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Feng J, Zhang L, Tang J, Zhang B, Xiao X, Shi X. Clinical Analysis of Lacosamide Monotherapy in the Treatment of Self-Limited Epilepsy with Centrotemporal Spikes. Neuropsychiatr Dis Treat 2024; 20:459-467. [PMID: 38463459 PMCID: PMC10924107 DOI: 10.2147/ndt.s452784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/22/2024] [Indexed: 03/12/2024] Open
Abstract
Objective To evaluate the efficacy and safety of lacosamide (LCM) monotherapy in the treatment of self-limited epilepsy with centrotemporal spikes (SeLECTS). Methods In this study, 89 children with SeLECTS who were treated with LCM monotherapy in the Children's Hospital Affiliated to Soochow University from June 2019 to June 2021 were included. Clinical seizures and spike wave index (SWI) on video EEG during slow-wave sleep were evaluated before and after treatment. The role of LCM monotherapy in improving SWI, controlling clinical seizures and improving cognition was analyzed, and corresponding adverse reactions were documented. Results There were 52 males and 37 females in this group, with an average age of 7.6 ± 2.1 years. The total effective rate was 93.83% and at 18 months of treatment, the cumulative control rate was 85.19%, the retention rate was 91.01% and the effective rate in terms of EEG spike index was 72.92%, all of which showed a high rate; there was no statistically significant difference in intelligence quotient before and after treatment (P > 0.05). In addition, it was found in the study that the earlier the age of onset, the less obvious the improvement in SWI after LCM treatment; the lower the baseline seizure frequency, the more significant the improvement in SWI after LCM treatment. Conclusion LCM monotherapy had curative effect and adverse reactions for SeLECTS, with no negative impact on cognition. These significant findings indicate that LCM is likely to become a widely prescribed ASM for the treatment of SeLECTS. Meanwhile, the onset age and baseline seizure frequency had certain value in judging prognosis and predicting curative effect.
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Affiliation(s)
- Jun Feng
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Liya Zhang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Jihong Tang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Bingbing Zhang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Xiao Xiao
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Xiaoyan Shi
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
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Wang T, Li L, Sun F, Yang Y, Liu X. Efficacy and safety of perampanel for the treatment of epilepsy in adolescents: a meta-analysis. Int J Neurosci 2023; 133:1008-1016. [PMID: 35301936 DOI: 10.1080/00207454.2022.2032045] [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: 05/20/2021] [Revised: 10/11/2021] [Accepted: 01/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the present meta-analysis, the efficacy and safety of perampanel (PER) for the treatment of adolescents with epilepsy were assessed. METHODS Keyword searches were performed in Embase, PubMed, Cochrane Library, Web of Science, EBSCO and CNKI from 1 January 2020 to 10 October 2020. The randomized controlled trials (RCTs) and case-control studies in which PER was compared with other Anti-seizure drugs (ASDs) and/or placebo in children with epilepsy, were considered eligible studies. Odds ratio (OR) with 95% confidence interval (95% CI) for the dichotomous outcome statistic was calculated using a fixed-effects or random-effects model. RESULTS Three RCTs with a total of 372 adolescents' patients were included in this meta-analysis. Placebo was used as a control in these studies. Compared with placebo, PER showed better efficacy in median seizure frequency reduction from baseline per 28 days (OR = 2.49, 95% CI: 1.25-4.96, p = 0.009) and in responder rate (OR = 1.87, 95% CI: 1.15-3.05, p = 0.01); both were considered statistically increased in PER group. Regarding adverse effects (AEs), significant differences between PER and placebo (OR = 1.47, 95% CI: 0.92-2.41, p = 0.11) were not found, and the most common AEs of PER were dizziness (24.0%), somnolence (15.9%), headache (11.2%), nasopharyngitis (9.7%), upper respiratory tract infection (7.0%) and aggression (7.0%). CONCLUSION Based on the results in this study, PER showed better efficacy than placebo therapy in children with epilepsy and the AEs were similar in PER group and placebo group. PER showed good efficacy and a low risk of AEs, and might be a promising medication for the treatment of pediatric epilepsy. In the future, well-designed and large-scale RCTs are necessary to validate the present findings.
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Affiliation(s)
- Ting Wang
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
| | - Limin Li
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
| | - Fei Sun
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
| | - Yonghua Yang
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
| | - Xiaohong Liu
- Department of Pediatrics, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China
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Yang C, Liu Z, Peng Y, Zhang L, Yu D. Effectiveness and safety of Lacosamide therapy for children with focal epilepsy: a real world study. Front Pharmacol 2023; 14:1186768. [PMID: 37621311 PMCID: PMC10446477 DOI: 10.3389/fphar.2023.1186768] [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: 03/15/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives: To compare the effectiveness and safety of the new antiepileptic drug, lacosamide (LCM) with Levetiracetam, for the treatment of focal epilepsy in children. Methods: This study was a cohort study. Children with focal epilepsy who received LCM or Levetiracetam treatment in West China Second Hospital of Sichuan University were recruited and followed up for 12 months. Changes in the frequency of epilepsy, 50% and 75% responder rates, and seizure freedom rates from baseline to the maintenance period and adherence score were assessed. In addition, adverse events (AEs) were recorded. Results: 92 patients completed the study, and were divided into two groups: LCM (n = 46) and Levetiracetam (n = 46). Participants were aged from 2 to 16.3 years, with a mean epilepsy duration of 2.57 years. The average maintenance dose of LCM was 5.03 ± 1.91 mg/kg/d after the titration period. There was no significant difference between the two groups in terms of the mean seizure frequency during subsequent visits at 1, 3,6, 9, 12 months. There was significant difference between the two groups in terms of the 50% responder rate at 6 months. No serious AEs were reported in both groups. The vast majority of patients had good adherence (adherence score = 4) in the LCM group. Conclusion: LCM is effective as adjunctive therapy in children with epilepsy and has good safety, tolerability and adherence. Large sample size studies with long-term follow-up are needed in the future to comprehensively evaluate the use of LCM in children. Clinical Trial Registration: [https://www.chictr.org.cn/showproj.html?proj=41041], identifier [ChiCTR1900024507].
