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Nagarajan S, Prabu R, Parachuri N, Thulasidas M. Electroretinogram as a Screening Tool to Assess Vigabatrin-Induced Retinal Toxicity in Children With Infantile Spasms. J Pediatr Ophthalmol Strabismus 2024; 61:273-278. [PMID: 38482803 DOI: 10.3928/01913913-20240215-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
PURPOSE To assess the utility of electroretinogram (ERG) as a screening tool for vigabatrin-induced retinal toxicity in children with infantile spasms. METHODS This was an observational cohort study including children with infantile spasms receiving treatment with vigabatrin. A 30-Hz flicker potential ERG, using the RETeval system (LKC Technologies), was done at baseline before starting vigabatrin at 6 months and 1 year. The amplitudes were recorded. RESULTS Eleven children were included in the study. The most common etiologic factor for infantile spasms was tuberous sclerosis (36.4%) followed by West syndrome (27.3%). The mean age of the children was 7.14 ± 2.9 months, with a range of 3 to 16 months. The mean difference in amplitude was 3.21 ± 2.45 and 5.72 ± 4.18 µV at 6 and 12 months follow-up, respectively (P < .001). Eight of the 11 children (72.7%) showed vigabatrin-induced retinal toxicity, and all 8 children were receiving vigabatrin for more than 6 months. CONCLUSIONS ERG can be used for vigabatrin-induced retinal toxicity monitoring in children with infantile spasms. Vigabatrin-induced retinal toxicity is related to the duration of treatment rather than cumulative dosage. [J Pediatr Ophthalmol Strabismus. 2024;61(4):273-278.].
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Colmers PLW, Arshad MN, Mukherjee J, Lin S, Ng SFJ, Sarmiere P, Davies PA, Moss SJ. Sustained Inhibition of GABA-AT by OV329 Enhances Neuronal Inhibition and Prevents Development of Benzodiazepine Refractory Seizures. eNeuro 2024; 11:ENEURO.0137-24.2024. [PMID: 38937107 PMCID: PMC11236575 DOI: 10.1523/eneuro.0137-24.2024] [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: 03/28/2024] [Revised: 06/18/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024] Open
Abstract
γ-Aminobutyric acid (GABA) is the principal inhibitory neurotransmitter in the adult brain which mediates its rapid effects on neuronal excitability via ionotropic GABAA receptors. GABA levels in the brain are critically dependent upon GABA-aminotransferase (GABA-AT) which promotes its degradation. Vigabatrin, a low-affinity GABA-AT inhibitor, exhibits anticonvulsant efficacy, but its use is limited due to cumulative ocular toxicity. OV329 is a rationally designed, next-generation GABA-AT inhibitor with enhanced potency. We demonstrate that sustained exposure to OV329 in mice reduces GABA-AT activity and subsequently elevates GABA levels in the brain. Parallel increases in the efficacy of GABAergic inhibition were evident, together with elevations in electroencephalographic delta power. Consistent with this, OV329 exposure reduced the severity of status epilepticus and the development of benzodiazepine refractory seizures. Thus, OV329 may be of utility in treating seizure disorders and associated pathologies that result from neuronal hyperexcitability.
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Affiliation(s)
- Phillip L W Colmers
- Department of Neuroscience, Tufts University School of Medicine, Boston, Massachusetts 02111
| | - Muhammad Nauman Arshad
- Department of Neuroscience, Tufts University School of Medicine, Boston, Massachusetts 02111
| | | | | | - Shu Fun Josephine Ng
- Department of Neuroscience, Tufts University School of Medicine, Boston, Massachusetts 02111
| | | | - Paul A Davies
- Department of Neuroscience, Tufts University School of Medicine, Boston, Massachusetts 02111
| | - Stephen J Moss
- Department of Neuroscience, Tufts University School of Medicine, Boston, Massachusetts 02111
- Department of Neuroscience, Physiology and Pharmacology, University College London, London WC1 6BT, United Kingdom
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Giuliano L, Durante V, Battaglia G, Gasparini S, Zambrelli E, Ermio C, La Neve A, Mostacci B. Sex Differences in Adverse Effects of Antiseizure Medications in Adults with Epilepsy: A Systematic Review. CNS Drugs 2024; 38:409-423. [PMID: 38691320 DOI: 10.1007/s40263-024-01088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Sex differences in epilepsy have been described in prevalence, seizure propensity and response to treatment. Therefore, taking into account sex-based differences in epilepsy is important for both diagnostic purposes and therapeutic considerations. However, little is known about sex differences in adverse effects of antiseizure medications (ASMs). OBJECTIVES We performed a systematic review searching for sex differences in adverse effects of ASMs in adult persons with epilepsy (PWE) as part of a wider project aimed to assess sex-based differences in efficacy and adverse effects of ASMs in PWE. METHODS We conducted a comprehensive literature search in the PubMed database. The search was conducted with no restriction on publication date, and all results up to April 2020 were included. We included articles written in English, Italian, Spanish, or French that evaluated adverse effects of one or more ASMs in PWE, with specific mention of the two sexes. When appropriate, Newcastle-Ottawa or Jadad scales were used to assess study quality. RESULTS Of 5164 identified studies, only 167 considered sex in the analysis and were therefore included. Significant sex-related differences were found in 58 of those studies. We found a consistently higher frequency of cutaneous adverse effects in females; higher risk of developing general adverse effects on different ASMs in females; stronger risk of adverse effects on bone metabolism in females, mainly on treatment with enzyme-inducing ASMs; a concordant higher risk of visual field loss was noted in males on vigabatrin; an overall worse lipid profile in males; as well as higher leptin levels and higher body mass index in females treated with various ASMs. CONCLUSIONS Our analysis has identified some important sex differences in the adverse effects of ASMs. Clinicians should be aware of these differences when informing patients about the risks associated with ASM treatment in PWE.
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Affiliation(s)
- Loretta Giuliano
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy.
| | - Vania Durante
- Neurology Unit, "A. Perrino" Hospital, Brindisi, Italy
| | - Giulia Battaglia
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Regional Epilepsy Center, "Great Metropolitan Hospital", Reggio Calabria, Italy
| | - Elena Zambrelli
- Epilepsy Center, Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Caterina Ermio
- Department of Neuroscience, "S. Giovanni Paolo II" Hospital, Lamezia Terme, Catanzaro, Italy
| | - Angela La Neve
- Department DiBrain, University of Bari "Aldo Moro", Bari, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the ERN EpiCARE, Bologna, Italy
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Deckard E, Sathe R, Tabibzadeh D, Terango A, Groves A, Rajaraman RR, Nariai H, Hussain SA. Epileptic spasms relapse is associated with response latency but not conventional attributes of post-treatment EEG. Epilepsia Open 2024; 9:1034-1041. [PMID: 38588009 PMCID: PMC11145600 DOI: 10.1002/epi4.12931] [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: 09/20/2023] [Revised: 02/06/2024] [Accepted: 03/09/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE Relapse of epileptic spasms after initial treatment of infantile epileptic spasms syndrome (IESS) is common. However, past studies of small cohorts have inconsistently linked relapse risk to etiology, treatment modality, and EEG features upon response. Using a large single-center IESS cohort, we set out to quantify the risk of epileptic spasms relapse and identify specific risk factors. METHODS We identified all children with epileptic spasms at our center using a clinical EEG database. Using the electronic medical record, we confirmed IESS syndrome classification and ascertained treatment, response, time to relapse, etiology, EEG features, and other demographic factors. Relapse-free survival analysis was carried out using Cox proportional hazards regression. RESULTS Among 599 children with IESS, 197 specifically responded to hormonal therapy and/or vigabatrin (as opposed to surgery or other second-line treatments). In this study, 41 (21%) subjects exhibited relapse of epileptic spasms within 12 months of response. Longer duration of IESS prior to response (>3 months) was strongly associated with shorter latency to relapse (hazard ratio = 3.11; 95% CI 1.59-6.10; p = 0.001). Relapse was not associated with etiology, developmental status, or any post-treatment EEG feature. SIGNIFICANCE This study suggests that long duration of IESS before response is the single largest clinical predictor of relapse risk, and therefore underscores the importance of prompt and successful initial treatment. Further study is needed to evaluate candidate biomarkers of epileptic spasms relapse and identify treatments to mitigate this risk. PLAIN LANGUAGE SUMMARY Relapse of infantile spasms is common after initially successful treatment. With study of a large group of children with infantile spasms, we determined that relapse is linked to long duration of infantile spasms. In contrast, relapse was not associated with the cause of infantile spasms, developmental measures, or EEG features at the time of initial response. Further study is needed to identify tools to predict impending relapse of infantile spasms.
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Affiliation(s)
- Emmi Deckard
- Department of PediatricsDivision of NeurologyUniversity of California Los Angeles and UCLA Mattel Children's HospitalCaliforniaLos AngelesUSA
| | - Rujuta Sathe
- Department of PediatricsDivision of NeurologyUniversity of California Los Angeles and UCLA Mattel Children's HospitalCaliforniaLos AngelesUSA
| | - David Tabibzadeh
- Department of PediatricsDivision of NeurologyUniversity of California Los Angeles and UCLA Mattel Children's HospitalCaliforniaLos AngelesUSA
| | - Aria Terango
- Department of PediatricsDivision of NeurologyUniversity of California Los Angeles and UCLA Mattel Children's HospitalCaliforniaLos AngelesUSA
| | - Aran Groves
- Department of PediatricsDivision of NeurologyUniversity of California Los Angeles and UCLA Mattel Children's HospitalCaliforniaLos AngelesUSA
| | - Rajsekar R. Rajaraman
- Department of PediatricsDivision of NeurologyUniversity of California Los Angeles and UCLA Mattel Children's HospitalCaliforniaLos AngelesUSA
| | - Hiroki Nariai
- Department of PediatricsDivision of NeurologyUniversity of California Los Angeles and UCLA Mattel Children's HospitalCaliforniaLos AngelesUSA
| | - Shaun A. Hussain
- Department of PediatricsDivision of NeurologyUniversity of California Los Angeles and UCLA Mattel Children's HospitalCaliforniaLos AngelesUSA
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Kuchenbuch M, Lo Barco T, Chemaly N, Chiron C, Nabbout R. Fifteen years of real-world data on the use of vigabatrin in individuals with infantile epileptic spasms syndrome. Epilepsia 2024; 65:430-444. [PMID: 37872396 DOI: 10.1111/epi.17808] [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: 03/17/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate our treatment algorithm for infantile epileptic spasms syndrome (IESS) used between 2000 and 2018. We initiated vigabatrin (VGB), and steroids were added if the electroclinical response (spasms and electroencephalogram [EEG]) to VGB was not obtained or incomplete. METHODS Individuals with IESS treated with VGB were recruited from our hospital clinical data warehouse based on electronic health records (EHRs) generated since 2009 and containing relevant keywords. We confirmed the diagnosis of IESS. Clinical, EEG, imaging, and biological data were extracted from the EHRs. We analyzed factors associated with short-term response, time to response, relapse, time to relapse of spasms, and the presence of spasms at last follow-up. RESULTS We collected data from 198 individuals (female: 46.5%, IESS onset: 6 [4.5-10.3] months, follow-up: 4.6 [2.5-7.6] years, median [Q1-Q3]) including 129 (65.2%) with identifiable etiology. VGB was started 17 (5-57.5) days after IESS diagnosis. A total of 113 individuals were responders (57.1% of the cohort), 64 with VGB alone and 38 with VGB further combined with steroids (56.6% and 33.6% of responders, respectively). Among responders, 33 (29%) experienced relapses of spasms, mostly those with later onset of spasms (p = .002) and those who received VGB for <24 months after spasms cessation compared to a longer duration on VGB (45% vs. 12.8%, p = .003). At follow-up, 92 individuals were seizure-free (46.5% of the whole cohort), including 26 free of therapy (13.1%). One hundred twelve individuals (56.6%) were still receiving VGB, with a duration of 3.2 (1.75-5.7) years. SIGNIFICANCE Our sequential protocol introducing VGB then adding steroids is an effective alternative to a combined VGB-steroids approach in IESS. It avoids steroid-related adverse events, as well as those from VGB-steroid combination. According to our data, a period of 7 days seems sufficient to assess VGB response and enables the addition of steroids rapidly if needed. Continuing VGB for 2 years may balance the risk of relapse and treatment-induced adverse events.
