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Dono F, Evangelista G, Rodorigo D, Rollo E, Romozzi M, Corniello C, Liviello D, Dasara M, Capriati L, Quintieri P, Servidei S, Della Marca G, Calabresi P, Sensi SL, Vollono C. Clinical characteristics and treatment approach of established New-Onset status epilepticus (eNOSE): A Real-World multicenter experience. Epilepsy Behav 2024; 159:109951. [PMID: 39111103 DOI: 10.1016/j.yebeh.2024.109951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION Status Epilepticus (SE) can occur in patients without a previous epilepsy diagnosis, a condition identified as "new-onset status epilepticus" (NOSE). Treatment with benzodiazepine may fail in NOSE termination, requiring anti-seizure medication (ASM) employment. The term "established NOSE" (eNOSE) is generally employed in this context. This study aims to describe the main clinical characteristics of a large sample of patients suffering from eNOSE, compare the ASM efficacy, and explore the risk factors associated with ASM treatment unresponsiveness and eNOSE-associated mortality. METHODS Adult patients diagnosed with eNOSE were retrospectively selected between January 2016 and December 2022. We reviewed demographics, clinical data, diagnostic work-up, and treatment. We considered the last ASM introduced before the eNOSE termination as effective. RESULTS 123 patients were included (age: 67.9 ± 17.3). eNOSE acute etiology was mostly reported. In the overall cohort, phenytoin showed the highest response rate (p = 0.01). In the pairwise comparisons, valproate was superior to levetiracetam (p = 0.02) but not to lacosamide (p = 0.50). Phenytoin had a significantly higher resolution rate than levetiracetam (p = 0.001) but not lacosamide (p = 0.14). Thirty patients were refractory to ASM treatment. No predictors of refractoriness were identified. Thirty-nine patients died. Age and GCS were identified as eNOSE-related mortality risk factors. CONCLUSION eNOSE frequently has an acute etiology with several associated syndromes. Phenytoin is more effective in managing eNOSE, even though lacosamide, valproate, and levetiracetam can represent further therapeutic options. Age and GCS are the main risk factors for eNOSE-associated mortality.
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Affiliation(s)
- Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST-, University G. D'Annunzio of Chieti-Pescara, Italy.
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST-, University G. D'Annunzio of Chieti-Pescara, Italy
| | - Davide Rodorigo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Eleonora Rollo
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marina Romozzi
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Clarissa Corniello
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Davide Liviello
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Michelangelo Dasara
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST-, University G. D'Annunzio of Chieti-Pescara, Italy
| | - Luca Capriati
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Università Cattolica del Sacro Cuore, Rome, Italy; Neurofisiopatologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Paolo Quintieri
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Serenella Servidei
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Università Cattolica del Sacro Cuore, Rome, Italy; Neurofisiopatologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Giacomo Della Marca
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Università Cattolica del Sacro Cuore, Rome, Italy; Neurofisiopatologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Paolo Calabresi
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Università Cattolica del Sacro Cuore, Rome, Italy; Neurologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST-, University G. D'Annunzio of Chieti-Pescara, Italy.
| | - Catello Vollono
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Università Cattolica del Sacro Cuore, Rome, Italy; Neurofisiopatologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
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Rollo E, Romozzi M, Dono F, Bernardo D, Consoli S, Anzellotti F, Ricciardi L, Paci L, Sensi SL, Della Marca G, Servidei S, Calabresi P, Vollono C. Treatment of benzodiazepine-refractory status epilepticus: A retrospective, cohort study. Epilepsy Behav 2023; 140:109093. [PMID: 36739634 DOI: 10.1016/j.yebeh.2023.109093] [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: 06/27/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Status epilepticus (SE) is a frequent neurological emergency, derived from the failure of mechanisms responsible for seizure termination. The present study aims to compare the efficacy of the most common antiseizure medications (ASMs) employed for the treatment of benzodiazepine-refractory SE. METHODS We performed a retrospective cohort study of all SE episodes treated in our hospital between January 2016 and December 2020. Inclusion criteria were: age ≥ 18 years; a diagnosis of status epilepticus. Exclusion criteria were: status epilepticus resolved by initial therapy with benzodiazepines; impossibility to retrieve medical records. We considered as effective the ASM that was the last drug introduced or increased in dose before termination of SE and without changes in the co-medication. RESULTS A total of 244 episodes in 219 patients were included in the study. The mean age of the final study cohort was 63.6 ± 19.2, with 108 (49%) men. In the total cohort, phenytoin (PHT) showed the highest response rate (57.6%), followed by lacosamide (LCM) (40.7%) and valproate (VPA) (39.8%). The comparative efficacy among the different drugs was significantly different (p < 0.001). In the pairwise comparisons, VPA was superior to levetiracetam (LEV) (response rate: 39.75% vs 24.71%; p = 0.004), but not to LCM. Phenytoin had a significantly higher resolution rate compared to VPA (response rate: 57.63% vs 39.75%; p = 0.02) and LEV (response rate: 57.63% vs 24.71; p < 0.001). The clinical predictors of anaesthetics administration were a disorder of consciousness upon clinical presentation, previous diagnosis of epilepsy, and younger age. CONCLUSION In our cohort of SE, PHT showed higher effectiveness in terminating established SE, as well as refractory SE in the subgroup of patients treated with anaesthetics.
