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Vatansever Pınar Z, Sağer SG, Çimen İD, Çağ Y. The Effect of Levetiracetam and Valproic Acid Treatment on Anger and Attention Deficit Hyperactivity Disorder Clinical Features in Children and Adolescents with Epilepsy: A Prospective Study. Paediatr Drugs 2024:10.1007/s40272-024-00652-8. [PMID: 39331340 DOI: 10.1007/s40272-024-00652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Antiseizure medications (ASMs) can potentially trigger psychobehavioral adverse events associated with the onset or exacerbation of psychiatric symptoms such as irritability, aggression, and hyperactivity. The objective of this study was to evaluate the effects of levetiracetam and valproic acid on changes in clinical features of anger, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). The purpose was to furnish guidance on rational drug selection in children and adolescents with epilepsy to minimize psychiatric comorbidity in the treatment of epilepsy. METHOD This was a prospective, observational, cohort study involving treatment-naïve children aged 7-18 years with newly diagnosed generalized or focal epilepsy who were prescribed levetiracetam or valproic acid as monotherapy for a 6-month period and regularly followed up. Psychiatric assessment was conducted at the time of the new epilepsy diagnosis and at the six-month follow-up. These assessments were performed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Current and Lifetime Version (DSM-5), a structured psychiatric interview, as well as the State-Trait Anger Expression Style Inventory and Turgay DSM-IV Based Disruptive Behaviour Disorders Screening and Rating Scale. Anger subscores, ADHD symptoms, change in diagnosis, focal and generalized epilepsy groups, continuous seizures and seizure-free periods before and 6 months after treatment with valproic acid and levetiracetam were compared. RESULTS A total of 50 children, 25 in the valproic acid group and 25 in the levetiracetam group, with a mean age of 11.92 ± 3.08 years, were included in the study. There was a statistically significant increase in the ADHD subscale score post-treatment among patients receiving levetiracetam (p = 0.045) and valproic acid (p = 0.034) compared with pre-treatment. The change in both anger-in and anger-out expression scores with treatment was significantly higher in patients receiving levetiracetam (p = 0.035) compared with those receiving valproic acid (p = 0.026). Statistically, there was a significant difference in the diagnostic criteria of the levetiracetam group pre- and post-treatment (p = 0.026). The proportion of patients in whom the diagnostic criteria for ADHD+ODD were fulfilled increased from 16% before treatment to 48% after treatment, a statistically significant increase (p = 0.026). CONCLUSION This study found an increase in internalized anger features and ADHD symptom severity in children with epilepsy treated with valproic acid and levetiracetam. In those prescribed levetiracetam, there was a statistically significant rise in the proportion meeting the diagnostic criteria for ADHD + ODD. Our research is one of the first to prospectively examine the psychiatric assessment of children diagnosed with epilepsy. The remarkable results demonstrate changes in psychiatric diagnoses associated with the treatment of levetiracetam and valproic acid. Furthermore, a considerable rise in ADHD symptoms was observed in those treated with valproic acid.
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Affiliation(s)
- Zeynep Vatansever Pınar
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, İstanbul, Turkey.
| | - Safiye Güneş Sağer
- Department of Pediatric Neurology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - İrem Damla Çimen
- Department of Child and Adolescent Psychiatry, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Yakup Çağ
- Department of Pediatrics, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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Hajder D, Sekulić S, Ignjatović VB, Popović S, Popović N, Nikolašević Ž, Bukurov KG. Clinical and sociodemographic predictors of depressive symptoms in epilepsy patients in a single tertiary epilepsy center. Acta Neurol Belg 2024:10.1007/s13760-024-02632-8. [PMID: 39231908 DOI: 10.1007/s13760-024-02632-8] [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: 02/07/2024] [Accepted: 08/28/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE The purpose of this cross-sectional study was to determine the frequency of depressive symptoms in patients with epilepsy (PWE) in a tertiary epilepsy center and to analyse possible predictors of depression in several domains, including clinical characteristics of epilepsy and sociodemographic factors. METHODS PWE patients who visited our epilepsy clinic during the 6th month in 2020 and 2021 were enrolled in our study. To collect the data, structured scales were created for the clinical characteristics of the disease and for the sociodemographic data. All participants completed the Back Depression Inventory II (BDI-II). Univariate analysis and binary logistic regression were also conducted to identify the factors associated with depressive symptoms in PWE. RESULTS A total of 131 PWE were recruited for this study. It was determined that depressive symptoms were present in 51.1% of PWE. Of these, 49.25% manifested severe depressive symptoms. Approximately 18% of PWE use antidepressant medications, which is significantly less than that of PWE who are currently depressed. Univariate regression analysis revealed that female sex (p = 0.013), severe seizure frequency in the past year (p = 0.001), the use of the antiseizure medication polytherapy (p = 0.018), the presence of side effects of antiseizure medications (p = 0.001), a history of febrile seizures (p = 0.015), focal impaired awareness seizures (p = 0,051), and a combination of focal aware seizures with focal impaired awareness seizures combined with bilateral tonic‒clonic seizures (p = 0,006) may be associated with depressive symptoms in PWE patients. Binary logistic regression analysis demonstrated that side effects of antiseizure medications (OR = 3.01; 95% CI = 1.09-8.32), history of febrile seizures (OR = 3.75; 95% CI = 1.07-13.11), female sex (OR = 2.16; 95% CI = 0.984-4.73), and combination of focal aware seizures to focal impaired awareness seizures to bilateral tonic‒clonic seizures (OR = 7.32; 95% CI = 0.830-64.59) were unique, independent predictors of depressive symptoms in patients with epilepsy. CONCLUSION Depressive symptoms in PWE are frequent, severe, undiagnosed, and mostly untreated. The side effects of antiseizure medications, history of febrile seizures, female sex, and combination of focal awareness seizures and focal impaired awareness seizures combined with bilateral tonic‒clonic seizures are unique, independent predictors of depressive symptoms in PWE.
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Affiliation(s)
- Dragica Hajder
- Clinic of Neurology, University Clinical Center Vojvodina, 1 Hajduk Veljkova St, Novi Sad, 21 000, Serbia.
| | - Slobodan Sekulić
- Clinic of Neurology, University Clinical Center Vojvodina, 1 Hajduk Veljkova St, Novi Sad, 21 000, Serbia
- Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova St, Novi Sad, 21 000, Serbia
| | - Vojislava Bugarski Ignjatović
- Clinic of Neurology, University Clinical Center Vojvodina, 1 Hajduk Veljkova St, Novi Sad, 21 000, Serbia
- Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova St, Novi Sad, 21 000, Serbia
| | - Sanela Popović
- Clinic of Neurology, University Clinical Center Vojvodina, 1 Hajduk Veljkova St, Novi Sad, 21 000, Serbia
- Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova St, Novi Sad, 21 000, Serbia
| | - Nemanja Popović
- Clinic of Neurology, University Clinical Center Vojvodina, 1 Hajduk Veljkova St, Novi Sad, 21 000, Serbia
| | - Željka Nikolašević
- Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova St, Novi Sad, 21 000, Serbia
| | - Ksenija Gebauer Bukurov
- Clinic of Neurology, University Clinical Center Vojvodina, 1 Hajduk Veljkova St, Novi Sad, 21 000, Serbia
- Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova St, Novi Sad, 21 000, Serbia
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Mesraoua B, Brigo F, Abou-Khalil B, Ali M, Lattanzi S. Risk of suicide and suicide-related events in subjects treated with antiseizure medications. Expert Rev Neurother 2024; 24:865-878. [PMID: 38978408 DOI: 10.1080/14737175.2024.2376110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION In the United States, it is reported that 1.4% of the general population commits suicide. It has been postulated that antiseizure medications (ASMs) can lead to the development of suicidal ideation and suicidal behavior; however, this risk is still very low and has yet to be precisely established. AREAS COVERED This narrative review evaluates the risk of suicide-related events (SREs) in subjects taking ASMs for various neurological disorders. Screening tools for suicidal ideation and suicidal behavior are also discussed. References for this article were found using PubMed/MEDLINE. EXPERT OPINION Although some ASMs can be associated with SREs, this is not yet clearly established. The mechanisms involved in suicide risk in subjects taking ASMs are multifactorial. The bidirectional relationship between depression and epilepsy, as well as other associations, should be kept in mind when interpreting any impact of ASMs in PWE. Screening for SREs, close monitoring of subjects taking ASMs are the most appropriate strategies to minimize suicide risk. More efforts should be made to achieve accurate risk stratification through prognostic models that could be applied to subjects taking ASMs. Studies exploring the association between ASMs and suicide should consider ASMs individually and control for prior SREs.
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Affiliation(s)
- Boulenouar Mesraoua
- Neurosciences Department, Hamad Medical Corporation and Weill Cornell Medical College, Doha, Qatar
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | | | - Musab Ali
- Neurosciences Department, Hamad Medical Corporation, Doha, Qatar
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
- Neurological Clinic, AOU of Marche, Ancona, Italy
- Neurology Department, IRCCS INRCA, Ancona, Italy
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Lorkiewicz SA, Modiano YA, Miller BI, Van Cott AC, Haneef Z, Sullivan-Baca E. The neuropsychological presentation of women with epilepsy: Clinical considerations and future directions. Clin Neuropsychol 2024; 38:1382-1408. [PMID: 37993977 DOI: 10.1080/13854046.2023.2283937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Objective: Cognitive, mood, and behavioral changes are common among persons with epilepsy (PWE), resulting in a complex neuropsychological presentation. Women with epilepsy (WWE) represent a distinct cohort within the broader epilepsy population due to sex and gender-specific factors impacting epilepsy semiology and treatment. However, unique neuropsychological profiles among WWE have not been established. This narrative review aims to further define neuropsychological correlates in WWE and promote meaningful discussion related to enhancing the provision of neuropsychological care within this clinical population. Method: Current literature in PWE examining differences in cognitive function, mental health, and quality of life (QoL) between women and men was critically reviewed, emphasizing considerations for neuropsychological practice. Results: WWE demonstrate a preservation of verbal learning and memory compared to men both pre- and post-surgically, with sex-based, neurobiological mechanisms likely contributing to this association. WWE also have elevated risk for affective disorder psychopathology, suicidality, and traumatic experiences. Epidemiology related to psychotic and bipolar spectrum disorders is less clear, and findings are mixed regarding sex-specific behavioral side effects of antiseizure and psychotropic medication. Finally, hormonal and obstetric factors are highlighted as important contributors to neuropsychological symptoms in WWE, with elevated risk for low QoL and increased stigma associated with greater medical and psychiatric comorbidities compared to men. Conclusions: While emerging literature has begun to characterize the neuropsychological presentation of WWE, future research is needed to define sex and gender differences in neuropsychological sequalae among PWE to ensure consistency and quality of care for WWE.
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Affiliation(s)
| | - Yosefa A Modiano
- Neurosciences, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - Brian I Miller
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Anne C Van Cott
- Neurology Division, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zulfi Haneef
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
- Epilepsy Centers of Excellence, Veteran's Health Administration, USA
| | - Erin Sullivan-Baca
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Vaneva I, Kuzmanova R, Stambolieva K. The Most Frequent Psychiatric Comorbidities in Bulgarian Patients With Epilepsy: Their Connection With the Main Clinical Characteristics and Quality of Life. Cureus 2024; 16:e66149. [PMID: 39233990 PMCID: PMC11372338 DOI: 10.7759/cureus.66149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2024] [Indexed: 09/06/2024] Open
Abstract
AIM The objective of this study is to determine and compare the relationship of the most common psychiatric comorbidities in Bulgarian patients with epilepsy with the main clinical characteristics, as well as to evaluate their impact on certain aspects of the quality of life. CLINICAL RATIONALE Psychiatric comorbidities occur in about one-third of people with epilepsy throughout their lifetime, and their incidence is much greater in high-risk groups such as patients with treatment-resistant epilepsy. MATERIAL AND METHODS The study group consisted of 129 participants, of whom 104 were divided into four groups according to the presence of one of the most frequently diagnosed psychiatric comorbidities in our patients with epilepsy: personality and behavioral disorder (PBD) (n=25), mild to moderate depressive disorder (n=26), anxiety disorder (n=32), and dissociative and conversion disorders (n=21). A control group was also formed with a similar number of participants with epilepsy (n=25) without psychiatric comorbidity. Some sociodemographic and clinical characteristics of epilepsy were analyzed in all patients. All patients filled out two questionnaires: the Bulgarian version of quality of life in epilepsy - 89 (QOLIE-89) and the Bulgarian version of SIDAED (assessing SIDe effects in antiepileptic drugs (AED) treatment). RESULTS The analysis revealed a negative influence of psychiatric comorbidity on the presence of epileptic seizures, unwanted drug effects, and lower scores for all aspects of the quality of life of patients with epilepsy. CONCLUSION AND CLINICAL IMPLICATIONS The main conclusion of our study is the presence of an interaction between psychiatric comorbidity, the clinical course of the disease, and the deteriorated quality of life (QOL) in patients with epilepsy. Further attention, comprehensive care, and targeted research are needed to analyze individual psychiatric comorbidities in patients with epilepsy for early detection and treatment.
