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Reed L, Ciliberto M, Fong SL, Nickels K, Kossoff E, Wirrell E, Joshi C. Efficacy of felbamate in a cohort of patients with epilepsy with myoclonic atonic seizures (EMAtS). Epilepsy Res 2024; 201:107314. [PMID: 38354549 DOI: 10.1016/j.eplepsyres.2024.107314] [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: 11/04/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
Epilepsy with myoclonic atonic seizures (EMAtS) is a rare childhood onset developmental and epileptic encephalopathy which is frequently refractory to medical therapy. The optimal antiseizure medication remains unknown. This study reports the efficacy of felbamate in children with EMAtS. Six large pediatric epilepsy centers performed a retrospective chart review on patients diagnosed with EMAtS at their institutions and collected data on felbamate usage and efficacy. Responders were classified as patients who had a 50% or greater reduction in seizures with a given therapy. Out of 259 patients, 37 (14%) were treated with felbamate. The efficacy of felbamate was 62%, which was greater than that of either levetiracetam or valproic acid (15%, p < 0.001% and 32%, p = 0.001 respectively) and similar to that of the ketogenic diet (69%, p = 0.8). Felbamate appears to be an effective treatment for EMAtS and should be strongly considered in the treatment course of this disease.
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Affiliation(s)
- Laurel Reed
- University of Michigan, C.S. Mott Children's Hospital, 1500 E. Hospital Dr., SPC 4279, Ann Arbor, MI 48109-4279, USA.
| | | | - Susan L Fong
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 2015, Cincinnati, OH 45529-3026, USA
| | | | - Eric Kossoff
- Johns Hopkins Hospital, Suite 2158 - 200 North Wolfe Street, Baltimore, MD 21287, USA
| | | | - Charuta Joshi
- University of Texas, Southwestern, 1935 Medical District Dr, Dallas, TX 75235, USA
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Gil‐Nagel A, Aledo‐Serrano A, Beltrán‐Corbellini Á, Martínez‐Vicente L, Jimenez‐Huete A, Toledano‐Delgado R, Gacía‐Morales I, Valls‐Carbó A. Efficacy and tolerability of add-on stiripentol in real-world clinical practice: An observational study in Dravet syndrome and non-Dravet developmental and epileptic encephalopathies. Epilepsia Open 2024; 9:164-175. [PMID: 37867433 PMCID: PMC10839358 DOI: 10.1002/epi4.12847] [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: 07/03/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE To assess efficacy and tolerability of stiripentol (STP) as adjunctive treatment in Dravet syndrome and non-Dravet refractory developmental and epileptic encephalopathies (DREEs). METHODS Retrospective observational study of all children and adults with DREE and prescribed adjunctive STP at Hospital Ruber Internacional from January 2000 to February 2023. Outcomes were retention rate, responder rate (proportion of patients with ≥50% reduction in total seizure frequency relative to baseline), seizure freedom rate, responder rate for status epilepticus, rate of adverse event and individual adverse events, reported at 3, 6, and 12 months and at final visit. Seizure outcomes are reported overall, and for Dravet and non-Dravet subgroups. RESULTS A total of 82 patients (55 Dravet syndrome and 27 non-Dravet DREE) were included. Median age was 5 years (range 1-59 years), and median age of epilepsy onset was younger in the Dravet group (4.9 [3.6-6] months) than non-Dravet (17.9 [6-42.3], P < 0.001). Median follow-up time STP was 24.1 months (2 years; range 0.3-164 months) and was longer in the Dravet group (35.9 months; range 0.8-164) than non-Dravet (17 months range 0.3-62.3, P < 0.001). At 12 months, retention rate, responder rate and seizure free rate was 68.3% (56/82), 65% [48-77%] and 18% [5.7-29%], respectively. There were no statistically significant differences between groups on these seizure outcomes. Adverse events were reported in 46.3% of patients (38/82), without differences between groups. SIGNIFICANCE In this population of patients with epileptic and developmental encephalopathies, outcomes with adjunctive STP were similar in patients with non-Dravet DREE to patients with Dravet syndrome.
