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Lee WT, Chan DWS, Gulati S, Likasitwattanakul S, Lim BC, Okumura A, Sanchez-Gan B, Wang Y, Liu KT. Role of Perampanel in the Management of Pediatric Epilepsies in Asia: Expert Opinion. Pediatr Neurol 2024; 151:5-16. [PMID: 38041905 DOI: 10.1016/j.pediatrneurol.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/08/2023] [Accepted: 09/29/2023] [Indexed: 12/04/2023]
Abstract
Management of pediatric epilepsies poses unique challenges around diagnosis, treatment options, comorbidities, and the potential for these factors to interact with processes in the developing brain. In pediatric patients, broad-spectrum antiseizure medications (ASMs) with minimal potential for adverse events (AEs) and limited impact on cognition and behavior are preferred. Perampanel is a first-in-class ASM with broad-spectrum efficacy, a tolerable safety profile, minimal negative impact on cognitive function, and other features that make it a viable treatment option in this patient population. However, evidence and experience of its use in pediatric patients are less extensive than in adult patients. Experts in pediatric epilepsy across the region convened at a series of meetings to discuss the use of perampanel in pediatric patients, including dose optimization, AE prevention and management, and considerations in particular groups. This article summarizes key evidence for perampanel in the pediatric population and consolidates the experts' recommendations for using the ASM in managing pediatric epilepsies.
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Affiliation(s)
- Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | | | - Sheffali Gulati
- Center of Excellence and Advanced Research on Childhood Neurodevelopmental Disorders, Child Neurology Division, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Surachai Likasitwattanakul
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Benilda Sanchez-Gan
- Division of Pediatric Neurology, Departments of Pediatrics and Neurosciences, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Kam Tim Liu
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital and Queen Mary Hospital, Hong Kong SAR, China.
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Ben Salem C, Denguezli M. Commonly prescribed medications associated with alopecia. J Am Acad Dermatol 2023; 89:e281. [PMID: 37633463 DOI: 10.1016/j.jaad.2023.07.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Chaker Ben Salem
- Professor of Clinical Pharmacology, Pharmacovigilance Center of Sousse, University of Sousse, Sousse, Tunisia.
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Zgolli F, Aouinti I, Charfi O, Kaabi W, Hamza I, Daghfous R, Kastalli S, Lakhoua G, Aidli SE. Cutaneous adverse effects of antiepileptic drugs. Therapie 2023:S0040-5957(23)00141-5. [PMID: 37865562 DOI: 10.1016/j.therap.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/15/2023] [Accepted: 09/11/2023] [Indexed: 10/23/2023]
Abstract
Antiepileptic drugs (AED) are widely used in therapy. They are mainly indicated in the treatment of epilepsy and some psychiatric pathologies as well as for their analgesic action. Their cutaneous adverse effects (CAE) are common, often mild but sometimes serious. The aim of this work was to study the epidemiological and clinical features of CAE occurring in adults and elderly patients (aged over 20 years-old) and to identify the most implicated AED. We conducted a descriptive retrospective study over a period of five years from January 2017 to December 2022 about CAE of AED in adults and elderly patients notified to The National Center Chalbi Belkahia of Pharmacovigilance (Tunis,Tunisia). All cases were analyzed according to the updates French methods of imputability. We collected 71 cases of patients aged over 20 years old who presented CAE to AED. The age ranged from 20 to 79 years (mean age=44.8 years). The sex ratio F/M was 0.7. AED were indicated for neurological pathology in 70.5% of cases, for psychiatric pathology in 15.9% of cases and for their analgesic action in 12.9% of cases. Epilepsy was the first indication (51.1% of cases). The most notified CAE in our study were drug reaction with eosinophilia and systemic symptoms (DRESS syndrome; 34% of cases), maculopapular exanthema (MPE; 26% of cases), erythematous rash (8% of cases) and photosensitivity in 5% of cases. Severe cutaneous adverse reactions were accounted for 37% of all CAE. The most implicated AED were carbamazepine (52%), phenobarbital (24%) and lamotrigine (18%). However, further study with a larger number of patients and in collaboration with prescribing physicians are needed to better clarify features of CAE associated with AED intake and specify the risk factors, specific to our Tunisian population.
