A preliminary observation of the adverse effects of phenobarbital among patients with convulsive epilepsy in rural West China

Polysaccharide-rich extract of Genipa americana leaves protects seizures and oxidative stress in the mice model of pentylenetetrazole-induced epilepsy

Plant polysaccharides have biological activities in the brain and those obtained from Genipa americana leaves present antioxidant and anticonvulsant effects in the mice model of pentylenetetrazole (PTZ)-induced acute seizures. This study aimed to evaluate the polysaccharide-rich extract of Genipa americana leaves (PRE-Ga) in the models of acute seizures and chronic epilepsy (kindling) induced by PTZ. In the acute seizure model, male Swiss mice (25-35 g) received PRE-Ga (1 or 9 mg/kg; intraperitoneal- IP), alone or associated with diazepam (0.01 mg/kg), 30 min before induction of seizures with PTZ (70 mg/kg; IP). In the chronic epilepsy model, seizures were induced by PTZ (40 mg/kg) 30 min after treatment and in alternated days up to 30 days and evaluated by video. Brain areas (prefrontal cortex, hippocampus, striatum) were assessed for inflammatory and oxidative stress markers. Diazepam associated to PRE-Ga (9 mg/kg; i.p.) increased the latency of seizures in acute (222.4 ± 47.57 vs. saline: 62.00 ± 4.709 s) and chronic models (6.267 ± 0.502 vs. saline: 4.067 ± 0.407 s). In hippocampus, PRE-Ga (9 mg/kg) inhibited TNF-α (105.9 ± 5.38 vs. PTZ: 133.5 ± 7.62 pmol/g) and malondialdehyde (MDA) (473.6 ± 60.51) in the chronic model. PTZ increased glial fibrillar acid proteins (GFAP) and Iba-1 in hippocampus, which was reversed by PRE-Ga (GFAP: 1.9 ± 0.23 vs PTZ: 3.1 ± 1.3 and Iba-1: 2.2 ± 0.8 vs PTZ: 3.2 ± 1.4). PRE-Ga presents neuroprotector effect in the mice model of epilepsy induced by pentylenetetrazole reducing seizures, gliosis, inflammatory cytokines and oxidative stress.

An information-motivation-behavioral skills model-based intervention for patients with epilepsy

PURPOSE

Self-management is crucial for patients with epilepsy (PWE) as it can effectively control the condition, improve treatment outcomes, and reduce the risk of seizures. The objective of this study was to evaluate the effectiveness of health education based on the Information-Motivation-Behavioral Skills (IMB) model in improving self-management, quality of life, and medication adherence among PWE.

METHOD

This study was conducted in a district in Shanghai, China, from September 2022 to March 2023. A total of 90 PWE were randomly assigned to an intervention group or a control group. Patients in the intervention group received health education based on the IMB model, whereas those in the control group received routine medical treatment only. The effectiveness of the intervention was evaluated by measuring self-management ability, quality of life, and medication adherence at three months and six months after the intervention.

RESULTS

The study included a total of 90 PWE; among them, 55 patients (61.11%) were male, divided into two groups: 45 participants in the control group and 45 participants in the intervention group. After 3 and 6 months of intervention, the self-management scores of the intervention group were significantly higher than those of the control group (t = 14.274, 12.448; P < 0.05). After 6 months of the intervention, the quality-of-life scores of the intervention group were significantly higher than those of the control group (t = 2.025, P < 0.05), and the medication adherence in the intervention group was significantly higher than that in the control group (X2 = 9.003, P < 0.05).

CONCLUSION

Health education based on the IMB model is a promising approach to improving self-management, quality of life, and medication adherence among PWE. It provides personalized, patient-centered interventions that consider patients' knowledge, motivation, and behavior skills, and could be a useful tool for healthcare providers in developing comprehensive care plans for individuals with epilepsy.

Movement disorders associated with antiseizure medications: A systematic review

New-onset movement disorders have been frequently reported in association with the use of antiseizure medications (ASMs). The frequency of specific motor manifestations and the spectrum of their semiology for various ASMs have not been well characterized. We carried out a systematic review of literature and conducted a search on CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Scopus from inception to April 2021. We compiled the data for all currently available ASMs using the conventional terminology of movement disorders. Among 5123 manuscripts identified by the search, 437 met the inclusion criteria. The largest number of reports of abnormal movements were in association with phenobarbital, valproic acid, lacosamide, and perampanel, and predominantly included tremor and ataxia. The majority of attempted interventions for all agents were discontinuation of the offending drug or dose reduction which led to the resolution of symptoms in most patients. Familiarity with the movement disorder phenomenology previously encountered in relation with specific ASMs facilitates early recognition of adverse effects and timely institution of targeted interventions.