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Affiliation(s)
- Eleonora Rollo
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marina Romozzi
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fedele Dono
- Dipartimento di Neuroscienze, Imaging e Scienze Cliniche, "G. D'Annunzio" Università di Chieti-Pescara, Chieti, Italy; Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST-, University G. D'Annunzio of Chieti-Pescara, Italy.
| | - Daniela Bernardo
- Centro Clinico NEMO, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Consoli
- Dipartimento di Neuroscienze, Imaging e Scienze Cliniche, "G. D'Annunzio" Università di Chieti-Pescara, Chieti, Italy
| | - Francesca Anzellotti
- Dipartimento di Neuroscienze, Imaging e Scienze Cliniche, "G. D'Annunzio" Università di Chieti-Pescara, Chieti, Italy
| | | | | | - Stefano L Sensi
- Dipartimento di Neuroscienze, Imaging e Scienze Cliniche, "G. D'Annunzio" Università di Chieti-Pescara, Chieti, Italy; Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology-CAST-, University G. D'Annunzio of Chieti-Pescara, Italy
| | - Giacomo Della Marca
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; Neurologia, Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Serenella Servidei
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; Neurofisiopatologia, Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Paolo Calabresi
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; Neurologia, Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Catello Vollono
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; Neurofisiopatologia, Dipartimento di Scienze dell'invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Llauradó A, Campos D, Quintana M, Ballvé A, Fonseca E, Abraira L, Giffreu A, Toledo M, Santamarina E. Reponse of second-line treatment in focal status epilepticus: A tertiary hospital experience. Epilepsy Res 2022; 185:106988. [PMID: 35907324 DOI: 10.1016/j.eplepsyres.2022.106988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/02/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the response to various antiseizure medications (ASMs) in the treatment of focal status epilepticus (SE) in the established phase, and the effect of administering several ASMs prior to sedation. METHODS All SE cases in patients aged > 16 years treated with non-BZDs ASMs were prospectively collected in our centre from February 2011 to April 2019. In total, 281 episodes were analysed. RESULTS Median age at SE onset was 65.1 years; 47 % were focal motor and 53 % focal non-motor episodes. SE cessation was achieved in 79 % episodes with second-line drugs, whereas a third line (anesthetics) was required in 47 episodes. SE cessation was achieved in only 27 % with the first ASM, 48 % with the second, and 51 % with the third. Prompt resolution of the SE episode with a first or second ASM was associated with a better outcome than episodes requiring a larger number of drugs (p = 0.024). The first option in our sample was levetiracetam in 70 % of cases. Among the total of non-responding SE cases treated with levetiracetam as the first ASM option, 107 were subsequently given lacosamide (seizure cessation in 53.3 %) and 34 valproic acid (seizure cessation in 29.4 %) (p = 0.015). CONCLUSION Our findings further support the notion that early termination of SE with a first or second ASM confers a better functional outcome. The large difference in response between the first ASM and consecutive ones suggests that the sum of different ASMs might be the key to resolving focal SE.
