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Aldakhil AF. Prevalence of developmental dyslexia among primary school children in Arab countries: a systematic review and meta-analysis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 152:104812. [PMID: 39079361 DOI: 10.1016/j.ridd.2024.104812] [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: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Dyslexia is one of the most common learning disabilities. It poses challenges in reading skills development and can have a lasting impact in other areas of learning. AIMS To investigate the prevalence of developmental dyslexia among primary school children aged 6-13 in Arab countries, and to explore associations with gender and residency. METHOD Following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, we included studies up to December 2023 that were found in English and Arabic research database searches. Random-effects proportional meta-analyses determined the prevalence of dyslexia in Arab countries, with a direct comparison between girls and boys using odds ratios. RESULTS The meta-analysis included 18 studies with 30,243 participants: eight studies (44 %) from Egypt, four (22 %) from Saudi Arabia, and six (34 %) from other Arab countries. The pooled prevalence of dyslexia for children aged 6-13 in these studies was 11 %. The odds ratio for girls vs. boys was 0.85 (95 %). Geographical variations were notable, with eight studies (44 %) from Asia and ten (56 %) from Africa. Eight studies (44 %) were from the Gulf region, while ten (56 %) were from non-Gulf region. Prevalence of dyslexia was significantly higher in Arab countries in Asia (24 %) than in Africa (12 %), and the prevalence in non-Gulf countries was 13 % which was nearly half in comparison to Gulf countries (24 %). CONCLUSIONS The prevalence rates of dyslexia in primary school children varies across the Arab world, with higher rates among boys, Arab countries in Asia, and Gulf countries. Further research is needed to include both genders and standardized diagnostics across more Arab countries to understand and address dyslexia effectively.
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Affiliation(s)
- Ali Fahad Aldakhil
- Department of Special Education, College of Education, Majmaah University, Majmaah 11952, Saudi Arabia.
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Kishk N, Hosny H, Badry R, Elmenshawi I, Hamdy MM, Shaker E, Shehata HS, Magdy R, Ramzy GM, Hemeda M, Gaber A, Abdelhamed M, Abohagar A, Yassine IA, Abbas M, Shaheen HA, Abdel Moety M, Metwally HMH, Saeed MA, Essmat A, Abdou A, Soliman RH, Oraby MI, Morad AE, Kasem SM, Aidaros M, El Heneedy Y, ElNemr A, Elkady A, Amin R, Abdel Ghany WA, Morsy AA, Hamdi H, Shamloul R. Consensus Guideline on the Management of Epilepsy in Egypt: A National Delphi Consensus Study. Epilepsia Open 2024; 9:1233-1251. [PMID: 38790148 PMCID: PMC11296093 DOI: 10.1002/epi4.12922] [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: 03/04/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE In epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day-to-day practice in Egypt as well as several other resource-limited countries. Premature mortality, poor quality of life, socio-economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus. METHODS The consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements. RESULTS Of 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements. SIGNIFICANCE With the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt. PLAIN LANGUAGE SUMMARY This work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource-limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.