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Affiliation(s)
- Irina Vaneva
- Department of Epilepsy, Multiprofile Hospital for Active Treatment in Neurology and Psychiatry "St. Naum", Sofia, BGR
- Department of Neurology, Medical University, Akad, Sofia, BGR
| | - Rumyana Kuzmanova
- Department of Epilepsy, Multiprofile Hospital for Active Treatment in Neurology and Psychiatry "St. Naum", Sofia, BGR
- Department of Neurology, Medical University, Akad, Sofia, BGR
| | - Katerina Stambolieva
- Department of Cognitive Psychophysiology, Bulgarian Academy of Science, Institute of Neurobiology, Sofia, BGR
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Punia V, Klein P, Mihaylova T, Biton V, Samad O, Ngo LY, Kumar D, Malhotra M. Perampanel as monotherapy or first adjunctive therapy in pediatric and adult patients with epilepsy: the first United States-based phase IV open-label ELEVATE study. J Neurol 2024; 271:4587-4598. [PMID: 38730096 PMCID: PMC11233369 DOI: 10.1007/s00415-024-12399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024]
Abstract
ELEVATE (Study 410; NCT03288129) is the first prospective, multicenter, open-label, Phase IV study of perampanel as monotherapy or first adjunctive therapy in patients aged ≥ 4 years with focal-onset seizures or generalized tonic-clonic seizures in the United States. The study included Screening, Titration (≤ 13 weeks), Maintenance (39 weeks), and Follow-up (4 weeks) Periods. During Titration, perampanel was initiated at 2 mg/day and up-titrated to 4 mg/day at Week 3. Depending on response and tolerability, optional up-titrations to a maximum of 12 mg/day occurred. The primary endpoint was retention rate; additional endpoints included seizure-freedom rate, 50% responder rate, and incidence of treatment-emergent adverse events (TEAEs). At baseline, 10 (18.5%) patients were assigned to the monotherapy group and 44 (81.5%) patients to the first adjunctive therapy group. However, due to the addition of an anti-seizure medication along with perampanel on the first day of treatment, one patient was excluded from the monotherapy subgroup analyses. The mean perampanel exposure duration was 39.8 weeks and 32 (59.3%) patients completed the study. Retention rate at 12 months (or study completion) was 63.0% (monotherapy, 77.8%; first adjunctive therapy, 59.1%). Seizure-freedom rate during the Maintenance Period was 32.7% (monotherapy, 44.4%; first adjunctive therapy, 29.5%) and the 50% responder rate was 78.7% (monotherapy, 85.7%; first adjunctive therapy, 76.9%). TEAEs and serious TEAEs were reported by 88.9% (n = 48/54) and 7.4% (n = 4/54) of patients, respectively. Overall, the efficacy and safety of perampanel as monotherapy or first adjunctive therapy support the use of perampanel as early-line treatment for epilepsy.
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Affiliation(s)
- Vineet Punia
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
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Meador KJ, Dimova S, Bourikas D, Elmoufti S, Floricel F, Laloyaux C, Moseley B, Nondonfaz X, Klein P. Time-course of drug-related psychiatric and behavioral treatment-emergent adverse events during brivaracetam treatment in adults with focal-onset seizures. Epilepsy Behav 2024; 156:109844. [PMID: 38788664 DOI: 10.1016/j.yebeh.2024.109844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE We previously analyzed data from three phase lll trials of adjunctive brivaracetam (BRV) in adults showing that the incidence and prevalence of drug-related central nervous system treatment-emergent adverse events (TEAEs) quickly peaked and decreased over several weeks following BRV treatment initiation. However, that analysis did not assess psychiatric and behavioral side effects which can occur with antiseizure medication (ASM) treatment. Here, we investigate the time-course of psychiatric and behavioral TEAEs by week of BRV treatment and how these TEAEs were managed. METHODS Data were pooled from three trials (N01252 [NCT00490035]; N01253 [NCT00464269]; N01358 [NCT01261325]) in adult patients (≥16 years of age) with focal-onset seizures receiving BRV adjunctive therapy. This post hoc analysis reports data on the incidence and prevalence of drug-related psychiatric or behavioral TEAEs over time in patients who received BRV doses of 50-200 mg/day (without titration) or placebo (PBO) during the 12-week treatment period. A logistic regression model was used to determine if psychiatric or behavioral comorbid conditions were predictors for drug-related psychiatric or behavioral TEAEs, or BRV discontinuation due to psychiatric or behavioral TEAEs. RESULTS A total of 803 patients received BRV 50-200 mg/day, and 459 patients received PBO. Drug-related psychiatric or behavioral TEAEs were reported by 11.0 % of patients during adjunctive BRV treatment (PBO: 4.8 %) with onset early after BRV initiation (median time to onset of first drug-related psychiatric or behavioral TEAE: 15 days). Incidence peaked at week 1 and decreased over the first 4 weeks following BRV initiation. Prevalence peaked at week 4 and then remained stable between weeks 5-12. In an analysis excluding patients on concomitant levetiracetam (BRV: n = 744; PBO: n = 422), the incidence of drug-related psychiatric or behavioral TEAEs was similar to the incidence in the overall population. The most common drug-related psychiatric or behavioral TEAEs were irritability, insomnia, depression, and anxiety. Only 2 % of patients discontinued BRV due to psychiatric or behavioral TEAEs (PBO: 1.3 %), while most patients on BRV who reported drug-related psychiatric or behavioral TEAEs did not require a change in dose (84.1 %; PBO: 63.6 %). A history of psychiatric or behavioral comorbid conditions (not ongoing at BRV initiation) was not associated with an increased likelihood of drug-related psychiatric or behavioral TEAEs, or BRV discontinuation due to psychiatric or behavioral TEAEs. Ongoing psychiatric or behavioral comorbid conditions at BRV initiation increased the likelihood of drug-related psychiatric or behavioral TEAEs, but not the likelihood of BRV discontinuation due to psychiatric or behavioral TEAEs. CONCLUSIONS Drug-related psychiatric and behavioral TEAEs occurred early during BRV treatment, and most patients did not require a change in BRV dose. These data can help guide clinician monitoring and patient expectations after starting BRV.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA.
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Szaflarski JP, Besson H, D'Souza W, Faught E, Klein P, Reuber M, Rosenow F, Salas-Puig J, Soto Insuga V, Steinhoff BJ, Strzelczyk A, Bourikas D, Daniels T, Floricel F, Friesen D, Laloyaux C, Villanueva V. Effectiveness and tolerability of brivaracetam in patients with epilepsy stratified by comorbidities and etiology in the real world: 12-month subgroup data from the international EXPERIENCE pooled analysis. J Neurol 2024; 271:3169-3185. [PMID: 38436680 PMCID: PMC11136785 DOI: 10.1007/s00415-024-12253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To assess the effectiveness and tolerability of brivaracetam (BRV) in adults with epilepsy by specific comorbidities and epilepsy etiologies. METHODS EXPERIENCE/EPD332 was a pooled analysis of individual patient records from several non-interventional studies of patients with epilepsy initiating BRV in clinical practice. Outcomes included ≥ 50% reduction from baseline in seizure frequency, seizure freedom (no seizures within prior 3 months), continuous seizure freedom (no seizures since baseline), BRV discontinuation, and treatment-emergent adverse events (TEAEs) at 3, 6, and 12 months. Analyses were performed for all adult patients (≥ 16 years of age) and stratified by comorbidity and by etiology at baseline (patients with cognitive/learning disability [CLD], psychiatric comorbidity, post-stroke epilepsy, brain tumor-related epilepsy [BTRE], and traumatic brain injury-related epilepsy [TBIE]). RESULTS At 12 months, ≥ 50% seizure reduction was achieved in 35.6% (n = 264), 38.7% (n = 310), 41.7% (n = 24), 34.1% (n = 41), and 50.0% (n = 28) of patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE, respectively; and continuous seizure freedom was achieved in 5.7% (n = 318), 13.7% (n = 424), 29.4% (n = 34), 11.4% (n = 44), and 13.8% (n = 29), respectively. During the study follow-up, in patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE, 37.1% (n = 403), 30.7% (n = 605), 33.3% (n = 51), 39.7% (n = 68), and 27.1% (n = 49) of patients discontinued BRV, respectively; and TEAEs since prior visit at 12 months were reported in 11.3% (n = 283), 10.0% (n = 410), 16.7% (n = 36), 12.5% (n = 48), and 3.0% (n = 33), respectively. CONCLUSIONS BRV as prescribed in the real world is effective and well tolerated among patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE.
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Affiliation(s)
- Jerzy P Szaflarski
- University of Alabama at Birmingham (UAB) Heersink School of Medicine Department of Neurology and UAB Epilepsy Center, Birmingham, AL, USA.
| | | | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | | | - Victor Soto Insuga
- Pediatric Neurology, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | - Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, EpiCARE member, Valencia, Spain
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Kim JS, Kim WS, Sung WY, Woo H. Psychiatric and behavioral concerns of perampanel with concomitant levetiracetam in children with epilepsy. Epilepsy Behav 2024; 154:109740. [PMID: 38547767 DOI: 10.1016/j.yebeh.2024.109740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/21/2024] [Accepted: 03/10/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Perampanel (PER) is expanding the therapeutic scope for pediatric epilepsy owing to its efficacy and favorable safety profile. However, concerns about psychiatric and behavioral adverse events (PBAEs) in combination therapy with levetiracetam (LEV) continue to contribute to hesitation in its prescription. We investigated the risk profiles for PBAEs when adding PER to pediatric epilepsy treatment and analyzed the differences according to the presence of concomitant LEV. METHODS We retrospectively reviewed the medical records of children aged 4-18 years with epilepsy who were prescribed PER as adjunctive therapy from March 2016 to February 2023. We compared the occurrence and management of PBAEs between the PER without LEV and PER with LEV groups. The risk factors for PBAEs were also analyzed. RESULTS Ninety-four patients (53 boys and 41 girls) were included in this study. The median age of total patients at the time of adding PER was 14.9 years (12.3-16.4 years), and 53 patients (56.4 %) had concomitant LEV. Forty-seven PBAEs occurred in 34 patients (36.2 %), with no significant differences depending on whether concomitant LEV is present or not. The most common PBAEs were aggression (14.9 %), irritability (9.6 %), affect lability (7.4 %), and acute psychosis (6.4 %). PBAEs occurred at a lower dosage (2-6 mg/day) in 70.6 % of the patients. In addition, 73.5 % of patients with PBAEs continued PER treatment by follow-up observation or by reducing the PER dosage. No risk factors, such as the presence of concomitant LEV or lamotrigine, any comorbid conditions, higher PER dosage (8-12 mg/day), two or more concomitant anti-seizure medications, and younger age (<13 years) at PER add-on, showed significant associations. CONCLUSION When expanding the use of anti-seizure medications in pediatric patients, real-world evidence on safety issues is crucial for pediatric epileptologists. We confirmed that combination therapy with PER and LEV did not increase the risk profile of PBAEs.
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Affiliation(s)
- Jon Soo Kim
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Won Seop Kim
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea; Department of Pediatrics, Chungbuk National University, College of Medicine, Cheongju, Republic of Korea
| | - Won Young Sung
- Department of Emergency Medicine, Daejeon Eulji Medical Center, Eulji University, Daejeon, Republic of Korea
| | - Hyewon Woo
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea.
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10
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Miller DJ, Komanapalli H, Dunn DW. Comorbidity of attention deficit hyperactivity disorder in a patient with epilepsy: Staring down the challenge of inattention versus nonconvulsive seizures. Epilepsy Behav Rep 2024; 25:100651. [PMID: 38357032 PMCID: PMC10865219 DOI: 10.1016/j.ebr.2024.100651] [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: 10/23/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
Epilepsy is a heterogeneous disorder of recurrent seizures which often is comorbid with anxiety, depression, attention deficit hyperactivity disorder (ADHD), intellectual disability (ID), and other psychiatric manifestations. Treating both epilepsy and behavioral symptoms from psychiatric disorders can result in polypharmacy with interactions of medications leading to both worsened efficacy of antiseizure medications due to psychotropic effects and worsening of psychiatric symptoms due to antiseizure medication side effects. We aim to suggest pragmatic strategies for the neurologist in the diagnosis and management of comorbid ADHD in patients with epilepsy based on the International League Against Epilepsy (ILAE) Pediatric Commission guidelines and additional literature review. The screening tool of choice for the symptoms of ADHD is validated in the country of practice and written in the language of the family, though various screening tools and advantages and disadvantages of each will be discussed. Once ADHD is diagnosed, recent safety data suggest that Methylphenidate, Amphetamine, and Atomoxetine are generally safe for patients with epilepsy. We present a case of a child with epilepsy and ADHD and discuss the clinical signs, symptoms, and strategies for treatment as well as when to refer to child psychiatry.
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Affiliation(s)
- Derryl J. Miller
- Clinical Neurology, Indiana University School of Medicine and Riley Hospital for Children, 705 Riley Hospital Dr, Indianapolis, IN 46202, USA
| | - Hannah Komanapalli
- Undergraduate Medical Education, Indiana University School of Medicine, 635 Barnhill Dr, Indianapolis, IN 46202, USA
| | - David W. Dunn
- Psychiatry and Neurology, Indiana University School of Medicine and Riley Hospital for Children, 705 Riley Hospital Dr, Indianapolis, IN 46202, USA
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11
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Scorrano G, Lattanzi S, Salpietro V, Giannini C, Chiarelli F, Matricardi S. The Cognitive and Behavioural Effects of Perampanel in Children with Neurodevelopmental Disorders: A Systematic Review. J Clin Med 2024; 13:372. [PMID: 38256507 PMCID: PMC10816822 DOI: 10.3390/jcm13020372] [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: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
In children and adolescents with epilepsy, neurodevelopmental comorbidities can impair the quality of life more than seizures. The aim of this review was to evaluate the cognitive and behavioural effects of perampanel (PER) in the paediatric population. We performed a systematic search of the literature, selecting studies published in English including children and adolescents with epilepsy treated with PER. Cognitive and behavioural outcomes were assessed through validated neuropsychological standardised scales. Eighteen studies involving 3563 paediatric patients were included. Perampanel did not impair general cognitive functions and visuospatial skills, whereas a slight improvement in verbal memory and a decline in attentional power were detected. In adolescents with refractory epilepsies, high doses and/or rapid titration of PER and an underlying psychiatric disorder were risk factors for developing or worsening psychiatric outcomes such as anger, aggressiveness, and irritability. Data on children and adolescents treated with new antiseizure medications are scant, and neuropsychiatric effects are tricky to be detected during developmental age. According to the currently available evidence, PER showed an overall favourable risk-benefit profile. Pharmacodynamics, co-administration of other antiseizure medications, and family and personal history of neuropsychiatric disorders should be considered before PER treatment.