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Affiliation(s)
- Fatma Zgolli
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia.
| | - Imen Aouinti
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Ons Charfi
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Widd Kaabi
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Imen Hamza
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Riadh Daghfous
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Sarrah Kastalli
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Ghozlane Lakhoua
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
| | - Sihem El Aidli
- National Center Chalbi Belkahia of Pharmacovigilance, 1006 Tunis, Tunisia; Research unit: UR17ES12, La Rabta, Faculty of Medicine, University of Tunis El Manar, 1007 Tunis, Tunisia
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Pitton Rissardo J, Fornari Caprara AL, Casares M, Skinner HJ, Hamid U. Antiseizure Medication-Induced Alopecia: A Literature Review. MEDICINES (BASEL, SWITZERLAND) 2023; 10:35. [PMID: 37367730 DOI: 10.3390/medicines10060035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
Background: Adverse effects of antiseizure medications (ASMs) remain one of the major causes of non-adherence. Cosmetic side effects (CSEs) are among the most commonly reported side effects of ASMs. In this context, alopecia is one of the CSEs that has a high intolerance rate leading to poor therapeutical compliance. Methods: We performed a literature review concerning alopecia as a secondary effect of ASMs. Results: There are 1656 individuals reported with ASM-induced alopecia. Valproate (983), lamotrigine (355), and carbamazepine (225) have been extensively reported. Other ASMs associated with alopecia were cenobamate (18), levetiracetam (14), topiramate (13), lacosamide (7), vigabatrin (6), phenobarbital (5), gabapentin (5), phenytoin (4), pregabalin (4), eslicarbazepine (3), brivaracetam (2), clobazam (2), perampanel (2), trimethadione (2), rufinamide (2), zonisamide (2), primidone (1), and tiagabine (1). There were no reports of oxcarbazepine and felbamate with drug-induced alopecia. Hair loss seen with ASMs was diffuse and non-scarring. Telogen effluvium was the most common cause of alopecia. A characteristic feature was the reversibility of alopecia after ASM dose adjustment. Conclusions: Alopecia should be considered one important adverse effect of ASMs. Patients reporting hair loss with ASM therapy should be further investigated, and specialist consultation is recommended.
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Affiliation(s)
- Jamir Pitton Rissardo
- Medicine Department, Federal University of Santa Maria, Santa Maria 97105-900, Brazil
| | | | - Maritsa Casares
- AdventHealth Orlando Neuroscience Institute, 615 E Princeton Street, Suite 540, Orlando, FL 32803, USA
| | - Holly J Skinner
- AdventHealth Epilepsy at Orlando, 615 E Princeton Street, Suite 540, Orlando, FL 32803, USA
| | - Umair Hamid
- Department of Neurology, College of Medicine, University of Illinois, Peoria, IL 61605, USA
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Evers S, Wald S. Effluvium and alopecia associated with monoclonal calcitonin gene-related peptide antibody use. Headache 2023; 63:165-167. [PMID: 36504402 DOI: 10.1111/head.14427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Stefan Evers
- Medical Faculty, University of Münster, Münster, Germany.,Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany
| | - Susan Wald
- Department of Neurology, Lindenbrunn Hospital, Coppenbrügge, Germany
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Liang CY, Chiang KL, Hsieh LP, Chien LN. Prescription patterns and dosages of antiepileptic drugs in prevalent patients with epilepsy in Taiwan: A nationwide retrospective cross-sectional study. Epilepsy Behav 2022; 126:108450. [PMID: 34864625 DOI: 10.1016/j.yebeh.2021.108450] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the prescription patterns and prescribed daily dose (PDD)/defined daily dose (DDD) ratios of antiepileptic drugs (AEDs) in prevalent patients with epilepsy in Taiwan. MATERIALS AND METHODS A nationwide retrospective cross-sectional study was conducted for prevalent patients with epilepsy in 2016 using the Taiwanese National Health Insurance Research Database. The prescription records of AEDs of all prevalent patients with epilepsy were retrieved. The mean PDDs and PDD/DDD ratios of AEDs in adult patients were obtained to evaluate dosing adequacy. A chi-square test and two-sample t test were used to analyze the differences in AED prescription patterns and dosages, respectively, among patients with different ages, sexes, comorbidities, and therapeutic approaches. RESULTS A total of 118,937 prevalent patients with epilepsy were enrolled. The predominant therapeutic approach was monotherapy, especially in the elder adults, accounting for 82.9% of elder adult patients with epilepsy. The proportion of AED monotherapy was higher in patients with dementia (78.9%) and stroke (80.6%). The top three antiepileptic monotherapies were valproic acid (28.7%), levetiracetam (19.1%), and phenytoin (16.9%); however, oxcarbazepine (22.8%) was substituted for carbamazepine (3.9%) as monotherapy for patients aged 0-17 years. Among adult patients with epilepsy, the PDD/DDD ratio of each AED in monotherapy was less than 1.00. The mean PDD of each AED was higher in polytherapy than in monotherapy (p < 0.01), except for lacosamide. The mean PDDs of all evaluated AEDs in monotherapy were lower in elder adult patients than in younger adult patients, most of which reached statistical significance (p < 0.001). CONCLUSIONS In Taiwan, valproic acid was the most prescribed AED for prevalent patients with epilepsy. The mean PDDs of most AEDs were lower than the DDDs developed by the World Health Organization.
