, Greece.
| | - Evangelos Pavlou
- 2nd Department of Pediatrics, University General Hospital AHEPA, Thessaloniki, Greece
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Barzegar M, Afghan M, Tarmahi V, Behtari M, Rahimi Khamaneh S, Raeisi S. Ketogenic diet: overview, types, and possible anti-seizure mechanisms. Nutr Neurosci 2019; 24:307-316. [PMID: 31241011 DOI: 10.1080/1028415x.2019.1627769] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The ketogenic diet (KD) has been used for a long time as a therapeutic approach for drug-resistant epilepsy. It is a high-fat, low-carbohydrate, and adequate protein diet. There are various types of KD with some differences in their compositions that mainly include classic KD, medium-chain triglyceride diet, modified Atkins diet, and low glycemic index treatment. The anti-seizure mechanisms of KDs have not yet completely understood but, some possible mechanisms can be theorized. The aim of the present study was to review the various types of KD and explain the probable biochemical mechanisms involved in its anti-seizure property.
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Affiliation(s)
- Mohammad Barzegar
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadreza Afghan
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Tarmahi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Meysam Behtari
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Sina Raeisi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Engineering brain activity patterns by neuromodulator polytherapy for treatment of disorders. Nat Commun 2019; 10:2620. [PMID: 31197165 PMCID: PMC6565674 DOI: 10.1038/s41467-019-10541-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/15/2019] [Indexed: 11/08/2022] Open
Abstract
Conventional drug screens and treatments often ignore the underlying complexity of brain network dysfunctions, resulting in suboptimal outcomes. Here we ask whether we can correct abnormal functional connectivity of the entire brain by identifying and combining multiple neuromodulators that perturb connectivity in complementary ways. Our approach avoids the combinatorial complexity of screening all drug combinations. We develop a high-speed platform capable of imaging more than 15000 neurons in 50ms to map the entire brain functional connectivity in large numbers of vertebrates under many conditions. Screening a panel of drugs in a zebrafish model of human Dravet syndrome, we show that even drugs with related mechanisms of action can modulate functional connectivity in significantly different ways. By clustering connectivity fingerprints, we algorithmically select small subsets of complementary drugs and rapidly identify combinations that are significantly more effective at correcting abnormal networks and reducing spontaneous seizures than monotherapies, while minimizing behavioral side effects. Even at low concentrations, our polytherapy performs superior to individual drugs even at highest tolerated concentrations. Brain disorders are associated with network dysfunctions that are not addressed by conventional drug screens. Here, the authors use high-throughput functional imaging of brain activity in zebrafish larvae to study the effects of individual drugs on network connectivity and demonstrate an algorithm that predicts the most effective drug combinations to normalize both the activity patterns and the animal behavior.
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Mehdizadeh A, Barzegar M, Negargar S, Yahyavi A, Raeisi S. The current and emerging therapeutic approaches in drug-resistant epilepsy management. Acta Neurol Belg 2019; 119:155-162. [PMID: 30868468 DOI: 10.1007/s13760-019-01120-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/06/2019] [Indexed: 01/08/2023]
Abstract
Epilepsy is a neurologic disorder consisting of recurrent spontaneous seizures. Antiepileptic drugs administration is the most commonly used therapeutic strategy in the management of epilepsy. However, 20-30% of epilepsy patients have seizure episodes that are not controlled by these medicines (drug-resistant epilepsy). The management of drug-resistant epilepsy, especially in the children, is challenging and can cause economic and social problems, and lower the patients' quality of life, cognition, and mood. Several therapeutic approaches for drug-resistant epilepsy are available including surgical methods, neurostimulation treatments, and diet therapies which lead to diminishing the epileptic seizures. An increasing number of novel and potential therapeutic approaches such as gene therapy, gene editing, cell therapy, exosome therapy, and molecular network targeting have also been explored. The present study is aimed to review these current and emerging therapeutic approaches for drug-resistant epilepsy.
