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Meador KJ, Dimova S, Bourikas D, Elmoufti S, Floricel F, Laloyaux C, Moseley B, Nondonfaz X, Klein P. Time-course of drug-related psychiatric and behavioral treatment-emergent adverse events during brivaracetam treatment in adults with focal-onset seizures. Epilepsy Behav 2024; 156:109844. [PMID: 38788664 DOI: 10.1016/j.yebeh.2024.109844] [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: 02/21/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE We previously analyzed data from three phase lll trials of adjunctive brivaracetam (BRV) in adults showing that the incidence and prevalence of drug-related central nervous system treatment-emergent adverse events (TEAEs) quickly peaked and decreased over several weeks following BRV treatment initiation. However, that analysis did not assess psychiatric and behavioral side effects which can occur with antiseizure medication (ASM) treatment. Here, we investigate the time-course of psychiatric and behavioral TEAEs by week of BRV treatment and how these TEAEs were managed. METHODS Data were pooled from three trials (N01252 [NCT00490035]; N01253 [NCT00464269]; N01358 [NCT01261325]) in adult patients (≥16 years of age) with focal-onset seizures receiving BRV adjunctive therapy. This post hoc analysis reports data on the incidence and prevalence of drug-related psychiatric or behavioral TEAEs over time in patients who received BRV doses of 50-200 mg/day (without titration) or placebo (PBO) during the 12-week treatment period. A logistic regression model was used to determine if psychiatric or behavioral comorbid conditions were predictors for drug-related psychiatric or behavioral TEAEs, or BRV discontinuation due to psychiatric or behavioral TEAEs. RESULTS A total of 803 patients received BRV 50-200 mg/day, and 459 patients received PBO. Drug-related psychiatric or behavioral TEAEs were reported by 11.0 % of patients during adjunctive BRV treatment (PBO: 4.8 %) with onset early after BRV initiation (median time to onset of first drug-related psychiatric or behavioral TEAE: 15 days). Incidence peaked at week 1 and decreased over the first 4 weeks following BRV initiation. Prevalence peaked at week 4 and then remained stable between weeks 5-12. In an analysis excluding patients on concomitant levetiracetam (BRV: n = 744; PBO: n = 422), the incidence of drug-related psychiatric or behavioral TEAEs was similar to the incidence in the overall population. The most common drug-related psychiatric or behavioral TEAEs were irritability, insomnia, depression, and anxiety. Only 2 % of patients discontinued BRV due to psychiatric or behavioral TEAEs (PBO: 1.3 %), while most patients on BRV who reported drug-related psychiatric or behavioral TEAEs did not require a change in dose (84.1 %; PBO: 63.6 %). A history of psychiatric or behavioral comorbid conditions (not ongoing at BRV initiation) was not associated with an increased likelihood of drug-related psychiatric or behavioral TEAEs, or BRV discontinuation due to psychiatric or behavioral TEAEs. Ongoing psychiatric or behavioral comorbid conditions at BRV initiation increased the likelihood of drug-related psychiatric or behavioral TEAEs, but not the likelihood of BRV discontinuation due to psychiatric or behavioral TEAEs. CONCLUSIONS Drug-related psychiatric and behavioral TEAEs occurred early during BRV treatment, and most patients did not require a change in BRV dose. These data can help guide clinician monitoring and patient expectations after starting BRV.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA.
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2
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Kim JS, Kim WS, Sung WY, Woo H. Psychiatric and behavioral concerns of perampanel with concomitant levetiracetam in children with epilepsy. Epilepsy Behav 2024; 154:109740. [PMID: 38547767 DOI: 10.1016/j.yebeh.2024.109740] [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: 11/29/2023] [Revised: 02/21/2024] [Accepted: 03/10/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Perampanel (PER) is expanding the therapeutic scope for pediatric epilepsy owing to its efficacy and favorable safety profile. However, concerns about psychiatric and behavioral adverse events (PBAEs) in combination therapy with levetiracetam (LEV) continue to contribute to hesitation in its prescription. We investigated the risk profiles for PBAEs when adding PER to pediatric epilepsy treatment and analyzed the differences according to the presence of concomitant LEV. METHODS We retrospectively reviewed the medical records of children aged 4-18 years with epilepsy who were prescribed PER as adjunctive therapy from March 2016 to February 2023. We compared the occurrence and management of PBAEs between the PER without LEV and PER with LEV groups. The risk factors for PBAEs were also analyzed. RESULTS Ninety-four patients (53 boys and 41 girls) were included in this study. The median age of total patients at the time of adding PER was 14.9 years (12.3-16.4 years), and 53 patients (56.4 %) had concomitant LEV. Forty-seven PBAEs occurred in 34 patients (36.2 %), with no significant differences depending on whether concomitant LEV is present or not. The most common PBAEs were aggression (14.9 %), irritability (9.6 %), affect lability (7.4 %), and acute psychosis (6.4 %). PBAEs occurred at a lower dosage (2-6 mg/day) in 70.6 % of the patients. In addition, 73.5 % of patients with PBAEs continued PER treatment by follow-up observation or by reducing the PER dosage. No risk factors, such as the presence of concomitant LEV or lamotrigine, any comorbid conditions, higher PER dosage (8-12 mg/day), two or more concomitant anti-seizure medications, and younger age (<13 years) at PER add-on, showed significant associations. CONCLUSION When expanding the use of anti-seizure medications in pediatric patients, real-world evidence on safety issues is crucial for pediatric epileptologists. We confirmed that combination therapy with PER and LEV did not increase the risk profile of PBAEs.
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Affiliation(s)
- Jon Soo Kim
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Won Seop Kim
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Pediatrics, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Won Young Sung
- Department of Emergency Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, Republic of Korea
| | - Hyewon Woo
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea.
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Abell K, Sit DK, Wisner KL. Depression in Persons With Epilepsy: Lessons From Case Review. J Clin Psychopharmacol 2024; 44:272-277. [PMID: 38684049 DOI: 10.1097/jcp.0000000000001848] [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] [Indexed: 05/02/2024]
Abstract
BACKGROUND Major depressive disorder is highly prevalent among persons with epilepsy (PWEs). Between 30% and 50% of PWEs suffer from depression. Many factors contribute to this prevalence, including the psychosocial impact of the diagnosis, restrictions on driving and certain types of work, and adverse effects associated with antiseizure medications. Without proper treatment, depressed PWEs have increased risks for suicide, strained relationships, lowered seizure control, and impairment in functioning. Our objective was to use the existing literature and insights from our experience in treating depression and anxiety in PWEs within an academic mood disorders center. We aimed to provide practical guidance for health care professionals who treat depression in this population. METHODS Persons with epilepsy and depression were identified by their treating psychiatrists. Their electronic health records were reviewed and compiled for this report, with a total of 12 included in this review. Records were reviewed regarding antiseizure medications, psychotropic medications, light therapy, psychotherapy, other interventions, and treatment response. RESULTS Based on our review of literature, as well as review of cases of individuals with epilepsy and comorbid psychiatric conditions, we recommend a step-wise evidence-based approach of optimizing psychiatric medication doses, augmenting with additional medication and/or implementing nonpharmacological interventions such as light therapy and psychotherapy. CONCLUSIONS In PWEs, improvement in depression, other psychiatric symptoms, and function are the goals of drug and nondrug interventions. Depression care has the potential to significantly improve the quality of life of PWEs and reduce both morbidity and mortality.
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Affiliation(s)
- Kathryn Abell
- From the Department of Psychiatry and Behavioral Health, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Dorothy K Sit
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Katherine L Wisner
- Developing Brain Institute, Children's National Hospital, Washington, DC
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Torres-Fortuny A, Aras LM, Duñabeitia JA. Assessment of aggressive behavior in Dravet syndrome: a critical look. Front Integr Neurosci 2024; 18:1403681. [PMID: 38741918 PMCID: PMC11089182 DOI: 10.3389/fnint.2024.1403681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
| | - Luis Miguel Aras
- Asociación ApoyoDravet, Donostia-San Sebastian, Spain
- Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Jon Andoni Duñabeitia
- Centro de Investigación Nebrija en Cognición (CINC), Universidad Nebrija, Madrid, Spain
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Besag FMC, Berry D, Vasey MJ, Patsalos PN. Drug-drug interactions between antiseizure medications and antipsychotic medications: a narrative review and expert opinion. Expert Opin Drug Metab Toxicol 2023; 19:829-847. [PMID: 37925741 DOI: 10.1080/17425255.2023.2278676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Antiseizure medications (ASMs) and antipsychotic drugs are frequently coadministered with the potential for drug-drug interactions. Interactions may either be pharmacokinetic or pharmacodynamic, resulting in a decrease or increase in efficacy and/or an increase or decrease in adverse effects. AREAS COVERED The clinical evidence for pharmacokinetic and pharmacodynamic interactions between ASMs and antipsychotics is reviewed based on the results of a literature search in MEDLINE conducted in April 2023. EXPERT OPINION There is now extensive published evidence for the clinical importance of interactions between ASMs and antipsychotics. Enzyme-inducing ASMs can decrease blood concentrations of many of the antipsychotics. There is also evidence that enzyme-inhibiting ASMs can increase antipsychotic blood concentrations. Similarly, there is limited evidence showing that antipsychotic drugs may affect the blood concentrations of ASMs through pharmacokinetic interactions. There is less available evidence for pharmacodynamic interactions, but these can also be important, as can displacement from protein binding. The lack of published evidence for an interaction should not be interpreted as meaning that the given interaction does not occur; the evidence is building continually. There is no substitute for careful patient monitoring and sound clinical judgment.
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Affiliation(s)
- Frank M C Besag
- Child and Adolescent Mental Health Services (CAMHS), East London NHS Foundation Trust, Bedford, UK
- School of Pharmacy, University College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dave Berry
- Toxicology Unit, Kings College Hospital, London, UK
| | - Michael J Vasey
- Child and Adolescent Mental Health Services (CAMHS), East London NHS Foundation Trust, Bedford, UK
| | - Philip N Patsalos
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, UK
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Laskar S, Chaudhry N, Choudhury C, Garg D. Gender differences in quality of life and psychiatric comorbidities among persons with juvenile myoclonic epilepsy: A single-center cross-sectional study. J Neurosci Rural Pract 2023; 14:482-487. [PMID: 37692809 PMCID: PMC10483207 DOI: 10.25259/jnrp_34_2023] [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: 01/16/2023] [Accepted: 05/19/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized/genetic epilepsy syndrome. Gender differences are known in clinical presentation, with a well-identified female predilection. We aimed to study gender-based differences in quality of life (QoL) and psychiatric comorbidities among persons with JME. Materials and Methods This was a cross-sectional study conducted at a teaching hospital in Delhi, India. Persons above 11 years of age with JME diagnosed according to the International League Against Epilepsy criteria established in 2001 were enrolled. QoL assessment was made using Quality of Life in Epilepsy Inventory-Adolescents-48 (QOLIE-AD-48) and Patient-Weighted Quality of Life in Epilepsy Inventory 31 (QOLIE-31-P) for adolescent and adult patients, respectively. For the assessment of psychiatric comorbidities, participants were administered the Mini-International Neuropsychiatric Interview (M.I.N.I). Participants who tested positive for psychiatric comorbidities on M.I.N.I subsequently underwent the Diagnostic and Statistical Manual-5 categorization. Results We enrolled 50 patients with JME. Eighteen (36%) were male and 32 (64%) were female patients. The median age of males at study enrollment was 23.5 (range 15-38) years. The median age of females was 22 (16-48) years. The median QOLIE-31-P score among males was 68.31 (37.13-91.82) and for females was 66.9 (31.7-99.1). The median overall QoL score for males was 65 (25-87.5), which qualified as "fair" QoL. For females, the median overall QoL score was 62.5 (10-87.5) which also qualified as "fair" QoL. No significant difference was noted between genders in QoL (P = 0.723). Among males, 55.5% had psychiatric comorbidity. Of these, two had mild depression and eight had anxiety. Among female patients, 34.4% had comorbid psychiatric issues; 6 had anxiety and 5 had depression. No significant difference was noted between genders (P = 0.9136). Conclusion Persons with JME do not have gender-stratified differences in terms of psychiatric comorbidities and QoL despite differences in exposure to antiseizure medications and other gender-related factors. All persons with JME should be screened for psychiatric comorbidities, specifically anxiety, and depression.
