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Moon S, Watkins L, O'Dwyer M, Shankar R. Relationship between anti-seizure medication and behaviors that challenge in older persons with intellectual disability and epilepsy: a review. Expert Rev Neurother 2024; 24:1097-1105. [PMID: 39160772 DOI: 10.1080/14737175.2024.2393322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 08/13/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION There is increased focus on the negative impact of the overprescribing of medication, specifically psychotropic medication, including anti-seizure medications (ASM), in people with Intellectual Disability (ID). This is particularly important for the older adult population, where multi-morbidity and polypharmacy are more common. ASMs are associated with psychiatric and behavioral adverse effects. Furthermore, there is growing awareness of the anticholinergic burden for older adults with epilepsy and ID and the relationship with behaviors that challenge (BtC). AREAS COVERED This review defines the older adult population and outlines the relationship between epilepsy and ID. BtC is outlined in the context of the population and the relationship with ASMs. The evidence base to guide prescribing and de-prescribing for newer ASMs is also presented, including pragmatic data. EXPERT OPINION Polypharmacy, particularly psychotropics, are a mortality risk factor for older adults with epilepsy and ID. Therefore, any BtC requires a holistic assessment with a multi-disciplinary approach. This includes specific consideration of all prescribed medicines in the context of polypharmacy. There should be routine reviews, at least annually, for those aged 40 years and over particularly focused on anticholinergic burden and/or polypharmacy.
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Affiliation(s)
- Seungyoun Moon
- Department of learning disability, Swansea Bay University Health Board, Swansea, Wales, UK
| | - Lance Watkins
- Department of learning disability, Swansea Bay University Health Board, Swansea, Wales, UK
- University of South Wales, Wales, UK
- Cornwall Intellectual Disability Research (CIDER), Peninsula Schools of Medicine and Dentistry, University of Plymouth, England, UK
| | - Maire O'Dwyer
- School of pharmacy, Trinity College, Dublin, Ireland
| | - Rohit Shankar
- Cornwall Intellectual Disability Research (CIDER), Peninsula Schools of Medicine and Dentistry, University of Plymouth, England, UK
- Department of developmental Neuropsychiatry, Cornwall Partnership NHS Foundation Trust, England UK
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Allard J, Henley W, Sellers A, O'Shaughnessy E, Thomson O, McLean B, Parrett M, Rajakulendran S, Watkins L, Maguire M, Ellawela S, Tittensor P, Sen A, Mohanraj R, Bagary M, Ram S, Brown A, Shankar R. Efficacy and tolerability of Brivaracetam in people with intellectual disability compared to those without intellectual disability. Epilepsy Behav 2024; 158:109906. [PMID: 38936308 DOI: 10.1016/j.yebeh.2024.109906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/19/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION In England, nearly a quarter of people with intellectual disability (PwID) have epilepsy. Though 70 % of PwID have pharmaco-resistant seizures only 10 % are prescribed anti-seizure medication (ASMs) licenced for pharmaco-resistance. Brivaracetam (BRV) licenced in 2016 has had nine post-marketing studies involving PwID. These studies are limited either by lack of controls or not looking at outcomes based on differing levels of ID severity. This study looks at evidence comparing effectiveness and side-effects in PwID to those without ID prescribed Brivaracetam (BRV). METHODS Pooled case note data for patients prescribed BRV (2016-2022) at 12 UK NHS Trusts were analysed. Demographics, starting and maximum dose, side-effects, dropouts and seizure frequency between ID (mild vs. moderate-profound (M/P)) and general population for a 12-month period were compared. Descriptive analysis, Mann-Whitney, Fisher's exact and logistic regression methods were employed. RESULTS 37 PwID (mild 17 M/P 20) were compared to 102 without ID. Mean start and maximum dose was lower for PwID than non-ID. Mean maximum dose reduced slightly with ID severity. No difference was found between ID and non-ID or between ID groups (Mild vs M/P) in BRV's efficacy i.e. >50 % seizure reduction or tolerability. Mental and behavioural side-effects were more prevalent for PwID (27.0 % ID, 17.6 % no ID) but not significantly higher (P = 0.441) or associated with ID severity (p = 0.255). CONCLUSION This is the first study on BRV, which compares ID cohorts with differing severity and non-ID. Efficacy, tolerability and side-effects reported are similar across differing ID severity to those with no ID.
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Affiliation(s)
- Jon Allard
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom; CIDER, Peninsula School of Medicine, University of Plymouth, United Kingdom
| | | | - Adrian Sellers
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Emma O'Shaughnessy
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Oliver Thomson
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Brendan McLean
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom; CIDER, Peninsula School of Medicine, University of Plymouth, United Kingdom
| | - Mary Parrett
- Royal Cornwall Hospital NHS Trust, United Kingdom
| | - Sanjeev Rajakulendran
- The National Hospital for Neurology and Neurosurgery, University College Hospitals, United Kingdom
| | - Lance Watkins
- CIDER, Peninsula School of Medicine, University of Plymouth, United Kingdom; Swansea Bay University Health Board, United Kingdom
| | | | - Shan Ellawela
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | | | - Arjune Sen
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | | | - Manny Bagary
- Birmingham and Solihull Mental Health NHS Foundation Trust, United Kingdom
| | - Sunil Ram
- Somerset NHS Foundation Trust, United Kingdom
| | - Allan Brown
- Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, United Kingdom; CIDER, Peninsula School of Medicine, University of Plymouth, United Kingdom.