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Affiliation(s)
- Giovanna Scorrano
- Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (G.S.); (C.G.); (F.C.)
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, 60020 Ancona, Italy;
| | - Vincenzo Salpietro
- Department of Neuromuscular Disease, UCL Institute of Neurology, University College London, London WC1N 3BG, UK;
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L’Aquila, 67100 L’Aquila, Italy
| | - Cosimo Giannini
- Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (G.S.); (C.G.); (F.C.)
| | - Francesco Chiarelli
- Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (G.S.); (C.G.); (F.C.)
| | - Sara Matricardi
- Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (G.S.); (C.G.); (F.C.)
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12
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Mula M. Impact of psychiatric comorbidities on the treatment of epilepsies in adults. Expert Rev Neurother 2023; 23:895-904. [PMID: 37671683 DOI: 10.1080/14737175.2023.2250558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Epilepsy is often accompanied by psychiatric comorbidities and the management of epilepsy in these patients presents unique challenges due to the interplay between the underlying neurological condition and the psychiatric symptoms and the combined use of multiple medications. AREAS COVERED This paper aims to explore the complexities associated with managing epilepsy in the presence of psychiatric comorbidities, focusing on the impact of psychiatric disorders on epilepsy treatment strategies and the challenges posed by the simultaneous administration of multiple medications. EXPERT OPINION Patients with epilepsy and psychiatric comorbidities seem to present with a more severe form of epilepsy that is resistant to drug treatments and burdened by an increased morbidity and mortality. Whether prompt treatment of psychiatric disorders can influence the long-term prognosis of the epilepsy is still unclear as well as the role of specific treatment strategies, such as neuromodulation, in this group of patients. Clinical practice recommendations and guidelines will prompt the development of new models of integrated care to be implemented.
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Affiliation(s)
- Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospital, London, UK of Great Britain and Northern Ireland
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
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13
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Li Z, Chen L, Xu C, Chen Z, Wang Y. Non-invasive sensory neuromodulation in epilepsy: Updates and future perspectives. Neurobiol Dis 2023; 179:106049. [PMID: 36813206 DOI: 10.1016/j.nbd.2023.106049] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Epilepsy, one of the most common neurological disorders, often is not well controlled by current pharmacological and surgical treatments. Sensory neuromodulation, including multi-sensory stimulation, auditory stimulation, olfactory stimulation, is a kind of novel noninvasive mind-body intervention and receives continued attention as complementary safe treatment of epilepsy. In this review, we summarize the recent advances of sensory neuromodulation, including enriched environment therapy, music therapy, olfactory therapy, other mind-body interventions, for the treatment of epilepsy based on the evidence from both clinical and preclinical studies. We also discuss their possible anti-epileptic mechanisms on neural circuit level and propose perspectives on possible research directions for future studies.
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Affiliation(s)
- Zhongxia Li
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Zhejiang Rehabilitation Medical Center Department, The Third Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Liying Chen
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhong Chen
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yi Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China; Zhejiang Rehabilitation Medical Center Department, The Third Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China.
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14
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Kanner AM, Saporta AS, Kim DH, Barry JJ, Altalib H, Omotola H, Jette N, O'Brien TJ, Nadkarni S, Winawer MR, Sperling M, French JA, Abou-Khalil B, Alldredge B, Bebin M, Cascino GD, Cole AJ, Cook MJ, Detyniecki K, Devinsky O, Dlugos D, Faught E, Ficker D, Fields M, Gidal B, Gelfand M, Glynn S, Halford JJ, Haut S, Hegde M, Holmes MG, Kalviainen R, Kang J, Klein P, Knowlton RC, Krishnamurthy K, Kuzniecky R, Kwan P, Lowenstein DH, Marcuse L, Meador KJ, Mintzer S, Pardoe HR, Park K, Penovich P, Singh RK, Somerville E, Szabo CA, Szaflarski JP, Lin Thio KL, Trinka E, Burneo JG. Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy: An Analysis of a Complex Comorbidity. Neurology 2023; 100:e1123-e1134. [PMID: 36539302 PMCID: PMC10074468 DOI: 10.1212/wnl.0000000000201671] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Mood, anxiety disorders, and suicidality are more frequent in people with epilepsy than in the general population. Yet, their prevalence and the types of mood and anxiety disorders associated with suicidality at the time of the epilepsy diagnosis are not established. We sought to answer these questions in patients with newly diagnosed focal epilepsy and to assess their association with suicidal ideation and attempts. METHODS The data were derived from the Human Epilepsy Project study. A total of 347 consecutive adults aged 18-60 years with newly diagnosed focal epilepsy were enrolled within 4 months of starting treatment. The types of mood and anxiety disorders were identified with the Mini International Neuropsychiatric Interview, whereas suicidal ideation (lifetime, current, active, and passive) and suicidal attempts (lifetime and current) were established with the Columbia Suicidality Severity Rating Scale (CSSRS). Statistical analyses included the t test, χ2 statistics, and logistic regression analyses. RESULTS A total of 151 (43.5%) patients had a psychiatric diagnosis; 134 (38.6%) met the criteria for a mood and/or anxiety disorder, and 75 (21.6%) reported suicidal ideation with or without attempts. Mood (23.6%) and anxiety (27.4%) disorders had comparable prevalence rates, whereas both disorders occurred together in 43 patients (12.4%). Major depressive disorders (MDDs) had a slightly higher prevalence than bipolar disorders (BPDs) (9.5% vs 6.9%, respectively). Explanatory variables of suicidality included MDD, BPD, panic disorders, and agoraphobia, with BPD and panic disorders being the strongest variables, particularly for active suicidal ideation and suicidal attempts. DISCUSSION In patients with newly diagnosed focal epilepsy, the prevalence of mood, anxiety disorders, and suicidality is higher than in the general population and comparable to those of patients with established epilepsy. Their recognition at the time of the initial epilepsy evaluation is of the essence.
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Affiliation(s)
- Andres M Kanner
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine.
| | - Anita S Saporta
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Dong H Kim
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - John J Barry
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Hamada Altalib
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Hope Omotola
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Nathalie Jette
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Terence J O'Brien
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Siddhartha Nadkarni
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Melodie R Winawer
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Michael Sperling
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jacqueline A French
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Bassel Abou-Khalil
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Brian Alldredge
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Martina Bebin
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Gregory D Cascino
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Andrew J Cole
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Mark J Cook
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kamil Detyniecki
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Orrin Devinsky
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Dennis Dlugos
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Edward Faught
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - David Ficker
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Madeline Fields
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Barry Gidal
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Michael Gelfand
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Simon Glynn
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jonathan J Halford
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Sheryl Haut
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Manu Hegde
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Manisha G Holmes
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Reetta Kalviainen
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Joon Kang
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Pavel Klein
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Robert C Knowlton
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kaarkuzhali Krishnamurthy
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Ruben Kuzniecky
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Patrick Kwan
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Daniel H Lowenstein
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Lara Marcuse
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kimford J Meador
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Scott Mintzer
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Heath R Pardoe
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Kristen Park
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Patricia Penovich
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Rani K Singh
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Ernest Somerville
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Charles A Szabo
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jerzy P Szaflarski
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - K Liu Lin Thio
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Eugen Trinka
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
| | - Jorge G Burneo
- From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine
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15
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Adachi N, Onuma T, Kato M, Sekimoto M, Okazaki M, Hara K, Ishii R, Ito M, Akanuma N, Fenwick P. Psychoses after an antiepileptic drug administration: Frequency, timing, and duration. Epilepsy Behav 2023; 140:109087. [PMID: 36702055 DOI: 10.1016/j.yebeh.2023.109087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To clarify the pathophysiology of psychoses after the new administration of antiepileptic drugs (AED), we analyzed the annual incidence, timing of development, and duration of episodes. METHODS Psychotic outcomes in the first 6-month period after an AED or non-AED administration in patients with focal epilepsy were exhaustively reviewed in eight Japanese neuropsychiatry institutions. In cases with psychotic episodes, the subtype of psychosis, timing of development, previous history of psychosis, and duration of the episode were evaluated. RESULTS Between 1981 and 2015, 5018 new drugs (4402 AED and 616 non-AED) were administered to 2067 patients with focal epilepsy. In the first 6-month period, 105 psychotic episodes occurred (81 interictal psychosis [IIP] and 24 postictal psychosis). Furthermore, 55 cases were first episodes and 50 were recurrent episodes. The frequency of psychoses is significantly higher after AED administration (n = 102) compared with non-AED administration (n = 3). Psychosis occurred most frequently in the initial 1-month period after new-AED administration and tended to decrease with increasing time. The estimated annual incidence of all psychoses after a new AED administration was 3.5% (2.0% for first-episode psychosis and 1.8% for first-episode IIP). Duration of psychoses (mean, 38.5 weeks) was equivalent to overall IIP. Duration of IIP did not shorten with discontinuation of newly administered AED. SIGNIFICANCE Patients with epilepsy exhibit psychosis more frequently after new AED administration than after non-AED administration. This study shows the pathophysiology of psychoses after AED administration with annual incidence, the timing of development, and the duration of PAP, which have rarely been reported.
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Affiliation(s)
- Naoto Adachi
- Adachi Mental Clinic, Sapporo, Japan; National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan.
| | - Teiichi Onuma
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Masaaki Kato
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Masanori Sekimoto
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Mitsutoshi Okazaki
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan
| | | | - Ryouhei Ishii
- Department of Psychiatry, University of Osaka Graduate School of Medicine, Osaka, Japan
| | - Masumi Ito
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Jozen Clinic, Sapporo, Japan
| | - Nozomi Akanuma
- National Center Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter Fenwick
- South London and Maudsley NHS Foundation Trust, London, UK
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16
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Pisani F, Pisani LR, Barbieri MA, de Leon J, Spina E. Optimization of Therapy in Patients with Epilepsy and Psychiatric Comorbidities: Key Points. Curr Neuropharmacol 2023; 21:1755-1766. [PMID: 35619263 PMCID: PMC10514544 DOI: 10.2174/1570159x20666220526144314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/24/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022] Open
Abstract
Psychiatric disorder comorbidity in patients with epilepsy (PWE) is very frequent with a mean percentage prevalence of up to 50% and even higher. Such a high frequency suggests that epilepsy and psychiatric disorders might share common pathological pathways. Various aspects contribute in making the matter very complex from a therapeutic point of view. Some antiseizure medications (ASMs), namely valproic acid, carbamazepine, and lamotrigine, have mood-stabilising effects and are routinely used for the treatment of bipolar disorder in patients who do not have epilepsy. Pregabalin and, to a lesser extent, gabapentin, exerts anxiolytic effects. However, several ASMs, in particular levetiracetam, topiramate, and perampanel, may contribute to psychiatric disorders, including depression, aggressive behaviour, and even psychosis. If these ASMs are prescribed, the patient should be monitored closely. A careful selection should be made also with psychotropic drugs. Although most of these can be safely used at therapeutic doses, bupropion, some tricyclic antidepressants, maprotiline, and clozapine may alter seizure threshold and facilitate epileptic seizures. Interactions between ASMs and psychotropic medication may make it difficult to predict individual response. Pharmacokinetic interactions can be assessed with drug monitoring and are consequently much better documented than pharmacodynamic interactions. Another aspect that needs a careful evaluation is patient adherence to treatment. Prevalence of non-adherence in PWE and psychiatric comorbidities is reported to reach values even higher than 70%. A careful evaluation of all these aspects contributes in optimizing therapy with a positive impact on seizure control, psychiatric wellbeing, and quality of life.
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Affiliation(s)
- Francesco Pisani
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | | | | | - Jose de Leon
- Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA and Psychiatry and Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Italy
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17
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Liang S, Fan X, Chen F, Liu Y, Qiu B, Zhang K, Qi S, Zhang G, Liu J, Zhang J, Wang J, Wang X, Song Z, Luan G, Yang X, Jiang R, Zhang H, Wang L, You Y, Shu K, Lu X, Gao G, Zhang B, Zhou J, Jin H, Han K, Li Y, Wei J, Yang K, You G, Ji H, Jiang Y, Wang Y, Lin Z, Li Y, Liu X, Hu J, Zhu J, Li W, Wang Y, Kang D, Feng H, Liu T, Chen X, Pan Y, Liu Z, Li G, Li Y, Ge M, Fu X, Wang Y, Zhou D, Li S, Jiang T, Hou L, Hong Z. Chinese guideline on the application of anti-seizure medications in the perioperative period of supratentorial craniocerebral surgery. Ther Adv Neurol Disord 2022; 15:17562864221114357. [PMID: 35992894 PMCID: PMC9386849 DOI: 10.1177/17562864221114357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
Seizures are a common symptom of craniocerebral diseases, and epilepsy is one of the comorbidities of craniocerebral diseases. However, how to rationally use anti-seizure medications (ASMs) in the perioperative period of craniocerebral surgery to control or avoid seizures and reduce their associated harm is a problem. The China Association Against Epilepsy (CAAE) united with the Trauma Group of the Chinese Neurosurgery Society, Glioma Professional Committee of the Chinese Anti-Cancer Association, Neuro-Oncology Branch of the Chinese Neuroscience Society, and Neurotraumatic Group of Chinese Trauma Society, and selected experts for consultancy regarding outcomes from evidence-based medicine in domestic and foreign literature. These experts referred to the existing research evidence, drug characteristics, Chinese FDA-approved indications, and expert experience, and finished the current guideline on the application of ASMs during the perioperative period of craniocerebral surgery, aiming to guide relevant clinical practice. This guideline consists of six sections: application scope of guideline, concepts of craniocerebral surgery-related seizures and epilepsy, postoperative application of ASMs in patients without seizures before surgery, application of ASMs in patients with seizures associated with lesions before surgery, emergency treatment of postoperative seizures, and 16 recommendations.