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Affiliation(s)
- Sanghamitra Laskar
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neera Chaudhry
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Cankatika Choudhury
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Adachi N, Onuma T, Kato M, Sekimoto M, Okazaki M, Hara K, Ishii R, Ito M, Akanuma N, Fenwick P. Psychoses after an antiepileptic drug administration: Frequency, timing, and duration. Epilepsy Behav 2023; 140:109087. [PMID: 36702055 DOI: 10.1016/j.yebeh.2023.109087] [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: 11/13/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To clarify the pathophysiology of psychoses after the new administration of antiepileptic drugs (AED), we analyzed the annual incidence, timing of development, and duration of episodes. METHODS Psychotic outcomes in the first 6-month period after an AED or non-AED administration in patients with focal epilepsy were exhaustively reviewed in eight Japanese neuropsychiatry institutions. In cases with psychotic episodes, the subtype of psychosis, timing of development, previous history of psychosis, and duration of the episode were evaluated. RESULTS Between 1981 and 2015, 5018 new drugs (4402 AED and 616 non-AED) were administered to 2067 patients with focal epilepsy. In the first 6-month period, 105 psychotic episodes occurred (81 interictal psychosis [IIP] and 24 postictal psychosis). Furthermore, 55 cases were first episodes and 50 were recurrent episodes. The frequency of psychoses is significantly higher after AED administration (n = 102) compared with non-AED administration (n = 3). Psychosis occurred most frequently in the initial 1-month period after new-AED administration and tended to decrease with increasing time. The estimated annual incidence of all psychoses after a new AED administration was 3.5% (2.0% for first-episode psychosis and 1.8% for first-episode IIP). Duration of psychoses (mean, 38.5 weeks) was equivalent to overall IIP. Duration of IIP did not shorten with discontinuation of newly administered AED. SIGNIFICANCE Patients with epilepsy exhibit psychosis more frequently after new AED administration than after non-AED administration. This study shows the pathophysiology of psychoses after AED administration with annual incidence, the timing of development, and the duration of PAP, which have rarely been reported.
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Affiliation(s)
- Naoto Adachi
- Adachi Mental Clinic, Sapporo, Japan; National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan.
| | - Teiichi Onuma
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Masaaki Kato
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Masanori Sekimoto
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Mitsutoshi Okazaki
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan
| | | | - Ryouhei Ishii
- Department of Psychiatry, University of Osaka Graduate School of Medicine, Osaka, Japan
| | - Masumi Ito
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Jozen Clinic, Sapporo, Japan
| | - Nozomi Akanuma
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter Fenwick
- South London and Maudsley NHS Foundation Trust, London, UK
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Li KY, Hsu CY, Yang YH. A review of cognitive and behavioral outcomes of Brivaracetam. Kaohsiung J Med Sci 2023; 39:104-114. [PMID: 36661137 DOI: 10.1002/kjm2.12648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023] Open
Abstract
Anti-seizure medications (ASMs) can cause cognitive or behavioral adverse drug reactions, which is an important consideration when selecting an appropriate ASM. Brivaracetam (BRV) is a newer synaptic vesicle protein 2A ligand, which is expected to result in fewer neuropsychiatric adverse effects due to its mechanism of action. To understand the impact of BRV on cognition and behavior compared with other ASMs, we conducted a review of the literature using the Cochrane Library, PubMed/MEDLINE, and Embase. After the screening process, a total of two animal studies, one randomized controlled trial, one pooled analysis of clinical trials, one controlled study, and nine observational studies were included. The animal studies showed that BRV did not worsen cognitive or behavioral performance in rodents. The human studies showed that BRV was associated with fewer cognitive adverse events compared with other second- or third-generation ASMs. In addition, BRV was less associated with behavioral disturbance than levetiracetam. In summary, this review revealed that BRV has a limited impact on cognition and behavior. For patients who are intolerant to levetiracetam and have levetiracetam-related behavioral side effects, switching to BRV could be beneficial. However, heterogeneity between studies resulted in low-quality of evidence, and further trials are needed to confirm the findings.
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Affiliation(s)
- Kuan-Ying Li
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chung-Yao Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of and Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Pisani F, Pisani LR, Barbieri MA, de Leon J, Spina E. Optimization of Therapy in Patients with Epilepsy and Psychiatric Comorbidities: Key Points. Curr Neuropharmacol 2023; 21:1755-1766. [PMID: 35619263 PMCID: PMC10514544 DOI: 10.2174/1570159x20666220526144314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/24/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022] Open
Abstract
Psychiatric disorder comorbidity in patients with epilepsy (PWE) is very frequent with a mean percentage prevalence of up to 50% and even higher. Such a high frequency suggests that epilepsy and psychiatric disorders might share common pathological pathways. Various aspects contribute in making the matter very complex from a therapeutic point of view. Some antiseizure medications (ASMs), namely valproic acid, carbamazepine, and lamotrigine, have mood-stabilising effects and are routinely used for the treatment of bipolar disorder in patients who do not have epilepsy. Pregabalin and, to a lesser extent, gabapentin, exerts anxiolytic effects. However, several ASMs, in particular levetiracetam, topiramate, and perampanel, may contribute to psychiatric disorders, including depression, aggressive behaviour, and even psychosis. If these ASMs are prescribed, the patient should be monitored closely. A careful selection should be made also with psychotropic drugs. Although most of these can be safely used at therapeutic doses, bupropion, some tricyclic antidepressants, maprotiline, and clozapine may alter seizure threshold and facilitate epileptic seizures. Interactions between ASMs and psychotropic medication may make it difficult to predict individual response. Pharmacokinetic interactions can be assessed with drug monitoring and are consequently much better documented than pharmacodynamic interactions. Another aspect that needs a careful evaluation is patient adherence to treatment. Prevalence of non-adherence in PWE and psychiatric comorbidities is reported to reach values even higher than 70%. A careful evaluation of all these aspects contributes in optimizing therapy with a positive impact on seizure control, psychiatric wellbeing, and quality of life.
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Affiliation(s)
- Francesco Pisani
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | | | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA and Psychiatry and Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Italy
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Wang Q, Xu Y, Chen Y, Wu X, Ge Y, Zhu G. Effectiveness and safety of perampanel as adjunctive therapy among Chinese patients with focal-onset epilepsy: A real-world prospective observational study. Epilepsy Behav 2022; 136:108937. [PMID: 36215830 DOI: 10.1016/j.yebeh.2022.108937] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Perampanel (PER) has previously been shown to be effective and tolerable when used as an adjunctive therapy for patients with focal-onset seizures (FOS). This study aimed to evaluate the effect of PER as adjunctive therapy for patients with FOS in the Chinese population under real-world conditions for 1 year. METHODS A prospective, single-center, 1-year observational study was conducted at Huashan Hospital, enrolling both under age (≥4 years old) and adult patients with FOS. Response to PER was assessed at 3-, 6-, and 12-month checkpoints by analyzing the 50 % responder rate, the seizure-free rate, and reduction in seizure frequency. RESULTS One hundred and eight patients (mean age: 26.6 years, 56.5 % males) with FOS were included, with seventy-six patients finishing the 1-year follow-up (retention rate: 70.4 %, mean PER dose: 4.3 mg/day). The seizure frequency was reduced significantly at 3, 6, and 12 months relative to baseline (p < 0.001 for each seizure type). At 12 months, the responder rate was 65.8 %, and the seizure-free rate was 39.5 %. A significantly higher responder rate was found in patients with focal to bilateral tonic-clonic seizures (p = 0.024), among which the percentage of patients with sleep-related epilepsy was significantly high (p = 0.045). Responders had a lower number of concomitant anti-seizure medications (ASMs) than the non-responders (p = 0.009). Drug-related adverse events (AEs) were reported in 37 % of patients, mostly mild or moderate, and the patients who experienced AEs had a higher daily dose of PER than those who did not (p = 0.026). CONCLUSION Perampanel, an add-on therapy for focal-onset seizures, was found to be effective and tolerable in Chinese patients at 12 months.
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Affiliation(s)
- Qinyue Wang
- Department of Neurology, Huashan Hospital, Fudan University, China
| | - Ye Xu
- Department of Neurology, Huashan Hospital, Fudan University, China
| | - Yuncan Chen
- Department of Neurology, Huashan Hospital, Fudan University, China
| | - Xunyi Wu
- Department of Neurology, Huashan Hospital, Fudan University, China; National Center for Neurological Disorders, Shanghai, China.
| | - Yan Ge
- Department of Neurology, Huashan Hospital, Fudan University, China; National Center for Neurological Disorders, Shanghai, China
| | - Guoxing Zhu
- Department of Neurology, Huashan Hospital, Fudan University, China; National Center for Neurological Disorders, Shanghai, China
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Sánchez-Villalobos JM, Aledo-Serrano Á, Villegas-Martínez I, Shaikh MF, Alcaraz M. Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios. Front Pharmacol 2022; 13:991244. [PMID: 36278161 PMCID: PMC9583251 DOI: 10.3389/fphar.2022.991244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Epilepsy represents a challenge in the management of patients with brain tumors. Epileptic seizures are one of the most frequent comorbidities in neuro-oncology and may be the debut symptom of a brain tumor or a complication during its evolution. Epileptogenic mechanisms of brain tumors are not yet fully elucidated, although new factors related to the underlying pathophysiological process with possible treatment implications have been described. In recent years, the development of new anti-seizure medications (ASM), with better pharmacokinetic profiles and fewer side effects, has become a paradigm shift in many clinical scenarios in neuro-oncology, being able, for instance, to adapt epilepsy treatment to specific features of each patient. This is crucial in several situations, such as patients with cognitive/psychiatric comorbidity, pregnancy, or advanced age, among others. In this narrative review, we provide a rationale for decision-making in ASM choice for neuro-oncologic patients, highlighting the strengths and weaknesses of each drug. In addition, according to current literature evidence, we try to answer some of the most frequent questions that arise in daily clinical practice in patients with epilepsy related to brain tumors, such as, which patients are the best candidates for ASM and when to start it, what is the best treatment option for each patient, and what are the major pitfalls to be aware of during follow-up.
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Affiliation(s)
- José Manuel Sánchez-Villalobos
- Department of Neurology, University Hospital Complex of Cartagena, Murcia, Spain
- Department of Cell Biology and Histology, School of Medicine, Regional Campus of International Excellence, “Campus Mare Nostrum”, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - Ángel Aledo-Serrano
- Epilepsy Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
- *Correspondence: Ángel Aledo-Serrano,
| | | | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Miguel Alcaraz
- Department of Radiology and Physical Medicine, School of Medicine, Regional Campus of International Excellence, “Campus Mare Nostrum”, IMIB-Arrixaca, University of Murcia, Murcia, Spain
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12
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Interictal Heart Rate Variability as a Biomarker for Comorbid Depressive Disorders among People with Epilepsy. Brain Sci 2022; 12:brainsci12050671. [PMID: 35625056 PMCID: PMC9139412 DOI: 10.3390/brainsci12050671] [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: 03/29/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 12/10/2022] Open
Abstract
Depressive disorders are common among people with epilepsy (PwE). We here aimed to report an unbiased automatic classification of epilepsy comorbid depressive disorder cases via training a linear support vector machine (SVM) model using the interictal heart rate variability (HRV) data. One hundred and eighty-six subjects participated in this study. Among all participants, we recorded demographic information, epilepsy states and neuropsychiatric features. For each subject, we performed simultaneous electrocardiography and electroencephalography recordings both in wakefulness and non-rapid eye movement (NREM) sleep stage. Using these data, we systematically explored the full parameter space in order to determine the most effective combinations of data to classify the depression status in PwE. PwE with depressive disorders exhibited significant alterations in HRV parameters, including decreased time domain and nonlinear domain values both in wakefulness and NREM sleep stage compared with without depressive disorders and non-epilepsy controls. Interestingly, PwE without depressive disorder showed the same level of HRV values as the non-epilepsy control subjects. The SVM classification model of PwE depression status achieved a higher classification accuracy with the combination of HRV parameters in wakefulness and NREM sleep stage. Furthermore, the receiver operating characteristic (ROC) curve of the SVM classification model showed a satisfying area under the ROC curve (AUC: 0.758). Intriguingly, we found that the HRV measurements during NREM sleep are particularly important for correct classification, suggesting a mechanistic link between the dysregulation of heart rate during sleep and the development of depressive disorders in PwE. Our classification model may provide an objective measurement to assess the depressive status in PwE.
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13
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Lee K, Klein P, Dongre P, Choi EJ, Rhoney DH. Intravenous Brivaracetam in the Management of Acute Seizures in the Hospital Setting: A Scoping Review. J Intensive Care Med 2022; 37:1133-1145. [PMID: 35306914 PMCID: PMC9393655 DOI: 10.1177/08850666211073598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Clinical considerations for drug treatment of acute seizures involve
variables such as safety, tolerability, drug-drug interactions, dosage,
route of administration, and alterations in pharmacokinetics because of
critical illness. Therapy options that are easily and quickly administered
without dilution, well tolerated, and effective are needed for the treatment
of acute seizures. The objective of this review is to focus on the clinical
considerations relating to the use of intravenous brivaracetam (IV BRV) for
the treatment of acute seizures in the hospital, focusing on critically ill
patients. Methods This was a scoping literature review of PubMed from inception to April 13,
2021, and search of the American Academy of Neurology (AAN) 2021 Annual
Meeting website for English language publications/conference abstracts
reporting the results of IV BRV use in hospitalized patients, particularly
in the critical care setting. Outcomes of interest relating to the clinical
pharmacology, safety, tolerability, efficacy, and effectiveness of IV BRV
were reviewed and are discussed. Results Twelve studies were included for analysis. One study showed that plasma
concentrations of IV BRV 15 min after the first dose were similar between
patients receiving IV BRV as bolus or infusion. IV BRV was generally well
tolerated in patients with acute seizures in the hospital setting, with a
low incidence of individual TEAEs classified as behavioral disorders. IV BRV
demonstrated efficacy and effectiveness and had a rapid onset, with clinical
and electrophysiological improvement in seizures observed within minutes.