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Affiliation(s)
- Nirmeen Kishk
- Neurology Department, Faculty of MedicineCairo UniversityGizaEgypt
| | - Hassan Hosny
- Neurology Department, Faculty of MedicineCairo UniversityGizaEgypt
| | - Reda Badry
- Neurology Department, Faculty of MedicineAssiut UniversityAsyutEgypt
| | - Ibrahim Elmenshawi
- Neurology Department, Faculty of MedicineMansoura UniversityMansouraEgypt
| | - Mohamed M. Hamdy
- Neurology Department, Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Ehab Shaker
- Neurology Department, Faculty of MedicineCairo UniversityGizaEgypt
| | - Hatem S. Shehata
- Neurology Department, Faculty of MedicineCairo UniversityGizaEgypt
| | - Rehab Magdy
- Neurology Department, Faculty of MedicineCairo UniversityGizaEgypt
| | - Gihan M. Ramzy
- Neurology Department, Faculty of MedicineCairo UniversityGizaEgypt
| | - Mahmoud Hemeda
- Neurology Department, Faculty of MedicineAin Shams UniversityCairoEgypt
| | - Ahmed Gaber
- Neurology Department, Faculty of MedicineAin Shams UniversityCairoEgypt
| | | | - Ahmed Abohagar
- Neurology Department, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | - Imane A. Yassine
- Neurology Department, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | - Mohammed Abbas
- Neurology Department, Faculty of MedicineMansoura UniversityMansouraEgypt
| | - Hala A. Shaheen
- Neurology Department, Faculty of MedicineFayoum UniversityFayoumEgypt
| | | | | | | | - Ahmed Essmat
- Neurology Department, Faculty of MedicineAl‐Azhar UniversityCairoEgypt
| | - Ashraf Abdou
- Neurology Department, Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | | | - Mohammed I. Oraby
- Neurology Department, Faculty of MedicineBeni‐Suef UniversityBeni SuefEgypt
| | | | | | - Magdy Aidaros
- Neurology Department, Faculty of MedicineZagazig UniversityZagazigEgypt
| | | | - Ahmed ElNemr
- Neurology DepartmentMaadi Military HospitalCairoEgypt
| | - Ahmed Elkady
- Neurology DepartmentMataria Teaching HospitalEl MatareyaEgypt
| | - Ramy Amin
- Neurosurgery Department, Faculty of MedicineCairo UniversityGizaEgypt
| | | | - Ahmed A. Morsy
- Neurosurgery Department, Faculty of MedicineZagazig UniversityZagazigEgypt
| | - Hussein Hamdi
- Neurosurgery Department, Faculty of MedicineTanta UniversityTantaEgypt
| | - Reham Shamloul
- Neurology Department, Faculty of MedicineCairo UniversityGizaEgypt
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Elmazny A, Alkharisi MAA, Ibrahim YSJ, Albarakati ABA, Almutairi SS, Altalhi LA, Darwish EM, Magdy R, Elsebaie EH, Dahshan A. Public misconceptions and attitudes towards persons diagnosed with epilepsy in the Kingdom of Bahrain: A cross-sectional study. Epilepsy Behav 2024; 153:109731. [PMID: 38452516 DOI: 10.1016/j.yebeh.2024.109731] [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: 12/28/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Despite significant advancements in the understanding and treatment of epilepsy, the quality of life for persons diagnosed with Epilepsy (PdwE) can still be negatively impacted due to prevalent misconceptions and societal attitudes. This study aimed to investigate the knowledge, misconceptions, and attitudes towards epilepsy in Bahrain. METHODS This cross-sectional study involved 1079 participants aged ≥ 18 years living in Bahrain. Data collection occurred between June and December 2023 through an online questionnaire. The questionnaire consisted of four sections: sociodemographic characteristics, sources of information, knowledge about epilepsy, and attitudes toward PdwE. RESULTS Most participants (1063 out of 1179) were familiar with epilepsy, with social media being the main source of information (56.7%). While 75.6% correctly recognized epilepsy as a nervous system disorder. About 30% of participants believed that body shaking and falling to the ground were the only types of seizures. In terms of attitudes, 47.9% believed that PdwE could achieve high levels of education, but 40% thought they might face job loss due to their condition. Additionally, 27.5% disagreed with the idea of marrying someone with epilepsy or allowing a family member to do so. Being female, young, highly educated, and having a family member with epilepsy were associated with significantly more positive attitudes compared to other groups. CONCLUSION The studied sample of the Bahraini public demonstrated a satisfactory level of knowledge about epilepsy. However, they still held certain misconceptions that could impact their attitudes towards PdwE. Community awareness campaigns can address this knowledge gap and reduce epilepsy stigma.