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Affiliation(s)
- Shuli Liang
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing 100045, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Chen
- Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Yonghong Liu
- Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Binghui Qiu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kai Zhang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Songtao Qi
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guojun Zhang
- Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Jinfang Liu
- Xiangya Hospital, Central South University, Changsha, China
| | - Jianguo Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiu Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ziyang Song
- Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Guoming Luan
- Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xuejun Yang
- Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Rongcai Jiang
- Tianjin Medical University General Hospital, Tianjin, China
| | - Hua Zhang
- Department of Neurosurgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Lei Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongping You
- Jiangsu Provincial People's Hospital, Nanjing, China
| | - Kai Shu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojie Lu
- The Affiliated Hospital, Jiangnan University, Wuxi, China
| | - Guoyi Gao
- Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bo Zhang
- Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jian Zhou
- Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Hai Jin
- General Hospital of Northern Theater Command, Shenyang, China
| | - Kaiwei Han
- Shanghai Changzheng Hospital, Shanghai Neurosurgical Institute, Shanghai, China
| | - Yiming Li
- Shanghai Changzheng Hospital, Shanghai Neurosurgical Institute, Shanghai, China
| | - Junji Wei
- Peking Union Medical College Hospital, Beijing, China
| | - Kun Yang
- The First Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Gan You
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongming Ji
- Shanxi Provincial People's Hospital, Taiyuan, China
| | - Yuwu Jiang
- Peking University First Hospital, Beijing, China
| | - Yi Wang
- Children's Hospital of Fudan University, Shanghai, China
| | - Zhiguo Lin
- First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yan Li
- Children's Hospital of Soochow University, Suzhou, China
| | - Xuewu Liu
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China; Institute of Epilepsy, Shandong University, Jinan, China
| | - Jie Hu
- Huashan Hospital, Fudan University, Shanghai, China
| | - Junming Zhu
- The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Wenling Li
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yongxin Wang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dezhi Kang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hua Feng
- The Southwest Hospital, Army Medical University, Chongqing, China
| | - Tinghong Liu
- Xijing Hospital of Airforce Medical University, Xi'an, China
| | - Xin Chen
- Tianjin Medical University General Hospital, Tianjin, China
| | - Yawen Pan
- Lanzhou University Second Hospital, Lanzhou, China
| | - Zhixiong Liu
- Xiangya Hospital, Central South University, Changsha, China
| | - Gang Li
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yunqian Li
- The First Hospital of Jilin University, Changchun, China
| | - Ming Ge
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Key Laboratory of Major Disease in Children, Ministry of Education, Beijing, China
| | - Xianming Fu
- The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - Yuping Wang
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dong Zhou
- West China Hospital, Sichuan University, Chengdu, China
| | - Shichuo Li
- China Association Against Epilepsy, No. 135 Xizhimen Wai Avenue, Beijing 100044, China
| | - Tao Jiang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 10070, China
| | - Lijun Hou
- Shanghai Changzheng Hospital, Shanghai Neurosurgical Institute, No. 415, Fengyan Road, Huangpu District, Shanghai 200003, China
| | - Zhen Hong
- Huashan Hospital, Fudan University, No. 12, Urumqi Middle Road, Jing'an District, Shanghai 200044, China
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18
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Okanishi T, Fujii Y, Sakuma S, Shiraishi H, Motoi H, Yazaki K, Enoki H, Fujimoto A. Lacosamide monotherapy for the treatment of childhood epilepsy with centrotemporal spikes. Brain Dev 2022; 44:380-385. [PMID: 35241306 DOI: 10.1016/j.braindev.2022.02.005] [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: 12/19/2021] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Childhood epilepsy with centrotemporal spikes (CECTS) is known as age-limited focal epilepsy syndrome in childhood. Lacosamide is a third-generation antiepileptic drug. This study aimed to evaluate the efficacy of lacosamide monotherapy for the treatment of CECTS. METHODS We enrolled 18 patients (6 girls and 12 boys) who met the following criteria: 1) the age of onset of the seizures was between 3 and 13 years of age; 2) showing at least hemifacial and/or oropharyngeal seizures; 3) interictal discharges in central and/or middle temporal electrodes; 4) no intellectual disability; 5) treatment duration of lacosamide monotherapy over 6 months. We retrospectively collected and analyzed clinical data and treatment information. We evaluated the seizure occurrences during 0-3, 4-6, and 7-12 months from the treatment initiation and the last 6 months of the follow-up. We also evaluated the outcomes as seizure-free if the patients developed no seizures both over 6 months and 3 times of pretreatment mean seizure interval at the last follow-up. RESULTS Of the patients, 39%, 67% and 72% were seizure-free during 0-3, 4-6, and 7-12 months from treatment initiation, respectively. Finally, 83% of the patients achieved seizure freedom. Seizure freedom was achieved in 72% during the first 4 months of treatment. All patients continued lacosamide monotherapy during the study, although four patients showed transient fatigue or somnolence. CONCLUSIONS Lacosamide showed good efficacy for controlling seizures with fewer adverse effects, and therefore may be a good candidate as a first-line medication for the treatment of new-onset CECTS.
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Affiliation(s)
- Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital Hamamatsu, Japan.
| | - Yuji Fujii
- Department of Pediatrics, Hiroshima City Funairi Citizens Hospital, Hiroshima, Japan
| | - Satoru Sakuma
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hideaki Shiraishi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hirotaka Motoi
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan
| | - Kotaro Yazaki
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hideo Enoki
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital Hamamatsu, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital Hamamatsu, Japan
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19
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Qi Y, Cheng H, Lou Q, Wang X, Lai N, Gao C, Wu S, Xu C, Ruan Y, Chen Z, Wang Y. Paradoxical effects of posterior intralaminar thalamic calretinin neurons on hippocampal seizure via distinct downstream circuits. iScience 2022; 25:104218. [PMID: 35494226 PMCID: PMC9046245 DOI: 10.1016/j.isci.2022.104218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/02/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022] Open
Abstract
Epilepsy is a circuit-level brain disorder characterized by hyperexcitatory seizures with unclear mechanisms. Here, we investigated the causal roles of calretinin (CR) neurons in the posterior intralaminar thalamic nucleus (PIL) in hippocampal seizures. Using c-fos mapping and calcium fiber photometry, we found that PIL CR neurons were activated during hippocampal seizures in a kindling model. Optogenetic activation of PIL CR neurons accelerated seizure development, whereas inhibition retarded seizure development. Further, viral-based circuit tracing verified that PIL CR neurons were long-range glutamatergic neurons, projecting toward various downstream regions. Interestingly, selective inhibition of PIL-lateral amygdala CR circuit attenuated seizure progression, whereas inhibition of PIL-zona incerta CR circuit presented an opposite effect. These results indicated that CR neurons in the PIL play separate roles in hippocampal seizures via distinct downstream circuits, which complements the pathogenic mechanisms of epilepsy and provides new insight for the precise medicine of epilepsy. PIL CR neurons are activated during hippocampal seizures Optogenetic control of PIL CR neurons bidirectionally modulates seizure development LA-projecting and ZI-projecting CR circuits present opposite effects in seizure modulation
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Affiliation(s)
- Yingbei Qi
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Heming Cheng
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qiuwen Lou
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xia Wang
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Nanxi Lai
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Chenshu Gao
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuangshuang Wu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yeping Ruan
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhong Chen
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Corresponding author
| | - Yi Wang
- Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Corresponding author
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20
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Fong YO, Huang P, Hsu CY, Yang YH. Effects of Perampanel on Seizure Control, Cognition, Behavior, and Psychological Status in Patients With Epilepsy: A Systematic Review. J Clin Neurol 2022; 18:653-662. [DOI: 10.3988/jcn.2022.18.6.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yi-On Fong
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Poyin Huang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- School of Post-Baccalaureate Medicine, Colleague of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Ongchuan Martin S, Sadeghifar F, Snively BM, Alexander H, Kimball J, Conner K, O'Donovan CA, Munger Clary HM. Positive anxiety or depression screen despite ongoing antidepressant prescription in people with epilepsy: A large cross-sectional analysis. Epilepsy Behav Rep 2022; 20:100572. [PMID: 36411879 PMCID: PMC9674492 DOI: 10.1016/j.ebr.2022.100572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/30/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose While antidepressants are recommended to manage anxiety or depression in epilepsy, limited effectiveness data exist in real-world epilepsy samples, and prior work indicated frequent positive screens despite antidepressant prescription. In response, this study evaluates factors associated with positive anxiety or depression screen during ongoing antidepressant prescription. Methods Clinical and sociodemographic characteristics were collected among consecutive adult epilepsy clinic patients completing validated anxiety and depression instruments. The sample was divided by presence vs absence of existing antidepressant prescription at time of screening. Among those on an antidepressant, multivariable logistic regression was performed on pre-selected characteristics to evaluate for association with positive anxiety and/or depression screen. Pre-selected characteristics included: antidepressant dose, antidepressant prescriber specialty, antiseizure medications (number, potential psychotropic effects), seizure frequency, employment, visit no-shows, and medical insurance. Results Of 563 people with epilepsy, 152 had evidence of antidepressant prescription at time of screening and 73/152(48%) had positive anxiety and/or depression screen. Multivariable modeling demonstrated low antidepressant dose and no-show visit(s) were associated with positive screens (adjusted OR 2.29, CI 1.00-5.48 and 3.11, 1.26-8.22 respectively). Conclusion Low antidepressant dose and factors potentially associated with adherence (visit no-shows) may contribute to persistent anxiety and/or depression among epilepsy patients on an antidepressant.
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Affiliation(s)
| | - Fatemeh Sadeghifar
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Beverly M Snively
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Halley Alexander
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - James Kimball
- Department of Psychiatry, Wake Forest Unversity School of Medicine, Winston-Salem, NC, USA
| | - Kelly Conner
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Cormac A O'Donovan
- Department of Neurology and Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Heidi M Munger Clary
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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The antiepileptic drug lacosamide and memory - A preclinial study. Epilepsy Behav 2021; 125:108401. [PMID: 34775245 DOI: 10.1016/j.yebeh.2021.108401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Lacosamide (LC) belongs to a new generation of antiepileptic drugs (AEDs) and demonstrates unique mechanism of action. The drug also shows neuroprotective activity on the hippocampus. In this study, the impact of LC on learning processes was assessed. METHODS Adult male Wistar rats (n = 40) were used. Lacosamide was administered p.o. as a single (25 mg/kg or 75 mg/kg) or repeated doses (75 mg/kg). The effect of the drug was assessed in the Morris water maze (spatial memory) and the passive avoidance (PA) (emotional memory). RESULTS Lacosamide administered at a single dose or repeatedly did not impair spatial memory in Morris water maze. Higher swimming speed was observed in rats after administration of acute doses of LC. In PA, the disturbance of emotional memory was observed only after the single high dose of LC. CONCLUSION Lacosamide does not impair memory and learning processes. The emotional memory impairment observed after the acute high dose appears to be temporary and did not occur after repeated administration.
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Ahmed GK, Elbeh K, Elserogy Y, Mostafa S. Effect of long-term administration of clonazepam, carbamazepine, and valproate on cognitive, psychological, and personality changes in adult epilepsy: a case–control study. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00161-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Epilepsy can be treated with antiepileptic drugs (AEDs) which may have psychiatric and behavioral side effects. Additionally, the availability of new AEDs has increased, and our understanding of variability to combinations of several AEDs has evolved. Based on the treatment outcomes of carbamazepine, valproate, and clonazepam, this study aims to compare the cognitive function, personality, and psychological issues associated with these drugs and evaluate seizure-related factors related to them. Only 139 participants were included. Clonazepam was used as an add-on antiepileptic drug. Participants were categorized into five groups: group 1, carbamazepine; group 2, valproate; group 3, carbamazepine and clonazepam; group 4, valproate and clonazepam; and group 5, epileptic patients without AED. All participants were assessed using the Wechsler Adult Intelligence Scale (WAIS), Structured Interview for the Five-Factor Personality Model (SIFFM), Hamilton Anxiety and Depression Rating Scale, and Minnesota Multiphasic Personality Inventory-2 (MMPI-2).
Results
In the WAIS, group 1 had the worst mean of verbal intelligence quotient (IQ). Moreover, group 3 was more vulnerable in symptomatic response in all subscales of MMPI-2 except the masculinity–femininity subscale and a high percentage in moderate severity of anxiety and depression in the Hamilton scales.
Conclusions
The use of clonazepam and carbamazepine might increase the incidence of behavioral problems especially increased severity of anxiety and depression and decreased performance IQ compared with either clonazepam or carbamazepine alone. Moreover, patients with carbamazepine treatment might have more personality changes and lowered verbal IQ than others.
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Matsunuma S, Sunaga S, Hoshiai A, Arai T, Jimbo H, Yoshimoto K. Psychiatric disorders of the combination of levetiracetam either with lacosamide or perampanel: a retrospective cohort study. Int J Clin Pharm 2021; 43:1516-1522. [PMID: 34121153 DOI: 10.1007/s11096-021-01274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Background The number of patients with epilepsy receiving perampanel or lacosamide as an add-on treatment following levetiracetam treatment has increased. Although levetiracetam causes psychiatric disorders, it is unclear whether they occur with the combined use of these antiepileptic drugs. Objective To determine the frequency of psychiatric disorders in patients received lacosamide or perampanel in combination with levetiracetam. Setting A single-center retrospective cohort study. Method Patients who received levetiracetam + lacosamide or levetiracetam + perampanel were selected. Medical records from the start of combination therapy contained characteristics of patients and the incidence of psychiatric disorders. Main outcome measure The frequency of psychiatric disorders, the time to onset, dose reduction or discontinuation following psychiatric disorders, and the clinical course following disorder onset. Results Forty-four patients used levetiracetam + lacosamide and 50 used levetiracetam + perampanel. The incidence of psychiatric disorders was significantly lower (p < 0.001) with levetiracetam + lacosamide (6.8%) than with levetiracetam + perampanel (44%). The incidence of affect lability was significantly higher with levetiracetam + perampanel than with levetiracetam + lacosamide (p = 0.018). The time to the onset of psychiatric disorders was within 1 month of dose initiation or increase in one case (33.3%) with levetiracetam + lacosamide and 16 cases (72.7%) with levetiracetam + perampanel. There was no significant difference in clinical characteristics and antiepileptic drug dosages owing to the presence or absence of psychiatric disorders. Conclusion As the frequency of psychiatric disorders was higher with levetiracetam + perampanel therapy, levetiracetam + lacosamide may be preferable. These disorders tended to develop within 1 month of therapy and were not dose-dependent. Antiepileptic drugs should be cautiously prescribed to avoid psychiatric disorders.
