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Filippi C, Damioli S, Accorsi P, Crotti E, Fazzi EM, Galli J, Martelli P, Morandi A, Muda A, Pinghini S, Saottini S, Sforza SE, Milito G, Giordano L. Early onset absence epilepsy of childhood: Epidemiologic data, treatment and outcome in a sample of 56 patients born between 2000 and 2018. Seizure 2024; 118:47-52. [PMID: 38636356 DOI: 10.1016/j.seizure.2024.03.014] [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: 02/13/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE The aim of our work is to describe the characteristics of Early Onset Absence Epilepsy (EOAE) and to observe whether specific anamnestic, clinical or electroencephalographic characteristics can influence the drug sensitivity of this pathology. METHODS We carried out a retrospective study of patients affected by absence epilepsy with onset under four years of age, born between January 1st 2000 and December 31st 2018, who were reffered to the Regional Epilepsy Center of Spedali Civili of Brescia. We then divided the sample into three groups based on the age of onset. RESULTS Our sample is composed of 56 patients. Among the children with epilepsy onset under two years of age (11), all were still on therapy after three and six years of follow-up, and 64 % of them required polytherapy. Among patients with epilepsy onset between two and three years of age (24), 87 % were still on therapy after three years of follow-up and 68 % after six years of follow-up; 46 % of these subjects required polytherapy. Among patients with epilepsy onset between three and four years of age (21), 89 % were still on therapy after three years of follow-up and 38 % after six years of follow-up; 38 % of them required polytherapy. CONCLUSIONS We observe that patients with an earlier epilepsy onset have a worse outcome and a lower drug sensitivity. This may allow to predict in which cases it would be appropriate to maintain antiseizure therapy for a prolonged period.
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Affiliation(s)
- C Filippi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy.
| | - S Damioli
- NeMO - Brescia Clinical Center for Neuromuscular Diseases, Brescia Italy
| | - P Accorsi
- Epilepsy Regional Center, Unit of Child Neurology and Psychiatry - ASST Spedali Civili of Brescia, Brescia Italy
| | - E Crotti
- Epilepsy Regional Center, Unit of Child Neurology and Psychiatry - ASST Spedali Civili of Brescia, Brescia Italy
| | - E M Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy; Unit of Child Neurology and Psychiatry, ASST Spedali Civili of Brescia, Brescia Italy
| | - J Galli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - P Martelli
- Epilepsy Regional Center, Unit of Child Neurology and Psychiatry - ASST Spedali Civili of Brescia, Brescia Italy
| | - A Morandi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - A Muda
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - S Pinghini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - S Saottini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - S E Sforza
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia Italy
| | - G Milito
- Epilepsy Regional Center, Unit of Child Neurology and Psychiatry - ASST Spedali Civili of Brescia, Brescia Italy
| | - L Giordano
- Epilepsy Regional Center, Unit of Child Neurology and Psychiatry - ASST Spedali Civili of Brescia, Brescia Italy
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Nordli DR, Bagiella E, Arzimanoglou A, Wang J, Kumar D, Laurenza A, French J. Meta-analysis of drug efficacy in adult vs pediatric trials of patients with PGTC seizures. Neurology 2020; 94:e1845-e1852. [PMID: 32238509 PMCID: PMC7274844 DOI: 10.1212/wnl.0000000000009325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 11/20/2019] [Indexed: 12/31/2022] Open
Abstract
Objective A meta-analysis of published studies was performed to determine whether the efficacy of antiseizure drugs in adults with primary generalized tonic-clonic seizures (PGTCS) is comparable with that in the pediatric population (2–12 years of age). Methods Electronic searches were conducted in EMBASE, Medline, and the Cochrane Central Register of Controlled Trials for clinical trials of PGTCS in adults and children 2–12 years of age. Neurologists used standardized search and study evaluations to select eligible trials. Median percent reduction in seizure frequency from baseline and ≥50% responder rates were used to compare drug efficacy in adults and children. Results Among 7 adjunctive-therapy PGTCS trials in adults and children (2–12 years of age) that met evaluation criteria, effect sizes were consistent between adults and children for lamotrigine and topiramate. The baseline-subtracted median percent seizure reduction in seizure frequency ranged from 50.0% to 79.7% in children and 57.0% to 64.0% in adults. The ≥50% responder rate was similar between children and adults in a topiramate study (50% in children compared with 58% in adults). Conclusions This meta-analysis supports the use of drug response from antiseizure drug clinical trials for PGTCS in adults to predict comparable treatment response in children 2–12 years of age with PGTCS.
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Affiliation(s)
- Douglas R Nordli
- From the University of Chicago (D.R.N.), IL; Mount Sinai School of Medicine (E.B.), New York, NY; Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology (A.A.), University Hospitals of Lyon (HCL), Member of the European Reference Network EpiCARE, Lyon, France; Paediatric Epilepsy Unit (A.A.), Hospital Sant Joan de Déu, Member of the European Reference Network EpiCARE and Universitat de Barcelona, Spain; Eisai Inc. (J.W., D.K., A.L.), Woodcliff Lake, NJ; and NYU Comprehensive Epilepsy Center (J.F.), New York, NY.