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Affiliation(s)
- Amir Mehdizadeh
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Barzegar
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sohrab Negargar
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azita Yahyavi
- Department of Anesthesia, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Raeisi
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Abstract
Mutationally activated BRAFV600E influences the behavior of different types of cells in the brain and leads to promotion of seizures as well as brain tumors, indicating how both can be pharmacologically targeted in the clinic.
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Affiliation(s)
- Jean M Mulcahy Levy
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado and University of Colorado, Denver, CO, USA.
| | - Martin McMahon
- Huntsman Cancer Institute and Department of Dermatology, University of Utah, Salt Lake City, UT, USA.
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Rezaei S, Harsini S, Kavoosi M, Badv RS, Mahmoudi M. Efficacy of low glycemic index treatment in epileptic patients: a systematic review. Acta Neurol Belg 2018; 118:339-349. [PMID: 29368115 DOI: 10.1007/s13760-018-0881-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/03/2018] [Indexed: 01/01/2023]
Abstract
Low glycemic index treatment (LGIT) is one of the new kinds of ketogenic diet (KD), designed to simplify the implementation of the KD. To date, several studies have attempted to determine the efficacy of LGIT in patients with epilepsy; however, their results are debatable. This study aims to retrieve all the LGIT studies to shed light on LGIT efficacy in epileptic patients. Electronic literature databases including MEDLINE/PubMed, Web of Science, Scopus, EMBASE were searched in July 2017. Interventional or observational studies exploring the efficacy of LGIT were included in the study. The National Heart, Lung, and Blood Institute quality assessment tool was used for the quality assessment of included studies. Two hundred and eighteen records were retrieved through a literature search. Following the screening process, eight studies were included. According to the ratings of the quality assessment tool, four studies were classified as good and four were categorized as fair. The result of the current study reveals that LGIT has a beneficial effect in patients with intractable epilepsy. However, more high-quality studies are required to determine the efficacy of LGIT in patients with intractable epilepsy.
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Affiliation(s)
- Shahabeddin Rezaei
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, 14155-6447, Iran
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Harsini
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mona Kavoosi
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, 14155-6447, Iran
| | - Reza Shervin Badv
- Department of Paediatric Neurology, Paediatrics Centre of Excellence, Children's Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mahmoudi
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, 14155-6447, Iran.
- Pediatric Gastroenterology and Hepatology Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
- Dietitians and Nutrition Experts Team (DiNET), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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Łażewska D, Kaleta M, Hagenow S, Mogilski S, Latacz G, Karcz T, Lubelska A, Honkisz E, Handzlik J, Reiner D, Satała G, Filipek B, Stark H, Kieć-Kononowicz K. Novel naphthyloxy derivatives – Potent histamine H3 receptor ligands. Synthesis and pharmacological evaluation. Bioorg Med Chem 2018; 26:2573-2585. [DOI: 10.1016/j.bmc.2018.04.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 12/22/2022]
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Rapacz A, Głuch-Lutwin M, Mordyl B, Filipek B, Abram M, Kamiński K. Evaluation of anticonvulsant and analgesic activity of new hybrid compounds derived from N-phenyl-2-(2,5-dioxopyrrolidin-1-yl)-propanamides and -butanamides. Epilepsy Res 2018; 143:11-19. [PMID: 29631129 DOI: 10.1016/j.eplepsyres.2018.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/12/2018] [Accepted: 03/28/2018] [Indexed: 02/06/2023]
Abstract
Epilepsy is a chronic neurological disorder that is associated with various types of recurrent seizures, which are drug-resistant in about one third of patients. Moreover, anticonvulsant drugs are used to treat a wide range of non-epileptic conditions, including chronic pain. Here, we investigated the anticonvulsant activity of six new hybrid compounds based on the pyrrolidine-2,5-dione scaffold in the 6 Hz corneal stimulation test with 44 mA stimulus intensity in mice, which is the model of pharmacoresistant seizures. We demonstrated that two molecules, DK-10 (11) and DK-14 (14) show higher anticonvulsant activity and similar safety profile in comparison with valproic acid and much higher in comparison with levetiracetam in the aforementioned test. The second aim of this study was to examine analgesic activity of these compounds. For this purpose, the hot plate test, the formalin test, and the oxaliplatin-induced peripheral neuropathy model were performed. Among tested agents DK-11 (12) revealed prominent antinociceptive activity at non-sedative doses in the second (inflammatory) phase of the formalin test, which is the model of tonic pain and antiallodynic activity in the oxaliplatin-induced neuropathic pain, the model of painful chemotherapy-induced peripheral neuropathy. No cytotoxic effect on hepatoma cells was observed. Compound DK-10 (11) had high affinity for voltage-gated sodium channels, whereas compound DK-11 (12) showed weak binding toward sodium and calcium voltage-gated channels and the NMDA receptor. As a result, hybrid compounds reported herein seem to be very promising broad spectrum anticonvulsant molecules with collateral analgesic activity.
