1
|
Winter JD, Kerns JW, Qato DM, Winter KM, Brandt N, Wastila L, Winter C, Krist AH, Reves SR, Etz RS. Understanding Long-Stay Gabapentin Use Increases: A National Nursing Home Clinician Survey on Prescribing Intent. Clin Gerontol 2024:1-11. [PMID: 39016302 DOI: 10.1080/07317115.2024.2379974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
OBJECTIVES Explore the indications for long-stay gabapentin use and elucidate the factors spurring the rapid increase in gabapentin prescribing in nursing homes (NHs). METHODS National cross-sectional survey of NH prescribers distributed anonymously using SurveyMonkey. Sampling for convenience was obtained through crowdsourcing, leveraging collaborations with NH clinician organizations. Developed by a multidisciplinary team, pilot data/existing literature informed survey content. RESULTS A total of 131 surveys completed. Participants: 71% white, 52% female, 71% physicians. Off-label gabapentin prescribing was ubiquitous. Nearly every clinician used gabapentin for neuropathic pain, most for any form of pain. Many clinicians also prescribe gabapentin to moderate psychiatric symptoms and behaviors. Clinicians' prescribing was influenced by opioid, antipsychotic, and anxiolytic reduction policies because gabapentin was perceived as an unmonitored and safer alternative. CONCLUSIONS Off-label gabapentin increases are closely linked to opioid reduction efforts as more NH clinicians utilize gabapentin as an unmonitored opioid alternative. Our results highlight, however, the less recognized significance of long-stay prescribing for psychiatric symptoms and the similar contribution of psychotropic reduction initiatives, a phenomenon warranting further scrutiny. CLINICAL IMPLICATIONS Clinicians perceive gabapentin as safer than the drugs it is replacing. Whether this is true remains unclear; the individual- and population-level risks of increased gabapentin use are largely unknown.
Collapse
Affiliation(s)
- Jonathan D Winter
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Shenandoah Valley Family Practice Residency, Front Royal, Virginia, USA
| | - J William Kerns
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Shenandoah Valley Family Practice Residency, Front Royal, Virginia, USA
| | - Danya M Qato
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA; Peter Lamy Center on Drug Therapy and Aging, Baltimore, Maryland, USA
| | | | - Nicole Brandt
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA; Peter Lamy Center on Drug Therapy and Aging, Baltimore, Maryland, USA
| | - Linda Wastila
- University of Maryland School of Pharmacy, Baltimore, Maryland, USA; Peter Lamy Center on Drug Therapy and Aging, Baltimore, Maryland, USA
| | - Christopher Winter
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Sarah R Reves
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Larry A. Green Center, Richmond, Virginia, USA
| | - Rebecca S Etz
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Larry A. Green Center, Richmond, Virginia, USA
| |
Collapse
|
2
|
Klein A, Berger TC, Hapfelmeier A, Schaffert M, Matuja W, Schmutzhard E, Winkler AS. Does the presence of a specialist doctor reduce the burden of disease in people with epilepsy in low-resource settings? A comparison of two epilepsy clinics in rural Tanzania. Epilepsy Behav 2023; 139:109030. [PMID: 36577550 DOI: 10.1016/j.yebeh.2022.109030] [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: 08/26/2022] [Revised: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND With an estimated lifetime prevalence of epilepsy of 7.6 per 1,000 people, epilepsy represents one of the most common neurological disorders worldwide, with the majority of people with epilepsy (PWE) living in low-income and middle-income countries (LMICs). Adequately treated, up to 70 % of PWE will become seizure-free, however, as many as 85% of PWE worldwide, mostly from LMICs, do not receive adequate treatment. OBJECTIVE To assess the impact of the presence of a neurologist on the management of PWE in Tanzania. METHODS Two epilepsy clinics in rural Tanzania, one continuously attended by a neurologist, and one mainly attended by nurses with training in epilepsy and supervised intermittently by specialist doctors (neurologists/psychiatrists) were comparatively analyzed by multivariable linear and logistic regression models with regard to the outcome parameters seizure frequency, the occurrence of side effects of antiepileptic medication and days lost after a seizure. RESULTS The presence of a neurologist significantly reduced the mean number of seizures patients experienced per month by 4.49 seizures (p < 0.01) while leading to an increase in the occurrence of reported side effects (OR: 2.15, p = 0.02). CONCLUSION The presence of a neurologist may play a substantial role in reducing the burden of the disease of PWE in LMICs. Hence, specialist training should be encouraged, and relevant context-specific infrastructure established.
Collapse
Affiliation(s)
- Ana Klein
- Center for Global Health, Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany.
| | - Toni Christoph Berger
- Center for Global Health, Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany; Department of Neurology, Oslo University Hospital, Oslo, Norway.
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, School of Medicine, Technical University of Munich, Germany; Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Germany.
| | - Matthias Schaffert
- Paracelsus Medical University, Department for Paediatric and Adolescent Surgery, Salzburg, Austria.
| | - William Matuja
- Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | | | - Andrea S Winkler
- Center for Global Health, Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany; Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
| |
Collapse
|
3
|
Prétat T, Aícua-Rapún I, André P, Lebon S, Rossetti AO, Decosterd LA, Buclin T, Novy J. Treatment-emergent adverse events and antiseizure medication actual drug load. Epilepsy Behav 2022; 137:108980. [PMID: 36375306 DOI: 10.1016/j.yebeh.2022.108980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/05/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The correlation between treatment-emergent adverse events (TEAE) and antiseizure medication (ASM) drug load is a controversial topic. Previous studies used daily defined dosage (DDD) to measure drug load. We aim to assess if ASM adjusted to body weight and plasma levels were associated with TEAE. METHODS We analyzed clinical visits of a trial on therapeutic drug monitoring in outpatients with epilepsy. TEAE, treatment, and its changes, as well as ASM plasma levels, were recorded at each visit. Each medication level was stratified according to its position in relation to its proposed reference range (below, in the lower half, upper half, or above). RESULTS We analyzed 424 visits (151 participants). Treatment-emergent adverse events were reported in 84 (20%) visits. There was no significant difference when comparing visits with TEAE with those without TEAE in terms of ASM drug load (calculated with DDD), corrected for body weight, their changes since the last visit, as well as summed plasma levels compared to reference ranges. SIGNIFICANCE Actual drug load seems not to represent a major determinant of TEAE recorded during routine visits, even when accounting thoroughly for the patient's exposure to the treatment. The use of structured questionnaires and neuropsychometric tests may assess more accurately the potential consequences of drug loads.
Collapse
Affiliation(s)
| | - Irene Aícua-Rapún
- Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland; Spitalzentrum Biel, Switzerland
| | - Pascal André
- Service of Clinical Pharmacology, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland
| | - Sebastien Lebon
- Unit of Pediatric Neurology and Pediatric Neurorehabilitation, Woman-Mother-Child Department, Lausanne University Hospital CHUV, Switzerland
| | - Andrea O Rossetti
- Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland
| | - Laurent A Decosterd
- Laboratory of Clinical Pharmacology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Thierry Buclin
- Service of Clinical Pharmacology, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland
| | - Jan Novy
- Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital (CHUV) and University of Lausanne, Switzerland.
| |
Collapse
|
4
|
Willems LM, Schubert-Bast S, Grau J, Hertzberg C, Kurlemann G, Wiemer-Kruel A, Bast T, Bertsche A, Bettendorf U, Fiedler B, Hahn A, Hartmann H, Hornemann F, Immisch I, Jacobs J, Kieslich M, Klein KM, Klotz KA, Kluger G, Knuf M, Mayer T, Marquard K, Meyer S, Muhle H, Müller-Schlüter K, Noda AH, Ruf S, Sauter M, Schlump JU, Syrbe S, Thiels C, Trollmann R, Wilken B, Zöllner JP, Rosenow F, Strzelczyk A. Health-related quality of life in children and adolescents with tuberous sclerosis complex and their caregivers: A multicentre cohort study from Germany. Eur J Paediatr Neurol 2021; 35:111-122. [PMID: 34673401 DOI: 10.1016/j.ejpn.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/17/2021] [Accepted: 10/03/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study aimed to measure health-related quality of life (HRQOL) in children and adolescents with tuberous sclerosis complex (TSC) and quality of life (QOL) and depressive symptoms among caregivers. METHODS Adequate metrics were used to assess HRQOL in children and adolescents with TSC (4-18 years, KINDLR) as well as QOL (EQ-5D) and symptoms of depression (BDI-II) among caregivers. Predictors for reduced HRQOL and depressive symptoms were identified by variance analysis, ordinal regression, and bivariate correlation. RESULTS The mean HRQOL score was 67.9 ± 12.7, and significantly lower values were associated with increasing age, attending special needs education, TSC-associated psychiatric symptoms, and drug-related adverse events. The mean QOL of caregivers was 85.4 ± 15.7, and caregiver's sex, TSC mutation locus, familial TSC clustering, special needs education, degree of disability, care dependency, presence of TSC-associated psychiatric symptoms, and TSC severity were significant predictors of lower QOL. Depressive symptoms were identified in 45.7% of caregivers, associated with female sex of the caregiver, familial TSC clustering, special needs education, and presence of TSC-associated psychiatric symptoms of the child. Multivariate regression analysis revealed adolescence and drug-related adverse events as significant predictors for lower HRQOL in TSC children, and TSC2 variants predicted lower QOL and depressive symptoms in caregivers. CONCLUSION Compared with other chronic diseases, such as headache, diabetes or obesity, children with TSC have significantly lower HRQOL, which further decreases during adolescence. A decreased HRQOL of patients correlates with a lower QOL and increased symptoms of depression of their caregivers. These results may improve the comprehensive therapy and care of children and adolescents with TSC and their families and caregivers. TRIAL REGISTRATION DRKS, DRKS00016045. Registered 01 March 2019, http://www.drks.de/DRKS00016045.