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Affiliation(s)
- Satoru Matsunuma
- Department of Pharmacy, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji City, Tokyo, Japan.
| | - Shigeki Sunaga
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Akira Hoshiai
- Department of Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Takao Arai
- Department of Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Koichi Yoshimoto
- Department of Pharmacy, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji City, Tokyo, Japan
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Hamard J, Rigal M, Gony M, Bagheri H. Lacosamide-induced personality changes: An unexpected adverse effect. Fundam Clin Pharmacol 2021; 36:224-226. [PMID: 33960008 DOI: 10.1111/fcp.12692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe an 'unexpected' case of abrupt personality following the introduction of lacosamide. METHODS A description of an 82-year-old male receiving neurological follow-up since 2010 due to epilepsy secondary to haemorrhagic stroke. We report a case of abrupt personality change in an 82-year-old male following the introduction of lacosamide with a return to the previous state after its discontinuation. We explored possible mechanisms and pharmacokinetic concerns explaining this personality change. RESULTS In fact, a few days after introducing lacosamide, the patient was described as 'gentle', 'calm' and apologetic for his past aggressions against his family and caregivers which was in complete contrast to his usual personality. There was also marked insistence and the use of sexualised language towards women in his close circle, especially his home nurses. In view of his insistent behaviour towards his nurses and unusual sexualised language, lacosamide was withdrawn. A few days later, the patient displayed his usual, vindictive, aggressive and forceful character. He no longer made any sexualised remarks to his home nurses. CONCLUSION To our knowledge, this is the first case of a sudden behavioural and personality change reported by family, friends and carers following the introduction of lacosamide.
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Affiliation(s)
- Jacques Hamard
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU de Toulouse, INSERM U1027, Faculté de Médecine, Université de Toulouse, Toulouse, France
| | - Mathieu Rigal
- Service de Neurologie, Centre Hospitalier d'Auch, Auch, France
| | - Mireille Gony
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU de Toulouse, INSERM U1027, Faculté de Médecine, Université de Toulouse, Toulouse, France
| | - Haleh Bagheri
- Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, CHU de Toulouse, INSERM U1027, Faculté de Médecine, Université de Toulouse, Toulouse, France
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Steinhoff BJ, Klein P, Klitgaard H, Laloyaux C, Moseley BD, Ricchetti-Masterson K, Rosenow F, Sirven JI, Smith B, Stern JM, Toledo M, Zipfel PA, Villanueva V. Behavioral adverse events with brivaracetam, levetiracetam, perampanel, and topiramate: A systematic review. Epilepsy Behav 2021; 118:107939. [PMID: 33839453 DOI: 10.1016/j.yebeh.2021.107939] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To understand the currently available post-marketing real-world evidence of the incidences of and discontinuations due to the BAEs of irritability, anger, and aggression in people with epilepsy (PWE) treated with the anti-seizure medications (ASMs) brivaracetam (BRV), levetiracetam (LEV), perampanel (PER), and topiramate (TPM), as well as behavioral adverse events (BAEs) in PWE switching from LEV to BRV. METHODS A systematic review of published literature using the Cochrane Library, PubMed/MEDLINE, and Embase was performed to identify retrospective and prospective observational studies reporting the incidence of irritability, anger, or aggression with BRV, LEV, PER, or TPM in PWE. The incidences of these BAEs and the rates of discontinuation due to each were categorized by ASM, and where possible, weighted means were calculated but not statistically assessed. Behavioral and psychiatric adverse events in PWE switching from LEV to BRV were summarized descriptively. RESULTS A total of 1500 records were identified in the searches. Of these, 44 published articles reporting 42 studies met the study criteria and were included in the data synthesis, 7 studies were identified in the clinical trial database, and 5 studies included PWE switching from LEV to BRV. Studies included a variety of methods, study populations, and definitions of BAEs. While a wide range of results was reported across studies, weighted mean incidences were 5.6% for BRV, 9.9% for LEV, 12.3% for PER, and 3.1% for TPM for irritability; 3.3%* for BRV, 2.5% for LEV, 2.0% for PER, and 0.2%* for TPM for anger; and 2.5% for BRV, 2.6% for LEV, 4.4% for PER, and 0.5%* for TPM for aggression. Weighted mean discontinuation rates were 0.8%* for BRV, 3.4% for LEV, 3.0% for PER, and 2.2% for TPM for irritability and 0.8%* for BRV, 2.4% for LEV, 9.2% for PER, and 1.2%* for TPM for aggression. There were no discontinuations for anger. Switching from LEV to BRV led to improvement in BAEs in 33.3% to 83.0% of patients (weighted mean, 66.6%). *Denotes only 1 study. CONCLUSIONS This systematic review characterizes the incidences of irritability, anger, and aggression with BRV, LEV, PER, and TPM, and it provides robust real-world evidence demonstrating that switching from LEV to BRV may improve BAEs. While additional data remain valuable due to differences in methodology (which make comparisons difficult), these results improve understanding of the real-world incidences of discontinuations due to these BAEs in clinical practice and can aid in discussions and treatment decision-making with PWE.
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Affiliation(s)
- Bernhard J Steinhoff
- Epilepsiezentrum Kork, Landstraße 1, 77694 Kehl, Kehl-Kork; Albert-Ludwigs University of Freiburg, Department of Neurology and Clinical Neurophysiology, Freiburg, Germany.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, 6410 Rockledge Drive, #610, Bethesda, MD 20817, USA.
| | - Henrik Klitgaard
- UCB Pharma, Allee de la Recherche 60, 1070 Anderlecht, Brussels, Belgium.
| | - Cédric Laloyaux
- UCB Pharma, Allee de la Recherche 60, 1070 Anderlecht, Brussels, Belgium.
| | - Brian D Moseley
- University of Cincinnati, Department of Neurology and Rehabilitation Medicine, Stetson Building, 260 Stetson Street, Suite 2300, Cincinnati, OH 45267-0525, USA
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-12, Haus 95, Frankfurt a.M., 60528, Germany.
| | - Joseph I Sirven
- Mayo Clinic, Neurology and Neurosurgery, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
| | - Brien Smith
- OhioHealth Physician Group, 3430 OhioHealth Pkwy, 4th Floor North, Columbus, OH 43202, USA.
| | - John M Stern
- University of California, Department of Neurology, 300 Medical Plaza Driveway, Suite B200, Los Angeles, CA 90095, USA.
| | - Manuel Toledo
- Epilepsy Unit. Neurology Department, Hospital Vall d'Hebron, Servicio de Neurologia, Passeig de la Vall d'Hebron 119, Barcelona, 08035, Spain.
| | - Patricia A Zipfel
- MicroMass, an Ashfield Company, 100 Regency Forest Dr, Cary, NC, USA.
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politecnico La Fe, Avenida Fernando Abril Martorell 106, Valencia 46026, Spain
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Levetiracetam, perampanel, and the issue of aggression: A self-report study. Epilepsy Behav 2021; 117:107806. [PMID: 33621813 DOI: 10.1016/j.yebeh.2021.107806] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 01/16/2023]
Abstract
This study investigated to which degree levetiracetam (LEV) and perampanel (PER), antiseizure medications (ASM) that are both known to cause aggression and irritability, share the same or different, behavioral side-effect profiles. In this self-report study, 68 participants with epilepsy treated with LEV (n = 35) or PER (n = 33) as part of their medication were asked to rate their behavioral experience with the respective drug as positive, neutral, or negative. Results of a German adaptation of the Adverse Events Profile (AEP) and of the "FPZ", a German personality questionnaire, were analyzed as a function of drug and rating. Thirty-eight percent of the LEV group and 36% of the PER group experienced negative change after the evaluated drug was introduced. By subdividing participants in the LEV sample into those who attributed the negative effects to LEV and those with neutral or positive experience with LEV, a negative evaluation of LEV was associated with significantly worse scores in cognition, mood, and physical domains (80% versus 20-40%). Subdividing participants in the PER sample into those who attributed negative the side effects to PER, and those with a neutral or positive experience with PER, significance could be shown for mood domains only (100% versus 50%), and within this domain only for increased aggression and irritability. Comparing features of the behavioral negative side effects of LEV and PER revealed that LEV appears to have a negative impact on a much broader range of behaviors than PER, which specifically seems to induce aggression and irritability and no other psychiatric side effects. Further research should aim at different expression and different mechanisms of aggression and irritability underlying the superficially similar effects of the two drugs.
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Chen L, Wang Y, Chen Z. Adult Neurogenesis in Epileptogenesis: An Update for Preclinical Finding and Potential Clinical Translation. Curr Neuropharmacol 2021; 18:464-484. [PMID: 31744451 PMCID: PMC7457402 DOI: 10.2174/1570159x17666191118142314] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/31/2019] [Accepted: 11/18/2019] [Indexed: 12/22/2022] Open
Abstract
Epileptogenesis refers to the process in which a normal brain becomes epileptic, and is characterized by hypersynchronous spontaneous recurrent seizures involving a complex epileptogenic network. Current available pharmacological treatment of epilepsy is generally symptomatic in controlling seizures but is not disease-modifying in epileptogenesis. Cumulative evidence suggests that adult neurogenesis, specifically in the subgranular zone of the hippocampal dentate gyrus, is crucial in epileptogenesis. In this review, we describe the pathological changes that occur in adult neurogenesis in the epileptic brain and how adult neurogenesis is involved in epileptogenesis through different interventions. This is followed by a discussion of some of the molecular signaling pathways involved in regulating adult neurogenesis, which could be potential druggable targets for epileptogenesis. Finally, we provide perspectives on some possible research directions for future studies.
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Affiliation(s)
- Liying Chen
- Institute of Pharmacology & Toxicology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yi Wang
- Institute of Pharmacology & Toxicology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhong Chen
- Institute of Pharmacology & Toxicology, Key Laboratory of Medical Neurobiology of the Ministry of Health of China, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.,Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,College of Pharmaceutical Science, Zhejiang Chinese Medical University, Hangzhou, China
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Akanuma N, Adachi N, Fenwick P, Ito M, Okazaki M, Hara K, Ishii R, Sekimoto M, Kato M, Onuma T. Individual vulnerabilities to psychosis after antiepileptic drug administration. BMJ Neurol Open 2021; 2:e000036. [PMID: 33681791 PMCID: PMC7903174 DOI: 10.1136/bmjno-2019-000036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 07/19/2020] [Accepted: 07/28/2020] [Indexed: 11/06/2022] Open
Abstract
Background Psychosis often develops after the administration of antiepileptic drugs (AEDs) in patients with epilepsy. However, the individual vulnerability and clinical condition of such patients have been rarely scrutinised. We investigated the effect of individually consistent (trait-dependent) and inconsistent (state-dependent) characteristics. Methods The individual characteristics, clinical states and psychotic outcome of patients from eight adult epilepsy clinics were retrospectively reviewed over 6-month periods after a new drug (AED or non-AED) administration between 1981 and 2015. Results A total of 5018 new drugs (4402 AEDs and 616 non-AEDs) were used in 2015 patients with focal epilepsy. Subsequently, 105 psychotic episodes (81 interictal and 24 postictal) occurred in 89 patients. Twelve patients exhibited multiple episodes after different AED administrations. Trait-dependent characteristics (early onset of epilepsy, known presumed causes of epilepsy, lower intellectual function and a family history of psychosis) were significantly associated with the patients who exhibited psychosis. Absence of family history of epilepsy was also associated with psychosis but not significantly. Subsequent logistic regression analysis with a model incorporating family history of psychosis and epilepsy, and intellectual function was the most appropriate (p=0.000). State-dependent characteristics, including previous psychotic history and epilepsy-related variables (longer duration of epilepsy, AED administration, higher seizure frequency and concomitant use of AEDs) were significantly associated with psychotic episodes. Subsequent analysis found that a model including AED administration and previous psychotic history was the most appropriate (p=0.000). Conclusion Psychosis occurring after new AED administration was related to the individual vulnerability to psychosis and intractability of epilepsy.
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Affiliation(s)
- Nozomi Akanuma
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Peter Fenwick
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Mitsutoshi Okazaki
- Department of Psychiatry, National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan
| | | | - Ryouhei Ishii
- Department of Psychiaty, University of Osaka Graduate School of Medicine, Osaka, Japan
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Determination of health fatalism and the factors affecting health fatalism in patients with epilepsy in the North of Turkey. Epilepsy Behav 2021; 115:107641. [PMID: 33341394 DOI: 10.1016/j.yebeh.2020.107641] [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: 10/03/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In individuals with epilepsy, health fatalism can affect their perceptions of health and their responses to solutions offered, both positively and negatively. This study aimed to investigate health fatalism in people with epilepsy in Turkey and the factors that influence their health fatalism. METHOD This descriptive and cross-sectional study was conducted between December 2019 and April 2020 with 100 epilepsy patients who were referred to a neurology outpatient clinic in the North of Turkey. The data for the study were collected using a descriptive information form and the Health Fatalism Scale (HES). RESULTS The total mean score on the Health Fatalism Scale for the study participants was found to be 56,16 ± 15,71. Significant association was found between health fatalism and educational status (p < 0,05), polytherapy (p < 0,05), and frequency of seizures (p < 0,001). CONCLUSION In this study, individuals with epilepsy expressed high levels of fatalism in their health beliefs. It was found that illiterate individuals with epilepsy held more fatalistic beliefs. In addition, it was found that participants who used polytherapy and those who had frequent seizures also had higher levels of fatalistic health beliefs.