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Barbour K, Tian N, Yozawitz EG, Wolf S, McGoldrick PE, Sands TT, Nelson A, Basma N, Grinspan ZM. Creating rare epilepsy cohorts using keyword search in electronic health records. Epilepsia 2023; 64:2738-2749. [PMID: 37498137 PMCID: PMC10984273 DOI: 10.1111/epi.17725] [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: 01/12/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Administrative codes to identify people with rare epilepsies in electronic health records are limited. The current study evaluated the use of keyword search as an alternative method for rare epilepsy cohort creation using electronic health records data. METHODS Data included clinical notes from encounters with International Classification of Diseases, Ninth Revision (ICD-9) codes for seizures, epilepsy, and/or convulsions during 2010-2014, across six health care systems in New York City. We identified cases with rare epilepsies by searching clinical notes for keywords associated with 33 rare epilepsies. We validated cases via manual chart review. We compared the performance of keyword search to manual chart review using positive predictive value (PPV), sensitivity, and F-score. We selected an initial combination of keywords using the highest F-scores. RESULTS Data included clinical notes from 77 924 cases with ICD-9 codes for seizures, epilepsy, and/or convulsions. The all-keyword search method identified 6095 candidates, and manual chart review confirmed that 2068 (34%) had a rare epilepsy. The initial combination method identified 1862 cases with a rare epilepsy, and this method performed as follows: PPV median = .64 (interquartile range [IQR] = .50-.81, range = .20-1.00), sensitivity median = .93 (IQR = .76-1.00, range = .10-1.00), and F-score median = .71 (IQR = .63-.85, range = .18-1.00). Using this method, we identified four cohorts of rare epilepsies with over 100 individuals, including infantile spasms, Lennox-Gastaut syndrome, Rett syndrome, and tuberous sclerosis complex. We identified over 50 individuals with two rare epilepsies that do not have specific ICD-10 codes for cohort creation (epilepsy with myoclonic atonic seizures, Sturge-Weber syndrome). SIGNIFICANCE Keyword search is an effective method for cohort creation. These findings can improve identification and surveillance of individuals with rare epilepsies and promote their referral to specialty clinics, clinical research, and support groups.
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Affiliation(s)
- Kristen Barbour
- University of California San Diego, San Diego, California, USA
| | - Niu Tian
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elissa G Yozawitz
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Steven Wolf
- Boston Children's Health Physicians, Hawthorne, New York, USA
- New York Medical College, Valhalla, New York, USA
| | - Patricia E McGoldrick
- Boston Children's Health Physicians, Hawthorne, New York, USA
- New York Medical College, Valhalla, New York, USA
| | - Tristan T Sands
- Columbia University Irving Medical Center, New York, New York, USA
| | - Aaron Nelson
- New York University Langone Medical Center, New York, New York, USA
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Santangelo A, Corsello A, Spolidoro GCI, Trovato CM, Agostoni C, Orsini A, Milani GP, Peroni DG. The Influence of Ketogenic Diet on Gut Microbiota: Potential Benefits, Risks and Indications. Nutrients 2023; 15:3680. [PMID: 37686712 PMCID: PMC10489661 DOI: 10.3390/nu15173680] [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: 07/13/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
The ketogenic diet (KD) restricts carbohydrate consumption, leading to an increase in ketone bodies, such as acetoacetate, β-hydroxybutyrate, and acetone, which are utilized as energy substrates. This dietary approach impacts several biochemical processes, resulting in improved clinical management of various disorders, particularly in childhood. However, the exact mechanisms underlying the efficacy of KD remain unclear. Interestingly, KD may also impact the gut microbiota, which plays a pivotal role in metabolism, nutrition, and the development of the immune and nervous systems. KD has gained popularity for its potential benefits in weight loss, blood sugar control, and certain neurological conditions. This narrative review sums up KD-related studies published over 30 years. While short-term studies have provided valuable insights into the effects of KD on the gut microbiota, persistent uncertainties surround its long-term efficacy and potential for inducing dysbiosis. The significant influence of KD on epigenetic mechanisms, intracellular pathways, and gut microbial composition underscores its potential as a therapeutic choice. However, a judicious consideration of the potential risks associated with the strict adherence to a low-carbohydrate, high-fat, and high-protein regimen over prolonged periods is imperative. As KDs gain popularity among the adolescent and young adult demographic for weight management, it becomes imperative to undertake additional research to comprehensively assess their impact on nutritional status and gut microbiota, ensuring a holistic and sustainable approach to medical nutrition.