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Allard J, Sellers A, Henley W, McLean B, Parrett M, Rajakulendran S, Watkins L, Maguire M, Ellawela S, Tittensor P, Bransgrove J, Sen A, Mohanraj R, Bagary M, Ram S, Vernon N, Baldwin S, Gill J, Shankar R. Efficacy and tolerability of levetiracetam in people with and without intellectual disabilities: A naturalistic case control study. Seizure 2024; 120:25-32. [PMID: 38897161 DOI: 10.1016/j.seizure.2024.05.010] [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: 03/22/2024] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION People with Intellectual Disabilities (PwID) are twenty times more likely than general population to have epilepsy. Guidance for prescribing antiseizure medication (ASM) to PwID is driven by trials excluding them. Levetiracetam (LEV) is a first-line ASM in the UK. Concerns exist regarding LEV's behavioural and psychological adverse effects, particularly in PwID. There is no high-quality evidence comparing effectiveness and adverse effects in PwID to those without, prescribed LEV. METHODS Pooled casenote data for patients prescribed LEV (2000-2020) at 18 UK NHS Trusts were analysed. Demographics, starting and maximum dose, adverse effects, dropouts and seizure frequency between ID (mild vs. moderate-profound (M/P)) and general population for a 12-month period were compared. Descriptive analysis, Mann-Whitney, Fisher's exact and logistic regression methods were employed. RESULTS 173 PwID (mild 53 M/P 120) were compared to 200 without ID. Mean start and maximum dose were similar across all groups. PwID (Mild & M/P) were less likely to withdraw from treatment (P = 0.036). No difference was found between ID and non-ID or between ID groups (Mild vs M/P) in LEV's efficacy i.e. >50 % seizure reduction. Significant association emerged between ID severity and psychiatric adverse effects (P = 0.035). More irritability (14.2 %) and aggression (10.8 %) were reported in M/P PwID. CONCLUSION PwID and epilepsy have high rates of premature mortality, comorbidities, treatment resistance and polypharmacy but remain poorly researched for ASM use. This is the largest studied cohort of PwID trialled on LEV compared to general population controls. Findings support prescribing of LEV for PwID as a first-line ASM.
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Affiliation(s)
- Jon Allard
- Cornwall Intellectual Disability Equitable Research (CIDER) Cornwall Partnership NHS Foundation Trust, United Kingdom; CIDER, Peninsula School of medicine, University of Plymouth, United Kingdom
| | - Adrian Sellers
- Cornwall Intellectual Disability Equitable Research (CIDER) Cornwall Partnership NHS Foundation Trust, United Kingdom
| | | | - Brendan McLean
- Cornwall Intellectual Disability Equitable Research (CIDER) Cornwall Partnership NHS Foundation Trust, United Kingdom; CIDER, Peninsula School of medicine, University of Plymouth, United Kingdom
| | - Mary Parrett
- Royal Cornwall Hospital NHS Trust, United Kingdom
| | - Sanjeev Rajakulendran
- The National Hospital for Neurology and Neurosurgery, University College Hospitals, United Kingdom
| | - Lance Watkins
- CIDER, Peninsula School of medicine, University of Plymouth, United Kingdom; Swansea Bay University Health Board, United Kingdom
| | | | - Shan Ellawela
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | | | | | - Arjune Sen
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | | | - Many Bagary
- Birmingham and Solihull Mental Health NHS Foundation Trust, United Kingdom
| | - Sunil Ram
- Somerset NHS Foundation Trust, United Kingdom
| | - Nathan Vernon
- Royal Devon University Healthcare NHS Foundation Trust, United Kingdom
| | - Sandy Baldwin
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Jagdish Gill
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER) Cornwall Partnership NHS Foundation Trust, United Kingdom; CIDER, Peninsula School of medicine, University of Plymouth, United Kingdom.
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Branford D, Sun JJ, Burrows L, Shankar R. Patterns of antiseizure medications prescribing in people with intellectual disability and epilepsy: A narrative review and analysis. Br J Clin Pharmacol 2023; 89:2028-2038. [PMID: 37060156 DOI: 10.1111/bcp.15748] [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: 01/14/2023] [Revised: 03/26/2023] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
People with intellectual disabilities (PwID) have a bidirectional relationship with epilepsy. Nearly 25% of PwID have seizures and 30% people with epilepsy are thought to have a significant intellectual impairment. Furthermore, 70% of PwID are thought to have treatment-resistant epilepsy. In the United Kingdom, antiseizure medications (ASMs) are the second most widely prescribed psychotropic agent for PwID. However, it is unclear what the current evidence and patterns is on current prescribing of ASMs, including when and how a case is made to withdraw them. A narrative review along with an analysis of large-scale NHS Digital published data (2015-2020) on several aspects of ASM prescribing by general practices for PwID was undertaken. The review results and data analysis are consolidated and presented as 11 themes to provide a comprehensive overview of the study topic. Recent studies estimate that one-third and one-fifth of PwID are prescribed ASMs. A history of epilepsy is seen as the primary prescribing reason; however, often it is a legacy, and the indication is no longer clear. The proportion receiving ASMs continues to rise with age. This pattern of use does not correlate well with seizure onset. There are limited data on de-prescribing ASMs in PwID. The study population heterogenicity, associated polypharmacy, multimorbidity and higher sudden unexpected death in epilepsy risks are outlined. Suggestions are made from available evidence for improving prescribing practices for PwID and seizures, and key areas for further research in this complex clinical area are outlined.