Although outside of the approved label, findings from several studies
suggest that IV BRV reduces seizures and is generally well tolerated in
patients with status epilepticus. Conclusions IV BRV shows effectiveness, and is generally well tolerated in the management
of acute seizures in hospitalized patients where rapid administration is
needed, representing a clinically relevant antiseizure medication for
potential use in the critical care setting.
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Affiliation(s)
- Kiwon Lee
- Department of Neurology, Division of Stroke and Critical Care, Rutgers, The State University of New Jersey, 12287Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | | | | | - Denise H Rhoney
- 15521UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC, USA
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14
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Mammì A, Ferlazzo E, Gasparini S, Bova V, Neri S, Labate A, Mastroianni G, Bianco CL, Cianci V, Aguglia U. Psychiatric and Behavioural Side Effects Associated With Perampanel in Patients With Temporal Lobe Epilepsy. A Real-World Experience. Front Neurol 2022; 13:839985. [PMID: 35321512 PMCID: PMC8936072 DOI: 10.3389/fneur.2022.839985] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
Psychiatric and behavioural side effects are common, undesirable effects associated with antiseizure medication use. Temporal lobe epilepsy is the most common focal epilepsy in adults and it is frequently associated with drug resistance. Patients with intractable epilepsy are more likely to have psychiatric and behavioural side effects when taking antiseizure medications and seem to be at higher risk for psychiatric comorbidities. Perampanel is a novel anti-seizure medication approved for focal and generalised epilepsies as add-on therapy. This is a 12-week short-term observational prospective study on people with focal epilepsy consecutively recruited from an Italian tertiary epilepsy centre, aimed to compare incidence and severity of psychiatric and behavioural side effects associated with perampanel use in patients with temporal lobe epilepsy as compared to other focal epilepsies. All patients received add-on perampanel according to indication and clinical judgement. Incidence and severity of psychiatric and behavioural side effects were rated by Neuropsychiatric Inventory Questionnaire. All patients enrolled answered the questionnaire before starting perampanel and after 12 weeks of treatment. We found no significant difference in terms of incidence and severity of psychiatric and behavioural side effects associated with perampanel in patients with temporal lobe epilepsy as compared to other focal epilepsies. In line with the literature, the most common adverse effects were “irritability” for both groups and “aggression” for patients with other focal epilepsies.
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Affiliation(s)
- Anna Mammì
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Valentina Bova
- Regional Epilepsy Centre, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Sabrina Neri
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Angelo Labate
- Neurology Unit, Department of BIOMORF, University of Messina, Messina, Italy
| | - Giovanni Mastroianni
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Concetta Lo Bianco
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Regional Epilepsy Centre, Great Metropolitan Hospital BMM, Reggio Calabria, Italy
- *Correspondence: Umberto Aguglia
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15
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Yadav J, Singh P, Dabla S, Gupta R. Psychiatric comorbidity and quality of life in patients with epilepsy on anti-epileptic monotherapy and polytherapy. Tzu Chi Med J 2022; 34:226-231. [PMID: 35465291 PMCID: PMC9020250 DOI: 10.4103/tcmj.tcmj_34_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/23/2021] [Accepted: 05/18/2021] [Indexed: 11/04/2022] Open
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16
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Kawai M, Goji H, Kanemoto K. Differences in aggression as psychiatric side effect of levetiracetam and perampanel in patients with epilepsy. Epilepsy Behav 2022; 126:108493. [PMID: 34933187 DOI: 10.1016/j.yebeh.2021.108493] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Aggression is the most commonly encountered antiepileptic-drug (AED)-induced psychiatric adverse effects. Levetiracetam (LEV) is well known to be associated with increased rates of aggression, while perampanel (PER) is also recognized as a potentially aggression-promoting agent, though opinions vary. However, few studies have addressed questions regarding whether the nature of irritability-aggression differs between those drugs. The present study used a standardized rating scale to examine aggression among patient with epilepsy who received LEV or PER using specific measures to confirm the effects of the drugs. METHODS We enrolled 144 consecutive outpatients receiving treatment for epilepsy with LEV (n = 103) or PER (n = 41), and determined their effects regarding aggression using the Buss-Perry Aggression Questionnaire (BAQ). For analysis, total BAQ scores for the LEV and PER subjects were compared to determine whether the aggression-promoting effects of the agents differed, and which BAQ subdomains (physical aggression, verbal aggression, anger, hostility) were related to production of aggression in patients taking either LEV or PER. As a subsidiary analysis, clinical variables inclusive of administered AED type that showed a significant impact on BAQ scores were determined. RESULTS The LEV group had a significantly higher hostility score (19.4 ± 5.8) as compared to the PER group (17.2 ± 6.3) in subscale analysis (p < 0.05). In multiple regression analysis, LEV had a significant association with higher hostility score (P = 0.006). CONCLUSION Our results indicate that while easily visible outward-directed aggression tends to be dominant in patients given PER, aggression provoked by LEV may be felt more subjectively or in an inward-directed manner, which can lead to more diverse expression and misrecognition.
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Affiliation(s)
- Mihoko Kawai
- Neuropsychiatric Department, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute-shi, Aichi 480-1195, Japan.
| | - Hiroko Goji
- Neuropsychiatric Department, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute-shi, Aichi 480-1195, Japan
| | - Kousuke Kanemoto
- Neuropsychiatric Department, Aichi Medical University, 1-1 Karimata, Yazako, Nagakute-shi, Aichi 480-1195, Japan
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17
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Sánchez-Villalobos JM, Aledo-Serrano Á, Serna-Berna A, Salinas-Ramos J, Martínez-Alonso E, Pérez-Vicente JA, Alcaraz-Baños M. Antiseizure medication for brain metastasis-related epilepsy: Findings of optimal choice from a retrospective cohort. Epilepsy Res 2021; 178:106812. [PMID: 34844092 DOI: 10.1016/j.eplepsyres.2021.106812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the prevalence of antiseizure medication (ASM) in patients with brain metastasis-related epilepsy (BMRE) treated with radiosurgery and the relationship between ASM and psychiatric comorbidity. MATERIAL AND METHODS This is a cross-sectional observational design study with retrospective review of medical records of all patients with brain metastases treated with volumetric modulated arc therapy radiosurgery (VMAT-RS) between 2012 and 2018 in a tertiary oncology center. We included those patients with BMRE, analyzing the clinical and demographic data, with special attention to psychiatric comorbidities and the use of ASM. RESULTS Of the 121 patients with brain metastases included for treatment with VMAT-RS, a total of 38 presented BMRE. The most widely used ASM as first-line treatment was levetiracetam (89%). Only 8% of the patients received sodium channel blockers. The most common psychiatric comorbidity was depression (42.1%). CONCLUSIONS Levetiracetam is the most widely used ASM in patients with BMRE treated with VMAT-RS. Nevertheless, common psychiatric comorbidities in this population might change the decision-making of ASM choice.
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Affiliation(s)
- José Manuel Sánchez-Villalobos
- Department of Radiology and Physical Medicine, Faculty of Medicine/Dentistry, University of Murcia, Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain; Department of Neurology, University Hospital Complex of Cartagena (Santa Lucia University Hospital - Santa María del Rosell University Hospital), Murcia, Spain.
| | - Ángel Aledo-Serrano
- Epilepsy Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
| | - Alfredo Serna-Berna
- Department of Medical Physics and Radiation Protection, University Hospital Complex of Cartagena (Santa Lucia University Hospital - Santa María del Rosell University Hospital), Murcia, Spain
| | - Juan Salinas-Ramos
- Department of Radiation Oncology, University Hospital Complex of Cartagena (Santa Lucia University Hospital - Santa María del Rosell University Hospital), Murcia, Spain
| | - Emma Martínez-Alonso
- Department of Cell Biology and Histology, Faculty of Medicine/Dentistry, University of Murcia, Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
| | - José Antonio Pérez-Vicente
- Department of Neurology, University Hospital Complex of Cartagena (Santa Lucia University Hospital - Santa María del Rosell University Hospital), Murcia, Spain
| | - Miguel Alcaraz-Baños
- Department of Radiology and Physical Medicine, Faculty of Medicine/Dentistry, University of Murcia, Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
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18
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Kanazono S, Ukai M, Hiramoto A. Abnormal Behavior Episodes Associated With Zonisamide in Three Dogs: A Case Report. Front Vet Sci 2021; 8:763822. [PMID: 34778438 PMCID: PMC8589241 DOI: 10.3389/fvets.2021.763822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Psychiatric adverse effect associated with anti-seizure drugs has been well-recognized in human medicine. This case report describes three dogs with presumptive idiopathic epilepsy presented for abnormal behavior episodes. Abnormal behavior episodes included sudden rage and aggression to the family members, insomnia, restlessness, and/or constant attention-seeking behavior. MRI study and cerebrospinal fluid analysis in two dogs were unremarkable. The abnormal behavior episodes deteriorated along with gradual dose increment of zonisamide and these episodes almost completely disappeared within 5 days after discontinuation of zonisamide. The exact same episodes relapsed within days after re-administration of zonisamide and disappeared again shortly after discontinuation of zonisamide. Dose adjustments of other anti-seizure medications in case 2 did not result in significant changes in these behavior episodes. Although psychiatric adverse effects including aggressive behavior associated with zonisamide are widely recognized in humans, this is the first report in dogs in the clinical setting.
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Affiliation(s)
- Shinichi Kanazono
- Neurology and Neurosurgery Service, Veterinary Specialists & Emergency Center, Kawaguchi, Japan.,Saitama Animal Medical Center, Iruma, Japan
| | - Masayasu Ukai
- Saitama Animal Medical Center, Iruma, Japan.,Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Akira Hiramoto
- Neurology and Neurosurgery Service, Veterinary Specialists & Emergency Center, Kawaguchi, Japan
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19
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Forthoffer N, Tarrada A, Brissart H, Maillard L, Hingray C. Anxiety and Depression in Newly Diagnosed Epilepsy: A Matter of Psychological History? Front Neurol 2021; 12:744377. [PMID: 34675875 PMCID: PMC8525707 DOI: 10.3389/fneur.2021.744377] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/25/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: Anxiety and depression are highly prevalent in patients with epilepsy (PWE), and these symptoms can even precede the onset of the pathology. We aimed to define the prevalence of anxiety and depressive symptoms at the time of the epilepsy diagnosis and the factors related to their presence in newly diagnosed adult patients. Methods: One hundred and twelve newly diagnosed patients were assessed, usually in the week after diagnosis. Patients were untreated at this time. We used the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E, cut-off ≥15) and the Generalized Anxiety Disorder 7-Item scale (GAD-7, cut-off >7). A semi-structured interview was conducted to collect sociodemographic and epilepsy data and patients' psychiatric history. We first compared patients with and without anxiety symptoms, then patients with and without depressive symptoms. Results: According to the GAD-7 scale, the prevalence of anxiety symptoms at the time of diagnosis was 35%. Patients with anxiety symptoms had significantly more psychiatric history (26%, p = 0.001) and more history of psychological trauma (51%, p = 0.003) than patients with no anxiety symptoms. According to the NDDI-E scores, the prevalence of depressive symptoms at the time of the diagnosis was 11%. Patients with depressive symptoms had significantly more psychiatric history (43%, p < 0.001) and more history of psychological trauma (65%, p = 0.007) than patients with no depressive symptoms. No difference between groups was found for other sociodemographic variables (age and gender), epilepsy characteristics (number of seizures prior to diagnosis, time from first seizure to diagnosis, type of epilepsy, and localization in focal epilepsy), or neurological comorbidities. Conclusions: Anxiety symptoms are common whereas depressive symptoms are less prevalent at the time of diagnosis. It appears essential to be aware of anxiety and depression in newly diagnosed epileptic patients. They should be screened and routinely monitored, especially those patients with a history of psychological trauma and/or psychiatric disorders. Longitudinal follow-up is required to identify whether these factors and anxiety and depression themselves have an impact on the future course of care.