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Affiliation(s)
- Andrea Santangelo
- Department of Pediatrics, Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (A.S.); (A.O.); (D.G.P.)
| | - Antonio Corsello
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (G.C.I.S.); (C.A.); (G.P.M.)
| | - Giulia Carla Immacolata Spolidoro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (G.C.I.S.); (C.A.); (G.P.M.)
| | - Chiara Maria Trovato
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, 00165 Rome, Italy;
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (G.C.I.S.); (C.A.); (G.P.M.)
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alessandro Orsini
- Department of Pediatrics, Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (A.S.); (A.O.); (D.G.P.)
| | - Gregorio Paolo Milani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy; (G.C.I.S.); (C.A.); (G.P.M.)
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Diego Giampietro Peroni
- Department of Pediatrics, Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy; (A.S.); (A.O.); (D.G.P.)
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Caraballo RH, Reyes Valenzuela G, Fortini S, Espeche A, Gamboni B, Silva W, Semprino M, Fasulo L, Chacón S, Gallo A, Galicchio S, Cachia P. Cannabidiol in children with treatment-resistant epilepsy with myoclonic-atonic seizures. Epilepsy Behav 2023; 143:109245. [PMID: 37182500 DOI: 10.1016/j.yebeh.2023.109245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE This multicenter study aimed to evaluate the efficacy and tolerability of add-on cannabidiol (CBD) in treatment-resistant patients with epilepsy with myoclonic-atonic seizures (EMAtS) (n = 22) and Sturge Weber syndrome (SWS) with myoclonic-atonic seizures (n = 4). METHODS Patients who met the diagnostic criteria of treatment-resistant EMAtS or SWS with myoclonic-atonic seizures were included. Cannabidiol was added in doses ranging from 8 to 40 mg/kg/day. Efficacy was assessed by comparing seizure frequency before and after initiating CBD therapy. Neurologic examinations, brain magnetic resonance imaging, repeated prolonged electroencephalography (EEG) and/or video-EEG recordings, and neurometabolic studies were performed in all patients, and genetic investigations in 15. RESULTS After a mean follow-up of 19 months, 15/26 patients (57.7%) who received add-on CBD had a >50% seizure decrease; three (11.5%) became seizure-free. The remaining 11 patients (42.3%) had a 25-50% seizure reduction. Drop attacks, including myoclonic-atonic seizures and generalized tonic-clonic seizures, as well as atypical absences and nonconvulsive status epilepticus responded well to CBD. In SWS patients, focal motor seizures without consciousness impairment and focal non-motor seizures with consciousness impairment were recognized in two each; in three a 30% reduction of focal seizures was observed. Side effects were mild and did not lead to CBD discontinuation. CONCLUSION This study evaluating the use of add-on CBD in children with EMAtS or SWS with myoclonic-atonic seizures found that 15/26 (57.7%) had a >50% seizure reduction with good tolerability; three (11.5%) became seizure-free.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Adolfo Gallo
- Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | | | - Pedro Cachia
- Hospital de Niños Victor J Vilela, Rosario, Santa Fé, Argentina
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Perinelli MG, Riva A, Amadori E, Follo R, Striano P. Learnings in developmental and epileptic encephalopathies: what do we know? Expert Rev Neurother 2023; 23:45-57. [PMID: 36726225 DOI: 10.1080/14737175.2023.2176221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Developmental and Epileptic Encephalopathies (DEEs) encompass a group of neurological disorders caused by either abnormal neuronal development and white matter maturation or even by weak synaptic plasticity. Hitherto, patients commonly have epileptic seizures featuring cognitive dysfunction, such as neurosensory disorders, difficulties in learning, behavioral disturbances, or speech delay. AREAS COVERED This paper provides a comprehensive review of the current knowledge of DEEs and cognition. Medline/Pubmed database was screened for in-English articles published between 1967-2022 dealing with the topic of DEEs and cognitive development. Two authors independently screened the title and abstract of each record and reviewed the selected articles. Reviews, randomized clinical trials, and case reports were selected. EXPERT OPINION Scientific literature has never explicitly dealt with the early neuro-psychomotor rehabilitation and neuropsychological assessment of patients with DEEs. Targeted intervention and environmental stimuli can influence the maturation of neuronal circuits and shape changes in physical and mental development based on neuronal plasticity, particularly if applied in 'critical periods' liable to heightened sensitivity. Thus, 'early neurorehabilitation interventions' are worthy of being more and more applied to clinical practice to improve the quality of life and reduce the psychosocial burden on families and caregivers.