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Affiliation(s)
- David Branford
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
| | - James J Sun
- Royal Free London NHS Foundation Trust, London, UK
| | | | - Rohit Shankar
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth Peninsula School of Medicine, Truro, UK
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Truro, UK
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Hou L, Yang J, Zhang X, Li N, Li S, Zhang L, Zhao J, Wang Q. Efficacy and tolerability of perampanel in patients with seizures in real-world clinical practice: A systematic review and meta-analysis. Front Pharmacol 2023; 14:1139514. [PMID: 37056989 PMCID: PMC10086234 DOI: 10.3389/fphar.2023.1139514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Objectives: The aim of this study was to systematically review the efficacy and tolerability of perampanel (PER) when used as add-on treatment or monotherapy in patients with epilepsy aged 12 years and older in routine clinical practice.Methods: Electronic and clinical trials databases were searched for observational studies of PER published up to 1 March 2022. The outcomes of interest were responder rates, adverse effects (AEs), and withdrawal rates. Subgroup analyses were performed to explore the potential factors that might affect the efficacy and safety of PER usage.Results: A total of 56 studies, which included 10,688 patients, were enrolled. The results showed that after 3, 6, and 12 months of PER treatment, the pooled 50% responder rates in patients with epilepsy were 50.0% (95% CI: 0.41–0.60), 44.0% (95% CI: 0.38–0.50), and 39.0% (95% CI: 0.31–0.48), respectively, and the pooled seizure-free rates were 24.0% (95% CI: 0.17–0.32), 21.0% (95% CI: 0.17–0.25), and 20.0% (95% CI: 0.16–0.24), respectively. Subgroup analyses revealed that the efficacy of PER could be affected by the way in which PER is administrated. Patients in the groups where PER was used as the first add-on, primary monotherapy, or combined with non–enzyme-inducing AEDs (non-EIAEDs) displayed a high 50% responder rate and seizure-free rate when compared with those in the late add-on, conversion therapy, or combined with the EIAEDs groups, respectively. Furthermore, the incidences of AEs at 3, 6, and 12 months of PER treatment were 46% (95% CI: 0.38–0.55), 52.0% (95% CI: 0.43–0.60), and 46.0% (95% CI: 0.40–0.52), respectively. The withdrawal rates due to AEs were 8.0% (95% CI: 0.06–0.11), 16.0% (95% CI: 0.13–0.20), and 16% (95% CI: 0.11–0.21) at 3, 6, and 12 months of PER treatment, respectively. Subgroup analyses showed a higher withdrawal rate in the rapid (30%, 95% CI: 0.22–0.38) than in the slow (12%, 95% CI: 0.06–0.18) titration group.Conclusion: Altogether, PER was effective and could be fairly tolerated in both short-term and long-term usage in patients with epilepsy in routine clinical practice. Furthermore, PER appeared to be more effective when PER was used as the first add-on, monotherapy, or concomitant with non-EIAEDs.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022384532.
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Affiliation(s)
- Liyan Hou
- Dalian Medical University Library, Dalian Medical University, Dalian, China
| | - Jingjing Yang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xuan Zhang
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
| | - Na Li
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
| | - Sheng Li
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
| | - Lei Zhang
- Dalian Medical University Library, Dalian Medical University, Dalian, China
- *Correspondence: Lei Zhang, ; Jie Zhao, ; Qingshan Wang,
| | - Jie Zhao
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
- *Correspondence: Lei Zhang, ; Jie Zhao, ; Qingshan Wang,
| | - Qingshan Wang
- National-Local Joint Engineering Research Center for Drug-Research and Development R & D of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
- School of Public Health, Dalian Medical University, Dalian, China
- *Correspondence: Lei Zhang, ; Jie Zhao, ; Qingshan Wang,
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Estévez-María JC, Garamendi-Ruiz I. The real-world effectiveness and safety of perampanel in Europe: A scoping review. Epilepsy Behav 2022; 134:108777. [PMID: 35816832 DOI: 10.1016/j.yebeh.2022.108777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022]
Abstract
In order to characterize the real-world effectiveness and safety of perampanel during clinical use in Europe, we conducted a structured literature search and scoping review of real-world studies conducted in Europe in adolescents (aged ≥ 12 years) or adults who were prescribed perampanel for focal epilepsy or primary generalized tonic-clonic seizures in the context of idiopathic generalized epilepsy, published between January 2016 and July 2021. We identified 29 relevant studies (20 retrospective and 9 prospective) in 3608 patients; median study duration was 12 months. Most patients (76.1%) were receiving two or more antiseizure drugs (ASDs) when perampanel was initiated. The maintenance perampanel dose ranged from 2 to 16 mg/day (most commonly 6 mg/day). Retention rate at 12 months ranged from 46% to 90.5% (median 71.1%). The proportion of patients who were free of seizures during perampanel ranged from 1.8% to 84.6%, but were consistently below 20% in studies where patients had received an average of ≥5 prior ASDs and above 20% where patients had received an average of <5 prior ASDs. The proportion of patients who achieved ≥50% reduction in seizures during perampanel ranged from 20.0% to 85.7%. Across all studies, the incidence of adverse events (AEs) ranged from 18.2% to 67.4% (median 37.1%) and discontinuation due to AEs from 6.2% to 56% (median 12.5%). Discontinuation rates tended to be higher in UK studies than in studies from Italy or Spain. The most commonly reported individual AEs were dizziness/vertigo (median incidence 13.7%), somnolence (median 11.9%), aggression (median 9.8%), irritability (median 9.1%), and cognitive deficits (median 7.0%). There was no relationship between the overall rate of AEs and perampanel dose, perampanel plasma levels, or number of concomitant medications. Our global overview of European observational studies with perampanel provides evidence that this agent is effective and safe in clinical practice in a range of countries, patients, and settings.