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Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Zheng Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuxuan Peng
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- NMPA Key Laboratory for Technical Research on Drug Products in Vitro and in Vivo Correlation, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Yu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Children’s Genetic Endocrinology and Metabolism, West China Second University Hospital, Sichuan University, Chengdu, China
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Bertoncelli CM, Costantini S, Persia F, Bertoncelli D, D'Auria D. PredictMed-epilepsy: A multi-agent based system for epilepsy detection and prediction in neuropediatrics. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 236:107548. [PMID: 37149974 DOI: 10.1016/j.cmpb.2023.107548] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Epileptic seizures are associated with a higher incidence of Developmental Disabilities and Cerebral Palsy. Early evaluation and management of epilepsy is strongly recommended. We propose and discuss an application to predict epilespy (PredictMed-Epilepsy) and seizures via a deep-learning module (PredictMed-Seizures) encompassed within a multi-agent based healthcare system (PredictMed-MHS); this system is meant, in perspective, to be integrated into a clinical decision support system (PredictMed-CDSS). PredictMed-Epilespy, in particular, aims to identify factors associated with epilepsy in children with Developmental Disabilities and Cerebral Palsy by using a prediction-learning model named PredictMed. PredictMed-epilespy methods: We performed a longitudinal, multicenter, double-blinded, descriptive study of one hundred and two children with Developmental Disabilities and Cerebral Palsy (58 males, 44 females; 65 inpatients, 37 outpatients; 72 had epilepsy - 22 of intractable epilepsy, age: 16.6±1.2y, range: 12-18y). Data from 2005 to 2021 on Cerebral Palsy etiology, diagnosis, type of epilepsy and spasticity, clinical history, communication abilities, behaviors, intellectual disability, motor skills, and eating and drinking abilities were collected. The machine-learning model PredictMed was exploited to identify factors associated with epilepsy. The guidelines of the "Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis" Statement (TRIPOD) were followed. PredictMed-epilepsy results: Cerebral Palsy etiology [(prenatal > perinatal > postnatal causes) p=0.036], scoliosis (p=0.048), communication (p=0.018) and feeding disorders (p=0.002), poor motor function (p<0.001), intellectual disabilities (p=0.007), and type of spasticity [(quadriplegia/triplegia > diplegia > hemiplegia), p=0.002)] were associated with having epilepsy. The prediction model scored an average of 82% of accuracy, sensitivity, and specificity. Thus, PredictMed defined the computational phenotype of children with Developmental Disabilities/Cerebral Palsy at risk of epilepsy. Novel contribution of the work: We have been developing and we have prototypically implemented a Multi-Agent Systems (MAS) that encapsulates the PredictMed-Epilepsy module. More specifically, we have implemented the Patient Observing MAS (PoMAS), which, as a novelty w.r.t. the existing literature, includes a complex event processing module that provides real-time detention of short- and long-term events related to the patient's condition.
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Affiliation(s)
- Carlo M Bertoncelli
- EEAP H. GERMAIN, Fondation Lenval, 337, Chemin de la Ginestiere, Nice 06200, France; Hal Marcus College of Science & Engineering, Department of Computer Science, University of West Florida, Pensacola, FL 32514, USA
| | - Stefania Costantini
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, Via Vetoio snc Loc. Coppito, L'Aquila 67100, Italy
| | - Fabio Persia
- Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, Via Vetoio snc Loc. Coppito, L'Aquila 67100, Italy.
