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Yao J, Liao C, Wang Y, Xiao Z. A meta-analysis of the relationship between abnormal pretreatment EEG and epilepsy recurrence. Epilepsy Res 2024; 203:107368. [PMID: 38713974 DOI: 10.1016/j.eplepsyres.2024.107368] [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: 01/09/2024] [Revised: 04/04/2024] [Accepted: 04/22/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Researchers have studied the risk factors for epilepsy recurrence among patients who withdraw from antiseizure medication (ASM). These studies aimed to determine the optimal time for ASM withdrawal. EEG findings are one of the risk factors that has been studied. However, it remains unclear whether abnormal pretreatment EEG findings are a risk factor for recurrence after ASM withdrawal. We performed this meta-analysis to clarify this issue. METHODS We retrieved literature from the PubMed and Embase databases, and used the NewcastleOttawa Scale to evaluate the methodological quality of the included studies. RevMan 5.3 software was used to analyse the data. RESULTS In total,710 articles were retrieved from the databases. Ultimately, after screening, 11 articles involving 1686 patients with epilepsy were included. Compared with that for a normal EEG, the odds ratio (OR) for an abnormal EEG was 1.10 (P=0.50), with an I2 value of 32% (P=0.15). Subgroup analysis revealed that the children-to-adolescents subgroup had an OR of 1.21 (P=0.27), and the children-to-adults subgroup had an OR of 0.64 (P=0.14) for an abnormal EEG. A separate subgroup analysis revealed that the focal epilepsy subgroup had an OR of 1.30 (P=0.37), and the generalized epilepsy and focal epilepsy subgroup had an OR of 1.07 (P=0.67) for an abnormal EEG. CONCLUSIONS The risk of epilepsy recurrence is not related to pretreatment EEG findings, regardless of age or epilepsy classification. The associations of pre- and posttreatment EEG alterations with epilepsy recurrence are controversial. Due to the limitations of our article, further research is needed.
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Affiliation(s)
- Juan Yao
- Department of Electrophysiology, People's Hospital of Chongqing Liang Jiang New Area, Chongqing 401147, China
| | - Chengrong Liao
- Department of Electrophysiology, People's Hospital of Chongqing Liang Jiang New Area, Chongqing 401147, China
| | - Yao Wang
- Department of Electrophysiology, People's Hospital of Chongqing Liang Jiang New Area, Chongqing 401147, China
| | - Zheng Xiao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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Steinhoff BJ, Schuler M, Mighali M, Intravooth T. Critical flicker fusion in patients with epilepsy under antiseizure medication. Epileptic Disord 2024; 26:181-187. [PMID: 38116676 DOI: 10.1002/epd2.20193] [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: 03/02/2023] [Revised: 11/02/2023] [Accepted: 12/17/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Critical flicker frequency (CFF) and flicker frequency (FF) are used as indicators for the neurotoxic adverse events of drugs in pharmacology. In this pilot study, we investigated whether patients with epilepsy (PWE) treated with various antiseizure medications (ASM) had significantly different CFFs compared with healthy controls. In addition, we investigated the appropriateness of CFF as an objective measurement tool in PWE who reported adverse events according to the adverse event profile (AEP). METHODS Patients receiving regular antiseizure treatment at our center, along with healthy controls, were included in this study. Clinical neurotoxic symptoms, AEP scores, and serum ASM levels were assessed in the PWE group. We used a CFF device that produced a red-black, green-black, blue-black, or white-black flicker. CFF and FF were compared between PWE and healthy controls. In PWE, the correlation of alterations in CFF and FF with AEP results and through ASM serum concentrations was calculated. RESULTS A total of 33 PWE and 20 healthy controls participated in the study. Except for two light modalities, CFF and FF were significantly reduced in PWE compared with controls. CFF and FF did not differ significantly between PWE with AEP scores >44 points and those with lower scores. CFF and FF levels did not correlate with changes in AEP scores, serum concentrations, or doses. SIGNIFICANCE CFF and FF distinguished PWE with ASM from healthy controls. No clinically relevant differentiation was detected in the heterogenous PWE group. To investigate whether CFF and FF may serve as subtle indicators of neurotoxicity or specific modes of action, additional studies are needed in more homogenous PWE groups.
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Affiliation(s)
- Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork, Germany
- Medical Faculty, Albert-Ludwigs-University, Freiburg, Germany
| | | | - Matteo Mighali
- Kork Epilepsy Center, Kehl-Kork, Germany
- College of Technics, Business and Media, Offenburg, Germany
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Lallana S, Fonseca E, Quintana M, Abraira L, Campos-Fernández D, López-Maza S, Santamarina E, Toledo M, Salas-Puig J. Antiseizure medication withdrawal in adult patients with idiopathic generalized epilepsy: Performance of two seizure recurrence prediction models. Epilepsy Behav 2024; 153:109718. [PMID: 38428177 DOI: 10.1016/j.yebeh.2024.109718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Currently, there is a limited availability of tools to predict seizure recurrence after discontinuation of antiseizure medications (ASMs). This study aimed to establish the seizure recurrence rate following ASM cessation in adult patients with idiopathic generalized epilepsy (IGE) and to assess the predictive performance of the Lamberink and the Stevelink prediction models using real-world data. METHODS Retrospective longitudinal study in IGE patients who underwent ASM withdrawal in a tertiary epilepsy clinic since June 2011, with the latest follow up in January 2024. The minimum follow-up period was 12 months. Clinical and demographic variables were collected, and the seizure recurrence prediction models proposed by Lamberink and Stevelink were applied and evaluated. RESULTS Forty-seven patients (mean age 33.15 ± 8 [20-55] years; 72.35 % women) were included. During the follow-up period, seizures recurred in 25 patients (53.2 %). Median time to recurrence was 8 months [IQR 3-13.5 months], and 17 patients (68 %) relapsed within the first year. None of the relapsing patients developed drug-resistant epilepsy. The only significant risk factor associated with recurrence was a seizure-free period of less than 2 years before discontinuing medication (91.7 % vs 40 %, p =.005). The Stevelink prediction model at both 2 (p =.015) and 5 years (p =.020) achieved statistical significance, with an AUC of 0.72 (95 % CI 0.56-0.88), while the Lamberink model showed inadequate prognostic capability. CONCLUSION In our real-world cohort, a seizure-free period of at least 2 years was the only factor significantly associated with epilepsy remission after ASM withdrawal. Larger studies are needed to accurately predict seizure recurrence in IGE patients.
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Affiliation(s)
- Sofía Lallana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Samuel López-Maza
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Ernawati I, Yasin NM, Setyopranoto I, Ikawati Z. Effect of Mobile Health Applications on Improving Self-Management Knowledge and Seizure Control in Epilepsy Patients: A Scoping Review. Healthc Inform Res 2024; 30:127-139. [PMID: 38755103 PMCID: PMC11098771 DOI: 10.4258/hir.2024.30.2.127] [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: 12/16/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES Mobile health app-based interventions are increasingly being developed to support chronic disease management, particularly for epilepsy patients. These interventions focus on managing stress, monitoring drug side effects, providing education, and promoting adherence to medication regimens. Therefore, this scoping review aims to assess how mobile health applications improve epilepsy patients' knowledge and seizure control, and to identify the features of these apps that are frequently used and have proven to be beneficial. METHODS This scoping review was conducted using scientific databases such as ScienceDirect, PubMed, and Google Scholar, adhering to the Joanna Briggs Institute guidelines. The review framework consisted of five steps: identifying research questions, finding relevant articles, selecting articles, presenting data, and compiling the results. The literature search included all original articles published in English from 2013 to 2023. RESULTS Among six articles that discussed mobile applications for epilepsy patients, all featured similar functionalities, including education on epilepsy management and seizure monitoring. Four of the articles highlighted behavioral interventions, such as reminder systems, designed to improve medication adherence. The remaining two articles focused on a side-effect reporting system that enabled doctors or health workers to evaluate and regularly monitor adverse effects. CONCLUSIONS This scoping review reveals that mobile health applications employing a combination of educational and behavioral interventions for epilepsy patients significantly improve knowledge about patient self-management and medication adherence. These interventions can prevent seizures, increase awareness, enable better activity planning, improve safety, and reduce the frequency of seizures and side effects of antiepileptic drugs.
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Affiliation(s)
- Iin Ernawati
- Doctoral Program in Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
- Akademi Farmasi Surabaya, Surabaya,
Indonesia
| | - Nanang Munif Yasin
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
| | - Ismail Setyopranoto
- Department of Neurology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta,
Indonesia
| | - Zullies Ikawati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
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Sepulveda R, Chong J, Shegog R, Martin K, Begley C, Addy R, Rosales O, Nuño T, Soto S, Rosales C, Labiner D. Experiences of using the MINDSET Self-Management mobile health app among Hispanic Patients:Results of a qualitative study. Epilepsy Behav 2024; 153:109702. [PMID: 38412570 DOI: 10.1016/j.yebeh.2024.109702] [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] [Received: 09/05/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Interventions focusing on epilepsy self-management (ESM) are vital for promoting the health of people living with epilepsy. E-technology and mobile health (mHealth) tools are becoming increasingly integrated into practice to promote self-management strategies for chronic diseases, enhance care delivery, and reduce health disparities. Management Information and Decision Support Epilepsy Tool (MINDSET), a bilingual decision support tool (available in English and Spanish), was found to be both feasible and effective in facilitating goal-based ESM in the clinic. PURPOSE To assess the experience of using MINDSET as an ESM intervention among Hispanic patients with epilepsy to inform future interventional studies. METHODS This study used a Qualitative Descriptive (QD) framework to provide a rich and straightforward description of patients' subjective experiences using MINDSET. Participants were enrolled in the intervention group of a larger parent study (RCT) to assess the efficacy of MINDSET among Hispanic People with Epilepsy (PWE). The purposive, convenient, criterion-based sample for this qualitative analysis comprised of 42 patients who agreed to participate in a semi-structured interview at the end of the larger RCT. This RCT was conducted between August 2017 and January 2019. Spanish and English-speaking Hispanic adult patients (n = 94) with epilepsy in Arizona (n = 53) and Texas (n = 41) were randomly assigned within 6 neurology clinics to treatment (MINDSET plus Usual Care, hereafter referred to as MINDSET; n = 46) and comparison (Usual Care Only; n = 48) conditions. RESULTS Patient demographics, epilepsy conditions, and ESM behavioral characteristics were representative of the intervention group. Study participants were Hispanic, mainly of Mexican descent (94 %), with a mean age of 39 years, mostly female (53 %), and most of the participants reported having had one or more seizures per month (54 %). The MINDSET intervention revealed five ESM themes: (1) Awareness and Realization of Epilepsy Self-Management, (2) Communication and Partnership with Health Care Providers HCP, (3) Epilepsy Self-Management and Quality of Life, (4) Seizure Control, and (5) Optimism and Agency. CONCLUSION The participants who used MINDSET as a self-management intervention reported an overall positive experience. Qualitative data in this study show that MINDSET is a valuable ESM tool for Hispanic patients with epilepsy. Findings from this qualitative study were consistent with results from a larger parent study that recognized MINDSET as an effective platform for improving epilepsy self-management adherence.
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Affiliation(s)
- Refugio Sepulveda
- University of Arizona, Department of Neurology, College of Medicine, Tucson, AZ; University of Arizona, Division of Public Health Practice & Translational Research, Mel & Enid Zuckerman College of Public Health, Phoenix, AZ.
| | - Jenny Chong
- University of Arizona, Department of Neurology, College of Medicine, Tucson, AZ
| | - Ross Shegog
- University of Texas School of Public Health, Behavioral Science, Houston, TX, United States of America
| | - Kimberly Martin
- Epilepsy Foundation Central & South Texas, San Antonio, TX, United States of America
| | - Charles Begley
- University of Texas School of Public Health, Behavioral Science, Houston, TX, United States of America
| | - Robert Addy
- University of Texas School of Public Health, Behavioral Science, Houston, TX, United States of America
| | - Omar Rosales
- University of Arizona, Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, Tucson, AZ
| | - Tomas Nuño
- University of Arizona, Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, Tucson, AZ
| | - Shiela Soto
- University of Arizona, Division of Public Health Practice & Translational Research, Mel & Enid Zuckerman College of Public Health, Phoenix, AZ
| | - Cecilia Rosales
- University of Arizona, Division of Public Health Practice & Translational Research, Mel & Enid Zuckerman College of Public Health, Phoenix, AZ
| | - David Labiner
- University of Arizona, Department of Neurology, College of Medicine, Tucson, AZ
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Wu Y, Zhang Z, Liang P, Li L, Zou B, Wang D, Dong X, Tang H, Qiu H, Zhai X. Postoperative interictal epileptiform discharges predict seizure recurrence after antiepileptic drug withdrawal regardless of concordance with surgical site. WORLD JOURNAL OF PEDIATRIC SURGERY 2024; 7:e000641. [PMID: 38374897 PMCID: PMC10875540 DOI: 10.1136/wjps-2023-000641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
Objective The study aimed to explore the association between the site of interictal epileptic discharges (IEDs) on postoperative electroencephalogram (EEG) and seizure recurrence after antiepileptic drug (AED) withdrawal. The study hypothesizes that the concordance of IED sites with surgical sites indicates incomplete resection of epileptic focus, while non-concordance of IED sites with surgical sites indicates postoperative changes or cortical stimulation. The former has a higher risk of seizure recurrence. Methods We retrospectively analyzed the postoperative EEG pattern of 182 consecutive children who underwent resection surgery. To identify the risk factors for seizure recurrence, we compared the attributes of seizure recurred and seizure-free groups by univariate and multivariate analyses. AED tapering was standardized, involving a 25% reduction in the dose of a single type of AED every 2 weeks, independent of the presurgical AED load. Results We attempted AED withdrawal in 116 (63.7%) children. Twenty-eight (24.1%) children experienced seizure recurrence during or after AED withdrawal. A greater number of AEDs used at the time of surgery (p=0.005), incomplete resection (p=0.001), and presence of IED on postoperative EEG (p=0.011) are predictors of seizure recurrence. The completeness of resection and seizure recurrence after AED withdrawal were related to the presence of IED on the EEG, but not to the concordance of IED with surgical sites. Conclusion For children with abnormal EEG, the decision to discontinue AED should be made more cautiously, regardless of the relative location of the discharge site and the surgical site.
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Affiliation(s)
- Yuxin Wu
- Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - ZaiYu Zhang
- Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Ping Liang
- Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Lusheng Li
- Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Bin Zou
- Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Difei Wang
- Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xinyu Dong
- Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Haotian Tang
- Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Hanli Qiu
- Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Xuan Zhai
- Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
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Athira SB, Pal P, Nair PP, Nanda N, Aghoram R. Influence of sleep disturbance, depression, anxiety, and stress on quality of life in people with epilepsy. Epileptic Disord 2024; 26:69-78. [PMID: 37815730 DOI: 10.1002/epd2.20169] [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: 06/27/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES We assessed the quality of life, sleep, depression, anxiety, and stress in people with pharmacoresistant epilepsy (PRE) and newly diagnosed epilepsy (NDE). We also assessed the influence of sleep, depression, anxiety, and stress on the quality of life (QOL) and the complex association between these factors. METHODS We recruited 80 PRE and 70 NDE people attending the epilepsy clinic. We assessed QOL, sleep quality, daytime sleepiness, and mood using the quality of life in epilepsy-31 inventory (QOLIE-31), Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), and depression anxiety stress scale (DASS-21). We compared the results between the two groups of epilepsy populations. We performed univariate and multivariate linear regression to determine the factors affecting the QOLIE-31 total score. We applied Spearman's rank correlation to find the interrelationship between variables influencing QOL. RESULTS We found significantly lower QOLIE-31 total scores (p = .001) in PRE compared to NDE. The PSQI and ESS did not differ significantly between the PRE and NDE groups. Anxiety (p = .002) and stress (p = .003) scores were significantly higher in PRE than in NDE. QOLIE-31 total scores showed a negative correlation with PSQI as well as symptoms of depression, anxiety, and stress scores in both groups. Multiple linear regression analysis revealed depression as a major factor influencing the QOLIE-31 total score in PRE (p = .001) and NDE (p = .003). We found significant complex associations between PSQI, depression, anxiety, stress, and QOLIE total scores in both groups. SIGNIFICANCE The QOL is poorer for people with PRE than for those with NDE. Depression is a major determinant of QOL in PWE. These factors need to be considered to improve the QOL in epilepsy.