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Affiliation(s)
- Mathieu Kuchenbuch
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Service de Pédiatrie, Reference Center for Rare Epilepsies, member of ERN EpiCARE, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Tommaso Lo Barco
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Nicole Chemaly
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
| | - Catherine Chiron
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Rima Nabbout
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Université de Paris Cité, Paris, France
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Gatson TN, Freemont OA, Coleman RL, Lockett SJ, Spillers NJ, Ahmadzadeh S, Viswanath O, Varrassi G, Shekoohi S, Kaye AD. Vigabatrin (Sabril) for the Treatment of Refractory Complex Focal Seizures in Adults: Pharmacologic and Clinical Considerations. Cureus 2023; 15:e46414. [PMID: 37927747 PMCID: PMC10621625 DOI: 10.7759/cureus.46414] [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: 08/08/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
To review the pharmacokinetics, efficacy, and adverse effects of vigabatrin (Sabril) and its role in managing refractory focal unaware seizures in adults. In the present investigation, a search of English-language literature from 1999 through 2023 was conducted using vigabatrin and Sabril as search terms to identify relevant studies and review articles. A 2000 double-blind, placebo-controlled multicenter study found that out of 90 adult patients, 48% of those treated with vigabatrin achieved a 50% or greater reduction in the frequency of complex partial seizures, compared to 26% of placebo-treated patients. This study also observed that vigabatrin was well tolerated by 72.4% of patients, with the most common side effects being drowsiness, dizziness, headache, and fatigue. Further studies with a significant risk of vigabatrin-associated visual field loss necessitate vigabatrin only being an option for refractory cases. Additional studies suggest that despite the potential risk of vision loss and adverse effects, adult patients continue to use vigabatrin long-term. Sabril is an antiepileptic medication prescribed as an additional treatment for refractory complex partial seizures in patients at least ten years old who have not responded well to other alternative therapies. Multiple clinical trials indicate that Sabril sufficiently reduces the frequency of seizures when used as an adjunct treatment of refractory complex focal seizures. However, it is important to carefully monitor patients for any adverse effects, particularly long-term use, and to discontinue the drug if serious side effects occur.
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Affiliation(s)
- Taylor N Gatson
- Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Orlandria A Freemont
- Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Rachel L Coleman
- Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Stewart J Lockett
- Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Noah J Spillers
- Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Shahab Ahmadzadeh
- Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Omar Viswanath
- Pain Management, Valley Pain Consultants - Envision Physician Services, Phoenix, USA
| | | | - Sahar Shekoohi
- Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
| | - Alan D Kaye
- Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, USA
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Boothman I, Clayton LM, McCormack M, Driscoll AM, Stevelink R, Moloney P, Krause R, Kunz WS, Diehl S, O’Brien TJ, Sills GJ, de Haan GJ, Zara F, Koeleman BP, Depondt C, Marson AG, Stefansson H, Stefansson K, Craig J, Johnson MR, Striano P, Lerche H, Furney SJ, Delanty N, Sisodiya SM, Cavalleri GL. Testing for pharmacogenomic predictors of ppRNFL thinning in individuals exposed to vigabatrin. Front Neurosci 2023; 17:1156362. [PMID: 37790589 PMCID: PMC10542409 DOI: 10.3389/fnins.2023.1156362] [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] [Received: 04/25/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Background The anti-seizure medication vigabatrin (VGB) is effective for controlling seizures, especially infantile spasms. However, use is limited by VGB-associated visual field loss (VAVFL). The mechanisms by which VGB causes VAVFL remains unknown. Average peripapillary retinal nerve fibre layer (ppRNFL) thickness correlates with the degree of visual field loss (measured by mean radial degrees). Duration of VGB exposure, maximum daily VGB dose, and male sex are associated with ppRNFL thinning. Here we test the hypothesis that common genetic variation is a predictor of ppRNFL thinning in VGB exposed individuals. Identifying pharmacogenomic predictors of ppRNFL thinning in VGB exposed individuals could potentially enable safe prescribing of VGB and broader use of a highly effective drug. Methods Optical coherence topography (OCT) and GWAS data were processed from VGB-exposed individuals (n = 71) recruited through the EpiPGX Consortium. We conducted quantitative GWAS analyses for the following OCT measurements: (1) average ppRNFL, (2) inferior quadrant, (3) nasal quadrant, (4) superior quadrant, (5) temporal quadrant, (6) inferior nasal sector, (7) nasal inferior sector, (8) superior nasal sector, and (9) nasal superior sector. Using the summary statistics from the GWAS analyses we conducted gene-based testing using VEGAS2. We conducted nine different PRS analyses using the OCT measurements. To determine if VGB-exposed individuals were predisposed to having a thinner RNFL, we calculated their polygenic burden for retinal thickness. PRS alleles for retinal thickness were calculated using published summary statistics from a large-scale GWAS of inner retinal morphology using the OCT images of UK Biobank participants. Results The GWAS analyses did not identify a significant association after correction for multiple testing. Similarly, the gene-based and PRS analyses did not reveal a significant association that survived multiple testing. Conclusion We set out to identify common genetic predictors for VGB induced ppRNFL thinning. Results suggest that large-effect common genetic predictors are unlikely to exist for ppRNFL thinning (as a marker of VAVFL). Sample size was a limitation of this study. However, further recruitment is a challenge as VGB is rarely used today because of this adverse reaction. Rare variants may be predictors of this adverse drug reaction and were not studied here.
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Affiliation(s)
- Isabelle Boothman
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- The SFI Futureneuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
- The SFI Centre for Research Training in Genomics Data Science, Galway, Ireland
| | - Lisa M. Clayton
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Bucks, United Kingdom
| | - Mark McCormack
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Remi Stevelink
- Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Patrick Moloney
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Roland Krause
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Wolfram S. Kunz
- Division of Neurochemistry, Department of Epileptology, University Bonn Medical Center, Bonn, Germany
| | - Sarah Diehl
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Terence J. O’Brien
- Departments of Neuroscience and Neurology, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Graeme J. Sills
- School of Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Gerrit-Jan de Haan
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
| | - Federico Zara
- "IRCCS”G. Gaslini" Institute, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Bobby P. Koeleman
- Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Chantal Depondt
- Department of Neurology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Anthony G. Marson
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | | | | | - John Craig
- Department of Neurology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Michael R. Johnson
- Division of Brain Sciences, Imperial College Faculty of Medicine, London, United Kingdom
| | - Pasquale Striano
- "IRCCS”G. Gaslini" Institute, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Simon J. Furney
- Genomic Oncology Research Group, Deptartment of Physiology and Medical Physics, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Norman Delanty
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
- Chalfont Centre for Epilepsy, Bucks, United Kingdom
| | - Gianpiero L. Cavalleri
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- The SFI Futureneuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
- The SFI Centre for Research Training in Genomics Data Science, Galway, Ireland
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Schein Y, Miller KD, Han Y, Yu Y, de Alba Campomanes AG, Binenbaum G, Oatts JT. Ocular examinations, findings, and toxicity in children taking vigabatrin. J AAPOS 2022; 26:187.e1-187.e6. [PMID: 35817277 PMCID: PMC10947413 DOI: 10.1016/j.jaapos.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/21/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The antiepileptic medication vigabatrin has been associated with ocular toxicity, and close ophthalmic monitoring has been recommended; however, there is no clear consensus regarding the value and feasibility of such monitoring in children. We describe ophthalmic assessments in children in a real-world clinical setting, the incidence of vigabatrin-related ocular toxicity, and the utility of regular screening or ancillary testing in children taking vigabatrin. METHODS The medical records of children taking vigabatrin with one or more ophthalmic assessments at Children's Hospital of Philadelphia or University of California, San Francisco, between May 2010 and May 2021, were reviewed retrospectively. Abnormalities on ophthalmic examination, visual field (VF), electroretinogram (ERG), and optical coherence tomography (OCT) were reviewed and categorized as attributable to vigabatrin, possibly attributable to vigabatrin, or not attributable to vigabatrin. RESULTS A total of 1,281 assessments of 284 children (mean age, 2.09 years) were included. Of these, 283 (99.6%) had funduscopic examination(s), 37 (13.0%) had ERG, 19 (6.7%) had OCT, and 6 (2.1%) had formal VF. Rate of examinations and ERGs per child decreased over the 10-year study period. Two children (0.7%) had definite vigabatrin-related ocular toxicity, both identified on ERG. An additional 4 children (1.4%) had optic atrophy of unclear relation to vigabatrin, categorized as possible toxicity. The remaining 278 children did not have abnormal examination or testing findings attributable to vigabatrin. CONCLUSIONS The incidence of vigabatrin-related ocular toxicity in children was low in our cohort. Ocular and neurologic comorbidities and limited examinations in children make identification of such toxicity challenging and the value of screening is unclear.
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Affiliation(s)
- Yvette Schein
- Division of Ophthalmology, Children's Hospital of Philadelphia, Pennsylvania
| | | | - Ying Han
- Department of Ophthalmology, University of California, San Francisco
| | - Yinxi Yu
- Scheie Eye Institute, Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Gil Binenbaum
- Division of Ophthalmology, Children's Hospital of Philadelphia, Pennsylvania
| | - Julius T Oatts
- Department of Ophthalmology, University of California, San Francisco.
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9
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Jonsson H, Lehto M, Vanhatalo S, Gaily E, Linnankivi T. Visual field defects after vigabatrin treatment during infancy: retrospective population-based study. Dev Med Child Neurol 2022; 64:641-648. [PMID: 34716587 DOI: 10.1111/dmcn.15099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 02/02/2023]
Abstract
AIM To investigate the prevalence of vigabatrin-attributed visual field defect (VAVFD) in infantile spasms and the utility of optical coherence tomography (OCT) in detecting vigabatrin-related damage. METHOD We examined visual fields by Goldmann or Octopus perimetry and the thickness of peripapillary retinal nerve fiber layer (RNFL) with spectral-domain OCT at school age or adolescence. RESULTS Out of 88 patients (38 females, mean age at study 15y, SD 4y 3mo, range 6y 4mo-23y 3mo [n=65] or deceased [n=21] or moved abroad [n=2]) exposed to vigabatrin in infancy, 28 were able to perform formal visual field testing. Two had visual field defect from structural causes. We found mild VAVFD in four patients and severe VAVFD in one patient. Median vigabatrin treatment duration for those with normal visual field was 11 months compared to 19 months for those with VAVFD (p=0.04). OCT showed concomitant attenuated RNFL in three children with VAVFD, and was normal in one. The temporal half of the peripapillary RNFL was significantly thinner in the VAVFD group compared to the normal visual field group. INTERPRETATION The overall prevalence of VAVFD is lower after exposure in infancy compared to 52% which has been reported after exposure in adulthood. The risk increases with longer treatment duration. Further studies should identify infants particularly susceptible to VAVFD and clarify the role of OCT.