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Watkins LV, O'Dwyer M, Shankar R. A review of the pharmacotherapeutic considerations for managing epilepsy in people with autism. Expert Opin Pharmacother 2022; 23:841-851. [PMID: 35341433 DOI: 10.1080/14656566.2022.2055461] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Autism, like other neurodevelopmental disorders (NDDs), has a strong association with epilepsy. There are known common genetic pathways in both autism and epilepsy. There are also specific genetic syndromes associated with both complex epilepsy and the autism phenotype. AREAS COVERED This review explores the evidence for common genetic etiologies and pathophysiological pathways in relation to both epilepsy and autism. Autism with comorbid epilepsy are associated with a high prevalence of medical and psychiatric comorbidities. This paper discusses how this influences assessment, treatment, and outcomes. The evidence for the treatment of specific seizure types in the context of NDDs is also examined alongside clinical commentary. EXPERT OPINION Despite the strong association, there is a limited evidence base to support the efficacy and tolerability of anti-seizure medications specifically in autism, with no Level 1 evidence or National Guidance available. Autism and epilepsy should be approached under a NDD model with cautious introduction and titration of anti-seizure medication. Alongside this, there is evidence to support a move toward precision medicine in specific genetic syndromes such as Tuberous Sclerosis Complex and other genetic seizure disorders. The first-line treatments that should be considered for focal seizures include carbamazepine, lamotrigine, and levetiracetam.
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Affiliation(s)
- Lance V Watkins
- Epilepsy Specialist Service Swansea Bay University Health Board, Cardiff, UK
| | - Maire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences Trinity College, Dublin 2, Ireland
| | - Rohit Shankar
- Department of Intellectual Disability Neuropsychiatry, Cornwall Partnership NHS Foundation Trust, Truro, UK.,Cornwall Intellectual Disability Equitable Research (CIDER) University of Plymouth Medical School, Truro, UK
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Connor GS, Williamson A. Effectiveness and safety of adjunctive cenobamate for focal seizures in adults with developmental disability treated in clinical practice. Epilepsy Behav Rep 2022; 18:100533. [PMID: 35345772 PMCID: PMC8956884 DOI: 10.1016/j.ebr.2022.100533] [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: 01/10/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
92.9% (26/28 patients) continued cenobamate through 6 months, showing high retention. High responder rates/substantial focal seizure reduction occurred with cenobamate. 100% seizure reduction occurred in 48.2% of patients at 6 months. Adverse effects were often mitigated by concomitant antiseizure medication reduction.
Effectiveness and tolerability of adjunctive cenobamate for uncontrolled focal seizures in adults living with a developmental disability are not defined. Retrospective medical record review included adults ≥18 years old living with a developmental disability, either in a group home or with parents, and experiencing uncontrolled focal seizures despite stable doses of ≥1 antiseizure medication (ASM). Effectiveness was examined as percentage change in focal seizure frequency per month from the 2-month average before cenobamate to the average of months 5 and 6 while receiving cenobamate. Percentages of patients achieving responder rates in focal seizure frequency at 6 months of cenobamate treatment were examined. Adverse effects and concomitant ASM dosage adjustments were assessed. Of the 28 included patients, 26 (92.9%) continued cenobamate beyond 6 months. The responder rate of 100% seizure reduction (seizure-free) occurred in 48.2% of the patients who continued cenobamate for 6 months. Ten adverse effects were reported in 9 patients (32.1%), and 80% (8/10) were resolved by reducing concomitant ASM dosages. Two patients (7.1%) discontinued cenobamate due to adverse effects. Cenobamate resulted in substantial reduction in focal seizure frequency and was well tolerated.
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Affiliation(s)
- Gregory S. Connor
- Neurological Center of Oklahoma, 6585 South Yale Avenue, Suite 620, Tulsa, OK 74136, United States
- Corresponding author at: Neurological Center of Oklahoma, PLC, 6585 South Yale Avenue, Suite 620, Tulsa, OK 74136, United States.
| | - Amanda Williamson
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, United States
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O'Dwyer M, Watkins L, McCallion P, McCarron M, Henman M, Shankar R. Optimising medicines use in older adults with intellectual disability who have epilepsy: challenges and perspectives. Ther Adv Drug Saf 2021; 12:20420986211025157. [PMID: 34394909 PMCID: PMC8361510 DOI: 10.1177/20420986211025157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Maire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin, 2, Ireland
| | - Lance Watkins
- Swansea Bay University Health Board Ringgold Standard Institution, Neath Port Talbot, UK
| | - Philip McCallion
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mary McCarron
- Trinity Centre for Ageing and Intellectual Disability, School of Nursing and Midwifery, University of Dublin, Trinity College Dublin, Ireland
| | - Martin Henman
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin, Ireland
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, UK, and Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
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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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Sagar P, Wawryk O, Vogrin S, Whitham E, Kiley M, Frasca J, Carne R, Seneviratne U, Cook MJ, Lawn N, Nikpour A, D'Souza WJ. Efficacy and tolerability of adjuvant perampanel: an Australian multicenter real-world observational study in refractory focal and generalized epilepsy syndromes. Epilepsy Behav 2021; 119:107935. [PMID: 33930626 DOI: 10.1016/j.yebeh.2021.107935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore the efficacy and tolerability of adjuvant perampanel (PER) and their associated risk factors in late add-on drug-resistant epilepsy. METHOD Retrospective multicenter 'real-world' observational study. Consecutively identified patients commenced on PER, with mixed epilepsy syndromes, from nine Australian epilepsy centers. Primary efficacy endpoints were at least 50% reduction in seizure frequency (responders), seizure freedom, and retention at 6 and 12 months, following a 3-month titration period. Tolerability endpoints were cessation of PER for any reason, cessation of PER due to treatment-emergent adverse events (TEAE), or cessation due to inefficacy. Outcomes were assessed for a-priori risk factors associated with efficacy and tolerability. RESULTS Three-hundred and eighty seven adults were identified and followed up for a median of 12.1 months (IQR 7.0-25.2). Focal epilepsy accounted for 79.6% (FE), idiopathic generalized epilepsy (IGE), 10.3% and developmental epileptic encephalopathy (DEE) 10.1%, of the cohort. All patients had drug-resistant epilepsy, 71.6% had never experienced six months of seizure freedom, and the mean number of antiepileptic medications (AEDs) prior to starting PER was six. At 12 months, with missing cases classified as treatment failure, retention was 40.0%, responder 21.7%, and seizure freedom 9.0%, whereas, using last outcome carried forward (LOCF), responder and seizure freedom rates were 41.3% and 14.7%, respectively. Older age of epilepsy onset was associated with a marginal increase in the likelihood of seizure freedom at 12-month maintenance (OR 1.04, 95% CI 1.02, 1.06). Male sex (adjusted OR [aOR] 2.06 95% CI 1.33, 3.19), lower number of prior AEDs (aOR 0.84, 95% CI 0.74, 0.96) and no previous seizure-free period of at least 6-month duration (aOR 2.04 95% CI 1.21, 3.47) were associated with retention. Perampanel combined with a GABA receptor AED was associated with a lower responder rate at 12 months but reduced cessation of PER. The most common TEAEs were neuropsychiatric (18.86%), followed by dizziness (13.70%), and sleepiness (5.68%). CONCLUSIONS Adjuvant PER treatment, even in late-add on drug-resistant epilepsy is an effective and well-tolerated treatment for drug-resistant epilepsy.