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Affiliation(s)
| | - Pravati Pal
- Department of Physiology, JPMER, Puducherry, India
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Brigo F, Zelano J, Abraira L, Bentes C, Ekdahl CT, Lattanzi S, Ingvar Lossius M, Redfors P, Rouhl RPW, Russo E, Sander JW, Vogrig A, Wickström R. Proceedings of the "International Congress on Structural Epilepsy & Symptomatic Seizures" (STESS, Gothenburg, Sweden, 29-31 March 2023). Epilepsy Behav 2024; 150:109538. [PMID: 38039602 DOI: 10.1016/j.yebeh.2023.109538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.
| | - Johan Zelano
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Laura Abraira
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Carla Bentes
- Neurophysiological Monitoring Unit - EEG/Sleep Laboratory, Refractory Epilepsy Reference Centre (member of EpiCARE), Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Centro de Estudos Egas Moniz, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Christine T Ekdahl
- Division of Clinical Neurophysiology and Department of Clinical Sciences, Lund University, Sweden; Lund Epilepsy Center, Department of Clinical Sciences, Lund University, Sweden
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Morten Ingvar Lossius
- National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Member of the ERN EpiCARE, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petra Redfors
- Department of Neurology, Member of the ERN EpiCARE, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rob P W Rouhl
- Department of Neurology, Maastricht University Medical Centre+, Maastricht, The Netherlands; Academic Centre for Epileptology Kempenhaeghe/MUMC+ Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Emilio Russo
- Science of Health Department, University Magna Grecia of Catanzaro, Italy
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK; Centre for Epilepsy, Chalfont St Peter, Bucks., SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, The Netherlands; Neurology Department, West of China Hospital, Sichuan University, Chengdu 610041, China
| | - Alberto Vogrig
- Department of Medicine (DAME), University of Udine, Udine, Italy; Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Ronny Wickström
- Neuropediatric Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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Bergamaschi EDNC, Machado G, Rodrigues GM, Lin K. Self-reported attention and hyperactivity symptoms among adults with epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-7. [PMID: 38286432 PMCID: PMC10824590 DOI: 10.1055/s-0044-1779298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/24/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Patients with epilepsy (PWE) frequently have comorbid psychiatric disorders, the most common of which are depression and anxiety. Attention deficit disorder with hyperactivity (ADHD) is also more frequent among PWE, though that condition has been scarcely studied among the adult PWE population. OBJECTIVE This study aimed to compare the presence of ADHD symptoms between adult PWE and the general population. METHODS This was an observational case-control study. Ninety-five adult PWE from a tertiary center in southern Brazil were compared with 100 healthy controls. All subjects were submitted to three structured scales: 1) the World Health Organization Adult ADHD Self-Report Scale version 1.1 (ASRS); 2) the Hospital Anxiety and Depression Scale (HADS); and 3) the Adverse Events Profile (AEP). Dichotomic variables were analyzed through chi-square test and Fisher's exact test, as appropriate, and non-parametric variables were analyzed through the Mann-Whitney U test. RESULTS Medians and interquartile ranges (IR) were: 1) ASRS: 26.00 (IR: 18 to 38) among PWE versus 17.00 (IR: 11 to 24) among controls, p < 0.001; 2) HADS: 14.00 (IR: 8 to 21) among PWE versus 11.00 (IR: 8 to 16) among controls, p = 0.007; 3) AEP: 3800 (IR: 31 to 49) among PWE versus 33.00 (IR: 23 to 43) among controls, p = 0.001. CONCLUSION PWE showed a higher burden of symptoms of ADHD, depression, and anxiety when compared with controls, which replicates in the Brazilian population the findings of current literature that point toward a higher prevalence of such disorders among PWE.
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Affiliation(s)
| | - Gabriela Machado
- Universidade Federal de Santa Catarina, Florianópolis SC, Brazil.
| | | | - Katia Lin
- Universidade Federal de Santa Catarina, Florianópolis SC, Brazil.
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Helmstaedter C, Meschede C, Mastani S, Moskau-Hartmann S, Rademacher M, von Wrede R, Witt JA. Normalization and cross-sectional validation of an extended Adverse Event Profile (E AEP) in a large cohort of patients with epilepsy. Seizure 2024; 114:9-17. [PMID: 38029647 DOI: 10.1016/j.seizure.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
PURPOSE The Liverpool Adverse Event Profile (L AEP) is commonly used in clinical practice and pharmacological trials for the monitoring of side effects of anti-seizure medication (ASM). However potentially unrelated, additional symptoms and normative data should be considered to put patients´ complaints into perspective. METHODS An extended 32-item AEP (E AEP) was given to 537 healthy subjects and 1,605 patients with epilepsy as part of the Bonn ASM side effect registry. The tool was factor-analyzed, corrected for age, gender, and repeated application, and related to drug load and individual substances (with N> 100) on item and scale level (total E AEP and its subscales cognition, dizziness, energy, mood, bodily symptoms, aggression, and sexuality). RESULTS Compared to non-normalized results, at item level, between one and two-thirds of responses suggesting impairment were found to be unlikely to be related to ASM treatment after normalization. Binary regression analyses revealed differential effects of medication choice, but also of antidepressants and neuroleptics on complaint domains. The explained variance was better for physical than psychological domains. The results reflect both known drug side effects and indications. Patients´ explicit attribution of problems to their medications barely improved the correlation of the E AEP and treatment parameters. CONCLUSION Application of a norm-referenced AEP is highly recommended to avoid overestimation of treatment related problems in patients with epilepsy. It allows evaluation on item and scale level for individuals as well as groups in drug trials. Plausible relations to individual drugs and to drug load can be demonstrated. The explanatory power was better for physical than psychological domains. Drug-related complaint patterns reflect known drug side effects (e.g. perampanel and brivaracetam with aggression) as well as drug indications (e.g. lamotrigine for depression). This is likely to be particularly relevant when side effects may have affected treatment decisions. Longitudinal evaluation with repeated application of the E AEP with changes of drug treatment is in progress.
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Affiliation(s)
| | - Carolin Meschede
- Department of Epileptology, University Hospital Bonn (UKB), 53127 Bonn, Germany
| | - Sandra Mastani
- Department of Epileptology, University Hospital Bonn (UKB), 53127 Bonn, Germany
| | | | - Michael Rademacher
- Department of Epileptology, University Hospital Bonn (UKB), 53127 Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn (UKB), 53127 Bonn, Germany
| | - Juri-Alexander Witt
- Department of Epileptology, University Hospital Bonn (UKB), 53127 Bonn, Germany
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11
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Zelano J, Nika O, Asztely F, Larsson D, Andersson K, Andrén K. Prevalence and nature of patient-reported antiseizure medication side effects in a Swedish regional multi-center study. Seizure 2023; 113:23-27. [PMID: 37931352 DOI: 10.1016/j.seizure.2023.10.016] [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: 08/21/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Side effects is one of the major clinical problems in epilepsy care. We assessed the prevalence of ASM side effects in participants in a large regional multicenter observational study in western Sweden and aimed to identify risk factors and inventory the nature of side effects with different ASM regimes. METHODS Cross-sectional analysis of survey answers and clinical characteristics of 406 adult participants recruited to a regional observational study between December 2020 and March 2023. Half of the participants had been seizure free for one year. Second-generation or newer ASMs were the most common. RESULTS A total of 164 (40 %, 95 %CI: 36-45) patients reported side effects. Patients reporting side effects were younger (median 41 vs 47 years, p = 0.015), had more frequently experienced a seizure in the last year (p = 0.02), and were more often on ASM polytherapy (p < 0.01). ASM polytherapy and age were significant risk factors in regression models, but the explanatory value was low. The most common side effect was tiredness followed by cognitive symptoms. CONCLUSIONS Our findings show that side effects are still common in epilepsy care and suggests that unnecessary polypharmacy should be avoided. Apart from number or ASMs, predicting who will experience side effects is difficult and more research on individual vulnerability is needed.
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Affiliation(s)
- Johan Zelano
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden.
| | - Olha Nika
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Fredrik Asztely
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Angered hospital, SV hospital group, Gothenburg, Sweden
| | - David Larsson
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Klara Andersson
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Kerstin Andrén
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Angered hospital, SV hospital group, Gothenburg, Sweden
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12
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Siddiqui F, Soomro BA, Badshah M, Rehman EU, Numan A, Ikram A, Khan MWA, Ali S, Hashim H, Salam JU, Akram A, Irfan Hashmat M, Iqbal S, Zeeshan Javed M, Iqbal SZ, Maqsood A, Khan A, Maheshwary N, Khan MA. Efficacy and Safety of Brivaracetam in Persons With Epilepsy in a Real-World Setting: A Prospective, Non-Interventional Study. Cureus 2023; 15:e50313. [PMID: 38205459 PMCID: PMC10777439 DOI: 10.7759/cureus.50313] [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] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND AND AIM Epilepsy stands out as one of the most prevalent neurological conditions. Brivaracetam (BRV) is a noteworthy antiseizure medication (ASM) distinguished by its pronounced and selective interaction with the synaptic vesicle protein 2A (SV2A) within the brain. Prior investigations, including regulatory trials, post-marketing assessments, and comparative meta-analyses, have consistently underscored BRV's equivalency in efficacy and superior tolerability when pitted against other antiseizure drugs. This study aimed to evaluate the effectiveness, safety, and acceptability of BRV in treating epileptic patients in the Pakistani population. METHODS This prospective observational study, conducted in Pakistan from February to December 2022, employed a non-probability consecutive sampling technique. This study included 368 adult patients diagnosed with epilepsy, with a focus on those aged 18 and above experiencing focal seizures. Demographic data, clinical history, seizure types, and epilepsy profiles were recorded. Patients were administered BRV (Brivera; manufactured by Helix Pharma Pvt Ltd., Sindh, Pakistan) monotherapy therapy under physician guidance and followed up for three months. The study assessed changes in seizure frequency, side effects, and drug resistance at baseline, 14th day, and 90th day. Safety aspects were monitored, including documenting any adverse effects associated with BRV therapy. RESULTS A total of 368 epileptic patients were included in this study, of which 287 (61.3%) were males and 181 (38.7%) were females. The mean age was 32.91±17.11 years. The mean number of seizures at the baseline visit was 5.74±6.21, at 14 days was 2.89±3.84 and at 90 days was 1.73±5.01 (p<0.001). Overall, a more than 50% reduction in seizure episodes was achieved in 178 (56.3%) patients at day 90, and less than 50% reduction in seizure episodes was achieved by 95 (26.8%) patients on Day 14, with a highly significant association between them (p<0.001). Among 316 patients, only 41 (4.4%) of all BRV-treated patients experienced adverse events; Of these 41 patients, 17 (41.7%) reported dizziness and 14(34.2%) reported behavioral issues. CONCLUSIONS Epileptic patients receiving BRV demonstrated a substantial reduction of greater than 50% seizure episodes at the end of follow-up visits. Moreover, BRV exhibited fewer adverse effects in individuals with epilepsy.
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Affiliation(s)
- Fowzia Siddiqui
- Neurology, The Aga Khan University Hospital (AKUH), Karachi, PAK
| | | | - Mazhar Badshah
- Neurology, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | - Ehsan U Rehman
- Neurology, Akhtar Saeed Medical and Dental College, Islamabad, PAK
| | - Ahsan Numan
- Neurology, Mayo Hospital, King Edward Medical University, Lahore, PAK
| | - Amer Ikram
- Neurology, Doctors Hospital Lahore, Lahore, PAK
| | | | - Sajjad Ali
- Neurology, Dar ul Shifa Hospital Sialkot, Sialkot, PAK
| | | | - Jawwad-Us Salam
- Medicine/Neurology, Dow International Medical College, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Shahid Iqbal
- Neurology, Rehman Medical Institute, Peshawar, PAK
| | | | - S Zafar Iqbal
- Neurology, Tahsil Head Quarter (TQH) Hospital Sadiqabad, Sadiqabad, PAK
| | - Atif Maqsood
- Neurology, Aziz Fatima Hospital, Faisalabad, PAK
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R S, K N. Teratogenic impacts of Antiepileptic drugs on development, behavior and reproduction in Drosophila melanogaster. Neurotoxicol Teratol 2023; 100:107305. [PMID: 37805079 DOI: 10.1016/j.ntt.2023.107305] [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: 06/19/2023] [Revised: 08/27/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
Clobazam (CLB) and Vigabatrin (VGB) are the two widely used Antiepileptic drugs, which may have teratogenic potentiality and it has been evaluated in the fruit fly Drosophila melanogaster. These different concentrations of CLB (0.156, 0.25, and 0.312 μg/ml) and VGB (17.6, 22, and 44 μg/ml) were used to evaluate the life-history parameters, developmental, and behavioral abnormalities. The results revealed that life-history parameters (fecundity, fertility, larval and pupal mortality) were significantly affected along with varied developmental duration, and pupal and adult deformities in flies on exposure of CLB and VGB in concentration dependent manner. The present study demonstrated that the prenatal treatment of CLB and VGB has displayed clear teratogenic potentiality with various deformities in the fruit fly. The findings could be correlated with the various abnormalities in human caused by the use of AEDs.
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Affiliation(s)
- Shamapari R
- Department of PG Studies and Research in Applied Zoology, Kuvempu University, Jnana Sahyadri, Shankaraghatta, Karnataka 577451, India
| | - Nagaraj K
- Department of PG Studies and Research in Applied Zoology, Kuvempu University, Jnana Sahyadri, Shankaraghatta, Karnataka 577451, India.
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Zhu J, Lu J, He Y, Shen X, Xia H, Li W, Zhang J, Fan X. Association of ABCB1 Polymorphisms with Efficacy and Adverse Drug Reactions of Valproic Acid in Children with Epilepsy. Pharmaceuticals (Basel) 2023; 16:1536. [PMID: 38004402 PMCID: PMC10675623 DOI: 10.3390/ph16111536] [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: 09/12/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Genetic polymorphisms in ATP-binding cassette subfamily B member 1 (ABCB1, also known as MDR1) have been reported to be possibly associated with the regulation of response to antiseizure medications. The aim of this study was to investigate the association of ABCB1 polymorphisms with the efficacy of and adverse drug reactions to valproic acid among Chinese children with epilepsy. A total of 170 children from southern China with epilepsy treated with valproic acid for more than one year were recruited, including 61 patients with persistent seizures and 109 patients who were seizure-free. Two single nucleotide polymorphisms of ABCB1, rs1128503 and rs3789243, were genotyped using the Sequenom MassArray system. The two single nucleotide polymorphisms of ABCB1 were found to be significantly associated with treatment outcomes of valproic acid in children with epilepsy. Carriers with the TT genotype of ABCB1 rs1128503 were more inclined to exhibit persistent seizures after treatment with valproic acid (p = 0.013). The CC genotype of rs3789243 was observed to be a potential protective factor for valproic acid-induced gastrointestinal adverse drug reactions (p = 0.018), but possibly increased the risk of valproic acid-induced cutaneous adverse drug reactions (p = 0.011). In contrast, the CT genotype of rs3789243 was associated with a lower risk of valproic acid-induced cutaneous adverse drug reactions (p = 0.011). Haplotype analysis showed that CC haplotype carriers tended to respond better to valproic acid treatment (p = 0.009). Additionally, no significant association was found between ABCB1 polymorphisms and serum concentrations of valproic acid. This study revealed that the polymorphisms and haplotypes of the ABCB1 gene might be associated with the treatment outcomes of valproic acid in Chinese children with epilepsy.
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Affiliation(s)
- Jiahao Zhu
- Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou 511436, China; (J.Z.); (J.L.); (Y.H.); (X.S.); (J.Z.)
- Department of Pharmacy, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen 518102, China; (H.X.); (W.L.)
| | - Jieluan Lu
- Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou 511436, China; (J.Z.); (J.L.); (Y.H.); (X.S.); (J.Z.)
| | - Yaodong He
- Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou 511436, China; (J.Z.); (J.L.); (Y.H.); (X.S.); (J.Z.)
- Department of Pharmacy, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen 518102, China; (H.X.); (W.L.)
| | - Xianhuan Shen
- Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou 511436, China; (J.Z.); (J.L.); (Y.H.); (X.S.); (J.Z.)