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Affiliation(s)
- Henna Jonsson
- Department of Pediatric Neurology, New Children's Hospital and Pediatric Research Center, Epilepsia Helsinki, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mikko Lehto
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sampsa Vanhatalo
- Department of Children's Clinical Neurophysiology, BABA Center, Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital, Helsinki, Finland.,Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Eija Gaily
- Department of Pediatric Neurology, New Children's Hospital and Pediatric Research Center, Epilepsia Helsinki, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tarja Linnankivi
- Department of Pediatric Neurology, New Children's Hospital and Pediatric Research Center, Epilepsia Helsinki, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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10
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Lin S, Liao J, Zhao X, Hu Y, Chen L, Chen Y, Liu G, Yao Y, Su Q, Scheffer IE, Wen F. Focal Epilepsy in Children With Tuberous Sclerosis Complex: Does Vigabatrin Control Focal Seizures? J Child Neurol 2022; 37:329-333. [PMID: 35321578 DOI: 10.1177/08830738211048326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We evaluated the efficacy and safety of vigabatrin in focal epilepsy associated with tuberous sclerosis complex by retrospectively reviewing patients with focal epilepsy and tuberous sclerosis complex treated with vigabatrin at a pediatric epilepsy center over an 8-year period. Of 85 patients, 20 (23.5%) were seizure-free for >12 months, 45 (52.9%) were responders (≥50% seizure reduction), and 20 (23.5%) were nonresponders. The median age (in months) at seizure onset in the seizure-free group (median, 15; interquartile range [IQR], 6-23.3) was higher than that of responders (median, 5; IQR, 3-14) and nonresponders (median, 6; IQR, 2-12). Fewer patients in the seizure-free group had calcification in their largest tubers, but the presence of tuber calcification did not differ among groups. Vigabatrin is more likely to result in seizure freedom in children with tuberous sclerosis complex who have later infantile onset of focal seizures and no calcification in their largest tuber.
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Affiliation(s)
- Sufang Lin
- Department of Pediatrics, The First Affiliated Hospital 162698Jinan University, Guangzhou, Guangdong, China
- Department of Neurology, 85113Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- Department of Epilepsy Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Jianxiang Liao
- Department of Neurology, 85113Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Xia Zhao
- Department of Neurology, 85113Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Yan Hu
- Department of Neurology, 85113Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Li Chen
- Department of Neurology, 85113Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Yan Chen
- Department of Epilepsy Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Guosheng Liu
- Department of Pediatrics, The First Affiliated Hospital 162698Jinan University, Guangzhou, Guangdong, China
| | - Yi Yao
- Department of Epilepsy Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Qiru Su
- Institute of Pediatrics, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Ingrid E Scheffer
- University of Melbourne, Austin Health and Royal Children's Hospital, Florey and Murdoch Institutes, Melbourne, Australia
| | - Feiqiu Wen
- Department of Pediatrics, The First Affiliated Hospital 162698Jinan University, Guangzhou, Guangdong, China
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
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11
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Yang G, Wan L, Zhang S, Shi X, Wang J, Hu L, Zou L. CLOCK, SIRT1, and HDAC2 Knockdown along with Melatonin Intervention Significantly Decreased the Level Glucocorticoid Receptor. RUSS J GENET+ 2022. [DOI: 10.1134/s1022795422010148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Ikeda A, Tomiyasu M, Yamamoto A, Tsuyusaki Y, Kawai Y, Tanabe M, Tsuji M, Iai M, Aida N, Goto T. Elevation of brain gamma‐aminobutyric acid levels is associated with vigabatrin‐associated brain abnormalities on magnetic resonance imaging. Epilepsy Res 2022; 181:106881. [DOI: 10.1016/j.eplepsyres.2022.106881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/14/2022] [Accepted: 02/04/2022] [Indexed: 11/29/2022]
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13
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Kooiker MJG, van Gils MM, van der Zee YJ, Swarte RMC, Smit LS, Loudon S, van der Steen S, Reiss IKM, Pel JJM, van der Steen J. Early Screening of Visual Processing Dysfunctions in Children Born Very or Extremely Preterm. Front Hum Neurosci 2021; 15:729080. [PMID: 34790105 PMCID: PMC8591256 DOI: 10.3389/fnhum.2021.729080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Children with early brain damage or dysfunction are at risk of developing cerebral visual impairment (CVI), including visual processing dysfunctions (VPD), which currently remain largely undetected until school age. Our aim was to systematically screen for possible VPD in children born very or extremely preterm from 1 to 2 years corrected age (CA) and to evaluate the effectiveness of early referral. Method: We included N = 48 children born < 30 weeks from 1 year CA. They underwent a two-step VPD screening based on (1) neurological signs indicative of visual brain damage evaluated by neonatologists and/or pediatric neurologist and (2) a functional assessment of visual orienting functions (VOF) with an eye tracking-based test. If at least one of these assessments was abnormal for their age, the children were classified as a risk of VPD and referred to undergo conventional visual diagnostics: ophthalmic exam and visual function assessment (VFA). At 2 years CA, VOF screening was repeated and neurodevelopment was assessed. Results: 18 children (38%) were classified as at risk of VPD at 1 year CA. 7 children had abnormal neurological signs, 5 children had abnormal VOF, and 6 children had both. Subsequent ophthalmic exams (N = 14) showed severe hypermetropia in 21% and strabismus in 14%. VFA (N = 10) showed abnormal visual function and behavior in only 1 child. At 2 years CA, the total group showed an increase in abnormal VOF. Whereas the children at risk showed some normalization, the group without VPD risk at 1 year CA showed deterioration of VOF. Neurodevelopmental outcome did not clearly differ between risk groups. Conclusion: Our findings show a substantial risk of VPD during visual screening (in 38%) at 1 year CA, but relatively few deficits on subsequent conventional ophthalmic exams and VFA. The data suggest that most conventional visual diagnostic methods at this young age are not related to the established VPD risks. VOF assessment should be used complimentary to these methods. The fact that at 2 years CA the number of children with a VPD risk based on abnormal VOF increased argues for more extensive and continuous screening in risk groups, at least until school age.
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Affiliation(s)
- Marlou J G Kooiker
- Department Neuroscience, Erasmus MC, Rotterdam, Netherlands.,Royal Dutch Visio, Heerhugowaard, Netherlands
| | - Maud M van Gils
- Department Neuroscience, Erasmus MC, Rotterdam, Netherlands.,Department Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Renate M C Swarte
- Division of Neonatology, Department Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Liesbeth S Smit
- Division of Neonatology, Department Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.,Division of Pediatric Neurology, Department Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Sjoukje Loudon
- Department Pediatric Ophthalmology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | | | - Irwin K M Reiss
- Division of Neonatology, Department Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Johan J M Pel
- Department Neuroscience, Erasmus MC, Rotterdam, Netherlands
| | - Johannes van der Steen
- Department Neuroscience, Erasmus MC, Rotterdam, Netherlands.,Royal Dutch Visio, Huizen, Netherlands
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14
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Hakami T. Efficacy and tolerability of antiseizure drugs. Ther Adv Neurol Disord 2021; 14:17562864211037430. [PMID: 34603506 PMCID: PMC8481725 DOI: 10.1177/17562864211037430] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022] Open
Abstract
Drug-resistant epilepsy occurs in 25-30% of patients. Furthermore, treatment with a first-generation antiseizure drug (ASD) fails in 30-40% of individuals because of their intolerable adverse effects. Over the past three decades, 20 newer- (second- and third-)generation ASDs with unique mechanisms of action and pharmacokinetic profiles have been introduced into clinical practice. This advent has expanded the therapeutic armamentarium of epilepsy and broadens the choices of ASDs to match the individual patient's characteristics. In recent years, research has been focused on defining the ASD of choice for different seizure types. In 2017, the International League Against Epilepsy published a new classification for seizure types and epilepsy syndrome. This classification has been of paramount importance to accurately classify the patient's seizure type(s) and prescribe the ASD that is appropriate. A year later, the American Academy of Neurology published a new guideline for ASD selection in adult and pediatric patients with new-onset and treatment-resistant epilepsy. The guideline primarily relied on studies that compare the first-generation and second-generation ASDs, with limited data for the efficacy of third-generation drugs. While researchers have been called for investigating those drugs in future research, epilepsy specialists may wish to share their personal experiences to support the treatment guidelines. Given the rapid advances in the development of ASDs in recent years and the continuous updates in definitions, classifications, and treatment guidelines for seizure types and epilepsy syndromes, this review aims to present a complete overview of the current state of the literature about the efficacy and tolerability of ASDs and provide guidance to clinicians about selecting appropriate ASDs for initial treatment of epilepsy according to different seizure types and epilepsy syndromes based on the current literature and recent US and UK practical guidelines.
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Affiliation(s)
- Tahir Hakami
- The Faculty of Medicine, Jazan University, P.O. Box 114, Jazan 45142, Saudi Arabia
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15
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O'Neill EK, Smith R. Visual electrophysiology in the assessment of toxicity and deficiency states affecting the visual system. Eye (Lond) 2021; 35:2344-2353. [PMID: 34290445 PMCID: PMC8377028 DOI: 10.1038/s41433-021-01663-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023] Open
Abstract
Visual disturbance or visual failure due to toxicity of an ingested substance or a severe nutritional deficiency can present significant challenges for diagnosis and management, for instance, where an adverse reaction to a prescribed medicine is suspected. Objective assessment of visual function is important, particularly where structural changes in the retina or optic nerve have not yet occurred, as there may be a window of opportunity to mitigate or reverse visual loss. This paper reviews a number of clinical presentations where visual electrophysiological assessment has an important role in early diagnosis or management alongside clinical assessment and ocular imaging modalities. We highlight the importance of vitamin A deficiency as an easily detected marker for severe combined micronutrient deficiency.
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Affiliation(s)
- Emily K O'Neill
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK. Emily.O'
| | - Richard Smith
- Eye Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK.
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16
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Nabbout R, Kuchenbuch M, Chiron C, Curatolo P. Pharmacotherapy for Seizures in Tuberous Sclerosis Complex. CNS Drugs 2021; 35:965-983. [PMID: 34417984 DOI: 10.1007/s40263-021-00835-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 01/18/2023]
Abstract
Epilepsy is one of the main symptoms affecting the lives of individuals with tuberous sclerosis complex (TSC), causing a high rate of morbidity. Individuals with TSC can present with various types of seizures, epilepsies, and epilepsy syndromes that can coexist or appear in relation to age. Focal epilepsy is the most frequent epilepsy type with two developmental and epileptic encephalopathies: infantile spasms syndrome and Lennox-Gastaut syndrome. Active screening and early management of epilepsy is recommended in individuals with TSC to limit its consequences and its impact on quality of life, cognitive outcome and the economic burden of the disease. The progress in the knowledge of the mechanisms underlying epilepsy in TSC has paved the way for new concepts in the management of epilepsy related to TSC. In addition, we are moving from traditional "reactive" and therapeutic choices with current antiseizure medications used after the onset of seizures, to a proactive approach, aimed at predicting and preventing epileptogenesis and the onset of epilepsy with vigabatrin, and to personalized treatments with mechanistic therapies, namely mechanistic/mammalian target of rapamycin inhibitors. Indeed, epilepsy linked to TSC is one of the only epilepsies for which a predictive and preventive approach can delay seizure onset and improve seizure response. However, the efficacy of such interventions on long-term cognitive and psychiatric outcomes is still under investigation.