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Affiliation(s)
- Anna Rapacz
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland.
| | - Monika Głuch-Lutwin
- Department of Pharmacobiology, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland.
| | - Barbara Mordyl
- Department of Pharmacobiology, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland.
| | - Barbara Filipek
- Department of Pharmacodynamics, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland.
| | - Michał Abram
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland.
| | - Krzysztof Kamiński
- Department of Medicinal Chemistry, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, 30-688 Krakow, Poland.
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Mercadé Cerdá JM, López Gonzalez FJ, Serrano Castro P, Castro Vilanova MD, Campos Blanco DM, Querol Pascual MR. Observational multicentre study into the use of antiepileptic drugs in Spanish neurology consultations. Neurologia 2018. [PMID: 29530436 DOI: 10.1016/j.nrl.2018.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The study aims to quantify the types of antiepileptic drugs (AED) prescribed in neurology consultations. MATERIAL AND METHOD This descriptive, observational study included a sample of 559 patients older than 14 years, diagnosed with epilepsy, and receiving pharmacological treatment. Data were collected at outpatient consultations by 47 Spanish neurologists in May 2016. Epilepsy was defined based on the International League Against Epilepsy classification. According to the year of marketing, AEDs were categorised as classic (before 1990) or new (after 1990). We performed a descriptive analysis of qualitative and quantitative variables. RESULTS Female patients accounted for 54.6% of the sample. Mean age was 42.7 years; mean age of onset was 22.4. Regarding epilepsy type, 75.7% of patients experienced partial seizures, 51.5% were symptomatic,32.4% had refractory epilepsy, 35.6% had been seizure-free for the previous year, and 59.2% had associated comorbidities.A total of 1103 AED prescriptions were made; 64.6% of prescriptions were for new AEDs; 85.4% of patients received new AEDs. Patients received a mean of 2 AEDs (range, 1-5). A total of 59.6% of patients received polytherapy.The most frequently prescribed AEDs were levetiracetam (42.6%), valproic acid (25.4%), lamotrigine (19.5%), carbamazepine (17.9%), and lacosamide (17.5%). No AED was employed exclusively as monotherapy. The most frequently prescribed AEDs for generalised and partial seizures were valproic acid (48.2%) and levetiracetam (43.2%), respectively. Valproic acid was less frequently prescribed to female patients. Patients with refractory epilepsy or with associated comorbidities were more frequently prescribed a combination of new and classic AEDs (48.7% and 45.6%, respectively) than only one type of AED. CONCLUSIONS The majority of patients received new AEDs. The combination of classic and new AEDs was more frequently prescribed to patients with refractory epilepsy or with associated comorbidities.