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Affiliation(s)
- Parveen Sagar
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia.
| | - Olivia Wawryk
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia
| | - Sara Vogrin
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia
| | - Emma Whitham
- Department of Neurology, Flinders Medical Centre, Australia
| | - Michelle Kiley
- Department of Neurology, Royal Adelaide Hospital, Australia
| | - Joseph Frasca
- Department of Neurology, Flinders Medical Centre, Australia
| | - Ross Carne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia; Department of Neurology, Monash Medical Centre, Melbourne, Australia
| | - Mark J Cook
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia
| | - Nicholas Lawn
- Western Australian Adult Epilepsy Service, Sir Charles Gairdner Hospital, Perth, Australia
| | - Armin Nikpour
- Department of Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Australia
| | - Wendyl Jude D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Australia
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Allard J, Lawthom C, Henley W, Mclean B, Hudson S, Tittensor P, Rajakulendran S, Ellawela S, Pace A, Shankar R. Eslicarbazepine acetate response in intellectual disability population versus general population. Acta Neurol Scand 2021; 143:256-260. [PMID: 33131083 DOI: 10.1111/ane.13368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND A quarter of people with intellectual disability (ID) have epilepsy, compared to approximately one in a hundred across the general population. Evidence for the safe and effective prescribing of antiepileptic drugs (AEDs) for those with ID is, however, limited. AIMS OF STUDY This study seeks to strengthen the research evidence around Eslicarbazepine Acetate (ESL), a new AED, by comparing response of individuals with ID to those from the general population who do not have ID. METHODS A single data set was created through retrospective data collection from English and Welsh NHS Trusts. The UK-based Epilepsy Database Research Register (Ep-ID) data collection and analysis method were used. RESULTS Data were collected for 93 people (36 ID and 57 'no ID'). Seizure improvement of '>50%' was higher at 12 months for 'no ID' participants (56%), compared to ID participants (35%). Retention rates were slightly higher for those with ID (56% compared to 53%). Neither difference was significant. CONCLUSIONS Tolerance and Efficacy for ID and 'no ID' people in our data set were similar. Seizure improvement and retention rates were slightly lower than that found in other European data sets, but findings strengthen the evidence for the use of ESL in the ID population.
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Affiliation(s)
- Jon Allard
- Cornwall Intellectual Disability & Epilepsy Research (CIDER) Centre Cornwall Partnership NHS Foundation Trust Bodmin UK
| | - Charlotte Lawthom
- Swansea University Swansea UK
- Aneurin Bevan University Health Board Newport UK
| | | | | | - Sharon Hudson
- Cornwall Intellectual Disability & Epilepsy Research (CIDER) Centre Cornwall Partnership NHS Foundation Trust Bodmin UK
| | | | - Sanjeev Rajakulendran
- The National Hospital for Neurology and Neurosurgery University College Hospitals NHS Foundation Trust London UK
| | - Shan Ellawela
- The Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle Upon Tyne UK
| | - Adrian Pace
- Salford Royal NHS Foundation Trust Salford UK
| | - Rohit Shankar
- Cornwall Intellectual Disability & Epilepsy Research (CIDER) Centre Cornwall Partnership NHS Foundation Trust Bodmin UK
- University of Exeter Medical School Truro UK
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Davis Jones G, Stavropoulos I, Ibrahim K, Tristram M, Neale M, Jory C, Adcock J, Esposito M, Hamandi K, Shankar R, Rugg-Gunn F, Elwes R, Sen A. An evaluation of the effectiveness of perampanel in people with epilepsy who have previously undergone resective surgery and/or implantation of a vagal nerve stimulator. Epilepsy Behav 2021; 116:107738. [PMID: 33517199 DOI: 10.1016/j.yebeh.2020.107738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
About 30% of people with epilepsy (PWE) are drug-resistant. Those with focal seizures may be suitable for epilepsy surgery. Those not amenable to resective surgery can be considered for vagus nerve stimulation (VNS). However, after operative procedures, around 50% of patients continue to experience seizures. A multi-center retrospective study assessing perampanel effectiveness and tolerability for PWE who have undergone surgical resection and/or VNS implantation was performed. The primary outcome was ≥50% reduction in seizure frequency while secondary outcomes included side effects (SEs), dose-related effectiveness, and toxicity. The median perampanel dose was 6 mg. Only one PWE became seizure free. A ≥50% decrease in seizure frequency was observed in 52.8% of the post-resection group and 16.9% of the VNS group (p < 0.001), while SEs were seen in 44.8% and 41.1%, respectively. Perampanel doses greater than 8 mg led to better response in both groups, especially in the post-VNS cohort. SEs were not dose-related and the safety profile was similar to previous observational studies. Perampanel can be beneficial in these two super-refractory epilepsy groups, particularly in PWE with seizures after surgical resection. Doses of more than 8 mg appear to be well tolerated and may be more effective than lower doses in PWE after surgical interventions.
