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Epilepsy in Older Persons. Neurol Clin 2022; 40:891-905. [DOI: 10.1016/j.ncl.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Wang Y, Du Z, Chen Y, Liu Y, Yang Z. Meta-analysis: combination of meropenem vs ceftazidime and amikacin for empirical treatment of cancer patients with febrile neutropenia. Medicine (Baltimore) 2021; 100:e24883. [PMID: 33663117 PMCID: PMC7909104 DOI: 10.1097/md.0000000000024883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/09/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Meropenem monotherapy vs ceftazidime plus amikacin have been approved for use against febrile neutropenia. To assess the effectiveness and safety of them for empirical treatment of cancer patients with febrile neutropenia, we conducted a meta-analysis of randomized controlled trial. METHODS Randomized controlled trials on ceftazidime plus amikacin, or/and monotherapy with meropenem for the treatment of cancer patients with febrile neutropenia were identified by searching Cochrane Library, PubMed, Science Direct, Wiley Online, Science Citation Index, Google (scholar), National Center for Biotechnology Information, and China National Knowledge Infrastructure. Data on interventions, participants' characteristics and the outcomes of therapy, were extracted for statistical analysis. Seven trials fulfilled the inclusion criteria. RESULT The treatment with ceftazidime plus amikacin was more effective than meropenem (OR = 1.17; 95% CI 0.93-1.46; 1270 participants). However, the treatment effects of the 2 therapy methods were almost parallel in adults (OR = 1.15; 95% CI 0.91-1.46; 1130 participants older than 16). Drug-related adverse effects afflicted more patients treated with ceftazidime plus amikacin (OR = 0.78; 95% CI 0.52-1.15; 1445 participants). The common responses were nausea, diarrhea, rash, and increased in serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and bilirubin. CONCLUSION Ceftazidime plus amikacin should be the first choice for empirical treatment of cancer patients with febrile neutropenia, and meropenem may be chosen as a last defense against pathogenic bacteria.
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Affiliation(s)
- Ying Wang
- Department of Pharmacology, Medical College and Affiliated Hospital of Hebei University of Engineering
| | - Zhichao Du
- Department of Pharmacology, Medical College and Affiliated Hospital of Hebei University of Engineering
| | | | | | - Zhitang Yang
- Department of Neurology, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, PR China
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Quon RJ, Mazanec MT, Schmidt SS, Andrew AS, Roth RM, MacKenzie TA, Sajatovic M, Spruill T, Jobst BC. Antiepileptic drug effects on subjective and objective cognition. Epilepsy Behav 2020; 104:106906. [PMID: 32006792 PMCID: PMC7064420 DOI: 10.1016/j.yebeh.2020.106906] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE Cognitive impairment is one of the most common complaints for persons with epilepsy (PWE). These impairments are not only associated with seizures, but are also regularly reported as adverse effects of antiepileptic drugs (AEDs). Previous studies have examined cognitive effects of both AED monotherapy and polytherapy, yet there is limited research on these differences with respect to both subjective and objective cognition. The current study uses data from previous research conducted by the Centers for Disease Control and Prevention (CDC)-sponsored Managing Epilepsy Well (MEW) Network collaborative. We used three distinct archival datasets from the following: (1) the HOBSCOTCH efficacy trial at Dartmouth-Hitchcock Medical Center (HOB-1), (2) the multisite replication trial (HOB-2), and (3) epilepsy self-management research conducted at the NYU School of Medicine. METHODS This retrospective analysis combined baseline data from three datasets to determine how the number of AEDs and the type of AEDs were associated with subjective (patient-reported) and objective (examiner-assessed) cognition. Subjective cognition was captured using the cognitive subscale of the Quality of Life in Epilepsy Inventory (QOLIE-31) in all three datasets (n = 224), while objective cognition was measured using the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) in the HOB-1 dataset (n = 65) and the Brief Test of Adult Cognition by Telephone (BTACT) in the HOB-2 dataset (n = 91). Multivariable linear regression was utilized for our initial assessments, followed by propensity score matching to provide stronger control of covariates. Matching was based on significantly different covariates, such as education, depression, and history of prior epilepsy surgery. Nonparametric statistical tests were utilized to compare these matched subjects. RESULTS Subjective cognitive impairment was significantly worse among individuals on polytherapy (2 + AEDs) compared with those on monotherapy (1 AED) (adjusted p = 0.041). These findings were consistent with our propensity score matched comparison of monotherapy and polytherapy, which indicated that polytherapy was associated with worse overall subjective cognition (adjusted p = 0.01), in addition to impairments on the RBANS (Total score p = 0.05) and specific subdomains of the BTACT (Episodic Verbal Memory p < 0.01, Working Memory p < 0.01, Processing Speed p < 0.01). Interestingly, older generation AEDs were associated with better language performance than newer generation and combined generation AED therapy (RBANS Language p = 0.03). These language-specific findings remained significant after controlling for the effects of topiramate and zonisamide (p = 0.04). CONCLUSIONS A greater number of AEDs is significantly and negatively associated with subjective and objective cognition in PWE, and is in line with previous research. Antiepileptic drug type did not, in itself, appear to be associated with subjective cognition. Our findings suggest that ineffective AEDs should be replaced, rather than introducing additional AEDs to a treatment regimen. Further, while subjective and objective cognition assessments were both sensitive at detecting differences based on AED status, the neuropsychological objective subdomains offer additional and specific insights into how cognition is impaired with AEDs.