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Affiliation(s)
- Chun-Yu Liang
- Department of Neurology, Yumin Medical Corporation Yumin Hospital, No. 200, Sec. 1, Taiping Rd., Caotun Township, Nantou County 542007, Taiwan; Department of Neurology, Changhua Christian Hospital, No. 135, Nanxiao St., Changhua City, Changhua County 500209, Taiwan.
| | - Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, No. 117, Shatian Rd., Shalu Dist., Taichung City 433401, Taiwan
| | - Liang-Po Hsieh
- Department of Neurology, Cheng-Ching Hospital, No. 966, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City 407211, Taiwan.
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei 110301, Taiwan.
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Praharaj SK, Munoli RN, Udupa ST, Vaidyanathan S. Valproate-associated hair abnormalities: Pathophysiology and management strategies. Hum Psychopharmacol 2022; 37:e2814. [PMID: 34532891 DOI: 10.1002/hup.2814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review the literature on valproate-associated hair abnormalities and the available treatment options. METHODS We searched PubMed and Google Scholar with keywords including "valproate", "valproic acid", "hair", "alopecia", and "effluvium," supplemented with hand search from cross-references. We included all types of studies including case reports in this review. RESULTS The pathophysiology of hair loss includes telogen effluvium, biotin, mineral deficiency, and possibly hyperandrogenism. Diagnosis is based on history of hair loss or abnormalities following valproate treatment, and is confirmed by use of simple clinical tests such as pull test and modified wash test. Treatment involves reassurance and advice on hair care, and if possible drug discontinuation or dose reduction. Medications such as biotin and other vitamins with minerals supplementation is effective for most individuals with hair loss. Other treatment options are agomelatine, topical valproate or minoxidil, though these lack evidence. CONCLUSION Hair abnormalities with valproate are common, benign adverse effects, and management includes general measures and specific treatment options.
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Affiliation(s)
- Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravindra N Munoli
- Department of Psychiatry, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Suma T Udupa
- Department of Psychiatry, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sivapriya Vaidyanathan
- Department of Psychiatry, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Jouyban A, Farajzadeh MA, Afshar Mogaddam MR, Nemati M, Khoubnasabjafari M, Jouyban-Gharamaleki V. Molecularly imprinted polymer based-solid phase extraction combined with dispersive liquid–liquid microextraction using new deep eutectic solvent; selective extraction of valproic acid from exhaled breath condensate samples. Microchem J 2021. [DOI: 10.1016/j.microc.2020.105772] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Tran A, Desir AK, Okafor LC, Jafferany M, Copes LE. Psychodermatology in clinical practice: An examination of physician attitudes, beliefs, and interventions toward psychocutaneous disease. Dermatol Ther 2020; 33:e13612. [DOI: 10.1111/dth.13612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Alison Tran
- Frank H. Netter M.D. School of Medicine at Quinnipiac University North Haven Connecticut USA
| | - Alexandra K. Desir
- Frank H. Netter M.D. School of Medicine at Quinnipiac University North Haven Connecticut USA
| | - Lauren C. Okafor
- Frank H. Netter M.D. School of Medicine at Quinnipiac University North Haven Connecticut USA
| | - Mohammad Jafferany
- Central Michigan University and CMU Medical Education Partners Saginaw Michigan USA
| | - Lynn E. Copes
- Frank H. Netter M.D. School of Medicine at Quinnipiac University North Haven Connecticut USA