| | - Domenico Bertoncelli
- Hal Marcus College of Science & Engineering, Department of Computer Science, University of West Florida, Pensacola, FL 32514, USA
| | - Daniela D'Auria
- Faculty of Computer Science, Free University of Bozen-Bolzano, Piazza Domenicani 3, Bolzano 39100, Italy
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Zhang L, Li Y, Wang W, Wang C. Comparative antiseizure medications of adjunctive treatment for children with drug-resistant focal-onset seizures: A systematic review and network meta-analysis. Front Pharmacol 2022; 13:978876. [PMID: 36588743 PMCID: PMC9800847 DOI: 10.3389/fphar.2022.978876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose: In this study, we intended to compare and rank the efficacy and acceptability of antiseizure medications (ASMs) for adjunctive treatment of children with drug-resistant focal-onset seizures. Method: We conducted a computerized search of PubMed, EMBASE, Cochrane Library, Web of Science, and Google Scholar to identify eligible randomized controlled trials (RCTs) published before 31 May 2022. We included studies evaluating the efficacy and tolerability of antiseizure medications for children with drug-resistant focal-onset seizures. The efficacy and safety were reported in terms of responder and dropout rate along with serious adverse events, the outcomes were ranked with the surface under the cumulative ranking curve (SUCRA). Results: A total of 14 studies (16 trials) with 2,464 patients were included, involving 10 active antiseizure medications. For the primary endpoint of at least 50% reduction in focal-onset seizures, the surface under the cumulative ranking curve ranking suggested that lamotrigine and levetiracetam were more effective as compared with other antiseizure medications; moreover, levetiracetam had the highest probability of rank first for achieving seizure freedom. Concerning tolerability, oxcarbazepine and eslicarbazepine acetate were associated with higher dropout rates relative to other antiseizure medications and placebo, and topiramate was associated with higher occurrence of side effects. No significant differences were found between active antiseizure medications concerning dropout for side effects. Conclusion: According to the surface under the cumulative ranking curve ranking, lamotrigine, levetiracetam, and oxcarbazepine were more efficacious than other active antiseizure medications in terms of responder rate. Concerning tolerability, oxcarbazepine was more likely to lead to dropout and topiramate was associated with higher occurrence of side effects.
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Bertoncelli CM, Dehan N, Bertoncelli D, Bagui S, Bagui SC, Costantini S, Solla F. Prediction Model for Identifying Factors Associated with Epilepsy in Children with Cerebral Palsy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121918. [PMID: 36553361 PMCID: PMC9777044 DOI: 10.3390/children9121918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
(1) Background: Cerebral palsy (CP) is associated with a higher incidence of epileptic seizures. This study uses a prediction model to identify the factors associated with epilepsy in children with CP. (2) Methods: This is a retrospective longitudinal study of the clinical characteristics of 102 children with CP. In the study, there were 58 males and 44 females, 65 inpatients and 37 outpatients, 72 had epilepsy, and 22 had intractable epilepsy. The mean age was 16.6 ± 1.2 years, and the age range for this study was 12−18 years. Data were collected on the CP etiology, diagnosis, type of epilepsy and spasticity, clinical history, communication abilities, behaviors, intellectual disability, motor function, and feeding abilities from 2005 to 2020. A prediction model, Epi-PredictMed, was implemented to forecast the factors associated with epilepsy. We used the guidelines of “Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis” (TRIPOD). (3) Results: CP etiology [(prenatal > perinatal > postnatal causes) p = 0.036], scoliosis (p = 0.048), communication (p = 0.018), feeding disorders (p = 0.002), poor motor function (p < 0.001), intellectual disabilities (p = 0.007), and the type of spasticity [(quadriplegia/triplegia > diplegia > hemiplegia), p = 0.002)] were associated with having epilepsy. The model scored an average of 82% for accuracy, sensitivity, and specificity. (4) Conclusion: Prenatal CP etiology, spasticity, scoliosis, severe intellectual disabilities, poor motor skills, and communication and feeding disorders were associated with epilepsy in children with CP. To implement preventive and/or management measures, caregivers and families of children with CP and epilepsy should be aware of the likelihood that these children will develop these conditions.
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Affiliation(s)
- Carlo Mario Bertoncelli
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
- EEAP H Germain & Department of Pediatric Orthopaedic Surgery, Lenval University Pediatric Hospital of Nice, 06200 Nice, France
- Department of Information Engineering Computer Science and Mathematics, University of L’Aquila, 67100 L’Aquila, Italy
- Correspondence:
| | - Nathalie Dehan
- Lenval University Pediatric Hospital of Nice, 06200 Nice, France
| | - Domenico Bertoncelli
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
- Department of Information Engineering Computer Science and Mathematics, University of L’Aquila, 67100 L’Aquila, Italy
| | - Sikha Bagui
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
| | - Subhash C. Bagui
- Department of Computer Science, Hal Marcus College of Science & Engineering, University of West Florida, Pensacola, FL 32514, USA
| | - Stefania Costantini
- Department of Information Engineering Computer Science and Mathematics, University of L’Aquila, 67100 L’Aquila, Italy
| | - Federico Solla
- EEAP H Germain & Department of Pediatric Orthopaedic Surgery, Lenval University Pediatric Hospital of Nice, 06200 Nice, France
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Effectiveness and tolerability of adjunctive perampanel in the treatment of pediatric patients with uncontrolled epilepsy: A retrospective, single-center, real-world study. Epilepsy Behav 2022; 137:108961. [PMID: 36327645 DOI: 10.1016/j.yebeh.2022.108961] [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: 07/05/2022] [Revised: 10/06/2022] [Accepted: 10/15/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The main aim of this study was to assess the efficacy, safety, and tolerability of adjunctive perampanel (PER) in the treatment of children and adolescents with epilepsy. METHODS Pediatric patients who visited the pediatric epilepsy clinic of Henan Provincial People's Hospital between May 2020 and December 2021 were recruited. All participants were treated with PER as adjunctive therapy and were seen routinely (minimum: a baseline and 12-week visit). The efficacy and tolerability of adjunctive PER for the treatment of epilepsy were investigated. RESULTS One hundred and fourteen patients were enrolled, among whom 7 (6.1%) were lost to follow-up. At 12 weeks, the responder rate and the seizure-free rate were 56.1% (60/107) and 32.7% (35/107), respectively. The responder rate increased with the duration of PER administration and was significantly higher when PER was used as an early add-on (after ≤2 prior antiseizure medications (ASMs)) than a late add-on (after >2 prior ASMs). However, there was no significant difference in the treatment efficacy of adjunctive PER in patients with different epilepsy etiologies or types. Adverse events, including irritability, dizziness, somnolence, ataxic gait, weight gain, and tinnitus, were reported in thirty-two patients (29.9%). CONCLUSIONS In a routine clinical setting of pediatric patients with epilepsy, good effectiveness and tolerability of adjunctive PER were demonstrated. Notably, patients initiating PER as an early add-on showed a better seizure outcome than those initiating PER as a late add-on.