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Affiliation(s)
- Robert J Quon
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Morgan T Mazanec
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Samantha S Schmidt
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Angeline S Andrew
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Robert M Roth
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Todd A MacKenzie
- Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; The Dartmouth Institute, Dartmouth College, Hanover, NH, USA
| | - Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tanya Spruill
- Department of Population Health, New York University Langone, New York, NY, USA; Department of Medicine, New York University Langone, New York, NY, USA
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Weissinger F, Losch F, Winter Y, Brecht S, Lendemans D, Kockelmann E. Effectiveness of eslicarbazepine acetate in dependency of baseline anticonvulsant therapy: Results from a German prospective multicenter clinical practice study. Epilepsy Behav 2019; 101:106574. [PMID: 31678808 DOI: 10.1016/j.yebeh.2019.106574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/23/2019] [Accepted: 09/14/2019] [Indexed: 11/25/2022]
Abstract
Eslicarbazepine acetate (ESL) is a third-generation antiepileptic drug (AED) approved as monotherapy for partial-onset seizures in adults and as adjunctive therapy in patients aged above 6 years in the European Union (EU). The prospective observational Zebinix Effects in DEpendency of BAseline Conditions (ZEDEBAC) study aimed at investigating the effectiveness of ESL in clinical practice, with ESL being administered as monotherapy (mono group), as only add-on to a current monotherapy (1+ group), or as add-on to ≥2 baseline AEDs (≥2+ group). In total, 237 patients were included, 35 in the mono group, 114 in the 1+, and 88 in the ≥2+ group. Six-month retention rates were 93.9%, 78.0%, and 75.3% in the mono, 1+, and ≥2+ group. There were 90.5%, 77.6%, and 48.3% of patients in the mono, 1+, and ≥2+ groups who were responders (patients with a ≥50% reduction in seizure frequency at follow-up vs. baseline). Seizure freedom rates were 81.5%, 47.9%, and 23.4%, respectively. Adverse drug reactions (ADRs) occurred in 11.4% of patients of the mono, 19.3% of the 1+, and 28.4% of patients of the ≥2+ group. Hyponatremia was reported as ADR in 3.4% of all patients. Although baseline variables differed considerably, with most elderly patients with tumor-related and vascular etiologies in the mono group and most patients with refractory epilepsies with pronounced use of concomitant sodium channel blockers (SCBs) in the ≥2+ group, retention as a measure of real-life effectiveness turned out not to be substantially different and favorable in all groups.
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Affiliation(s)
- Florian Weissinger
- Epilepsy Centre, Department of Neurology, Vivantes Humboldt Hospital, Am Nordgraben 2, 13509 Berlin, Germany; Department of Neurology, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany
| | - Florian Losch
- Epilepsy Centre, Department of Neurology, Vivantes Humboldt Hospital, Am Nordgraben 2, 13509 Berlin, Germany
| | - Yaroslav Winter
- Mainz Comprehensive Epilepsy Center, Department of Neurology, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Silvia Brecht
- Eisai GmbH, Lyoner Str. 36, 60528 Frankfurt, Germany.