- Department of Pharmacy, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen 518102, China; (H.X.); (W.L.)
| | - Hanbing Xia
- Department of Pharmacy, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen 518102, China; (H.X.); (W.L.)
| | - Wenzhou Li
- Department of Pharmacy, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen 518102, China; (H.X.); (W.L.)
| | - Jianping Zhang
- Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou 511436, China; (J.Z.); (J.L.); (Y.H.); (X.S.); (J.Z.)
| | - Xiaomei Fan
- Department of Pharmacy, Shenzhen Baoan Women’s and Children’s Hospital, Jinan University, Shenzhen 518102, China; (H.X.); (W.L.)
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15
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Gunasekera CL, Sirven JI, Feyissa AM. The evolution of antiseizure medication therapy selection in adults: Is artificial intelligence -assisted antiseizure medication selection ready for prime time? J Cent Nerv Syst Dis 2023; 15:11795735231209209. [PMID: 37868934 PMCID: PMC10586013 DOI: 10.1177/11795735231209209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Antiseizure medications (ASMs) are the mainstay of symptomatic epilepsy treatment. The primary goal of pharmacotherapy with ASMs in epilepsy is to achieve complete seizure remission while minimizing therapy-related adverse events. Over the years, more ASMs have been introduced, with approximately 30 now in everyday use. With such a wide variety, much guidance is needed in choosing ASMs for initial therapy, subsequent replacement monotherapy, or adjunctive therapy. The specific ASMs are typically tailored by the patient's related factors, including epilepsy syndrome, age, sex, comorbidities, and ASM characteristics, including the spectrum of efficacy, pharmacokinetic properties, safety, and tolerability. Weighing these key clinical variables requires experience and expertise that may be limited. Furthermore, with this approach, patients may endure multiple trials of ineffective treatments before the most appropriate ASM is found. A more reliable way to predict response to different ASMs is needed so that the most effective and tolerated ASM can be selected. Soon, alternative approaches, such as deep machine learning (ML), could aid the individualized selection of the first and subsequent ASMs. The recognition of epilepsy as a network disorder and the integration of personalized epilepsy networks in future ML platforms can also facilitate the prediction of ASM response. Augmenting the conventional approach with artificial intelligence (AI) opens the door to personalized pharmacotherapy in epilepsy. However, more work is needed before these models are ready for primetime clinical practice.
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Pearl NZ, Babin CP, Catalano NT, Blake JC, Ahmadzadeh S, Shekoohi S, Kaye AD. Narrative Review of Topiramate: Clinical Uses and Pharmacological Considerations. Adv Ther 2023; 40:3626-3638. [PMID: 37368102 DOI: 10.1007/s12325-023-02586-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
Due to the diverse mechanisms of action of antiseizure drugs, there has been a rise in prescriptions of these drugs for non-epileptic pathologies. One drug that is now being used for a variety of conditions is topiramate. This is a narrative review that used PubMed, Google Scholar, MEDLINE, and ScienceDirect to review literature on the clinical and pharmacologic properties of topiramate. Topiramate is a commonly prescribed second-generation antiseizure drug. The drug works through multiple pathways to prevent seizures. In this regard, topiramate blocks sodium and calcium voltage-gated channels, inhibits glutamate receptors, enhances gamma-aminobutyric acid (GABA) receptors, and inhibits carbonic anhydrase. Topiramate is approved by the Food and Drug Administration (FDA) for epilepsy treatment and migraine prophylaxis. Topiramate in combination with phentermine is also FDA-approved for weight loss in patients with a body mass index (BMI) > 30. The current target dosing for topiramate monotherapy is 400 mg/day and 100 mg/day to treat epilepsy and migraines, respectively. Commonly reported side effects include paresthesia, confusion, fatigue, dizziness, and change in taste. More uncommon and serious adverse effects can include acute glaucoma, metabolic acidosis, nephrolithiasis, hepatotoxicity, and teratogenicity. Related to a broad side effect profile, physicians prescribing this drug should routinely monitor for side effects and/or toxicity. The present investigation reviews various anti-seizure medications before summarizing indications of topiramate, off-label uses, pharmacodynamics, pharmacokinetics, adverse effects, and drug-drug interactions.
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Affiliation(s)
- Nathan Z Pearl
- School of Medicine, LSU Health Sciences Center New Orleans, 1901 Perdido Street, New Orleans, LA, 70112, USA
| | - Caroline P Babin
- School of Medicine, LSU Health Sciences Center New Orleans, 1901 Perdido Street, New Orleans, LA, 70112, USA
| | - Nicole T Catalano
- School of Medicine, LSU Health Sciences Center New Orleans, 1901 Perdido Street, New Orleans, LA, 70112, USA
| | - James C Blake
- School of Medicine, LSU Health Sciences Center New Orleans, 1901 Perdido Street, New Orleans, LA, 70112, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
- Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
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17
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Zhu J, Lu J, Shen X, He Y, Xia H, Li W, Guo H, Zhang J, Fan X. SCN1A Polymorphisms and Haplotypes Are Associated With Valproic Acid Treatment Outcomes in Chinese Children With Epilepsy. Pediatr Neurol 2023; 146:55-64. [PMID: 37451178 DOI: 10.1016/j.pediatrneurol.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/20/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Sodium channel genes, especially SCN1A, were reported to play an important role in the treatment outcomes of antiseizure medications. The aim of this study was to explore the association of SCN1A polymorphisms with efficacy and adverse drug reactions (ADRs) related to valproic acid (VPA) among Chinese children with epilepsy. METHODS A total of 126 children with epilepsy treated with VPA for at least 12 months were enrolled in this study. Three single nucleotide polymorphisms (SNPs) of SCN1A including rs2298771, rs10167228, and rs3812718 were genotyped using Sequenom MassArray system. Bioinformatics tools were used to explore the potential targets and pathways of SCN1A in VPA-related ADRs. RESULTS The three SNPs in this study were found to be closely associated with treatment outcomes for VPA. Carriers of SCN1A rs3812718 TT genotype tended to be seizure-free with VPA treatment (P = 0.007). AA genotype of rs10167228 and TT genotype of rs2298771 might be protective factors for weight gain induced by VPA, whereas TA genotype of rs10167228 and CT genotype of rs2298771 increased the risk. TAT haplotype carriers were found to respond better to VPA treatment (P = 0.017), whereas CTC haplotype might be a risk factor for VPA-induced weight gain (P = 0.035). Bioinformatics analysis suggested that SCN1A might play a role in VPA-induced weight gain by regulating gated channel activity and GABAergic synapse pathway. CONCLUSION This study revealed that SCN1A rs2298771, rs10167228, and rs3812718 polymorphisms and haplotypes might affect the treatment outcomes of VPA in Chinese children with epilepsy.
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Affiliation(s)
- Jiahao Zhu
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China; Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Jieluan Lu
- Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Xianhuan Shen
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China; Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Yaodong He
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China; Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China
| | - Hanbing Xia
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China
| | - Wenzhou Li
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China
| | - Huijuan Guo
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China
| | - Jianping Zhang
- Department of Clinical Pharmacology, College of Pharmacy, Jinan University, Guangzhou, Guangdong, China.
| | - Xiaomei Fan
- Department of Pharmacy, Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, Guangdong, China.
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Vary-O'Neal A, Miranzadeh S, Husein N, Holroyd-Leduc J, Sajobi TT, Wiebe S, Deacon C, Tellez-Zenteno JF, Josephson CB, Keezer MR. Association Between Frailty and Antiseizure Medication Tolerability in Older Adults With Epilepsy. Neurology 2023; 100:e1135-e1147. [PMID: 36535780 PMCID: PMC10074467 DOI: 10.1212/wnl.0000000000201701] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 11/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Frailty is an important aspect of biological aging, referring to the increased vulnerability of individuals with frailty to physical and psychological stressors. While older adults with epilepsy are an important and distinct clinical group, there are no data on frailty in this population. We hypothesize that frailty will correlate with the seizure frequency and especially the tolerability of antiseizure medications (ASMs) in older adults with epilepsy. METHODS We recruited individuals aged 60 years or older with active epilepsy from 4 Canadian hospital centers. We reported the seizure frequency in the 3 months preceding the interview, while ASM tolerability was quantified using the Liverpool Adverse Events Profile (LAEP). We applied 3 measures of frailty: grip strength as a measure of physical frailty, 1 self-reported score (Edmonton frail score [EFS]), and 1 scale completed by a healthcare professional (clinical frailty scale [CFS]). We also administered standardized questionnaires measuring levels of anxiety, depression, functional disability, and quality of life and obtained relevant clinical and demographic data. RESULTS Forty-three women and 43 men aged 60-93 years were recruited, 87% of whom had focal epilepsy, with an average frequency of 3.4 seizures per month. Multiple linear regression and zero-inflated negative binomial regression models showed that EFS and CFS scores were associated with decreased ASM tolerability, each point increase leading to 1.83 (95% CI: 0.67-4.30) and 2.49 (95% CI: 1.27-2.39) point increases on the LAEP scale, respectively. Neither the EFS and CFS scores nor grip strength were significantly associated with seizure frequency. The EFS was moderately correlated with depression, anxiety, quality of life, and functional disability, demonstrating the best construct validity among the 3 tested measures of frailty. DISCUSSION The EFS was significantly, both statistically and clinically, associated with ASM tolerability. It also showed multiple advantages in performance while assessing for frailty in older adults with epilepsy, when compared with the 2 other measures of frailty that we tested. Future studies must focus on what role the EFS during epilepsy diagnosis may play in ASM selection among older adults with epilepsy.
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Affiliation(s)
- Arielle Vary-O'Neal
- From the Centre de Recherche du Centre hospitalier de l'Université de Montréal (crCHUM) (A.V., N.H., M.R.K.), Canada; Department of Neurosciences (A.V., M.R.K.), Université de Montréal, Canada; Division of Neurology (S.M., J.T.), University of Saskatchewan, Canada; School of Public Health of the Université de Montréal (N.H., M.R.K.), Canada; Department of Medicine, University of Calgary (J.H.), Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute (T.T.S., S.W., C.B.J.), University of Calgary, Canada; and Division of Neurology (C.D.), Centre Hospitalier Universitaire de Sherbrooke (CHUS), Canada
| | - Sareh Miranzadeh
- From the Centre de Recherche du Centre hospitalier de l'Université de Montréal (crCHUM) (A.V., N.H., M.R.K.), Canada; Department of Neurosciences (A.V., M.R.K.), Université de Montréal, Canada; Division of Neurology (S.M., J.T.), University of Saskatchewan, Canada; School of Public Health of the Université de Montréal (N.H., M.R.K.), Canada; Department of Medicine, University of Calgary (J.H.), Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute (T.T.S., S.W., C.B.J.), University of Calgary, Canada; and Division of Neurology (C.D.), Centre Hospitalier Universitaire de Sherbrooke (CHUS), Canada
| | - Nafisa Husein
- From the Centre de Recherche du Centre hospitalier de l'Université de Montréal (crCHUM) (A.V., N.H., M.R.K.), Canada; Department of Neurosciences (A.V., M.R.K.), Université de Montréal, Canada; Division of Neurology (S.M., J.T.), University of Saskatchewan, Canada; School of Public Health of the Université de Montréal (N.H., M.R.K.), Canada; Department of Medicine, University of Calgary (J.H.), Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute (T.T.S., S.W., C.B.J.), University of Calgary, Canada; and Division of Neurology (C.D.), Centre Hospitalier Universitaire de Sherbrooke (CHUS), Canada
| | - Jayna Holroyd-Leduc
- From the Centre de Recherche du Centre hospitalier de l'Université de Montréal (crCHUM) (A.V., N.H., M.R.K.), Canada; Department of Neurosciences (A.V., M.R.K.), Université de Montréal, Canada; Division of Neurology (S.M., J.T.), University of Saskatchewan, Canada; School of Public Health of the Université de Montréal (N.H., M.R.K.), Canada; Department of Medicine, University of Calgary (J.H.), Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute (T.T.S., S.W., C.B.J.), University of Calgary, Canada; and Division of Neurology (C.D.), Centre Hospitalier Universitaire de Sherbrooke (CHUS), Canada
| | - Tolulope T Sajobi
- From the Centre de Recherche du Centre hospitalier de l'Université de Montréal (crCHUM) (A.V., N.H., M.R.K.), Canada; Department of Neurosciences (A.V., M.R.K.), Université de Montréal, Canada; Division of Neurology (S.M., J.T.), University of Saskatchewan, Canada; School of Public Health of the Université de Montréal (N.H., M.R.K.), Canada; Department of Medicine, University of Calgary (J.H.), Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute (T.T.S., S.W., C.B.J.), University of Calgary, Canada; and Division of Neurology (C.D.), Centre Hospitalier Universitaire de Sherbrooke (CHUS), Canada
| | - Samuel Wiebe
- From the Centre de Recherche du Centre hospitalier de l'Université de Montréal (crCHUM) (A.V., N.H., M.R.K.), Canada; Department of Neurosciences (A.V., M.R.K.), Université de Montréal, Canada; Division of Neurology (S.M., J.T.), University of Saskatchewan, Canada; School of Public Health of the Université de Montréal (N.H., M.R.K.), Canada; Department of Medicine, University of Calgary (J.H.), Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute (T.T.S., S.W., C.B.J.), University of Calgary, Canada; and Division of Neurology (C.D.), Centre Hospitalier Universitaire de Sherbrooke (CHUS), Canada
| | - Charles Deacon
- From the Centre de Recherche du Centre hospitalier de l'Université de Montréal (crCHUM) (A.V., N.H., M.R.K.), Canada; Department of Neurosciences (A.V., M.R.K.), Université de Montréal, Canada; Division of Neurology (S.M., J.T.), University of Saskatchewan, Canada; School of Public Health of the Université de Montréal (N.H., M.R.K.), Canada; Department of Medicine, University of Calgary (J.H.), Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute (T.T.S., S.W., C.B.J.), University of Calgary, Canada; and Division of Neurology (C.D.), Centre Hospitalier Universitaire de Sherbrooke (CHUS), Canada
| | - Jose Francisco Tellez-Zenteno
- From the Centre de Recherche du Centre hospitalier de l'Université de Montréal (crCHUM) (A.V., N.H., M.R.K.), Canada; Department of Neurosciences (A.V., M.R.K.), Université de Montréal, Canada; Division of Neurology (S.M., J.T.), University of Saskatchewan, Canada; School of Public Health of the Université de Montréal (N.H., M.R.K.), Canada; Department of Medicine, University of Calgary (J.H.), Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute (T.T.S., S.W., C.B.J.), University of Calgary, Canada; and Division of Neurology (C.D.), Centre Hospitalier Universitaire de Sherbrooke (CHUS), Canada
| | - Colin Bruce Josephson
- From the Centre de Recherche du Centre hospitalier de l'Université de Montréal (crCHUM) (A.V., N.H., M.R.K.), Canada; Department of Neurosciences (A.V., M.R.K.), Université de Montréal, Canada; Division of Neurology (S.M., J.T.), University of Saskatchewan, Canada; School of Public Health of the Université de Montréal (N.H., M.R.K.), Canada; Department of Medicine, University of Calgary (J.H.), Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute (T.T.S., S.W., C.B.J.), University of Calgary, Canada; and Division of Neurology (C.D.), Centre Hospitalier Universitaire de Sherbrooke (CHUS), Canada
| | - Mark R Keezer
- From the Centre de Recherche du Centre hospitalier de l'Université de Montréal (crCHUM) (A.V., N.H., M.R.K.), Canada; Department of Neurosciences (A.V., M.R.K.), Université de Montréal, Canada; Division of Neurology (S.M., J.T.), University of Saskatchewan, Canada; School of Public Health of the Université de Montréal (N.H., M.R.K.), Canada; Department of Medicine, University of Calgary (J.H.), Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute (T.T.S., S.W., C.B.J.), University of Calgary, Canada; and Division of Neurology (C.D.), Centre Hospitalier Universitaire de Sherbrooke (CHUS), Canada.