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Affiliation(s)
- Alaa Elmazny
- Internal Medicine Department, College of Medicine and Medical Science, Arabian Gulf University, Manama, Bahrain; Neurology Department, Faculty of medicine, Cairo University, Egypt
| | | | | | | | | | | | - Enas Mostafa Darwish
- College of Health and Sports Sciences, University of Bahrain, Bahrain; Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - Rehab Magdy
- Neurology Department, Faculty of medicine, Cairo University, Egypt.
| | - Eman Hany Elsebaie
- Public Health and Community Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Dahshan
- Neurology Department, Faculty of medicine, Cairo University, Egypt
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Roussos S, Gerogianni G, Vasilopoulos G, Koutelekos I, Pavlatou N, Kalogianni A, Toulia G, Zartaloudi A, Polikandrioti M. Factors Associated With Anxiety and Depression in Persons With Epilepsy (PWE). Cureus 2024; 16:e56401. [PMID: 38633953 PMCID: PMC11023706 DOI: 10.7759/cureus.56401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Epilepsy is a common neurological disease that is associated with increased morbidity and mortality globally. Persons with epilepsy (PWE) experience a heavy emotional burden mainly due to social stigmatization and limited opportunities in life. The purpose of this study was to explore factors associated with anxiety and depression in PWE. MATERIAL AND METHODS In the present cross-sectional study, we enrolled 100 PWE who visited outpatient settings in a public hospital for scheduled follow-up. Data collection was carried out by the completion of the Hospital Anxiety and Depression Scale (HADS), which included participants' characteristics. The statistical significance level was p < 0.05. RESULTS Of the 100 participants, the majority were women (65%), below 50 years old (62%), and single (40%). In terms of mental comorbidity, 58% and 48% experienced anxiety and depression, respectively. A statistically significant association was observed between anxiety and age (p = 0.002). Furthermore, a statistically significant association was observed between depression and gender (p = 0.044), age (p = 0.001), marital status (p = 0.036), educational level (p = 0.003), job (p = 0.025), residency (p = 0.041), and whether they went out at night (p = 0.009). CONCLUSION Identifying factors associated with anxiety and depression is essential for PWE to receive appropriate support.
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Affiliation(s)
- Spyridon Roussos
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
| | | | - Georgios Vasilopoulos
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
| | | | - Niki Pavlatou
- Department of Nursing, University of West Attica, Athens, GRC
| | | | - Georgia Toulia
- Department of Nursing, University of West Attica, Athens, GRC
| | | | - Maria Polikandrioti
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
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Ashraf Mahmoud M, El Rashidi O, Halim G, Amgad Elkholy M, Aglan O, Rahman El Sabbagh A, Kamel Basha A, Hamdi H, El Sayed AM, Amin Saleh D, Shatla R, Abdel Ghany W. The dual effect of vagus nerve stimulation in pediatric patients with drug-resistant epilepsy: Is there more than seizure control? Epilepsy Behav Rep 2024; 27:100653. [PMID: 38841319 PMCID: PMC11150965 DOI: 10.1016/j.ebr.2024.100653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 06/07/2024] Open
Abstract
This is a retrospective and comparative pilot study to investigate the role of vagus nerve stimulation (VNS) in improving cognitive functions in the pediatric age group with drug resistant epilepsy (DRE). It was conducted from January 2018 to February 2023. Children between the ages of 4 and 18 years were divided into two groups, the "VNS group" and the "best medical treatment (BMT) group". Follow up period was 12 months. Demographic, clinical, etiological and investigational data were recorded. Cognitive assessment using the Modified Mini-Mental State Examination for children (MMSE) was recorded at baseline and 12 months later for each group. 76.4 % of patients were classified as epilepsy secondary to cerebral palsy. 75 % of patients showed ≥ 50 % seizure frequency reduction among the VNS group as compared to 12.5 % in the BMT group. None of both groups achieved seizure freedom. At 12 months, both BMT and VNS groups showed statistically significantly improved overall cognitive score from baseline records (p = 0.027) and (p = 0.012), respectively, with a significantly higher improvement in VNS group. Also, statistical sub-analysis of cognitive subscales in cerebral palsy patients in both groups was conducted and revealed a significant improvement (p = 0.02) in the VNS group. We concluded that there is a potential role of VNS in improving cognitive functions which was shown by using a cost-effective screening tool. A significant effect was observed specially in cerebral palsy patients. This is very beneficial in limited-resources countries since VNS has good safety profile, high seizure control, and added value to cognitive functions.