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Villanueva V, Sánchez-Álvarez JC, Carreño M, Salas-Puig J, Caballero-Martínez F, Gil-Nagel A. Initiating antiepilepsy treatment: An update of expert consensus in Spain. Epilepsy Behav 2021; 114:107540. [PMID: 33243687 DOI: 10.1016/j.yebeh.2020.107540] [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: 08/27/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022]
Abstract
Following publication in 2014 of the International League Against Epilepsy (ILAE) official report changing the definition of epilepsy, a number of questions remain unresolved in regard to deciding when to start treatment and to the choice of a particular antiseizure medication (ASM). This study uses a Delphi method to update consensus among a panel of experts on the initiation of epilepsy treatment in order to provide insight regarding those questions. The study was undertaken in four phases. Firstly, a multi-center steering committee met to review relevant bibliography and to draft a questionnaire. Secondly, a panel of neurologists specialized in epilepsy was selected and convened. Thirdly, an online survey was carried out in two rounds. Fourthly, the final results were discussed at a face-to-face meeting of the steering committee to draw conclusions. The final questionnaire focused on three independent sections: the decision to commence ASM in different clinical situations, the choice of initial monotherapy depending on the type of epilepsy and the patient's age/sex (including childbearing potential), and the choice of initial monotherapy depending on comorbidity. In these two latter sections, fourteen ASMs approved for monotherapy use by the EMA and available in Spain were considered. Regarding the decision as to when to commence treatment, the results show agreement exists to initiate treatment following a first generalized tonic-clonic seizure or a focal seizure if the electroencephalography (EEG) reveals epileptiform activity, if the MRI reveals a lesion, or when it occurs in elderly patients. With respect to the choice of initial monotherapy depending on the type of epilepsy and the patient's age/sex profile, it is agreed to avoid valproic acid (VPA) in women with childbearing potential, with levetiracetam (LEV) and lamotrigine (LTG) being the preferable options in generalized epilepsy. In focal epilepsy, the options are broader, particularly in men, and include the most recent ASMs approved for monotherapy. In the elderly, LEV, lacosamide (LCM), eslicarbazepine acetate (ESL) and LTG are considered the most suitable drugs for initiating treatment. With regard to comorbidities, the recommendation is to avoid enzyme inducing ASMs, with LEV, the most recent ASMs approved for monotherapy and LTG being the preferred options. In conclusion, as the ILAE definition states, there are different situations that lead to treatment initiation after a first seizure. When choosing the first ASM, the type of epilepsy, childbearing potential and drug-drug interaction are key factors.
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Affiliation(s)
- Vicente Villanueva
- Unidad Epilepsia Refractaria, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | | | - Mar Carreño
- Unidad de Epilepsia, Hospital Clínic, Barcelona, Spain
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Shakeshaft A, Panjwani N, McDowall R, Crudgington H, Peña Ceballos J, Andrade DM, Beier CP, Fong CY, Gesche J, Greenberg DA, Hamandi K, Koht J, Lim KS, Orsini A, Rees MI, Rubboli G, Selmer KK, Smith AB, Striano P, Syvertsen M, Talvik I, Thomas RH, Zarubova J, Richardson MP, Strug LJ, Pal DK. Trait impulsivity in Juvenile Myoclonic Epilepsy. Ann Clin Transl Neurol 2020; 8:138-152. [PMID: 33264519 PMCID: PMC7818143 DOI: 10.1002/acn3.51255] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 01/22/2023] Open
Abstract
Objective Impulsivity is a multidimensional construct that can predispose to psychopathology. Meta‐analysis demonstrates an association between response impulsivity and Juvenile Myoclonic Epilepsy (JME), a common genetic generalized epilepsy. Here, we test the hypotheses that trait impulsivity is (i) elevated in JME compared to controls; (ii) moderated by specific seizure characteristics; and (iii) associated with psychiatric adverse effects of antiepileptic drugs (AEDs). Methods 322 participants with JME and 126 age and gender‐matched controls completed the Barratt’s Impulsiveness Scale (BIS‐brief) alongside information on seizure history and AED use. We compared group BIS‐brief scores and assessed associations of JME BIS‐brief scores with seizure characteristics and AED adverse effects. Results The mean BIS‐brief score in JME was 18.1 ± 4.4 compared with 16.2 ± 4.1 in controls (P = 0.0007). Elevated impulsivity was associated with male gender (P = 0.027), frequent absence seizures (P = 0.0004) and lack of morning predominance of myoclonus (P = 0.008). High impulsivity significantly increased the odds of a psychiatric adverse event on levetiracetam (P = 0.036), but not any other psychiatric or somatic adverse effects. Interpretation Trait impulsivity is elevated in JME and comparable to scores in personality and neurotic disorders. Increased seizure frequency and absence of circadian seizure pattern moderate BIS score, suggesting disruption of both cortico‐striatal and thalamocortical networks as a shared mechanism between seizures and impulsivity in JME. These findings warrant consideration of impulsivity as a distinct target of intervention, and as a stratifying factor for AED treatment in JME, and perhaps other types of epilepsy. The role of impulsivity in treatment adherence and psychosocial outcome requires further investigation.
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Affiliation(s)
- Amy Shakeshaft
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,MRC Centre for Neurodevelopmental Disorders, King's College London, UK
| | | | - Robert McDowall
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Holly Crudgington
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Javier Peña Ceballos
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | | | - Choong Yi Fong
- Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Jeanette Koht
- Department of Neurology, Drammen Hospital, Vestre Viken Health Trust, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Kheng Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Alessandro Orsini
- Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy
| | - Mark I Rees
- Neurology Research Group, Swansea University Medical School, UK
| | - Guido Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark.,University of Copenhagen, Denmark
| | - Kaja K Selmer
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Norway.,National Centre for Epilepsy, Oslo University Hospital, Norway
| | - Anna B Smith
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Pasquale Striano
- IRCCS Istituto 'G. Gaslini', Genova, Italy.,University of Genova, Genova, Italy
| | - Marte Syvertsen
- Department of Neurology, Drammen Hospital, Vestre Viken Health Trust, Oslo, Norway
| | | | - Rhys H Thomas
- Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - Jana Zarubova
- Department of Neurology, Motol University Hospital, Prague, Czech Republic.,Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Mark P Richardson
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,MRC Centre for Neurodevelopmental Disorders, King's College London, UK.,King's College Hospital, London, UK
| | | | - Deb K Pal
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,MRC Centre for Neurodevelopmental Disorders, King's College London, UK.,King's College Hospital, London, UK.,Evelina London Children's Hospital, London, UK
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Li KY, Huang LC, Chang YP, Yang YH. The effects of lacosamide on cognitive function and psychiatric profiles in patients with epilepsy. Epilepsy Behav 2020; 113:107580. [PMID: 33242771 DOI: 10.1016/j.yebeh.2020.107580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cognitive and psychiatric problems are common in people with epilepsy. They can have multiple causes, including structural brain lesions, the active epilepsy, and the effect of anti-epileptic therapy. Since patients' treatment compliance and quality of life are affected by cognitive and emotional status, it is crucial for clinicians to understand how anti-seizure medications (ASMs) affect cognition and mood, and to choose the proper ASM. OBJECTIVE To conduct a literature review of the impact on cognition and mood status of lacosamide (LCM) in people with epilepsy. METHODS Wesearched PubMed, the Cochrane Database of Systematic Reviews and reference lists of articles for all types of articles with no limitations on publication date. RESULTS A total of 251 records were obtained, including 247 articles in PubMed and 4 articles from reference lists. We included 2 meta-analyses, one randomized controlled trials and 14 observational studies after the screening process. Most studies agree LCM has low risk of treatment-emergent adverse events (TEAEs) on cognition. Comparisons with other ASMs, LCM may be preferable to carbamazepine, topiramate and perampanel, and not inferior to lamotrigine. In spite of low incident rate, depression is the most common psychiatric change of LCM. There are no consistent positive or negative psychiatric effects of LCM. CONCLUSION Lacosamide has limited impact on cognitive and mood status in this review. Several factors including mechanism of co-administration of ASMs and personal history of psychiatric disorder should be considered as important in the development of cognitive and psychiatric side effects. However, the heterogeneity between studies make the quality of evidence weaker and further trials are needed.
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Affiliation(s)
- Kuan-Ying Li
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ling-Chun Huang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Master's Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Sales F, Chaves J, McMurray R, Loureiro R, Fernandes H, Villanueva V. Eslicarbazepine acetate in post-stroke epilepsy: Clinical practice evidence from Euro-Esli. Acta Neurol Scand 2020; 142:563-573. [PMID: 32691850 PMCID: PMC7754143 DOI: 10.1111/ane.13323] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 12/21/2022]
Abstract
Objectives To assess the effectiveness and safety/tolerability of eslicarbazepine acetate (ESL) in patients included in the Euro‐Esli study who had focal seizures associated with post‐stroke epilepsy (PSE). Materials and Methods Euro‐Esli was a pooled analysis of 14 European clinical practice studies. Effectiveness assessments (evaluated after 3, 6 and 12 months of ESL treatment and at final follow‐up [“last visit”]) included rates of response (≥50% seizure frequency reduction), seizure freedom (no seizures since at least the prior visit) and retention. Safety/tolerability was assessed throughout ESL treatment by evaluating adverse events (AEs) and discontinuation due to AEs. A post hoc analysis was conducted of patients with PSE versus patients without PSE (“non‐PSE”). Results Of 1656 patients included in the analysis, 76 (4.6%) had PSE and 1580 (95.4%) had non‐PSE. Compared with non‐PSE patients, PSE patients were significantly older, had significantly shorter epilepsy duration, significantly lower total baseline seizure frequency, and were treated with significantly fewer prior and concomitant antiepileptic drugs (P < .001 for all). At the last visit, the responder rate was significantly higher in PSE versus non‐PSE patients (72.9% vs 60.6%; P = .040), as was the seizure freedom rate (48.6% vs 31.7%; P = .003). After 12 months, retention was significantly higher in PSE versus non‐PSE patients (87.8% vs 77.4%; P = .035). The incidence of AEs was similar for PSE versus non‐PSE patients (36.0% vs 35.8%; P = .966). Conclusions These findings suggest that ESL may be an effective and well‐tolerated treatment option for patients with focal seizures due to PSE.
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Affiliation(s)
- Francisco Sales
- Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - João Chaves
- Department of Neurology Hospital Santo AntónioCentro Hospitalar Porto Porto Portugal
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Campos-Fernández D, Fonseca E, Olivé-Gadea M, Quintana M, Abraira L, Seijo-Raposo I, Santamarina E, Toledo M. The mediating role of epileptic seizures, irritability, and depression on quality of life in people with epilepsy. Epilepsy Behav 2020; 113:107511. [PMID: 33129044 DOI: 10.1016/j.yebeh.2020.107511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Psychiatric comorbidity is common in epilepsy and has a considerable impact on patient quality of life (QoL). This study aimed to analyze the relationship between seizure frequency, irritability, and depression and describe how they mediate each other's effect on QoL in epilepsy. METHODS This is a cross-sectional study of consecutive adults seen at an outpatient epilepsy clinic of a tertiary hospital in Barcelona, Spain. All the patients were evaluated for psychiatric comorbidity and administered the State-Trait Anger Expression Inventory-2 (STAXI-2), the Hospital Anxiety and Depression Scale (HADS), and the Quality Of Life in Epilepsy Inventory-10 (QOLIE-10). Mediation analysis with multiple linear regression followed by the Sobel test was performed. RESULTS We studied 157 patients. Seizure frequency (R = -0.193, P = .053), irritability (R = 0.216, P = .039), and depression (R = -0.598, P < .001) had all a negative effect on QoL. In the adjusted linear regression model, depression was the only independent predictor of impaired QoL (B = -2.453 [95% confidence interval (CI): -3.161, -1.744], P < .001). The Sobel test showed that depression exerted a significant mediating effect on seizure frequency (Z = -1.984; P = .047) and irritability (Z = -3.669; P < .001) in their influence on QoL. CONCLUSION Depression is an independent predictor of worse QoL and significantly mediated the effects of irritability and poor seizure control on QoL impairment in patients with epilepsy.
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Affiliation(s)
- Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
| | - Marta Olivé-Gadea
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Iván Seijo-Raposo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Bass JS, Tuo AH, Ton LT, Jankovic MJ, Kapadia PK, Schirmer C, Krishnan V. On the Digital Psychopharmacology of Valproic Acid in Mice. Front Neurosci 2020; 14:594612. [PMID: 33240040 PMCID: PMC7677503 DOI: 10.3389/fnins.2020.594612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/13/2020] [Indexed: 12/20/2022] Open
Abstract
Antiepileptic drugs (AEDs) require daily ingestion for maximal seizure prophylaxis. Adverse psychiatric consequences of AEDs present as: (i) reversible changes in mood, anxiety, anger and/or irritability that often necessitate drug discontinuation, and (ii) autism and/or cognitive/psychomotor delays following fetal exposure. Technical advances in quantifying naturalistic rodent behaviors may provide sensitive preclinical estimates of AED psychiatric tolerability and neuropsychiatric teratogenicity. In this study, we applied instrumented home-cage monitoring to assess how valproic acid (VPA, dissolved in sweetened drinking water) alters home-cage behavior in adult C57BL/6J mice and in the adult offspring of VPA-exposed breeder pairs. Through a pup open field assay, we also examined how prenatal VPA exposure impacts early spontaneous exploratory behavior. At 500-600 mg/kg/d, chronic VPA produced hyperphagia and increased wheel-running without impacting sleep, activity and measures of risk aversion. When applied to breeder pairs of mice throughout gestation, VPA prolonged the latency to viable litters without affecting litter size. Two-weeks old VPA-exposed pups displayed open field hypoactivity without alterations in thigmotaxis. As adults, prenatal VPA-exposed mice displayed active state fragmentation, hypophagia and increased wheel running, together with subtle alterations in home-cage dyadic behavior. Together, these data illustrate how automated home-cage assessments of spontaneous behavior capture an ethologically centered psychopharmacological profile of enterally administered VPA that is aligned with human clinical experience. By characterizing the effects of pangestational VPA exposure, we discover novel murine expressions of pervasive neurodevelopment. Incorporating such rigorous assessments of psychological tolerability may inform the design of future AEDs with improved neuropsychiatric safety profiles, both for patients and their offspring.