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Shih JJ, Whitlock JB, Chimato N, Vargas E, Karceski SC, Frank RD. Epilepsy treatment in adults and adolescents: Expert opinion, 2016. Epilepsy Behav 2017; 69:186-222. [PMID: 28237319 DOI: 10.1016/j.yebeh.2016.11.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION There are over twenty anti-seizure medications and anti-seizure devices available commercially in the United States. The multitude of treatment options for seizures can present a challenge to clinicians, especially those who are not subspecialists in the epilepsy field. Many clinical questions are not adequately answered in double-blind randomized controlled studies. In the presence of a knowledge gap, many clinicians consult a respected colleague with acknowledged expertise in the field. Our survey was designed to provide expert opinions on the treatment of epilepsy in adults and adolescents. METHOD We surveyed a group of 42 physicians across the United States who are considered experts based on publication record in the field of epilepsy, or a leadership role in a National Association of Epilepsy Centers comprehensive epilepsy program. The survey consisted of 43 multiple-part patient scenario questions and was administered online using Redcap software. The experts provided their opinion on 1126 treatment options based on a modified Rand 9-point scale. The patient scenarios focused on genetically-mediated generalized epilepsy and focal epilepsy. The scenarios first focused on overall treatment strategy and then on specific pharmacotherapies. Other questions focused on treatment of specific patient populations (pregnancy, the elderly, patients with brain tumors, and post organ transplant patients), epilepsy patients with comorbidities (renal and hepatic disease, depression), and how to combine medications after failure of monotherapy. Statistical analysis of data used the expert consensus method. RESULTS Valproate was considered a drug of choice in all genetically-mediated generalized epilepsies, except in the population of women of child-bearing age. Ethosuximide was a drug of choice in patient with absence seizures, and levetiracetam was a drug of choice in patients with genetic generalized tonic-clonic seizures and myoclonic seizures. Lamotrigine, levetiracetam and oxcarbazepine were considered drugs of choice for initial treatment of focal seizures. Lamotrigine and levetiracetam were the drugs of choice for women of child-bearing age with either genetic generalized epilepsy or focal epilepsy. Lamotrigine and levetiracetam were the drugs of choice in the elderly population. Lamotrigine was preferred in patients with co-morbid depression. Levetiracetam was the drug of choice in treating patients with hepatic failure, or who have undergone organ transplantation. Compared to the 2005 and 2001 surveys, there was increased preference for the use of levetiracetam and lamotrigine, and decreased preference for the use of phenytoin, gabapentin, phenobarbital and carbamazepine. DISCUSSION The study presented here provides a "snapshot" of the clinical practices of experts in the treatment of epilepsy. The experts were very often in agreement, and reached consensus in 81% of the possible responses. However, expert opinion does not replace the medical literature; instead, it acts to supplement existing information. Using the study results is similar to requesting an expert consultation. Our findings suggest options that the clinician should consider to achieve best practice.
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Affiliation(s)
- Jerry J Shih
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.
| | - Julia B Whitlock
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Nicole Chimato
- Department of Health Sciences and Research, Mayo Clinic, Jacksonville, FL, United States
| | - Emily Vargas
- Department of Health Sciences and Research, Mayo Clinic, Jacksonville, FL, United States
| | - Steven C Karceski
- Department of Neurology, Weill Cornell Medical Center, New York, NY, United States
| | - Ryan D Frank
- Department of Health Sciences and Research, Mayo Clinic, Jacksonville, FL, United States
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O' Rourke G, O' Brien JJ. Identifying the barriers to antiepileptic drug adherence among adults with epilepsy. Seizure 2016; 45:160-168. [PMID: 28063375 DOI: 10.1016/j.seizure.2016.12.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To identify the barriers to antiepileptic drug (AED) adherence among adults with epilepsy (AWE). The impact of AED non-adherence on quality of life (QoL) was also examined. METHOD Systematic design (SR) study. A search strategy was undertaken with no time limits, for articles published in English, in MEDLINE, CINANL, PsycINFO, EMBASE, Cochrane databases and grey literature sources. Eligibility criteria included participants with epilepsy over 18 years, who were prescribed AEDs. Adherence had to be defined and adherence assessment measurements identified. A screening process was undertaken to select eligible studies. Eight studies met the inclusion criteria and were included in a quantitative synthesis. Quality of evidence was conducted using the EBL critical appraisal checklist and assessing risk of bias within individual studies. RESULTS Across the included studies a high prevalence of non-adherence was identified. AED non-adherence was associated with specific beliefs about medications, being depressed or anxious, poor medication self-administration management, uncontrolled recent seizures, frequent medication dosage times, poor physician-patient relationship and perceived social support. Additionally, AED non-adherence impacted negatively on QoL as a result of poor seizure control. CONCLUSION Although included studies were of good quality, risk of biases reduced the generalisability of results. Findings suggested that comprehensive adherence assessments should routinely be performed. Recommendations for future research include the use of longitudinal research designs and a follow up SR to include the 16-18-year-old population.
