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Trinka E, Rocamora R, Chaves J, Koepp MJ, Rüegg S, Holtkamp M, Moreira J, Fonseca MM, Castilla-Fernández G, Ikedo F. Lipid profile with eslicarbazepine acetate and carbamazepine monotherapy in adult patients with newly diagnosed focal seizures: post hoc analysis of a phase III trial and open-label extension study. Ther Adv Neurol Disord 2023; 16:17562864231193530. [PMID: 37675038 PMCID: PMC10478566 DOI: 10.1177/17562864231193530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/20/2023] [Indexed: 09/08/2023] Open
Abstract
Background Antiseizure medications can have negative effects on plasma lipid levels. Objectives To evaluate plasma lipid changes in patients with newly diagnosed focal epilepsy treated with eslicarbazepine acetate (ESL) or controlled-release carbamazepine (CBZ-CR) monotherapy during a phase III, randomized, double-blind (DB) trial and 2 years of ESL treatment in an open-label extension (OLE). Design Post hoc analysis of a phase III trial and OLE study. Methods Proportions of patients with elevated levels of total cholesterol and low-density lipoprotein (LDL) cholesterol were assessed at DB baseline, OLE baseline (last visit of DB trial), and end of OLE. Results A total of 184 patients received ESL monotherapy during the OLE: 96 received ESL monotherapy in the DB trial and 88 patients received CBZ-CR monotherapy. The proportions of patients with elevated total cholesterol and LDL cholesterol increased significantly during the DB trial in those treated with CBZ-CR monotherapy [total cholesterol, +14.9% (p < 0.001); LDL cholesterol, +11.5% (p = 0.012)] but decreased significantly after switching to ESL monotherapy in the OLE [total cholesterol, -15.3% (p = 0.008); LDL cholesterol, -11.1% (p = 0.021)]. No significant changes were observed in those treated with ESL monotherapy during the DB trial and OLE. At the end of the DB trial, between-group differences (ESL-CBZ-CR) in the proportions of patients with elevated total and LDL cholesterol were -13.6% (p = 0.037) and -12.3% (p = 0.061), respectively; at the end of the OLE, these between-group differences were -6.0% (p = 0.360) and -0.6% (p = 1.000), respectively. Conclusion A lower proportion of patients with newly diagnosed focal epilepsy had increased levels of total and LDL cholesterol, compared to baseline, following monotherapy with ESL versus CBZ-CR; after switching from CBZ-CR to ESL, the proportions of patients with increased levels decreased significantly. Registration ClinicalTrials.gov NCT01162460/NCT02484001; EudraCT 2009-011135-13/2015-001243-36.
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Affiliation(s)
- Eugen Trinka
- Department of Neurology, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of the European Reference Centre EpiCARE, Ignaz Harrerstrasse 79, Salzburg A-5020, Austria
- Neuroscience Institute, Christian-Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria
- Institute of Public Health, Medical Decision-Making and HTA, UMIT – Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
| | - Rodrigo Rocamora
- Hospital del Mar Medical Research Institute, Barcelona Spain
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Member of the European Reference Centre EpiCARE, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - João Chaves
- Department of Neurology, Hospital Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mathias J. Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - Stephan Rüegg
- Department of Neurology, Hospital of the University of Basel and University of Basel, Basel, Switzerland
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Fábio Ikedo
- Bial – Portela & Cª, S.A., Coronado, Portugal
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Viloria-Alebesque A, Bellosta-Diago E, Navarro-Pérez MP, Santos-Lasaosa S, Mauri-Llerda JÁ. Circadian rhythm of blood pressure in patients with drug-resistant mesial temporal lobe epilepsy. Seizure 2023; 108:43-48. [PMID: 37080123 DOI: 10.1016/j.seizure.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE To determine whether patients with drug-resistant mesial temporal lobe epilepsy present with an alteration in the autonomic circadian regulation of blood pressure. METHODS A prospective case‒control study was designed, with a case group comprising patients with drug-resistant mesial temporal lobe epilepsy and a control group comprising healthy volunteers. Twenty-four-hour outpatient blood pressure monitoring was performed to assess the existence of a normal (dipping) or altered (non-dipping) circadian pattern. In addition, analytical and ultrasound parameters (carotid intima-media thickness) of vascular risk and sleep quality were evaluated. RESULTS Twenty-four subjects were recruited in each study group, amongst whom no demographic differences or history of vascular risk were observed. A higher percentage of participants with a non-dipping pattern was observed in the group of patients with epilepsy (62.5% vs. 12.5, p = 0.001). In the case group, significant differences were also observed in carotid intima-media thickness, with a greater probability of presenting with pathological values (p = 0.022). CONCLUSION The results suggest a disorder of the central autonomic control of blood pressure in patients with drug-resistant mesial temporal lobe epilepsy, with a greater probability of developing an alteration of the circadian rhythm of blood pressure. This dysfunction may be a factor involved in the increased cardiovascular risk in this population.
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Affiliation(s)
- Alejandro Viloria-Alebesque
- Neurology Department, Hospital Universitario Miguel Servet- Hospital General de la Defensa, P.º de Isabel la Católica 1-3, Zaragoza 50009, Spain; Aragon Health Research Institute, C/ San Juan Bosco 13, Zaragoza 50009, Spain.
| | - Elena Bellosta-Diago
- Aragon Health Research Institute, C/ San Juan Bosco 13, Zaragoza 50009, Spain; Neurology Department, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco 15, Zaragoza 50009, Spain
| | - María Pilar Navarro-Pérez
- Aragon Health Research Institute, C/ San Juan Bosco 13, Zaragoza 50009, Spain; Neurology Department, Hospital Obispo Polanco, Av/ Ruiz Jarabo s/n, Teruel 44002, Spain
| | - Sonia Santos-Lasaosa
- Aragon Health Research Institute, C/ San Juan Bosco 13, Zaragoza 50009, Spain; Neurology Department, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco 15, Zaragoza 50009, Spain
| | - José Ángel Mauri-Llerda
- Aragon Health Research Institute, C/ San Juan Bosco 13, Zaragoza 50009, Spain; Neurology Department, Hospital Clínico Universitario Lozano Blesa, C/San Juan Bosco 15, Zaragoza 50009, Spain
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Haris A, Bachour K, Hopkins RB, Tarride JE, Keezer MR. The treatment of epilepsy in younger and older adults: demographic differences and prescribing patterns of anti-seizure medications in Canada. Epilepsy Res 2022; 184:106941. [DOI: 10.1016/j.eplepsyres.2022.106941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/11/2022] [Accepted: 05/04/2022] [Indexed: 11/03/2022]
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