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Affiliation(s)
- Natacha Forthoffer
- Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), Centre National de la Recherche Scientifique (CNRS), Université de Strasbourg, Strasbourg, France.,Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Alexis Tarrada
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Unité de Formation et de Recherche (UFR) Médecine Paris Centre, Université de Paris, Paris, France
| | - Hélène Brissart
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Centre de Recherche en Automatique de Nancy (CRAN), Centre National de la Recherche Scientifique (CNRS), Université de Lorraine, Nancy, France
| | - Louis Maillard
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Centre de Recherche en Automatique de Nancy (CRAN), Centre National de la Recherche Scientifique (CNRS), Université de Lorraine, Nancy, France
| | - Coraline Hingray
- Département de Neurologie, Centre Hospitalier Universitaire de Nancy, Nancy, France.,Centre de Recherche en Automatique de Nancy (CRAN), Centre National de la Recherche Scientifique (CNRS), Université de Lorraine, Nancy, France
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20
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Rohracher A, Trinka E. [Epilepsy in the aged : Challenges in diagnostics and treatment]. Z Gerontol Geriatr 2021; 54:395-408. [PMID: 33891210 PMCID: PMC8222019 DOI: 10.1007/s00391-021-01882-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/25/2021] [Indexed: 12/01/2022]
Abstract
Epilepsy is the third most frequent neurological disorder in aged patients after stroke and dementia. The incidence of epilepsy increases with age with the highest rates in patients ≥ 65 years old. Due to demographic changes the number of aged patients with epilepsy is expected to increase further in the coming years. The leading cause of new onset epilepsy in aged patients is cerebrovascular disease followed by dementia. The recognition of seizures in aged patients is often delayed. Status epilepticus occurs more frequently in aged patients and is associated with a high mortality and morbidity. Antiepileptic drug (AED) treatment of aged patients is complicated by comorbidities and polypharmacy and AEDs with a low interaction profile and high tolerability should be selected. Levetiracetam and lamotrigine are the AEDs of choice due to low interactions and good tolerability.
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Affiliation(s)
- Alexandra Rohracher
- Paracelsus Medizinische Privatuniversität Salzburg, Universitätsklinik für Neurologie, Ignaz-Harrer-Str. 79, 5020, Salzburg, Österreich
| | - Eugen Trinka
- Paracelsus Medizinische Privatuniversität Salzburg, Universitätsklinik für Neurologie, Ignaz-Harrer-Str. 79, 5020, Salzburg, Österreich.
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21
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Dreischmeier E, Zuloaga A, Kotloski RJ, Karasov AO, Gidal BE. Levetiracetam-associated irritability and potential role of vitamin B6 use in veterans with epilepsy. Epilepsy Behav Rep 2021; 16:100452. [PMID: 34142077 PMCID: PMC8188361 DOI: 10.1016/j.ebr.2021.100452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Levetiracetam, a commonly prescribed antiseizure medication (ASM), may cause irritability, depression, and anger. The mechanisms underlying these behavioral effects and individual risk factors remain unknown. Mitigation strategies are limited, including discontinuation, supplementation with vitamin B6, or switching to an alternative ASM. Several retrospective studies and anecdotal reports, primarily in pediatric populations, suggest vitamin B6 supplementation may be helpful in reducing levetiracetam-associated irritability. Although data in adult patients is limited, and no data is available for Veterans. The objective of this project was to describe our preliminarily experience with vitamin B6 supplementation for alleviating levetiracetam-associated irritability in male Veterans with epilepsy. METHODS Retrospective chart reviews were completed for patients who had an active prescription for levetiracetam from the William S. Middleton Memorial Veterans Hospital from January 1, 2015 to June 1, 2020. A total of 26 charts were screened. Patients were excluded if not using vitamin B6 supplementation or if deceased at end of data collection. Baseline characteristics were compared, including age, sex, comorbidities, and concomitant medications. Charts were then reviewed to identify any clinical description of irritability, including subjective assessment of change in symptoms across multiple visits, and scores from standardized instruments including the patient health questionnaire (PHQ-9), generalized anxiety disorder questionnaire (GAD-7), and/or irritability in adult patients with epilepsy (I-EPI) questionnaire. These symptoms and scores were then compared pre- and post-B6 supplementation. RESULTS Of 22 patients, data was available for 20 (91%). For patients with data available, 9 (45%) showed improved irritability following supplementation with vitamin B6 and 11 (55%) showed no improvement. CONCLUSIONS This project suggests that vitamin B6 supplementation may have a role in mitigating levetiracetam-associated irritability in a male Veteran population. These results support future prospective controlled studies to assess further the efficacy of this approach and characteristics associated with successful treatment in veterans.
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Affiliation(s)
- Emma Dreischmeier
- School of Pharmacy, University of Wisconsin, Madison, WI, USA
- Department of Pharmacy, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Andrea Zuloaga
- Department of Pharmacy, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Robert J. Kotloski
- Department of Pharmacy, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ariela O. Karasov
- Department of Pharmacy, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Barry E. Gidal
- School of Pharmacy, University of Wisconsin, Madison, WI, USA
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22
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Steinhoff BJ, Klein P, Klitgaard H, Laloyaux C, Moseley BD, Ricchetti-Masterson K, Rosenow F, Sirven JI, Smith B, Stern JM, Toledo M, Zipfel PA, Villanueva V. Behavioral adverse events with brivaracetam, levetiracetam, perampanel, and topiramate: A systematic review. Epilepsy Behav 2021; 118:107939. [PMID: 33839453 DOI: 10.1016/j.yebeh.2021.107939] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To understand the currently available post-marketing real-world evidence of the incidences of and discontinuations due to the BAEs of irritability, anger, and aggression in people with epilepsy (PWE) treated with the anti-seizure medications (ASMs) brivaracetam (BRV), levetiracetam (LEV), perampanel (PER), and topiramate (TPM), as well as behavioral adverse events (BAEs) in PWE switching from LEV to BRV. METHODS A systematic review of published literature using the Cochrane Library, PubMed/MEDLINE, and Embase was performed to identify retrospective and prospective observational studies reporting the incidence of irritability, anger, or aggression with BRV, LEV, PER, or TPM in PWE. The incidences of these BAEs and the rates of discontinuation due to each were categorized by ASM, and where possible, weighted means were calculated but not statistically assessed. Behavioral and psychiatric adverse events in PWE switching from LEV to BRV were summarized descriptively. RESULTS A total of 1500 records were identified in the searches. Of these, 44 published articles reporting 42 studies met the study criteria and were included in the data synthesis, 7 studies were identified in the clinical trial database, and 5 studies included PWE switching from LEV to BRV. Studies included a variety of methods, study populations, and definitions of BAEs. While a wide range of results was reported across studies, weighted mean incidences were 5.6% for BRV, 9.9% for LEV, 12.3% for PER, and 3.1% for TPM for irritability; 3.3%* for BRV, 2.5% for LEV, 2.0% for PER, and 0.2%* for TPM for anger; and 2.5% for BRV, 2.6% for LEV, 4.4% for PER, and 0.5%* for TPM for aggression. Weighted mean discontinuation rates were 0.8%* for BRV, 3.4% for LEV, 3.0% for PER, and 2.2% for TPM for irritability and 0.8%* for BRV, 2.4% for LEV, 9.2% for PER, and 1.2%* for TPM for aggression. There were no discontinuations for anger. Switching from LEV to BRV led to improvement in BAEs in 33.3% to 83.0% of patients (weighted mean, 66.6%). *Denotes only 1 study. CONCLUSIONS This systematic review characterizes the incidences of irritability, anger, and aggression with BRV, LEV, PER, and TPM, and it provides robust real-world evidence demonstrating that switching from LEV to BRV may improve BAEs. While additional data remain valuable due to differences in methodology (which make comparisons difficult), these results improve understanding of the real-world incidences of discontinuations due to these BAEs in clinical practice and can aid in discussions and treatment decision-making with PWE.
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Affiliation(s)
- Bernhard J Steinhoff
- Epilepsiezentrum Kork, Landstraße 1, 77694 Kehl, Kehl-Kork; Albert-Ludwigs University of Freiburg, Department of Neurology and Clinical Neurophysiology, Freiburg, Germany.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, 6410 Rockledge Drive, #610, Bethesda, MD 20817, USA.
| | - Henrik Klitgaard
- UCB Pharma, Allee de la Recherche 60, 1070 Anderlecht, Brussels, Belgium.
| | - Cédric Laloyaux
- UCB Pharma, Allee de la Recherche 60, 1070 Anderlecht, Brussels, Belgium.
| | - Brian D Moseley
- University of Cincinnati, Department of Neurology and Rehabilitation Medicine, Stetson Building, 260 Stetson Street, Suite 2300, Cincinnati, OH 45267-0525, USA
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-12, Haus 95, Frankfurt a.M., 60528, Germany.
| | - Joseph I Sirven
- Mayo Clinic, Neurology and Neurosurgery, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
| | - Brien Smith
- OhioHealth Physician Group, 3430 OhioHealth Pkwy, 4th Floor North, Columbus, OH 43202, USA.
| | - John M Stern
- University of California, Department of Neurology, 300 Medical Plaza Driveway, Suite B200, Los Angeles, CA 90095, USA.
| | - Manuel Toledo
- Epilepsy Unit. Neurology Department, Hospital Vall d'Hebron, Servicio de Neurologia, Passeig de la Vall d'Hebron 119, Barcelona, 08035, Spain.
| | - Patricia A Zipfel
- MicroMass, an Ashfield Company, 100 Regency Forest Dr, Cary, NC, USA.
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politecnico La Fe, Avenida Fernando Abril Martorell 106, Valencia 46026, Spain
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23
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Ballvé A, Salas‐Puig J, Quintana M, Campos D, Llauradó A, Raspall M, Fonseca E, Abraira L, Santamarina E, Toledo M. Levetiracetam as first-line monotherapy for Idiopathic Generalized Epilepsy in women. Acta Neurol Scand 2021; 143:407-412. [PMID: 33452703 DOI: 10.1111/ane.13389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Levetiracetam (LEV) is effective in Idiopathic Generalized Epilepsy (IGE) and seems to be a good alternative to valproic acid in women of childbearing age. However, there is lack of approval for this indication as monotherapy. The aim of this study is to assess the efficacy of LEV as a first-line therapy in this population. METHODS The study is a descriptive analysis of women aged between 16 and 45 years old diagnosed with IGE and treated with LEV as first-line monotherapy. Minimum follow-up was 24 months. RESULTS 26 women. Mean age: 25.4 years (17-43). 14 Juvenile Myoclonic Epilepsy; 8 Tonic-Clonic Seizures Alone; 4 Juvenile Absence. Mean follow-up: 68.3 months (24-120). 11 patients (40.7%) continued to take LEV as monotherapy, of which 10 were seizure-free, and three (11.5%) continue to be seizure-free after withdrawing LEV. 12 patients (46.2%) required a change of treatment: 25% (3/12) due to lack of efficacy, 42% (5/12) due to adverse effects and 33% (4/12) due to both. Irritability was the most frequent adverse effect. At the last assessment, three patients (11.5%) continued to have seizures despite polytherapy. Estimated retention rates were 78.1% at one year (SE 7.3%) and 51% at 5 years (SE 9.8%). Estimated median retention time is 72 months (CI 95%: 50.9-93.1). CONCLUSION LEV could be an effective drug as first-line treatment for IGE in women of childbearing potential. The adverse effects are its main limitation. Comparative studies are needed in order to establish it for this indication.
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Affiliation(s)
- Alejandro Ballvé
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Javier Salas‐Puig
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Manuel Quintana
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Daniel Campos
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Arnau Llauradó
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
| | - Miquel Raspall
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Department of Paediatric Neurology Vall d'Hebron University Hospital Barcelona Spain
| | - Elena Fonseca
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Laura Abraira
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Estevo Santamarina
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Manuel Toledo
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Epilepsy Research Group Vall d'Hebron Research Institute (VHIR Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
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24
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Loshali A, Joshi BC, Sundriyal A, Uniyal S. Antiepileptic effects of antioxidant potent extract from Urtica dioica Linn. root on pentylenetetrazole and maximal electroshock induced seizure models. Heliyon 2021; 7:e06195. [PMID: 33644470 PMCID: PMC7887401 DOI: 10.1016/j.heliyon.2021.e06195] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 12/17/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022] Open
Abstract
Urtica dioica Linn. (Urticaceae) is a medicinal plant that has shown various therapeutic utilities in folklore medicine along with its use in the treatment of epilepsy. The entire plant has a sensible reservoir of nutritional elements and micronutrients. The purpose of the present study was to investigate the antiepileptic effect of antioxidant potent extract of Urtica dioica root on animal models. Antioxidant activity of various solvent extracts i.e. Petroleum ether extract (PEE), Ethyl acetate extract (EAE), Chloroform extract (CE) and Ethanolic extract (EE) were screened by DPPH radical scavenging assay using Ascorbic acid as the standard. Further the most potent antioxidant extract was subjected to antiepileptic activity against MES and PTZ model. The IC50 values of different Urtica dioica extracts (PEE, CE, EAE, and EE) in antioxidant assay were found to be 167.54 ± 1.97, 134.41 ± 0.82, 88.15 ± 1.39 and 186.38 ± 1.91 μg/ml in DPPH radical scavenging assay, respectively. The EAE has showed the potent antioxidant activity. In experimental study the EAE (100 and 200 mg/kg, p.o) has found to be effective and significant against MES and PTZ induced seizures. The present study also suggested that antioxidant potent extract (EAE) of Urtica dioica root has antiepileptic effect against MES and PTZ induced seizures. However, further research studies will investigate the active component(s) of Urtica dioica responsible for the observed anticonvulsant effects.