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Giorgi FS, Guida M, Vergallo A, Bonuccelli U, Zaccara G. Treatment of epilepsy in patients with Alzheimer’s disease. Expert Rev Neurother 2016; 17:309-318. [DOI: 10.1080/14737175.2017.1243469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Filippo Sean Giorgi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa-Pisa University Hospital, Pisa, Italy
| | - Melania Guida
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa-Pisa University Hospital, Pisa, Italy
| | - Andrea Vergallo
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa-Pisa University Hospital, Pisa, Italy
| | - Ubaldo Bonuccelli
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa-Pisa University Hospital, Pisa, Italy
| | - Gaetano Zaccara
- Neurology Unit, Department of Medicine, Florence Health Authority, Firenze, Italy
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Cardinali DP, Golombek DA, Rosenstein RE, Brusco LI, Vigo DE. Assessing the efficacy of melatonin to curtail benzodiazepine/Z drug abuse. Pharmacol Res 2016; 109:12-23. [DOI: 10.1016/j.phrs.2015.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 12/15/2022]
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Biton V, Gil-Nagel A, Isojarvi J, Doty P, Hebert D, Fountain NB. Safety and tolerability of lacosamide as adjunctive therapy for adults with partial-onset seizures: Analysis of data pooled from three randomized, double-blind, placebo-controlled clinical trials. Epilepsy Behav 2015; 52:119-27. [PMID: 26414341 DOI: 10.1016/j.yebeh.2015.09.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/04/2015] [Accepted: 09/04/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The objective of this study was to describe a priori protocol-defined analyses to evaluate the safety and tolerability of adjunctive oral lacosamide (200-600 mg/day) in adults (ages 16-70 years) with partial-onset seizures (POS) using data pooled from three similarly designed randomized, double-blind, placebo-controlled trials (SP667, SP754 [NCT00136019], SP755 [NCT00220415]). METHODS Patients with POS (≥2 years' duration, ≥2 previous antiepileptic drugs [AEDs]) uncontrolled by a stable dosing regimen of 1-3 concomitant AEDs were randomized to treatment with lacosamide at doses of 200 mg/day, 400 mg/day, or 600 mg/day, or placebo. Studies comprised a 4- to 6-week titration phase to target dose followed by a 12-week maintenance phase. Safety outcomes included treatment-emergent adverse events (TEAEs) of particular relevance to patients with POS, overall TEAEs, and discontinuations due to TEAEs. Post hoc analyses included evaluation of TEAEs potentially related to cognition and TEAEs leading to discontinuation analyzed by concomitant AEDs. RESULTS One thousand three hundred eight patients were randomized to and received treatment; 944 to lacosamide and 364 to placebo. Most patients (84.4%) were taking 2 or 3 concomitant AEDs. The most common drug-associated TEAEs (reported by ≥5% of patients in any lacosamide dose group and with an incidence at least twice that reported for placebo during the treatment phase) were dizziness (30.6% for lacosamide vs 8.2% for placebo), nausea (11.4% vs 4.4%), and diplopia (10.5% vs 1.9%). Common drug-associated TEAEs generally appeared to be dose-related, and the incidence of each was lower during the 12-week maintenance phase than during the titration phase. Most TEAEs were either mild or moderate in intensity; severe TEAEs were predominantly observed with lacosamide 600 mg/day. No individual serious TEAE occurred in ≥1% of all lacosamide-treated patients. Treatment-emergent adverse events led to discontinuation in 8.1%, 17.2%, and 28.6% of the lacosamide 200-, 400-, and 600-mg/day groups, respectively (vs 4.9% of placebo). Few TEAEs were related to rash, weight loss/gain, changes in clinical chemistry parameters, or psychiatric disturbances, or were seizure-related. The odds of reporting any potential cognition-related TEAE vs placebo increased with dose and were similar between lacosamide doses of 200 and 400mg/day and placebo (odds ratio 1.3, 95% confidence interval 0.7-2.4). Discontinuations due to TEAEs based on most commonly used AEDs taken in combination with lacosamide (all doses combined) were carbamazepine (15.3% [51/334] vs 3.9% [5/129] placebo), lamotrigine (19.2% [56/291] vs 4.3% [5/117]), and levetiracetam (10.1% [28/278] vs 3.9% [4/103]). CONCLUSIONS The safety and tolerability profile of adjunctive lacosamide in this detailed evaluation was similar to that observed in the individual double-blind trials. Adjunctive lacosamide was associated with TEAEs related to the nervous system and gastrointestinal tract, predominantly during titration.
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Affiliation(s)
- Victor Biton
- Arkansas Epilepsy Program, #2 Lile Court Suite 100, Little Rock, AR 72205, USA.
| | - Antonio Gil-Nagel
- Department of Neurology, Epilepsy Program, Hospital Ruber Internacional, La Masó 38, 28034 Madrid, Spain.
| | - Jouko Isojarvi
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC 27617, USA.
| | - Pamela Doty
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC 27617, USA.
| | - David Hebert
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC 27617, USA.
| | - Nathan B Fountain
- FE Dreifuss Comprehensive Epilepsy Program, University of Virginia, Box 800394, Charlottesville, VA 22908, USA.