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19
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Meaadi J, Obara I, Eldabe S, Nazar H. The safety and efficacy of gabapentinoids in the management of neuropathic pain: a systematic review with meta-analysis of randomised controlled trials. Int J Clin Pharm 2023:10.1007/s11096-022-01528-y. [PMID: 36848024 DOI: 10.1007/s11096-022-01528-y] [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: 08/12/2022] [Accepted: 12/01/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND There are increasing concerns regarding the abusive potential of gabapentinoids putting at risk patients with neuropathic pain requiring long-term pain management. The evidence to support this is rather inconcusive. AIM This systematic review aimed to evaluate the safety and efficacy of gabapentinoids in the management of neuropathic pain with a focus on randomised controlled trials (RCTs) and categorising the side effects according to the body systems they were affecting. METHOD Searches were conducted in MEDLINE (PubMed), EMBASE, Web of Science, PsycoINFO, and CINAHL (EBSCO), and included RCTs to identify and critically appraise studies investigating safety and therapeutic effects of gabapentionoids in adults with neuropathic pain. Data extraction was conducted using an established Cochrane form and the risk-of-bias tool was used in the assessment of quality. RESULTS 50 studies (12,398 participants) were included. The majority of adverse events pertained to the nervous system (7 effects) or psychiatric (3 effects) disorders. There were more adverse effects reported with pregabalin (36 effects) than with gabapentin (22 effects). Six pregabalin studies reported euphoria as a side effect, while no studies reported euphoria with gabapentin. This was the only side effect that may correlate with addictive potential. Gabapentioids were reported to significantly reduce pain compared to placebo. CONCLUSION Despite RCTs documenting the adverse events of gabapentionoids on the nervous system, there was no evidence of gabapentinoid use leading to addiction, suggesting an urgent need to design studies investigating their abusive potential.
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Affiliation(s)
- Jawza Meaadi
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK.,King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ilona Obara
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU, UK. .,Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK.
| | - Sam Eldabe
- Department of Pain and Anaesthesia, James Cook Hospital, Middlesbrough, UK
| | - Hamde Nazar
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle-Upon-Tyne, NE1 7RU, UK.,Population Health Sciences Institute, Newcastle University, Newcastle-Upon-Tyne, UK
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20
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Gajate-García V, Gutiérrez-Viedma Á, Romeral-Jiménez M, Serrano-García I, Parejo-Carbonell B, Montalvo-Moraleda T, Valls-Carbó A, García-Morales I. Seizures in the Emergency Department: clinical and diagnostic data from a series of 153 patients. Neurologia 2023; 38:29-34. [PMID: 34836845 DOI: 10.1016/j.nrleng.2020.02.011] [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: 10/14/2019] [Accepted: 02/08/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Seizures are a frequent reason for admission to emergency departments and require early, precise diagnosis and treatment. The objective of this study was to describe the clinical and prognostic characteristics of a series of patients with seizures attended at our hospital's emergency department. METHODS We performed a retrospective, observational study of all patients with seizures who were admitted to our hospital's emergency department and attended by the on-call neurology service between February and August 2017. RESULTS We included 153 patients, representing 9.9% of all neurological emergency department admissions. The median age was 58 years, 52.3% of patients were women, and 51% had history of epilepsy. Onset was focal in 82.4% of cases, and the most frequent aetiology was cerebrovascular disease (24.2%). Twelve patients (7.8%) developed status epilepticus, which was associated with higher scores on the ADAN scale (P < .001) and with history of refractory epilepsy (P = .002). The in-hospital mortality rate was 3.7%, and in-hospital mortality was associated with older age (P = .049) and status epilepticus (P = .018). Eighty percent of patients with no history of epilepsy were diagnosed with epilepsy at the emergency department; all started treatment. The kappa coefficient for epilepsy diagnosis in the emergency department compared to diagnosis after one year of follow-up by the epilepsy unit was 0.45 (diagnosis was modified in 20% of patients). CONCLUSIONS Seizures are a frequent neurological emergency with potential complications and considerable morbidity and mortality rates. In patients with no known history of epilepsy, the condition may be diagnosed in the emergency department, but follow-up at specialised epilepsy units is recommended.
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Affiliation(s)
- V Gajate-García
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Á Gutiérrez-Viedma
- Servicio de Neurología, Hospital Fundación Jiménez Díaz, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (iiSFJD), Madrid, Spain.
| | - M Romeral-Jiménez
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - I Serrano-García
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Unidad de Metodología de Investigación y Epidemiología Clínica, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain
| | - B Parejo-Carbonell
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - T Montalvo-Moraleda
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - A Valls-Carbó
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - I García-Morales
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
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21
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Kress GT, Chan F, Garcia CA, Merrifield WS. Utilizing machine learning algorithms to predict subject genetic mutation class from in silico models of neuronal networks. BMC Med Inform Decis Mak 2022; 22:290. [DOI: 10.1186/s12911-022-02038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Epilepsy is the fourth-most common neurological disorder, affecting an estimated 50 million patients globally. Nearly 40% of patients have uncontrolled seizures yet incur 80% of the cost. Anti-epileptic drugs commonly result in resistance and reversion to uncontrolled drug-resistant epilepsy and are often associated with significant adverse effects. This has led to a trial-and-error system in which physicians spend months to years attempting to identify the optimal therapeutic approach.
Objective
To investigate the potential clinical utility from the context of optimal therapeutic prediction of characterizing cellular electrophysiology. It is well-established that genomic data alone can sometimes be predictive of effective therapeutic approach. Thus, to assess the predictive power of electrophysiological data, machine learning strategies are implemented to predict a subject’s genetically defined class in an in silico model using brief electrophysiological recordings obtained from simulated neuronal networks.
Methods
A dynamic network of isogenic neurons is modeled in silico for 1-s for 228 dynamically modeled patients falling into one of three categories: healthy, general sodium channel gain of function, or inhibitory sodium channel loss of function. Data from previous studies investigating the electrophysiological and cellular properties of neurons in vitro are used to define the parameters governing said models. Ninety-two electrophysiological features defining the nature and consistency of network connectivity, activity, waveform shape, and complexity are extracted for each patient network and t-tests are used for feature selection for the following machine learning algorithms: Neural Network, Support Vector Machine, Gaussian Naïve Bayes Classifier, Decision Tree, and Gradient Boosting Decision Tree. Finally, their performance in accurately predicting which genetic category the subjects fall under is assessed.
Results
Several machine learning algorithms excel in using electrophysiological data from isogenic neurons to accurately predict genetic class with a Gaussian Naïve Bayes Classifier predicting healthy, gain of function, and overall, with the best accuracy, area under the curve, and F1. The Gradient Boosting Decision Tree performs the best for loss of function models indicated by the same metrics.
Conclusions
It is possible for machine learning algorithms to use electrophysiological data to predict clinically valuable metrics such as optimal therapeutic approach, especially when combining several models.
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22
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Stevelink R, Al-Toma D, Jansen FE, Lamberink HJ, Asadi-Pooya AA, Farazdaghi M, Cação G, Jayalakshmi S, Patil A, Özkara Ç, Aydın Ş, Gesche J, Beier CP, Stephen LJ, Brodie MJ, Unnithan G, Radhakrishnan A, Höfler J, Trinka E, Krause R, Irelli EC, Di Bonaventura C, Szaflarski JP, Hernández-Vanegas LE, Moya-Alfaro ML, Zhang Y, Zhou D, Pietrafusa N, Specchio N, Japaridze G, Beniczky S, Janmohamed M, Kwan P, Syvertsen M, Selmer KK, Vorderwülbecke BJ, Holtkamp M, Viswanathan LG, Sinha S, Baykan B, Altindag E, von Podewils F, Schulz J, Seneviratne U, Viloria-Alebesque A, Karakis I, D'Souza WJ, Sander JW, Koeleman BP, Otte WM, Braun KP. Individualised prediction of drug resistance and seizure recurrence after medication withdrawal in people with juvenile myoclonic epilepsy: A systematic review and individual participant data meta-analysis. EClinicalMedicine 2022; 53:101732. [PMID: 36467455 PMCID: PMC9716332 DOI: 10.1016/j.eclinm.2022.101732] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify predictors of drug resistance and seizure recurrence to allow for individualised prediction of treatment outcomes in people with JME. METHODS We performed an individual participant data (IPD) meta-analysis based on a systematic search in EMBASE and PubMed - last updated on March 11, 2021 - including prospective and retrospective observational studies reporting on treatment outcomes of people diagnosed with JME and available seizure outcome data after a minimum one-year follow-up. We invited authors to share standardised IPD to identify predictors of drug resistance using multivariable logistic regression. We excluded pseudo-resistant individuals. A subset who attempted to withdraw ASM was included in a multivariable proportional hazards analysis on seizure recurrence after ASM withdrawal. The study was registered at the Open Science Framework (OSF; https://osf.io/b9zjc/). FINDINGS Our search yielded 1641 articles; 53 were eligible, of which the authors of 24 studies agreed to collaborate by sharing IPD. Using data from 2518 people with JME, we found nine independent predictors of drug resistance: three seizure types, psychiatric comorbidities, catamenial epilepsy, epileptiform focality, ethnicity, history of CAE, family history of epilepsy, status epilepticus, and febrile seizures. Internal-external cross-validation of our multivariable model showed an area under the receiver operating characteristic curve of 0·70 (95%CI 0·68-0·72). Recurrence of seizures after ASM withdrawal (n = 368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an average internal-external cross-validation concordance-statistic of 0·70 (95%CI 0·68-0·73). INTERPRETATION We were able to predict and validate clinically relevant personalised treatment outcomes for people with JME. Individualised predictions are accessible as nomograms and web-based tools. FUNDING MING fonds.
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Affiliation(s)
- Remi Stevelink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
- Corresponding author. Department of Child Neurology, University Medical Center Utrecht, 3584 CX, Utrecht, Netherlands.
| | - Dania Al-Toma
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Floor E. Jansen
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Herm J. Lamberink
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Ali A. Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
- Department of Neurology, Thomas Jefferson University, 909 Walnut Street, Philadelphia, PA, 19107, USA
| | - Mohsen Farazdaghi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Zand, Shiraz, Iran
| | - Gonçalo Cação
- Department of Neurology, Unidade Local de Saude do Alto Minho, Estrada de Santa Luzia, Viana do Castelo, 4904-858, Portugal
| | - Sita Jayalakshmi
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Anuja Patil
- Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad, 500003, India
| | - Çiğdem Özkara
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Kocamustafapaşa caddesi, Istanbul, 34098, Turkey
| | - Şenay Aydın
- Department of Neurology, Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, University of Health Sciences, Belgrat Kapı yolu, Istanbul, 34020, Turkey
| | - Joanna Gesche
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Christoph P. Beier
- Department of Neurology, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 4, Odense, 5000, Denmark
| | - Linda J. Stephen
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Martin J. Brodie
- Epilepsy Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Gopeekrishnan Unnithan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Ashalatha Radhakrishnan
- Department of Neurology, R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Chalakkuzhi, Medical College Road, Trivandrum, 695011, India
| | - Julia Höfler
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
| | - Eugen Trinka
- Department of Neurology and Neuroscience Institute, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, European Reference Network EpiCARE, Ignaz-Harrer Straße 79, Salzburg, 5020, Austria
- Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Hellbrunner Straße 34, Salzburg, 3100, Austria
- Department of Public Health, University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, 6060, Austria
| | - Roland Krause
- Bioinformatics Core Facility, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 6 Ave du Swing, Belvaux, 4367, Luxembourg
| | | | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Epilepsy Unit, Sapienza, University of Rome, Viale dell'Università 30, Rome, 00185, Italy
| | - Jerzy P. Szaflarski
- Departments of Neurology, Neurosurgery, and Neurobiology, UAB Epilepsy Center, University of Alabama at Birmingham Heersink School of Medicine, 1670 University Blvd, Birmingham, AL, 35294, USA
| | - Laura E. Hernández-Vanegas
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Monica L. Moya-Alfaro
- Department of Clinical Research, Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Insurgentes Sur 3877, Mexico, 14269, Mexico
| | - Yingying Zhang
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
| | - Nicola Pietrafusa
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Nicola Specchio
- Department of Neuroscience, Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome, 00165, Italy
| | - Giorgi Japaridze
- Department of Clinical Neurophysiology, Institute of Neurology and Neuropsychology, 83/11 Vazha-Pshavela Ave., Tbilisi, 186, Georgia
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Filadelfia, Visby Allé 5, Dianalund, 4293, Denmark
- Department of Clinical Neurophysiology, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Blvd. 99, Aarhus, 8200, Denmark
| | - Mubeen Janmohamed
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
- Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Marte Syvertsen
- Department of Neurology, Vestre Viken Hospital Trust, Dronninggata 28, Drammen, 3004, Norway
| | - Kaja K. Selmer
- National Centre for Epilepsy & Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, G. F. Henriksens vei 29, Sandvika, 1337, Norway
| | - Bernd J. Vorderwülbecke
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore, 560029, India
| | - Betül Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, Istanbul, 34390, Turkey
| | - Ebru Altindag
- Department of Neurology, Istanbul Florence Nightingale Hospital, Abide-i Hürriyet Cad, Istanbul, 34381, Turkey
| | - Felix von Podewils
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Juliane Schulz
- Department of Neurology, Epilepsy Center, University Medicine Greifswald, Sauerbruchstraße, Greifswald, 17489, Germany
| | - Udaya Seneviratne
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
- Department of Medicine, The School of Clinical Sciences at Monash Health, Monash University, Clayton Road, Melbourne, Victoria, 3168, Australia
| | - Alejandro Viloria-Alebesque
- Department of Neurology, Hospital General de la Defensa, Vía Ibérica 1, Zaragoza, 50009, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, Avda. San Juan Bosco 13, Zaragoza, 50009, Spain
| | - Ioannis Karakis
- Department of Neurology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Office 335, Atlanta, GA, 30303, USA
| | - Wendyl J. D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, 55 Victoria Parade, Melbourne, Victoria, 3065, Australia
| | - Josemir W. Sander
- Department of Neurology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610000, China
- Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 7, Heemstede, Netherlands
- UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Bobby P.C. Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Willem M. Otte
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
| | - Kees P.J. Braun
- Department of Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, European Reference Network EpiCARE, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands
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Gremke N, Printz M, Möller L, Ehrenberg C, Kostev K, Kalder M. Association between anti-seizure medication and the risk of lower urinary tract infection in patients with epilepsy. Epilepsy Behav 2022; 135:108910. [PMID: 36115082 DOI: 10.1016/j.yebeh.2022.108910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this retrospective study was to analyze the incidence of lower urinary tract infections (LUTI) and antibiotic prescriptions within 12 months after initial prescription of anti-seizure medication (ASM) between January and December 2020 (index date) and to investigate the association between a broad spectrum of ASMs and the risk of LUTI in patients with epilepsy. METHODS This retrospective cohort study included a total of 9186 adult patients (≥18 years) with an initial diagnosis of epilepsy and a prescription of an ASM treated in 1284 general practices in Germany between January 2010 and December 2020 (index date). Six frequently prescribed ASMs with at least 1000 available patients were analyzed. Patients treated with one of six ASMs were matched to each other by propensity scores based on sex, age, and secondary diagnoses. Cox regression models were used to analyze the association between the use of ASM and LUTI risk. RESULTS The cumulative LUTI incidence 12 months after the start of therapy was highest in patients treated with pregabalin (16.7%), followed by valproate (11.6%) and gabapentin (10.2%). A similar trend was observed for LUTI with antibiotic prescription (9.2% pregabalin, 6.8% valproate, 6.8% gabapentin). Conditional regression analyses revealed that pregabalin therapy was significantly positively associated with LUTI (HR: 1.76; 95% CI 1.29-2.39) and LUTI-based antibiotic prescription (HR: 2.16; 95% CI 1.43-3.27). Carbamazepine was associated with a significantly lower incidence of LUTI in women (HR: 0.47; 95% CI: 0.30-0.75), but not in men. No significant associations were observed for other ASMs. CONCLUSION The present study identifies a significant positive association between ASM and LUTI incidence and antibiotic prescriptions in patients with epilepsy treated with pregabalin, whereas a protective effect was found for carbamazepine in women only. No significant associations were observed for the four remaining ASMs.