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Affiliation(s)
- Aanchal Loshali
- School of Pharmaceutical Sciences, Sardar Bhagwan Singh Post Graduate Institute of Biomedical Sciences &Research, Balawala, Dehradun, Uttarakhand, 248001, India
| | - Bhuwan Chandra Joshi
- School of Pharmaceutical Sciences, Sardar Bhagwan Singh Post Graduate Institute of Biomedical Sciences &Research, Balawala, Dehradun, Uttarakhand, 248001, India
| | - Ankush Sundriyal
- School of Pharmaceutical Sciences, Sardar Bhagwan Singh Post Graduate Institute of Biomedical Sciences &Research, Balawala, Dehradun, Uttarakhand, 248001, India
| | - Sushmita Uniyal
- School of Pharmaceutical Sciences, Shri Guru Ram Rai Institute of Technology & Science, Patel Nagar, Dehradun, Uttarakhand, 248001, India
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25
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Kawai M, Goji H, Kanemoto K. Aggression as psychiatric side effect of newer AEDs in patients with epilepsy: Cross-sectional study based on Buss-Perry Aggression Questionnaire. Epilepsy Behav 2021; 115:107546. [PMID: 33444989 DOI: 10.1016/j.yebeh.2020.107546] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Aggression-irritability is the most commonly encountered antiepileptic-drug-induced psychiatric adverse effects. In this cross-sectional study, we tried to assess antiepileptic-drug-induced aggression in patients with epilepsy (PWE) with a standardized rating scale. METHODS Two hundred sixty-six consecutive outpatients receiving treatment for epilepsy with antiepileptic drugs (AEDs) were initially examined, and the effects of the investigated drugs in regard to aggression were investigated using the Buss-Perry Aggression Questionnaire (BAQ). We compared BAQ scores as a function of a specific class of AEDs, levetiracetam (LEV), lacosamaide (LCM), perampanel (PER), and carbamazepine (CBZ), and determined whether AED type had a relationship with aggression. Additionally, the association of BAQ score with other clinico-demographic variables was also assessed. RESULTS One-way ANOVA revealed that the LEV group had a significantly higher mean BAQ score as compared to the CBZ (P = 0.001) and LCM (P = 0.029) groups for total score. In subscale analysis, the LEV group had higher scores than the CBZ group for the physical aggression (p = 0.01), verbal aggression (p = 0.02) and hostility (p = 0.01) subscales, while the LEV group had a significantly higher mean score than the LCM group for hostility (p = 0.025). In multiple regression analysis, LEV had a statistically significant impact on increased total BAQ score (B = 0.119, p = 0.049). In contrast, CBZ (B = -0.191, p = 0.002), older age at epilepsy onset (B = -0.269, p = 0.000) and female gender (B = -0.210, p = 0.000) had a significant association with lower total BAQ score. CONCLUSIONS Our results indicate that LEV is associated with increased aggression, while CBZ and LCM showed effects to reduce aggression.
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Affiliation(s)
- Mihoko Kawai
- Neuropsychiatric Department, Aichi Medical University, Japan.
| | - Hiroko Goji
- Neuropsychiatric Department, Aichi Medical University, Japan
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26
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Can We Anticipate and Prevent the Occurrence of Iatrogenic Psychiatric Events Caused by Anti-seizure Medications and Epilepsy Surgery? Curr Top Behav Neurosci 2021; 55:281-305. [PMID: 33860467 DOI: 10.1007/7854_2021_228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Psychiatric disorders and behavioral manifestations in patients with epilepsy have complex and multifactorial etiologies. The psychotropic properties of anti-seizure medications (ASMs) and psychiatric effects of epilepsy surgery can result in iatrogenic psychiatric symptoms or episodes or can yield a therapeutic effect of underlying psychiatric disorders and have a significant impact on the patients' quality of life. The aims of this chapter are to review the available evidence of psychotropic properties of ASMs, which may be responsible for iatrogenic psychiatric symptoms and/or disorders. Moreover, the several aspects associated with the impact of epilepsy surgery on the possible improvement/development of psychiatric disorders were addressed.
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27
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Integration of postmortem amygdala expression profiling, GWAS, and functional cell culture assays: neuroticism-associated synaptic vesicle glycoprotein 2A (SV2A) gene is regulated by miR-133a and miR-218. Transl Psychiatry 2020; 10:297. [PMID: 32839459 PMCID: PMC7445165 DOI: 10.1038/s41398-020-00966-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 12/27/2022] Open
Abstract
Recent genome-wide studies have begun to identify gene variants, expression profiles, and regulators associated with neuroticism, anxiety disorders, and depression. We conducted a set of experimental cell culture studies of gene regulation by micro RNAs (miRNAs), based on genome-wide transcriptome, proteome, and miRNA expression data from twenty postmortem samples of lateral amygdala from donors with known neuroticism scores. Using Ingenuity Pathway Analysis and TargetScan, we identified a list of mRNA-protein-miRNA sets whose expression patterns were consistent with miRNA-based translational repression, as a function of trait anxiety. Here, we focused on one gene from that list, which is of particular translational significance in Psychiatry: synaptic vesicle glycoprotein 2A (SV2A) is the binding site of the anticonvulsant drug levetiracetam ((S)-α-Ethyl-2-oxo-1-pyrrolidineacetamide), which has shown promise in anxiety disorder treatments. We confirmed that SV2A is associated with neuroticism or anxiety using an original GWAS of a community cohort (N = 1,706), and cross-referencing a published GWAS of multiple cohorts (Ns ranging from 340,569 to 390,278). Postmortem amygdala expression profiling implicated three putative regulatory miRNAs to target SV2A: miR-133a, miR-138, and miR-218. Moving from association to experimental causal testing in cell culture, we used a luciferase assay to demonstrate that miR-133a and miR-218, but not miR-138, significantly decreased relative luciferase activity from the SV2A dual-luciferase construct. In human neuroblastoma cells, transfection with miR-133a and miR-218 reduced both endogenous SV2A mRNA and protein levels, confirming miRNA targeting of the SV2A gene. This study illustrates the utility of combining postmortem gene expression data with GWAS to guide experimental cell culture assays examining gene regulatory mechanisms that may contribute to complex human traits. Identifying specific molecular mechanisms of gene regulation may be useful for future clinical applications in anxiety disorders or other forms of psychopathology.
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28
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Mehta D, Davis M, Epstein AJ, Williams GR. Healthcare Resource Utilization Pre- and Post-Initiation of Eslicarbazepine Acetate Among Pediatric Patients with Focal Seizure: Evidence from Routine Clinical Practice. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:379-387. [PMID: 32801808 PMCID: PMC7384864 DOI: 10.2147/ceor.s261960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To examine the impact of initiating treatment with eslicarbazepine acetate (ESL) on healthcare resource utilization (HCRU) among pediatric patients with focal seizures (FS). Methods This retrospective study used Symphony Health’s Integrated Dataverse® claims data. Patients aged 4 to 17 years with a diagnosis of FS and a new prescription for ESL between April 2015 and June 2018 were included and defined as the overall patient population. Index date was the first dispensed claim for ESL. Baseline period was the 90-day block immediately prior to the index date. The follow-up period comprised up to 4 consecutive 90-day blocks immediately following the index date. Subgroups were defined based on the presence (DP+) or absence (DP−) of developmental and/or psychiatric disorders at baseline. All-cause and FS-related inpatient (IP), emergency room (ER), outpatient (OP) hospital, and office (OF) visits were measured during the follow-up period. Reduction in HCRU per block in the post-ESL period was assessed using fixed-effects linear regression models. Results A total of 234 patients were included in the overall study population, of whom 86 (36.8%) were DP+ and 148 (63.2%) were DP−. Relative to the baseline period, significant reductions were observed in the overall population for all-cause ER (P=0.001), OP (P<0.001), and OF (P<0.001) visits and FS-related IP (P=0.037) and OF (P<0.001) visits in the follow-up period. Among DP+ and DP− patients, significant reductions were observed for all-cause ER (DP+: P=0.024; DP−: P=0.017), OP (DP+: P<0.001; DP−: P=0.035), and OF (DP+: P=0.004; DP−: P=0.001) visits during the follow-up period. No significant differences were observed between DP+ and DP− patients in the change in all-cause or FS-related HCRU from baseline to the follow-up period. Conclusion Pediatric patients with FS (DP+ and DP-) who initiated ESL had significant reductions in all-cause ER, OP, and OF visits and FS-related IP and OF visits.
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Affiliation(s)
- Darshan Mehta
- Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Matthew Davis
- Health Economics and Outcomes Research, Medicus Economics, LLC, Milton, MA, USA
| | - Andrew J Epstein
- Health Economics and Outcomes Research, Medicus Economics, LLC, Milton, MA, USA
| | - G Rhys Williams
- Health Economics and Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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29
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Yamada SM, Tomita Y, Takaya Y. Features of psychological reactions induced by perampanel: A case report. J Clin Pharm Ther 2020; 45:822-824. [PMID: 32406128 DOI: 10.1111/jcpt.13141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/24/2020] [Accepted: 03/16/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Perampanel, an anticonvulsant, might induce psychological reactions. CASE DESCRIPTION A 70-year-old woman, who had been taking 2500 mg/day levetiracetam, complained of right-hand minor-convulsion. Perampanel of 2 mg/day was additionally prescribed, and the dosage was increased to 4 mg/day. Two weeks after taking 4 mg/day perampanel, she changed her personality and kept insulting her husband; however, the patient herself was aware of her strange behaviour. She regained her normal personality after quitting the perampanel medication. WHAT IS NEW AND CONCLUSION This self-awareness is crucial to distinguish the perampanel-induced reaction from psychosis.
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Affiliation(s)
- Shoko M Yamada
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Yusuke Tomita
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Yoshinori Takaya
- Department of Neurosurgery, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
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30
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Abstract
Epilepsy is considered a major serious chronic neurological disorder, characterized by recurrent seizures. It is usually associated with a history of a lesion in the nervous system. Irregular activation of inflammatory molecules in the injured tissue is an important factor in the development of epilepsy. It is unclear how the imbalanced regulation of inflammatory mediators contributes to epilepsy. A recent research goal is to identify interconnected inflammation pathways which may be involved in the development of epilepsy. The clinical use of available antiepileptic drugs is often restricted by their limitations, incidence of several side effects, and drug interactions. So development of new drugs, which modulate epilepsy through novel mechanisms, is necessary. Alternative therapies and diet have recently reported positive treatment outcomes in epilepsy. Vitamin D (Vit D) has shown prophylactic and therapeutic potential in different neurological disorders. So, the aim of current study was to review the associations between different brain inflammatory mediators and epileptogenesis, to strengthen the idea that targeting inflammatory pathway may be an effective therapeutic strategy to prevent or treat epilepsy. In addition, neuroprotective effects and mechanisms of Vit D in clinical and preclinical studies of epilepsy were reviewed.