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Affiliation(s)
- Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades University Hospital, APHP, Université de Paris, 149 rue de Sèvres, 75015, Paris, France.
- UMR 1163, Institut National de la Santé et de la Recherche Médicale (INSERM), Imagine Institute, Université de Paris, Paris, France.
| | - Mathieu Kuchenbuch
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades University Hospital, APHP, Université de Paris, 149 rue de Sèvres, 75015, Paris, France
- UMR 1163, Institut National de la Santé et de la Recherche Médicale (INSERM), Imagine Institute, Université de Paris, Paris, France
| | - Catherine Chiron
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades University Hospital, APHP, Université de Paris, 149 rue de Sèvres, 75015, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1141, Neurospin, Gif sur Yvette, France
| | - Paolo Curatolo
- Department of System Medicine, Child Neurology and Psychiatry Unit, Tor Vergata University Hospital, Rome, Italy
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17
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What is the optimal duration for vigabatrin monotherapy in patients with infantile spasms: 6 months or longer? Seizure 2021; 91:503-506. [PMID: 34371246 DOI: 10.1016/j.seizure.2021.07.032] [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: 03/11/2021] [Revised: 07/10/2021] [Accepted: 07/30/2021] [Indexed: 11/19/2022] Open
Abstract
Vigabatrin (VGB) is approved as monotherapy for pediatric patients with Infantile Spasms (IS). Duration of VGB use should be limited because of the risk of retinal and neurotoxicity, but the optimal length of treatment is unknown. Our study aimed to determine the risk of spasms relapse after 6 months of VGB as first-line therapy in IS patients deemed VGB good responders. The participants were 44 infants with IS who demonstrated both absence of clinical spasms and hypsarrhythmia four weeks after starting VGB, obtained from two cohorts: 29 patients from a multicenter prospective cohort and 15 patients from a retrospective single-center cohort. We divided them post hoc into two groups according to the duration of VGB treatment: 6-month group (n=34) and >6-month group (n=10) and compared outcome between the two groups. No patient in either group had a relapse of spasms. For patients with non-identified etiology (NIE) in the 6 months treatment group, no other seizure types were observed. Late epilepsy, in the form of focal seizures, emerged in only 5/37 patients (3/30 in the 6-month treatment group; 2/7 in the extended treatment group); all within the first 6-9 months after VGB initiation. Our study provides substantial evidence that a shortened VGB course of 6 months could be sufficient to treat and prevent relapse of spasms in children with IS, particularly those with NIE.
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18
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Affiliation(s)
- Phil E M Smith
- From the Department of Neurology, University Hospital of Wales, Cardiff, United Kingdom
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19
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Baba S, Okanishi T, Homma Y, Yoshida T, Goto T, Fukasawa T, Kobayashi S, Kamei A, Fujii Y, Hino‐Fukuyo N, Yamada K, Daida A, Kawawaki H, Hoshino H, Sejima H, Ishida Y, Okazaki T, Inui T, Kanai S, Motoi H, Itamura S, Nishimura M, Enoki H, Fujimoto A. Efficacy of long-term adrenocorticotropic hormone therapy for West syndrome: A retrospective multicenter case series. Epilepsia Open 2021; 6:402-412. [PMID: 34095686 PMCID: PMC8166796 DOI: 10.1002/epi4.12497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 04/09/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Long-term adrenocorticotropic therapy (LT-ACTH), which consisted of 2-4 weeks of daily injections of adrenocorticotropic hormone (ACTH) and subsequent months of weekly injections, was tried for relapsed West syndrome (WS) or other intractable epilepsies in small case reports. Our aim was to explore the efficacy of LT-ACTH for preventing WS relapse, as well as the prevalence of its adverse events. METHODS This is a retrospective, nationwide, multicenter case series of patients with WS who underwent LT-ACTH. Clinical information of the patients and protocol of LT-ACTH were collected from participating institutes in this study. We defined clinical response to ACTH as achievement of hypsarrhythmia and epileptic spasms resolution. Patients who responded to daily ACTH injections were identified and assessed whether they experienced WS relapse during/after the weekly ACTH injection period. The outcome was measured by the nonrelapse rate at 24 months after daily ACTH injections using the Kaplan-Meier method. RESULTS Clinical information of 16 children with WS was analyzed. The median age at LT-ACTH initiation was 14.5 months (range: 7-68 months). Thirteen (81%) patients had previously undergone conventional ACTH treatment. The LT-ACTH regimens comprised a median of 16 days of daily injections (range: 11-28 days) and 10 months of weekly injections (range: 3-22 months). Seven patients experienced WS relapse during/after subsequent weekly ACTH period, and the nonrelapse rate at 24 months after daily injections was estimated at 60.6% (95% confidence interval: 32.3%-80.0%). Height stagnation, hypertension, and irritability were observed; lethal adverse events were not reported. SIGNIFICANCE Our study firstly explored the efficacy of LT-ACTH for preventing WS relapse. LT-ACTH might be a treatment option for patients with relapsed or intractable WS; however, we note that our study is limited by its small sample size and the lack of an appropriate control group.
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Affiliation(s)
- Shimpei Baba
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Tohru Okanishi
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Yoichiro Homma
- General Internal MedicineSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Takeshi Yoshida
- Department of PediatricsKyoto University Graduate School of MedicineKyotoJapan
| | - Tomohide Goto
- Department of NeurologyKanagawa Children's Medical CenterYokohamaJapan
| | | | - Satoru Kobayashi
- Department of PediatricsNagoya City West Medical CenterNagoyaJapan
| | - Atsushi Kamei
- Department of PediatricsIwate Medical University School of MedicineShiwaJapan
| | - Yuji Fujii
- Department of PediatricsHiroshima City Funairi Citizens HospitalHiroshimaJapan
| | - Naomi Hino‐Fukuyo
- Department of PediatricsTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Keitaro Yamada
- Department of Pediatric NeurologyAichi Developmental Disability Center Central HospitalKasugaiJapan
| | - Atsuro Daida
- Department of PediatricsSt. Luke's International HospitalTokyoJapan
| | - Hisashi Kawawaki
- Department of Pediatric NeurologyOsaka City General HospitalOsakaJapan
| | - Hideki Hoshino
- Department of PediatricsTeikyo University School of MedicineTokyoJapan
| | - Hitoshi Sejima
- Department of PediatricsMatsue Red‐Cross HospitalMatsueJapan
| | - Yusuke Ishida
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Tetsuya Okazaki
- Division of Child NeurologyDepartment of Brain and NeurosciencesSchool of MedicineTottori University Faculty of MedicineYonagoJapan
| | - Takehiko Inui
- Department of Pediatric NeurologyMiyagi Children's HospitalMiyagiJapan
| | - Sotaro Kanai
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Hirotaka Motoi
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Shinji Itamura
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Mitsuyo Nishimura
- Division of Clinical LaboratorySeirei Hamamatsu General HospitalHamamatsuJapan
| | - Hideo Enoki
- Department of Child NeurologyComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
| | - Ayataka Fujimoto
- Epilepsy and SurgeryComprehensive Epilepsy CenterSeirei Hamamatsu General HospitalHamamatsuJapan
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20
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Sharma S, Kaushik JS, Srivastava K, Goswami JN, Sahu JK, Vinayan KP, Mittal R. Association of Child Neurology (AOCN) — Indian Epilepsy Society (IES) Consensus Guidelines for the Diagnosis and Management of West Syndrome. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2097-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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21
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Hu TY, Wang HQ, Zhang WP, Tian RF, Lei GS, Deng YC, Xing JL. Network meta-analysis of antiepileptic drugs in focal drug-resistant epilepsy. Epilepsy Res 2020; 167:106433. [DOI: 10.1016/j.eplepsyres.2020.106433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/29/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022]
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22
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Biswas A, Yossofzai O, Vincent A, Go C, Widjaja E. Vigabatrin-related adverse events for the treatment of epileptic spasms: systematic review and meta-analysis. Expert Rev Neurother 2020; 20:1315-1324. [PMID: 33078964 DOI: 10.1080/14737175.2020.1840356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Although vigabatrin (VGB) is effective and well tolerated for the treatment of epileptic spasms, there are safety concerns. The aim of this systematic review and metaanalysis was to assess adverse events of VGB for the treatment of epileptic spasms. Methods: MEDLINE, EMBASE, and Cochrane databases were searched. The population was infants treated with VGB for epileptic spasms. The outcomes were VGB-related adverse events. Meta-analyses of VGB-related MRI abnormalities, retinal toxicity as measured by electroretinogram (ERG), visual field defect as measured by perimetry, and other adverse events were conducted. Results: Fifty-seven articles were included in the systematic review. The rate of VGB-related MRI abnormalities was 21% (95% CI: 15-29%). Risk factors for MRI abnormalities were age younger than 12 months and higher VGB dose. VGB-related retinal toxicity and visual field defect occurred in 29% (95% CI: 7-69%) and 28% (95% CI: 4-78%) respectively. Other adverse events occurred in 23% (95% CI: 16-34%), consisting predominantly of central nervous system symptoms, and the majority of these did not require therapeutic modification. Conclusion: This study will inform physicians and families on the risk profile of VGB for the treatment of epileptic spasms and will help decisions on treatment options.
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Affiliation(s)
- Asthik Biswas
- Department of Diagnostic Imaging, The Hospital for Sick Children , Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto , Toronto, ON, Canada
| | - Omar Yossofzai
- Neuroscience and Mental Health, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Ajoy Vincent
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Cristina Go
- Division of Neurology, The Hospital for Sick Children , Toronto, Ontario, Canada
| | - Elysa Widjaja
- Department of Diagnostic Imaging, The Hospital for Sick Children , Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto , Toronto, ON, Canada.,Neuroscience and Mental Health, The Hospital for Sick Children , Toronto, Ontario, Canada.,Division of Neurology, The Hospital for Sick Children , Toronto, Ontario, Canada
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23
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Uliel-Sibony S, Chernuha V, Meirson H, Fattal-Valevski A. Medical treatment of tuberous sclerosis-related epilepsy. Childs Nerv Syst 2020; 36:2511-2517. [PMID: 32829444 DOI: 10.1007/s00381-020-04772-7] [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: 05/15/2020] [Accepted: 06/23/2020] [Indexed: 01/13/2023]
Abstract
Epilepsy is one of the most frequent CNS manifestations of tuberous sclerosis, and for most patients, it is the major debilitating factor. In up to 70% of the cases, the epilepsy is refractory and usually associated with significant behavioral as well as developmental consequences. Therefore, controlling seizures is one of the biggest medical and surgical challenges. Understanding the cellular mechanism involved in the disease empowered targeted research aimed toward early intervention in the epileptogenicity process. In this review, we present an update on the pharmacological treatments in tuberous sclerosis-related epilepsy.