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Affiliation(s)
| | - F J López Gonzalez
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
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González-Castillo Z, Solórzano Gómez E, Torres-Gómez A, Venta Sobero JA, Gutiérrez Moctezuma J. Intravenous immunoglobulin G as adjuvant treatment in drug-resistant childhood epilepsy. Neurologia 2017; 35:395-399. [PMID: 29196143 DOI: 10.1016/j.nrl.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 08/23/2017] [Accepted: 09/12/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Epilepsy is the most common neurological disease in childhood; depending on the definition of drug-resistant epilepsy, incidence varies from 10% to 23% in the paediatric population. The objective of this study was to account for the decrease in the frequency and/or monthly duration of epileptic seizures in paediatric patients with drug-resistant epilepsy treated with antiepileptic drugs, before and after adding intravenous immunoglobulin G (iIV IgG). METHODS This is an analytic, observational, retrospective case-control study. We studied paediatric patients with drug-resistant epilepsy who were treated with IV IgG at the Centro Médico Nacional 20 de Noviembre, in Mexico City, from 2003 to 2013. RESULTS One hundred and sixty seven patients (19.5%) had drug-resistant epilepsy and 44 (5.1%) started adjuvant treatment with IV IgG. The mean age of patients at the beginning of treatment was 6.12 years±5.14); aetiology was structural acquired in 28 patients (73.6%), genetic in 5 (13.1%), immune in 1 (2.6%), and unknown in 4 (10.5%). At 2 months from starting IV IgG, seizure duration had reduced to 66.66%; the frequency of seizures was reduced by 64% at 4 months after starting treatment (P<.001). CONCLUSIONS According to the results of this study, intravenous immunoglobulin may be an effective therapy for reducing the frequency and duration of seizures in paediatric patients with drug-resistant epilepsy.
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Affiliation(s)
- Z González-Castillo
- Departamento de Neurología Pediátrica, Centro Médico Nacional 20 de Noviembre, ISSSTE, Ciudad de México, México.
| | - E Solórzano Gómez
- Departamento de Neurología Pediátrica, Centro Médico Nacional 20 de Noviembre, ISSSTE, Ciudad de México, México
| | - A Torres-Gómez
- Departamento de Ortopedia, Centro Médico ABC, Ciudad de México, México
| | - J A Venta Sobero
- Departamento de Neurología Pediátrica, Centro Médico Nacional 20 de Noviembre, ISSSTE, Ciudad de México, México
| | - J Gutiérrez Moctezuma
- Departamento de Neurología Pediátrica, Centro Médico Nacional 20 de Noviembre, ISSSTE, Ciudad de México, México
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Chen YC, Zhu GY, Wang X, Shi L, Du TT, Liu DF, Liu YY, Jiang Y, Zhang X, Zhang JG. Anterior thalamic nuclei deep brain stimulation reduces disruption of the blood-brain barrier, albumin extravasation, inflammation and apoptosis in kainic acid-induced epileptic rats. Neurol Res 2017; 39:1103-1113. [PMID: 28918702 DOI: 10.1080/01616412.2017.1379241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective The therapeutic efficacy of anterior thalamic nuclei deep brain stimulation (ATN-DBS) against seizures has been largely accepted; however, the effects of ATN-DBS on disruption of the blood-brain barrier (BBB), albumin extravasation, inflammation and apoptosis still remain unclear. Methods Rats were distributed into four treatment groups: physiological saline (PS, N = 12), kainic acid (KA, N = 12), KA-sham-DBS (N = 12) and KA-DBS (N = 12). Seizures were monitored using video-electroencephalogram (EEG). One day after surgery, all rats were sacrificed. Then, samples were prepared for quantitative real-time PCR (qPCR), western blot, immunofluorescence (IF) staining, and transmission electron microscopy to evaluate the disruption of the BBB, albumin extravasation, inflammation, and apoptosis. Result Because of the KA injection, the disruption of the BBB, albumin extravasation, inflammation and apoptosis were more severe in the KA and the KA-sham-DBS groups compared to the PS group (all Ps < 0.05 or < 0.01). The ideal outcomes were observed in the KA-DBS group. ATN-DBS produced a 46.3% reduction in seizure frequency and alleviated the disruption of the BBB, albumin extravasation, inflammatory reaction and apoptosis in comparison to the KA-sham-DBS group (all Ps < 0.05 or < 0.01). Conclusion (1) Seizures can be reduced using ATN-DBS in the epileptogenic stage. (2) ATN-DBS can reduce the disruption of the BBB and albumin extravasation. (3) ATN-DBS has an anti-inflammatory effect in epileptic models.