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Affiliation(s)
| | - Daniel Campos
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
| | | | | | - Elena Fonseca
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
| | | | - Manuel Toledo
- Epilepsy Unit. Hospital Vall Hebron, Barcelona, Spain
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Panda PK, Panda P, Dawman L, Sharawat IK. Efficacy of lacosamide and phenytoin in status epilepticus: A systematic review. Acta Neurol Scand 2021; 144:366-374. [PMID: 33999428 DOI: 10.1111/ane.13469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/14/2021] [Accepted: 05/02/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare the evidence on efficacy, safety, tolerability, and impact on short term/long functional outcome of lacosamide (LCM) and phenytoin (PHT) in patients with status epilepticus. MATERIALS & METHODS We conducted a systematic literature search of relevant electronic databases using a suitable search strategy to identify studies directly comparing PHT and LCM, irrespective of dose and duration in patients with convulsive and/or nonconvulsive status epilepticus (SE). We used a standardized assessment form to extract information on the study design, data sources, methodologic framework, efficacy, and adverse events attributed to PHT and LCM from included studies and compared the efficacy and safety outcomes, using a fixed/random effect model. RESULTS Five studies were found to be eligible for inclusion out of 192 search items, enrolling a total of 115 and 166 participants (predominantly with SE) in LCM and PHT arm, respectively. Baseline characteristics were comparable between both arms. The proportion with seizure control was comparable between both arms (57.3% in LCM vs. 45.7% in PHT arm, p = 0.28) and even in the subgroup analysis separately for convulsive and non-convulsive SE. Proportion with treatment-emergent adverse events (TEAE) were comparable in both (17.6% vs. 12.2%, p = 0.20), but serious adverse events (SAE) were higher in PHT arm (5.1% vs. 0.8%, p = 0.049). The proportion with all-cause mortality and survival with moderate-severe disability were comparable between both arms (p = 0.23 and 0.37, respectively). CONCLUSION LCM has comparable efficacy with fewer SAEs as compared to PHT for achieving seizure control in patients with SE.
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Affiliation(s)
- Prateek Kumar Panda
- Pediatric Neurology Division Department of Pediatrics All India Institute of Medical Sciences Rishikesh India
| | - Pragnya Panda
- Department of Pediatrics Post Graduate Institute of Medical Education and Research Chandigarh India
| | - Lesa Dawman
- Department of Neurology King George Medical University Lucknow India
| | - Indar Kumar Sharawat
- Pediatric Neurology Division Department of Pediatrics All India Institute of Medical Sciences Rishikesh India
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Yang H, Song L, Zou Y, Sun D, Wang L, Yu Z, Guo J. Role of Hyaluronic Acids and Potential as Regenerative Biomaterials in Wound Healing. ACS APPLIED BIO MATERIALS 2021; 4:311-324. [PMID: 35014286 DOI: 10.1021/acsabm.0c01364] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The skin can protect the body from external harm, sense environmental changes, and maintain physiological homeostasis. Cutaneous repair and regeneration associated with surgical wounds, acute traumas, and chronic diseases are a central concern of healthcare. Patients may experience the failure of current treatments due to the complexity of the healing process; therefore, emerging strategies are needed. Hyaluronic acids (HAs, also known as hyaluronan), a glycosaminoglycan (GAG) of the extracellular matrix (ECM), play key roles in cell differentiation, proliferation, and migration throughout tissue development and regeneration. Recently, HA derivatives have been developed as regenerative biomaterials for treating skin damage and injury. In this review, the healing process, namely, hemostasis, inflammation, proliferation, and maturation, is described and the role of HAs in the healing process is discussed. This review also provides recent examples in the development of HA derivatives for wound healing.