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Linder C, Neideman M, Gambell‐Barroso M, Gustafsson LL, Wide K, Pohanka A, Bastholm‐Rahmner P. Parents' perspectives on dried blood spot self-sampling from children with epilepsy: A mixed-method study. Acta Paediatr 2020; 109:2789-2798. [PMID: 32198892 DOI: 10.1111/apa.15264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/02/2020] [Accepted: 03/17/2020] [Indexed: 01/21/2023]
Abstract
AIM Children with epilepsy often have concomitant diagnoses. Dried blood spot samples for drug monitoring can be collected by parents at home as an alternative to traditional sampling. This mixed-method study aimed to understand the parents' perspectives on blood self-sampling from their children and to identify factors contributing to successful sampling. METHOD Parents who had collected a sample from their child during a visit to the neuropediatric clinic were asked to fill in a questionnaire. To get in-depth information and individual perspectives, parents and nurses participated in semi-structured interviews and analysed with thematic analysis. RESULTS The results from questionnaires (n = 64) and interviews (n = 9) were interpreted together. Watching an instruction video and practical training contributed to successful sampling. 97% of the parents managed to collect a sample, 72% thought it was easy to perform, and 80% found self-sampling at home desirable. Factors for success were as follows: high motivation, prepared parents with pre-understanding, a pragmatic attitude, flexible education, effective communication and willingness to take on the role as a performer. Risk factors were as follows: conflict, fear, unprepared parents, confused or worried children. CONCLUSION Voluntary self-sampling at home for parents of children with epilepsy is feasible and can reduce stress factors in everyday life.
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Affiliation(s)
- Camilla Linder
- Department of Laboratory Medicine Division of Clinical Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Clinical Pharmacology Karolinska University Hospital Stockholm Sweden
| | - Mirja Neideman
- Department of Paediatrics Sachsska Children's Hospital Stockholm Sweden
| | | | - Lars L. Gustafsson
- Department of Laboratory Medicine Division of Clinical Pharmacology Karolinska Institutet Stockholm Sweden
| | - Katarina Wide
- Department of Clinical Science, Technology and Intervention (CLINTEC) Division of Paediatrics Karolinska Institutet Stockholm Sweden
- Department of Paediatrics Karolinska University Hospital Stockholm Sweden
| | - Anton Pohanka
- Department of Laboratory Medicine Division of Clinical Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Clinical Pharmacology Karolinska University Hospital Stockholm Sweden
| | - Pia Bastholm‐Rahmner
- Department of Laboratory Medicine Division of Clinical Pharmacology Karolinska Institutet Stockholm Sweden
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Farkas V, Steinborn B, Flamini JR, Zhang Y, Yuen N, Borghs S, Bozorg A, Daniels T, Martin P, Carney HC, Dimova S, Scheffer IE. Efficacy and tolerability of adjunctive lacosamide in pediatric patients with focal seizures. Neurology 2019; 93:e1212-e1226. [PMID: 31462582 PMCID: PMC6808531 DOI: 10.1212/wnl.0000000000008126] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/26/2019] [Indexed: 01/02/2023] Open
Abstract
Objective To evaluate efficacy and tolerability of adjunctive lacosamide in children and adolescents with uncontrolled focal (partial-onset) seizures. Methods In this double-blind trial (SP0969; NCT01921205), patients (age ≥4–<17 years) with uncontrolled focal seizures were randomized (1:1) to adjunctive lacosamide/placebo. After a 6-week titration, patients who reached the target dose range for their weight (<30 kg: 8–12 mg/kg/d oral solution; ≥30–<50 kg: 6–8 mg/kg/d oral solution; ≥50 kg: 300–400 mg/d tablets) entered a 10-week maintenance period. The primary outcome was change in focal seizure frequency per 28 days from baseline to maintenance. Results Three hundred forty-three patients were randomized; 306 (lacosamide 152 of 171 [88.9%]; placebo 154 of 172 [89.5%]) completed treatment (titration and maintenance). Adverse events (AEs) were the most common reasons for discontinuation during treatment (lacosamide 4.1%; placebo 5.8%). From baseline to maintenance, percent reduction in focal seizure frequency per 28 days for lacosamide (n = 170) vs placebo (n = 168) was 31.7% (p = 0.0003). During maintenance, median percent reduction in focal seizure frequency per 28 days was 51.7% for lacosamide and 21.7% for placebo. Fifty percent responder rates (≥50% reduction) were 52.9% and 33.3% (odds ratio 2.17, p = 0.0006). During treatment, treatment-emergent AEs were reported by 67.8% lacosamide-treated patients (placebo 58.1%), most commonly (≥10%) somnolence (14.0%, placebo 5.2%) and dizziness (10.5%, placebo 3.5%). Conclusions Adjunctive lacosamide was efficacious in reducing seizure frequency and generally well tolerated in patients (age ≥4–<17 years) with focal seizures. ClinicalTrials.gov identifier: NCT01921205. Classification of evidence This trial provides Class I evidence that for children and adolescents with uncontrolled focal seizures, adjunctive lacosamide reduces seizure frequency.