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Affiliation(s)
| | | | - George Halim
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | | | - Osama Aglan
- Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | | | | | - Hussein Hamdi
- Neurosurgery Department, Tanta University, Tanta, Egypt
| | | | - Dina Amin Saleh
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - R.H. Shatla
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
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Alaamery M, Massadeh S, Aldarwish M, Albesher N, Aljawini N, Alahmed O, Kashgari A, Walsh CA, Eyaid W. Case report: A founder UGDH variant associated with developmental epileptic encephalopathy in Saudi Arabia. Front Genet 2024; 14:1294214. [PMID: 38292436 PMCID: PMC10824937 DOI: 10.3389/fgene.2023.1294214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
Congenital disorders of glycosylation (CDG) are a group of more than 100 rare genetic disorders characterized by impaired glycosylation of proteins and lipids. The clinical presentation of CDG varies tremendously, from single-organ to multi-organ involvement and from prenatal death to a normal adult phenotype. In this case study, we report a large consanguineous family with multiple children suffering from cerebral palsy, seizure, developmental and epileptic encephalopathy, and global developmental delay. Whole-exome sequencing (WES) analysis revealed a homozygous variant in the UDP-glucose dehydrogenase (UGDH) gene (c.950G>A; p.R317Q) which segregates with the familial phenotype with a plausible autosomal recessive mode of inheritance, indicating a potential disease-causing association. The UGDH gene encodes the UDP-glucose dehydrogenase, a key enzyme in the synthesis of specific extracellular matrix constituents (proteoglycans and glycolipids) involved in neural migration and connectivity during early brain development. Many pathogenic mutations of UGDH have been reported in recent literature works. However, the variant identified in this study has been observed only in the Saudi population (13 families) and not in any other ethnic background, suggesting that it may be an ancient founder mutation.
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Affiliation(s)
- Manal Alaamery
- Developmental Medicine Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- Saudi Genome Program, National Centre for Genomic Technologies, King Abdulaziz City for Science and Technology (KACST), Riyadh, Saudi Arabia
- KACST-BWH Centre of Excellence for Biomedicine, Joint Centres of Excellence Program, King Abdulaziz City for Science and Technology (KACST), Riyadh, Saudi Arabia
| | - Salam Massadeh
- Developmental Medicine Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
- Saudi Genome Program, National Centre for Genomic Technologies, King Abdulaziz City for Science and Technology (KACST), Riyadh, Saudi Arabia
- KACST-BWH Centre of Excellence for Biomedicine, Joint Centres of Excellence Program, King Abdulaziz City for Science and Technology (KACST), Riyadh, Saudi Arabia
| | - Manar Aldarwish
- Genetics and Precision Medicine Department (GPM), King Abdullah Specialized Children’s Hospital (KASCH), King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Nour Albesher
- Saudi Genome Program, National Centre for Genomic Technologies, King Abdulaziz City for Science and Technology (KACST), Riyadh, Saudi Arabia
- Faculty of Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nora Aljawini
- KACST-BWH Centre of Excellence for Biomedicine, Joint Centres of Excellence Program, King Abdulaziz City for Science and Technology (KACST), Riyadh, Saudi Arabia
| | - Othman Alahmed
- Developmental Medicine Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Amna Kashgari
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Radiology, King Abdullah Specialized Children’s Hospital, King Abdul Aziz Medical City, Riyadh, Saudi Arabia
| | - Christopher A. Walsh
- Division of Genetics and Genomics and Howard Hughes Medical Institute, Department of Pediatrics, Boston Children’s Hospital, and Departments of Neurology and Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Wafaa Eyaid