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Affiliation(s)
- Hao Yang
- School of Pharmaceutical Sciences, Jilin University, Changchun 130021, China
| | - Liu Song
- School of Pharmaceutical Sciences, Jilin University, Changchun 130021, China
| | - Yifang Zou
- School of Pharmaceutical Sciences, Jilin University, Changchun 130021, China
| | - Dandan Sun
- School of Pharmaceutical Sciences, Jilin University, Changchun 130021, China
| | - Limei Wang
- Department of Pharmacy, The General Hospital of FAW, Changchun 130011, China
| | - Zhuo Yu
- Department of Hepatopathy, Shuguang Hospital, Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jianfeng Guo
- School of Pharmaceutical Sciences, Jilin University, Changchun 130021, China
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Treatment of status epilepticus with zonisamide: A multicenter cohort study of 34 patients and review of literature. Epilepsy Behav 2020; 109:107139. [PMID: 32417381 DOI: 10.1016/j.yebeh.2020.107139] [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: 03/21/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We present a summary of clinical cases of oral zonisamide (ZNS) used to treat refractory and super-refractory episodes of status epilepticus (SE). METHODS Zonisamide administration in SE was identified in the clinical records of patients treated in Frankfurt and Marburg between 2011 and 2017. RESULTS Zonisamide was administered during a total of 37 SE episodes in 34 patients with a mean age of 58.7 ± 17.8 years, 21 of them were female (61.7%). The median latency from the onset of SE to administration of ZNS was 6.3 days. Patients had already undergone unsuccessful treatment with a median of three other antiseizure drugs (ASDs). The median initial dose of ZNS was 100 mg/d, titrated to a median maintenance dose of 400 mg/d. Patients underwent ZNS treatment for a median period of 7 days. Zonisamide was the final drug administered in 9 of 37 (24.3%) episodes, with a clinical effect attributed to ZNS observed in 6 of 37 (16.2%) episodes. An effect attributed to ZNS was observed in 5 out of 30 episodes of refractory SE (RSE) and in one out of 7 episodes of super-refractory SE (SRSE). Possible negative side effects of ZNS were observed in two patients (one patient each with ataxia and skin rash). The mortality rate in hospitalized patients was 10.4% (n = 4). CONCLUSION The rate of SE resolution attributed to ZNS treatment (16.2%) can be considered relevant, particularly since ZNS treatment tends to be administered only after several other options have been tried, and has a treatment latency of over six days. Zonisamide may therefore be considered as an alternative oral treatment option in RSE and SRSE.
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Fechner A, Hubert K, Jahnke K, Knake S, Konczalla J, Menzler K, Ronellenfitsch MW, Rosenow F, Strzelczyk A. Treatment of refractory and superrefractory status epilepticus with topiramate: A cohort study of 106 patients and a review of the literature. Epilepsia 2019; 60:2448-2458. [DOI: 10.1111/epi.16382] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Anne Fechner
- Department of Neurology Epilepsy Center Frankfurt Rhine‐Main Goethe University Frankfurt Frankfurt am Main Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER) Goethe University Frankfurt Frankfurt am Main Germany
| | - Kristina Hubert
- Department of Neurology Epilepsy Center Frankfurt Rhine‐Main Goethe University Frankfurt Frankfurt am Main Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER) Goethe University Frankfurt Frankfurt am Main Germany
| | - Kolja Jahnke
- Department of Neurology Epilepsy Center Frankfurt Rhine‐Main Goethe University Frankfurt Frankfurt am Main Germany
| | - Susanne Knake
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER) Goethe University Frankfurt Frankfurt am Main Germany
- Department of Neurology Epilepsy Center Hessen Philipps University Marburg Marburg (Lahn) Germany
| | - Jürgen Konczalla
- Department of Neurosurgery Goethe University Frankfurt Frankfurt am Main Germany
| | - Katja Menzler
- Department of Neurology Epilepsy Center Hessen Philipps University Marburg Marburg (Lahn) Germany
| | - Michael W. Ronellenfitsch
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER) Goethe University Frankfurt Frankfurt am Main Germany
- Dr Senckenberg Institute of Neurooncology Goethe University Frankfurt Frankfurt am Main Germany
- Frankfurt Cancer Institute Goethe University Frankfurt Frankfurt am Main Germany
| | - Felix Rosenow
- Department of Neurology Epilepsy Center Frankfurt Rhine‐Main Goethe University Frankfurt Frankfurt am Main Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER) Goethe University Frankfurt Frankfurt am Main Germany
| | - Adam Strzelczyk
- Department of Neurology Epilepsy Center Frankfurt Rhine‐Main Goethe University Frankfurt Frankfurt am Main Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER) Goethe University Frankfurt Frankfurt am Main Germany
- Department of Neurology Epilepsy Center Hessen Philipps University Marburg Marburg (Lahn) Germany
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Mostacci B, Bisulli F, Muccioli L, Minardi I, Bandini M, Licchetta L, Zucchelli M, Leta C, Michelucci R, Zanello M, Tinuper P. Super refractory status epilepticus in Lafora disease interrupted by vagus nerve stimulation: A case report. Brain Stimul 2019; 12:1605-1607. [PMID: 31471204 DOI: 10.1016/j.brs.2019.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/15/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- B Mostacci
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy.