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Affiliation(s)
- Gabriel Davis Jones
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK
| | - Ioannis Stavropoulos
- Department of Clinical Neurophysiology, King's College Hospital, London, UK; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Kareem Ibrahim
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK
| | - Maggie Tristram
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK
| | - Marcus Neale
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK
| | - Caryn Jory
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, UK
| | - Jane Adcock
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK
| | - Michelle Esposito
- The Welsh Epilepsy Centre, Department of Neurology, University Hospital of Wales, Cardiff CF144XW, UK
| | - Khalid Hamandi
- The Welsh Epilepsy Centre, Department of Neurology, University Hospital of Wales, Cardiff CF144XW, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Threemilestone Industrial Estate, Truro, UK; University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - Fergus Rugg-Gunn
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery, and UCL Institute of Neurology, London, UK
| | - Robert Elwes
- Department of Clinical Neurophysiology, King's College Hospital, London, UK
| | - Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, UK
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Allard J, Henley W, Snoeijen‐Schouwenaars F, Ool J, Tan I, Jurgen Schelhaas H, Majoie MHJM, Hudson S, McLean B, Shankar R. European perspective of perampanel response in people with Intellectual Disability. Acta Neurol Scand 2020; 142:255-259. [PMID: 32383205 DOI: 10.1111/ane.13261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/21/2020] [Accepted: 05/03/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Epilepsy prevalence is over 20% for those with ID. It is difficult to diagnose and treat and more likely to be treatment resistant. The evidence informing prescribing is sparse, particularly for new drugs such as perampanel (PMP). AIMS OF THE STUDY This study seeks to strengthen the research evidence regarding PMP for people with ID by pooling information from two isolated and separately conducted studies: the UK-based Epilepsy Database Register (Ep-ID) and the data from the Kempenhaeghe clinic in the Netherlands. METHODS A single data set of comparable data was created and analysed under agreement and supervision of a UK statistician. RESULTS Seizure reduction within twelve months was evident in 62% of Dutch and 47% of UK patients. Retention rates were higher for those in the UK (P = .01) and for patients with moderate to profound ID, whilst side effects were more prominent in the Dutch cohort. CONCLUSIONS Comparable rates of seizure reduction are in line with estimates for non-ID patients, adding to the evidence suggesting that PMP has a similar impact on those with ID. Taking a European perspective and sharing data across centres can help strengthen the evidence for prescribing antiepileptic drugs in the ID population.
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Affiliation(s)
- Jon Allard
- Cornwall Partnership NHS Foundation Trust Redruth UK
| | | | | | - Jans Ool
- Department of Residential Care Academic Centre for Epileptology Kempenhaeghe Heeze The Netherlands
| | - In Tan
- Department of Residential Care Academic Centre for Epileptology Kempenhaeghe Heeze The Netherlands
| | | | - Marian H. J. M. Majoie
- School of Mental Health and Neuroscience Maastricht University Medical Center Maastricht The Netherlands
- School of Health Professions Education Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht The Netherlands
- Department of Neurology Academic Centre for Epileptology Kempenhaeghe Heeze The Netherlands
| | - Sharon Hudson
- Cornwall Partnership NHS Foundation Trust Redruth UK
| | | | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust Redruth UK
- University of Exeter Truro UK
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15
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Allard J, Henley W, Mclean B, Sellers A, Hudson S, Rajakulendran S, Pace A, Pashley S, Maguire M, Mohan M, Ellawela S, Tittensor P, Ram S, Bagary M, Shankar R. Lacosamide in the general population and in people with intellectual disability: Similar responses? Seizure 2020; 76:161-166. [PMID: 32106016 PMCID: PMC7113834 DOI: 10.1016/j.seizure.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Epilepsy prevalence is significantly higher in people with Intellectual Disability (ID) compared to people with epilepsy (PWE) from the general population. Increased psychological and behavioural problems, healthcare costs, morbidity, mortality and treatment resistance to antiepileptic drugs (AEDs) is associated with epilepsy in ID populations. Prescribing AEDs for PWE and ID is challenging and influenced heavily by studies conducted with the general population. Our study compares Lacosamide (LCM) response for the ID population to those from the general population; using data from an UK based epilepsy database register (EP ID/PDD AED Register). METHODS Pooled retrospective case notes data for PWE prescribed LCM at 11 UK NHS Trusts were analysed. Participants were classified as per WHO guidance into groups of moderate-profound ID, mild ID and General population. Demographics, concomitant AEDs, starting and maximum dosage, exposure length, adverse effects, dropout rates, seizure frequency were collected. Group differences were reported as odds ratios estimated from univariable logistic regression models. RESULTS Of 232 consented participants, 156 were from the general population and 76 had ID (24 mild, 52 moderate-profound). Twelve month withdrawal rates and reasons, efficacy, side-effects, start and maximum doses were similar between the groups. Dose titration between baseline and three months was significantly slower in the ID group (p = 0.02). CONCLUSION There were no differences for LCM outcomes between general and ID groups. Slower LCM titration in ID populations in the first 3 months was associated with higher retention and lower behavioural side effects as compared to similar European studies.