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Affiliation(s)
- Shimrit Uliel-Sibony
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel. .,Pediatric Neurology institute, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
| | - Veronika Chernuha
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Hadas Meirson
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
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24
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Retinal Diseases that Can Masquerade as Neurological Causes of Vision Loss. Curr Neurol Neurosci Rep 2020; 20:51. [PMID: 32930896 DOI: 10.1007/s11910-020-01071-1] [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: 10/23/2022]
Abstract
PURPOSE OF REVIEW This review aims to discuss retinal diseases that may masquerade as neurological causes of vision loss and highlights modern ophthalmic ancillary testing that can help to establish these diagnoses. RECENT FINDINGS Retinal diseases with signs and symptoms overlapping with neurological causes of vision loss include central serous chorioretinopathy, retinal ischemia, acute macular neuroretinopathy, Acute zonal occult outer retinopathy (AZOOR) complex diseases, paraneoplastic retinopathy, retinal dystrophy, and toxic retinopathy. Diagnosis is facilitated by electrophysiologic studies and multimodal ophthalmic imaging including optical coherence tomography and fundus autofluorescence imaging. Looking into the future, translation of adaptive optics ophthalmoscopy into clinical practice may facilitate early detection of microscopic retinal abnormalities that characterize these conditions. With conventional methods of physical examination, diagnosis of retinal diseases that may masquerade as neurological causes of vision loss can be challenging. Current advance in multimodal ophthalmic imaging along with electrophysiologic studies enhances the provider's ability to make early diagnosis and monitor progression of these conditions.
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Ryu HW, Kim H, Lim BC, Hwang H, Chae JH, Choi JE, Kim KJ. Short Course and Early Switch of Vigabatrin for Infantile spasms. ANNALS OF CHILD NEUROLOGY 2020. [DOI: 10.26815/acn.2020.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Clinical implications and cost of electroretinography screening for vigabatrin toxicity. Can J Ophthalmol 2020; 55:e98-e100. [DOI: 10.1016/j.jcjo.2019.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 11/17/2022]
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Ji X, Wright T, VandenHoven C, MacKeen L, McFarlane M, Liu H, Dupuis A, Westall C. Reliability of Handheld Optical Coherence Tomography in Children Younger Than Three Years of Age Undergoing Vigabatrin Treatment for Childhood Epilepsy. Transl Vis Sci Technol 2020; 9:9. [PMID: 32704429 PMCID: PMC7347507 DOI: 10.1167/tvst.9.3.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose Vigabatrin-associated retinal toxicity manifests as reduction in the clinical electroretinogram and retinal nerve fiber layer (RNFL) thinning. This observational investigation of RNFL thickness in young vigabatrin-treated children was to identify intravisit and intervisit reliabilities of peripapillary RNFL thickness measurements performed with Envisu (optical coherence tomography) OCT. Secondarily, a longitudinal assessment investigated the presence and extent of RNFL thinning. Methods We measured the handheld OCT in sedated children to evaluate the RNFL thickness using segmentation software. Intraclass correlation coefficient (ICC) statistics identified intravisit and intervisit reliabilities for RNFL thickness. Results Twenty-nine children (10.1 ± 6.0 months old) underwent handheld optical coherence tomography (OCT). Fourteen of these completed follow-up assessments. Intravisit reliability was good for the right eye (ICCs = 0.82-0.98) and the left eye (ICCs = 0.75-0.89) for each of the 4 retinal quadrants. Inter-visit ICCs for each of the 4 retinal quadrants were good (ICC = 0.82-0.98). There was no consistent change in RNFL thickness longitudinally. Conclusions In this pediatric cohort, RNFL thickness measures using handheld OCT provided good reliability within a single visit and between consecutive visits supporting its use as an adjunctive tool in the clinical setting. Further long-term follow-up is required to understand RNFL thickness changes in this specific population and its association with vigabatrin toxicity. Translational Relevance The findings of good reliability and clinical feasibility would provide an opportunity for the handheld OCT to monitor reliably for vigabatrin-associated retinal toxicity in children who often show noncompliance to traditional testing approaches.
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Affiliation(s)
- Xiang Ji
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Tom Wright
- Kensington Eye Institute, Toronto, ON, Canada
| | - Cynthia VandenHoven
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Leslie MacKeen
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle McFarlane
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Henry Liu
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Annie Dupuis
- Clinical Research Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Carol Westall
- Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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Chan K, Hoon M, Pattnaik BR, Ver Hoeve JN, Wahlgren B, Gloe S, Williams J, Wetherbee B, Kiland JA, Vogel KR, Jansen E, Salomons G, Walters D, Roullet JB, Gibson K M, McLellan GJ. Vigabatrin-Induced Retinal Functional Alterations and Second-Order Neuron Plasticity in C57BL/6J Mice. Invest Ophthalmol Vis Sci 2020; 61:17. [PMID: 32053727 PMCID: PMC7326505 DOI: 10.1167/iovs.61.2.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose Vigabatrin (VGB) is an effective antiepileptic that increases concentrations of inhibitory γ-aminobutyric acid (GABA) by inhibiting GABA transaminase. Reports of VGB-associated visual field loss limit its clinical usefulness, and retinal toxicity studies in laboratory animals have yielded conflicting results. Methods We examined the functional and morphologic effects of VGB in C57BL/6J mice that received either VGB or saline IP from 10 to 18 weeks of age. Retinal structure and function were assessed in vivo by optical coherence tomography (OCT), ERG, and optomotor response. After euthanasia, retinas were processed for immunohistochemistry, and retinal GABA, and VGB quantified by mass spectrometry. Results No significant differences in visual acuity or total retinal thickness were identified between groups by optomotor response or optical coherence tomography, respectively. After 4 weeks of VGB treatment, ERG b-wave amplitude was enhanced, and amplitudes of oscillatory potentials were reduced. Dramatic rod and cone bipolar and horizontal cell remodeling, with extension of dendrites into the outer nuclear layer, was observed in retinas of VGB-treated mice. VGB treatment resulted in a mean 3.3-fold increase in retinal GABA concentration relative to controls and retinal VGB concentrations that were 20-fold greater than brain. Conclusions No evidence of significant retinal thinning or ERG a- or b-wave deficits were apparent, although we describe significant alterations in ERG b-wave and oscillatory potentials and in retinal cell morphology in VGB-treated C57BL/6J mice. The dramatic concentration of VGB in retina relative to the target tissue (brain), with a corresponding increase in retinal GABA, offers insight into the pathophysiology of VGB-associated visual field loss.
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Affiliation(s)
- Kore Chan
- Department of Ophthalmology & Visual Science, University of Wisconsin–Madison, Madison, Wisconsin, United States
- McPherson Eye Research Institute, Madison, Wisconsin, United States
| | - Mrinalini Hoon
- Department of Ophthalmology & Visual Science, University of Wisconsin–Madison, Madison, Wisconsin, United States
- McPherson Eye Research Institute, Madison, Wisconsin, United States
| | - Bikash R. Pattnaik
- McPherson Eye Research Institute, Madison, Wisconsin, United States
- Pediatrics Ophthalmology & Visual Science, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - James N. Ver Hoeve
- Department of Ophthalmology & Visual Science, University of Wisconsin–Madison, Madison, Wisconsin, United States
- McPherson Eye Research Institute, Madison, Wisconsin, United States
| | - Brad Wahlgren
- Department of Ophthalmology & Visual Science, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Shawna Gloe
- Department of Ophthalmology & Visual Science, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Jeremy Williams
- Department of Ophthalmology & Visual Science, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Brenna Wetherbee
- Department of Ophthalmology & Visual Science, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Julie A. Kiland
- Department of Ophthalmology & Visual Science, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Kara R. Vogel
- Department of Ophthalmology & Visual Science, University of Wisconsin–Madison, Madison, Wisconsin, United States
- McPherson Eye Research Institute, Madison, Wisconsin, United States
| | - Erwin Jansen
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Gajja Salomons
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Dana Walters
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, Washington, United States
| | - Jean-Baptiste Roullet
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, Washington, United States
| | - K Michael Gibson
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, Washington, United States
| | - Gillian J. McLellan
- Department of Ophthalmology & Visual Science, University of Wisconsin–Madison, Madison, Wisconsin, United States
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, Wisconsin, United States
- McPherson Eye Research Institute, Madison, Wisconsin, United States
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Regier PS, Kampman KM, Childress AR. Clinical Trials for Stimulant Use Disorders: Addressing Heterogeneities That May Undermine Treatment Outcomes. Handb Exp Pharmacol 2020; 258:299-322. [PMID: 32193666 DOI: 10.1007/164_2019_303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In recent years, use of cocaine and amphetamines and deaths associated with stimulants have been on the rise, and there are still no FDA-approved medications for stimulant use disorders. One contributing factor may involve heterogeneity. At the neurobiological level, dual dopamine dysfunction may be undermining medication efficacy, suggesting a need for combination pharmacotherapies. At the population level, individual variability is expressed in a number of ways and, if left unaddressed, may interfere with medication efficacy. This chapter reviews studies investigating medications to address dopamine dysfunction, and it also identifies several prominent heterogeneities associated with stimulant (and other substance) use disorders. The chapter has implications for improving interventions to treat stimulant use disorders, and the theme of individual heterogeneity may have broader application across substance use disorders.
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Affiliation(s)
- Paul S Regier
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kyle M Kampman
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna Rose Childress
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, PA, USA
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McFarlane MT, Wright T, McCoy B, Snead OC, Westall CA. Retinal defect in children with infantile spasms of varying etiologies: An observational study. Neurology 2019; 94:e575-e582. [PMID: 31792095 DOI: 10.1212/wnl.0000000000008686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/11/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence of retinal defect in children with infantile spasms (IS) unrelated to treatment with vigabatrin and clarify if specific primary etiologies for IS are associated with retinal defect more than others. METHODS This was an observational cohort study including 312 patients (176 male, 136 female) with IS who were vigabatrin-naive. Participants ranged from 1.7 to 34.7 months of age (mean 8.8 months). Electroretinograms (ERGs) were performed according to the International Society for Clinical Electrophysiology of Vision. Retinal defect was identified as abnormal if the 30-Hz flicker ERG amplitude was lower than the age-corrected normal 95% prediction interval. The primary etiology for IS, as determined by the treating pediatric neurologist(s), was obtained from patient health records and classified into 1 of 9 etiologic subgroups: (1) genetic disorders alone, (2) genetic-structural disorders, (3) structural-congenital, (4) structural-acquired (perinatal), (5) structural-acquired (postnatal), (6) metabolic disorders, (7) immunologic disorders, (8) infectious, and (9) unknown causes. RESULTS Fifty-nine of the 312 vigabatrin-naive children (18.9%) showed retinal defect and the prevalence of retinal defect was highest (24.4%) in the structural-acquired (perinatal) subgroup, which included hypoxic-ischemic defect. Retinal function compared across subgroups showed no significant difference. CONCLUSIONS Care is required in diagnosing retinal toxicity, which would be enhanced by baseline flicker ERG in children with IS prior to starting vigabatrin.