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Affiliation(s)
- Viktor Farkas
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia.
| | - Barbara Steinborn
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - J Robert Flamini
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Ying Zhang
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Nancy Yuen
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Simon Borghs
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Ali Bozorg
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Tony Daniels
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Paul Martin
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Hannah C Carney
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Svetlana Dimova
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia
| | - Ingrid E Scheffer
- From the First Department of Pediatrics (V.F.), Semmelweis University, Budapest, Hungary; Department of Developmental Neurology (B.S.), Poznań University of Medical Sciences, Poland; PANDA Neurology (J.R.F.), Atlanta, GA; UCB Pharma (Y.Z., N.Y., A.B., T.D.), Raleigh, NC; UCB Pharma (S.B.), Slough, UK; UCB Pharma (P.M.), Braine-l'Alleud, Belgium; Evidence Scientific Solutions (H.C.C.), Horsham, UK; UCB Pharma (S.D.), Brussels, Belgium; and Austin Health (I.E.S.), Florey and Murdoch Children's Research Institute, University of Melbourne, Australia
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10
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Kim SY, Kim WJ, Kim H, Choi SA, Lim BC, Chae JH, Kim KJ. Clinical Experience with Perampanel in Intractable Focal Epilepsy Over 12 Months of Follow-Up. J Epilepsy Res 2018; 8:61-65. [PMID: 30809498 PMCID: PMC6374530 DOI: 10.14581/jer.18010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/25/2018] [Accepted: 12/05/2018] [Indexed: 11/03/2022] Open
Abstract
Background and Purpose There are only limited studies on perampanel (PER), one of the latest antiepileptic drug. This study aimed to evaluate the long-term efficacy and tolerability of perampanel as an add-on therapy in patients with intractable focal epilepsy. Methods The medical records of 97 patients (age, 12-30 years) were retrospectively reviewed and analyzed. The patients had been diagnosed with focal epilepsy, treated with PER, and regularly followed up over 12 months. Results All patients had uncontrolled seizures despite treatment with two or more antiepileptic drugs. The mean age of seizure onset was 5.2 years (range, 0-17.0). PER was first prescribed at an average age of 15.7 years (range, 12.0-25.3), and mean follow-up duration after PER initiation was 15.9 months (range, 12-20). The responder rate was 41.7%, with over 75% seizure reduction obtained in 11 cases (15.3%), including three seizure-free cases (4.2%). The retention rates at 3, 6, 12, and 18 months of follow-up were 82.5% (80/97), 72.1% (70/97), 60.8% (59/97), and 37.5% (6/16), respectively. Forty-four patients (44/97, 45.4%) discontinued PER, because of treatment-related adverse events in 20 (20.6%) and no efficacy in 24 (24.7%). Treatment-related adverse events were reported by 52 patients (53.6%). The most common adverse event was somnolence or lethargy, reported by 17 patients (17/97, 23%), followed by dizziness (15/97, 20%) and psychological problems such as aggressiveness or irritability (15/97, 20%). Thirty-three patients (33/52, 63.4%) showed their first adverse symptom for 2 or 4 mg/day of PER. Conclusions PER would be an effective therapeutic option for patients with intractable focal epilepsy. However, careful monitoring of adverse events is essential from treatment initiation, with particular attention to psychological problems in adolescents and young adults.
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Affiliation(s)
- Soo Yeon Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Woo Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Hyuna Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Sun Ah Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Byung Chan Lim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
| | - Ki Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Korea
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11
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Datta AN, Xu Q, Sachedina S, Boelman C, Huh L, Connolly MB. Clinical Experience With Perampanel for Refractory Pediatric Epilepsy in One Canadian Center. J Child Neurol 2017; 32:834-839. [PMID: 28511603 DOI: 10.1177/0883073817709195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Perampanel (PER) is a new antiseizure medication that inhibits the α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) class of glutamate receptors. It is important for physicians to be aware of the efficacy and tolerability of new drugs in the postmarketing phase. We performed a retrospective review of our experience with perampanel at BC Children's Hospital. Twenty-four pediatric patients prescribed perampanel from 2014 to 2016 were identified. Fifteen (63%) discontinued perampanel, and 10 (42%) had greater than 50% reduction in seizures. Twelve (50%) had behavioral and 8 (33%) had nonbehavioral adverse events. One-third experienced serious adverse events. One patient experienced oculogyric crisis, which is not previously reported with perampanel. Adverse events were not dose related and were reversible. Possible risk factors for behavioral adverse events include a history of behavioral problems with other antiseizure medications and preexisting behavioral comorbidities. It is important to counsel patients about the potential for serious adverse events, particularly behavioral, when prescribing perampanel.