Collapse
Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Janina Grau
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | | | | | - Thomas Bast
- Epilepsy Center Kork, Clinic for Children and Adolescents, Kehl-Kork, Germany
| | - Astrid Bertsche
- Department of Neuropediatrics, University Hospital for Children and Adolescents, Rostock, Germany
| | | | - Barbara Fiedler
- Department of General Pediatrics, Division of Neuropediatrics, University Hospital Münster, Germany
| | - Andreas Hahn
- Department of Neuropediatrics, Justus-Liebig-University Gießen, Gießen, Germany
| | - Hans Hartmann
- Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Frauke Hornemann
- Department of Neuropediatrics, Leipzig University Hospital for Children and Adolescents, Leipzig, Germany
| | - Ilka Immisch
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Julia Jacobs
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i.Br., Germany; Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthias Kieslich
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Karl Martin Klein
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany; Departments of Clinical Neurosciences, Medical Genetics and Community Health Sciences, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kerstin A Klotz
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg i.Br., Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg i.Br., Germany
| | - Gerhard Kluger
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Clinic Vogtareuth, Germany; Research Institute, Rehabilitation, Transition and Palliation, PMU Salzburg, Salzburg, Austria
| | - Markus Knuf
- Department of Pediatrics, Klinikum Worms, Worms, Germany; Department of Pediatrics, University Medicine Mainz, Mainz, Germany
| | - Thomas Mayer
- Epilepsy Center Kleinwachau, Dresden-Radeberg, Germany
| | - Klaus Marquard
- Department of Pediatric Neurology, Psychosomatics and Pain management, Klinikum Stuttgart, Stuttgart, Germany
| | - Sascha Meyer
- Department of Neuropediatrics, University Children's Hospital of Saarland, Homburg, Germany
| | - Hiltrud Muhle
- Department of Neuropediatrics, Christian-Albrechts-University Kiel & University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Karen Müller-Schlüter
- Epilepsy Center for Children, University Hospital Neuruppin, Brandenburg Medical School, Neuruppin, Germany
| | - Anna H Noda
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Ruf
- Department of Neuropediatrics, University Hospital Tübingen, Tübingen, Germany
| | - Matthias Sauter
- Klinikum Kempten, Klinikverbund Allgäu, Kempten/Allgäu, Germany
| | - Jan-Ulrich Schlump
- Department of Neuropediatrics, University of Witten/Herdecke, Herdecke, Germany
| | - Steffen Syrbe
- Division of Pediatric Epileptology, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Charlotte Thiels
- Department of Neuropediatrics and Social Pediatrics, Ruhr University Bochum, Bochum, Germany
| | - Regina Trollmann
- Department of Neuropediatrics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Bernd Wilken
- Department of Neuropediatrics, Klinikum Kassel, Kassel, Germany
| | - Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University Frankfurt, Frankfurt am Main, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg, Germany.
| |
Collapse
|
5
|
Jasionis A, Jasionytė G, Mameniškienė R. Tolerability of antiseizure medicines using Lithuanian version of the Liverpool Adverse Events Profile. Epilepsy Behav 2021; 124:108371. [PMID: 34757263 DOI: 10.1016/j.yebeh.2021.108371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To develop and validate a Lithuanian version of the Liverpool Adverse Events Profile (LT-LAEP), and to evaluate the main demographic, clinical, and pharmacological determinants of its score. MATERIALS AND METHODS We developed the LT-LAEP and examined its psychometric properties. People with epilepsy (PWE) were asked to fill in the LT-LAEP, the Generalized Anxiety Disorder scale-7 (GAD-7), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and a questionnaire addressing key demographic and clinical information. Antiseizure medicine (ASM) burden was expressed as a number of ASM and total drug load. Multiple linear regression analysis was used to determine the influence of various variables on LAEP results. RESULTS The data of 157 participants with the established diagnosis of epilepsy and stable ASM regimen were included in the final analysis. The mean LT-LAEP score was 48.72 ± 13.65. High internal consistency (Cronbach's α = 0.912) and test-retest reliability (ICC = 0.801) were demonstrated. The most common adverse effects (AEs) were tiredness (24.8%) and memory problems (23.6%). Lithuanian version of the Liverpool Adverse Events Profile score significantly correlated with NDDI-E (r = 0.635, p < 0.001) and GAD-7 (r = 0.640, p < 0.001) scores. The correlation between LT-LAEP score and total drug load was weak (r = 0.243, p = 0.002). The significant predictors of higher LT-LAEP score were female sex (β = -4.768, p = 0.003), higher seizure frequency (β = 4.757, p < 0.001), and higher NDDI-E (β = 1.457, p < 0.001) and GAD-7 scores (β = 0.610, p = 0.007) (F(4,152) = 43.975, R2 = 0.536, p < 0.001). CONCLUSIONS The LT-LAEP is a reliable and valid instrument for the evaluation of the AEs of ASM. A higher score of LT-LAEP is predicted by female sex, seizure frequency, and anxiety and depression levels rather than total drug load.
Collapse
|
6
|
Kaneko S, Nakahara T, Sumikawa Y, Fukunaga A, Masuda K, Kakamu T, Morita E. Current status of the satisfaction levels of adult patients receiving drugs for atopic dermatitis and chronic urticaria. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2021. [DOI: 10.1002/cia2.12200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sakae Kaneko
- Department of Dermatology Masuda Red Cross Hospital Masuda Japan
- Department of Dermatology Faculty of Medicine Shimane University Izumo Japan
| | - Takeshi Nakahara
- Division of Skin Surface Sensing Department of Dermatology Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yasuyuki Sumikawa
- Department of Dermatology School of Medicine Sapporo Medical University Sapporo Japan
| | - Atsushi Fukunaga
- Division of Dermatology Department of Internal Related Kobe University Graduate School of Medicine Kobe Japan
| | - Koji Masuda
- Department of Dermatology Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto Japan
| | - Takeyasu Kakamu
- Department of Hygiene & Preventive Medicine Fukushima Medical University School of Medicine Fukushima Japan
| | - Eishin Morita
- Department of Dermatology Faculty of Medicine Shimane University Izumo Japan
| |
Collapse
|
7
|
Efficacy, Retention and Tolerability of Everolimus in Patients with Tuberous Sclerosis Complex: A Survey-Based Study on Patients' Perspectives. CNS Drugs 2021; 35:1107-1122. [PMID: 34275102 PMCID: PMC8478774 DOI: 10.1007/s40263-021-00839-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The approval of everolimus (EVE) for the treatment of angiomyolipoma (2013), subependymal giant cell astrocytoma (2013) and drug-refractory epilepsy (2017) in patients with tuberous sclerosis complex (TSC) represents the first disease-modifying treatment option available for this rare and complex genetic disorder. OBJECTIVE The objective of this study was to analyse the use, efficacy, tolerability and treatment retention of EVE in patients with TSC in Germany from the patient's perspective. METHODS A structured cross-age survey was conducted at 26 specialised TSC centres in Germany and by the German TSC patient advocacy group between February and July 2019, enrolling children, adolescents and adult patients with TSC. RESULTS Of 365 participants, 36.7% (n = 134) reported the current or past intake of EVE, including 31.5% (n = 115) who were taking EVE at study entry. The mean EVE dosage was 6.1 ± 2.9 mg/m2 (median: 5.6 mg/m2, range 2.0-15.1 mg/m2) in children and adolescents and 4 ± 2.1 mg/m2 (median: 3.7 mg/m2, range 0.8-10.1 mg/m2) in adult patients. An early diagnosis of TSC, the presence of angiomyolipoma, drug-refractory epilepsy, neuropsychiatric manifestations, subependymal giant cell astrocytoma, cardiac rhabdomyoma and overall multi-organ involvement were associated with the use of EVE as a disease-modifying treatment. The reported efficacy was 64.0% for angiomyolipoma (75% in adult patients), 66.2% for drug-refractory epilepsy, and 54.4% for subependymal giant cell astrocytoma. The overall retention rate for EVE was 85.8%. The retention rates after 12 months of EVE therapy were higher among adults (93.7%) than among children and adolescents (88.7%; 90.5% vs 77.4% after 24 months; 87.3% vs 77.4% after 36 months). Tolerability was acceptable, with 70.9% of patients overall reporting adverse events, including stomatitis (47.0%), acne-like rash (7.7%), increased susceptibility to common infections and lymphoedema (each 6.0%), which were the most frequently reported symptoms. With a total score of 41.7 compared with 36.8 among patients not taking EVE, patients currently being treated with EVE showed an increased Liverpool Adverse Event Profile. Noticeable deviations in the sub-items 'tiredness', 'skin problems' and 'mouth/gum problems', which are likely related to EVE-typical adverse effects, were more frequently reported among patients taking EVE. CONCLUSIONS From the patients' perspective, EVE is an effective and relatively well-tolerated disease-modifying treatment option for children, adolescents and adults with TSC, associated with a high long-term retention rate that can be individually considered for each patient. Everolimus therapy should ideally be supervised by a centre experienced in the use of mechanistic target of rapamycin inhibitors, and adverse effects should be monitored on a regular basis.