| | - Emilia Bagiella
- From the University of Chicago (D.R.N.), IL; Mount Sinai School of Medicine (E.B.), New York, NY; Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology (A.A.), University Hospitals of Lyon (HCL), Member of the European Reference Network EpiCARE, Lyon, France; Paediatric Epilepsy Unit (A.A.), Hospital Sant Joan de Déu, Member of the European Reference Network EpiCARE and Universitat de Barcelona, Spain; Eisai Inc. (J.W., D.K., A.L.), Woodcliff Lake, NJ; and NYU Comprehensive Epilepsy Center (J.F.), New York, NY
| | - Alexis Arzimanoglou
- From the University of Chicago (D.R.N.), IL; Mount Sinai School of Medicine (E.B.), New York, NY; Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology (A.A.), University Hospitals of Lyon (HCL), Member of the European Reference Network EpiCARE, Lyon, France; Paediatric Epilepsy Unit (A.A.), Hospital Sant Joan de Déu, Member of the European Reference Network EpiCARE and Universitat de Barcelona, Spain; Eisai Inc. (J.W., D.K., A.L.), Woodcliff Lake, NJ; and NYU Comprehensive Epilepsy Center (J.F.), New York, NY
| | - Jinping Wang
- From the University of Chicago (D.R.N.), IL; Mount Sinai School of Medicine (E.B.), New York, NY; Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology (A.A.), University Hospitals of Lyon (HCL), Member of the European Reference Network EpiCARE, Lyon, France; Paediatric Epilepsy Unit (A.A.), Hospital Sant Joan de Déu, Member of the European Reference Network EpiCARE and Universitat de Barcelona, Spain; Eisai Inc. (J.W., D.K., A.L.), Woodcliff Lake, NJ; and NYU Comprehensive Epilepsy Center (J.F.), New York, NY
| | - Dinesh Kumar
- From the University of Chicago (D.R.N.), IL; Mount Sinai School of Medicine (E.B.), New York, NY; Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology (A.A.), University Hospitals of Lyon (HCL), Member of the European Reference Network EpiCARE, Lyon, France; Paediatric Epilepsy Unit (A.A.), Hospital Sant Joan de Déu, Member of the European Reference Network EpiCARE and Universitat de Barcelona, Spain; Eisai Inc. (J.W., D.K., A.L.), Woodcliff Lake, NJ; and NYU Comprehensive Epilepsy Center (J.F.), New York, NY
| | - Antonio Laurenza
- From the University of Chicago (D.R.N.), IL; Mount Sinai School of Medicine (E.B.), New York, NY; Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology (A.A.), University Hospitals of Lyon (HCL), Member of the European Reference Network EpiCARE, Lyon, France; Paediatric Epilepsy Unit (A.A.), Hospital Sant Joan de Déu, Member of the European Reference Network EpiCARE and Universitat de Barcelona, Spain; Eisai Inc. (J.W., D.K., A.L.), Woodcliff Lake, NJ; and NYU Comprehensive Epilepsy Center (J.F.), New York, NY
| | - Jacqueline French
- From the University of Chicago (D.R.N.), IL; Mount Sinai School of Medicine (E.B.), New York, NY; Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology (A.A.), University Hospitals of Lyon (HCL), Member of the European Reference Network EpiCARE, Lyon, France; Paediatric Epilepsy Unit (A.A.), Hospital Sant Joan de Déu, Member of the European Reference Network EpiCARE and Universitat de Barcelona, Spain; Eisai Inc. (J.W., D.K., A.L.), Woodcliff Lake, NJ; and NYU Comprehensive Epilepsy Center (J.F.), New York, NY
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Arzimanoglou A, D'Cruz O, Nordli D, Shinnar S, Holmes GL. A Review of the New Antiepileptic Drugs for Focal-Onset Seizures in Pediatrics: Role of Extrapolation. Paediatr Drugs 2018; 20:249-264. [PMID: 29616471 DOI: 10.1007/s40272-018-0286-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Most antiepileptic drugs (AEDs) receive regulatory approval for children years after the drug is available in adults, encouraging off-label use of the drug in children and hindering attempts to obtain quality pediatric data in controlled trials. Extrapolating adult efficacy data to pediatrics can reduce the time between approval in adults and that in children. To extrapolate efficacy from adults to children, several assumptions must be supported, such as (1) a similar disease progression and response to interventions in adults and children, and (2) similar exposure response in adults and children. The Pediatric Epilepsy Academic Consortium for Extrapolation (PEACE) addressed these assumptions in focal-onset seizures (FOS), the most common seizure type in both adults and children. PEACE reviewed the biological and clinical evidence that supported the assumptions that children with FOS have a similar disease progression and response to intervention as adults with FOS. After age 2 years, the pathophysiological underpinnings of FOS and the biological milieu in which seizures are initiated and propagated in children, seizure semiology, electroencephalographic features, etiology and AED response to FOS in children are similar to those in adults with FOS. PEACE concluded that extrapolation of efficacy data in adults to pediatrics in FOS is supported by strong scientific and clinical evidence. However, safety and pharmacokinetic (PK) data cannot be extrapolated from adults to children. Based on extrapolation, eslicarbazepine is now approved for children with FOS, down to age 4 years. Perampanel, lacosamide and brivaracetam are now undergoing PK and safety studies for the purposes of extrapolation down to age 2 or 4 years. When done in conjunction with PK and safety investigations in children, extrapolation of adult data from adults to children can reduce the time delay between approval of effective and safe AEDs in adults and approval in children.
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Affiliation(s)
- Alexis Arzimanoglou
- Department of Clinical Epileptology, Sleep Disorders and Functional Pediatric Neurology, University Hospitals of Lyon (HCL), Lyon, France.,Sección Epilepsia, Sueño y Neurofisiología, Servicio Neurología, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - O'Neill D'Cruz
- Consulting and Neurological Services, Chapel Hill, NC, USA
| | - Douglas Nordli
- Division of Pediatric Neurology, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Shlomo Shinnar
- Departments of Neurology, Pediatrics and Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Gregory L Holmes
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
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