- Genetics and Precision Medicine Department (GPM), King Abdullah Specialized Children’s Hospital (KASCH), King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Elmazny A, Alzayani S, Shehata MH, Magdy R. Knowledge, awareness, and attitudes towards epilepsy among elementary schoolteachers in the Kingdom of Bahrain. Eur J Paediatr Neurol 2023; 47:13-17. [PMID: 37659186 DOI: 10.1016/j.ejpn.2023.08.001] [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: 03/05/2023] [Revised: 07/11/2023] [Accepted: 08/08/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Teachers' awareness of epilepsy and attitudes toward students with epilepsy (SWE) largely affect their health, behavior, and academic performance. This study aimed to assess elementary schoolteachers' background knowledge and attitudes toward epilepsy in the Kingdom of Bahrain. METHODS A 23-item online questionnaire was distributed to elementary school teachers in all public schools in Bahrain between September 2022 and February 2023. The questionnaire included three sets of questions about teachers'1) demographics and teaching experience, 2) knowledge and experience with epilepsy, and 3) attitude towards SWE. RESULTS Three hundred and sixty-seven teachers responded to the questionnaire. Only 82 participants (22.3%) thought they had enough information about epilepsy. Approximately 25% had previously taught SWE. Even though 9.3% have witnessed a seizure before, only 2.2% received seizure first aid training courses. Most respondents (68.7%) knew that epilepsy is caused by abnormal brain electrical activity and is not contagious (95.1%). Regarding seizure types, 76.6% were aware of uncontrollable jerky movements, while staring spells were recognized by 45%. Most first-aid responses were inappropriate, as 59.7% would open the patient's mouth. Only 39.5% agreed on patient transfer to the hospital if the seizure lasted ≥5 min. Epilepsy was thought to cause mental retardation by 32.4%. Also, the belief that SWE were more prone to bullying was reported by 57.2%. CONCLUSION The knowledge and attitudes of schoolteachers in Bahrain towards epilepsy are relatively good but with remaining improvement potential. They do not fully grasp all seizure types nor adequate first-aid measures promoting future epilepsy educational programs.
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Affiliation(s)
- Alaa Elmazny
- Internal Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain; Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Salman Alzayani
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mohamed Hany Shehata
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Rehab Magdy
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Gatson TN, Freemont OA, Coleman RL, Lockett SJ, Spillers NJ, Ahmadzadeh S, Viswanath O, Varrassi G, Shekoohi S, Kaye AD. Vigabatrin (Sabril) for the Treatment of Refractory Complex Focal Seizures in Adults: Pharmacologic and Clinical Considerations. Cureus 2023; 15:e46414. [PMID: 37927747 PMCID: PMC10621625 DOI: 10.7759/cureus.46414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
To review the pharmacokinetics, efficacy, and adverse effects of vigabatrin (Sabril) and its role in managing refractory focal unaware seizures in adults. In the present investigation, a search of English-language literature from 1999 through 2023 was conducted using vigabatrin and Sabril as search terms to identify relevant studies and review articles. A 2000 double-blind, placebo-controlled multicenter study found that out of 90 adult patients, 48% of those treated with vigabatrin achieved a 50% or greater reduction in the frequency of complex partial seizures, compared to 26% of placebo-treated patients. This study also observed that vigabatrin was well tolerated by 72.4% of patients, with the most common side effects being drowsiness, dizziness, headache, and fatigue. Further studies with a significant risk of vigabatrin-associated visual field loss necessitate vigabatrin only being an option for refractory cases. Additional studies suggest that despite the potential risk of vision loss and adverse effects, adult patients continue to use vigabatrin long-term. Sabril is an antiepileptic medication prescribed as an additional treatment for refractory complex partial seizures in patients at least ten years old who have not responded well to other alternative therapies. Multiple clinical trials indicate that Sabril sufficiently reduces the frequency of seizures when used as an adjunct treatment of refractory complex focal seizures. However, it is important to carefully monitor patients for any adverse effects, particularly long-term use, and to discontinue the drug if serious side effects occur.