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Golombek DA, Pandi-Perumal SR, Brown GM, Cardinali DP. Some implications of melatonin use in chronopharmacology of insomnia. Eur J Pharmacol 2015; 762:42-8. [DOI: 10.1016/j.ejphar.2015.05.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 04/10/2015] [Accepted: 05/11/2015] [Indexed: 12/20/2022]
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Assis TRD, Nascimento OJM, Costa G, Bacellar A. Antiepileptic drugs patterns in elderly inpatients in a Brazilian tertiary center, Salvador, Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:874-80. [DOI: 10.1590/0004-282x20140151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/15/2014] [Indexed: 11/21/2022]
Abstract
Epilepsy is very prevalent among elderly inpatients and treatment is far from ideal. Objective To analyze prescribing patterns of antiepileptic drugs (AEDs) for hospitalized elderly with epilepsy, their relations with comorbidities and comedications. Method We assessed prescription regimen of elderly patients that were under AED use for treatment of epileptic seizures, during hospitalization. One hundred and nine patients were enrolled. AED regimen was categorized into two groups: Group 1 defined as appropriate (carbamazepine, oxcarbazepine, valproic acid, gabapentin, clobazan and lamotrigine) and Group 2 as inappropriate (phenytoin and phenobarbital). Results We found 73.4% of patients used inappropriate AEDs (p<0.001). Monotherapy was prescribed for 71.6% of patients. The most common comorbidity was hypertension. Potentially proconvulsant drugs as comedications were used for nearly half of patients. Conclusion Inappropriate AED therapy was commonly prescribed regimen for elderly inpatients. Some recommendations are discussed for a better care of elderly inpatients with epilepsy.
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Beretta S, Beghi E, Messina P, Gerardi F, Pescini F, La Licata A, Specchio L, Ferrara M, Canevini MP, Turner K, La Briola F, Franceschetti S, Binelli S, Giglioli I, Galimberti CA, Fattore C, Zaccara G, Tramacere L, Sasanelli F, Pirovano M, Ferrarese C. Comprehensive educational plan for patients with epilepsy and comorbidity (EDU-COM): a pragmatic randomised trial. J Neurol Neurosurg Psychiatry 2014; 85:889-94. [PMID: 24403284 DOI: 10.1136/jnnp-2013-306553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The impact of educational strategies in the management of adverse treatment effects and drug interactions in adult patients with epilepsy with comorbidities remains undetermined. OBJECTIVE The EDU-COM study is a randomised, pragmatic trial investigating the effect of a patient-tailored educational plan in patients with epilepsy with comorbidity. METHODS 174 adult patients with epilepsy with chronic comorbidities, multiple-drug therapy and reporting at least one adverse treatment effect and/or drug interaction at study entry were randomly assigned to the educational plan or usual care. The primary endpoint was the number of patients becoming free from adverse treatment events and/or drug interactions after a 6-month follow-up. The number of adverse treatment events and drug interactions, health-related quality of life (HRQOL) summary score changes and the monetary costs of medical contacts and drugs were assessed as secondary outcomes. RESULTS The primary endpoint was met by 44.0% of patients receiving the educational plan versus 28.9% of those on usual care (p=0.0399). The control group reported a significantly higher risk not to meet successfully the primary endpoint at the end of the study: OR (95% CI) of 2.29 (1.03 to 5.09). A separate analysis on drug adverse effects and drug interactions showed that the latter were more sensitive to the effect of educational treatment. Quality of life and costs were not significantly different in the two groups. CONCLUSIONS A patient-tailored educational strategy is effective in reducing drug-related problems (particularly drug interactions) in epilepsy patients with chronic comorbidities, without adding significant monetary costs. Registered at ClinicalTrials.gov, identifier NCT01804322, (http://www.clinicaltrials.gov).