Collapse
|
8
|
Sokić N, Ristić AJ, Bukumirić Z, Vojvodić N, Kovačević M, Sokić D. Validation of the Serbian version of the Liverpool Adverse Events Profile of antiseizure therapy in patients with epilepsy. Epilepsy Behav 2020; 111:107309. [PMID: 32698103 DOI: 10.1016/j.yebeh.2020.107309] [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: 04/13/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
The Liverpool Adverse Event Profile (LAEP) is a useful instrument in assessing the consequences of adverse events in patients using antiseizure medication. The LAEP scale has been validated in several languages to date. The aim of our study was to validate the LAEP scale in the Serbian language (SVLAEP). Validation of the SVLAEP scale was conducted by translating the original English version into the Serbian language and backtranslated into the English language. The translation was accepted when the two versions of the text were compatible. The questionnaire is then given to a group of patients with epilepsy treated with a stable dose of antiseizure medication. For the assessment of the quality of life and depression, we used the Serbian version of the Quality of Life in Epilepsy Inventory-31 (SVQOLIE-31) and the Serbian version of the Neurological Disorders Depression Inventory for Epilepsy (SVNDDI-E). From a total of 166 patients, 118 patients were included, and the remaining 48 were excluded because of other comorbidities and using other psychotropic drugs. Internal consistency (Cronbach's α = 0.87) and test-retest reliability (intraclass correlation coefficient (ICC) = 0.80) were satisfactory. The SVLAEP and SVQOLIE-31 had a strong negative statistical correlation (rs = -0.73; p < 0.001). The SVLAEP and SVNDDI-E final scores had a positive moderate correlation (rs = 0.52; p < 0.001). A moderate negative statistical correlation was found between SVNDDI-E and SVQOLIE-31 (rs = -0.56; p < 0.001). Our study showed that the LAEP scale is a useful indicator for the frequency of the adverse events in antiepileptic drug (AED) usage, despite a minor overlap with the symptoms of depression.
Collapse
Affiliation(s)
- Nataša Sokić
- Faculty of Medicine, University in Belgrade, Serbia
| | | | - Zoran Bukumirić
- Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Serbia
| | - Nikola Vojvodić
- Clinic for Neurology, Faculty of Medicine, University in Belgrade, Serbia
| | - Maša Kovačević
- Clinic for Neurology, Faculty of Medicine, University in Belgrade, Serbia
| | - Dragoslav Sokić
- Clinic for Neurology, Faculty of Medicine, University in Belgrade, Serbia
| |
Collapse
|
9
|
Lee BI, Park KM, Kim SE, Heo K. Clinical opinion: Earlier employment of polytherapy in sequential pharmacotherapy of epilepsy. Epilepsy Res 2019; 156:106165. [PMID: 31351239 DOI: 10.1016/j.eplepsyres.2019.106165] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/07/2019] [Indexed: 01/22/2023]
Abstract
Modern pharmacotherapy for epilepsy consists of orderly, sequential drug trials, in which antiepileptic drugs (AEDs) are chosen under the concept of individual patient-oriented (or - tailored) pharmacotherapy. Although monotherapy has been established as the preferred mode of AEDs therapy in both newly diagnosed and drug resistant epilepsies, there are still lack of evidence to favor either monotherapy or polytherapy in epilepsy, which has generated continuing controversies on the preferred mode of pharmacotherapy. However, each mode of pharmacotherapy may have both advantages and disadvantages, which are different and variable related to individual case scenario. We conducted a brief comparative overview between monotherapy and polytherapy to provide clues for earlier employment of polytherapy in each steps of sequential drug trials. Previous claims about the advantages of monotherapy over polytherapy are not supported but gradually losing its ground by the introduction of a large number of drugs carrying pharmacological advantages for combination therapy. Current evidence stresses the importance of combining drugs having synergistic interactions for better outcome of polytherapy, which has not been considered in previous clinical investigations comparing monotherapy and polytherapy. It is likely that a significant improvement in the outcome of current AEDs therapy is feasible by earlier employment of polytherapy as well as identification of combination drug regimens carrying synergistic interactions. At present, lamotrigine(LTG) and valproate(VPA) combination regimen is the only well documented synergistic regimen, but there are a long-list of candidate regimens requiring future trials in appropriate designs.
Collapse
Affiliation(s)
- Byung In Lee
- Department of Neurology and Epilepsy Center, Inje University Haeundae Paik Hospital, Busan, Republic of Korea.
| | - Kang Min Park
- Department of Neurology and Epilepsy Center, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Sung Eun Kim
- Department of Neurology and Epilepsy Center, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Yonsei University College of Medicine, Severance Hospital, Epilepsy Research Institute, Seoul, Republic of Korea
| |
Collapse
|
10
|
Adverse Events of Antiepileptic Drugs Using Indonesian Version of Liverpool Adverse Events Profile. Neurol Res Int 2018; 2018:8490639. [PMID: 30595918 PMCID: PMC6286758 DOI: 10.1155/2018/8490639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/05/2018] [Accepted: 11/08/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Adverse events (AEs) associated with antiepileptic drugs (AEDs) affect people with epilepsy's (PWE) quality of life. A study conducted in 15 European countries showed that the AEs prevalence of AEDs in PWE was up to 80%. To date, there are no validated screening instruments to detect AEs of AEDs in Indonesian PWE. Therefore its epidemiology is currently unknown. This study aimed to validate the Indonesian version of Liverpool Adverse Events Profile (LAEP), consequently increasing physicians' awareness toward the probability of AEs and its necessary evaluation. Furthermore, this study was intended to determine the AEs prevalence of AEDs in Indonesian PWE. Methods The questionnaire was translated from English into Indonesian version. The validity and reliability were tested using Spearman correlation and Cronbach's alpha measurement. An observational cross-sectional study was carried out on consecutive PWE in outpatient clinic, Cipto Mangunkusumo Hospital. We analyzed duration of epilepsy, onset of epilepsy, seizure frequency, type of epilepsy, etiology and epilepsy syndrome, number of AEDs, duration of AED use, and comorbidity. Results All of the 19 items in the questionnaire were valid, with correlation coefficient ranging from 0.465 to 0.690 (moderate-strong correlation). Cronbach's alpha value was 0.846 (good consistency). The total of 90 subjects were enrolled with 91% screened as having AEs using LAEP questionnaire. The most common AEs were tiredness (67.8%), sleepiness (66.7%), memory problems (62.2%), and difficulty in concentrating (56.7%). The only clinical variable that influenced AEs was polytherapy. Conclusion The Indonesian version of LAEP was a valid and reliable instrument to screen AE of AEDs in PWE. Almost all the subjects in this study were suspected having AEs. Polytherapy was the independent factor of AE.
