1
|
Kopan DT, Özçelik AA, Kopan MA, Taysi S. Assessment of oxidative/nitrosative stress and antioxidant capacity in children with epilepsy. Int J Neurosci 2024; 134:652-657. [PMID: 36287826 DOI: 10.1080/00207454.2022.2140426] [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: 04/15/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 10/31/2022]
Abstract
Background: The underlying pathophysiological mechanisms in epilepsy, one of the most common neurological diseases, are still unknown. Oxidative/nitrosative stress is considered a possible mechanism involved in epileptogenesis. The production of reactive oxygen species (ROS) and reactive nitrogen species (RNS) is involved in the pathogenesis of signal regulation, cellular damage and central nervous system conditions in living organisms. In this study, we aimed to compare peoxynitrite (ONOO-), a marker of nitrosative stress, total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and 8-hydroxy-2-deoxyguanosine (8-OHdG), DNA damage marker, levels in epileptic patients receiving monotherapy and polytherapy with the healthy control group.Methods: The study included 120 patients with diagnosis of epilepsy and 40 healthy volunteers as controls. The TOS, TAS, OSI, ONOO- and 8-OHdG were studied in all groups.Results: The study group included 30 girls (50%) and 30 boys (50%) receiving monotherapy and 31 girls (51.7%) and boys 49.3%) receiving polytherapy while control group included 19 girls (47.5%) and 21 boys (52.5%). The TOS and OSI values were found to be significantly higher in polytherapy group when compared to monotherapy and control groups). The ONOO- values were found to be significantly lower in polytherapy group when compared to monotherapy and control groups. In addition, ONOO- values were found to be higher in monotherapy group than controls. There was no significant difference in 8-OHdG values between the groups.Conclusions: Significant increases were observed in TOS and OSI parameters in polytherapy group when compared to monotherapy and control groups, suggesting that antiepileptic treatment enhances oxidative stress. Lack of significant difference in 8-OHdG suggested that the treatment is effective in patients and that no DNA damage occurred yet.
Collapse
Affiliation(s)
- Dila Tuğçe Kopan
- Department of Pediatrics, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Ayşe Aysima Özçelik
- Department of Pediatric Neurology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Mehmet Ali Kopan
- Department of Pediatrics, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Seyithan Taysi
- Department of Medical Biochemistry, Gaziantep University School of Medicine, Gaziantep, Turkey
| |
Collapse
|
2
|
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
| |
Collapse
|
3
|
Nabavi Nouri M, Puka K, Palmar K, Speechley KN. Impact of number of anti-seizure medications on long-term health-related quality of life in children with epilepsy: A prospective cohort study. Seizure 2022; 99:120-126. [PMID: 35636159 DOI: 10.1016/j.seizure.2022.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/01/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Health-related quality of life (HRQL) is compromised in children with epilepsy. We aimed to determine whether children diagnosed with epilepsy between ages 4-12 years who are exposed to a higher number of anti-seizure medication (ASM) over the first 2 years, have poorer HRQL 10 years after diagnosis. METHODS Data were obtained from 195 children enrolled in the Health-Related Quality of Life in Children with Epilepsy Study (HERQULES) in Canada. HRQL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) completed by parents at baseline through to 10 years after diagnosis. The total number of ASM were reported by physicians four times in the first two years after diagnosis. Multivariable block-wise linear regression was used to assess the impact of ASM (categorized as none, one, or more than one), as well as clinical and family factors on children's HRQL 10 years after diagnosis. RESULTS Children had a mean age of 7.9 ± 2.3 years at diagnosis and 92 (47%) were female. Mean QOLCE at baseline and 10 years was 72.04±14 and 78.7±16,respectively. Clinically meaningful improvement in HRQL from the 2 to 10-year follow-up was detected in 35% of children, reported similarly across all ASM treatment categories (p = .38). The number of ASM prescribed in the first two years was associated with HRQL at the 10-year follow-up, however this association was not significant when adjusting for clinical characteristics, family factors, and HRQL at the two-year follow-up (p = .75). Our data showed that HRQL at 2 years was the only variable associated with better HRQL scores at 10 years (p = <.001). CONCLUSION In children with new onset epilepsy, exposure to a higher number of ASM, when accounting for clinical and family factors as well as HRQL at 2 years, is not independently associated with lower long-term HRQL. Early HRQL was found to be a good indicator of long-term HRQL, despite the number of ASMs prescribed.
Collapse
Affiliation(s)
- Maryam Nabavi Nouri
- Department of Pediatrics, Schulich school of Dentistry and Medicine, Western University, London, ON, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.
| | - Klajdi Puka
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada; Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Katie Palmar
- Department of Clinical Geriatrics, NVS, Karolinska Institute, Stockholm, Sweden
| | - Kathy N Speechley
- Department of Pediatrics, Schulich school of Dentistry and Medicine, Western University, London, ON, Canada; Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada; Epidemiology and Biostatistics, Western University, London, ON, Canada
| |
Collapse
|
4
|
Albanji M, Alshehri S, Eljaaly K. The effect of erythromycin and clarithromycin versus azithromycin on serum valproate concentration. Saudi Pharm J 2022; 30:337-339. [PMID: 35527827 PMCID: PMC9068565 DOI: 10.1016/j.jsps.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/06/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Unlike azithromycin, erythromycin and clarithromycin strongly inhibit CYP450, which metabolizes valproic acid. The aim of this study was to evaluate the impact of macrolide administration on serum valproate trough levels. Methods This retrospective cohort study included hospitalized adult patients who concomitantly received valproate with a macrolide. Patients who received a carbapenem, those who do not have a baseline and/or post-levels, and those who received different doses of valproate were excluded. The change in serum valproate trough level from baseline to after the occurrence of co-administration (post-level) was compared in patients who received either erythromycin or clarithromycin versus those who received azithromycin. Results A total of thirteen patients were included in the comparison. The mean ± SD for change in serum valproate trough levels was significantly higher in the erythromycin/clarithromycin group than the azithromycin group (209.1 ± 105.9 µmol/L [equivalent to 30.1 ± 15.2 mg/L] vs. 12.7 ± 52.1 µmol/L [equivalent to 1.8 ± 7.5 mg/L]; P = 0.002). Conclusion This study found a significantly higher increase in serum trough levels of valproate after co-administration of erythromycin/clarithromycin versus azithromycin. Clinicians should consider avoiding co-administration of erythromycin and clarithromycin with valproate if possible or close monitoring of valproate levels with dose reduction.