Efficacy of Phenobarbital and Prognosis Predictors in Women With Epilepsy From Rural Northeast China: A 10-Year Follow-Up Study

Objective

To investigate the efficacy of phenobarbital (PB), factors associated with it, reasons for early treatment termination, and mortality rates in adult women living in rural Northeast China.

Methods

A prospective study was conducted in seven counties of Jilin Province from 2010 to 2020. Adult women diagnosed with convulsive epilepsy were recruited into the study and baseline demographics recorded upon enrollment. Seizure frequency, prescribed drug dose, and adverse reactions were monitored monthly by door-to-door survey or telephone interview.

Results

A total of 1,333 women were included in the study. During the follow-up period, 169 participants (12.7%) were lost to follow-up, and 100 of them (7.5%) died. The percentage of seizure-free participants was 45.3% in the first year, 74.6% in the third year, and 96.6% in the 10th year. A higher baseline seizure frequency (OR = 1.005, 95% CI: 1.002–1.009), more frequent loss-of-consciousness seizures (OR = 1.620, 95% CI: 1.318–1.990), a higher daily dose of PB in the first year (OR = 1.018, 95% CI: 1.014–1.022), a younger age at onset (OR = 0.990, 95% CI: 0.982–0.998), and more severe drowsiness (OR = 1.727, 95% CI: 1.374–2.173) were associated with an increased risk of seizures in the first year, and the higher baseline seizure frequency was still associated with the occurrence of seizures in the third (OR = 1.007, 95% CI: 1.004–1.010) and fifth year (OR = 1.005, 95% CI: 1.002–1.008). Age at enrollment (HR = 0.983, 95% CI: 0.971–0.994) was the only factor that correlated with withdrawal from the study and with the death of the participant during the follow up period, but the correlation in each case was in opposite directions.

Significance

PB has high effectiveness, retention rate, mild side effects, and tolerability when used as a treatment for epilepsy in women from rural areas. Baseline seizure frequency is an important predictor of prognosis regardless of treatment duration. PB is still a valuable tool for the management of epilepsy in adult women from poverty-stricken areas.

Efficacy of phenobarbital in treating elderly epilepsy patients in rural northeast China: A community-based intervention trial

OBJECT

To provide information on the characteristics of elderly epilepsy patients in rural Northeast China.

METHOD

Consecutive patients (aged >60) who were diagnosed with convulsive epilepsy in seven counties in Jilin Province, Northeast China, between January 2010 and December 2019 were included in the program and were divided into the EOE (early-onset epilepsy) group and the LOE (late-onset epilepsy) group. The patients were followed up once a month, and demographics and clinical data were recorded.

RESULT

There were 471 patients enrolled in this study, with 329 patients classified into the EOE group and 142 patients recruited into the LOE group. At baseline, the EOE group was younger than the LOE group (t=-9.007, p < 0.001). The most common etiologies for the EOE and LOE groups were post-trauma (4.0%, n=13) and stroke (9.2%, n=13). Elderly epilepsy patients had a good response to PB monotherapy, and no significant difference was found between the two groups (p > 0.05). EOE patients complained of more serious adverse events (p < 0.05), and drowsiness (52%) and ataxia (28%) were the most common adverse events reported by the EOE and LOE groups, respectively; however, more LOE patients were prone to withdrawal due to side effects (p = 0.036). A total of 63 patients withdrew from the study, and nonadherence was the commonest cause for withdrawal (56% in EOE and 50% in LOE). In the entire follow-up period, 112 patients (63 in the EOE group and 49 in the LOE group) died; the most common causes of death were stroke (n=44, 39%) and heart disease (n=36, 32%). The LOE group had a shorter survival time than the EOE group (χ²=42.216, p < 0.001). The LOE group (HR=3.47, 95% CI: 2.36-5.09) and higher seizure frequency (HR=1.72, 95% CI: 1.17-2.52) were the risk factors for death.

CONCLUSION

Elderly epilepsy patients had a good response to PB monotherapy. EOE patients complained of more serious adverse events, but more LOE patients were prone to withdrawal due to side effects. Nonadherence was the commonest cause of drug withdrawal, and it reflects the limited education regarding the impact of seizures and the differences in priorities of rural communities. EOE patients survive longer than LOE patients.