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Affiliation(s)
- Niklas Gremke
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany.
| | - Marcel Printz
- Department of Neurology, Philipps-University, Marburg, Germany
| | - Leona Möller
- Department of Neurology, Philipps-University, Marburg, Germany
| | | | | | - Matthias Kalder
- Department of Gynecology and Obstetrics, Philipps-University, Marburg, Germany
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24
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Ioannou P, Foster DL, Sander JW, Dupont S, Gil-Nagel A, Drogon O'Flaherty E, Alvarez-Baron E, Medjedovic J. The burden of epilepsy and unmet need in people with focal seizures. Brain Behav 2022; 12:e2589. [PMID: 36017757 PMCID: PMC9480957 DOI: 10.1002/brb3.2589] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/24/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Epilepsy is one of the most common neurological conditions worldwide. As a chronic condition, epilepsy imposes a significant burden on people with epilepsy and society. We aimed to assess the burden and unmet need of individuals with epilepsy and their caregivers, focusing on focal seizures, the main type of seizure in adults and children. METHODS A targeted evidence review of the burden of epilepsy, focusing on focal seizures, was conducted to identify articles reporting: epidemiology, mortality, morbidity, quality of life (QoL), and costs. RESULTS Focal seizures affect up to ∼61% of people with epilepsy. They are associated with an increased risk of injury and premature death than the general population. People with epilepsy also have high comorbidity, particularly depression, anxiety, and cognitive impairments. Higher seizure frequency, adverse treatment events, and employment concerns reduce QoL. A reduction in caregivers' QoL is also often reported. Epilepsy requires long-term treatment accounting for high individual costs. Hospitalizations and antiseizure medications (ASMs) are the leading cost drivers of inpatient management and indirect costs with high unemployment rates, particularly in drug-resistant populations. Despite the advent of new treatments, a high unmet need remains unaddressed; approximately 40% of people with epilepsy are drug-resistant, further increasing the risks associated with epilepsy. CONCLUSIONS Our findings highlight a substantial burden of illness and unmet needs in individuals with focal seizures, especially those with drug-resistant epilepsy. Suboptimal treatment options negatively impact QoL and, consequently, a sizeable economic burden indicating the need for new treatments and prioritizing this condition.
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Affiliation(s)
| | | | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | | | - Antonio Gil-Nagel
- Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
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25
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Yıldırım M, Bektaş Ö, Kartal AT, Yeniay Süt N, Teber S. Risk of seizure relapse and long-term outcomes after discontinuation of antiseizure medication in children with epilepsy. Epilepsy Behav 2022; 134:108779. [PMID: 35763995 DOI: 10.1016/j.yebeh.2022.108779] [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] [Received: 02/22/2022] [Revised: 05/21/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the demographic and clinical characteristics of children with epilepsy who discontinued their antiseizure medication (ASM), to determine potential predictors of seizure relapse, to calculate the rate of seizure relapse, and to detect long-term seizure outcomes. METHODS A total of 269 seizure-free children with epilepsy who were decided to discontinue their ASM and were followed up for at least 18 months after ASM withdrawal were retrospectively evaluated. RESULTS The enrolled children had been followed up for a median of 46 months (range 18-126 months; IQR: 29-61) after ASM withdrawal and 90 (33.5%) of their seizures relapsed. The median time to seizure relapse was 8 months (range 0.23-117 months; IQR: 2-25). Seizure relapse occurred in 16.7% of the 90 children at 1 month, 45.6% at 6 months, 62.2% at 1 year, 74.4% at 2 years, and 94.4% at 5 years. Univariate logistic regression analyses revealed six predictors significantly related to relapse: age at first seizure, age at diagnosis of epilepsy, intellectual disability, EEG findings after ASM withdrawal, ASM tapering time, and number of seizures on ASM. In multivariate logistic regression analyses, age at first seizure, intellectual disability, and ASM tapering time were not significantly associated anymore. The other three remained independently predictive. Pharmacological control of seizures with monotherapy was restored in 93.3% of the children with seizure relapse. CONCLUSION This study evaluated potential predictors of seizure relapse, some of which have rarely been evaluated in previous studies. Adolescent age at diagnosis, abnormal EEG findings after ASM withdrawal, and high number of seizures on ASM were associated with a higher risk of seizure relapse. Abnormal MRI findings such as malformations of cortical development and hydrocephalus may be potential biomarkers for the risk of seizure relapse.
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Affiliation(s)
- Miraç Yıldırım
- Department of Pediatric Neurology, Ankara University, Faculty of Medicine, Ankara, Turkey.
| | - Ömer Bektaş
- Department of Pediatric Neurology, Ankara University, Faculty of Medicine, Ankara, Turkey.
| | - Ayşe Tuğba Kartal
- Department of Pediatric Neurology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Nurşah Yeniay Süt
- Department of Pediatric Neurology, Ankara University, Faculty of Medicine, Ankara, Turkey.
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University, Faculty of Medicine, Ankara, Turkey.
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de Toledo M, de la Fuente E, Ramos C, Ferreiros-Martinez R, Muro I, Vieira A, de Toledo MP, Lagares A, Sobrado M, Ovejero-Benito MC. Extensive pharmacokinetic variability of Levetiracetam. ¿Are doctors aware? Epilepsy Res 2022; 187:107029. [DOI: 10.1016/j.eplepsyres.2022.107029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/18/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
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Gracie L, Rostami‐Hochaghan D, Taweel B, Mirza N. The Seizure-Associated Genes Across Species (SAGAS) database offers insights into epilepsy genes, pathways and treatments. Epilepsia 2022; 63:2403-2412. [PMID: 35767389 PMCID: PMC9796383 DOI: 10.1111/epi.17352] [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: 03/01/2022] [Revised: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Decades of genetic studies on people with many different epilepsies, and on many nonhuman species, using many different technologies, have generated a huge body of literature about the genes associated with seizures/epilepsy. Collating these data can help uncover epilepsy genes, pathways, and treatments that would otherwise be overlooked. We aimed to collate and structure these data into a database, and use the database to identify novel epilepsy genes and pathways, and to prioritize promising treatments. METHODS We collated all the genes associated with all types of seizures/epilepsy in all species, and quantified the supporting evidence for each gene, by manually screening ~10 000 publications, and by extracting data from existing databases. RESULTS The largest published dataset of epilepsy genes includes only 977 genes, whereas our database (www.sagas.ac) includes 2876 genes, which demonstrates that the number of genes that can potentially contribute to seizures/epilepsy is much higher than previously envisaged. We use our database to identify 12 hitherto unreported polygenic epilepsy genes, 479 high-confidence monogenic epilepsy genes, and 394 more biological pathways than identified using the previously largest epilepsy gene dataset. We use a unique feature of Seizure-Associated Genes Across Species-the number of citations for each gene-to demonstrate that a drug is more likely to affect seizures if there is more evidence that the genes it affects are associated with seizures, and we use these data to identify promising candidate antiseizure drugs. SIGNIFICANCE This database offers insights into the causes of epilepsy and its treatments, and can accelerate future epilepsy research.
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Affiliation(s)
- Lara Gracie
- Birmingham Medical SchoolUniversity of BirminghamBirminghamUK
| | | | - Basel Taweel
- Department of Pharmacology & Therapeutics, Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
| | - Nasir Mirza
- Department of Pharmacology & Therapeutics, Institute of Systems, Molecular and Integrative BiologyUniversity of LiverpoolLiverpoolUK
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Kawada K, Ishida T, Jobu K, Ohta T, Fukuda H, Morisawa S, Kawazoe T, Tamura N, Miyamura M. Association of Aggression and Antiepileptic Drugs: Analysis Using the Japanese Adverse Drug Event Report (JADER) Database. Biol Pharm Bull 2022; 45:720-723. [PMID: 35650100 DOI: 10.1248/bpb.b21-00954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aggression is the most common adverse effect of antiepileptic drugs (AEDs). This study aimed to investigate the association of aggression with AED use. The reporting odds ratio (ROR) from adverse event reports, submitted to the Japanese Adverse Drug Event Report database between 2004 and 2020, was used to calculate and investigate the association between AEDs and aggression. We also analyzed the association of aggression with the combined use of AEDs and the relationship between AED-associated aggression and patient characteristics. A total of 433 patients developed aggression. Significant aggression signals were detected for perampanel (crude ROR: 325.04, 95% confidence interval (CI): 118.48-752.58, p < 0.01), levetiracetam (crude ROR: 17.14, 95% CI: 10.33-26.90, p < 0.01), lacosamide (crude ROR: 16.90, 95% CI: 2.02-62.51, p < 0.01), lamotrigine (crude ROR: 15.98, 95% CI: 9.99-24.39, p < 0.01), valproate (crude ROR: 6.68, 95% CI: 4.27-10.02, p < 0.01), and carbamazepine (crude ROR: 2.47, 95% CI: 1.17-4.59, p < 0.01). The combined therapy with perampanel and levetiracetam had a significant aggression signal (adjusted ROR: 25.90, 95% CI: 1.14-59.10, p < 0.01). In addition, we found that aggression frequently occurred in patients <60 year (adjusted ROR: 2.88, 95% CI: 1.49-5.56, p < 0.01) treated with levetiracetam. These results may be useful for minimizing the risk of aggression during the treatment of AEDs.
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Affiliation(s)
- Kei Kawada
- Graduate School of Integrated Arts and Sciences, Kochi University.,Department of Pharmacy, Kochi Medical School Hospital
| | | | - Kohei Jobu
- Department of Pharmacy, Kochi Medical School Hospital
| | - Tsuyoshi Ohta
- Department of Neurosurgery, National Cerebral and Cardiovascular Center Hospital
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi Medical School, Kochi University
| | - Shumpei Morisawa
- Graduate School of Integrated Arts and Sciences, Kochi University.,Department of Pharmacy, Kochi Medical School Hospital
| | - Tetsushi Kawazoe
- Graduate School of Integrated Arts and Sciences, Kochi University.,Department of Pharmacy, Kochi Medical School Hospital
| | - Naohisa Tamura
- Graduate School of Integrated Arts and Sciences, Kochi University.,Department of Pharmacy, Kochi Medical School Hospital
| | - Mitsuhiko Miyamura
- Graduate School of Integrated Arts and Sciences, Kochi University.,Department of Pharmacy, Kochi Medical School Hospital
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29
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Zafar SF, Rosenthal ES, Postma EN, Sanches P, Ayub MA, Rajan S, Kim JA, Rubin DB, Lee H, Patel AB, Hsu J, Patorno E, Westover MB. Antiseizure Medication Treatment and Outcomes in Patients with Subarachnoid Hemorrhage Undergoing Continuous EEG Monitoring. Neurocrit Care 2022; 36:857-867. [PMID: 34843082 PMCID: PMC9117405 DOI: 10.1007/s12028-021-01387-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with aneurysmal subarachnoid hemorrhage (aSAH) with electroencephalographic epileptiform activity (seizures, periodic and rhythmic patterns, and sporadic discharges) are frequently treated with antiseizure medications (ASMs). However, the safety and effectiveness of ASM treatment for epileptiform activity has not been established. We used observational data to investigate the effectiveness of ASM treatment in patients with aSAH undergoing continuous electroencephalography (cEEG) to develop a causal hypothesis for testing in prospective trials. METHODS This was a retrospective single-center cohort study of patients with aSAH admitted between 2011 and 2016. Patients underwent ≥ 24 h of cEEG within 4 days of admission. All patients received primary ASM prophylaxis until aneurysm treatment (typically within 24 h of admission). Treatment exposure was defined as reinitiation of ASMs after aneurysm treatment and cEEG initiation. We excluded patients with non-cEEG indications for ASMs (e.g., epilepsy, acute symptomatic seizures). Outcomes measures were 90-day mortality and good functional outcome (modified Rankin Scale scores 0-3). Propensity scores were used to adjust for baseline covariates and disease severity. RESULTS Ninety-four patients were eligible (40 continued ASM treatment; 54 received prophylaxis only). ASM continuation was not significantly associated with higher 90-day mortality (propensity-adjusted hazard ratio [HR] = 2.01 [95% confidence interval (CI) 0.57-7.02]). ASM continuation was associated with lower likelihood for 90-day good functional outcome (propensity-adjusted HR = 0.39 [95% CI 0.18-0.81]). In a secondary analysis, low-intensity treatment (low-dose single ASM) was not significantly associated with mortality (propensity-adjusted HR = 0.60 [95% CI 0.10-3.59]), although it was associated with a lower likelihood of good outcome (propensity-adjusted HR = 0.37 [95% CI 0.15-0.91]), compared with prophylaxis. High-intensity treatment (high-dose single ASM, multiple ASMs, or anesthetics) was associated with higher mortality (propensity-adjusted HR = 6.80 [95% CI 1.67-27.65]) and lower likelihood for good outcomes (propensity-adjusted HR = 0.30 [95% CI 0.10-0.94]) compared with prophylaxis only. CONCLUSIONS Our findings suggest the testable hypothesis that continuing ASMs in patients with aSAH with cEEG abnormalities does not improve functional outcomes. This hypothesis should be tested in prospective randomized studies.
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Affiliation(s)
- Sahar F Zafar
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Eric S Rosenthal
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Eva N Postma
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Paula Sanches
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Subapriya Rajan
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| | - Jennifer A Kim
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Daniel B Rubin
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Hang Lee
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Aman B Patel
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - John Hsu
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, MA, USA
| | | | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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30
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Fukuyama K, Okada M. Brivaracetam and Levetiracetam Suppress Astroglial L-Glutamate Release through Hemichannel via Inhibition of Synaptic Vesicle Protein. Int J Mol Sci 2022; 23:ijms23094473. [PMID: 35562864 PMCID: PMC9101419 DOI: 10.3390/ijms23094473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 02/07/2023] Open
Abstract
To explore the pathophysiological mechanisms of antiseizure and adverse behavioural/psychiatric effects of brivaracetam and levetiracetam, in the present study, we determined the effects of brivaracetam and levetiracetam on astroglial L-glutamate release induced by artificial high-frequency oscillation (HFO) bursts using ultra-high-performance liquid chromatography. Additionally, the effects of brivaracetam and levetiracetam on protein expressions of connexin43 (Cx43) and synaptic vesicle protein 2A (SV2A) in the plasma membrane of primary cultured rat astrocytes were determined using a capillary immunoblotting system. Acutely artificial fast-ripple HFO (500 Hz) burst stimulation use-dependently increased L-glutamate release through Cx43-containing hemichannels without affecting the expression of Cx43 or SV2A in the plasma membrane, whereas acute physiological ripple HFO (200 Hz) stimulation did not affect astroglial L-glutamate release or expression of Cx43 or SV2A. Contrarily, subchronic ripple HFO and acute pathological fast-ripple HFO (500 Hz) stimulations use-dependently increased L-glutamate release through Cx43-containing hemichannels and Cx43 expression in the plasma membrane. Subchronic fast-ripple HFO-evoked stimulation produced ectopic expression of SV2A in the plasma membrane, but subchronic ripple HFO stimulation did not generate ectopic SV2A. Subchronic administration of brivaracetam and levetiracetam concentration-dependently suppressed fast-ripple HFO-induced astroglial L-glutamate release and expression of Cx43 and SV2A in the plasma membrane. In contrast, subchronic ripple HFO-evoked stimulation induced astroglial L-glutamate release, and Cx43 expression in the plasma membrane was inhibited by subchronic levetiracetam administration, but was not affected by brivaracetam. These results suggest that brivaracetam and levetiracetam inhibit epileptogenic fast-ripple HFO-induced activated astroglial transmission associated with hemichannels. In contrast, the inhibitory effect of therapeutic-relevant concentrations of levetiracetam on physiological ripple HFO-induced astroglial responses probably contributes to the adverse behavioural/psychiatric effects of levetiracetam.
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SEDIGHI P, KHALILI N, KHALILI N, DOOSTI-IRANI A, MORADI A, MOGHADAM S, NEMATI M, MOHAMMADI Jorjafki S, SHERVIN BADV R, SEDIGHI I. Patterns of Antiepileptic Drug Reactions in Children: A Multicenter Study. IRANIAN JOURNAL OF CHILD NEUROLOGY 2022; 16:133-143. [PMID: 36204430 PMCID: PMC9531194 DOI: 10.22037/ijcn.v16i3.32872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 04/04/2021] [Indexed: 11/21/2022]
Abstract
Objectives Antiepileptic drugs are among the most common triggers of cutaneous adverse reactions. About 5-17% of epileptic patients develop idiosyncratic skin reactions at some point during their treatment course, most of which occur within the first two months of drug initiation. This study aimed to investigate the pattern of cutaneous drug reactions associated with anticonvulsant use among the pediatric population in Iran to identify high-risk individuals. Materials & Methods In this retrospective descriptive study, medical records of children aged two months to 14 years, who were diagnosed with drug reactions due to anticonvulsant drugs between April 2007 and March 2018, were reviewed, and relevant information were extracted. This multicenter study was conducted in several provinces of Iran. Results A total of 186 cases with a final diagnosis of the antiepileptic drug-induced eruption were evaluated. The median age of participants was 36 months (range: 2-168), and 56% were male. In approximately 70% of the children, the phenobarbital was the culprit. The median time interval between initiation of the causative drug and development of rash and fever was 10 and 7 days, respectively. The most common rash type was maculopapular rashes (69%). Overall, 33% of the patients only received antihistamines after discontinuation of the causative drug. Conclusion Similar to previously published studies in Iran, phenobarbital was the main cause of cutaneous drug reactions to antiepileptic drugs, indicating the necessity of paying more attention when prescribing phenobarbital for Iranian pediatrics.