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Affiliation(s)
- Simone Beretta
- Department of Neurology, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| | - Ettore Beghi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Paolo Messina
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Francesca Gerardi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | | | | | - Luigi Specchio
- Department of Medical and Experimental Sciences, Ospedali Riuniti, University of Foggia, Foggia, Italy
| | - Mariangela Ferrara
- Department of Medical and Experimental Sciences, Ospedali Riuniti, University of Foggia, Foggia, Italy
| | - Maria Paola Canevini
- Health Sciences Department, Epilepsy Center, San Paolo Hospital, University of Milano, Milano, Italy
| | - Katherine Turner
- Health Sciences Department, Epilepsy Center, San Paolo Hospital, University of Milano, Milano, Italy
| | - Francesca La Briola
- Health Sciences Department, Epilepsy Center, San Paolo Hospital, University of Milano, Milano, Italy
| | | | - Simona Binelli
- Neurophysiology Unit, Fondazione Carlo Besta Neurological Institute, Milano, Italy
| | - Isabella Giglioli
- Neurophysiology Unit, Fondazione Carlo Besta Neurological Institute, Milano, Italy
| | | | - Cinzia Fattore
- Clinical Trial Center & Antiepileptic Drugs, Fondazione Istituto "C. Mondino", Pavia, Italy
| | - Gaetano Zaccara
- Department of Neurology, S. Maria Nuova Hospital, Firenze, Italy
| | | | | | - Marta Pirovano
- Department of Neurology, Ospedale di Circolo, Melegnano, Italy
| | - Carlo Ferrarese
- Department of Neurology, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
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Grizzi F, Di Caro G, Laghi L, Hermonat P, Mazzola P, Nguyen DD, Radhi S, Figueroa JA, Cobos E, Annoni G, Chiriva-Internati M. Mast cells and the liver aging process. IMMUNITY & AGEING 2013; 10:9. [PMID: 23496863 PMCID: PMC3599827 DOI: 10.1186/1742-4933-10-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 03/04/2013] [Indexed: 12/15/2022]
Abstract
It has now ascertained that the clinical manifestations of liver disease in the elderly population reflect both the cumulative effects of longevity on the liver and the generalized senescence of the organism ability to adjust to metabolic, infectious, and immunologic insults. Although liver tests are not significantly affected by age, the presentation of liver diseases such as viral hepatitis may be subtler in the elderly population than that of younger patients. Human immunosenescence is a situation in which the immune system, particularly T lymphocyte function, deteriorates with age, while innate immunity is negligibly affected and in some cases almost up-regulated. We here briefly review the relationships between the liver aging process and mast cells, the key effectors in a more complex range of innate immune responses than originally though.
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Affiliation(s)
- Fabio Grizzi
- Laboratory of Molecular Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Giuseppe Di Caro
- Laboratory of Molecular Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Luigi Laghi
- Laboratory of Molecular Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Paul Hermonat
- Department of Internal medicine and Gene Therapy Program, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Paolo Mazzola
- Department of Health Sciences, University of Milano-Bicocca, Milan, and Geriatric Clinic, San Gerardo Hospital, Monza, Italy
| | - Diane D Nguyen
- Department of Internal Medicine, Division of Hematology/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Saba Radhi
- Department of Internal Medicine, Division of Hematology/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jose A Figueroa
- Department of Internal Medicine, Division of Hematology/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Everardo Cobos
- Department of Internal Medicine, Division of Hematology/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,The Laura W. Bush Institute for Women's Health and Center for Women's Health and Gender-Based Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Giorgio Annoni
- Department of Health Sciences, University of Milano-Bicocca, Milan, and Geriatric Clinic, San Gerardo Hospital, Monza, Italy
| | - Maurizio Chiriva-Internati
- Department of Internal Medicine, Division of Hematology/Oncology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.,The Laura W. Bush Institute for Women's Health and Center for Women's Health and Gender-Based Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA.,Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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14
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Al Za'abi M, Ahmed R, Al Asmi A, Al-Zakwani I. Utilization patterns of antiepileptic drugs among adult epileptic patients at a tertiary hospital in Oman. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2012; 21:117-22. [DOI: 10.1111/j.2042-7174.2012.00240.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 06/18/2012] [Indexed: 12/01/2022]
Abstract
Abstract
Objectives
To describe utilization patterns of antiepileptic drugs (AEDs) among adult epileptic patients at a tertiary hospital in Oman.
Methods
Data were collected retrospectively from January 2006 to December 2009. The study included all adult (>18 years) epileptic patients on AEDs and followed up at a neurology clinic at Sultan Qaboos University Hospital in Oman. All reported therapeutic drug monitoring (TDM) requests for serum AED concentrations were also collected. Institutional ethical approval was sought and obtained.
Key findings
The study included a total of 372 patients with a mean age of 34 ± 15 years. Monotherapy AEDs accounted for 53% of the prescriptions, whereas polytherapy with two or three AED combinations accounted for 27% and 20% respectively. The most frequently prescribed AED was sodium valproate (27%) followed by carbamazepine (23%). The commonly prescribed AED combinations were sodium valproate with clonazepam (12%) followed by sodium valproate with lamotrigine (12%). Evaluation of 574 TDM requests for three AEDs showed that 57% of carbamazepine, 78% of phenytoin and 54% of valproic acid requests were either above or below the recommended therapeutic threshold. Most of these requests were ordered from the hospital's emergency department for suspected insufficient serum concentrations.