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Affiliation(s)
- Martina Giorgia Perinelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Antonella Riva
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elisabetta Amadori
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Dietary Treatments for Epilepsy. Neurol Clin 2022; 40:785-797. [DOI: 10.1016/j.ncl.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bartolini E, Ferrari AR, Lattanzi S, Pradella S, Zaccara G. Drug-resistant epilepsy at the age extremes: Disentangling the underlying etiology. Epilepsy Behav 2022; 132:108739. [PMID: 35636351 DOI: 10.1016/j.yebeh.2022.108739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
The incidence of epilepsy is highest at the extreme age ranges: childhood and elderly age. The most common syndromes in these demographics - self-limited epilepsies of childhood and idiopathic generalized epilepsies in pediatric age, focal epilepsy with structural etiology in older people - are expected to be drug responsive. In this work, we focus on such epilepsy types, overviewing the complex clinical background of unexpected drug-resistance. For self-limited epilepsies of childhood and idiopathic generalized epilepsies, we illustrate drug-resistance resulting from syndrome misinterpretation, reason on possible unexpected courses of epilepsy, and explicate the influence of inappropriate treatments. For elderly-onset epilepsy, we show the challenges in differential diagnosis possibly leading to pseudoresistance and analyze how drug-resistant epilepsy can arise in stroke, neurocognitive disorders, brain tumors, and autoimmune encephalitis. In children and senior people, drug-resistance can be regarded as a hint to review the diagnosis or explore alternative therapeutic strategies. Refractory seizures are not only a therapeutic challenge, but also a cardinal sign not to be overlooked in syndromes commonly deemed to be drug-responsive.
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Affiliation(s)
- Emanuele Bartolini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Anna Rita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Silvia Pradella
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Prato, Italy.
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de Oliveira FR, da Silva NM, Hamoy M, Crespo-López ME, Ferreira IM, da Silva EO, de Matos Macchi B, do Nascimento JLM. The GABAergic System and Endocannabinoids in Epilepsy and Seizures: What Can We Expect from Plant Oils? Molecules 2022; 27:molecules27113595. [PMID: 35684543 PMCID: PMC9182121 DOI: 10.3390/molecules27113595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
Seizures and epilepsy are some of the most common serious neurological disorders, with approximately 80% of patients living in developing/underdeveloped countries. However, about one in three patients do not respond to currently available pharmacological treatments, indicating the need for research into new anticonvulsant drugs (ACDs). The GABAergic system is the main inhibitory system of the brain and has a central role in seizures and the screening of new ACD candidates. It has been demonstrated that the action of agents on endocannabinoid receptors modulates the balance between excitatory and inhibitory neurotransmitters; however, studies on the anticonvulsant properties of endocannabinoids from plant oils are relatively scarce. The Amazon region is an important source of plant oils that can be used for the synthesis of new fatty acid amides, which are compounds analogous to endocannabinoids. The synthesis of such compounds represents an important approach for the development of new anticonvulsant therapies.