| | - F Bisulli
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - L Muccioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - I Minardi
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - M Bandini
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - L Licchetta
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - M Zucchelli
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - C Leta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - R Michelucci
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - M Zanello
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - P Tinuper
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Santamarina E, Parejo Carbonell B, Sala J, Gutiérrez-Viedma Á, Miró J, Asensio M, Abraira L, Falip M, Ojeda J, López-González FJ, Rodríguez-Osorio X, Mauri JÁ, Aiguabella M, García Morales I, Toledo M. Use of intravenous brivaracetam in status epilepticus: A multicenter registry. Epilepsia 2019; 60:1593-1601. [PMID: 31260101 DOI: 10.1111/epi.16094] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The pharmacokinetics of brivaracetam (BRV), added to its effectiveness observed in animal models of status epilepticus (SE), makes this drug attractive for use in emergency situations. Our objective was to evaluate the use of intravenous BRV in a multicenter study. METHODS A retrospective multicenter registry of SE cases treated with BRV was created. These patients were evaluated between January and December 2018 at seven hospitals in Spain. Demographic variables, SE characteristics, concomitant drugs, loading doses, and response to treatment were collected. RESULTS Forty-three patients were registered. The mean age was 56 ± 23.1 years, 51.2% were male, 29 had previous epilepsy, 24 (55.8%) had prominent motor symptoms, and 19 had nonconvulsive symptoms. Regarding the etiology, 19 (44.2%) were considered acute symptomatic, 16 (17.2%) remote symptomatic, four (9.3%) progressive symptomatic, and four (9.3%) cryptogenic. Regarding concomitant antiepileptic drugs (AEDs), 17 had previously received levetiracetam (LEV). In 14 patients, BRV was used early (first or second AED). The median loading dose was 100 mg (range = 50-400), and the weight-adjusted dose was 1.8 mg/kg (range = 0.4-7.3). BRV was effective in 54% (n = 23), and a response was observed in <6 hours in 13 patients. We observed a tendency for it to be more effective when administered earlier (P = 0.09), but there were no differences regarding SE type and the concomitant use of LEV. In those with the fastest responses, we observed that both the total administered dose (300 mg vs 100 mg, P = 0.008) and the weight-adjusted dose (3.85 mg vs 1.43 mg, P = 0.006) were significantly higher. The receiver operating characteristic curve showed that the best cutoff point for a faster response was 1.82 mg/kg. SIGNIFICANCE BRV is useful for the treatment of SE, even when patients are already being treated with LEV. The response rate seems higher when it is administered earlier and at higher doses (>1.82 mg/kg).
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Affiliation(s)
| | | | - Jacint Sala
- Epilepsy Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Álvaro Gutiérrez-Viedma
- Epilepsy Unit, San Carlos Clinical Hospital, Madrid, Spain.,Department of Medicine, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Júlia Miró
- Epilepsy Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Montserrat Asensio
- Neurology Department, Alicante University General Hospital, Alicante, Spain
| | - Laura Abraira
- Epilepsy Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mercé Falip
- Epilepsy Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Joaquín Ojeda
- Neurology Department, Infanta Sofía Hospital, San Sebastián de los Reyes, Spain
| | | | - Xiana Rodríguez-Osorio
- Epilepsy Unit, Santiago de Compostela University Clinical Hospital, Santiago de Compostela, Spain
| | - José Ángel Mauri
- Epilepsy Unit, Lozano-Blesa University Hospital, Zaragoza, Spain
| | - Maria Aiguabella
- Epilepsy Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | | | - Manuel Toledo
- Epilepsy Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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10
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Dibué-Adjei M, Brigo F, Yamamoto T, Vonck K, Trinka E. Vagus nerve stimulation in refractory and super-refractory status epilepticus - A systematic review. Brain Stimul 2019; 12:1101-1110. [PMID: 31126871 DOI: 10.1016/j.brs.2019.05.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Refractory status epilepticus (RSE) is the persistence of status epilepticus despite second-line treatment. Super-refractory SE (SRSE) is characterized by ongoing status despite 48 h of anaesthetic treatment. Due to the high case fatality in RSE of 16-39%, off label treatments without strong evidence of efficacy in RSE are often administered. In single case-reports and small case series totalling 28 patients, acute implantation of VNS in RSE was associated with 76% and 26% success rate in generalized and focal RSE respectively. We performed an updated systematic review of the literature on efficacy of VNS in RSE/SRSE by including all reported patients. METHODS We systematically searched EMBASE, CENTRAL, Opengre.eu, and ClinicalTrials.gov, and PubMed databases to identify studies reporting the use of VNS for RSE and/or SRSE. We also searched conference abstracts from AES and ILAE meetings. RESULTS 45 patients were identified in total of which 38 were acute implantations of VNS in RSE/SRSE. Five cases had VNS implantation for epilepsia partialis