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Affiliation(s)
- Anita N Datta
- Department of Pediatrics, Division of Neurology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Qi Xu
- Department of Pediatrics, Division of Neurology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Shafina Sachedina
- Department of Pediatrics, Division of Neurology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Cyrus Boelman
- Department of Pediatrics, Division of Neurology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Linda Huh
- Department of Pediatrics, Division of Neurology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Mary B Connolly
- Department of Pediatrics, Division of Neurology, BC Children's Hospital, Vancouver, British Columbia, Canada
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12
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Linder C, Wide K, Walander M, Beck O, Gustafsson LL, Pohanka A. Comparison between dried blood spot and plasma sampling for therapeutic drug monitoring of antiepileptic drugs in children with epilepsy: A step towards home sampling. Clin Biochem 2017; 50:418-424. [DOI: 10.1016/j.clinbiochem.2016.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/12/2016] [Accepted: 12/22/2016] [Indexed: 01/23/2023]
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13
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Guzeva VI, Okhrim IV, Guzeva OV, Guzeva VV, Maksimova NE. New opportunities in the optimization of epilepsy treatment in adolescents. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:70-74. [DOI: 10.17116/jnevro20171179270-74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Glauser T, Laurenza A, Yang H, Williams B, Ma T, Fain R. Efficacy and tolerability of adjunct perampanel based on number of antiepileptic drugs at baseline and baseline predictors of efficacy: A phase III post-hoc analysis. Epilepsy Res 2016; 119:34-40. [DOI: 10.1016/j.eplepsyres.2015.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/09/2015] [Accepted: 11/13/2015] [Indexed: 01/07/2023]
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15
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A LC–MS/MS method for therapeutic drug monitoring of carbamazepine, lamotrigine and valproic acid in DBS. Bioanalysis 2015; 7:2031-9. [DOI: 10.4155/bio.15.99] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Therapeutic drug monitoring of antiepileptic drugs in children with epilepsy assists for personalized drug therapy but require numerous patient visits for venous blood sampling. DBS is an alternative matrix applicable to home sampling which can save time and reduce stress for this patient group. Results: A fast LC–MS/MS method for quantification of carbamazepine, lamotrigine and valproic acid based on DBS sampling was developed. The method showed linearity in therapeutically relevant concentration ranges and compatible with unknown volume sampling and expected hematocrit range of the patient group. Conclusion: A LC–MS/MS method for the three most commonly used antiepileptic drugs has been fully validated and clinically applied on DBSs from patients at the neuropediatric clinic at Karolinska University Hospital.
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16
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Rosenfeld W, Conry J, Lagae L, Rozentals G, Yang H, Fain R, Williams B, Kumar D, Zhu J, Laurenza A. Efficacy and safety of perampanel in adolescent patients with drug-resistant partial seizures in three double-blind, placebo-controlled, phase III randomized clinical studies and a combined extension study. Eur J Paediatr Neurol 2015; 19:435-45. [PMID: 25823975 DOI: 10.1016/j.ejpn.2015.02.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/18/2015] [Accepted: 02/21/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Assess perampanel's efficacy and safety as adjunctive therapy in adolescents (ages 12-17) with drug-resistant partial seizures. METHODS Adolescent patients enrolled in multinational, double-blind, placebo-controlled, phase III core studies (studies 304, 305, or 306) completed 19-week, double-blind phase (6-week titration/13-week maintenance) with once-daily perampanel or placebo. Upon completion, patients were eligible for the extension (study 307), beginning with 16-week, blinded conversion, during which placebo patients switched to perampanel. Patients then entered the open-label treatment. RESULTS Of 1480 patients from the core studies, 143 were adolescents. Pooled adolescent data from these core studies demonstrated median percent decreases in seizure frequency for perampanel 8 mg (34.8%) and 12 mg (35.6%) were approximately twice that of placebo (18.0%). Responder rates increased with perampanel 8 mg (40.9%) and 12 mg (45.0%) versus placebo (22.2%). Adolescents receiving concomitant enzyme-inducing antiepileptic drugs (AEDs) had smaller reductions in seizure frequency (8 mg:31.6%; 12 mg:26.8%) than those taking non-inducing AEDs (8 mg:54.6%; 12 mg:52.7%). Relative to pre-perampanel baseline, seizure frequency and responder rates during the extension (Weeks 1-52) improved with perampanel. Most commonly reported adverse events in adolescents during the core studies were dizziness (20.4%), somnolence (15.3%), aggression (8.2%), decreased appetite (6.1%), and rhinitis (5.1%). Dizziness (13.2%), somnolence (11.6%), and aggression (6.6%) most often led to perampanel interruption/dose adjustment during the extension. SIGNIFICANCE Data demonstrated adjunctive perampanel treatment in adolescents with drug-resistant partial seizures produced better seizure control versus placebo, sustained seizure frequency improvements, and a generally favorable safety profile. Results were comparable to the overall study population. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifiers: Study 304: NCT00699972; 305: NCT00699582; 306: NCT00700310; Study 307: NCT00735397.