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Affiliation(s)
- Fábio Rodrigues de Oliveira
- Programa de Pós-Graduação em Neurociências e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil; (F.R.d.O.); (N.M.d.S.); (E.O.d.S.)
- Laboratório de Controle de Qualidade e Bromatologia, Curso de Farmácia, Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Macapá 68902-280, Brazil
| | - Nágila Monteiro da Silva
- Programa de Pós-Graduação em Neurociências e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil; (F.R.d.O.); (N.M.d.S.); (E.O.d.S.)
- Laboratório de Neuroquímica Molecular e Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
| | - Moisés Hamoy
- Laboratório de Farmacologia e Toxicologia de Produtos Naturais, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
- Programa de Pós-Graduação em Farmacologia e Bioquímica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
| | - Maria Elena Crespo-López
- Programa de Pós-Graduação em Farmacologia e Bioquímica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil
| | - Irlon Maciel Ferreira
- Programa de Pós-Graduação em Ciências Farmacêuticas, Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Macapá 68902-280, Brazil;
- Laboratório de Biocatálise e Síntese Orgânica Aplicada, Departamento de Ciências Exatas e Tecnológicas, Universidade Federal do Amapá, Macapá 68902-280, Brazil
| | - Edilene Oliveira da Silva
- Programa de Pós-Graduação em Neurociências e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil; (F.R.d.O.); (N.M.d.S.); (E.O.d.S.)
- Laboratorio de Biologia Estrutural, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil
- Instituto Nacional de Ciência e Tecnologia de Biologia Estrutural e Bioimagem (INCT-INBEB), Rio de Janeiro 21941-590, Brazil
| | - Barbarella de Matos Macchi
- Laboratório de Neuroquímica Molecular e Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
- Programa de Pós-Graduação em Farmacologia e Bioquímica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
| | - José Luiz Martins do Nascimento
- Programa de Pós-Graduação em Neurociências e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil; (F.R.d.O.); (N.M.d.S.); (E.O.d.S.)
- Laboratório de Neuroquímica Molecular e Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
- Programa de Pós-Graduação em Farmacologia e Bioquímica, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil;
- Programa de Pós-Graduação em Ciências Farmacêuticas, Departamento de Ciências Biológicas e da Saúde, Universidade Federal do Amapá, Macapá 68902-280, Brazil;
- Instituto Nacional de Ciência e Tecnologia em Neuroimunomodulação (INCT-NIM), Rio de Janeiro 21040-900, Brazil
- Correspondence:
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Caraballo RH, Reyes Valenzuela G, Fortini S, Espeche A, Gamboni B, Bautista C, Cachia P, Semprino M, Gallo A, Galicchio S. Use of sulthiame as add-on therapy in children with myoclonic atonic epilepsy: A study of 35 patients. Epilepsy Behav 2022; 131:108702. [PMID: 35526461 DOI: 10.1016/j.yebeh.2022.108702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this retrospective study was to evaluate efficacy and tolerability of sulthiame (STM) as add-on treatment in 35 patients with myoclonic atonic epilepsy (MAE) resistant to other antiseizure medications (ASMs) and/or non-pharmacological treatment. METHODS Patients were selected according to the diagnostic definition of MAE and were resistant to at least four previous to ASM, alone or in combination. Neurologic examinations, brain magnetic resonance imaging, and repeated prolonged electroencephalography (EEG) or video-EEG studies as well as neurometabolic studies were performed in all cases. Genetic studies were performed in 15 patients. Data on school achievements and/or neuropsychological evaluations were obtained over a mean follow-up of 30 months. Sulthiame was added in doses ranging from 10 to 30 mg/kg/day. Efficacy was assessed by comparing seizure frequency before and after initiating STM therapy. RESULTS Twenty-one of 35 patients (60%) who received STM as add-on therapy had a greater than 50% seizure decrease after a mean follow-up of 30 months. Complete seizure freedom was achieved in two patients (5.8%). The remaining 14 patients (40%) had a 25-50% seizure reduction. Adverse effects, consisting of hyperpnea and dyspnea, decreased appetite, nausea, drowsiness, headache, and irritability, were observed in 11 (31.4%). The adverse effects were mild and transient in all cases. Discontinuation of STM was not necessary. CONCLUSION Add-on STM led to a more than 50% seizure reduction in 21 of 35 patients with MAE with only mild or moderate adverse effects.