continua, one for refractory electrical status epilepticus in sleep and one for acute encephalitis with refractory repetitive focal seizures. Acute VNS implantation was associated with cessation of RSE/SRSE in 74% (28/38) of acute cases. Cessation did not occur in 18% (7/38) of cases and four deaths were reported (11%); all of them due to the underlying disease and unlikely related to VNS implantation. Median duration of the RSE/SRSE episode pre and post VNS implantation was 18 days (range: 3-1680 days) and 8 days (range: 3-84 days) respectively. Positive outcomes occurred in 82% (31/38) of cases. CONCLUSION VNS can interrupt RSE and SRSE in 74% of patients; data originate from reported studies classified as level IV and the risk for reporting bias is high. Further prospective studies are warranted to investigate acute VNS in RSE and SRSE.
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Affiliation(s)
- Maxine Dibué-Adjei
- LivaNova Deutschland GmbH, LivaNova PLC-owned Subsidiary, Lindberghstraße 25, 80939, Munich, Germany; Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstraße 5, D-40225, Düsseldorf, Germany.
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Takamichi Yamamoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Kristl Vonck
- Brain Research Team, Department of Neurology, Ghent University, Ghent, Belgium
| | - Eugen Trinka
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria; Institute of Public Health, Medical Decision Making and HTA, UMIT, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
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11
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Santamarina E, Alpuente A, Maisterra O, Sueiras M, Sarria S, Guzman L, Abraira L, Salas-Puig J, Toledo M. Perampanel: A therapeutic alternative in refractory status epilepticus associated with MELAS syndrome. EPILEPSY & BEHAVIOR CASE REPORTS 2019; 11:92-95. [PMID: 30834194 PMCID: PMC6384302 DOI: 10.1016/j.ebcr.2019.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 11/10/2022]
Abstract
To our knowledge, there are no reports of status epilepticus (SE) associated with mitochondrial diseases and treated with perampanel (PER). We present three cases of patients with refractory SE associated with MELAS syndrome who responded favorably to PER. All cases were diagnosed as non-convulsive SE (focal without impairment of level of consciousness). After an initial treatment with other anti-seizure drugs, PER was added in all cases (8, 16 and 12 mg) and cessation of SE was observed within the next 4-8 hours. All the cases involved a stroke-like lesion present on brain MRI. In our patients, PER was an effective option in SE associated with MELAS syndrome. Status epilepticus (SE) in MELAS is associated with a stroke-lesion and it is usually refractory. We present three cases of refractory SE and MELAS who responded favorably to Perampanel. Perampanel (PER) may be an effective option in SE associated with MELAS syndrome.
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Affiliation(s)
- Estevo Santamarina
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alicia Alpuente
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Olga Maisterra
- Neurovascular Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Sueiras
- EEG Unit, Department of Neurophysiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Lorena Guzman
- EEG Unit, Department of Neurophysiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
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12
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The electroclinical spectrum, etiologies, treatment and outcome of nonconvulsive status epilepticus in the elderly. Epilepsy Behav 2018; 79:53-57. [PMID: 29253676 DOI: 10.1016/j.yebeh.2017.10.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nonconvulsive status epilepticus (NCSE) in the elderly is particularly difficult to diagnose, mainly due to subtle clinical manifestations and associated comorbidities. The recently validated electroencephalography (EEG) diagnostic criteria for NCSE and the proposed operational classification of status epilepticus provide tools that can allow an earlier diagnosis and better management of NCSE in this age group, possibly contributing to reduce its high mortality. MATERIAL AND METHODS we used these tools to identify and characterize a cohort of elderly (>60year-old) patients admitted at our institution in a 3-year period; the video-EEG and clinical files of the patients fulfilling EEG diagnostic criteria for NCSE were reviewed, being in this study described their electroclinical spectrum, etiologies, treatment, inhospital mortality, and status epilepticus severity score (STESS). RESULTS Fourty patients (23 women; mean age 76.6years) were identified. Although dyscognitive NCSE associated with >2.5Hz of epileptiform discharges (ED) was the most frequent electroclinical phenotype, this was quite heterogeneous, ranging from patients with aura continua to patients in coma, associated with frequent ED or rhythmic slow activities. Acute symptomatic (45%) and multifactorial (27.5%) etiologies were the most common, and associated with the worst prognosis. There was a trend to use newer antiepileptic drugs in the early steps of NCSE treatment. The inhospital mortality was high (22.5%) and predicted by STESS scores ≥3. CONCLUSION In the elderly, NCSE has heterogeneous electroclinical phenotypes and etiologies. In spite of the treatment limitations conditioned by the comorbidities, more aggressive treatments could be justified to reduce mortality in patients with high STESS scores.