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31
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Josephson CB, Engbers JDT, Jette N, Patten SB, Singh S, Sajobi TT, Marshall D, Agha-Khani Y, Federico P, Mackie A, Macrodimitris S, McLane B, Pillay N, Sharma R, Wiebe S. Prediction Tools for Psychiatric Adverse Effects After Levetiracetam Prescription. JAMA Neurol 2020; 76:440-446. [PMID: 30688969 DOI: 10.1001/jamaneurol.2018.4561] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Importance Levetiracetam is a commonly used antiepileptic drug, yet psychiatric adverse effects are common and may lead to treatment discontinuation. Objective To derive prediction models to estimate the risk of psychiatric adverse effects from levetiracetam use. Design, Setting, and Participants Retrospective open cohort study. All patients meeting the case definition for epilepsy after the Acceptable Mortality Reporting date in The Health Improvement Network (THIN) database based in the United Kingdom (inclusive January 1, 2000, to May 31, 2012) who received a first-ever prescription for levetiracetam were included. Of 11 194 182 patients registered in THIN, this study identified 7400 presumed incident cases (66.1 cases per 100 000 persons) over a maximum of 12 years' follow-up. The index date was when patients received their first prescription code for levetiracetam, and follow-up lasted 2 years or until an event, loss to follow-up, or censoring. The analyses were performed on April 22, 2018. Exposure A presumed first-ever prescription for levetiracetam. Main Outcomes and Measures The outcome of interest was a Read code for any psychiatric sign, symptom, or disorder as reached through consensus by 2 authors. This study used regression techniques to derive 2 prediction models, one for the overall population and one for those without a history of a psychiatric sign, symptom, or disorder during the study period. Results Among 1173 patients with epilepsy receiving levetiracetam, the overall median age was 39 (interquartile range, 25-56) years, and 590 (50.3%) were female. A total of 14.1% (165 of 1173) experienced a psychiatric symptom or disorder within 2 years of index prescription. The odds of reporting a psychiatric symptom were significantly elevated for women (odds ratio [OR], 1.41; 95% CI, 0.99-2.01; P = .05) and those with a preexposure history of higher social deprivation (OR, 1.15; 95% CI, 1.01-1.31; P = .03), depression (OR, 2.20; 95% CI, 1.49-3.24; P < .001), anxiety (OR, 1.74; 95% CI, 1.11-2.72; P = .02), or recreational drug use (OR, 2.02; 95% CI, 1.20-3.37; P = .008). The model performed well after stratified k = 5-fold cross-validation (area under the curve [AUC], 0.68; 95% CI, 0.58-0.79). There was a gradient in risk, with probabilities increasing from 8% for 0 risk factors to 11% to 17% for 1, 17% to 31% for 2, 30% to 42% for 3, and 49% when all risk factors were present. For those free of a preexposure psychiatric code, a second model performed comparably well after k = 5-fold cross-validation (AUC, 0.72; 95% CI, 0.54-0.90). Specificity was maximized using threshold cutoffs of 0.10 (full model) and 0.14 (second model); a score below these thresholds indicates safety of prescription. Conclusions and Relevance This study derived 2 simple models that predict the risk of a psychiatric adverse effect from levetiracetam. These algorithms can be used to guide prescription in clinical practice.
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Affiliation(s)
- Colin B Josephson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | - Nathalie Jette
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Shaily Singh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Yahya Agha-Khani
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paolo Federico
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Aaron Mackie
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Sophie Macrodimitris
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Brienne McLane
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Neelan Pillay
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruby Sharma
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Brandt C, Klein P, Badalamenti V, Gasalla T, Whitesides J. Safety and tolerability of adjunctive brivaracetam in epilepsy: In-depth pooled analysis. Epilepsy Behav 2020; 103:106864. [PMID: 31937513 DOI: 10.1016/j.yebeh.2019.106864] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/06/2019] [Accepted: 12/15/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this analysis was to provide a comprehensive analysis of safety data for adjunctive brivaracetam (BRV), an antiepileptic drug (AED) of the racetam class, for treatment of focal seizures in patients with epilepsy. METHODS Data were pooled from two phase II, placebo-controlled, double-blind, dose-ranging trials (N01114 [ClinicalTrials.gov: NCT00175929], N01193 [NCT00175825]) and three phase III, placebo-controlled, double-blind, 12-week trials (N01252 [NCT00490035], N01253 [NCT00464269], and N01358 [NCT01261325]) in patients aged ≥16 years with focal seizures, as well as a phase III, placebo-controlled, double-blind, 16-week trial in patients aged ≥16 years with focal or generalized epilepsy (N01254 [NCT00504881]). Data are presented for the approved therapeutic dose range of 50-200 mg/day. Data for BRV administered intravenously (25-150 mg doses) were pooled separately from one phase III trial (N01258 NCT01405508]) and two clinical pharmacology trials (N01256 [Part B] [UCB Pharma, data on file]; EP0007 [NCT01796899]). Adverse events (AEs) of interest were summarized in relevant categories. RESULTS The safety pool comprised 1957 patients: 1271 receiving adjunctive BRV and 686 receiving placebo. Overall, the incidence of treatment-emergent adverse events (TEAEs) was 66.9% with BRV versus 62.8% with placebo. The most frequently reported TEAEs with BRV (≥5% of patients) versus placebo were somnolence (13.3% vs. 7.9%), headache (10.5% vs. 11.5%), dizziness (10.0% vs. 7.0%), and fatigue (8.2% vs. 4.2%). Incidence of psychiatric disorder-related TEAEs was 11.3% with BRV versus 8.2% with placebo. Behavioral disorder-related TEAE incidence was low (4.0% with BRV vs. 2.5% with placebo). Irritability was reported in 2.7% of BRV-treated patients vs. 1.5% of patients receiving placebo; anger, aggression, and agitation were each reported by ≤1% of patients receiving BRV. Treatment-emergent adverse events potentially associated with psychosis were psychotic disorder (three patients on BRV vs. two patients on placebo), auditory hallucination, illusion, visual hallucination (one patient each on BRV), epileptic psychosis, and hallucination (one patient each on placebo). No additional safety concerns were identified in patients with intravenous (IV) BRV administration (n = 104). CONCLUSIONS These safety data for adjunctive BRV support its acceptable safety and tolerability profile.
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Affiliation(s)
- Christian Brandt
- Bethel Epilepsy Centre, Mara Hospital, Maraweg 21, 33617 Bielefeld, Germany.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Champlain Building, 6410 Rockledge Drive #610, Bethesda, MD 20817, USA.
| | | | - Teresa Gasalla
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC 27617, USA.
| | - John Whitesides
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC 27617, USA.
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Kılınç S, Campbell C, Guy A, van Wersch A. Negotiating the boundaries of the medical model: Experiences of people with epilepsy. Epilepsy Behav 2020; 102:106674. [PMID: 31783319 DOI: 10.1016/j.yebeh.2019.106674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 01/09/2023]
Abstract
People with epilepsy (PWE) continually report dissatisfaction with the support they receive, particularly in regard to their psychological wellbeing. With its focus on optimal seizure control, epilepsy treatment is entrenched in the medical model of illness, despite growing evidence of the broader psychosocial impact of the condition. This study aimed to explore how PWE experience healthcare in the context of their lives. Semistructured interviews were conducted with thirty-nine adults with epilepsy from across the UK. An adapted version of interpretative phenomenological analysis (IPA) was conducted, and three superordinate themes were identified. Firstly, "negotiating the space between health and illness" identified how participants rejected the illness identity and struggled with a treatment regime, which reminded them of the longevity of their condition. Secondly, "tensions in adopting a biomedical perspective" considered how medical professionals overlooked the negative side effects medication had on participants' lives, in favor of optimal seizure control. Thirdly, "the need for broader support" highlighted the additional psychosocial support PWE require. The findings indicate the need to incorporate person-centered, psychological services within the care pathway for PWE, as well as training for health professionals to recognize the broader impact of epilepsy beyond seizure management.
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Affiliation(s)
- Stephanie Kılınç
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough TS1 3BX, UK.
| | | | - Alison Guy
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough TS1 3BX, UK
| | - Anna van Wersch
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough TS1 3BX, UK
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Sarangi SC, Kaur N, Tripathi M. Assessment of psychiatric and behavioral adverse effects of antiepileptic drugs monotherapy: Could they have a neuroendocrine correlation in persons with epilepsy? Epilepsy Behav 2019; 100:106439. [PMID: 31574428 DOI: 10.1016/j.yebeh.2019.07.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/03/2019] [Accepted: 07/14/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The study investigated overall adverse event (AE) burden and specifically psychiatric and behavioral side effects (PBAEs) in persons with epilepsy (PWE) on antiepileptic drugs (AEDs) monotherapy. It also assessed their correlation with neuroendocrine and oxidative stress biomarkers. METHODS This cross-sectional observational study was conducted at a tertiary care hospital between 2016 and 2018. Persons with epilepsy above 18 years on monotherapy of levetiracetam (LEV) and conventional AEDs {carbamazepine (CBZ), phenytoin (PHT), or valproate (VPA)} for at least 6 months were enrolled. Validated questionnaires, 'Mini-International Neuropsychiatric Interview (MINI 7.02)', 'Depression, Anxiety, and Stress Scale 21 (DASS-21)', 'Buss-Perry Aggression Questionnaire (BPAQ)', 'patient-weighted Quality of life Index in Epilepsy (QOLIE-10)', 'Pittsburgh Sleep Quality Index (PSQI)', and 'Liverpool Adverse Events Profile (LAEP)' were used to assess the PBAEs, quality of life, sleep quality, and AE profile. A subgroup of PWE recruited consecutively were considered for estimation of the following neuroendocrine biomarker levels: brain-derived neurotrophic factor (BDNF), homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and total antioxidant capacity (TAC) which were then correlated with scores of above questionnaires. RESULTS After screening 220 PWE, 163 PWE (58 on LEV and 105 on conventional AEDs) with a mean age of 29 ± 10 years were enrolled. Mini-International Neuropsychiatric Interview revealed that LEV group had higher association with PBAEs and lower quality of sleep compared to conventional AEDs (p = 0.032 and 0.046, respectively). Other scales did not show significant difference between LEV and conventional AEDs. In the subset of PWE (n = 74, 36 on LEV and 38 on conventional AEDs), LEV group had more association with the PBAEs (p = 0.010), higher physical aggression and anger components of BPAQ (p = 0.03 and 0.02, respectively), and more AE (p = 0.049) than conventional AED group. However, there was no significant difference in neuroendocrine biomarker levels. CONCLUSION Levetiracetam had a higher association with PBAEs and more AE when compared to conventional AEDs. There was no differential correlation of AEDs with the following neuroendocrine markers: BDNF, HVA, 5-HIAA, and TAC. These facts necessitate exploration of other mechanisms for LEV-induced PBAEs.
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Aygun H, Ayyildiz M, Agar E. Effects of vitamin D and paricalcitol on epileptogenesis and behavioral properties of WAG/Rij rats with absence epilepsy. Epilepsy Res 2019; 157:106208. [PMID: 31581040 DOI: 10.1016/j.eplepsyres.2019.106208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/10/2019] [Accepted: 09/14/2019] [Indexed: 10/26/2022]
Abstract
AIM Vitamin D (Vit D) has been considered as a neurosteroid and has a pivotal role in neuroprotection including epilepsy. Vit D regulator acts via a Vit D receptor (VDR). WAG/Rij rats have a genetically epileptic model of absence epilepsy with comorbidity of depression. The aim of the present study was to investigate the effect of Vit D and paricalcitol (PRC) on WAG/Rij rats. MATERIAL AND METHODS Sixty-three male WAG/Rij rats and seven male Wistar rats were used. The effects of acute and chronic treatment with Vit D (5.000 and 60.000 IU/kg, i.p) and PRC (0.5, 5 and 10 μg/kg, i.p) on absence seizures, and related psychiatric comorbidity were investigated in WAG/Rij rats. Depression-like behavior was assayed by using the forced swimming test (FST) and; anxiety-like behavior by using the open field test (OFT). RESULTS Acute Vit D treatments (5.000 and 60.000 IU/kg) similarly reduced the number and duration of spike-wave discharges (SWDs) and showed anxiolytic-antidepressive effect whereas there were no significant changes in other measured parameters between the daily and the bolus dose of Vit D. Acute administration of PRC (0.5, 5 and 10 μg/kg) showed anti-convulsive and anxiolytic-antidepressive effect. The dose (0.5 μg/kg) of PRC was the most effective dose. Chronic treatment was more effective than acute therapy in all parameters. CONCLUSION The results of the present study demonstrate that Vit D and PRC have antiepileptic and anxiolytic-antidepressive effects on the absence epilepsy in WAG/Rij rats.
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Affiliation(s)
- Hatice Aygun
- Department of Physiology, Faculty of Medicine, University of Tokat Gaziosmanpasa, Tokat, Turkey.
| | - Mustafa Ayyildiz
- Department of Physiology, Faculty of Medicine, University of Ondokuz Mayis, Samsun, Turkey
| | - Erdal Agar
- Department of Physiology, Faculty of Medicine, University of Ondokuz Mayis, Samsun, Turkey
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Adachi N, Fenwick P, Akanuma N, Hara K, Ishii R, Okazaki M, Ito M, Sekimoto M, Kato M, Onuma T. Increased frequency of psychosis after second-generation antiepileptic drug administration in adults with focal epilepsy. Epilepsy Behav 2019; 97:138-143. [PMID: 31252268 DOI: 10.1016/j.yebeh.2019.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/02/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Many studies show psychoses after some antiepileptic drug (AED) administrations (post-AED administration psychoses [PAP]). It remains uncertain about psychogenetic potential of each AED and effects of clinical state factors on PAP. We examined the relations between AED-related factors (types, generations, dosages, and concomitant AED) and PAP. METHODS The clinical records of patients with focal epilepsy were retrospectively reviewed from eight adult epilepsy clinics, for every six-month period after administration of a new drug (either AED or non-AED) between 1981 and 2015. Characteristics of psychotic episodes, AED-related factors (type, daily dosage, and concomitant AED), and other state-related risk factors to psychosis (age, duration of epilepsy, history of psychosis, and seizure frequency) were examined. Psychogenetic risks of AED-related and state-related factors were analyzed with multifactorial procedures. RESULTS Of 2067 patients with focal epilepsy, 5018 new drugs (4402 AEDs and 616 non-AEDs) were administered. Within the first six-month period, 89 patients exhibited 105 psychotic episodes (81 interictal and 24 postictal psychoses: 55 first episodes and 50 recurrences). With second-generation AED (SAED) administration, particularly topiramate and lamotrigine, frequency of psychosis was significantly increased. Daily dosage of AED was not significantly associated with psychosis. Psychosis tended to occur with a higher number of concomitant AED. Subsequent analysis with AED-related and general factors showed that SAED administrations and previous psychotic history were the most significant risks for PAP. CONCLUSION Post-AED administration psychoses is associated with type of AED (SAED), rather than its dosage. Individual vulnerabilities are also associated with PAP.