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Affiliation(s)
- Michelle T McFarlane
- From the Departments of Ophthalmology and Vision Sciences (M.T.M., C.A.W.) and Neurology (B.M., O.C.S.), The Hospital for Sick Children; Kensington Eye Institute (T.W.), Toronto; and Institute of Medical Science (O.C.S., C.A.W.) and Ophthalmology and Vision Sciences (C.A.W.), University of Toronto, Canada
| | - Tom Wright
- From the Departments of Ophthalmology and Vision Sciences (M.T.M., C.A.W.) and Neurology (B.M., O.C.S.), The Hospital for Sick Children; Kensington Eye Institute (T.W.), Toronto; and Institute of Medical Science (O.C.S., C.A.W.) and Ophthalmology and Vision Sciences (C.A.W.), University of Toronto, Canada
| | - Blathnaid McCoy
- From the Departments of Ophthalmology and Vision Sciences (M.T.M., C.A.W.) and Neurology (B.M., O.C.S.), The Hospital for Sick Children; Kensington Eye Institute (T.W.), Toronto; and Institute of Medical Science (O.C.S., C.A.W.) and Ophthalmology and Vision Sciences (C.A.W.), University of Toronto, Canada
| | - O Carter Snead
- From the Departments of Ophthalmology and Vision Sciences (M.T.M., C.A.W.) and Neurology (B.M., O.C.S.), The Hospital for Sick Children; Kensington Eye Institute (T.W.), Toronto; and Institute of Medical Science (O.C.S., C.A.W.) and Ophthalmology and Vision Sciences (C.A.W.), University of Toronto, Canada
| | - Carol A Westall
- From the Departments of Ophthalmology and Vision Sciences (M.T.M., C.A.W.) and Neurology (B.M., O.C.S.), The Hospital for Sick Children; Kensington Eye Institute (T.W.), Toronto; and Institute of Medical Science (O.C.S., C.A.W.) and Ophthalmology and Vision Sciences (C.A.W.), University of Toronto, Canada.
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Objective Derivation of the Morphology and Staging of Visual Field Loss Associated with Long-Term Vigabatrin Therapy. CNS Drugs 2019; 33:817-829. [PMID: 31250314 DOI: 10.1007/s40263-019-00634-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The morphology and between-eye symmetry of the visual field loss associated with the antiepileptic drug vigabatrin (VAVFL) has received little attention. OBJECTIVE Our objective was to model the appearance and ensuing staging of VAVFL derived with the European Medicines Agency-approved perimetric protocol. METHODS This was a retrospective, cross-sectional, observational study that identified 123 adults who had received vigabatrin for refractory seizures and who had no evidence of co-existing retino-geniculo-cortical visual pathway abnormality. A further 38 adults with refractory seizures and identical inclusion criteria but no exposure to vigabatrin acted as controls. For each group, the median outcome at each stimulus location in each eye (of absolute loss, relative loss or Pattern Deviation probability level, as appropriate) was derived for each successive ten pairs of fields, ranked for severity. Between-eye symmetry was quantified by an index that accounted for severity of loss and that was referenced to the likelihood of the occurrence of symmetry due to chance. RESULTS The modelled VAVFL was bilateral and highly symmetrical and was described by six stages that were all independent of the extent of vigabatrin exposure. The loss originated in the extreme temporal periphery and encroached centripetally along all meridians towards fixation. The initial appearance within the central field (Stage 2) occurred inferior-nasally. Subsequent stages exhibited increasing loss, which was greater nasally than temporally. Stage 6 described concentric loss extending to approximately 15° eccentricity from fixation. CONCLUSION The model exhibited a consistent pattern of VAVFL. The staging of the loss could assist the risk:benefit analysis of vigabatrin for the treatment of epilepsy.
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Yoon DH, Moon JU, Lee JY, Lee IG. Reconsideration of Vigabatrin Effect in Infantile Spasms Treatment. ANNALS OF CHILD NEUROLOGY 2019. [DOI: 10.26815/acn.2019.00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Wan MJ, Chan KL, Jastrzembski BG, Ali A. Neuro-ophthalmological manifestations of tuberous sclerosis: current perspectives. Eye Brain 2019; 11:13-23. [PMID: 31417327 PMCID: PMC6592065 DOI: 10.2147/eb.s186306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/24/2019] [Indexed: 12/11/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a complex, multi-system disorder with a well-described underlying genetic etiology. While retinal findings are common in TSC and important in establishing the diagnosis, TSC also has many potential neuro-ophthalmology manifestations. The neuro-ophthalmology manifestations of TSC can have a significant impact on visual function and are sometimes a sign of serious neurological disease. The purpose of this review is to describe the neuro-ophthalmological manifestations of TSC. These manifestations include optic nerve hamartomas, elevated intracranial pressure, cranial nerve palsies, cortical visual impairment, visual field deficits, and ocular toxicity from vigabatrin treatment of infantile spasms. It is important to be aware of potential neuro-ophthalmological manifestations in these patients in order to detect signs of vision- or life-threatening disease and to optimize visual function and quality-of-life.
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Affiliation(s)
- Michael J Wan
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ka Lo Chan
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,School of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Benjamin G Jastrzembski
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Asim Ali
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Baudou E, Cances C, Dimeglio C, Hachon Lecamus C. Etiology of neonatal seizures and maintenance therapy use: a 10-year retrospective study at Toulouse Children's hospital. BMC Pediatr 2019; 19:136. [PMID: 31035972 PMCID: PMC6487521 DOI: 10.1186/s12887-019-1508-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/11/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND No guidelines exist concerning the maintenance antiepileptic drug to use after neonatal seizures. Practices vary from one hospital to another. The aim of this study was to investigate etiologies and to report on the use of maintenance antiepileptic therapy in our population of full-term neonates presenting neonatal seizures. METHODS From January 2004 to October 2014, we retrospectively collected data from all full-term neonates with neonatal seizures admitted to the Children's Hospital of Toulouse, France. RESULTS Two hundred and forty-three neonates were included (59% males, 48% electroencephalographic confirmation). The frequencies of etiologies of neonatal seizures were: hypoxic-ischemic encephalopathy (HIE) (n = 91; 37%), ischemic infarction (n = 36; 15%), intracranial hemorrhage (n = 29; 12%), intracranial infection (n = 19; 8%), metabolic or electrolyte disorders (n = 9; 3%), inborn errors of metabolism (n = 5; 2%), congenital malformations of the central nervous system (n = 11; 5%), epileptic syndromes (n = 27; 12%) and unknown (n = 16; 7%). A maintenance therapy was prescribed in 180 (72%) newborns: valproic acid (n = 123), carbamazepine (n = 28), levetiracetam (n = 17), vigabatrin (n = 2), and phenobarbital (n = 4). In our cohort, the choice of antiepileptic drug depended mainly on etiology. The average duration of treatment was six months. CONCLUSIONS In our cohort, valproic acid was the most frequently prescribed maintenance antiepileptic therapy. However, the arrival on the market of new antiepileptic drugs and a better understanding of the physiopathology of genetic encephalopathies is changing our practice. TRIAL REGISTRATION Retrospectively registered. Patient data were reported to the "Commission Nationale Informatique et Libertés" under the number 2106953 .
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Affiliation(s)
- E Baudou
- Unit of Pediatric Neurology, Hôpital des Enfants, CHU Toulouse, 330 av de Grande Bretagne-TSA, 31059, Toulouse Cedex, France. .,Service de Neurologie Pédiatrique, Hôpital des Enfants, CHU Toulouse, 330 avenue de Grande Bretagne-TSA, 31059, Toulouse Cedex, France.
| | - C Cances
- Unit of Pediatric Neurology, Hôpital des Enfants, CHU Toulouse, 330 av de Grande Bretagne-TSA, 31059, Toulouse Cedex, France
| | - C Dimeglio
- Biostatistiques, Informatique Médicale, UMR 1027 Inserm, Université Paul Sabatier, Toulouse, France
| | - C Hachon Lecamus
- Unit of Pediatric Neurology, Hôpital des Enfants, CHU Toulouse, 330 av de Grande Bretagne-TSA, 31059, Toulouse Cedex, France
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Hamed SA. Ocular dysfunctions and toxicities induced by antiepileptic medications: Types, pathogenic mechanisms, and treatment strategies. Expert Rev Clin Pharmacol 2019; 12:309-328. [PMID: 30840840 DOI: 10.1080/17512433.2019.1591274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Ocular dysfunctions and toxicities induced by antiepileptic drugs (AEDs) are rarely reviewed and not frequently received attention by treating physicians compared to other adverse effects (e.g. endocrinologic, cognitive and metabolic). However, some are frequent and progressive even in therapeutic concentrations or result in permanent blindness. Although some adverse effects are non-specific, others are related to the specific pharmacodynamics of the drug. Areas covered: This review was written after detailed search in PubMed, EMBASE, ISI web, SciELO, Scopus, and Cochrane Central Register databases (from 1970 to 2019). It summarized the reported ophthalmologic adverse effects of the currently available AEDs; their risks and possible pathogenic mechanisms. They include ocular motility dysfunctions, retinopathy, maculopathy, glaucoma, myopia, optic neuropathy, and impaired retinal vascular autoregulation. In general, ophthalmo-neuro- or retino-toxic adverse effects of AEDs are classified as type A (dose-dependent), type B (host-dependent or idiosyncratic) or type C which is due to the cumulative effect from long-term use. Expert opinion: Ocular adverse effects of AEDs are rarely reviewed although some are frequent or may result in permanent blindness. Increasing knowledge of their incidence and improving understanding of their risks and pathogenic mechanisms are crucial for monitoring, prevention, and management of patients' at risk.
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Affiliation(s)
- Sherifa A Hamed
- a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt
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Rodrigues C, Chiron C, Ounissi M, Dulac O, Gaillard S, Nabbout R, Jullien V. Pharmacokinetic evaluation of vigabatrin dose for the treatment of refractory focal seizures in children using adult and pediatric data. Epilepsy Res 2019; 150:38-45. [PMID: 30639958 DOI: 10.1016/j.eplepsyres.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/13/2018] [Accepted: 01/06/2019] [Indexed: 11/27/2022]
Abstract
Vigabatrin is indicated as adjunctive therapy for refractory focal seizures. For children, European recommendations indicate maintenance doses varying from 30 to 100 mg/kg/day for this indication. Since cumulated dose was associated with retinal toxicity, it is essential to administrate the lowest effective dose to patients. This work was conducted with the purpose to determine the pediatric doses of vigabatrin that allow a similar exposure than effective doses in adults (2-3 g/day) through a pharmacokinetic (PK) study, using both pediatric and adult data. For this study, we focused on the active S(+) enantiomer of vigabatrin. First, the adult effective exposition range of vigabatrin-S was determined from an adult PK model. Then, this same model was scaled to the pediatric population using allometry and maturation principles to account for growth and development. The ability of the model to predict pediatric data was assessed by comparing population predictions with observed pediatric data. Finally, the extrapolated pediatric model was used to simulate pediatric expositions which were compared to the adult exposition range (36.5-77.9 mg.h/L). From those simulations, we determined that, for children aged between 3 months and 18 years, doses between 40 and 50 mg/kg/day allow vigabatrin-S expositions similar to those found in adults at the recommended posology. We proposed those doses as optimal maintenance doses that may be increased, if necessary, by slow titration.