Collapse
|
11
|
Allen EN, Chandler CIR, Mandimika N, Leisegang C, Barnes K. Eliciting adverse effects data from participants in clinical trials. Cochrane Database Syst Rev 2018; 1:MR000039. [PMID: 29372930 PMCID: PMC7098080 DOI: 10.1002/14651858.mr000039.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Analysis of drug safety in clinical trials involves assessing adverse events (AEs) individually or by aggregate statistical synthesis to provide evidence of likely adverse drug reactions (ADR). While some AEs may be ascertained from physical examinations or tests, there is great reliance on reports from participants to detect subjective symptoms, where he/she is often the only source of information. There is no consensus on how these reports should be elicited, although it is known that questioning methods influence the extent and nature of data detected. This leaves room for measurement error and undermines comparisons between studies and pooled analyses. This review investigated comparisons of methods used in trials to elicit participant-reported AEs. This should contribute to knowledge about the methodological challenges and possible solutions for achieving better, or more consistent, AE ascertainment in trials. OBJECTIVES To systematically review the research that has compared methods used within clinical drug trials (or methods that would be specific for such trials) to elicit information about AEs defined in the protocol or in the planning for the trial. SEARCH METHODS Databases (searched to March 2015 unless indicated otherwise) included: Embase; MEDLINE; MEDLINE in Process and Other Non-Indexed Citations; Cochrane Methodology Register (July 2012); Cochrane Central Register of Controlled Trials (February 2015); Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects (January 2015); Health Technology Assessment database (January 2015); CINAHL; CAB Abstracts; BIOSIS (July 2013); Science Citation Index; Social Science Citation Index; Conference Proceedings Citation Index - Science. The search used thesaurus headings and synonyms for the following concepts: (A): Adverse events AND measurement; (B): Participants AND elicitation (also other synonyms for extraction of information about adverse effects from people); (C): Participants AND checklists (also other synonyms as for B). Pragmatic ways were used to limit the results whilst trying to maintain sensitivity. There were no date or sample size restrictions but only reports published in English were included fully, because of resource constraints as regards translation. SELECTION CRITERIA Two types of studies were included: drug trials comparing two or more methods within- or between-participants to elicit participant-reported AEs, and research studies performed outside the context of a trial to compare methods which could be used in trials (evidenced by reference to such applicability). Primary outcome data included AEs elicited from participants taking part in any such clinical trial. We included any participant-reported data relevant for an assessment of drug-related harm, using the original authors' terminology (and definition, where available), with comment on whether the data were likely to be treatment-emergent AEs or not. DATA COLLECTION AND ANALYSIS Titles and abstracts were independently reviewed for eligibility. Full texts of potentially eligible citations were independently reviewed for final eligibility. Relevant data were extracted and subjected to a 100% check. Disagreements were resolved by discussion, involving a third author. The risk of bias was independently assessed by two authors. The Cochrane 'Risk of bias' tool was used for reports comparing outcomes between participants, while for within-participant comparisons, each study was critically evaluated in terms of potential impact of the design and conduct on findings using the framework of selection, performance, detection, attrition, reporting, and other biases. An attempt was made to contact authors to retrieve protocols or specific relevant missing information. Reports were not excluded on the basis of quality unless data for outcomes were impossible to compare (e.g. where denominators differed). A narrative synthesis was conducted because differences in study design and presentation meant that a quantitative meta-analysis was not possible. MAIN RESULTS The 33 eligible studies largely compared open questions with checklist-type questions or rating scales. Two included participant interviews. Despite different designs, populations and details of questioning methods, the narrative review showed that more specific questioning of participants led to more AEs detected compared to a more general enquiry. A subset of six studies suggested that more severe, bothersome, or otherwise clinically relevant AEs were reported when an initial open enquiry was used, while some less severe, bothersome, or clinically relevant AEs were only reported with a subsequent specific enquiry. However, two studies showed that quite severe or debilitating AEs were only detected by an interview, while other studies did not find a difference in the nature of AEs between elicitation methods. No conclusions could be made regarding the impact of question method on the ability to detect a statistically significant difference between study groups. There was no common statistical rubric, but we were able to represent some effect measures as a risk ratio of the proportion of participants with at least one AE. This showed a lower level of reporting for open questions (O) compared to checklists (CL), with a range for the risk ratios of 0.12 to 0.64. AUTHORS' CONCLUSIONS This review supports concerns that methods to elicit participant-reported AEs influence the detection of these data. There was a risk for under-detection of AEs in studies using a more general elicitation method compared to those using a comprehensive method. These AEs may be important from a clinical perspective or for patients. This under-detection could compromise ability to pool AE data. However, the impact on the nature of the AE detected by different methods is unclear. The wide variety and low quality of methods to compare elicitation strategies limited this review. Future studies would be improved by using and reporting clear definitions and terminology for AEs (and other important variables), frequency and time period over which they were ascertained, how they were graded, assessed for a relationship to the study drug, coded, and tabulated/reported. While the many potential AE endpoints in a trial may preclude the development of general AE patient-reported outcome measurement instruments, much could also be learnt from how these employ both quantitative and qualitative methods to better understand data elicited. Any chosen questioning method needs to be feasible for use by both staff and participants.
Collapse
Affiliation(s)
- Elizabeth N Allen
- University of Cape TownDivision of Clinical Pharmacology, Department of MedicineK45, Old Main Building, Groote Schuur HospitalObservatoryCape TownWestern CapeSouth Africa7925
| | - Clare IR Chandler
- London School of Hygiene and Tropical MedicineDept of Global Health & Development309, 15‐17 Tavistock PlaceLondonUKWC1H 9SH
| | - Nyaradzo Mandimika
- University of Cape TownDivision of Clinical Pharmacology, Department of MedicineK45, Old Main Building, Groote Schuur HospitalObservatoryCape TownWestern CapeSouth Africa7925
| | - Cordelia Leisegang
- University of Cape TownDivision of Clinical Pharmacology, Department of MedicineK45, Old Main Building, Groote Schuur HospitalObservatoryCape TownWestern CapeSouth Africa7925
| | - Karen Barnes
- University of Cape TownDivision of Clinical Pharmacology, Department of MedicineK45, Old Main Building, Groote Schuur HospitalObservatoryCape TownWestern CapeSouth Africa7925
| | | |
Collapse
|
12
|
Elafros MA, Birbeck GL, Gardiner JC, Siddiqi OK, Sikazwe I, Paneth N, Bositis CM, Okulicz JF. Patient-Reported Adverse Effects Associated with Combination Antiretroviral Therapy and Coadministered Enzyme-Inducing Antiepileptic Drugs. Am J Trop Med Hyg 2017; 96:1505-1511. [PMID: 28719255 DOI: 10.4269/ajtmh.16-0107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AbstractConcurrent treatment with combination antiretroviral therapy (cART) and an enzyme-inducing antiepileptic drug (EI-AED) is common in resource-limited settings; however, the incidence and impact of adverse effects in cotreated patients is largely unknown. Symptoms of adverse effects were assessed by both spontaneous report and checklist for 145 human immunodeficiency virus (HIV)-infected Zambian adults initiating various treatment combinations, such as cART with an EI-AED (N = 20), cART only (N = 43), or neither drug (untreated; N = 82). At study baseline, the cART + EI-AED group reported more headache, generalized fatigue, problems with concentration, and depression than the untreated group (P < 0.01 for all). At 2 weeks, a greater proportion of cART + EI-AED participants reported increased nausea or vomiting compared with baseline (P < 0.05). Adverse effects did not appear to impact self-reported adherence at 2 weeks as 100% cART adherence was reported in 19 of 20 (95%) and 42 of 43 (98%) cART + EI-AED and cART-only participants, respectively; 100% EI-AED adherence was reported in 19 of 20 (95%) participants. However, adherence at 6 months was suboptimal in both groups with 18 of 33 (56%) participants on cART experiencing greater than 1-week lapse in pharmacy-reported medication supply. Our results highlight the need to educate patients about the increased potential for nausea and vomiting with cART + EI-AED cotreatment. Although adherence was high early during treatment, adherence should be reinforced overtime to minimize the potential for HIV and/or epilepsy treatment failure.
Collapse
Affiliation(s)
- Melissa A Elafros
- Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Gretchen L Birbeck
- Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia.,Department of Neurology, University of Rochester, Rochester, New York
| | - Joseph C Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Omar K Siddiqi
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Global Neurology Program, Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | | | - Jason F Okulicz
- Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas
| |
Collapse
|
13
|
Damar U, Gersner R, Johnstone JT, Schachter S, Rotenberg A. Huperzine A: A promising anticonvulsant, disease modifying, and memory enhancing treatment option in Alzheimer's disease. Med Hypotheses 2016; 99:57-62. [PMID: 28110700 DOI: 10.1016/j.mehy.2016.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/17/2016] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) is the most frequent cause of dementia. Besides cognitive deterioration, patients with AD are prone to seizures - more than 20% of patients diagnosed with AD experience at least one unprovoked seizure and up to 7% have recurrent seizures. Although available antiepileptic drugs (AEDs) may suppress seizures in patients with AD, they may also worsen cognitive dysfunction and increase the risk of falls. On the basis of preclinical studies, we hypothesize that Huperzine A (HupA), a safe and potent acetylcholinesterase (AChE) inhibitor with potentially disease-modifying qualities in AD, may have a realistic role as an anticonvulsant in AD.