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Affiliation(s)
- Naoto Adachi
- Adachi Mental Clinic, Sapporo, Japan; National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan.
| | - Peter Fenwick
- Institute of Psychiatry [emeritus], King's College London, London, UK
| | - Nozomi Akanuma
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Lambeth Assessment, Liaison and Treatment Team, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Ryouhei Ishii
- Department of Psychiatry, University of Osaka Graduate School of Medicine, Osaka, Japan
| | - Mitsutoshi Okazaki
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan
| | - Masumi Ito
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Jozen Clinic, Sapporo, Japan
| | - Masanori Sekimoto
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Masaaki Kato
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Teiichi Onuma
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
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Doherty CP, Rheims S, Assenza G, Boero G, Chaves J, McMurray R, Villanueva V. Eslicarbazepine acetate in epilepsy patients with psychiatric comorbidities and intellectual disability: Clinical practice findings from the Euro-Esli study. J Neurol Sci 2019; 402:88-99. [DOI: 10.1016/j.jns.2019.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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Toledo M, Mazuela G, Mauri JA, Rodriguez-Osorio X, Gómez-Eguilaz M, Castro-Vilanova D, Rodriguez-Uranga J, Santamarina E. Levels of anger in epilepsy patients treated with eslicarbazepine acetate. Acta Neurol Scand 2019; 140:48-55. [PMID: 30953593 DOI: 10.1111/ane.13099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/22/2019] [Accepted: 04/03/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Aggressive behavior is commonly associated with epilepsy and can be influenced by the antiepileptic drugs (AEDs) taken. Sodium channel blockers, specifically the carboxamides derivatives such as carbamazepine and oxcarbazepine, are some of the AEDs considered to have a favorable psychiatric effect profile. OBJECTIVES We aimed to assess whether the carboxamide analogue eslicarbazepine acetate (ESL) has any effect on the levels of anger in patients with epilepsy. MATERIAL AND METHODS We prospectively recruited adult patients with epilepsy on treatment with ≦2 active AEDs, who required AED addition or substitution, excluding patients with active psychiatric disorders. All patients completed anger level (STAXI-2), depression-anxiety (HADS), and quality of life (QOLIE-10) assessments, and were evaluated at baseline and within 3-6 months after treatment initiation. RESULTS Of 78 patients receiving ESL, as add-on therapy or in substitution of a previous AED, were recruited into the ESL group, with an average age of 48 years and 54% men. We used a control group of 58 patients receiving AEDs other than carboxamides. CONCLUSIONS Patients overall showed improvements in anger levels, mood, and quality of life during the follow-up. A history of psychiatric disorders was a limiting factor to improve anger levels. As compared to controls, anger levels improved in ESL patients independently from seizure control. Therefore, ESL seems to exert a favorable influence on the anger levels of otherwise healthy patients with epilepsy, including those unresponsive to seizure control. The potential ESL anti-aggressive effect should be studied in patients with epilepsy and active psychiatric disorders.
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Affiliation(s)
- Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d´Hebron Hospital, Barcelona, Spain
| | - Gonzalo Mazuela
- Epilepsy Unit, Neurology Department, Vall d´Hebron Hospital, Barcelona, Spain
| | - Jose Angel Mauri
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Xiana Rodriguez-Osorio
- Epilepsy Unit, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | | | | | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d´Hebron Hospital, Barcelona, Spain
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El Otmani H, Amzil R, Rafai MA, El Moutawakil B. Complex hallucinations induced by lamotrigine. Rev Neurol (Paris) 2019; 175:410-411. [DOI: 10.1016/j.neurol.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/24/2018] [Accepted: 11/09/2018] [Indexed: 10/26/2022]
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Abstract
INTRODUCTION Myoclonus is a hyperkinetic movement disorder characterized by sudden, brief, lightning-like involuntary jerks. There are many possible causes of myoclonus and both the etiology and characteristics of the myoclonus are important in securing the diagnosis and treatment. Myoclonus may be challenging to treat, as it frequently requires multiple medications for acceptable results. Few randomized controlled trials investigating the optimal treatment for myoclonus are available, and expert experience and case series guide treatment. Areas Covered: In this article, the authors review the basics of myoclonus and its classification. The authors discuss the current management of myoclonus and then focus on recent updates in the literature, including both pharmacologic and surgical options. Expert opinion: Myoclonus remains a challenge to manage, and there is a paucity of rigorous clinical trials guiding treatment paradigms. Furthermore, due to the etiological heterogeneity of myoclonus, defining the appropriate scope for high-quality clinical trials is challenging. In order to advance the field, the myoclonus study group needs to be revived in the US and abroad so that interested investigators can collaborate on multicenter clinical trials for myoclonus treatments.
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Affiliation(s)
- Christine M Stahl
- a NYU Langone Health , The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, A Parkinson's Foundation Center of Excellence , New York , NY , USA
| | - Steven J Frucht
- a NYU Langone Health , The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, A Parkinson's Foundation Center of Excellence , New York , NY , USA
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Thelengana A, Shukla G, Srivastava A, Singh MB, Gupta A, Rajan R, Vibha D, Pandit AK, Prasad K. Cognitive, behavioural and sleep-related adverse effects on introduction of levetiracetam versus oxcarbazepine for epilepsy. Epilepsy Res 2019; 150:58-65. [PMID: 30641352 DOI: 10.1016/j.eplepsyres.2019.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is limited literature on cognitive, behaviour and sleep-related adverse effects of levetiracetam and oxcarbazepine among adult epilepsy patients, except for what is available from the initial efficacy trials. This study was initiated with the aim to evaluate the incidence and prevalence of various cognitive, behaviour and sleep-related adverse effects of levetiracetam versus oxcarbazepine among people with epilepsy. METHODS The study was conducted in two parts: part A was a cross-sectional study, and part B was a longitudinal study. Trail making test A & B, digit symbol substitution test, Stroop colour and word test, controlled oral word association test and PGI memory scale, Neuropsychiatric Inventory, sleep log and ESS-I were used for assessment of cognitive, behaviour and sleep-related adverse effects. RESULTS In the cross-sectional as well as prospective study, no significant difference was observed in the cognitive performance of patients in levetiracetam and oxcarbazepine group in any of the cognitive assessment. Among 120 patients enrolled in the cross-sectional study, significantly higher number of patients in the levetiracetam group compared to the oxcarbazepine group,had agitation/aggression (20% vs10%, p = 0.047) and irritability (26.7% vs 3.3%, p = 0.007).Among 132 patients enrolled in the prospective study, significantly higher increase in the domain score of agitation/aggression (14.5% vs 1.6%, p = 0.028) and irritability (17.7% vs 1.6%, p = 0.018) was observed in the levetiracetam group compared to oxcarbazepine group. A significantly higher proportion of patients in the oxcarbazepine group had hypersomnolence (11.3% vs 1.6%, p = 0.026), as compared to the levetiracetam group. SIGNIFICANCE On cross-sectional as well as on longitudinal assessment, nearly one-fifth of patients on levetiracetam have behaviour related adverse effects, with dose modification required for half among these. Nearly 11% of patients on oxcarbazepine reported sleep-related adverse effects (higher total sleep duration per 24 h).
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Affiliation(s)
- A Thelengana
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Shukla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anupama Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh Kishor Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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de Souza AG, Chaves Filho AJM, Souza Oliveira JV, de Souza DAA, Lopes IS, de Carvalho MAJ, de Lima KA, Florenço Sousa FC, Mendes Vasconcelos SM, Macedo D, de França Fonteles MM. Prevention of pentylenetetrazole-induced kindling and behavioral comorbidities in mice by levetiracetam combined with the GLP-1 agonist liraglutide: Involvement of brain antioxidant and BDNF upregulating properties. Biomed Pharmacother 2019; 109:429-439. [DOI: 10.1016/j.biopha.2018.10.066] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 12/24/2022] Open
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Mechanisms Underlying Aggressive Behavior Induced by Antiepileptic Drugs: Focus on Topiramate, Levetiracetam, and Perampanel. Behav Neurol 2018; 2018:2064027. [PMID: 30581496 PMCID: PMC6276511 DOI: 10.1155/2018/2064027] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/30/2018] [Indexed: 12/28/2022] Open
Abstract
Antiepileptic drugs (AEDs) are effective against seizures, but their use is often limited by adverse effects, among them psychiatric and behavioral ones including aggressive behavior (AB). Knowledge of the incidence, risk factors, and the underlying mechanisms of AB induced by AEDs may help to facilitate management and reduce the risk of such side effects. The exact incidence of AB as an adverse effect of AEDs is difficult to estimate, but frequencies up to 16% have been reported. Primarily, levetiracetam (LEV), perampanel (PER), and topiramate (TPM), which have diverse mechanisms of action, have been associated with AB. Currently, there is no evidence for a specific pharmacological mechanism solely explaining the increased incidence of AB with LEV, PER, and TPM. Serotonin (5-HT) and GABA, and particularly glutamate (via the AMPA receptor), seem to play key roles. Other mechanisms involve hormones, epigenetics, and “alternative psychosis” and related phenomena. Increased individual susceptibility due to an underlying neurological and/or a mental health disorder may further explain why people with epilepsy are at an increased risk of AB when using AEDs. Remarkably, AB may occur with a delay of weeks or months after start of treatment. Information to patients, relatives, and caregivers, as well as sufficient clinical follow-up, is crucial, and there is a need for further research to understand the complex relationship between AED mechanisms of action and the induction/worsening of AB.
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Chen B, Choi H, Hirsch LJ, Legge A, Buchsbaum R, Detyniecki K. Cross-sensitivity of psychiatric and behavioral side effects with antiepileptic drug use. Seizure 2018; 62:38-42. [DOI: 10.1016/j.seizure.2018.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022] Open
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Roberts MH, Takeda MY, Kindilien S, Barqawi YK, Borrego ME. Assessment of components included in published societal perspective or QALY outcome economic analyses for antiepileptic drug treatment in chronic epilepsy. Expert Rev Pharmacoecon Outcomes Res 2018; 18:487-503. [PMID: 29911955 PMCID: PMC6564682 DOI: 10.1080/14737167.2018.1489243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 06/12/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Antiepileptic drug (AED) treatments seek to control seizures with minimal or no adverse effects, effects which can substantially impact costs and outcomes for patients, caregivers, and third party payers. The First and Second Panel on Cost-Effectiveness in Health and Medicine recommend inclusion of a societal reference case, even in studies conducted from a healthcare sector perspective, for comparability of findings across studies. Cost and outcome evaluation components include direct medical, non-direct medical-related (e.g. patient-time and transportation costs for treatment) and non-healthcare sectors (e.g. lost productivity). AREAS COVERED Guided by Second Panel recommendations, this review developed an overall impact inventory and detailed adverse effect impact inventory to assess the scope and methods in published economic evaluations of AED treatments for adults with chronic epilepsy. Societal perspective evaluations or evaluations that utilized quality-adjusted life-years (QALYs) as an outcome were reviewed. The majority of reviewed articles were healthcare sector perspective studies, methods for estimating QALYs varied widely, and a minority considered specific AED treatment adverse effects. EXPERT COMMENTARY Only considering a healthcare sector perspective fails to provide full information for patients on AED treatments. Using an impact inventory to guide study scope and design will facilitate full reporting of costs and benefits.