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Cook M, Murphy M, Bulluss K, D'Souza W, Plummer C, Priest E, Williams C, Sharan A, Fisher R, Pincus S, Distad E, Anchordoquy T, Abrams D. Anti-seizure therapy with a long-term, implanted intra-cerebroventricular delivery system for drug-resistant epilepsy: A first-in-man study. EClinicalMedicine 2020; 22:100326. [PMID: 32395709 PMCID: PMC7205744 DOI: 10.1016/j.eclinm.2020.100326] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/10/2020] [Accepted: 03/15/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A clinical feasibility study was undertaken at a single center of long-term intra-cerebroventricular drug delivery of the anti-seizure medication valproic acid, into the cerebrospinal fluid (CSF) in order to treat drug resistant focal seizures, using an implantable infusion system. The primary objective was to establish the dose range of VPA administered in this manner. Secondarily, safety, pharmacokinetics (PK) and a preliminary estimate of effectiveness were evaluated. METHODS In this single arm study, five adult subjects, with 29-234 focal onset seizures per month from a seizure focus involving the mesial temporal lobe were implanted with the system (clinicaltrials.gov identifier NCT02899611). Oral valproic acid (VPA) had previously been ineffective in all subjects. Post-surgery, pharmacokinetic studies of CSF infused VPA were performed. Valproic acid doses were increased stepwise in a standardised protocol. FINDINGS The procedure and implantation were well-tolerated by all subjects. Four subjects responded with > 50% seizure reduction at the highest tested dose of 160 mg/day. Two subjects experienced extended periods of complete seizure freedom. All five subjects reported significant quality of life improvement. No clinical dose limiting side effects were encountered and there was no evidence of local periventricular toxicity in three subjects who were evaluated with imaging (T2 MRI). Side effects included nausea and appetite loss but were not dose-limiting. Mean CSF valproic acid levels were 45 μg per ml (range 20-120 μg per ml), with corresponding serum levels of 4-14 μg per ml. Subjects have received therapy for up to 2.5 years in total . The efficacy analysis presented focuses on the period of time with the current pump with a mean 12.5 months, range 11.5-15 months. Pump failure requiring reimplantation was a significant initial issue in all subjects but resolved with use of pumps suitably compatible with long-term exposure to valproic acid. INTERPRETATION The study demonstrated that chronic intraventricular administration of valproic acid is safe and effective in subjects with medically refractory epilepsy over many months. The procedure for implanting the infusion system is safe and well-tolerated. High CSF levels are achieved with corresponding low serum levels and this therapy is shown to be effective despite unsuccessful earlier use of oral valproate preparations. Drug side effects were minimal. FUNDING The study was funded by Cerebral Therapeutics Inc., Suite 137 12635 East Montview Blvd Aurora CO 80045.
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Affiliation(s)
- Mark Cook
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
- Graeme Clark Institute, The University of Melbourne, 203 Bouverie St, Melbourne 3010, Australia
| | - Michael Murphy
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Kristian Bulluss
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Wendyl D'Souza
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Chris Plummer
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Emma Priest
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Catherine Williams
- St Vincent's Hospital, Departments of Medicine & Surgery, The University of Melbourne, 35 Victoria Parade, Fitzroy, 3065 VIC, Australia
| | - Ashwini Sharan
- Thomas Jefferson University, 4201 Henry Ave, Philadelphia, PA 19144, United States
| | - Robert Fisher
- Stanford University Stanford Epilepsy Center and EEG Lab, 213 Quarry Road, Room 4865, Palo Alto, CA 94304-5979, United States
| | - Sharon Pincus
- Cerebral Therapeutics, 12635 E. Montview Blvd., Aurora, CO 80010, Australia
| | - Eric Distad
- Cerebral Therapeutics, 12635 E. Montview Blvd., Aurora, CO 80010, Australia
| | - Tom Anchordoquy
- Skaggs School of Pharmacy and Pharmaceutical Sciences University of Colorado School of Pharmacy 12850 E. Montview Blvd., V20-4120, Aurora, CO 80045, United States
| | - Dan Abrams
- Cerebral Therapeutics, 12635 E. Montview Blvd., Aurora, CO 80010, Australia
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