Collapse
Affiliation(s)
- Ugur Damar
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roman Gersner
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Steven Schachter
- Department of Neurology, Beth Israel Deaconess Medical Center, and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander Rotenberg
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
14
|
PatientsLikeMe® Online Epilepsy Community: Patient characteristics and predictors of poor health-related quality of life. Epilepsy Behav 2016; 63:20-28. [PMID: 27544877 DOI: 10.1016/j.yebeh.2016.07.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/06/2016] [Accepted: 07/24/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The online PatientsLikeMe® Epilepsy Community allows patients with epilepsy to record, monitor, and share their demographic, disease, and treatment characteristics, providing valuable insights into patient perceptions and understanding of epilepsy. The objective of this retrospective analysis was to characterize the profile of users and their disease and identify factors predictive of poor health-related quality of life (HRQoL), while assessing the platform's potential in providing patient-reported data for research purposes. METHODS Data recorded (January 2010-November 2011) by Epilepsy Community members, with an epilepsy diagnosis and who reported >1 seizure, included the following: sociodemographic and disease characteristics, treatments, symptoms, side effects perceived as medication-related, seizure occurrence, and standardized questionnaires (Quality of Life in Epilepsy Inventory [QOLIE-31/P], EuroQoL 5-Dimensions Scale, 3 Levels [EQ-5D-3L], and Hospital Anxiety and Depression Scale [HADS]). Univariate and multivariate logistic regressions were conducted to identify predictors of poor HRQoL. RESULTS During the study period, the Epilepsy Community comprised 3073 patients, of whom 71.5% were female, had a mean age of 37.8years, and had a mean epilepsy duration of 17.7years. The most frequently reported moderate/severe symptoms (n=2135) included memory problems (60.2%), problems concentrating (53.8%), and fatigue (50.0%). Medication-related side effects (n=639) included somnolence (23.2%), fatigue (17.2%), and memory impairment (13.8%). The QOLIE-31/P scores (n=1121) were significantly worse in patients who experienced a recent seizure. For QOLIE-31/P, highly predictive factors for poor HRQoL included the following: mild/moderate problems concentrating, depression, memory problems, treatment side effects, occurrence of tonic-clonic seizures, and epilepsy duration ≤1year. For EQ-5D-3L, highly predictive factors for poor HRQoL included the following: pain, depression, and comorbidities. Patients on newer AEDs were less likely to report poor HRQoL (QOLIE-31/P). SIGNIFICANCE These findings move further towards supporting the feasibility and usefulness of collecting real-world, anonymized data recorded by patients online. The data provide insights into factors impacting HRQoL, suggesting that a holistic treatment approach beyond seizure control should be considered in epilepsy.
Collapse
|
15
|
Zaccara G, Giovannelli F, Schmidt D. Placebo and nocebo responses in drug trials of epilepsy. Epilepsy Behav 2015; 43:128-34. [PMID: 25703333 DOI: 10.1016/j.yebeh.2014.12.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 12/19/2022]
Abstract
Placebo response can be defined as any therapeutic change on placebo, while the nocebo response is any ill effect during placebo exposure. Several meta-analytic approaches have investigated the extent of placebo response in randomized, placebo-controlled, clinical trials of focal epilepsies. Placebo response rates (proportion of patients with ≥50% improvement of seizures versus baseline) ranging from 9.9% up to 15.2% have been reported. Interestingly, a sham response of 15.8% has been noted in trials of transcranial magnetic stimulation. Recently, nocebo response rates of 60.3% and 3.9% were noted, which were defined as the proportion of patients with adverse events (AEs) and those withdrawing because of intolerable AEs, respectively. Factors which were found to influence placebo response were as follows: the year of publication (with more recent studies showing higher rates of placebo response), some clinical characteristics of recruited patients (lower placebo response rates with a history of 7 or more prior lifetime AEDs, a high baseline seizure frequency, prior epilepsy surgery, and higher age at diagnosis), trial design and statistical analysis, and whether studies have been conducted in children or adults. Furthermore, placebo and nocebo rates were correlated with respective seizure outcome and adverse events of the experimental AED. Several mechanisms of placebo and nocebo responses are discussed. Specifically, the role of positive or negative expectations of patients and of investigators may influence the placebo and the nocebo response. Finally, recommendations are given on how to address placebo and nocebo responses in clinical practice.
Collapse
Affiliation(s)
- Gaetano Zaccara
- Unit of Neurology, Department of Medicine, Florence Health Authority, Firenze, Italy.
| | - Fabio Giovannelli
- Unit of Neurology, Department of Medicine, Florence Health Authority, Firenze, Italy; Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Firenze, Italy
| | | |
Collapse
|
16
|
Perfil de consumo de antiepilépticos en los pacientes epilépticos del Área Oeste de Málaga. Neurologia 2015; 30:67-9. [DOI: 10.1016/j.nrl.2013.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 02/03/2013] [Accepted: 02/08/2013] [Indexed: 11/24/2022] Open
|
17
|
Garcia-Martin G, Chamorro-Muñoz M, Martin-Reyes G, Dawid-Milner M, Perez-Errazquin F, Romero-Acebal M. Consumption patterns of antiepileptic drugs among epileptic patients in the Western Málaga district. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2013.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
18
|
Adverse events, placebo and nocebo effects in placebo-treated paediatric patients with refractory focal epilepsies. Analysis of double-blind studies. Epilepsy Res 2014; 108:1685-93. [DOI: 10.1016/j.eplepsyres.2014.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/13/2014] [Indexed: 12/18/2022]
|
19
|
Manan MM, Rusli RA, Ang WC, Al-Worafi YM, Ming LC. Assessing the pharmaceutical care issues of antiepileptic drug therapy in hospitalised epileptic patients. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2014. [DOI: 10.1002/jppr.1001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Mohamed M. Manan
- Faculty of Pharmacy; Universiti Teknologi MARA; Puncak Alam Malaysia
| | - Rose A. Rusli
- Faculty of Pharmacy; Universiti Teknologi MARA; Puncak Alam Malaysia
| | - Wei C. Ang
- Faculty of Pharmacy; Universiti Teknologi MARA; Puncak Alam Malaysia
| | - Yaser M.A. Al-Worafi
- Pharmacy Practice Department, College of Pharmacy; Qassim University; Buraydah Saudi Arabia
| | - Long C. Ming
- Faculty of Pharmacy; Universiti Teknologi MARA; Puncak Alam Malaysia
- Brain and Neuroscience Communities of Research; Universiti Teknologi MARA; Shah Alam Malaysia
| |
Collapse
|
20
|
Elafros MA, Bui E, Birbeck GL. Medication side effects among people with epilepsy taking phenobarbital in Zambia. Epilepsy Res 2014; 108:1680-4. [PMID: 25219354 DOI: 10.1016/j.eplepsyres.2014.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/14/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
Phenobarbital remains one of the most widely used antiepileptic drugs worldwide, yet there are limited data regarding side effects associated with its use in routine clinical care settings in low-income countries. Available data suggests that phenobarbital is as effective as other first-line drugs for treating tonic-clonic seizures, but side effect reports differ widely between high and low-income settings. A better understanding of phenobarbital side effect profile and severity in low-income settings is warranted given its role in efforts to decrease the epilepsy treatment gap. We used the Liverpool adverse events profile (LEAP) to assess side effects in consecutive patients with epilepsy on phenobarbital seeking care in rural Zambia. Data regarding age, gender, medication dose, and medication adherence were also collected. T-tests and Spearman's correlation coefficient were used to assess predictors of LEAP score and medication adherence. Thirty-five patients receiving a mean dose of 2.1mg/kg/day (SD: 2.78 mg/kg/day) of phenobarbital were assessed. All participants reported at least one side effect in the previous four weeks with a median of 6 symptoms (IQR: 4-8) and a mean side effects score of 28/76 (SD: 5.38). Over half reported sleepiness and dizziness. Memory problems and depression were also common (both 46%). Total LAEP score was not associated with age (p=0.88), gender (p=0.17), or phenobarbital dose (p=0.13). Medication adherence was not associated with side effects total score (p=0.56). Rural Zambian adults taking phenobarbital at doses recommended by the World Health Organization report a significant number of side effects. The most common side effects reported were similar to those reported in high-income countries. The significant burden of phenobarbital-associated side effects in this African cohort is in contrast to data from non-randomized clinical trials in China that reported phenobarbital to be well-tolerated with few side effects. Additional investigations regarding phenobarbital side effects during routine care in low income settings is warranted.