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Affiliation(s)
| | | | | | | | | | | | - Pedro Cachia
- Hospital de Niños Victor J Vilela. Rosario, Santa Fé, Argentina
| | | | - Adolfo Gallo
- Hospital de Pediatría "Prof. Dr. Juan P Garrahan", Buenos Aires, Argentina
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Abstract
PURPOSE OF REVIEW This article reviews the clinical features, typical EEG findings, treatment, prognosis, and underlying molecular etiologies of the more common genetic epilepsy syndromes. Genetic generalized epilepsy, self-limited focal epilepsy of childhood, self-limited neonatal and infantile epilepsy, select developmental and epileptic encephalopathies, progressive myoclonus epilepsies, sleep-related hypermotor epilepsy, photosensitive occipital lobe epilepsy, and focal epilepsy with auditory features are discussed. Also reviewed are two familial epilepsy syndromes: genetic epilepsy with febrile seizures plus and familial focal epilepsy with variable foci. RECENT FINDINGS Recent years have seen considerable advances in our understanding of the genetic factors underlying genetic epilepsy syndromes. New therapies are emerging for some of these conditions; in some cases, these precision medicine approaches may dramatically improve the prognosis. SUMMARY Many recognizable genetic epilepsy syndromes exist, the identification of which is a crucial skill for neurologists, particularly those who work with children. Proper diagnosis of the electroclinical syndrome allows for appropriate treatment choices and counseling regarding prognosis and possible comorbidities.
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Vasquez A, Buraniqi E, Wirrell EC. New and emerging pharmacologic treatments for developmental and epileptic encephalopathies. Curr Opin Neurol 2022; 35:145-154. [PMID: 35102126 DOI: 10.1097/wco.0000000000001029] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Summarize evidence on Developmental and Epileptic Encephalopathies (DEEs) treatments focusing on new and emerging pharmacologic therapies (see Video, http://links.lww.com/CONR/A61, Supplementary Digital Content 1, which provides an overview of the review). RECENT FINDINGS Advances in the fields of molecular genetics and neurobiology have led to the recognition of underlying pathophysiologic mechanisms involved in an increasing number of DEEs that could be targeted with precision therapies or repurposed drugs, some of which are currently being evaluated in clinical trials. Prompt, optimal therapy is critical, and promising therapies approved or in clinical trials for tuberous sclerosis complex, Dravet and Lennox-Gastaut Syndromes including mammalian target of rapamycin inhibitors, selective membrane channel and antisense oligonucleotide modulation, and repurposed drugs such as fenfluramine, stiripentol and cannabidiol, among others, may improve seizure burden and neurological outcomes. There is an urgent need for collaborative efforts to evaluate the efficacy and safety of emerging DEEs therapies. SUMMARY Development of new therapies promise to address unmet needs for patients with DEEs, including improvement of neurocognitive function and quality of life.