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Affiliation(s)
- Melissa H Roberts
- a Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy , University of New Mexico , Albuquerque , USA
| | - Mikiko Y Takeda
- a Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy , University of New Mexico , Albuquerque , USA
| | - Shannon Kindilien
- a Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy , University of New Mexico , Albuquerque , USA
| | - Yazan K Barqawi
- a Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy , University of New Mexico , Albuquerque , USA
| | - Matthew E Borrego
- a Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy , University of New Mexico , Albuquerque , USA
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Tallian K. Three clinical pearls in the treatment of patients with seizures and comorbid psychiatric disorders. Ment Health Clin 2018; 7:235-245. [PMID: 29955529 PMCID: PMC6007731 DOI: 10.9740/mhc.2017.11.235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A strong association exists between epilepsy and psychiatric comorbidities, especially depression, anxiety, attention deficit disorders, and psychosis. The impact of psychotropic medications in lowering seizure threshold both directly and indirectly, hypersensitivity reactions to antiepileptic and other psychotropic medications, and how antiepileptic drugs affect psychiatric disorders are explored through three patient cases. Ultimately, in selecting an appropriate psychotropic medication for an individual with epilepsy and psychiatric comorbidities, it is important to consider the clinical and quality-of-life impacts that a particular medication will have on that individual.
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Affiliation(s)
- Kimberly Tallian
- Advanced Practice Pharmacist - Psychiatry and PGY2 Residency Program Director, Psychiatry, Scripps Mercy Hospital, San Diego, California; Adjunct Clinical Professor - University of California, San Diego, Skaggs School of Pharmacy & Pharmaceutical Sciences, San Diego, California,
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Watson F, Rusbridge C, Packer RMA, Casey RA, Heath S, Volk HA. A review of treatment options for behavioural manifestations of clinical anxiety as a comorbidity in dogs with idiopathic epilepsy. Vet J 2018; 238:1-9. [PMID: 30103909 DOI: 10.1016/j.tvjl.2018.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 06/03/2018] [Accepted: 06/04/2018] [Indexed: 12/22/2022]
Abstract
Psychiatric comorbidities affect a large percentage of people with epilepsy and have a detrimental impact on their quality of life. Recently, behavioural comorbidities, with similar characteristics to human psychiatric diseases, have been identified in dogs with idiopathic epilepsy. In particular, behaviours motivated by the fear-anxiety emotional system have been found to be associated with the occurrence of idiopathic epilepsy in both dogs receiving anti-epileptic drugs, and drug-naïve dogs. There has been little research into the relationship between epilepsy and behavioural signs, and even less into potential treatment protocols. The following article will review available literature from human medicine to describe the current state of knowledge about the bi-directional relationship between anxiety and epilepsy, draw parallels from reported anxiogenic and anxiolytic properties of anti-epileptic drugs and attempt to provide pharmaceutical and behavioural guidance for veterinary patients with epilepsy and comorbid anxiety.
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Affiliation(s)
- F Watson
- The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK; Fitzpatrick Referrals, Halfway Lane, Godalming, Surrey, GU7 2QQ, UK.
| | - C Rusbridge
- Fitzpatrick Referrals, Halfway Lane, Godalming, Surrey, GU7 2QQ, UK; School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Main Academic Building (VSM), Daphne Jackson Road, Guildford, Surrey, GU2 7AL, UK
| | - R M A Packer
- The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | - R A Casey
- The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK; Dogs Trust, Clarissa Baldwin House, 17 Wakley Street, London, EC1V 7RQ, UK
| | - S Heath
- Behavioural Referrals Veterinary Practice, 10 Rushton Drive, Upton, Chester, CH2 1RE, UK
| | - H A Volk
- The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
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48
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Andermann E, Biton V, Benbadis SR, Shneker B, Shah AK, Carreño M, Trinka E, Ben-Menachem E, Biraben A, Rocha F, Gama H, Cheng H, Blum D. Psychiatric and cognitive adverse events: A pooled analysis of three phase III trials of adjunctive eslicarbazepine acetate for partial-onset seizures. Epilepsy Behav 2018; 82:119-127. [PMID: 29604484 DOI: 10.1016/j.yebeh.2017.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 11/20/2017] [Accepted: 12/18/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the nature and incidence of psychiatric and cognitive adverse events (AEs) reported with eslicarbazepine acetate (ESL) used as adjunctive treatment for refractory partial-onset seizures (POS) in adults. METHODS This was a post-hoc analysis of data pooled from three randomized double-blind, placebo-controlled trials (BIA-2093-301, -302, -304). After an 8-week baseline period, patients received placebo or adjunctive ESL 400mg (studies 301 and 302 only), 800mg, or 1200mg once daily (QD) for 14weeks (2-week titration period, 12-week maintenance period). Psychiatric and cognitive AEs were identified from individual patient data. Suicidality was also evaluated using the Columbia-Classification Algorithm of Suicide Assessment (C-CASA), or the Columbia-Suicide Severity Rating Scale (C-SSRS). P-values were obtained using the chi-square test of independence or Fisher's exact test, without correcting for multiplicity. RESULTS The analysis population included 1447 patients (ESL, n=1021; placebo, n = 426). Psychiatric treatment-emergent AEs (TEAEs) occurred in 10.8% of patients receiving ESL, and in a comparable proportion (10.3%) of patients receiving placebo (p=0.802). The incidence of depression and suicidality-related TEAEs was higher for ESL (7.4%) vs. placebo (3.8%) (p=0.009). The occurrence of these TEAEs differed between treatment groups (p = 0.010), but there was no notable trend between increasing ESL dose and increasing incidence of depression and suicidality-related TEAEs. Aggression/hostility-related TEAEs occurred in <0.1% of patients taking ESL vs. 0.9% taking placebo. The incidence of cognitive TEAEs was higher for ESL (7.1%) vs. placebo (4.0%) (p=0.023); incidences of memory impairment, attention disturbance, apathy, and aphasia were higher for ESL 1200mg than for other treatment groups. Incidences of psychiatric and cognitive serious AEs (SAEs) were 0.6% and 0.2% with ESL, and 0.5% and 0% with placebo, respectively. Psychiatric and cognitive TEAEs leading to discontinuation occurred in 1.9% and 1.4% of patients taking ESL, and 0.7% and 0.5% taking placebo, respectively. CONCLUSIONS In phase III clinical trials of adjunctive ESL for treatment-refractory POS, psychiatric and cognitive TEAEs were reported infrequently with ESL and placebo. The incidences of depression and suicidality-related TEAEs and of cognitive TEAEs were higher for patients taking ESL vs. placebo. Incidences of psychiatric and cognitive SAEs, and TEAEs leading to discontinuation, were low with ESL and placebo.
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Affiliation(s)
- Eva Andermann
- Neurogenetics Unit and Epilepsy Research Group, Montreal Neurological Institute and Hospital, 3801 University Street, Suite 127, Montreal, QC H3A 2B4, Canada; Department of Neurology and Neurosurgery, Department of Human Genetics, McGill University, Montreal, QC, Canada.
| | - Victor Biton
- Arkansas Epilepsy Program, Clinical Trials Inc., 2 Lile Court, Suite 100, Little Rock, AR 72205, USA.
| | - Selim R Benbadis
- Department of Neurology, University of South Florida, 2 Tampa General Circle, 7th Floor, Tampa, FL 33606, USA
| | - Bassel Shneker
- Nuvasive Inc., 7475 Lusk Blvd., San Diego, CA 92121, USA; OhioHealth, 1010 Refugee Rd, Pickerington, OH 43147, USA; Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, USA(2)
| | - Aashit K Shah
- Wayne State University, 4201 St Antoine, Detroit, MI 48201, USA; Detroit Medical Center, 4201 St. Antoine, Detroit, MI 48201, USA
| | - Mar Carreño
- Epilepsy Unit, Hospital Clinic, Villarroel 170, Barcelona 08036, Spain
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Ignaz Harrestrasse 79, Salzburg 5020, Austria; Department of Public Health and Health Technology Assessment, UMIT - University of Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria
| | - Elinor Ben-Menachem
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg 41345, Sweden
| | - Arnaud Biraben
- CHU Pontchaillou, 2 Rue Henri le Guilloux, Rennes 35000, France
| | - Francisco Rocha
- BIAL - Portela & C(a), S.A., Avenida da Siderurgia Nacional, 4745-457 São Mamede do Coronado, Portugal
| | - Helena Gama
- BIAL - Portela & C(a), S.A., Avenida da Siderurgia Nacional, 4745-457 São Mamede do Coronado, Portugal
| | - Hailong Cheng
- Sunovion Pharmaceuticals Inc., 84 Waterford Dr, Marlborough, MA 01752, USA
| | - David Blum
- Sunovion Pharmaceuticals Inc., 84 Waterford Dr, Marlborough, MA 01752, USA
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49
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Liguori C, Izzi F, Manfredi N, D'Elia A, Mari L, Mercuri NB, Fabio P. Efficacy and tolerability of perampanel and levetiracetam as first add-on therapy in patients with epilepsy: A retrospective single center study. Epilepsy Behav 2018; 80:173-176. [PMID: 29414548 DOI: 10.1016/j.yebeh.2018.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/04/2018] [Accepted: 01/04/2018] [Indexed: 11/29/2022]
Abstract
Perampanel (PER) is a third generation antiepileptic drug (AED), recently approved as add-on therapy in both focal and generalized seizures. Levetiracetam (LEV) is a second generation AED, widely used in patients with epilepsy because of its favorable safety and efficacy profiles. Perampanel and LEV treatments have been associated with the occurrence of similar adverse events (AEs) (sleepiness, irritability, depression, anxiety, aggressiveness). The aim of the present retrospective single center study was to verify the efficacy and tolerability of PER and LEV used as first add-on therapy in patients with epilepsy affected by secondarily generalized seizures. We collected data from 15 patients treated with PER and 26 patients treated with LEV and followed at our site with follow-up visits at 3, 6, and 12months. This retrospective study documented the comparable efficacy of PER and LEV as first add-on treatments in patients affected by uncontrolled secondarily generalized seizures. However, more patients withdrawn LEV because of AEs compared with PER at the 3- and 12-month follow-up visits. The better tolerability of PER observed in this study could be related to the low therapeutic dose of PER prescribed when it is used as first adjunctive treatment for better controlling secondarily generalized seizures.
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Affiliation(s)
- Claudio Liguori
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Francesca Izzi
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Natalia Manfredi
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alessio D'Elia
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Luisa Mari
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola Biagio Mercuri
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Placidi Fabio
- Epilepsy Centre, Neurophysiopathology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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50
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Nkamguie Nkantchoua GC, Kameni Njapdounke JS, Jules Fifen J, Sotoing Taiwe G, Josiane Ojong L, Kavaye Kandeda A, Ngo Bum E. Anticonvulsant effects of Senna spectabilis on seizures induced by chemicals and maximal electroshock. JOURNAL OF ETHNOPHARMACOLOGY 2018; 212:18-28. [PMID: 28986332 DOI: 10.1016/j.jep.2017.09.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 06/07/2023]
Abstract
Senna spectabilis (Fabaceae) is one of the medicinal plants used in Cameroon by traditional healers to treat epilepsy, constipation, insomnia, anxiety. The present study aimed to investigate the anticonvulsant effects of Senna spectabilis decoction on seizures induced by maximal electroshock (MES), pentylenetetrazole (PTZ), pilocarpine (PC) and its possible action mechanisms in animal models using flumazenil (FLU), methyl-ß-carboline-3-carboxylate (BC) and bicuculline (BIC). Senna spectabilis decoction (106.5 and 213.0mg/kg) antagonized completely tonic-clonic hind limbs of mice induced by MES. The lowest plant dose (42.6mg/kg) provided 100% of protection against seizures induced by PTZ (70mg/kg). Administration of different doses of the plant decoction antagonized seizures induced by PC up to 75%, causing a dose dependent protection and reduced significantly the mortality rate induced by this convulsant. Both FLU and BC antagonize strongly the anticonvulsant effects of this plant and are unable to reverse totally diazepam or the plant decoction effects on inhibiting seizures. The animals did not present any sign of acute toxicity even at higher doses of the plant decoction. In conclusion, Senna spectabilis possesses an anticonvulsant activity. We showed that its decoction protects significantly mice against seizures induced by chemicals and MES, delays the onset time and reduces mortality rate in seizures-induced. It also appears that the oral administration of the decoction of S. spectabilis is more active than the intraperitoneal administration of the ethanolic extract on inhibiting seizures induced by MES and PTZ. Moreover, the plant decoction could interact with GABAA complex receptor probably on the GABA and benzodiazepines sites.
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Affiliation(s)
| | | | - Jean Jules Fifen
- Department of Physics, Faculty of Science, The University of Ngaoundere, Cameroon
| | - Germain Sotoing Taiwe
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, Cameroon
| | - Lucie Josiane Ojong
- Department of Biological Sciences, Faculty of Science, The University of Ngaoundere, Cameroon
| | - Antoine Kavaye Kandeda
- Department of Animal Biology and Physiology, Faculty of Science, University of Yaounde 1, Cameroon
| | - Elisabeth Ngo Bum
- Department of Biological Sciences, Faculty of Science, The University of Ngaoundere, Cameroon
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