Collapse
Affiliation(s)
- Melissa A Elafros
- Michigan State University, International Neurologic & Psychiatric Epidemiology Program (INPEP), East Lansing, MI, USA; Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Esther Bui
- Sunnybrook Health Sciences Centre, Department of Medicine, Toronto, Ontario, Canada
| | - Gretchen L Birbeck
- Chikankata Hospital, Epilepsy Care Team, Mazabuka, Zambia; University of Rochester, Department of Neurology, Epilepsy Division, Rochester, NY, USA; University of Rochester, Department of Public Health, Rochester, NY, USA.
| |
Collapse
|
21
|
Beretta S, Beghi E, Messina P, Gerardi F, Pescini F, La Licata A, Specchio L, Ferrara M, Canevini MP, Turner K, La Briola F, Franceschetti S, Binelli S, Giglioli I, Galimberti CA, Fattore C, Zaccara G, Tramacere L, Sasanelli F, Pirovano M, Ferrarese C. Comprehensive educational plan for patients with epilepsy and comorbidity (EDU-COM): a pragmatic randomised trial. J Neurol Neurosurg Psychiatry 2014; 85:889-94. [PMID: 24403284 DOI: 10.1136/jnnp-2013-306553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The impact of educational strategies in the management of adverse treatment effects and drug interactions in adult patients with epilepsy with comorbidities remains undetermined. OBJECTIVE The EDU-COM study is a randomised, pragmatic trial investigating the effect of a patient-tailored educational plan in patients with epilepsy with comorbidity. METHODS 174 adult patients with epilepsy with chronic comorbidities, multiple-drug therapy and reporting at least one adverse treatment effect and/or drug interaction at study entry were randomly assigned to the educational plan or usual care. The primary endpoint was the number of patients becoming free from adverse treatment events and/or drug interactions after a 6-month follow-up. The number of adverse treatment events and drug interactions, health-related quality of life (HRQOL) summary score changes and the monetary costs of medical contacts and drugs were assessed as secondary outcomes. RESULTS The primary endpoint was met by 44.0% of patients receiving the educational plan versus 28.9% of those on usual care (p=0.0399). The control group reported a significantly higher risk not to meet successfully the primary endpoint at the end of the study: OR (95% CI) of 2.29 (1.03 to 5.09). A separate analysis on drug adverse effects and drug interactions showed that the latter were more sensitive to the effect of educational treatment. Quality of life and costs were not significantly different in the two groups. CONCLUSIONS A patient-tailored educational strategy is effective in reducing drug-related problems (particularly drug interactions) in epilepsy patients with chronic comorbidities, without adding significant monetary costs. Registered at ClinicalTrials.gov, identifier NCT01804322, (http://www.clinicaltrials.gov).
Collapse
Affiliation(s)
- Simone Beretta
- Department of Neurology, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| | - Ettore Beghi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Paolo Messina
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Francesca Gerardi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | | | | | - Luigi Specchio
- Department of Medical and Experimental Sciences, Ospedali Riuniti, University of Foggia, Foggia, Italy
| | - Mariangela Ferrara
- Department of Medical and Experimental Sciences, Ospedali Riuniti, University of Foggia, Foggia, Italy
| | - Maria Paola Canevini
- Health Sciences Department, Epilepsy Center, San Paolo Hospital, University of Milano, Milano, Italy
| | - Katherine Turner
- Health Sciences Department, Epilepsy Center, San Paolo Hospital, University of Milano, Milano, Italy
| | - Francesca La Briola
- Health Sciences Department, Epilepsy Center, San Paolo Hospital, University of Milano, Milano, Italy
| | | | - Simona Binelli
- Neurophysiology Unit, Fondazione Carlo Besta Neurological Institute, Milano, Italy
| | - Isabella Giglioli
- Neurophysiology Unit, Fondazione Carlo Besta Neurological Institute, Milano, Italy
| | | | - Cinzia Fattore
- Clinical Trial Center & Antiepileptic Drugs, Fondazione Istituto "C. Mondino", Pavia, Italy
| | - Gaetano Zaccara
- Department of Neurology, S. Maria Nuova Hospital, Firenze, Italy
| | | | | | - Marta Pirovano
- Department of Neurology, Ospedale di Circolo, Melegnano, Italy
| | - Carlo Ferrarese
- Department of Neurology, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| |
Collapse
|
22
|
Adverse events of placebo-treated, drug-resistant, focal epileptic patients in randomized controlled trials: a systematic review. J Neurol 2014; 262:501-15. [DOI: 10.1007/s00415-014-7391-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/27/2014] [Accepted: 05/27/2014] [Indexed: 12/24/2022]
|
23
|
Efficacy and tolerability of the first antiepileptic drug in children with newly diagnosed idiopathic epilepsy. Seizure 2014; 23:252-9. [DOI: 10.1016/j.seizure.2013.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/18/2013] [Accepted: 12/02/2013] [Indexed: 11/24/2022] Open
|
24
|
Pope RA, Centeno M, Flügel D, Symms MR, Koepp M, Thompson PJ, Foong J. Neural correlates of de novo depression following left temporal lobe epilepsy surgery: a voxel based morphometry study of pre-surgical structural MRI. Epilepsy Res 2013; 108:517-25. [PMID: 24438916 DOI: 10.1016/j.eplepsyres.2013.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/04/2013] [Accepted: 12/15/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate cerebral grey matter (GM) volumetric abnormalities in temporal lobe epilepsy (TLE) patients who develop de novo depression following TLE surgery using voxel-based morphometry (VBM). METHODS We retrospectively examined pre-surgical grey matter (GM) volumes in 30 patients with TLE due to unilateral left-sided hippocampal sclerosis using 1.5-T MRI scan, which were segmented with optimised VBM parameters and normalised to a sample template using DARTEL, with SPM8 software. Voxel-wise GM differences between patients that developed de novo post-surgical depression (n=5) were compared with patients with no pre- or postoperative psychiatric diagnoses (n=25), using independent samples t-tests with age, gender and secondary generalised tonic-clonic seizures (SGTCS) as covariates (p<.001, unc). KEY FINDINGS Reduced preoperative bilateral GM in orbitofrontal cortices (OFC) and ipsilateral cingulate gyrus and thalamus were significantly associated with the development of de novo depression within 4 years postoperatively. Further analyses revealed no differences in seizure freedom (ILAE 1 vs 2-6) or postoperative memory decline between the groups. SIGNIFICANCE Although the development of postoperative de novo depression following TLE surgery is likely to be multi-factorial, our results suggest that bilateral OFC and ipsilateral cingulate gyrus and thalamic atrophy in left-sided TLE patients may play a modulatory role. Abnormalities in these areas have also been implicated in primary mood disorders. Prospective neuroimaging studies with larger cohorts are warranted to replicate these results, and further elucidate the neural correlates of de novo depression.
Collapse
Affiliation(s)
- Rebecca Anne Pope
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3BG, UK.
| | - Maria Centeno
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; Institute of Child Health, University College London, London WC1N 1EH, UK
| | | | - Mark Robert Symms
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK
| | - Matthias Koepp
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 2BG, UK
| | - Pamela Jane Thompson
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 2BG, UK
| | - Jacqueline Foong
- Institute of Neurology, Department of Clinical and Experimental Epilepsy, University College London, Queen Square, London SL9 0RJ, UK; The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 2BG, UK
| |
Collapse
|
25
|
Chmielewska B, Lis K, Rejdak K, Balcerzak M, Steinborn B. Pattern of adverse events of antiepileptic drugs: results of the aESCAPE study in Poland. Arch Med Sci 2013; 9:858-64. [PMID: 24273570 PMCID: PMC3832831 DOI: 10.5114/aoms.2013.38679] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 07/24/2011] [Accepted: 09/04/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Adverse Event Scale in Patients With Epilepsy (aESCAPE) European study (NCT00394927) explored and analyzed adverse events (AEs) and reasons for modifying treatment in patients treated with newer and older antiepileptic drugs (AEDs) used in monotherapy or polytherapy. The present analysis concerns the results of patients recruited in Poland. MATERIAL AND METHODS Multicentre, international, observational, cross-sectional study investigating AEs in patients with epilepsy (aged ≥ 4 years), on stable AED treatment with one or two AED(s) for ≥ 3 months, using standardized questionnaires completed by a physician during a single study visit. RESULTS Out of 309 patients, 24.6% were treated exclusively with newer AED(s) in monotherapy or in combination, while 75.4% were treated with older AED(s) or a combination of older and newer AED(s). 60.8% were on monotherapy, and 39.9% on polytherapy. In general, 73.8% of patients reported ≥ 1 AE(s). There were no significant differences in the frequency of reported AEs in compared groups. The most common were disturbances in cognitive function (40.5%), psychological problems (36.2%), and sedation (32.7%). Some AEs were found to be more specific for particular types and treatment regimens. Changes in treatment or dose during the study visit occurred in 22.3% of the patients, mainly due to lack of efficacy (10.7%), AEs (5.2%) or absence of seizures (4.5%). CONCLUSIONS A detailed structured interview revealed high frequency of AEs in patients treated with AEDs. The main reasons for treatment modifications at the study visit were lack of efficacy, adverse events and absence of seizures.
Collapse
Affiliation(s)
| | | | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | | | - Barbara Steinborn
- Department of Developmental Neurology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
26
|
|
27
|
Drug-resistant epilepsy: Current recommendations for diagnosis and treatment in Spain. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2011.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
28
|
Sánchez-Álvarez J, Gil-Nagel A, Casas-Fernández C, Mauri-Llerda J, Salas-Puig J, Sancho-Rieger J. Epilepsia resistente a fármacos antiepilépticos: recomendaciones de actuación diagnóstica y terapéutica en España. Neurologia 2012; 27:575-84. [DOI: 10.1016/j.nrl.2011.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 09/05/2011] [Indexed: 10/15/2022] Open
|
29
|
Abstract
More than 150 years after bromide was introduced as the first antiepileptic drug, adverse effects remain a leading cause of treatment failure and a major determinant of impaired health-related quality of life in people with epilepsy. Adverse effects can develop acutely or many years after starting treatment and can affect any organ or structure. In the past two decades, many efforts have been made to reduce the burden of antiepileptic drug toxicity. Several methods to screen and quantify adverse effects have been developed. Patient profiles associated with increased risk of specific adverse effects have been uncovered through advances in the areas of epidemiology and pharmacogenomics. Several new-generation antiepileptic drugs with improved tolerability profiles and reduced potential for drug interaction have been added to the therapeutic armamentarium. Overall, these advances have expanded the opportunities to tailor treatment with antiepileptic drugs, to enhance effectiveness and minimise the risk of toxic effects.