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Affiliation(s)
- Taylor N Gatson
- Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Orlandria A Freemont
- Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Rachel L Coleman
- Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Stewart J Lockett
- Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Noah J Spillers
- Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Shahab Ahmadzadeh
- Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Omar Viswanath
- Pain Management, Valley Pain Consultants - Envision Physician Services, Phoenix, USA
| | | | - Sahar Shekoohi
- Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Alan D Kaye
- Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
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Alsaadi T, Almadani A, Al-Hashel J, Al Salti A, Melikyan G, Khan RA. Commentary: Consensus Guidelines on the Appropriate Use of Brand-Name and Generic Anti-Seizure Medication for the Management of Epilepsy in the Gulf Region. Neurol Ther 2023; 12:1015-1031. [PMID: 37222860 PMCID: PMC10310631 DOI: 10.1007/s40120-023-00491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION The clinical, social, and economic burden of epilepsy is undeniable. Local guidance on epilepsy management is limited and needed to address the both use of anti-seizure medication (ASM) and switching practices which influence clinical outcomes. AREAS COVERED An expert panel composed of practicing neurologists and epileptologists from countries of the Gulf Cooperation Council (GCC) met in 2022 to discuss local challenges in the management of epilepsy and formulate recommendations for clinical practice. Published literature on the outcomes of ASM switching was reviewed along with clinical practice/gaps, international guidelines, and local treatment availabilities. EXPERT OPINION Improper ASM use and inappropriate brand-name-to-generic or generic-to-generic switching can contribute to worsening clinical outcomes in epilepsy. ASMs should be used for the management of epilepsy based on patient clinical profile, underlying epilepsy syndrome, and drug availability to ensure optimal and sustainable treatment. Both first-generation and newer ASMs can be considered; appropriate use is recommended from the beginning of treatment. It is critical to avoid inappropriate ASM switching to avoid breakthrough seizures. All generic ASMs should fulfill strict regulatory requirements. If needed, ASM changes should always be approved by the treating physician. ASM switching (brand-name-to-generic, generic-to-generic, generic-to-brand-name) should be avoided in epilepsy patients who have achieved control but can be considered for those uncontrolled on current medication.
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Affiliation(s)
- Taoufik Alsaadi
- Neurology Department, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
| | | | - Jasem Al-Hashel
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Gayane Melikyan
- Neurology, Weill Cornell Medical College-Qatar (WCMC-Q), Ar-Rayyan, Qatar
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Beghi E, Giussani G, Costa C, DiFrancesco JC, Dhakar M, Leppik I, Kwan P, Akamatsu N, Cretin B, O'Dwyer R, Kraemer G, Piccenna L, Faught E. The epidemiology of epilepsy in older adults: A narrative review by the ILAE Task Force on Epilepsy in the Elderly. Epilepsia 2023; 64:586-601. [PMID: 36625133 DOI: 10.1111/epi.17494] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023]
Abstract
In an aging world, it is important to know the burden of epilepsy affecting populations of older persons. We performed a selective review of epidemiological studies that we considered to be most informative, trying to include data from all parts of the world. We emphasized primary reports rather than review articles. We reviewed studies reporting the incidence and prevalence of epilepsy that focused on an older population as well as studies that included a wider age range if older persons were tabulated as a subgroup. There is strong evidence that persons older than approximately 60 years incur an increasing risk of both acute symptomatic seizures and epilepsy. In wealthier countries, the incidence of epilepsy increases sharply after age 60 or 65 years. This phenomenon was not always observed among reports from populations with lower socioeconomic status. This discrepancy may reflect differences in etiologies, methods of ascertainment, or distribution of ages; this is an area for more research. We identified other areas for which there are inadequate data. Incidence data are scarcer than prevalence data and are missing for large areas of the world. Prevalence is lower than would be expected from cumulative incidence, possibly because of remissions, excess mortality, or misdiagnosis of acute symptomatic seizures as epilepsy. Segmentation by age, frailty, and comorbidities is desirable, because "epilepsy in the elderly" is otherwise too broad a concept. Data are needed on rates of status epilepticus and drug-resistant epilepsy using the newer definitions. Many more data are needed from low-income populations and from developing countries. Greater awareness of the high rates of seizures among older adults should lead to more focused diagnostic efforts for individuals. Accurate data on epilepsy among older adults should drive proper allocation of treatments for individuals and resources for societies.