Conclusions
Antiepileptic drug monotherapy is still the most frequently employed therapeutic strategy in adult patients with epilepsy in keeping with the standard therapeutic guidelines. Sodium valproate is commonly used for different types of seizures reflecting its wide spectrum of anticonvulsant potential. Newer AED utilizations are becoming increasingly popular in our subjects particularly as add-on with other standard AEDs.
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Affiliation(s)
- Mohammed Al Za'abi
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | - Rowayda Ahmed
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | - Abdullah Al Asmi
- Department of Medicine, Sultan Qaboos University Hospital, Al Khoud, Sultanate of Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
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15
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Chung S, Ceja H, Gawłowicz J, Avakyan G, McShea C, Schiemann J, Lu S. Levetiracetam extended release conversion to monotherapy for the treatment of patients with partial-onset seizures: a double-blind, randomised, multicentre, historical control study. Epilepsy Res 2012; 101:92-102. [PMID: 22516508 DOI: 10.1016/j.eplepsyres.2012.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 03/06/2012] [Accepted: 03/09/2012] [Indexed: 11/28/2022]
Abstract
This double-blind, randomised, multicentre, conversion to monotherapy, historical control study (N01280; NCT00419094) evaluated the efficacy, safety and tolerability of levetiracetam extended release (LEV XR) 2000mg/day once daily for the treatment of patients with partial-onset seizures compared with a historical control. Patients aged 12-75 years with 2-40 partial-onset seizures per 4 weeks, taking 1-2 antiepileptic drugs (AEDs) and receiving a stable dosage for ≥4 weeks prior to screening were randomised in a 3:1 ratio to LEV XR 2000 or 1000 mg/day. The study comprised baseline (8 weeks), LEV XR up-titration (2 weeks), baseline AED tapering (6 weeks), LEV XR monotherapy (10 weeks), and entry into open-label follow-up study or down-titration (1 week). The primary efficacy variable was the cumulative exit rate at Day 112 due to predefined exit criteria compared with the historical control. Of the 171 patients randomised to LEV XR 2000 mg/day and 57 randomised to 1000 mg/day, 141 (82.5%) and 50 (87.7%) completed the study. The cumulative exit rate for patients on LEV XR 2000 mg/day (0.375 [95% CI 0.297, 0.453]) was significantly lower than historical control (0.653). Both LEV doses were well tolerated. The most common adverse events during the treatment period were somnolence (21.9%), headache (19.7%) and convulsion (14.9%).
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Affiliation(s)
- Steve Chung
- Barrow Neurology Clinics, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
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16
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Effects of antiepileptic drug characteristics on medication adherence. Epilepsy Behav 2012; 23:437-41. [PMID: 22405862 DOI: 10.1016/j.yebeh.2012.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 01/29/2012] [Accepted: 02/01/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine whether antiepileptic drug (AED) characteristics are associated with medication adherence. METHODS We reviewed pharmacy and clinical records of 108 patients with epilepsy from the indigent care program at Shands-Jacksonville. We calculated the mean medication possession ratio (MMPR) for each AED. Using univariate analysis, we determined whether differences exist in the MMPR of various AEDs. We also determined whether the MMPR differs accordingly to the use of mono- or combination therapy, dosing frequency, release-type, or brand-name formulation. We employed multivariable analysis to determine if these differences persisted in the context of other demographic and clinical variables. RESULTS Mean medication possession ratio was higher (better) when using older AEDs, in monotherapy, and with more frequent dosing intervals. These variables remained significant on multivariable analysis. CONCLUSION Our findings contradict some commonly held beliefs on medication adherence and suggest that specific AED characteristics may be superseded by factors such as overall patient satisfaction with the drug regimen.
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17
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Therapeutic Drug Monitoring of Classical and Newer Anticonvulsants. Ther Drug Monit 2012. [DOI: 10.1016/b978-0-12-385467-4.00012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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18
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Regular Primary Care Decreases the Likelihood of Mortality in Older People With Epilepsy. Med Care 2010; 48:472-6. [DOI: 10.1097/mlr.0b013e3181d68994] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Brown ME, El-Mallakh RS. Role of eslicarbazepine in the treatment of epilepsy in adult patients with partial-onset seizures. Ther Clin Risk Manag 2010; 6:103-9. [PMID: 20421910 PMCID: PMC2857610 DOI: 10.2147/tcrm.s6382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Indexed: 11/23/2022] Open
Abstract
Eslicarbazepine is a new dibenzazepine antiepileptic agent. It is a high affinity antagonist of the voltage-gated sodium channel. It is closely related to both carbamazepine and oxcarbazepine. Eslicarbazepine has similar affinity to inactivated sodium channels (channels in just activated neurons) as carbamazepine, and greater efficacy in animal models of seizure than oxcarbazepine. In human placebo-controlled trials of a single daily dose of eslicarbazepine added to other anti-epileptic agents, significant seizure reductions occurred with 800 and 1200 mg daily, with nearly half of the patients experiencing a greater than 50% reduction in seizure frequency. Adverse events (AEs) occurred in over 50% of patients receiving therapeutic doses of eslicarbazepine (compared to 31.4%–44.7% of placebo-treated subjects), but were generally mild or moderate. Eight to 19.6% of eslicarbazepine treated patients discontinued due to AEs (compared to 3.9%–8.5% of placebo-treated subjects). In these patients receiving combination anticonvulsant therapy, the most common AEs were dizziness, nausea and vomiting, somnolence, and diplopia. Eslicarbazepine is an effective and reasonably well-tolerated adjunct in patients with suboptimal control of their partial seizures.