Collapse
Affiliation(s)
- Piero Perucca
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | |
Collapse
|
30
|
Kanner AM, Schachter SC, Barry JJ, Hesdorffer DC, Mula M, Trimble M, Hermann B, Ettinger AE, Dunn D, Caplan R, Ryvlin P, Gilliam F, LaFrance WC, LaFrance WC. Depression and epilepsy, pain and psychogenic non-epileptic seizures: clinical and therapeutic perspectives. Epilepsy Behav 2012; 24:169-81. [PMID: 22632407 DOI: 10.1016/j.yebeh.2012.01.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2012] [Indexed: 12/11/2022]
Abstract
The clinical manifestations of depression in people with epilepsy (PWE) are pleomorphic, often associated with anxiety symptoms and anxiety disorders. The ongoing debate of whether the clinical presentation of depression in PWE is unique to this neurologic disorder is reviewed. Comorbid depression can impact the recruitment of PWE for pharmacologic trials with antiepileptic drugs (AEDs). Yet, the impact of depression on the response of the seizure disorder to pharmacotherapy with AEDs and its impact on worse adverse events may bias the interpretation of the trial findings, particularly when depressed patients are included in the AED trials. PWE have a greater suicidal risk than the general population. This risk is mediated by multiple factors, and recent data from the FDA have imputed a potential pathogenic role to all AEDs. The recognition of patients at risk is reviewed. Yet, the validity of the FDA data has been questioned, and the status of this controversial question is analyzed. As in the case of epilepsy, depression and pain syndromes have a relatively high comorbidity. The negative impact of depression on pain is reminiscent of that of depression in PWE; furthermore, the high comorbidity may be also associated with the existence of common pathogenic mechanisms. Neurologists and in particular, epileptologists establish the diagnosis of psychogenic non-epileptic seizures (PNES) in whom a comorbid depressive disorder is very often identified. The role of depression in the course of PNES and its treatment are discussed. Scarce data are available on the treatment of depression in PWE. Thus, clinicians have had to adopt data from patients with primary depressive disorders. We outline a consensus strategy on the identification and treatment of depressive disorders in adult and pediatric patients with epilepsy.
Collapse
Affiliation(s)
- Andres M Kanner
- Department of Neurological Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Tolerability of antiepileptic drugs: can we determine differences? Epilepsy Behav 2012; 23:187-92. [PMID: 22366050 DOI: 10.1016/j.yebeh.2011.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 11/25/2011] [Accepted: 11/27/2011] [Indexed: 11/21/2022]
Abstract
Patient tolerability of adverse effects is integral to successful treatment. Although standard antiepileptic drugs (AEDs) are well tolerated by many patients, the promise of newer AEDs has been the potential for diminished burden of problems with similar seizure control. This report reviews the prevalence of systemic and neurological adverse effects reported in clinical trials of AED monotherapy. A central finding in this report was the unidirectional higher prevalence of selected adverse effects from standard compared with newer AEDs. A system of questioning every patient at every visit to elicit information may be helpful when balancing benefit-to-risk ratio of individualized therapy during everyday practice.
Collapse
|
32
|
Do Parkinson’s disease patients disclose their adverse events spontaneously? Eur J Clin Pharmacol 2011; 68:857-65. [DOI: 10.1007/s00228-011-1198-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
|
33
|
|
34
|
Tsounis S, Kimiskidis VK, Kazis D, Gkiatas K, Garganis K, Karageorgiou K, Giannakodimos S, Papathanasopoulos P, Plaitakis A, Papadimitriou A, Lyras L, Emir B. An open-label, add-on study of pregabalin in patients with partial seizures: A multicenter trial in Greece. Seizure 2011; 20:701-5. [DOI: 10.1016/j.seizure.2011.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 06/28/2011] [Accepted: 06/29/2011] [Indexed: 10/17/2022] Open
|
35
|
Cramer JA, Steinborn B, Striano P, Hlinkova L, Bergmann A, Bacos I, Baukens C, Buyle S. Non-interventional surveillance study of adverse events in patients with epilepsy. Acta Neurol Scand 2011; 124:13-21. [PMID: 21039365 DOI: 10.1111/j.1600-0404.2010.01440.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Compare adverse events (AEs) in patients with epilepsy taking different antiepileptic drugs (AEDs) using standardized physician-completed questionnaires. MATERIALS AND METHODS Multicenter, observational, cross-sectional study in epilepsy patients aged ≥4 , stable on 1-2 AED(s) for ≥3 months. RESULTS One thousand and nineteen patients were evaluated: 28.7% took newer, 71.3% older (or older + newer) AED(s); 56.9% monotherapy; 43.1% polytherapy. Overall, 68.3% reported ≥1 AE (61.3% newer; 71.1% older AEDs), most commonly: cognitive function disturbances, sedation, psychological problems. Patients taking newer AEDs were significantly less likely to report ≥1 AE (OR [95% CI]: 0.64 [0.46-0.89], P = 0.008). Treatment/dose changed at study visit: 22.8% (17.5% newer; 24.9% older AEDs) because of (newer/older); lack of efficacy (6.2%/7.8%); AEs (4.1/8.4%); absence of seizures (3.8/4.0%). Patients receiving levetiracetam or lamotrigine were significantly less likely to report AEs/modify treatment. CONCLUSION Patients taking newer AEDs were significantly less likely to report AEs, although the non-randomized study design does not allow the lower rate of AEs to be attributed with certainty to the use of newer AEDs. A standardized AE questionnaire appeared useful for monitoring AEs/optimizing AED therapy.
Collapse
Affiliation(s)
- J A Cramer
- Yale University, Epilepsy Therapy Project, Houston, TX 77027-9310, USA.
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Chen HF, Tsai YF, Shih MS, Chen JC. Validation of the Chinese version of the Liverpool Adverse Events Profile in patients with epilepsy. Epilepsy Res 2011; 94:45-52. [DOI: 10.1016/j.eplepsyres.2011.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 12/23/2010] [Accepted: 01/08/2011] [Indexed: 10/18/2022]
|
37
|
Emami S, Kebriaeezadeh A, Ahangar N, Khorasani R. Imidazolylchromanone oxime ethers as potential anticonvulsant agents: Anticonvulsive evaluation in PTZ-kindling model of epilepsy and SAR study. Bioorg Med Chem Lett 2010; 21:655-9. [PMID: 21195615 DOI: 10.1016/j.bmcl.2010.12.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 11/09/2010] [Accepted: 12/04/2010] [Indexed: 10/18/2022]
Abstract
As a continuation of our efforts to develop the azolylchromanone derivatives as potential anticonvulsant agents, we explored (Z)- and (E)-oxime ether derivatives of imidazolylchromanones bearing different lipophilic O-benzyl groups and tested their anticonvulsant activities in PTZ-kindling model of epilepsy. O-(2,4-Dichlorobenzyl) oximes 8a, 16a and 20a were significantly effective in delaying the onset of the PTZ-evoked seizures at the dose of 30mg/kg in kindled animals. The most effective compounds in delaying seizures were 7-chlorochromanone-O-(2,4-dichlorobenzyl) oximes 8a and 20a. SAR studies showed that introduction of a chlorine atom to the 7-position and/or a methyl group to the 2-position of the chroman ring resulted in an improvement of anti-seizure efficacy in O-(2,4-dichlorobenzyl) oxime series.
Collapse
Affiliation(s)
- Saeed Emami
- Department of Medicinal Chemistry and Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
| | | | | | | |
Collapse
|
38
|
Canevini MP, De Sarro G, Galimberti CA, Gatti G, Licchetta L, Malerba A, Muscas G, La Neve A, Striano P, Perucca E. Relationship between adverse effects of antiepileptic drugs, number of coprescribed drugs, and drug load in a large cohort of consecutive patients with drug-refractory epilepsy. Epilepsia 2010; 51:797-804. [PMID: 20545754 DOI: 10.1111/j.1528-1167.2010.02520.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
39
|
Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, Moshé SL, Perucca E, Wiebe S, French J. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 2009; 51:1069-77. [PMID: 19889013 DOI: 10.1111/j.1528-1167.2009.02397.x] [Citation(s) in RCA: 2792] [Impact Index Per Article: 186.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To improve patient care and facilitate clinical research, the International League Against Epilepsy (ILAE) appointed a Task Force to formulate a consensus definition of drug resistant epilepsy. The overall framework of the definition has two "hierarchical" levels: Level 1 provides a general scheme to categorize response to each therapeutic intervention, including a minimum dataset of knowledge about the intervention that would be needed; Level 2 provides a core definition of drug resistant epilepsy using a set of essential criteria based on the categorization of response (from Level 1) to trials of antiepileptic drugs. It is proposed as a testable hypothesis that drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom. This definition can be further refined when new evidence emerges. The rationale behind the definition and the principles governing its proper use are discussed, and examples to illustrate its application in clinical practice are provided.