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Affiliation(s)
- Parinaz SEDIGHI
- Student research committee, Hamadan University of Medical Sciences, Hamadan, Iran.,Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Neda KHALILI
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran KHALILI
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin DOOSTI-IRANI
- Department of Epidemiology, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Atefeh MORADI
- Department of Pediatric Growth Disorders Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Samira MOGHADAM
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Meshkat NEMATI
- School of Medicine , Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza SHERVIN BADV
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj SEDIGHI
- Department of Pediatrics, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Liang X, Yu N, Zhang YF, Gu L, Di Q. Prognostic implications of persistent interictal epileptiform discharges on antiseizure medication withdrawal in patients with epilepsy in five-year remission. Seizure 2021; 94:100-106. [PMID: 34883461 DOI: 10.1016/j.seizure.2021.11.009] [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: 07/19/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Whether patients with epilepsy in long-term remission and interictal epileptiform discharges (IEDs) can stop antiseizure medication (ASM) remains a challenging topic even though multiple studies have investigated ASM withdrawal. This study aimed to estimate seizure relapse and its risk factors in patients with epilepsy in five-year remission and persistent IEDs. METHODS Patients with epilepsy and persistent IEDs were prospectively recruited from the Affiliated Nanjing Brain Hospital of Nanjing Medical University from Dec.1, 2010 to Dec.30, 2019. All enrolled patients achieved seizure remission for over five years and were divided into the ASM withdrawal and continuous treatment groups according to their personal preference. Seizure outcomes and 24 h video electroencephalogram findings were obtained through clinical visits or telephone interviews every three months until March 31, 2021. The cumulative recurrence rate and its diversity between the ASM withdrawal and continuous treatment groups were tested using Kaplan-Meier analysis. Multivariate Cox regression analysis was performed to explore the independent predictors for seizure recurrence. Relapsed patients were further monitored for their seizure control and prognosis. RESULTS A total of 83 patients with epilepsy in five-year remission and persistent IEDs were enrolled in this study, including 41 (49.4%) in the ASM withdrawal group and 42 (50.6%) in the continuous ASM treatment group. During the follow-up with a median time of 36.8 months (range from 18.7 to 104.6 months), the seizure relapse in off-medication patients (43.9%, 18/41) was higher than that in on-medication patients (21.4%, 9/42; P = 0.031). In the multivariate analysis model, independent predictors for seizure recurrence were structural-metabolic epilepsy or unknown cause (HR = 6.185, 95% CI 1.166-32.805) and multiple seizure types (HR = 2.807, 95% CI 1.051-7.502). ASM withdrawal was not found to be an independent risk factor for seizure recurrence. Of 27 patients with seizure recurrence, 25 were given reinstitution or continuous ASM therapy, whereas two chose sustained observation without medication. At the end of the follow-up, 70.4% (19/27) of recurrence patients were completely free from seizures for at least one year again, and only one patient developed refractory epilepsy. CONCLUSION For patients with epilepsy in five-year remission and persistent IEDs, drug withdrawal may be a rational choice after the individualized assessment of benefits and risks. Furthermore, the independent risk factors for the seizure relapse were structural-metabolic epilepsy or an unknown cause, and multiple seizure types. Finally, patients with epilepsy relapsing after ASM withdrawal could achieve seizure remission again after ASM retreatment.
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Affiliation(s)
- Xue Liang
- The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Neurology, 210029, Nanjing, China
| | - Nian Yu
- The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Neurology, 210029, Nanjing, China
| | - Yan-Fang Zhang
- The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Neurology, 210029, Nanjing, China
| | - Li Gu
- The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Neurology, 210029, Nanjing, China
| | - Qing Di
- The Affiliated Nanjing Brain Hospital of Nanjing Medical University, Department of Neurology, 210029, Nanjing, China.
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Mirza N, Stevelink R, Taweel B, Koeleman BPC, Marson AG. Using common genetic variants to find drugs for common epilepsies. Brain Commun 2021; 3:fcab287. [PMID: 34988442 PMCID: PMC8710935 DOI: 10.1093/braincomms/fcab287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/17/2021] [Accepted: 10/20/2021] [Indexed: 12/18/2022] Open
Abstract
Better drugs are needed for common epilepsies. Drug repurposing offers the potential of significant savings in the time and cost of developing new treatments. In order to select the best candidate drug(s) to repurpose for a disease, it is desirable to predict the relative clinical efficacy that drugs will have against the disease. Common epilepsy can be divided into different types and syndromes. Different antiseizure medications are most effective for different types and syndromes of common epilepsy. For predictions of antiepileptic efficacy to be clinically translatable, it is essential that the predictions are specific to each form of common epilepsy, and reflect the patterns of drug efficacy observed in clinical studies and practice. These requirements are not fulfilled by previously published drug predictions for epilepsy. We developed a novel method for predicting the relative efficacy of drugs against any common epilepsy, by using its Genome-Wide Association Study summary statistics and drugs' activity data. The methodological advancement in our technique is that the drug predictions for a disease are based upon drugs' effects on the function and abundance of proteins, and the magnitude and direction of those effects, relative to the importance, degree and direction of the proteins' dysregulation in the disease. We used this method to predict the relative efficacy of all drugs, licensed for any condition, against each of the major types and syndromes of common epilepsy. Our predictions are concordant with findings from real-world experience and randomized clinical trials. Our method predicts the efficacy of existing antiseizure medications against common epilepsies; in this prediction, our method outperforms the best alternative existing method: area under receiver operating characteristic curve (mean ± standard deviation) 0.83 ± 0.03 and 0.63 ± 0.04, respectively. Importantly, our method predicts which antiseizure medications are amongst the more efficacious in clinical practice, and which antiseizure medications are amongst the less efficacious in clinical practice, for each of the main syndromes of common epilepsy, and it predicts the distinct order of efficacy of individual antiseizure medications in clinical trials of different common epilepsies. We identify promising candidate drugs for each of the major syndromes of common epilepsy. We screen five promising predicted drugs in an animal model: each exerts a significant dose-dependent effect upon seizures. Our predictions are a novel resource for selecting suitable candidate drugs that could potentially be repurposed for each of the major syndromes of common epilepsy. Our method is potentially generalizable to other complex diseases.
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Affiliation(s)
- Nasir Mirza
- Department of Pharmacology & Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3GE, UK
| | - Remi Stevelink
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht 3584 CX, the Netherlands; member of the ERN EpiCARE
- Department of Child Neurology, University Medical Center Utrecht Brain Center, Utrecht 3584 CX, the Netherlands
| | - Basel Taweel
- School of Medicine, University of Liverpool, Liverpool L69 3GE, UK
| | - Bobby P C Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht 3584 CX, the Netherlands; member of the ERN EpiCARE
| | - Anthony G Marson
- Department of Pharmacology & Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3GE, UK
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Amerineni R, Sun H, Lee H, Hsu J, Patorno E, Westover MB, Zafar SF. Using electronic health data to explore effectiveness of ICU EEG and anti-seizure treatment. Ann Clin Transl Neurol 2021; 8:2270-2279. [PMID: 34802196 PMCID: PMC8670316 DOI: 10.1002/acn3.51478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives The purpose of this study was to examine critical care continuous electroencephalography (cEEG) utilization and downstream anti‐seizure treatment patterns, their association with outcomes, and generate hypotheses for larger comparative effectiveness studies of cEEG‐guided interventions. Methods Single‐center retrospective study of critically ill patients (n = 14,523, age ≥18 years). Exposure defined as ≥24 h of cEEG and subsequent anti‐seizure medication (ASM) escalation, with or without concomitant anesthetic. Exposure window was the first 7 days of admission. Primary outcome was in‐hospital mortality. Multivariable analysis was performed using penalized logistic regression. Results One thousand and seventy‐three patients underwent ≥24 h of cEEG within 7 days of admission. After adjusting for disease severity, ≥24 h of cEEG followed by ASM escalation in patients not on anesthetics (n = 239) was associated with lower in‐hospital mortality (OR 0.76 [0.53–1.07]), though the finding did not reach significance. ASM escalation with concomitant anesthetic use (n = 484) showed higher odds for mortality (OR 1.41 [1.03–1.94]). In the seizures/status epilepticus subgroup, post cEEG ASM escalation without anesthetics showed lower odds for mortality (OR 0.43 [0.23–0.74]). Within the same subgroup, ASM escalation with concomitant anesthetic use showed higher odds for mortality (OR 1.34 [0.92–1.91]) though not significant. Interpretation Based on our findings we propose the following hypotheses for larger comparative effectiveness studies investigating the direct causal effect of cEEG‐guided treatment on outcomes: (1) cEEG‐guided ASM escalation may improve outcomes in critically ill patients with seizures; (2) cEEG‐guided treatment with combination of ASMs and anesthetics may not improve outcomes in all critically ill patients.
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Affiliation(s)
- Rajesh Amerineni
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Haoqi Sun
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hang Lee
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Hsu
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Sahar F Zafar
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Jasionis A, Jasionytė G, Mameniškienė R. Tolerability of antiseizure medicines using Lithuanian version of the Liverpool Adverse Events Profile. Epilepsy Behav 2021; 124:108371. [PMID: 34757263 DOI: 10.1016/j.yebeh.2021.108371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To develop and validate a Lithuanian version of the Liverpool Adverse Events Profile (LT-LAEP), and to evaluate the main demographic, clinical, and pharmacological determinants of its score. MATERIALS AND METHODS We developed the LT-LAEP and examined its psychometric properties. People with epilepsy (PWE) were asked to fill in the LT-LAEP, the Generalized Anxiety Disorder scale-7 (GAD-7), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and a questionnaire addressing key demographic and clinical information. Antiseizure medicine (ASM) burden was expressed as a number of ASM and total drug load. Multiple linear regression analysis was used to determine the influence of various variables on LAEP results. RESULTS The data of 157 participants with the established diagnosis of epilepsy and stable ASM regimen were included in the final analysis. The mean LT-LAEP score was 48.72 ± 13.65. High internal consistency (Cronbach's α = 0.912) and test-retest reliability (ICC = 0.801) were demonstrated. The most common adverse effects (AEs) were tiredness (24.8%) and memory problems (23.6%). Lithuanian version of the Liverpool Adverse Events Profile score significantly correlated with NDDI-E (r = 0.635, p < 0.001) and GAD-7 (r = 0.640, p < 0.001) scores. The correlation between LT-LAEP score and total drug load was weak (r = 0.243, p = 0.002). The significant predictors of higher LT-LAEP score were female sex (β = -4.768, p = 0.003), higher seizure frequency (β = 4.757, p < 0.001), and higher NDDI-E (β = 1.457, p < 0.001) and GAD-7 scores (β = 0.610, p = 0.007) (F(4,152) = 43.975, R2 = 0.536, p < 0.001). CONCLUSIONS The LT-LAEP is a reliable and valid instrument for the evaluation of the AEs of ASM. A higher score of LT-LAEP is predicted by female sex, seizure frequency, and anxiety and depression levels rather than total drug load.
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Yamamoto Y, Shiratani Y, Asai S, Usui N, Nishida T, Imai K, Kagawa Y, Takahashi Y. Risk factors for psychiatric adverse effects associated with perampanel therapy. Epilepsy Behav 2021; 124:108356. [PMID: 34662853 DOI: 10.1016/j.yebeh.2021.108356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To identify the risk factors for psychiatric adverse effects associated with perampanel therapy. METHODS We retrospectively evaluated the adverse effects of perampanel by reviewing clinical records from 895 Japanese patients with epilepsy (aged 1-86 years) who started perampanel therapy at National Epilepsy Center, Shizuoka, Japan, between June 2016 and December 2019. Patients were classified into 3 groups: those without adverse effects (Group I), those with psychiatric adverse effects (Group II), and those with common adverse effects (Group III). RESULTS The number of patients assigned to each group was as follows: Group I, n = 641; Group II, n = 93; and Group III, n = 161. The mean follow-up period was 458 ± 265 days (median, 511 days). Kaplan-Meier survival estimates showed that the median time to treatment failure was shorter in Group II than in Group III (294 vs. 392 days, respectively; log-rank test, p < 0.001). According to polytomous logistic regression, younger age (<16 years) was associated with a lower risk of common and psychiatric adverse effects. The risk factors for psychiatric adverse effects (Group II) were intellectual disability (adjusted odds ratio [AOR], 2.6; 95% confidence interval (CI), 1.5-4.5) and psychiatric comorbidity (AOR, 3.8; 95% CI, 2.3-6.3); in patients with intellectual disability, the occurrence of psychiatric adverse effects was concentration dependent. Patients with lamotrigine use had a 0.54-fold lower risk of psychiatric adverse effects. In Group III, concomitant use of inducers was associated with a decreased risk of common adverse effects (AOR, 0.68; 95% CI, 0.46-0.99). SIGNIFICANCE We found clear differences in the risk factors for psychiatric adverse effects. In patients with intellectual disability, care must be taken when titrating perampanel, and therapeutic drug monitoring should be performed.
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Affiliation(s)
- Yoshiaki Yamamoto
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Shizuoka 420-8688, Japan; Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Shizuoka 422-8526, Japan.
| | - Yuka Shiratani
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Shizuoka 420-8688, Japan
| | - Shoko Asai
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Shizuoka 420-8688, Japan
| | - Naotaka Usui
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Shizuoka 420-8688, Japan
| | - Takuji Nishida
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Shizuoka 420-8688, Japan
| | - Katsumi Imai
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Shizuoka 420-8688, Japan
| | - Yoshiyuki Kagawa
- Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Shizuoka 422-8526, Japan; Laboratory of Clinical Pharmacokinetics and Drug Safety, Shizuoka General Hospital, 4-27-1 Kita Ando, Shizuoka 420-8527, Japan
| | - Yukitoshi Takahashi
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Shizuoka 420-8688, Japan; Department of Clinical Pharmaceutics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Shizuoka 422-8526, Japan
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de Toledo M, Valladares-Salado L, Cebrian-Escudero J, Diaz-Perez C, de la Fuente E, Ferreiros R, Sanz-Sanz E, Vega-Piris L, Lagares A, Ovejero-Benito MC, Sobrado M. Pharmacokinetic variability of eslicarbazepine in real clinical practice. Epilepsy Behav 2021; 124:108284. [PMID: 34521058 DOI: 10.1016/j.yebeh.2021.108284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Eslicarbazepine acetate (ESL) is a sodium channel blocker indicated for partial-onset seizures with or without secondary generalization, at a single daily dose. There are very few publications on the levels of ESL metabolites in real clinical practice. OBJECTIVE To describe the serum levels of licarbazepine (main metabolite of ESL) in patients with refractory epilepsy in real clinical practice. To evaluate the influence of age, sex, and polytherapy on levels and adverse effects. METHODS This study involved a retrospective analysis of patients diagnosed with epilepsy treated with ESL for whom plasma levels of licarbazepine were available, measured by spectrophotometry. RESULTS Sixty-four patients were included. One patient had licarbazepine levels of 0 (admitted not taking the drug) was not analyzed. Mean licarbazepine levels of 7.66 µg/mL (400 mg/day dose), 16.56 µg/mL (800-mg dose), and 20.80 µg/mL (1200 mg) were significantly different. There was a significant correlation between daily dose and serum levels (p < 0.05) and between the concentration/dose ratio and lower to higher doses (p < 0.05). Pharmacokinetic variability (coefficient of variation for the concentration/dose ratio) was 33.2%. We found a decrease in the concentration/dose ratio in the 1200 mg/day dose, compared to lower doses. We did not find differences by sex or intake of other antiepileptic inducers or metabolic inhibitors. Fifteen patients (23.8%) had mild nonsymptomatic hyponatremia. CONCLUSION These results suggest that it is not necessary to routinely determine licarbazepine levels. In specific cases, licarbazepine levels can be useful to assess adherence to treatment and for personalized dose adjustment.