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Affiliation(s)
- William Rosenfeld
- Comprehensive Epilepsy Care Center for Children and Adults, St Louis, MO, USA.
| | - Joan Conry
- Children's National Medical Center, Washington, DC, USA.
| | | | | | - Haichen Yang
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA.
| | - Randi Fain
- Eisai Medical and Scientific Affairs, Woodcliff Lake, NJ, USA.
| | - Betsy Williams
- Eisai Medical and Scientific Affairs, Woodcliff Lake, NJ, USA.
| | - Dinesh Kumar
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA.
| | - Jin Zhu
- Formerly Eisai Inc., Woodcliff Lake, NJ, USA.
| | - Antonio Laurenza
- Eisai Neuroscience Product Creation Unit, Woodcliff Lake, NJ, USA.
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Mann D, Liu J, Chew ML, Bockbrader H, Alvey CW, Zegarac E, Pellock J, Pitman VW. Safety, tolerability, and pharmacokinetics of pregabalin in children with refractory partial seizures: A phase 1, randomized controlled study. Epilepsia 2014; 55:1934-43. [DOI: 10.1111/epi.12830] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | - Jing Liu
- Pfizer Inc; Groton Connecticut U.S.A
| | | | | | | | | | - John Pellock
- Children's Hospital of Richmond; Virginia Commonwealth University/Medical College of Virginia; Richmond Virginia U.S.A
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Cross JH, Auvin S, Patten A, Giorgi L. Safety and tolerability of zonisamide in paediatric patients with epilepsy. Eur J Paediatr Neurol 2014; 18:747-58. [PMID: 25128350 DOI: 10.1016/j.ejpn.2014.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/20/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Zonisamide has recently been approved in Europe for the adjunctive treatment of partial seizures (with or without secondary generalisation) in adolescents and children aged ≥6 years. AIM To further assess the safety of adjunctive zonisamide in paediatric epilepsy patients. METHODS A pooled analysis of data from 17 studies (including four randomised, double-blind trials) was conducted. The safety population comprised patients aged ≤16 years receiving at least one dose of study drug. Assessments included treatment-emergent adverse events (TEAEs), clinical laboratory parameters, vital signs and electrocardiography. RESULTS The analysis included 398 patients treated with zonisamide (<12 years, n = 191; 12-16 years, n = 207). All but seven patients received zonisamide as adjunctive therapy. Mean duration of exposure was 318.7 days (mean dose, 253.1 mg/day). Most TEAEs were of mild or moderate intensity. The most frequently reported treatment-related TEAEs were decreased appetite (15.6%), somnolence (12.1%), fatigue (9.3%), dizziness (6.0%), decreased weight (5.8%), irritability (5.8%) and headache (5.3%). Incidence of serious zonisamide-related TEAEs was low (3.5% overall). TEAEs most commonly leading to discontinuation were lethargy (1.0%) and fatigue (1.0%). TEAEs of decreased weight and decreased appetite occurred in 28 (7.0%) and 78 (19.6%) patients, respectively. Twenty-eight patients had decreased bicarbonate levels, but there were no reports of respiratory alkalosis or metabolic acidosis. No changes in vital signs of clinical concern were observed and there were no reports of clinically significant electrocardiogram abnormalities with zonisamide treatment. CONCLUSION Zonisamide demonstrated an acceptable safety profile when used as adjunctive treatment in paediatric patients.
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Affiliation(s)
- J Helen Cross
- UCL-Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London, and Young Epilepsy, Lingfield, UK.
| | - Stéphane Auvin
- APHP, Hôpital Robert Debré, Service de Neurologie Pédiatrique, Paris, France; Inserm, U676, Paris, France
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19
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Guerrini R, Rosati A, Segieth J, Pellacani S, Bradshaw K, Giorgi L. A randomized phase III trial of adjunctive zonisamide in pediatric patients with partial epilepsy. Epilepsia 2013; 54:1473-80. [PMID: 23837461 DOI: 10.1111/epi.12233] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess the efficacy and safety/tolerability of adjunctive zonisamide treatment in pediatric patients with partial epilepsy. METHODS In this phase III, double-blind, randomized, placebo-controlled, multicenter trial, 207 patients (age 6-17 years) with partial epilepsy, receiving one or two antiepileptic drugs, were randomized to receive adjunctive zonisamide or placebo. Zonisamide was initiated at 1 mg/kg/day, titrated to a target dose of 8 mg/kg/day over 8 weeks (one down-titration permitted), and maintained for 12 weeks. The primary efficacy end point was the proportion of responders (≥ 50% seizure frequency reduction from baseline) during the 12-week maintenance period. Safety/tolerability assessments included the incidence of treatment-emergent adverse events (TEAEs). KEY FINDINGS In total, 93 (86.9%) of 107 patients randomized to zonisamide and 90 (90.0%) of 100 patients randomized to placebo completed the trial. Responder rates were 50% for zonisamide versus 31% for placebo (p = 0.0044; intention-to-treat population, last observation carried forward). The overall incidence of TEAEs was similar for zonisamide (55.1%) versus placebo (50.0%), with low rates of serious TEAEs with zonisamide and placebo (3.7% vs. 2.0%) and TEAEs leading to withdrawal (0.9% vs. 3.0%). TEAEs reported more frequently with zonisamide versus placebo were decreased appetite (6.5% vs. 4.0%), decreased weight (4.7% vs. 3.0%), somnolence (4.7% vs. 2.0%), vomiting (3.7% vs. 2.0%), and diarrhea (3.7% vs. 1.0%). SIGNIFICANCE Adjunctive zonisamide treatment was shown to be effective and well tolerated in pediatric patients with partial epilepsy. No new or unexpected safety findings emerged.