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Affiliation(s)
- Jon Allard
- Cornwall Partnership NHS Foundation Trust, United Kingdom
| | | | - Brendan Mclean
- Royal Cornwall Hospital NHS Foundation Trust, United Kingdom
| | - Adrian Sellers
- Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Sharon Hudson
- Cornwall Partnership NHS Foundation Trust, United Kingdom
| | - Sanjeev Rajakulendran
- National Centre for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, United Kingdom
| | - Adrian Pace
- Salford Royal NHS Foundation Trust, United Kingdom
| | - Sarah Pashley
- Nottinghamshire Healthcare NHS Foundation Trust, United Kingdom
| | | | | | - Shan Ellawela
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | | | - Sunil Ram
- Somerset Partnership NHS Foundation Trust, United Kingdom
| | - Manny Bagary
- Birmingham and Solihull Mental Health NHS Foundation Trust, United Kingdom
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, United Kingdom; University of Exeter Medical School, United Kingdom.
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16
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Watkins L, O'Dwyer M, Kerr M, Scheepers M, Courtenay K, Shankar R. Quality improvement in the management of people with epilepsy and intellectual disability: the development of clinical guidance. Expert Opin Pharmacother 2019; 21:173-181. [PMID: 31790280 DOI: 10.1080/14656566.2019.1695780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: This clinical guidance looks at the specific concerns of delivery of medical treatment for people with epilepsy and intellectual disability (ID). People with ID have not been included in licensing drug trials of AEDs. However, this population has an over-representation of seizure comorbidity, treatment resistance, and polypharmacy while also being vulnerable to not having their views considered.Areas covered: This review summarizes the current most robust evidence available for the use of licensed AEDs in people with epilepsy and ID. The article provides practical evidence-based clinical information to help prescribers choose the most appropriate AED from the drugs discussed. The article highlights other important individualized factors to consider before initiating or changing antiepileptic medication.Expert opinion: A 'traffic light' coding system is applied to commonly used AEDs based on the level of evidence and expert clinical experience. Managing epilepsy in the ID population requires specialist care. Treatment plans need to be holistic and tailored to accommodate an individual's comorbidities, concurrent medications, general health, social and environmental status. There is a need for large quality trial data to assess the most suitable AEDs on seizure control and quality of life in this population with complex needs.
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Affiliation(s)
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Republic of Ireland
| | - Michael Kerr
- Department of Psychological Medicine & Clinical Neuroscience, Cardiff University, Cardiff, UK.,Vice Chair - SUDEP Action, Wantage, UK
| | | | | | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
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17
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Perampanel for the treatment of epilepsy; Longitudinal actuarial analysis and dose responses based on monthly outcomes. Seizure 2019; 69:125-132. [DOI: 10.1016/j.seizure.2019.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/10/2019] [Accepted: 04/13/2019] [Indexed: 12/22/2022] Open
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18
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Goji H, Kanemoto K. The effect of perampanel on aggression and depression in patients with epilepsy: A short-term prospective study. Seizure 2019; 67:1-4. [DOI: 10.1016/j.seizure.2019.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 01/01/2023] Open
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19
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Villanueva V, Montoya J, Castillo A, Mauri-Llerda JÁ, Giner P, López-González FJ, Piera A, Villanueva-Hernández P, Bertol V, Garcia-Escrivá A, Garcia-Peñas JJ, Garamendi I, Esteve-Belloch P, Baiges-Octavio JJ, Miró J, Falip M, Garcés M, Gómez A, Gil-López FJ, Carreño M, Rodriguez-Uranga JJ, Campos D, Bonet M, Querol R, Molins A, Tortosa D, Salas-Puig J. Perampanel in routine clinical use in idiopathic generalized epilepsy: The 12-month GENERAL study. Epilepsia 2018; 59:1740-1752. [PMID: 30062784 DOI: 10.1111/epi.14522] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To analyze the effectiveness and tolerability of perampanel across different seizure types in routine clinical care of patients with idiopathic generalized epilepsy (IGE). METHODS This multicenter, retrospective, 1-year observational study collected data from patient records at 21 specialist epilepsy units in Spain. All patients who were aged ≥12 years, prescribed perampanel before December 2016, and had a confirmed diagnosis of IGE were included. RESULTS The population comprised 149 patients with IGE (60 with juvenile myoclonic epilepsy, 51 generalized tonic-clonic seizures [GTCS] only, 21 juvenile absence epilepsy, 10 childhood absence epilepsy, 6 adulthood absence epilepsy, and one Jeavons syndrome). Mean age was 36 years. The retention rate at 12 months was 83% (124/149), and 4 mg was the most common dose. At 12 months, the seizure-free rate was 59% for all seizures (88/149); 63% for GTCS (72/115), 65% for myoclonic seizures (31/48), and 51% for absence seizures (24/47). Seizure frequency was reduced significantly at 12 months relative to baseline for GTCS (78%), myoclonic (65%), and absence seizures (48%). Increase from baseline seizure frequency was seen in 5.2% of patients with GTCS seizures, 6.3% with myoclonic, and 4.3% with absence seizures. Perampanel was effective regardless of epilepsy syndrome, concomitant antiepileptic drugs (AEDs), and prior AEDs, but retention and seizure freedom were significantly higher when used as early add-on (after ≤2 prior AEDs) than late (≥3 prior AEDs). Adverse events were reported in 50% of patients over 12 months, mostly mild or moderate, and irritability (23%), somnolence (15%), and dizziness (14%) were most frequent. SIGNIFICANCE In routine clinical care of patients with IGE, perampanel improved seizure outcomes for GTCS, myoclonic seizures, and absence seizures, with few discontinuations due to adverse events. This is the first real-world evidence with perampanel across different seizure types in IGE.