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Affiliation(s)
- Ettore Beghi
- Laboratory of Neurological Disorders, Department of Neuroscience, Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Giorgia Giussani
- Laboratory of Neurological Disorders, Department of Neuroscience, Mario Negri Institute of Pharmacological Research, Scientific Institute for Research and Health Care, Milan, Italy
| | - Cinzia Costa
- Section of Neurology, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Jacopo C DiFrancesco
- Department of Neurology, Istituto di Ricovero e Cura a Caraterre Scientifico, San Gerardo Foundation, University of Milan-Bicocca, Monza, Italy
| | - Monica Dhakar
- Department of Neurology, Brown University, Providence, Rhode Island, USA
| | - Ilo Leppik
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Naoki Akamatsu
- Division of Neurology, Neuroscience Center, Fukuoka Samo Hospital, International University of Health and Welfare, Fukuoka, Japan
| | - Benjamin Cretin
- Neuropsychology Unit, Department of Neurology of the University Hospitals of Strasbourg, Strasbourg, France
| | - Rebecca O'Dwyer
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | | | - Loretta Piccenna
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Faught
- Department of Neurology, Emory University, Atlanta, Georgia, USA
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Afif S, Rehan ST, Ul Hussain H, Islam MS. Low-intensity focused ultrasound, a novel approach to epilepsy treatment in developing countries. Brain Behav 2023; 13:e2852. [PMID: 36542525 PMCID: PMC9847596 DOI: 10.1002/brb3.2852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/12/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022] Open
Abstract
Approximately 80% of patients with epilepsy reside in poor resource settings. Despite the continued advancements and development of new treatment approaches, epilepsy remains a major health problem in developing countries. Consistent findings of epidemiologic studies reflect that both prevalence and treatment gap are higher in the developing world. The objective of this short review was to evaluate current treatment options and low-intensity, pulsed-focused ultrasound (FUS) as a potential new treatment option for epilepsy. Although some of the patients could be candidates for surgery, many factors, including poor health-care infrastructure, socioeconomic status, risks and complications associated with the surgery, and patients' preferences and attitudes toward the surgical procedure, limit the adherence to get surgical therapies. Low-intensity FUS, a novel and noninvasive therapeutic approach, has the potential to be approved by regulatory bodies and added to the list of standard treatment options for epilepsy. Improved understanding of epilepsy's prevalence and incidence in developing worlds, identification of potential new therapeutic options, and their evaluation through continuous studies and clinical trials are needed to reduce the burden of epilepsy and the treatment gap.
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Affiliation(s)
- Sadaf Afif
- Touro College of Osteopathic Medicine, New York, New York, USA
| | - Syeda Tayyaba Rehan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hassan Ul Hussain
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Md Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar Dhaka, Bangladesh.,Centre for Advanced Research Excellence in Public Health, Savar Dhaka, Bangladesh
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