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Redecker J, Wittstock M, Rösche J. The efficacy of different kinds of intravenously applied antiepileptic drugs in the treatment of status epilepticus. How can it be determined? Epilepsy Behav 2017; 71:35-38. [PMID: 28460320 DOI: 10.1016/j.yebeh.2017.03.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 11/18/2022]
Abstract
We explored the influence of four different efficacy criteria on the results of observational studies concerning the treatment of status epilepticus (SE) and its subtypes. We compared and contrasted the results of four different efficacy criteria for the effectiveness of phenytoin, valproate, levetiracetam, and lacosamide. Criterion 1=the last antiepileptic drug (AED) administered before SE termination. Criterion 2=the last drug introduced into the antiepileptic therapy within 72h before the cessation of SE and without changes in dosage or number of the co-medication. Criterion 3=the last drug introduced into the antiepileptic therapy or increased in dose within 24h before termination of the SE without changes in the co-medication. Criterion 4=the last drug introduced into the antiepileptic therapy within 72h before the cessation of SE even allowing changes in the co-medication. We used two-tailed χ2-tests with the Yates adjustment for small samples to evaluate statistical differences between efficacy rates of different AEDs in the entire group and in subgroups of SE according to the second level of subdivisions in axis 1 and according to axis 2 of the new ILAE classification. A total of 145 treatment episodes in 124 patients (47 male, 77 female) were evaluated. There were 23 significant differences in efficacy according to the different criteria. Only criteria 1 and 3 led to significant results in our analysis. When incorporating theoretical considerations and the results of this study, criterion 3 seems to be the most appropriate measure for the evaluation of efficacy of an AED in the treatment of SE, because it seems to be more reasonable than criterion 1.
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Affiliation(s)
| | | | - Johannes Rösche
- Department of Neurology, University of Rostock, Germany; Swiss Epilepsy-center, Zurich, Switzerland.
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14
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Beuchat I, Novy J, Rossetti AO. Newer Antiepileptic Drugs in Status Epilepticus: Prescription Trends and Outcomes in Comparison with Traditional Agents. CNS Drugs 2017; 31:327-334. [PMID: 28337727 DOI: 10.1007/s40263-017-0424-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Newer antiepileptic drugs (AEDs) are increasingly prescribed; however, relatively limited data are available regarding their use in status epilepticus (SE) and the impact on outcome. OBJECTIVES The aim of this study was to explore the evolution in prescription patterns of newer and traditional AEDs in this clinical setting, and their association with prognosis. METHODS We analyzed our prospective adult SE registry over a 10-year period (2007-2016) and assessed the yearly use of newer and traditional AEDs and their association with mortality, return to baseline conditions at discharge, and SE refractoriness, defined as treatment resistance to two AEDs, including benzodiazepines. RESULTS In 884 SE episodes, corresponding to 719 patients, the prescription of at least one newer AED increased from 0.38 per SE episode in 2007 to 1.24 per SE episode in 2016 (mostly due to the introduction of levetiracetam and lacosamide). Traditional AEDs (excluding benzodiazepines) decreased over time from 0.74 in 2007 to 0.41 in 2016, correlating with the decreasing use of phenytoin. The prescription of newer AEDs was independently associated with a lower chance of return to baseline conditions at discharge (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.40-0.84) and a higher rate of SE refractoriness (OR 19.84, 95% CI 12.76-30.84), but not with changes in mortality (OR 1.08, 95% CI 0.58-2.00). CONCLUSION We observed a growing trend in the prescription of newer AEDs in SE over the last decade; however, our findings might suggest an associated increased risk of SE refractoriness and new disability at hospital discharge. Pending prospective, comparative studies, this may justify some caution in the routine use of newer AEDs in SE.