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Affiliation(s)
| | - Javier Montoya
- Lluis Alcanyis Hospital, Xátiva, Spain.,General University Hospital Valencia, Valencia, Spain
| | | | | | - Pau Giner
- University Hospital Dr Peset, Valencia, Spain
| | | | - Anna Piera
- University Hospital Clinic Valencia, Valencia, Spain
| | | | | | | | | | | | | | | | - Júlia Miró
- University Hospital Bellvitge, Barcelona, Spain
| | - Mercè Falip
- University Hospital Bellvitge, Barcelona, Spain
| | | | - Asier Gómez
- University Hospital and Polytechnic La Fe, Valencia, Spain
| | | | | | | | | | | | - Rosa Querol
- University Complex Infanta Cristina, Badajoz, Spain
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20
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Rohracher A, Zimmermann G, Villanueva V, Garamendi I, Sander JW, Wehner T, Shankar R, Ben-Menachem E, Brodie MJ, Pensel MC, Di Gennaro G, Maurousset A, Strzelczyk A, Rheims S, Rácz A, Menzler K, Bertol-Alegre V, García-Morales I, López-González FJ, Toledo M, Carpenter KJ, Trinka E. Perampanel in routine clinical use across Europe: Pooled, multicenter, observational data. Epilepsia 2018; 59:1727-1739. [DOI: 10.1111/epi.14520] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/02/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Alexandra Rohracher
- Department of Neurology; Christian Doppler Medical Center and Center for Cognitive Neuroscience; Paracelsus Medical University; Salzburg Austria
| | - Georg Zimmermann
- Department of Neurology; Christian Doppler Medical Center and Center for Cognitive Neuroscience; Paracelsus Medical University; Salzburg Austria
- Department of Mathematics; Paris Lodron University; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg; Paracelsus Medical University; Salzburg Austria
| | | | | | - Josemir W. Sander
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; Queen Square, London UK
- Chalfont Centre for Epilepsy; Chalfont St Peter UK
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
| | - Tim Wehner
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; Queen Square, London UK
- Ruhr-Epileptology; Department of Neurology; Knappschaftskrankenhaus Bochum; Bochum Germany
| | | | | | | | - Max C. Pensel
- Department of Epileptology; University Hospital of Bonn; Bonn Germany
| | | | - Aude Maurousset
- University Hospital Bretonneau and INSERM U 930; Tours France
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main; Goethe University; Frankfurt Germany
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology; Hospices Civils de Lyon and University of Lyon; Lyon France
| | - Attila Rácz
- Department of Epileptology; University Hospital of Bonn; Bonn Germany
| | - Katja Menzler
- Epilepsy Center Hessen; University Hospital Marburg; Marburg Germany
| | | | | | | | | | | | - Eugen Trinka
- Department of Neurology; Christian Doppler Medical Center and Center for Cognitive Neuroscience; Paracelsus Medical University; Salzburg Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg; Paracelsus Medical University; Salzburg Austria
- Institute of Public Health; Medical Decision Making and HTA; Private University for Health Sciences Medical Informatics and Technology; Hall in Tyrol Austria
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21
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Morano A, Fattouch J, Albini M, Casciato S, Fanella M, Basili LM, Viganò A, Manfredi M, Giallonardo AT, Di Bonaventura C. Perampanel as adjunctive therapy in highly refractory epilepsies: Real-world data from an Italian tertiary care epilepsy centre. J Neurol Sci 2018; 390:67-74. [PMID: 29801910 DOI: 10.1016/j.jns.2018.04.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/26/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
Perampanel (PER) is a selective non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor antagonist, licensed as adjunctive therapy in focal epilepsy and primary generalized tonic-clonic seizures (pGTCSs). We performed a retrospective study on highly refractory adult patients taking PER, with 1-year follow-up. Retention rate represented the primary outcome of our work; seizure frequency reduction (≥50%), "switch rate" and proportion of adverse events (AEs) were evaluated as secondary endpoints. Eighty-nine subjects (47 females, age range: 19-78 years) were included. Seventy-three had focal epilepsy (FE), 9 generalized epilepsy and 7 epileptic encephalopathy. All patients were highly drug-resistant (medication failures: 5-17). Retention rate was 87.6%, 63% and 51.7% at 3, 6 and 12 months. Responders were 27/89 (30.3%), with 8/27 seizure-free. The number of previous treatment failures and the concomitant use of enzyme inducers negatively influenced clinical response, whereas no correlation was documented between PER dose and outcome. Responder proportion was more satisfying in structural FE than in FE of unknown etiology (33% versus 20%), and in secondarily GTCSs than focal seizures (54% vs 28%), whereas pGTCSs showed a lower reponse rate (25%). Mild-to-moderate AEs (mainly dizziness, gait disturbances and psychiatric effects) were reported by 40% of patients; serious psychiatric AEs usually occurred in subjects with psychiatric comorbidities. Our study confirms the tolerability and effectiveness of PER in highly drug-resistant patients with different epilepsy syndromes and aetiologies.
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Affiliation(s)
- Alessandra Morano
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Jinane Fattouch
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Mariarita Albini
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Sara Casciato
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Martina Fanella
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Luca Manfredi Basili
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Alessandro Viganò
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Mario Manfredi
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Anna Teresa Giallonardo
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy
| | - Carlo Di Bonaventura
- Neurology Unit, Department of Neurosciences and Mental Health, "Sapienza" University, Rome, Italy.
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