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Affiliation(s)
- Renzo Guerrini
- Children's Hospital Anna Meyer-University of Florence, Florence, Italy.
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20
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Cross JH, Kluger G, Lagae L. Advancing the management of childhood epilepsies. Eur J Paediatr Neurol 2013; 17:334-47. [PMID: 23558251 DOI: 10.1016/j.ejpn.2013.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 02/20/2013] [Accepted: 02/27/2013] [Indexed: 12/27/2022]
Abstract
Childhood epilepsies comprise a heterogeneous group of disorders and syndromes that vary in terms of severity, prognosis and treatment requirements. Effective management requires early, accurate recognition and diagnosis, and a holistic approach that addresses each individual's medical and psychosocial needs within the context of their overall health status and quality of life. With increasing understanding of underlying aetiologies, new approaches to management and treatment are emerging. For example, genetic testing is beginning to provide a tool to aid differential diagnosis and a means of predicting predisposition to particular types of epilepsy. Despite the availability of an increasing number of antiepileptic drugs (AEDs)--due not only to the development of new AEDs, but also to changes in regulatory requirements that have facilitated clinical development--seizure control and tolerability continue to be suboptimal in many patients, and there is therefore a continuing need for new treatment strategies. Surgery and other non-pharmacological treatments (e.g. vagus nerve stimulation, ketogenic diet) are already relatively well established in paediatric epilepsy. New pharmacological treatments include generational advances on existing AEDs and AEDs with novel modes of action, and non-AED pharmacological interventions, such as immunomodulation. Emerging technologies include novel approaches allowing the delivery of medicinal agents to specific areas of the brain, and 'closed-loop' experimental devices employing algorithms that allow treatment (e.g., electrical stimulation) to be targeted both spatially and temporally. Although in early stages of development, cell-based approaches (e.g., focal targeting of adenosine augmentation) and gene therapy may also provide new treatment choices in the future.
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Affiliation(s)
- J Helen Cross
- UCL-Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, London.
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Bath KG, Scharfman HE. Impact of early life exposure to antiepileptic drugs on neurobehavioral outcomes based on laboratory animal and clinical research. Epilepsy Behav 2013; 26:427-39. [PMID: 23305780 PMCID: PMC3925312 DOI: 10.1016/j.yebeh.2012.10.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 10/30/2012] [Indexed: 12/13/2022]
Abstract
Epilepsy affects approximately 1% of children under the age of 15, making it a very common neurological disorder in the pediatric population (Russ et al., 2012). In addition, ~0.4-0.8% of all pregnant women have some form of epilepsy (Hauser et al., 1996a,b; Borthen et al., 2009; Krishnamurthy, 2012). Despite the potential deleterious effects of antiepileptic drugs (AEDs) on the developing brain, their use is still required for seizure control in pregnant women (Krishnamurthy, 2012), and they represent the standard approach for treating children with epilepsy (Chu-Shore and Thiele, 2010; Quach et al., 2010; Verrotti et al., 2011). Even when AEDs are effective, there are potential side effects, including cognitive and affective changes or altered sleep and appetite. The consequences of AED exposure in development have been studied extensively (Canger et al., 1999; Modi et al., 2011a,b; Oguni, 2011). Despite intensive study, there is still debate about the long-term consequences of early life AED exposure. Here, we consider the evidence to date that AED exposure, either prenatally or in early postnatal life, has significant adverse effects on the developing brain and incorporate studies of laboratory animals as well as those of patients. We also note the areas of research where greater clarity seems critical in order to make significant advances. A greater understanding of the impact of AEDs on somatic, cognitive and behavioral development has substantial value because it has the potential to inform clinical practice and guide studies aimed at understanding the genetic and molecular bases of comorbid pathologies associated with common treatment regimens. Understanding these effects has the potential to lead to AEDs with fewer side effects. Such advances would expand treatment options, diminish the risk associated with AED exposure in susceptible populations, and improve the quality of life and health outcomes of children with epilepsy and children born to women who took AEDs during pregnancy.
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Affiliation(s)
- Kevin G. Bath
- Department of Neuroscience, Brown University, Box GL-N, 185 Meeting St., Providence, RI 02912, USA,Corresponding author. (K.G. Bath)
| | - Helen E. Scharfman
- The Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Rd., Bldg. 35, Orangeburg, NY 10962, USA,New York University Langone Medical Center, 550 First Ave., New York, NY 10016, USA
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