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Affiliation(s)
- Isabelle Beuchat
- Service de Neurologie, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), CHUV-BH07, and Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Jan Novy
- Service de Neurologie, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), CHUV-BH07, and Lausanne University Hospital, 1011, Lausanne, Switzerland
| | - Andrea O Rossetti
- Service de Neurologie, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), CHUV-BH07, and Lausanne University Hospital, 1011, Lausanne, Switzerland.
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15
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Challenges in the treatment of convulsive status epilepticus. Seizure 2017; 47:17-24. [DOI: 10.1016/j.seizure.2017.02.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 01/09/2023] Open
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16
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Banerjee A, Luong JA, Ho A, Saib AO, Ploski JE. Overexpression of Homer1a in the basal and lateral amygdala impairs fear conditioning and induces an autism-like social impairment. Mol Autism 2016; 7:16. [PMID: 26929812 PMCID: PMC4770673 DOI: 10.1186/s13229-016-0077-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 02/02/2016] [Indexed: 12/20/2022] Open
Abstract
Background Autism spectrum disorders (ASDs) represent a heterogeneous group of disorders with a wide range of behavioral impairments including social and communication deficits. Apart from these core symptoms, a significant number of ASD individuals display higher levels of anxiety, and some studies indicate that a subset of ASD individuals have a reduced ability to be fear conditioned. Deciphering the molecular basis of ASD has been considerably challenging and it currently remains poorly understood. In this study we examined the molecular basis of autism-like impairments in an environmentally induced animal model of ASD, where pregnant rats are exposed to the known teratogen, valproic acid (VPA), on day 12.5 of gestation and the subsequent progeny exhibit ASD-like symptoms. We focused our analysis on the basal and lateral nucleus of the amygdala (BLA), a region of the brain found to be associated with ASD pathology. Methods We performed whole genome gene expression analysis on the BLA using DNA microarrays to examine differences in gene expression within the amygdala of VPA-exposed animals. We validated one VPA-dysregulated candidate gene (Homer1a) using both quantitative PCR (qRT-PCR) and western blot. Finally, we overexpressed Homer1a within the basal and lateral amygdala of naïve animals utilizing adeno-associated viruses (AAV) and subsequently examined these animals in a battery of behavioral tests associated with ASD, including auditory fear conditioning, social interaction and open field. Results Our microarray data indicated that Homer1a was one of the genes which exhibited a significant upregulation within the amygdala. We observed an increase in Homer1a messenger RNA (mRNA) and protein in multiple cohorts of VPA-exposed animals indicating that dysregulation of Homer1a levels might underlie some of the symptoms exhibited by VPA-exposed animals. To test this hypothesis, we overexpressed Homer1a within BLA neurons utilizing a viral-mediated approach and found that overexpression of Homer1a impaired auditory fear conditioning and reduced social interaction, while having no influence on open-field behavior. Conclusions This study indicates that dysregulation of amygdala Homer1a might contribute to some autism-like symptoms induced by VPA exposure. These findings are interesting in part because Homer1a influences the functioning of Shank3, metabotropic glutamate receptors (mGluR5), and Homer1, and these proteins have previously been associated with ASD, indicating that these differing models of ASD may have a similar molecular basis. Electronic supplementary material The online version of this article (doi:10.1186/s13229-016-0077-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anwesha Banerjee
- Department of Cell Biology, Emory University, 615 Michael St. WBRB #415, Atlanta, GA 30322 USA
| | - Jonathan A Luong
- School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 West Campbell road, Richardson, TX 75080 USA
| | - Anthony Ho
- School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 West Campbell road, Richardson, TX 75080 USA
| | - Aeshah O Saib
- School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 West Campbell road, Richardson, TX 75080 USA
| | - Jonathan E Ploski
- School of Behavioral and Brain Sciences, University of Texas at Dallas, 800 West Campbell road, Richardson, TX 75080 USA
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