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Affiliation(s)
- Ying-Chuan Chen
- a Department of Neurosurgery , Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - Guan-Yu Zhu
- a Department of Neurosurgery , Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - Xiu Wang
- a Department of Neurosurgery , Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - Lin Shi
- a Department of Neurosurgery , Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - Ting-Ting Du
- a Department of Neurosurgery , Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - De-Feng Liu
- a Department of Neurosurgery , Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - Yu-Ye Liu
- a Department of Neurosurgery , Beijing Tiantan Hospital, Capital Medical University , Beijing , China
| | - Yin Jiang
- b Department of Functional Neurosurgery , Beijing Neurosurgical Institute, Capital Medical University , Beijing , China
| | - Xin Zhang
- b Department of Functional Neurosurgery , Beijing Neurosurgical Institute, Capital Medical University , Beijing , China
| | - Jian-Guo Zhang
- a Department of Neurosurgery , Beijing Tiantan Hospital, Capital Medical University , Beijing , China.,b Department of Functional Neurosurgery , Beijing Neurosurgical Institute, Capital Medical University , Beijing , China.,c Beijing Key Laboratory of Neurostimulation , Beijing , China
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Rao G, Mashkouri S, Aum D, Marcet P, Borlongan CV. Contemplating stem cell therapy for epilepsy-induced neuropsychiatric symptoms. Neuropsychiatr Dis Treat 2017; 13:585-596. [PMID: 28260906 PMCID: PMC5328607 DOI: 10.2147/ndt.s114786] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Epilepsy is a debilitating disease that impacts millions of people worldwide. While unprovoked seizures characterize its cardinal symptom, an important aspect of epilepsy that remains to be addressed is the neuropsychiatric component. It has been documented for millennia in paintings and literature that those with epilepsy can suffer from bouts of aggression, depression, and other psychiatric ailments. Current treatments for epilepsy include the use of antiepileptic drugs and surgical resection. Antiepileptic drugs reduce the overall firing of the brain to mitigate the rate of seizure occurrence. Surgery aims to remove a portion of the brain that is suspected to be the source of aberrant firing that leads to seizures. Both options treat the seizure-generating neurological aspect of epilepsy, but fail to directly address the neuropsychiatric components. A promising new treatment for epilepsy is the use of stem cells to treat both the biological and psychiatric components. Stem cell therapy has been shown efficacious in treating experimental models of neurological disorders, including Parkinson's disease, and neuropsychiatric diseases, such as depression. Additional research is necessary to see if stem cells can treat both neurological and neuropsychiatric aspects of epilepsy. Currently, there is no animal model that recapitulates all the clinical hallmarks of epilepsy. This could be due to difficulty in characterizing the neuropsychiatric component of the disease. In advancing stem cell therapy for treating epilepsy, experimental testing of the safety and efficacy of allogeneic and autologous transplantation will require the optimization of cell dosage, delivery, and timing of transplantation in a clinically relevant model of epilepsy with both neurological and neuropsychiatric symptoms of the disease as the primary outcome measures.
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Affiliation(s)
- Gautam Rao
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sherwin Mashkouri
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - David Aum
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Paul Marcet
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Cesar V Borlongan
- Department of Neurosurgery and Brain Repair, Center of Excellence for Aging and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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