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20
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Aymanns C, Keller F, Maus S, Hartmann B, Czock D. Review on pharmacokinetics and pharmacodynamics and the aging kidney. Clin J Am Soc Nephrol 2010; 5:314-27. [PMID: 20056753 DOI: 10.2215/cjn.03960609] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In people who are aged >65 years, pharmacokinetics are influenced more by the loss of kidney function than by the aging process of any other organ. A GFR of 30 to 60 ml/min, suggestive of stage 3 kidney disease, is observed in 15 to 30% of elderly people. Drug dosing must be adjusted to both changing pharmacokinetics and pharmacodynamics; the pharmacodynamics might be influenced by the aging of other organs, too. Using our NEPharm database, we extracted abstracts with pharmacokinetic parameters since 1999 from a weekly PubMed search. The recorded data were analyzed and compared with published recommendations on drug dosage and use in the elderly. Purely age-related changes in pharmacokinetic parameters were recorded from publications on 127 drugs. The analysis of our NEPharm records revealed an average (mean +/- SD) age-related prolongation of half-life of 1.39-fold (corresponding to +39 +/- 61%). Contrasting to common opinion, mean changes in clearance (-1 +/- 54%) and volume of distribution (+24 +/- 56%) were even less. The modest changes in pharmacokinetics do not suggest general dosage modifications in the elderly for most drugs. Changes in pharmacodynamics justify the common medication rule in the elderly-"start low + go slow"-especially for drugs that act on the central nervous system; however, in the case of anti-infective and anticancer therapy, the rule should be "hit hard = start high + go fast" to produce the target effect also in the elderly.
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Affiliation(s)
- Christian Aymanns
- Division of Nephrology, Department of Internal Medicine A, University of Greifswald, Greifswald, Germany
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21
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Pekcec A, Schneider EL, Baumgärtner W, Stein VM, Tipold A, Potschka H. Age-dependent decline of blood-brain barrier P-glycoprotein expression in the canine brain. Neurobiol Aging 2009; 32:1477-85. [PMID: 19836857 DOI: 10.1016/j.neurobiolaging.2009.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 08/12/2009] [Accepted: 08/25/2009] [Indexed: 11/18/2022]
Abstract
The efflux transporter P-glycoprotein serves as a major molecular gatekeeper at the blood-brain barrier. It has been suggested that a reduction of P-glycoprotein activity with aging might enhance exposure of brain tissue to exogenous and endogenous compounds thereby contributing to the development of neurodegenerative diseases. Brain tissue from owner-kept dogs renders an excellent tool to study the impact of aging on the background of variable environmental and genetic influencing factors. Therefore, we determined expression rates of P-glycoprotein in canine post-mortem tissue from 23 non-laboratory dogs. P-glycoprotein expression in the parahippocampal cortex exhibited a negative correlation with age. Analysis of the area labeled for P-glycoprotein in dogs aged >100 months revealed a 72% drop in P-glycoprotein expression as compared to young adults aged 23-36 months. Respective data from the dentate hilus and dentate gyrus indicated an earlier drop with a reduction by 77 and 80% in dogs aged 37-99 months in comparison with younger individuals. In contrast to the decline observed with aging in dogs without plaques, P-glycoprotein expression rates rather tended to increase with further aging in dogs with plaque formation. In conclusion, the thorough analysis of P-glycoprotein expression rates in non-laboratory dogs revealed a significant decline with aging. The data strongly support the concept that age-dependent changes might predispose to neurodegenerative diseases. In the early pathogenesis of Alzheimer's disease which is modelled by diffuse plaques in the canine brain, an up-regulation of P-glycoprotein might act as a compensatory mechanism to enhance Abeta efflux from the brain. Future studies are necessary to further evaluate the correlation between Abeta deposits and P-glycoprotein expression in different phases of the disease.
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Affiliation(s)
- A Pekcec
- Inst. of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University Munich, Koeniginstr. 16, 80539 Munich, Germany
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