Collapse
Affiliation(s)
- Patrick Kwan
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Gilliam F, Penovich PE, Eagan CA, Stern JM, Labiner DM, Onofrey M, Holmes GL, Mathis E, Cramer J. Conversations between community-based neurologists and patients with epilepsy: results of an observational linguistic study. Epilepsy Behav 2009; 16:315-20. [PMID: 19720567 DOI: 10.1016/j.yebeh.2009.07.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 07/24/2009] [Accepted: 07/26/2009] [Indexed: 01/01/2023]
Abstract
An in-office linguistic study was conducted to assess neurologist-patient discussions of epilepsy. Naturally occurring interactions among 20 neurologists and 60 of their patients with epilepsy were recorded. Participants were interviewed separately postvisit. Transcripts were analyzed using sociolinguistic techniques. Of 59 patients taking antiepileptic drugs previsit, 44 (75%) discussed side effects with their neurologist. Side effect discussions were most often neurologist initiated. Postvisit, patients and neurologists often disagreed about which side effects were experienced. The presence of a caregiver (e.g., spouse) usually resulted in lengthier, more detailed discussions of side effects, without drastically increasing overall visit length. Discussions of mood- and behavior-related comorbidities occurred infrequently (14 of 60 visits); postvisit, neurologists stated that they felt that management of these conditions was outside their area of expertise. Communication gaps observed in discussions of epilepsy and its treatment warrant further exploration. Additional research is currently underway to assess the efficacy of a previsit assessment tool.
Collapse
Affiliation(s)
- Frank Gilliam
- Comprehensive Epilepsy Center, Cornell University, New York, NY, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Worthen DR, Bence AK, Stables JP, Crooks PA. In vivo evaluation of diaminodiphenyls: Anticonvulsant agents with minimal acute neurotoxicity. Bioorg Med Chem Lett 2009; 19:5012-5. [DOI: 10.1016/j.bmcl.2009.07.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 07/08/2009] [Accepted: 07/09/2009] [Indexed: 11/26/2022]
|
42
|
Carreño M, Donaire A, Falip M, Maestro I, Fernández S, Nagel AG, Serratosa J, Salas J, Viteri C, Llorens J, Baró E. Validation of the Spanish version of the Liverpool Adverse Events Profile in patients with epilepsy. Epilepsy Behav 2009; 15:154-9. [PMID: 19435575 DOI: 10.1016/j.yebeh.2008.11.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 11/24/2008] [Accepted: 11/26/2008] [Indexed: 11/18/2022]
Abstract
The objective of the study was to validate the Spanish version of the Liverpool Adverse Events Profile (LAEP). An observational, cross-sectional, multicenter study was carried out on patients with epilepsy treated with a stable dose of antiepileptic drugs. Patients completed the LAEP, Quality of Life in Epilepsy Inventory-31 (QOLIE-31), and Hospital Anxiety and Depression Scale (HADS). Two hundred sixty-six patients were recruited. The LAEP was completed in a short time, perceived as easy to complete, and there was no relevant information missing. Ceiling/floor effects were negligible. Internal consistency (Cronbach's alpha=0.84) and test-retest reliability (ICC=0.81) were satisfactory. LAEP scores consistently correlated with QOLIE-31 (r=0.71) and HADS (r=0.52-0.63) scores. When the LAEP was used to discriminate between patients with and without adverse events, the scores on the QOLIE and HADS corresponded. The Spanish version of the LAEP scale exhibits adequate psychometric properties, suggesting that it is an appropriate instrument to measure adverse events among Spanish-speaking patients with epilepsy.
Collapse
Affiliation(s)
- Mar Carreño
- Servicio de Neurología, Hospital Clínic i Provicinal de Barcelona, C/Villarroel no 170, Barcelona 08036, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
Large interindividual variation in efficacy and adverse effects of anti-epileptic therapy presents opportunities and challenges in pharmacogenomics. Although the first true association of genetic polymorphism in drug-metabolizing enzymes with anti-epileptic drug dose was reported 10 years ago, most of the findings have had little impact on clinical practice so far. Most studies performed to date examined candidate genes and were focused on candidate gene selection. Genome-wide association and whole-genome sequencing technologies empower hypothesis-free comprehensive screening of genetic variation across the genome and now the main challenge remaining is to select and study clinically relevant phenotypes suitable for genetic studies. Here we review the current state of epilepsy pharmacogenetics focusing on phenotyping questions and discuss what characteristics we need to study to get answers.
Collapse
Affiliation(s)
- Dalia Kasperavičiūtė
- Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sanjay M Sisodiya
- Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| |
Collapse
|
44
|
Bharmal M, Payne K, Atkinson MJ, Desrosiers MP, Morisky DE, Gemmen E. Validation of an abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9) among patients on antihypertensive medications. Health Qual Life Outcomes 2009; 7:36. [PMID: 19397800 PMCID: PMC2678998 DOI: 10.1186/1477-7525-7-36] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 04/27/2009] [Indexed: 11/22/2022] Open
Abstract
Background The 14-item Treatment Satisfaction Questionnaire for Medication (TSQM) Version 1.4 is a reliable and valid instrument to assess patients' satisfaction with medication, providing scores on four scales – side effects, effectiveness, convenience and global satisfaction. In naturalistic studies, administering the TSQM with the side effects domain could provoke the physician to assess the presence or absence of adverse events in a way that is clinically atypical, carrying the potential to interfere with routine medical care. As a result, an abbreviated 9-item TSQM (TSQM-9), derived from the TSQM Version 1.4 but without the five items of the side effects domain was created. In this study, an interactive voice response system (IVRS)-administered TSQM-9 was psychometrically evaluated among patients taking antihypertensive medication. Methods A total of 3,387 subjects were invited to participate in the study from an online panel who self-reported taking a prescribed antihypertensive medication. The subjects were asked to complete the IVRS-administered TSQM-9 at the start of the study, along with the modified Morisky scale, and again within 7 to 14 days. Standard psychometric analyses were conducted; including Cronbach's alpha, intraclass correlation coefficients, structural equation modeling, Spearman correlation coefficients and analysis of covariance (ANCOVA). Results A total of 396 subjects completed all the study procedures. Approximately 50% subjects were male with a good racial/ethnic mix: 58.3% white, 18.9% black, 17.7% Hispanic and 5.1% either Asian or other. There was evidence of construct validity of the TSQM-9 based on the structural equation modeling findings of the observed data fitting the Decisional Balance Model of Treatment Satisfaction even without the side effects domain. TSQM-9 domains had high internal consistency as evident from Cronbach's alpha values of 0.84 and greater. TSQM-9 domains also demonstrated good test-retest reliability with high intraclass correlation coefficients exceeding 0.70. As expected, the TSQM-9 domains were able to differentiate between individuals who were low, medium and high compliers of medication, with moderate to high effect sizes. There was evidence of convergent validity with significant correlations with the medication adherence scale. Conclusion The IVRS-administered TSQM-9 was found to be a reliable and valid measure to assess treatment satisfaction in naturalistic study designs, in which there is potential that the administration of the side effects domain of the TSQM would interfere with routine clinical care.
Collapse
|
45
|
McAuley JW, Chen AY, Elliott JO, Shneker BF. An assessment of patient and pharmacist knowledge of and attitudes toward reporting adverse drug events due to formulation switching in patients with epilepsy. Epilepsy Behav 2009; 14:113-7. [PMID: 18768168 DOI: 10.1016/j.yebeh.2008.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Revised: 08/19/2008] [Accepted: 08/19/2008] [Indexed: 11/26/2022]
Abstract
A survey was developed to gather information from both patients with epilepsy and community pharmacists on the issue of antiepileptic drug (AED) formulation switching, which includes brand to generic, generic to brand, and generic to generic. Data were obtained from 82 patients (or parents of patients) with epilepsy and 112 community pharmacists. More than 92% of patients and 85% of pharmacists agreed that switching between forms of the same AEDs may cause an increase in seizures or adverse effects. More than two-thirds of our patient sample reported having problems with formulation switching; many also reported knowing other patients with problems. Just more than half (51%) of the pharmacists knew of patients who have described problems when they have changed AED formulations. Less than 50% of both populations knew that problems resulting from formulation switching should be reported as adverse drug events to the FDA. Not many pharmacists and far fewer patients use MedWatch to report these problems. We conclude that both patients with epilepsy and pharmacists are underinformed and underinvolved with reporting adverse drug events.
Collapse
Affiliation(s)
- James W McAuley
- Ohio State University College of Pharmacy, Columbus, OH 43210, USA.
| | | | | | | |
Collapse
|
46
|
Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|