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Affiliation(s)
- John Samuel Bass
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Anney H. Tuo
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Linh T. Ton
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Miranda J. Jankovic
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Paarth K. Kapadia
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Catharina Schirmer
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Vaishnav Krishnan
- Departments of Neuroscience, Psychiatry and Behavioral Sciences, Baylor Comprehensive Epilepsy Center, Baylor College of Medicine, Houston, TX, United States
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Dai Y, Song Y, Xie J, Xiao G, Li X, Li Z, Gao F, Zhang Y, He E, Xu S, Wang Y, Zheng W, Jiang X, Qi Z, Meng D, Fan Z, Cai X. CB1-Antibody Modified Liposomes for Targeted Modulation of Epileptiform Activities Synchronously Detected by Microelectrode Arrays. ACS APPLIED MATERIALS & INTERFACES 2020; 12:41148-41156. [PMID: 32809788 DOI: 10.1021/acsami.0c13372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Temporal lobe epilepsy (TLE) is a focal, recurrent, and refractory neurological disorder. Therefore, precisely targeted treatments for TLE are greatly needed. We designed anti-CB1 liposomes that can bind to CB1 receptors in the hippocampus to deliver photocaged compounds (ruthenium bipyridine triphenylphosphine γ-aminobutyric acid, RuBi-GABA) in the TLE rats. A 16-channel silicon microelectrode array (MEA) was implanted for simultaneously monitoring electrophysiological signals of neurons. The results showed that anti-CB1 liposomes were larger in size and remained in the hippocampus longer than unmodified liposomes. Following the blue light stimulation, the neural firing rates and the local field potentials of hippocampal neurons were significantly reduced. It is indicated that RuBi-GABA was enriched near hippocampal neurons due to anti-CB1 liposome delivery and photolyzed by optical stimulation, resulting dissociation of GABA to exert inhibitory actions. Furthermore, K-means cluster analysis revealed that the firing rates of interneurons were decreased to a greater extent than those of pyramidal neurons, which may have been a result of the uneven diffusion of RuBi-GABA due to liposomes binding to CB1. In this study, we developed a novel, targeted method to regulate neural electrophysiology in the hippocampus of the TLE rat using antibody-modified nanoliposomes, implantable MEA, and photocaged compounds. This method effectively suppressed hippocampal activities during seizure ictus with high spatiotemporal resolution, which is a crucial exploration of targeted therapy for epilepsy.
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Affiliation(s)
- Yuchuan Dai
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Yilin Song
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Jingyu Xie
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Guihua Xiao
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Xuanyu Li
- Beijing Engineering Research Center for BioNanotechnology, CAS Key Laboratory for Biological Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for NanoScience and Technology, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Ziyue Li
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Fei Gao
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Yu Zhang
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Enhui He
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Shengwei Xu
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Yun Wang
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Wenfu Zheng
- Beijing Engineering Research Center for BioNanotechnology, CAS Key Laboratory for Biological Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for NanoScience and Technology, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Xingyu Jiang
- Beijing Engineering Research Center for BioNanotechnology, CAS Key Laboratory for Biological Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for NanoScience and Technology, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Zhimei Qi
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Dongdong Meng
- National Engineering Research Center for DPSSL, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100094, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Zhongwei Fan
- National Engineering Research Center for DPSSL, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100094, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
| | - Xinxia Cai
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, P. R. China
- University of Chinese Academy of Sciences, Beijing 100049, P. R. China
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Toledano Delgado R, García-Morales I, Parejo-Carbonell B, Jiménez-Huete A, Herrera-Ramirez D, González-Hernández A, Ayuga Loro F, Santamarina E, Toledo M, Ojeda J, Poza JJ, Molins A, Giner P, Estévez María JC, Castro-Vilanova MD, Zurita J, Saiz-Diaz RA, Gómez-Ibañez A, Rodriguez-Uranga J, Gil-Nagel A, Campos D, Sánchez-Larsen Á, Aguilar-Amat Prior MJ, Mauri Llerda JA, Huertas González N, García-Barragán N. Effectiveness and safety of perampanel monotherapy for focal and generalized tonic-clonic seizures: Experience from a national multicenter registry. Epilepsia 2020; 61:1109-1119. [PMID: 32511754 DOI: 10.1111/epi.16548] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the effectiveness and tolerability of perampanel (PER) monotherapy in routine clinical practice for the treatment of focal onset and generalized tonic-clonic seizures (GTCS). METHODS This multicenter, retrospective, observational study was conducted in patients aged ≥12 years treated with PER as primary monotherapy or converted to PER monotherapy by progressive reduction of background antiepileptic drugs. Outcomes included retention, responder, and seizure-free rate after 3, 6, and 12 months and tolerability throughout the follow-up. RESULTS A total of 98 patients (mean age = 49.6 ± 21.7 years, 51% female) with focal seizures and/or GTCS were treated with PER monotherapy for a median exposure of 14 months (range = 1-57) with a median dose of 4 mg (range = 2-10). The retention rates at 3, 6, and 12 months and last follow-up were 93.8%, 89.3%, 80.9%, and 71.4%, respectively. The retention rates according to the type of monotherapy (primary vs conversion) did not differ (log-rank P value = .57). Among the 98 patients, 61.2% patients had seizures throughout the baseline period, with a median seizure frequency of 0.6 seizures per month (range = 0.3-26). Responder rates at 3, 6, and 12 months were 79.6%, 70.1%, and 52.8%, respectively, and seizure freedom rates at the same points were 62.7%, 56.1%, and 41.5%. Regarding the 33 patients who had GTCS in the baseline period, 87.8% were seizure-free at 3 months, 78.1% at 6 months, and 55.1% at 12 months. Over the entire follow-up, PER monotherapy was generally well tolerated, and only 16% of patients discontinued PER due to adverse events (AEs). Female patients were found to be at a higher risk of psychiatric AEs (female vs male odds ratio = 2.85, 95% confidence interval = 1-8.33, P = .046). SIGNIFICANCE PER demonstrated good effectiveness and a good safety profile when used as primary therapy or conversion to monotherapy at relatively low doses, in a clinical setting with patients with focal seizures and GTCS.
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Affiliation(s)
- Rafael Toledano Delgado
- Epilepsy Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain.,Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain.,Epilepsy Unit, Neurology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | | | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Hospital Vall d´Hebron, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Hospital Vall d´Hebron, Barcelona, Spain
| | - Joaquín Ojeda
- Neurology Department, Hospital Infanta Sofía, Madrid, Spain
| | - Juan José Poza
- Neurology Department, Hospital Donostia, San Sebastian, Spain
| | - Albert Molins
- Neurology Department, Hospital Josep Trueta, Girona, Spain
| | - Pau Giner
- Neurology Department, Hospital Dr. Peset, Valencia, Spain
| | | | | | - Jorge Zurita
- Neurology Department, Hospital Infanta Leonor, Madrid, Spain
| | | | | | | | - Antonio Gil-Nagel
- Epilepsy Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Dulce Campos
- Neurology Department, Hospital Clínico de Valladolid, Valladolid, Spain
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Abstract
This article reviews common and clinically important neuropsychiatric aspects of epilepsy. Comorbidities are common, underdiagnosed, and powerfully impact clinical outcomes. Biological, psychological, and social factors contribute to the associations between epilepsy and neuropsychiatric disorders. Epidemiologic studies point to a bidirectional relationships between epilepsy and neuropsychiatric disorders. People with epilepsy are more likely to develop certain neuropsychiatric disorders, and those with these disorders are more likely to develop epilepsy. This relationship suggests the possibility of shared underlying pathophysiologies. We review the neuropsychiatric impact of antiseizure medications and therapeutic options for treatment. Diagnosis and treatment involve close collaboration among a multidisciplinary team.
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Affiliation(s)
- Benjamin Tolchin
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA; Epilepsy Center of Excellence, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA
| | - William Curt LaFrance
- Brown University, Rhode Island Hospital, Potter 3, 593 Eddy Street, Providence, RI 02903, USA
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Mula M, Kanner AM, Jetté N, Sander JW. Psychiatric Comorbidities in People With Epilepsy. Neurol Clin Pract 2020; 11:e112-e120. [PMID: 33842079 DOI: 10.1212/cpj.0000000000000874] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
Purpose of Review To review the latest evidence concerning the epidemiology, clinical implications, and management of psychiatric disorders in epilepsy. Recent Findings People with epilepsy have a 2-5 times increased risk of developing any psychiatric disorder, and 1 in 3 patients with epilepsy have a lifetime psychiatric diagnosis. Psychiatric comorbidities represent a poor prognostic marker as they have been associated with a poor response to treatment (drugs and surgery), increased morbidity, and mortality. Validated screening instruments are available for mood and anxiety disorders in adults as well as attention-deficit hyperactivity disorder in children with epilepsy. Summary All patients with epilepsy should be routinely screened for psychiatric disorder at the onset and at least once a year. Patients with epilepsy and their relatives should be informed of the risk of mental health problems and the implications.
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Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
| | - Andres M Kanner
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
| | - Nathalie Jetté
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
| | - Josemir W Sander
- Institute of Medical and Biomedical Education (MM), St George's University of London and the Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Department of Neurology (AMK), Comprehensive Epilepsy Center and Epilepsy Division, University of Miami, Miller School of Medicine, FL; Division of Epilepsy and Division of Health Outcomes and Knowledge Translation Research (NJ), Department of Neurology, Icahn School of Medicine at Mount Sinai, New York; NIHR UCL Hospitals Biomedical Research Centre (JWS), UCL Queen Square Institute of Neurology, London, and Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland-SEIN (JWS), Heemstede, the Netherlands
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Patel AD, Badalamenti V, Gasalla T, Elmoufti S, Elshoff JP. Safety and tolerability of adjunctive brivaracetam in children with focal seizures: Interim analysis of pooled data from two open-label trials. Eur J Paediatr Neurol 2020; 25:68-76. [PMID: 31810577 DOI: 10.1016/j.ejpn.2019.11.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/27/2019] [Accepted: 11/17/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate long-term safety and tolerability of adjunctive brivaracetam (BRV) in children with epilepsy. METHODS This was an interim analysis (cut-off March 15, 2017) of pooled data from two open-label, single-arm, multicentre trials. N01263 (NCT00422422) was a 3-week trial of BRV 0.8-4 mg/kg/day in patients (1 month-<16 years) with epilepsy. Patients who completed this trial could continue into a long-term follow-up trial (N01266, NCT01364597) which also directly enrolled patients (4-<17 years) with focal seizures. After dose-escalation, patients received BRV 1-5 mg/kg/day (maximum 200 mg/day) during long-term evaluation. Data are reported for patients aged 4 to <16 years with focal seizures. RESULTS The safety set comprised 149 patients: 34 from the initial trial (26 entered long-term trial) and 115 directly enrolled into the long-term trial. At the cut-off, 90 patients were receiving BRV (total exposure: 299.4 patient-years). Treatment-emergent adverse events (TEAEs) were reported by 140/149 (94.0%) patients, most commonly (≥20%) nasopharyngitis (24.8%), pharyngitis (22.1%), convulsion (21.5%), and pyrexia (20.1%). TEAEs considered drug-related by the investigator were reported by 56/149 (37.6%) patients, most commonly somnolence (6.0%). Two patients died; neither death was considered related to BRV. Mean changes from baseline in child behaviour rating scales were small; most patients remained in their baseline category. CONCLUSION In this pooled analysis of two open-label trials including long-term data, adjunctive BRV was generally well tolerated in children aged 4 to <16 years with focal seizures. These findings supported approval of BRV as a new therapy option for children aged ≥4 years with focal seizures.
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Affiliation(s)
- Anup D Patel
- Nationwide Children's Hospital and The Ohio State University of Medicine, Columbus, OH, USA.
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Tareke M, Birehanu M, Amare D, Abate A. Common mental illness among epilepsy patients in Bahir Dar city, Ethiopia: A cross-sectional study. PLoS One 2020; 15:e0227854. [PMID: 31971965 PMCID: PMC6977727 DOI: 10.1371/journal.pone.0227854] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/31/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Common mental illness has a substantial impact on seizure control and negatively affects the overall quality of life among individuals with epilepsy. However, there is a dearth of studies that examined the associated factors of common mental illness among epilepsy patients in Ethiopia, particularly in the study area. This study aimed to assess the magnitude and factors associated with common mental disorders in epilepsy patients who attended government health institutions in Bahir Dar city, Ethiopia. METHOD Health institution based cross-sectional study was conducted using a systematic sampling technique among people living with epilepsy in Bahir Dar City Administration. Common mental illness was assessed using a self-reporting questionnaire and a semi-structured questionnaire was employed to collect data on socio-demographic and clinical related characteristics. Data were analyzed using descriptive statistics, univariate logistic regression, and multivariable logistic regression. RESULTS The magnitude of comorbid common mental illness among people living with epilepsy was found 35.4%. High magnitude of common mental illness was reported among females (39.9%) when compared to males (32.3%). The most prevalent common mental disorders symptoms include being worried, unhappy feeling, trouble thinking clearly, and difficult to enjoy daily activities. Family history of epilepsy, frequent seizures attacks, side effects of antiepileptic drugs, lack of social support and not adherent to antiepileptic drugs were factors associated with common mental illness. CONCLUSIONS Common mental illness was found to be prevalent among people living with epilepsy. Therefore, it is recommended that great attention should be given to mental illness besides controlling seizure attacks.