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Affiliation(s)
- Maria de Toledo
- Epilepsy Unit, Department of Neurology, Instituto de Investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain.
| | - Laura Valladares-Salado
- Department of Neurology, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Jose Cebrian-Escudero
- Department of Neurology, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Carolina Diaz-Perez
- Department of Neurology, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Elisa de la Fuente
- Department of Neurology, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Raquel Ferreiros
- Department of Clinical Laboratory Analysis, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Elena Sanz-Sanz
- Department of Clinical Laboratory Analysis, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Lorena Vega-Piris
- Methodologic Unit, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense Madrid, Instituto de Investigación i+12 CIBERESP, Spain
| | - Maria C Ovejero-Benito
- Clinical Pharmacology Unit, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain. Departamento de Ciencias Farmaceuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Urbanizacion Monteprincipe, 28925, Alcorcon, Madrid, Spain
| | - Monica Sobrado
- Department of Neurology, Instituto de investigacion Sanitaria Princesa, La Princesa University Hospital, Madrid, Spain
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Punia V, Honomichl R, Chandan P, Ellison L, Thompson N, Sivaraju A, Katzan I, George P, Newey C, Hantus S. Long-term continuation of anti-seizure medications after acute stroke. Ann Clin Transl Neurol 2021; 8:1857-1866. [PMID: 34355539 PMCID: PMC8419404 DOI: 10.1002/acn3.51440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/01/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the factors associated with the long‐term continuation of anti‐seizure medications (ASMs) in acute stroke patients. Methods We performed a retrospective cohort study of stroke patients with concern for acute symptomatic seizures (ASySs) during hospitalization who subsequently visited the poststroke clinic. All patients had continuous EEG (cEEG) monitoring. We generated a multivariable logistic regression model to analyze the factors associated with the primary outcome of continued ASM use after the first poststroke clinic visit. Results A total of 507 patients (43.4% ischemic stroke, 35.7% intracerebral hemorrhage, and 20.9% aneurysmal subarachnoid hemorrhage) were included. Among them, 99 (19.5%) suffered from ASySs, 110 (21.7%) had epileptiform abnormalities (EAs) on cEEG, and 339 (66.9%) had neither. Of the 294 (58%) patients started on ASMs, 171 (33.7%) were discharged on them, and 156 (30.3% of the study population; 53.1% of patients started on ASMs) continued ASMs beyond the first poststroke clinic visit [49.7 (±31.7) days after cEEG]. After adjusting for demographical, stroke‐ and hospitalization‐related variables, the only independent factors associated with the primary outcome were admission to the NICU [Odds ratio (OR) 0.37 (95% CI 0.15–0.9)], the presence of ASySs [OR 20.31(95% CI 9.45–48.43)], and EAs on cEEG [OR 2.26 (95% CI 1.14–4.58)]. Interpretation Almost a third of patients with poststroke ASySs concerns may continue ASMs for the long term, including more than half started on them acutely. Admission to the NICU may lower the odds, and ASySs (convulsive or electrographic) and EAs on cEEG significantly increase the odds of long‐term ASM use.
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Affiliation(s)
- Vineet Punia
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ryan Honomichl
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pradeep Chandan
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lisa Ellison
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicolas Thompson
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adithya Sivaraju
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Irene Katzan
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pravin George
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chris Newey
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Hantus
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Balzekas I, Sladky V, Nejedly P, Brinkmann BH, Crepeau D, Mivalt F, Gregg NM, Pal Attia T, Marks VS, Wheeler L, Riccelli TE, Staab JP, Lundstrom BN, Miller KJ, Van Gompel J, Kremen V, Croarkin PE, Worrell GA. Invasive Electrophysiology for Circuit Discovery and Study of Comorbid Psychiatric Disorders in Patients With Epilepsy: Challenges, Opportunities, and Novel Technologies. Front Hum Neurosci 2021; 15:702605. [PMID: 34381344 PMCID: PMC8349989 DOI: 10.3389/fnhum.2021.702605] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/29/2021] [Indexed: 01/10/2023] Open
Abstract
Intracranial electroencephalographic (iEEG) recordings from patients with epilepsy provide distinct opportunities and novel data for the study of co-occurring psychiatric disorders. Comorbid psychiatric disorders are very common in drug-resistant epilepsy and their added complexity warrants careful consideration. In this review, we first discuss psychiatric comorbidities and symptoms in patients with epilepsy. We describe how epilepsy can potentially impact patient presentation and how these factors can be addressed in the experimental designs of studies focused on the electrophysiologic correlates of mood. Second, we review emerging technologies to integrate long-term iEEG recording with dense behavioral tracking in naturalistic environments. Third, we explore questions on how best to address the intersection between epilepsy and psychiatric comorbidities. Advances in ambulatory iEEG and long-term behavioral monitoring technologies will be instrumental in studying the intersection of seizures, epilepsy, psychiatric comorbidities, and their underlying circuitry.
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Affiliation(s)
- Irena Balzekas
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
- Mayo Clinic Medical Scientist Training Program, Rochester, MN, United States
| | - Vladimir Sladky
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czechia
| | - Petr Nejedly
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Benjamin H. Brinkmann
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Daniel Crepeau
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Filip Mivalt
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Faculty of Electrical Engineering and Communication, Department of Biomedical Engineering, Brno University of Technology, Brno, Czechia
| | - Nicholas M. Gregg
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Tal Pal Attia
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Victoria S. Marks
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States
| | - Lydia Wheeler
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, United States
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
| | - Tori E. Riccelli
- Mayo Clinic Alix School of Medicine, Rochester, MN, United States
| | - Jeffrey P. Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Brian Nils Lundstrom
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Kai J. Miller
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Jamie Van Gompel
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States
| | - Vaclav Kremen
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czechia
| | - Paul E. Croarkin
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
| | - Gregory A. Worrell
- Bioelectronics, Neurophysiology, and Engineering Laboratory, Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Contento M, Bertaccini B, Biggi M, Magliani M, Failli Y, Rosati E, Massacesi L, Paganini M. Prediction of seizure recurrence risk following discontinuation of antiepileptic drugs. Epilepsia 2021; 62:2159-2170. [PMID: 34250596 PMCID: PMC8457060 DOI: 10.1111/epi.16993] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Discontinuation of antiepileptic drugs (AEDs) in seizure-free patients is an important goal because of possible long-term side effects and the social stigma burden of epilepsy. The purpose of this work was to assess seizure recurrence risk after suspension of AEDs, to evaluate predictors for recurrence, and to investigate the recovery of seizure control after relapse. In addition, the accuracy of a previously published prediction model of seizure recurrence risk was estimated. METHODS Seizure-free patients with epilepsy who had discontinued AEDs were retrospectively enrolled. The frequency of seizure relapses after AED withdrawal as well as prognosis after recurrence were assessed and the predictive role of baseline clinical-demographic variables was evaluated. The aforementioned prediction model was also validated and its accuracy assessed at different seizure-relapse probability levels. RESULTS The enrolled patients (n = 133) had been followed for a median of 3 years (range 0.8-33 years) after AED discontinuation; 60 (45%) of them relapsed. Previous febrile seizures in childhood (hazard ratio [HR] 3.927; 95% confidence interval [CI] 1.403-10.988), a seizure-free period on therapy of less than 2 years (HR 2.313; 95% CI 1.193-4.486), and persistent motor deficits (HR 4.568; 95% CI 1.412-14.772) were the clinical features associated with relapse risk in univariate analysis. Among these variables, only a seizure-free period on therapy of less than 2 years was associated with seizure recurrence in multivariate analysis (HR 2.365; 95% CI 1.178-4.7444). Pharmacological control of epilepsy was restored in 82.4% of the patients who relapsed. In this population, the aforementioned prediction model showed an unsatisfactory accuracy. SIGNIFICANCE A period of freedom from seizure on therapy of less than 2 years was the main predictor of seizure recurrence. The accuracy of the previously described prediction tool was low in this cohort, thus suggesting its cautious use in real-world clinical practice.
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Affiliation(s)
- Margherita Contento
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Bruno Bertaccini
- Department of Statistics Informatics and Application "G.Parenti", University of Florence, Florence, Italy
| | - Martina Biggi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Matteo Magliani
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Ylenia Failli
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Eleonora Rosati
- Department Neurology 2, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy.,Department Neurology 2, Careggi University Hospital, Florence, Italy
| | - Marco Paganini
- Department Neurology 2, Careggi University Hospital, Florence, Italy
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Matsunuma S, Sunaga S, Hoshiai A, Arai T, Jimbo H, Yoshimoto K. Psychiatric disorders of the combination of levetiracetam either with lacosamide or perampanel: a retrospective cohort study. Int J Clin Pharm 2021; 43:1516-1522. [PMID: 34121153 DOI: 10.1007/s11096-021-01274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Background The number of patients with epilepsy receiving perampanel or lacosamide as an add-on treatment following levetiracetam treatment has increased. Although levetiracetam causes psychiatric disorders, it is unclear whether they occur with the combined use of these antiepileptic drugs. Objective To determine the frequency of psychiatric disorders in patients received lacosamide or perampanel in combination with levetiracetam. Setting A single-center retrospective cohort study. Method Patients who received levetiracetam + lacosamide or levetiracetam + perampanel were selected. Medical records from the start of combination therapy contained characteristics of patients and the incidence of psychiatric disorders. Main outcome measure The frequency of psychiatric disorders, the time to onset, dose reduction or discontinuation following psychiatric disorders, and the clinical course following disorder onset. Results Forty-four patients used levetiracetam + lacosamide and 50 used levetiracetam + perampanel. The incidence of psychiatric disorders was significantly lower (p < 0.001) with levetiracetam + lacosamide (6.8%) than with levetiracetam + perampanel (44%). The incidence of affect lability was significantly higher with levetiracetam + perampanel than with levetiracetam + lacosamide (p = 0.018). The time to the onset of psychiatric disorders was within 1 month of dose initiation or increase in one case (33.3%) with levetiracetam + lacosamide and 16 cases (72.7%) with levetiracetam + perampanel. There was no significant difference in clinical characteristics and antiepileptic drug dosages owing to the presence or absence of psychiatric disorders. Conclusion As the frequency of psychiatric disorders was higher with levetiracetam + perampanel therapy, levetiracetam + lacosamide may be preferable. These disorders tended to develop within 1 month of therapy and were not dose-dependent. Antiepileptic drugs should be cautiously prescribed to avoid psychiatric disorders.
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Affiliation(s)
- Satoru Matsunuma
- Department of Pharmacy, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji City, Tokyo, Japan.
| | - Shigeki Sunaga
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Akira Hoshiai
- Department of Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Takao Arai
- Department of Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Koichi Yoshimoto
- Department of Pharmacy, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji City, Tokyo, Japan
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Krajewski S, Wójcik M, Harat M, Furtak J. Influence of Epilepsy on the Quality of Life of Patients with Brain Tumors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126390. [PMID: 34204841 PMCID: PMC8296208 DOI: 10.3390/ijerph18126390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Epilepsy is a common consequence of brain tumors, occurring in 35 to 75% of cases. Here we evaluated the influence of epilepsy on the quality of life (QoL) of patients with malignant brain tumors (primary and metastatic) and assessed which areas of function are most affected by epilepsy and brain tumors. Sixty patients undergoing brain tumor surgery at the Neurosurgery Clinic of the 10th Military Research Hospital, Bydgoszcz, Poland (30 with epilepsy and 30 without epilepsy) were studied. Relationships between categorical variables were determined with Pearson’s chi-squared test, while continuous data were analyzed with the Mann-Whitney U-test. A p value < 0.05 was considered statistically significant. A multiple regression model was used for multivariate analysis of QoL. Patients with epilepsy more frequently reported memory disorders as a problem in their daily life. There were trends towards greater impairments in social, professional, and family life, sports and recreational activities, and daily physical activities in brain tumor patients with epilepsy rather than those without epilepsy. Higher frequency and generalized seizures significantly and adversely influenced the ability of patients to leave home and drive vehicles, but a proportion of patients with frequent, generalized seizures continued to drive regardless. Patients with generalized seizures considered the adverse effects of taking medicines as significantly disruptive. Memory disorders significantly affect the QoL of patients with epilepsy, and the importance of stopping driving must be emphasized by all healthcare professionals.
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Affiliation(s)
- Stanisław Krajewski
- Department of Physiotherapy, University of Bydgoszcz, 85-059 Bydgoszcz, Poland;
- Department of Neurosurgery, 10th Military Research Hospital, 85-681 Bydgoszcz, Poland; (M.H.); (J.F.)
- Correspondence:
| | - Magdalena Wójcik
- Department of Physiotherapy, University of Bydgoszcz, 85-059 Bydgoszcz, Poland;
| | - Marek Harat
- Department of Neurosurgery, 10th Military Research Hospital, 85-681 Bydgoszcz, Poland; (M.H.); (J.F.)
- Department of Neurosurgery and Neurology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland
| | - Jacek Furtak
- Department of Neurosurgery, 10th Military Research Hospital, 85-681 Bydgoszcz, Poland; (M.H.); (J.F.)
- Department of Neurooncology and Radiosurgery, Franciszek Łukaszczyk Oncology Center, 85-796 Bydgoszcz, Poland
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43
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Choi SA, Lim K, Baek H, Yoo S, Cho A, Kim H, Hwang H, Kim KJ. Impact of mobile health application on data collection and self-management of epilepsy. Epilepsy Behav 2021; 119:107982. [PMID: 33946011 DOI: 10.1016/j.yebeh.2021.107982] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/12/2021] [Accepted: 04/05/2021] [Indexed: 12/22/2022]
Abstract
Recent advances in mobile health have enabled health data collection, which includes seizure and medication tracking and epilepsy self-management. We developed a mobile epilepsy management application, integrated with a hospital electronic health record (EHR). In this prospective clinical trial, we assessed whether the mobile application provides quality healthcare data compared to conventional clinic visits, and enhances epilepsy self-management for patients with epilepsy. The study population includes patients with epilepsy (ages 15 years and older) and caregivers for children with epilepsy. Participants were provided access to the application for 90 days. We compared healthcare data collected from the mobile application with data obtained from clinic visits. The healthcare data included seizure records, seizure triggering factors, medication adherence rate, profiles of adverse events resulting from anti-seizure medication (ASM), and comorbidity screenings. In addition, we conducted baseline and follow-up questionnaires after the 90-day period to evaluate how this mobile application improved epilepsy knowledge and self-efficacy in seizure management. Data of 99 participants (18 patients with epilepsy and 81 caregivers) were analyzed. Among 24 individuals who had seizures, we obtained detailed seizure records from 13 individuals through clinic visits and for 18 from the application. Aside from the 6 individuals who reported their medication adherence during clinic visitation, half of the study participants had adherence rates of over 70%, as monitored through the application. However, the adherence rates were not reliable due to high variability. Twenty-three individuals reported 59 adverse reactions on the application, whereas 21 individuals reported 24 adverse reactions during clinic visits. We collected comorbidity data from 4 individuals during clinic visits. In comparison, 64 participants underwent comorbidity self-screening on the application, and 2 of them were referred to neuropsychiatric services. Compared to rare/non-users, app users demonstrated significant improvement in epilepsy knowledge score (p < 0.001) and self-efficacy score (p = 0.038). In conclusion, mobile health technology would help patients and caregivers to record their healthcare data and aid in self-management. Mobile health technology would provide an influential clinical validity in epilepsy care when users engage and actively maintain records on the application.