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Affiliation(s)
- Christelle Rodrigues
- INSERM U1129, Paris, France; Paris Descartes University, CEA, Gif-sur-Yvette, France.
| | - Catherine Chiron
- INSERM U1129, Paris, France; Paris Descartes University, CEA, Gif-sur-Yvette, France.
| | - Marwa Ounissi
- INSERM U1129, Paris, France; Paris Descartes University, CEA, Gif-sur-Yvette, France.
| | - Olivier Dulac
- INSERM U1129, Paris, France; Paris Descartes University, CEA, Gif-sur-Yvette, France.
| | - Ségolène Gaillard
- Centre d'Investigation Clinique - CIC 1407- Hospices Civils de Lyon, France.
| | - Rima Nabbout
- INSERM U1129, Paris, France; Paris Descartes University, CEA, Gif-sur-Yvette, France; Reference Centre for Rare Epilepsies, APHP, Necker-Enfants Malades Hospital, Imagine Institute, Paris, France.
| | - Vincent Jullien
- INSERM U1129, Paris, France; Paris Descartes University, CEA, Gif-sur-Yvette, France; Service de Pharmacologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
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Mukherjee C, Al-Fahad Q, Elsherbiny S. The role of optical coherence tomography in therapeutics and conditions, which primarily have systemic manifestations: a narrative review. Ther Adv Ophthalmol 2019; 11:2515841419831155. [PMID: 30923793 PMCID: PMC6431765 DOI: 10.1177/2515841419831155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 01/22/2019] [Indexed: 12/22/2022] Open
Abstract
Optical coherence tomography is designed to evaluate in vivo qualitative and quantitative changes of the anterior segment, optic nerve and the retina. Initial applications of this technology were confined mainly to ophthalmic diseases. However recently, numerous studies have evaluated its use in systemic conditions and in therapeutics where, optic nerve and retinal architecture can be assessed to monitor progression of systemic conditions and its response to treatment. This is a narrative review aimed at evaluating the debate surrounding the role of spectral domain optical coherence tomography, in systemic conditions where optic nerve affection can be measured and be used in the diagnosis, monitoring and assessment of treatment effect as a non-invasive, quick, novel technique.
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Affiliation(s)
| | - Qusay Al-Fahad
- Birmingham Midland Eye Centre, Birmingham, UK; Machen Eye Unit, South Warwickshire Foundation Trust, Warwick, UK
| | - Samer Elsherbiny
- Birmingham Midland Eye Centre, Birmingham, UK; Machen Eye Unit, South Warwickshire Foundation Trust, Warwick, UK
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Abstract
The treatment of infantile spasms is challenging, especially in the context of the following: (1) a severe phenotype with high morbidity and mortality; (2) the urgency of diagnosis and successful early response to therapy; and (3) the paucity of effective, safe, and well-tolerated therapies. Even after initially successful treatment, relapse risk is substantial and the most effective therapies pose considerable risk with long-term administration. In evaluating any treatment for infantile spasms, the key short-term outcome measure is freedom from both epileptic spasms and hypsarrhythmia. In contrast, the most important long-term outcomes are enduring seizure-freedom and measures of intellectual performance in later childhood and adulthood. First-line treatment options-namely hormonal therapy and vigabatrin-display moderate to high efficacy but also exhibit substantial side-effect burdens. Data on efficacy and safety of each class of therapy, as well as the combination of these therapies, are reviewed in detail. Specific hormonal therapies (adrenocorticotropic hormone and various corticosteroids) are contrasted. Those etiologies that prompt specific therapies are reviewed briefly, as are an array of second-line therapies supported by less-compelling data. The ketogenic diet is discussed in greater detail, with a focus on the limitations of numerous available studies that generally suggest that it is efficacious. Special discussion is allocated to cannabidiol-the investigational therapy that has received the most attention, and which is already in use in the form of various artisanal cannabis extracts. Finally, a treatment algorithm reflecting the concepts and controversies discussed in this review is presented.
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Affiliation(s)
- Shaun A. Hussain
- Division of Pediatric NeurologyDavid Geffen School of MedicineUCLA Mattel Children's HospitalLos AngelesCaliforniaU.S.A.
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40
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Moavero R, Pisani LR, Pisani F, Curatolo P. Safety and tolerability profile of new antiepileptic drug treatment in children with epilepsy. Expert Opin Drug Saf 2018; 17:1015-1028. [PMID: 30169997 DOI: 10.1080/14740338.2018.1518427] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Treatment of pediatric epilepsy requires a careful evaluation of the safety and tolerability profile of antiepileptic drugs (AEDs) to avoid or minimize as much as possible adverse events (AEs) on various organs, hematological parameters, and growth, pubertal, motor, cognitive and behavioral development. AREAS COVERED Treatment-emergent AEs (TEAEs) reported in the literature 2000-2018 regarding second- and third-generation AEDs used in the pediatric age, with exclusion of the neonatal period that exhibits specific peculiarities, have been described on the basis of their frequency, severity/tolerability, and particular association with a given AED. EXPERT OPINION Somnolence/sedation and behavioral changes, like irritability and nervousness, are among the most commonly observed TEAEs associated with almost all AEDs. Lamotrigine, Gabapentin, Oxcarbazepine, and Levetiracetam appear to be the best-tolerated AEDs with a ≤2% withdrawal rate, while Tiagabine and Everolimus are discontinued in up to >20% of the patients because of intolerable TEAEs. For some AEDs, literature data are scanty to draw a high-level evidence on their safety and tolerability profile. The reasons are: insufficient population size, short duration of treatments, or lack of controlled trials. A future goal is that of identifying clearer, easier, and more homogeneous methodological strategies to facilitate AED testing in pediatric populations.
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Affiliation(s)
- Romina Moavero
- a Child Neurology and Psychiatry Unit, Systems Medicine Department , Tor Vergata University of Rome , Rome , Italy.,b Child Neurology Unit, Neuroscience and Neurorehabilitation Department , "Bambino Gesù", Children's Hospital, IRCCS , Rome , Italy
| | | | - Francesco Pisani
- d Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Paolo Curatolo
- a Child Neurology and Psychiatry Unit, Systems Medicine Department , Tor Vergata University of Rome , Rome , Italy
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Ounissi M, Rodrigues C, Bienayme H, Duhamel P, Pons G, Dulac O, Nabbout R, Chiron C, Jullien V. Proposition of a Minimal Effective Dose of Vigabatrin for the Treatment of Infantile Spasms Using Pediatric and Adult Pharmacokinetic Data. J Clin Pharmacol 2018; 59:177-188. [DOI: 10.1002/jcph.1309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Marwa Ounissi
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
| | - Christelle Rodrigues
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
| | | | - Paul Duhamel
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
| | - Gérard Pons
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
| | - Olivier Dulac
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
- Reference Centre for Rare Epilepsies; APHP; Necker-Enfants Malades Hospital; Imagine institute; Paris France
| | - Rima Nabbout
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
- Reference Centre for Rare Epilepsies; APHP; Necker-Enfants Malades Hospital; Imagine institute; Paris France
| | - Catherine Chiron
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
- Reference Centre for Rare Epilepsies; APHP; Necker-Enfants Malades Hospital; Imagine institute; Paris France
| | - Vincent Jullien
- INSERM U1129, Paris, France; Paris Descartes University, CEA; Gif-sur-Yvette France
- Service de pharmacologie; Hôpital Européen Georges Pompidou; Paris France
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Vigabatrin and high-dose prednisolone therapy for patients with West syndrome. Epilepsy Res 2018; 145:127-133. [DOI: 10.1016/j.eplepsyres.2018.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/20/2018] [Accepted: 06/22/2018] [Indexed: 11/18/2022]
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Abstract
West syndrome (WS), also known as infantile spasms, occurs in infancy with a peak between 4 and 7 months. Spasms, neurodevelopmental regression and hypsarrhythmia on electroencephalogram (EEG) basically define WS. The International League Against Epilepsy commission classifies the aetiologies of WS into genetic, structural, metabolic and unknown. Early diagnosis and a shorter lag time to treatment are essential for the overall outcome of WS patients. These goals are feasible with the addition of brain magnetic resonance imaging (MRI) and genetic and metabolic testing. The present work analysed the medical literature on WS and reports the principal therapeutic protocols of its management. Adrenocorticotropic hormone (ACTH), vigabatrin (VGB) and corticosteroids are the first-line treatments for WS. There is no unique therapeutic protocol for ACTH, but most of the evidence suggests that low doses are as effective as high doses for short-term treatment, which is generally 2 weeks followed by dose tapering. VGB is generally administered at doses from 50 to 150 mg/kg/day, but its related retinal toxicity, which occurs in 21-34% of infants, is most frequently observed when treatment periods last longer than 6 months. Among corticosteroids, a treatment of 14 days of oral prednisolone (40-60 mg/day) has been considered effective and well tolerated. Considering that an early diagnosis and a shorter lag time to treatment are essential for successful outcomes in these patients, further studies on efficacy of the different therapeutic approaches with evaluation of final outcome after cessation of therapy are needed.
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Kanner AM, Ashman E, Gloss D, Harden C, Bourgeois B, Bautista JF, Abou-Khalil B, Burakgazi-Dalkilic E, Park EL, Stern J, Hirtz D, Nespeca M, Gidal B, Faught E, French J. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs II: Treatment-resistant epilepsy: Report of the American Epilepsy Society and the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Epilepsy Curr 2018; 18:269-278. [PMID: 30254528 PMCID: PMC6145395 DOI: 10.5698/1535-7597.18.4.269] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To update the 2004 American Academy of Neurology (AAN) guideline for managing treatment-resistant (TR) epilepsy with second- and third-generation antiepileptic drugs (AEDs). Methods: 2004 criteria were used to systematically review literature (January 2003 to November 2015), classify pertinent studies according to the therapeutic rating scheme, and link recommendations to evidence strength. Results: Forty-two articles were included. Recommendations: The following are established as effective to reduce seizure frequency (Level A): immediate-release pregabalin and perampanel for TR adult focal epilepsy (TRAFE); vigabatrin for TRAFE (not first-line treatment; rufinamide for Lennox-Gastuat syndrome (LGS) (add-on therapy). The following should be considered to decrease seizure frequency (Level B): lacosamide, eslicarbazepine, and extended-release topiramate for TRAFE (ezogabine production discontinued); immediate- and extended-release lamotrigine for generalized epilepsy with TR generalized tonic-clonic (GTC) seizures in adults; levetiracetam (add-on therapy) for TR childhood focal epilepsy (TRCFE) (1 month to 16 years), TR GTC seizures, and TR juvenile myoclonic epilepsy; clobazam for LGS (add-on therapy); zonisamide for TRCFE (6-17 years); oxcarbazepine for TRCFE (1 month to 4 years). The text presents Level C recommendations. AED selection depends on seizure/syndrome type, patient age, concomitant medications, and AED tolerability, safety, and efficacy. This evidence-based assessment informs AED prescription guidelines for TR epilepsy and indicates seizure types and syndromes needing more evidence. A recent FDA strategy allows extrapolation of efficacy across populations; therefore, for focal epilepsy, eslicarbazepine and lacosamide (oral only for pediatric use) as add-on or monotherapy in persons ≥4 years of age and perampanel as monotherapy received FDA approval.