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Affiliation(s)
- Minale Tareke
- Psychiatry Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Minychil Birehanu
- Nursing Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Desalegne Amare
- Nursing Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Andargie Abate
- Nursing Department, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Lee SA, Jeon JY, Kim HW. Effect of perampanel on aggression in patients with refractory focal epilepsy: A 6-month longitudinal study. Epilepsy Behav 2020; 102:106658. [PMID: 31743838 DOI: 10.1016/j.yebeh.2019.106658] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/25/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Clinical trials have demonstrated the efficacy of perampanel for the treatment of epilepsy. However, patients treated with this and other antiepileptic drugs often exhibit aggressive behaviors. We investigated the clinical factors contributing to aggression in patients with refractory focal epilepsy during 6 months of adjunctive perampanel treatment. METHODS This was a single-center longitudinal study involving patients treated with perampanel (starting dose, 2 mg/day; maximal dose, 12 mg/day). Patients were assessed with an aggression questionnaire (Korean version of Aggression Questionnaire [AQ-K]) and the hospital anxiety depression scale (HADS) at the beginning of the study and after receiving treatment for 6 months. Paired t-tests were used to compare AQ-K and HADS scores at the beginning of the study with those recorded at the end, and stepwise linear regression models were applied to identify predictive factors. RESULTS Thirty-two patients (mean age, 42.4 ± 10.3 years) successfully completed the 6-month study. The AQ-K and HADS scores increased after 6 months of adjunctive perampanel treatment (p < .1). The HADS scores related to depression at baseline predicted changes in total AQ-K scores, whereas the change in this HADS score was a predictor of physical and verbal aggression. A perampanel dose of ≥8 mg was a predictive factor for changes in anger and HADS scores related to depression after 6 months. Unexpectedly, concomitant use of topiramate had protective effects on AQ-K scores (including for verbal aggression and anger) in patients receiving perampanel. CONCLUSION Depressive symptoms and a high dose of perampanel are potential predictors for aggression, whereas concomitant use of topiramate is protective against aggression in patients receiving perampanel for focal epilepsy.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Ji Ye Jeon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun-Woo Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Neininger MP, Woltermann S, Jeschke S, Herziger B, Müller RM, Kiess W, Bertsche T, Bertsche A. How do pediatric patients perceive adverse drug events of anticonvulsant drugs? A survey. Eur J Pediatr 2020; 179:1413-1420. [PMID: 32162065 PMCID: PMC7413904 DOI: 10.1007/s00431-020-03571-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/20/2019] [Accepted: 01/08/2020] [Indexed: 11/27/2022]
Abstract
Anticonvulsant drugs have a high risk of adverse drug events. Little is known about the perception of those events by pediatric patients. We performed a survey in the neuropediatric departments of two university hospitals. Using a questionnaire, we interviewed patients aged 6-18 years with current anticonvulsant treatment regarding (i) their fears about potential adverse drug events, (ii) experienced adverse drug events, and (iii) perceived burden of experienced adverse drug events. One hundred patients took part in the interview. (i) 40 (40%) expressed fears that the medication could harm them. Eighteen of 40 (45%) named fears concerning specific adverse drug events. Of those, 12/18 (67%) feared neurologic or psychiatric symptoms. (ii) 37 (37%) of children described altogether 60 experienced adverse drug events. Of those, 38 (63%) concerned neurologic or psychiatric symptoms. (iii) 32/37 (82%) children who experienced adverse drug events felt bothered by the experienced event. Among others, they described an emotional burden (11/37, 30%), and restrictions in school performance (8/37, 22%) and favorite leisure activities (4/37, 11%).Conclusion: School-aged children are well able to describe adverse drug events of their anticonvulsant medication. Almost two thirds of the described events concern neurologic or psychiatric symptoms that cause an emotional burden and restrictions according to the patients. What is Known: • Anticonvulsants have a high potential of adverse drug events. • In an earlier survey, parents expressed fears of severe adverse drug events such as liver failure, which seldom occur, and reported a high number of neurological and psychological adverse drug events. What is New: • Many children fear that their anticonvulsants could harm them, and they fear and experience neurological and psychological adverse drug events. • According to the children, adverse drug events cause an emotional burden and restrictions in school performance and favorite leisure activities.
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Affiliation(s)
- Martina Patrizia Neininger
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
| | - Sarah Woltermann
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Sarah Jeschke
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
| | - Birthe Herziger
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
| | - Ruth Melinda Müller
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
| | - Wieland Kiess
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Thilo Bertsche
- Drug Safety Center and Clinical Pharmacy, Institute of Pharmacy, Medical Faculty, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany
| | - Astrid Bertsche
- Center for Pediatric Research, University Hospital for Children and Adolescents, Liebigstraße 20a, 04103 Leipzig, Germany
- Neuropaediatrics, University Hospital for Children and Adolescents, Ernst-Heydemann-Str. 8, 18057 Rostock, Germany
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Tolerability and efficacy of lacosamide and controlled-release carbamazepine monotherapy in patients with newly diagnosed epilepsy and concomitant psychiatric conditions: Post hoc analysis of a prospective, randomized, double-blind trial. Epilepsy Res 2019; 159:106220. [PMID: 31812127 DOI: 10.1016/j.eplepsyres.2019.106220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/27/2019] [Accepted: 10/15/2019] [Indexed: 01/13/2023]
Abstract
Psychiatric comorbidities are common in patients with epilepsy. A double-blind noninferiority monotherapy trial (SP0993; NCT01243177) enrolled newly diagnosed patients (≥16 years) with focal or generalized tonic-clonic seizures. Patients were randomized 1:1 to lacosamide or carbamazepine controlled-release (carbamazepine-CR). Here, we report data from an exploratory post hoc analysis of patients who reported ongoing psychiatric conditions (Medical Dictionary for Regulatory Activities System Organ Class). Of 886 treated patients in the trial, 126 (14.2%; 64 on lacosamide; 62 on carbamazepine-CR) reported at least one ongoing psychiatric condition at screening, most commonly depression (38.1%), insomnia (27.8%), and anxiety (26.2%). In this subgroup, 32/64 (50.0%) patients on lacosamide and 22/62 (35.5%) on carbamazepine-CR completed the trial. The most common reasons for discontinuation in patients on lacosamide and carbamazepine-CR were adverse events (10.9%, 24.2%) and lack of efficacy (18.8%, 11.3%). Treatment-emergent adverse events (TEAEs) were reported in 52 (81.3%) of patients on lacosamide and 56 (90.3%) of patients on carbamazepine-CR, most commonly (≥10% patients in either treatment group; lacosamide, carbamazepine-CR) dizziness (12.5%, 16.1%), headache (12.5%, 14.5%), nasopharyngitis (12.5%, 9.7%), fatigue (7.8%, 14.5%), nausea (7.8%, 11.3%), somnolence (1.6%, 12.9%), and gamma-glutamyltransferase increase (1.6%, 12.9%). Overall, 15 (23.4%) lacosamide-treated and 10 (16.1%) carbamazepine-CR treated patients reported psychiatric TEAEs, most commonly (≥3 patients in either treatment group; lacosamide, carbamazepine-CR) depression (4.7%, 0) and anxiety (3.1%, 6.5%). There were no reports of psychotic disorder, epileptic psychosis, acute psychosis, or serious psychiatric TEAEs. Stratified Kaplan-Meier estimates for 6- and 12-month seizure freedom at the last evaluated dose were similar with lacosamide and carbamazepine-CR (6 months 81.0%, 75.6%; 12 months 62.5%, 66.6%). A higher proportion of patients on lacosamide than carbamazepine-CR completed 6 (67.2%, 45.2%) and 12 months (50.0%, 37.1%) of treatment at the last evaluated dose without a seizure. This exploratory post hoc analysis indicated that lacosamide monotherapy was efficacious and generally well tolerated in patients with newly diagnosed epilepsy and concomitant psychiatric conditions. In this subpopulation, lacosamide showed similar efficacy and numerically better effectiveness than carbamazepine-CR.
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Watkins LV, Pickrell WO, Kerr MP. Treatment of psychiatric comorbidities in patients with epilepsy and intellectual disabilities: Is there a role for the neurologist? Epilepsy Behav 2019; 98:322-327. [PMID: 30598258 DOI: 10.1016/j.yebeh.2018.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 01/03/2023]
Abstract
This paper will explore the nature of psychiatric co-morbidities in people with an intellectual disability (ID) who have epilepsy. The complexity of clinical presentations and associated co-morbidities require thorough assessment utilising both neurological and psychiatric skills. The neurologist plays a central role in the management of epilepsy in people with ID and therefore requires basic competencies in the assessment of neuropsychiatric co-morbidities. This is key to liaison with other specialist services to ensure individuals receive holistic person-centred care. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy".
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Affiliation(s)
| | - William Owen Pickrell
- Neurology and Molecular Neuroscience, Swansea University Medical School, Swansea University, Swansea, UK
| | - Michael Patrick Kerr
- Institute of psychological medicine and clinical neuroscience, Cardiff University, UK
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Adachi N, Fenwick P, Akanuma N, Hara K, Ishii R, Okazaki M, Ito M, Sekimoto M, Kato M, Onuma T. Increased frequency of psychosis after second-generation antiepileptic drug administration in adults with focal epilepsy. Epilepsy Behav 2019; 97:138-143. [PMID: 31252268 DOI: 10.1016/j.yebeh.2019.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/02/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Many studies show psychoses after some antiepileptic drug (AED) administrations (post-AED administration psychoses [PAP]). It remains uncertain about psychogenetic potential of each AED and effects of clinical state factors on PAP. We examined the relations between AED-related factors (types, generations, dosages, and concomitant AED) and PAP. METHODS The clinical records of patients with focal epilepsy were retrospectively reviewed from eight adult epilepsy clinics, for every six-month period after administration of a new drug (either AED or non-AED) between 1981 and 2015. Characteristics of psychotic episodes, AED-related factors (type, daily dosage, and concomitant AED), and other state-related risk factors to psychosis (age, duration of epilepsy, history of psychosis, and seizure frequency) were examined. Psychogenetic risks of AED-related and state-related factors were analyzed with multifactorial procedures. RESULTS Of 2067 patients with focal epilepsy, 5018 new drugs (4402 AEDs and 616 non-AEDs) were administered. Within the first six-month period, 89 patients exhibited 105 psychotic episodes (81 interictal and 24 postictal psychoses: 55 first episodes and 50 recurrences). With second-generation AED (SAED) administration, particularly topiramate and lamotrigine, frequency of psychosis was significantly increased. Daily dosage of AED was not significantly associated with psychosis. Psychosis tended to occur with a higher number of concomitant AED. Subsequent analysis with AED-related and general factors showed that SAED administrations and previous psychotic history were the most significant risks for PAP. CONCLUSION Post-AED administration psychoses is associated with type of AED (SAED), rather than its dosage. Individual vulnerabilities are also associated with PAP.
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Affiliation(s)
- Naoto Adachi
- Adachi Mental Clinic, Sapporo, Japan; National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan.
| | - Peter Fenwick
- Institute of Psychiatry [emeritus], King's College London, London, UK
| | - Nozomi Akanuma
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Lambeth Assessment, Liaison and Treatment Team, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Ryouhei Ishii
- Department of Psychiatry, University of Osaka Graduate School of Medicine, Osaka, Japan
| | - Mitsutoshi Okazaki
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan
| | - Masumi Ito
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Jozen Clinic, Sapporo, Japan
| | - Masanori Sekimoto
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Masaaki Kato
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
| | - Teiichi Onuma
- National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan
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Doherty CP, Rheims S, Assenza G, Boero G, Chaves J, McMurray R, Villanueva V. Eslicarbazepine acetate in epilepsy patients with psychiatric comorbidities and intellectual disability: Clinical practice findings from the Euro-Esli study. J Neurol Sci 2019; 402:88-99. [DOI: 10.1016/j.jns.2019.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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Toledo M, Mazuela G, Mauri JA, Rodriguez-Osorio X, Gómez-Eguilaz M, Castro-Vilanova D, Rodriguez-Uranga J, Santamarina E. Levels of anger in epilepsy patients treated with eslicarbazepine acetate. Acta Neurol Scand 2019; 140:48-55. [PMID: 30953593 DOI: 10.1111/ane.13099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/22/2019] [Accepted: 04/03/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Aggressive behavior is commonly associated with epilepsy and can be influenced by the antiepileptic drugs (AEDs) taken. Sodium channel blockers, specifically the carboxamides derivatives such as carbamazepine and oxcarbazepine, are some of the AEDs considered to have a favorable psychiatric effect profile. OBJECTIVES We aimed to assess whether the carboxamide analogue eslicarbazepine acetate (ESL) has any effect on the levels of anger in patients with epilepsy. MATERIAL AND METHODS We prospectively recruited adult patients with epilepsy on treatment with ≦2 active AEDs, who required AED addition or substitution, excluding patients with active psychiatric disorders. All patients completed anger level (STAXI-2), depression-anxiety (HADS), and quality of life (QOLIE-10) assessments, and were evaluated at baseline and within 3-6 months after treatment initiation. RESULTS Of 78 patients receiving ESL, as add-on therapy or in substitution of a previous AED, were recruited into the ESL group, with an average age of 48 years and 54% men. We used a control group of 58 patients receiving AEDs other than carboxamides. CONCLUSIONS Patients overall showed improvements in anger levels, mood, and quality of life during the follow-up. A history of psychiatric disorders was a limiting factor to improve anger levels. As compared to controls, anger levels improved in ESL patients independently from seizure control. Therefore, ESL seems to exert a favorable influence on the anger levels of otherwise healthy patients with epilepsy, including those unresponsive to seizure control. The potential ESL anti-aggressive effect should be studied in patients with epilepsy and active psychiatric disorders.
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Affiliation(s)
- Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d´Hebron Hospital, Barcelona, Spain
| | - Gonzalo Mazuela
- Epilepsy Unit, Neurology Department, Vall d´Hebron Hospital, Barcelona, Spain
| | - Jose Angel Mauri
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Xiana Rodriguez-Osorio
- Epilepsy Unit, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | | | | | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d´Hebron Hospital, Barcelona, Spain
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El Otmani H, Amzil R, Rafai MA, El Moutawakil B. Complex hallucinations induced by lamotrigine. Rev Neurol (Paris) 2019; 175:410-411. [DOI: 10.1016/j.neurol.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/24/2018] [Accepted: 11/09/2018] [Indexed: 10/26/2022]
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