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Affiliation(s)
- Sun Ah Choi
- Department of Pediatrics, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Kahyun Lim
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyunyoung Baek
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Anna Cho
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Dingen D, Van' T Veer M, Wammes-van der Heijden E, Lazeron RHC, van Mastrigt G, Majoie M. Evaluation of two anti-seizure medication strategies in refractory epilepsy patients from a tertiary center with complementary insights from data visualization. Epilepsy Res 2021; 174:106667. [PMID: 33989886 DOI: 10.1016/j.eplepsyres.2021.106667] [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: 01/05/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the healthcare resources in a tertiary center related to exclusive use of non-enzyme inducing anti-seizure medications relative to concomitant use of enzyme-inducing anti-seizure medications in patients with refractory epilepsy. METHODS In this retrospective case-time-control study, we compared the effects of two anti-seizure medication strategies: exclusively non-inducing anti-seizure medications (NIND) or a combination of NIND and inducing anti-seizure medications (IND+). The primary outcome parameter was the number of consultations with relevant healthcare professionals in our tertiary center, assessed with a negative binomial regression model, adjusting for several covariates like blood drug level and time interval (TI). Results from statistical models were visualized to explore the contribution of all covariates on the outcome in the total population and in subgroups. RESULTS From the 21538 patients with refractory epilepsy referred to our center 1648 patients met the inclusion criteria. The regression model showed that the IND + strategy was significantly associated with fewer consultations compared to the NIND strategy (p < 0.001), reflected in an incidence risk ratio (IRR) of 0.844 (0.799-0.890). Visualization of subgroups, defined by anti-seizure medications strategy, revealed patterns in contribution of blood drug level measurements on the outcome. Although sex was not included as a covariate in the regression model, as it was eliminated by the backward-elimination approach, visualization of this subgroup showed differences in effects of blood drug level and TI. CONCLUSION For patients with refractory epilepsy in our tertiary center, treatment following the IND + strategy is associated with fewer consultations with healthcare professionals compared to the NIND strategy. Comprehensive visualization of the results facilitated the exploration of effects of covariates across subgroups.
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Affiliation(s)
- Dennis Dingen
- Eindhoven University of Technology, Dept. Mathematics and Computer Science, the Netherlands.
| | - Marcel Van' T Veer
- Eindhoven University of Technology, Dept. Biomedical Engineering, the Netherlands; Catharina Hospital Eindhoven, Dept. Research & Education, the Netherlands
| | | | - Richard H C Lazeron
- Academic Center for Epileptology Kempenhaeghe and Maastricht University Medical Center, Heeze and Maastricht, the Netherlands; Eindhoven University of Technology, Dept. Electrical Engineering, the Netherlands
| | - Ghislaine van Mastrigt
- CAPHRI, Research School for Public Health and Primary Care, Dept. Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
| | - Marian Majoie
- Academic Center for Epileptology Kempenhaeghe and Maastricht University Medical Center, Heeze and Maastricht, the Netherlands
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45
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Steinhoff BJ, Klein P, Klitgaard H, Laloyaux C, Moseley BD, Ricchetti-Masterson K, Rosenow F, Sirven JI, Smith B, Stern JM, Toledo M, Zipfel PA, Villanueva V. Behavioral adverse events with brivaracetam, levetiracetam, perampanel, and topiramate: A systematic review. Epilepsy Behav 2021; 118:107939. [PMID: 33839453 DOI: 10.1016/j.yebeh.2021.107939] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To understand the currently available post-marketing real-world evidence of the incidences of and discontinuations due to the BAEs of irritability, anger, and aggression in people with epilepsy (PWE) treated with the anti-seizure medications (ASMs) brivaracetam (BRV), levetiracetam (LEV), perampanel (PER), and topiramate (TPM), as well as behavioral adverse events (BAEs) in PWE switching from LEV to BRV. METHODS A systematic review of published literature using the Cochrane Library, PubMed/MEDLINE, and Embase was performed to identify retrospective and prospective observational studies reporting the incidence of irritability, anger, or aggression with BRV, LEV, PER, or TPM in PWE. The incidences of these BAEs and the rates of discontinuation due to each were categorized by ASM, and where possible, weighted means were calculated but not statistically assessed. Behavioral and psychiatric adverse events in PWE switching from LEV to BRV were summarized descriptively. RESULTS A total of 1500 records were identified in the searches. Of these, 44 published articles reporting 42 studies met the study criteria and were included in the data synthesis, 7 studies were identified in the clinical trial database, and 5 studies included PWE switching from LEV to BRV. Studies included a variety of methods, study populations, and definitions of BAEs. While a wide range of results was reported across studies, weighted mean incidences were 5.6% for BRV, 9.9% for LEV, 12.3% for PER, and 3.1% for TPM for irritability; 3.3%* for BRV, 2.5% for LEV, 2.0% for PER, and 0.2%* for TPM for anger; and 2.5% for BRV, 2.6% for LEV, 4.4% for PER, and 0.5%* for TPM for aggression. Weighted mean discontinuation rates were 0.8%* for BRV, 3.4% for LEV, 3.0% for PER, and 2.2% for TPM for irritability and 0.8%* for BRV, 2.4% for LEV, 9.2% for PER, and 1.2%* for TPM for aggression. There were no discontinuations for anger. Switching from LEV to BRV led to improvement in BAEs in 33.3% to 83.0% of patients (weighted mean, 66.6%). *Denotes only 1 study. CONCLUSIONS This systematic review characterizes the incidences of irritability, anger, and aggression with BRV, LEV, PER, and TPM, and it provides robust real-world evidence demonstrating that switching from LEV to BRV may improve BAEs. While additional data remain valuable due to differences in methodology (which make comparisons difficult), these results improve understanding of the real-world incidences of discontinuations due to these BAEs in clinical practice and can aid in discussions and treatment decision-making with PWE.
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Affiliation(s)
- Bernhard J Steinhoff
- Epilepsiezentrum Kork, Landstraße 1, 77694 Kehl, Kehl-Kork; Albert-Ludwigs University of Freiburg, Department of Neurology and Clinical Neurophysiology, Freiburg, Germany.
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, 6410 Rockledge Drive, #610, Bethesda, MD 20817, USA.
| | - Henrik Klitgaard
- UCB Pharma, Allee de la Recherche 60, 1070 Anderlecht, Brussels, Belgium.
| | - Cédric Laloyaux
- UCB Pharma, Allee de la Recherche 60, 1070 Anderlecht, Brussels, Belgium.
| | - Brian D Moseley
- University of Cincinnati, Department of Neurology and Rehabilitation Medicine, Stetson Building, 260 Stetson Street, Suite 2300, Cincinnati, OH 45267-0525, USA
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-12, Haus 95, Frankfurt a.M., 60528, Germany.
| | - Joseph I Sirven
- Mayo Clinic, Neurology and Neurosurgery, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
| | - Brien Smith
- OhioHealth Physician Group, 3430 OhioHealth Pkwy, 4th Floor North, Columbus, OH 43202, USA.
| | - John M Stern
- University of California, Department of Neurology, 300 Medical Plaza Driveway, Suite B200, Los Angeles, CA 90095, USA.
| | - Manuel Toledo
- Epilepsy Unit. Neurology Department, Hospital Vall d'Hebron, Servicio de Neurologia, Passeig de la Vall d'Hebron 119, Barcelona, 08035, Spain.
| | - Patricia A Zipfel
- MicroMass, an Ashfield Company, 100 Regency Forest Dr, Cary, NC, USA.
| | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politecnico La Fe, Avenida Fernando Abril Martorell 106, Valencia 46026, Spain
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Elizebath R, Zhang E, Coe P, Gutierrez EG, Yang J, Krauss GL. Cenobamate treatment of focal-onset seizures: Quality of life and outcome during up to eight years of treatment. Epilepsy Behav 2021; 116:107796. [PMID: 33567400 DOI: 10.1016/j.yebeh.2021.107796] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
A large proportion of patients with focal-onset epilepsy have frequent seizures despite treatment with newer anti-seizure medications (ASMs). We describe our experience optimizing cenobamate treatment for 49 patients treated at one center for up to eight years. We assessed the influence of treatment response on measurements of quality of life (QOLIE). Forty-nine patients were evaluated from three cenobamate regulatory trials: two open-label extensions of randomized placebo-controlled studies and one open-label safety study at the Johns Hopkins Hospital (JHU). Patients had focal-onset seizures despite treatment with one to three ASMs and were 18 years of age and older. Patients kept seizure diaries for the duration of the study and had tri-monthly evaluations. Seizure responder rates were determined, and patients with long-term seizure freedom (≥six months seizure free) were identified. Cenobamate doses were adjusted within the range of 100-400 mg/day. Johns Hopkins Hospital patients who were continuing treatment when the studies ended (n = 37) were administered the QOLIE-31 survey and a separate survey to assess changes in independence and epilepsy-linked disability at the end of the study at JHU. Thirty-seven of 49 (76%) patients continued treatment for three to eight years (median 5.6 years). In their final three months of treatment, 45% of patients achieved ≥75% seizure reduction, 29% had ≥90% reduction, and 16% were seizure free (responder rates computed with n = 49). Posttraumatic etiologies did not reduce treatment responses. Increased dosage of cenobamate across 150-400 mg/day range was significantly associated with higher responder rates (p < 0.001). High seizure responses-particularly ≥90% reduction-correlated with high QOLIE scores. Patients with drug-resistant focal-onset epilepsy had stable treatment responses during up to eight years of cenobamate treatment. Patients often tolerated high doses of cenobamate; high responders appeared to benefit with high QOLIE scores.
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Affiliation(s)
- Reena Elizebath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
| | - Emily Zhang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
| | - Pamela Coe
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
| | - Erie G Gutierrez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
| | - Jun Yang
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
| | - Gregory L Krauss
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA.
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Abstract
Neuromodulation, including first-generation open-loop devices and second-generation closed-loop devices, is a valuable but poorly understood therapeutic option for patients with drug-refractory epilepsy. The precise therapy a patient receives is contingent on the relationship between the patient's own unique neurophysiology and the custom programming of detection and stimulation parameters. Recent evidence demonstrates that therapeutic efficacy can be achieved through neuromodulation of seizure networks, rather than simple disruption of seizure evolution. Nevertheless, the improvement in outcomes achieved combined with its minimally invasive, nondestructive nature make closed-loop stimulation a promising therapy for additional indications, such as generalized and pediatric epilepsy.
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Affiliation(s)
- Nathaniel D Sisterson
- Department of Neurological Surgery, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA
| | - Vasileios Kokkinos
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 429A Thier, Boston, MA 02114, USA.
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Alsfouk BAA, Brodie MJ, Walters M, Kwan P, Chen Z. Tolerability of Antiseizure Medications in Individuals With Newly Diagnosed Epilepsy. JAMA Neurol 2021; 77:574-581. [PMID: 32091535 DOI: 10.1001/jamaneurol.2020.0032] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Tolerability is a key determinant of the effectiveness of epilepsy treatment. It is important to evaluate whether the overall tolerability has improved. Objective To identify factors associated with poor tolerability of antiseizure medications (ASMs) and examine temporal changes in tolerability. Design, Setting, and Participants This was a longitudinal cohort study at a specialist clinic in Glasgow, Scotland. Patients with newly diagnosed and treated epilepsy between July 1982 and October 2012 were included from 2282 eligible individuals. They were followed up until April 2016 or death. Data analysis was completed in August 2019. Exposures Antiseizure medications. Main Outcomes and Measures Univariable and multivariable survival analyses were performed to examine associations between potential risk factors and development of intolerable adverse effects (AEs). Intolerable AE rates of the ASMs as the initial monotherapy were compared between 3 epochs (July 1982-June 1992, July 1992-June 2002, and July 2002-April 2016). Results Of 1795 patients, 969 (54.0%) were male, and the median (interquartile range) age was 33 (21-50) years. A total of 3241 ASMs were prescribed during the period, of which 504 (15.6%) were discontinued within 6 months owing to intolerable AEs. Children younger than 18 years had lower intolerable AE rates than adults (vs aged 18-64 years: adjusted hazard ratio [aHR], 1.58; 95% CI, 1.07-2.32; vs aged ≥65 years: aHR, 1.90; 95% CI, 1.19-3.02) while female individuals (aHR, 1.60; 95% CI, 1.30-1.96) and those who had more than 5 pretreatment seizures (aHR, 1.24; 95% CI, 1.03-1.49) were associated with having higher risk. For each ASM trial, the risk of intolerable AEs increased with the number of previous drug withdrawals due to AEs (aHR, 1.18; 95% CI, 1.09-1.28) and the number of concomitant ASMs (aHR, 1.31; 95% CI, 1.04-1.64). The proportion of second-generation ASMs prescribed as the initial monotherapy increased from 22.3% (33 of 148) in the first epoch to 68.7% (645 of 939) in the last (P < .001). Although differences in intolerable AE rates and types of AEs were found between the ASMs, there was no difference in the overall intolerable AEs rates to the initial monotherapy across the 3 epochs (first: 10.1% [15 of 148]; second: 13.8% [98 of 708]; third: 14.0% [131 of 939]; P = .41). Conclusions and Relevance In this cohort study, the increased use of the second-generation ASMs had not improved overall treatment tolerability. Greater effort to improve tolerability in ASM development is needed.
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Affiliation(s)
- Bshra Ali A Alsfouk
- University of Glasgow, Glasgow, Scotland.,College of Pharmacy, Department of Pharmaceutical Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Martin J Brodie
- University of Glasgow, Glasgow, Scotland.,Epilepsy Unit, Scottish Epilepsy Initiative, Glasgow, Scotland
| | | | - Patrick Kwan
- Central Clinical School, Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Zhibin Chen
- Central Clinical School, Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,School of Public Health and Preventive Medicine, Clinical Epidemiology, Monash University, Melbourne, Victoria, Australia
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49
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Tombini M, Assenza G, Quintiliani L, Ricci L, Lanzone J, Di Lazzaro V. Epilepsy and quality of life: what does really matter? Neurol Sci 2021; 42:3757-3765. [PMID: 33449244 DOI: 10.1007/s10072-020-04990-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/11/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess quality of life (QoL) in adult people with epilepsy (PWE) and identify the main factors affecting it. METHODS We enrolled consecutively 122 PWE. They were interviewed for a careful collection of demographic and clinical data. Patients completed dedicated questionnaires for the assessment of the quality of life (Quality of Life in Epilepsy Scale-31) (Q31) as well as psychosocial features: depressive symptoms (DS) (Beck Depression Inventory-II/BDI-II), difficulties of emotion regulation (Difficulties of Emotion Regulation Scale/DERS), and stigma related to epilepsy (Stigma Scale of Epilepsy/SSE and Jacoby's Stigma Scale/JSS). The results of Q31 and their subscales were correlated with clinical details of PWE, as well as the other scores. A stepwise multiple regression analysis was applied to identify the main factors affecting QoL. RESULTS Quality of life is inversely correlated mostly with psychosocial features, as DS, emotion dysregulation, and stigma perception, as well as with epilepsy-related factors, as the seizure frequency and number of antiseizure medications (ASMs). The combination of DS, perceived stigma, and number of ASMs best explained the QoL. Worse features of QoL were detected in females and in patients with age of epilepsy onset in adulthood. CONCLUSION Quality of life in adult PWE is predominantly affected by psychosocial factors more than epilepsy-related ones. These findings suggest that effective epilepsy management requires more than seizure control, and early detection of psychological dysfunction and tailored interventions to improve the QoL should be considered.
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Affiliation(s)
- Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy.
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Livia Quintiliani
- Psicologia Clinica, Università Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Jacopo Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico, via Álvaro del Portillo 21, 00128, Rome, Italy
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50
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Guery D, Rheims S. Clinical Management of Drug Resistant Epilepsy: A Review on Current Strategies. Neuropsychiatr Dis Treat 2021; 17:2229-2242. [PMID: 34285484 PMCID: PMC8286073 DOI: 10.2147/ndt.s256699] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
Drug resistant epilepsy (DRE) is defined as the persistence of seizures despite at least two syndrome-adapted antiseizure drugs (ASD) used at efficacious daily dose. Despite the increasing number of available ASD, about a third of patients with epilepsy still suffer from drug resistance. Several factors are associated with the risk of evolution to DRE in patients with newly diagnosed epilepsy, including epilepsy onset in the infancy, intellectual disability, symptomatic epilepsy and abnormal neurological exam. Pharmacological management often consists in ASD polytherapy. However, because quality of life is driven by several factors in patients with DRE, including the tolerability of the treatment, ASD management should try to optimize efficacy while anticipating the risks of drug-related adverse events. All patients with DRE should be evaluated at least once in a tertiary epilepsy center, especially to discuss eligibility for non-pharmacological therapies. This is of paramount importance in patients with drug resistant focal epilepsy in whom epilepsy surgery can result in long-term seizure freedom. Vagus nerve stimulation, deep brain stimulation or cortical stimulation can also improve seizure control. Lastly, considering the effect of DRE on psychologic status and social integration, comprehensive care adaptations are always needed in order to improve patients' quality of life.
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Affiliation(s)
- Deborah Guery
- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France
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- Department of Functional Neurology and Epileptology, Hospices Civils De Lyon and University of Lyon, Lyon, France.,Lyon's Neuroscience Research Center, INSERM U1028/CNRS UMR 5292, Lyon, France.,Epilepsy Institute, Lyon, France
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