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Affiliation(s)
| | | | - David Gloss
- 3Charleston Area Medical Center, Charleston, WV
| | | | | | | | | | | | | | - John Stern
- 10University of California in Los Angeles, School of Medicine, Los Angeles, CA
| | - Deborah Hirtz
- 11University of Vermont Medical Center, Burlington, VT
| | - Mark Nespeca
- 12Children's Hospital, University of California San Diego School of Medicine, CA
| | - Barry Gidal
- 13University of Wisconsin, School of Pharmacy, Madison, WI
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Kanner AM, Ashman E, Gloss D, Harden C, Bourgeois B, Bautista JF, Abou-Khalil B, Burakgazi-Dalkilic E, Llanas Park E, Stern J, Hirtz D, Nespeca M, Gidal B, Faught E, French J. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs II: Treatment-resistant epilepsy. Neurology 2018; 91:82-90. [DOI: 10.1212/wnl.0000000000005756] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/29/2018] [Indexed: 02/07/2023] Open
Abstract
ObjectiveTo update the 2004 American Academy of Neurology guideline for managing treatment-resistant (TR) epilepsy with second- and third-generation antiepileptic drugs (AEDs).Methods2004 criteria were used to systemically review literature (January 2003 to November 2015), classify pertinent studies according to the therapeutic rating scheme, and link recommendations to evidence strength.ResultsForty-two articles were included.RecommendationsThe following are established as effective to reduce seizure frequency (Level A): immediate-release pregabalin and perampanel for TR adult focal epilepsy (TRAFE); vigabatrin for TRAFE (not first-line treatment); rufinamide for Lennox-Gastaut syndrome (LGS) (add-on therapy). The following should be considered to decrease seizure frequency (Level B): lacosamide, eslicarbazepine, and extended-release topiramate for TRAFE (ezogabine production discontinued); immediate- and extended-release lamotrigine for generalized epilepsy with TR generalized tonic-clonic (GTC) seizures in adults; levetiracetam (add-on therapy) for TR childhood focal epilepsy (TRCFE) (1 month–16 years), TR GTC seizures, and TR juvenile myoclonic epilepsy; clobazam for LGS (add-on therapy); zonisamide for TRCFE (6–17 years); oxcarbazepine for TRCFE (1 month–4 years). The text presents Level C recommendations. AED selection depends on seizure/syndrome type, patient age, concomitant medications, and AED tolerability, safety, and efficacy. This evidence-based assessment informs AED prescription guidelines for TR epilepsy and indicates seizure types and syndromes needing more evidence. A recent Food and Drug Administration (FDA) strategy allows extrapolation of efficacy across populations; therefore, for focal epilepsy, eslicarbazepine and lacosamide (oral only for pediatric use) as add-on or monotherapy in persons ≥4 years of age and perampanel as monotherapy received FDA approval.
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46
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Abstract
Given the distinctive characteristics of both epilepsy and antiepileptic drugs (AEDs), therapeutic drug monitoring (TDM) can make a significant contribution to the field of epilepsy. The measurement and interpretation of serum drug concentrations can be of benefit in the treatment of uncontrollable seizures and in cases of clinical toxicity; it can aid in the individualization of therapy and in adjusting for variable or nonlinear pharmacokinetics; and can be useful in special populations such as pregnancy. This review examines the potential for TDM of newer AEDs such as eslicarbazepine acetate, felbamate, gabapentin, lacosamide, lamotrigine, levetiracetam, perampanel, pregabalin, rufinamide, retigabine, stiripentol, tiagabine, topiramate, vigabatrin, and zonisamide. We describe the relationships between serum drug concentration, clinical effect, and adverse drug reactions for each AED as well as the different analytical methods used for serum drug quantification. We discuss retrospective studies and prospective data on the serum drug concentration-efficacy of these drugs and present the pharmacokinetic parameters, oral bioavailability, reference concentration range, and active metabolites of newer AEDs. Limited data are available for recent AEDs, and we discuss the connection between drug concentrations in terms of clinical efficacy and nonresponse. Although we do not propose routine TDM, serum drug measurement can play a beneficial role in patient management and treatment individualization. Standardized studies designed to assess, in particular, concentration-efficacy-toxicity relationships for recent AEDs are urgently required.
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Affiliation(s)
- Shery Jacob
- Department of Pharmaceutics, College of Pharmacy, Gulf Medical University, University Street, P.O.Box No.4184, Ajman, UAE.
| | - Anroop B Nair
- Department of Pharmaceutics, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
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Schur RM, Gao S, Yu G, Chen Y, Maeda A, Palczewski K, Lu ZR. New GABA modulators protect photoreceptor cells from light-induced degeneration in mouse models. FASEB J 2018; 32:3289-3300. [PMID: 29401616 DOI: 10.1096/fj.201701250r] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
No clinically approved therapies are currently available that prevent the onset of photoreceptor death in retinal degeneration. Signaling between retinal neurons is regulated by the release and uptake of neurotransmitters, wherein GABA is the main inhibitory neurotransmitter. In this work, novel 3-chloropropiophenone derivatives and the clinical anticonvulsants tiagabine and vigabatrin were tested to modulate GABA signaling and protect against light-induced retinal degeneration. Abca4-/-Rdh8-/- mice, an accelerated model of retinal degeneration, were exposed to intense light after prophylactic injections of one of these compounds. Imaging and functional assessments of the retina indicated that these compounds successfully protected photoreceptor cells from degeneration to maintain a full-visual-field response. Furthermore, these compounds demonstrated a strong safety profile in wild-type mice and did not compromise visual function or damage the retina, despite repeated administration. These results indicate that modulating inhibitory GABA signaling can offer prophylactic protection against light-induced retinal degeneration.-Schur, R. M., Gao, S., Yu, G., Chen, Y., Maeda, A., Palczewski, K., Lu, Z.-R. New GABA modulators protect photoreceptor cells from light-induced degeneration in mouse models.
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Affiliation(s)
- Rebecca M Schur
- Case Center for Biomolecular Engineering, Department of Biomedical Engineering, School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Songqi Gao
- Department of Pharmacology, Cleveland Center for Membrane and Structural Biology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Guanping Yu
- Case Center for Biomolecular Engineering, Department of Biomedical Engineering, School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yu Chen
- Department of Pharmacology, Cleveland Center for Membrane and Structural Biology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Akiko Maeda
- Department of Ophthalmology and Visual Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Krzysztof Palczewski
- Department of Pharmacology, Cleveland Center for Membrane and Structural Biology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Zheng-Rong Lu
- Case Center for Biomolecular Engineering, Department of Biomedical Engineering, School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Treatment issues for children with epilepsy transitioning to adult care. Epilepsy Behav 2017; 69:153-160. [PMID: 28188045 DOI: 10.1016/j.yebeh.2016.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/22/2022]
Abstract
This is the third of three papers that summarize the second symposium on Transition in Epilepsies held in Paris in June 2016. This paper focuses on treatment issues that arise during the course of childhood epilepsy and make the process of transition to adult care more complicated. Some AEDs used during childhood, such as stiripentol, vigabatrin, and cannabidiol, are unfamiliar to adult epilepsy specialists. In addition, new drugs are being developed for treatment of specific childhood onset epilepsy syndromes and have no indication yet for adults. The ketogenic diet may be effective during childhood but is difficult to continue in adult care. Regional adult epilepsy diet clinics could be helpful. Polytherapy is common for patients transitioning to adult care. Although these complex AED regimes are difficult, they are often possible to simplify. AEDs used in childhood may need to be reconsidered in adulthood. Rescue medications to stop prolonged seizures and clusters of seizures are in wide home use in children and can be continued in adulthood. Adherence/compliance is notoriously difficult for adolescents, but there are simple clinical approaches that should be helpful. Mental health issues including depression and anxiety are not always diagnosed and treated in children and young adults even though effective treatments are available. Attention deficit hyperactivity disorder and aggressive behavior disorders may interfere with transition and successful adulthood but these can be treated. For the majority, the adult social outcome of children with epilepsy is unsatisfactory with few proven interventions. The interface between pediatric and adult care for children with epilepsy is becoming increasingly complicated with a need for more comprehensive transition programs and adult epileptologists who are knowledgeable about special treatments that benefit this group of patients.
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Zhang D, Liu X, Deng X. Genetic basis of pediatric epilepsy syndromes. Exp Ther Med 2017; 13:2129-2133. [PMID: 28565819 PMCID: PMC5443213 DOI: 10.3892/etm.2017.4267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 03/21/2017] [Indexed: 01/26/2023] Open
Abstract
Childhood epilepsy affects ~0.5-1% in the general population worldwide. Early-onset epileptic encephalopathies are considered to be severe neurological disorders, which lead to impaired motor, cognitive, and sensory development due to recurrence of seizures. Many of the observed epilepsy phenotypes are associated with specific chromosomal imbalances and thus display gene dosage effects, and also specific mutations of a variety of genes ranging from ion channels to transcription factors. High throughput sequencing technologies and whole exome sequencing have led to the recognition of several new candidate genes with a possible role in the pathogenesis of epileptic encephalopathies. The mutations causing channelopathies can be either a gain or a loss of ion channel function and contribute to the pathogenesis of epilepsy syndrome. Nearly 300 mutations of SCN1A gene coding for the Nav1.1 channel protein have been identified that contribute to the pathology of epilepsy. Besides Na, potassium and calcium channels are also implicated in epileptic encephalopathies. Therapeutic management of epileptic encephalopathies has been challenging as the majority of the medications are not efficient and often have many undesirable side effects. A better understanding of the molecular nature of epilepsy in an individual is important to design a personalized medication, considering the number of possible genetic mutations that can contribute to epileptic encephalopathies.
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Affiliation(s)
- Dongli Zhang
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Xiaoming Liu
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Xingqiang Deng
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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Hussain SA, Tsao J, Li M, Schwarz MD, Zhou R, Wu JY, Salamon N, Sankar R. Risk of vigabatrin-associated brain abnormalities on MRI in the treatment of infantile spasms is dose-dependent. Epilepsia 2017; 58:674-682. [DOI: 10.1111/epi.13712] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Shaun A. Hussain
- Division of Pediatric Neurology; David Geffen School of Medicine and Mattel Children's Hospital UCLA; Los Angeles California U.S.A
| | - Jackie Tsao
- Division of Pediatric Neurology; David Geffen School of Medicine and Mattel Children's Hospital UCLA; Los Angeles California U.S.A
| | - Menglu Li
- School of Medicine and Health Sciences; George Washington University; Washington District of Columbia U.S.A
| | - Madeline D. Schwarz
- School of Medicine; University of California, San Francisco; San Francisco California U.S.A
| | - Raymond Zhou
- Division of Pediatric Neurology; David Geffen School of Medicine and Mattel Children's Hospital UCLA; Los Angeles California U.S.A
| | - Joyce Y. Wu
- Division of Pediatric Neurology; David Geffen School of Medicine and Mattel Children's Hospital UCLA; Los Angeles California U.S.A
| | - Noriko Salamon
- Department of Radiology; David Geffen School of Medicine and Mattel Children's Hospital UCLA; Los Angeles California U.S.A
| | - Raman Sankar
- Division of Pediatric Neurology; David Geffen School of Medicine and Mattel Children's Hospital UCLA; Los Angeles California U.S.A
- Department of Neurology; David Geffen School of Medicine and Mattel Children's Hospital UCLA; Los Angeles California U.S.A
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