Epilepsy in China: major progress in the past two decades

China has approximately 10 million people with epilepsy. There is a vast epilepsy treatment gap in China, mainly driven by deficiencies in health-care delivery and social discrimination resulting from cultural beliefs about epilepsy. WHO's Global Campaign Against Epilepsy project in China showed that it was possible to treat epilepsy in primary care settings, which was a notable milestone. The China Association Against Epilepsy has been a necessary force to stimulate interest in epilepsy care and research by the medical and scientific community. Nearly 20 different anti-seizure medications are now available in China. Non-pharmacological options are also available, but there are still unmet needs for epilepsy management. The Chinese epilepsy research portfolio is varied, but the areas in which there are the most concentrated focus and expertise are epidemiology and clinical research. The challenges for further improvement in delivering care for people with epilepsy in China are primarily related to public health and reducing inequalities within this vast country.

Antiepileptic Drug Prices, Availability and Affordability in a Resource-Limited Setting

Background:

The availability and affordability of antiepileptic drugs (AEDs) are critical to the success of public health initiatives enabling care for people with epilepsy in the community.

Objective:

To pilot survey the availability and affordability of AEDs in the community.

Methods:

Field workers used standard WHO–Health Action International approaches and collected data on the availability of, and maximum retail prices of originator brands and least price generics of AEDs in 46 randomly selected public (n = 29), private (n = 8), and charitable (n = 9) pharmacy outlets. Median price ratios were computed apropos international reference prices of corresponding medications and affordability gauged with reference to daily wage of lowest paid worker.

Results:

Only 10 outlets (7 – private, 3 – public, and none – charitable) stocked at least one essential AED. Median price ratios varied between 1.1 and 1.5 essentially reflecting the difference between the least price generics and originator brands. Of note, carbamazepine-retard, 200 mg put up the slightest difference in prices of originator and least price generic brands and also was the most affordable AED.

Conclusions:

The availability and affordability of most AEDs were poor and hence, this needs to be studied on a wider scale and thereafter efforts to improve both the availability and affordability are desirable in order to address the huge treatment gap for epilepsy in India.

Prevalence and risk factors of depression and anxiety among patients with convulsive epilepsy in rural West China

OBJECTIVES

To explore the prevalence and risk factors of depression and anxiety in patients with convulsive epilepsy (PWE) in rural West China.

METHODS

PWE from rural West China were evaluated for depression and anxiety with the Neurological Disorders Depression Inventory for Epilepsy (C-NDDI-E; Chinese version) and the Generalized Anxiety Disorder-7 (GAD-7; Chinese version). We also assessed their quality of life using the Quality of Life in Epilepsy Inventory (QOLIE-31) and their level of social support using the Social Support Rating Scale (SSRS). We used logistic regression analysis to identify independent risk factors of depression and anxiety and analysis of variance (ANOVA) to investigate the association between quality of life and depression and anxiety.

RESULTS

Of the 458 PWE in our study, 33.4% have anxiety and 52.6% have depression. SSRS (P = 0.03) and seizure frequency (P = 0.007) are independent risk factors of anxiety, and annual income of the patients (P < 0.001) is an independent risk factor of depression. PWE with both depression and anxiety have significantly lower QOLIE-31 total and subtotal scores.

CONCLUSIONS

PWE have a high prevalence of depression and anxiety in rural West China, which may be impacting their quality of life. PWE with depression and anxiety got a worse quality of life, and depression had a greater impact on quality of life for PWE than anxiety. The risk factors of depression and anxiety include seizure frequency and social support, while annual income is an additional risk factor of depression. Identifying risk factors early may be helpful in the timely management of these symptoms.

Tolerability and Safety of Commonly Used Antiepileptic Drugs in Adolescents and Adults: A Clinician's Overview

This paper discusses the issues surrounding the tolerability and safety of the commonly used antiepileptic drugs (AEDs) in adolescents and adults. The content includes dose-related adverse effects, idiosyncratic reactions, behavioural and psychiatric comorbidities, chronic problems, enzyme induction and teratogenesis. Twenty-one AEDs are discussed in chronological order of their introduction into the UK, starting with phenobarbital and ending with brivaracetam. Wherever possible, advice is given on anticipating, recognising and managing these issues and thereby improving the lives of people with epilepsy, most of whom will need to take one or more of these agents for life. Avoidance of side effects will increase the possibility of achieving and maintaining long-term seizure freedom. Alternatively, adverse events from AEDs will substantially reduce quality of life and often result in higher healthcare costs.