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Affiliation(s)
- Alejandra Vasquez
- Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Jiang S, He X. Prediction Value of Epilepsy Secondary to Inferior Cavity Hemorrhage Based on Scalp EEG Wave Pattern in Deep Learning. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2084276. [PMID: 35340252 PMCID: PMC8941549 DOI: 10.1155/2022/2084276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022]
Abstract
Objective To search the predictive value of epilepsy secondary to acute subarachnoid hemorrhage (aSAH) based on EEG wave pattern in deep learning. Methods A total of 156 cases of secondary epilepsy with lower cavity hemorrhage in our hospital were selected and divided into the late epilepsy group and the early epilepsy group according to seizure time, and the nonseizure group and the seizure group according to seizure condition. General data of patients were collected, the EEG types of each group were analyzed, and the disease recurrence rate, treatment effect, and symptom onset time were compared. Results Rapid and slow and rapid blood flow velocity were the main abnormal manifestations of epilepsy secondary to inferior cavity hemorrhage, accounting for 33.3% and 18.6%, respectively. Compared with the seizure group, the proportion of type ii and type iii in the nonseizure group was higher, and the proportion of type ii and type iii in the early epilepsy group was higher than in the late epilepsy group (P < 0.05). The diagnostic accuracy, missed diagnosis rate, misdiagnosis rate, specificity, and sensitivity of the EEG wave pattern were 94.9%, 3.2%, 1.9%, 91.7%, and 96.2%, respectively. Compared with the early epilepsy group, the recurrence rate of type iii and type iv in the late epilepsy group was higher (P < 0.05). The effective rates of the attack group and the nonattack group were 72.7% and 97.0%, respectively. Compared with the attack group, the effective rate of the nonattack group was higher (P < 0.05). The effective rates of the early epilepsy group and the late epilepsy group were 91.7% and 85.0%, respectively. Compared with the late epilepsy group, the effective rate of the early epilepsy group was higher (P < 0.05). Compared with the early epilepsy group, the late epilepsy group had longer tonic-clonic seizures, atonic seizures, and absent seizures, and the difference between the groups was statistically significant (P < 0.05). Conclusion In aSAH secondary epilepsy disease prediction, based on indepth study of the scalp EEG wave type prediction, they play an important role, including aSAH high-risk secondary epilepsy wave types for V, III, and IV types, as well as early and late epilepsy associated with disease stage. Through the diagnosis method to predict the severity of disease, this builds a good foundation for clinical treatment. It is beneficial to improve the effective rate of treatment.
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Affiliation(s)
- Shishuang Jiang
- Department of Critical-care Medicine, Yongchuan Hospital Chongqing Medical University, Yongchuan, Chongqing 402160, China
| | - Xuenong He
- Department of Neurosurgery, Yongchuan Hospital Chongqing Medical University, Yongchuan, Chongqing 402160, China
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Epilepsy with myoclonic-atonic seizures, also known as Doose syndrome: Modification of the diagnostic criteria. Eur J Paediatr Neurol 2022; 36:37-50. [PMID: 34883415 DOI: 10.1016/j.ejpn.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/20/2021] [Accepted: 11/16/2021] [Indexed: 11/20/2022]
Abstract
The aim of this review is to propose the updated diagnostic criteria of epilepsy with myoclonic-atonic seizures (EMAS), which is a recent subject of genetic studies. Although EMAS has been well known as Doose syndrome, it is often difficult to diagnose due to a lack of consensus regarding some of the inclusion criteria. Along with progress in molecular genetic study on the syndrome, it becomes important to recruit electroclinical homogeneous EMAS patients, hence the validity of the clinical criteria should be verified based on recent clinical researches. At present, the most updated ILAE diagnostic manual of EMAS includes: (1) normal development and cognition before the onset of epilepsy; (2) onset of epilepsy between 6 months and 6 years of age (peak: 2-4 years); (3) myoclonic-atonic seizures (MAS) are mandatory (4) presence of generalized spike-wave discharges at 2-3 Hz without persistent focal spike discharges; and (5) exclusion of other myoclonic epilepsy syndromes. In the criteria, we should emphasize that the age at onset of MAS is between 2-5 years in (2), presence of myoclonic-atonic, atonic or myoclonic-flexor seizures (MASs) causing drop attacks associated with generalized spike-wave discharges is mandatory in (3), and epileptic spasms causing drop attacks must be excluded in (5). In the modified criteria, I propose that EMAS is redesignated as genetic generalized epilepsy with MASs, consistent with the familial genetic study conducted by Doose and the recent identification of candidate genes. It should also be noted that EMASs evolves to transient or long-lasting epileptic encephalopathy.
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