Collapse
Affiliation(s)
- Muradi Albanji
- Department of Pharmacy, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Samah Alshehri
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid Eljaaly
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
- Corresponding author at: Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi Arabia. @khalideljaaly
| |
Collapse
|
5
|
Sannagowdara K, Khan N. Medical Management in Focal versus Generalized Epilepsy. JOURNAL OF PEDIATRIC EPILEPSY 2021. [DOI: 10.1055/s-0040-1722297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractAbout 70% of children with new-onset epilepsy have the potential to become seizure-free on antiepileptic drug (AED) monotherapy with appropriately selected first-line medication. In ideal world, physician is expected to achieve best possible seizure control without impacting the quality of life. There is rapid increase in number of AEDs available over last couple of decades. Although not necessarily all of them are superior to old generation drugs in terms of seizure control, certainly there is change in landscape from perspective of tolerability and side-effect profile. Physicians must therefore be familiar with safety, tolerability, therapeutic effects, synergistic combinations as well as AEDs to avoid in specific circumstances. The article attempts to give general overview of available AEDs under broad umbrella of effectiveness against focal and generalized seizures as well as drugs with “broad spectrum.” The emergence of newer AEDs with broad spectrum and favorable side-effect profile is welcome. However, the future lies in better understanding of underlying diverse pathophysiology of clinical symptom “epilepsy” and developing new compounds acting on molecular targets as well as individualizing therapy. Technological advances in molecular genetics research are bringing precision medicine to the fore.
Collapse
Affiliation(s)
- Kumar Sannagowdara
- Department of Child Neurology and Epilepsy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Nadir Khan
- Department of Child Neurology and Epilepsy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| |
Collapse
|
6
|
Çilliler AE, Güven B. Inter-ictal fatigue and antiepileptic drugs in patients with epilepsy. Acta Neurol Belg 2021; 121:107-111. [PMID: 32043217 DOI: 10.1007/s13760-020-01292-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 01/30/2020] [Indexed: 11/26/2022]
Abstract
Fatigue is a frequently reported symptom in patients with epilepsy (PWE) while the pathophysiology, causes and effects on the disease are not yet fully understood. Fatigue may occur as a side effect of antiepileptic drugs (AEDs); however, it varies greatly depending on both the characteristics of the patients and the AEDs used. The aim of this study was to investigate the relation between fatigue, clinical features and AEDs and doses used in monotherapy in PWE. Ninety consecutive patients with the diagnosis of epilepsy, treated as monotherapy were included in the study. Demographic data, seizure type and frequency, AEDs and their doses were recorded. Fatigue severity scale (FSS) was used in the evaluation of fatigue. Cases of fatigue were defined by a FSS score ≥ 4. The mean age of the patients (57 females, 33 males) was 33 ± 12.7 years and the mean disease duration was 11.7 ± 9.1 years. Used as monotherapy, AEDs included carbamazepine (n = 29, 32.2%), valproic acid (n = 28, 31.1%), levetiracetam (n = 23, 25.6%) and lamotrigine (n = 10, 11.1%). Fatigue was reported by 52.2% of patients (FSS score ≥ 4). It was found that patients with fatigue had more seizures in the last year than those without (p = 0.031). There was no relation between fatigue and AEDs. The doses of carbamazepine and levetiracetam were significantly correlated with the scores of FSS (p = 0.042 and p = 0.023, respectively), and there was no correlation between the doses of valproic acid and lamotrigine and the scores of FSS. The results of our study showed that; approximately half of the patients with epilepsy had fatigue. Although the relation between AEDs and fatigue was not detected, it was pointed out that AED doses may play a role in the development of fatigue.
Collapse
Affiliation(s)
- Aslı Ece Çilliler
- Neurology Department, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Bülent Güven
- Neurology Department, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
7
|
Evaluation of the effects of antiepileptic drugs on complete blood count parameters. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.827657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
8
|
Sattar S, Kuperman R. Telehealth in pediatric epilepsy care: A rapid transition during the COVID-19 pandemic. Epilepsy Behav 2020; 111:107282. [PMID: 32759065 PMCID: PMC7386847 DOI: 10.1016/j.yebeh.2020.107282] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Abstract
Telehealth's first literature reference is an article in 1879 in the Lancet about using the telephone to reduce unnecessary office visits (Institute of Medicine & Board on Health Care Services, 2012). However, providers have been slow to adopt telehealth into their clinical practice secondary to barriers such as cost and reimbursement (Kane and Gillis, 2018) [2]. The advent of shelter in place orders combined with the ongoing need defined by the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma "for all Americans, and particularly vulnerable populations who are at heightened risk, to be able to access their providers" has resulted in the rapid implementation of telehealth across multiple specialties. The goal of this paper is to provide a practical framework for translating quality care in epilepsy as defined by the American Academy of Neurology (AAN) guidelines into a virtual care environment. We will also discuss the use and limitations of point of care testing in epilepsy management.
Collapse
Affiliation(s)
- Shifteh Sattar
- University of California, San Diego, Comprehensive Epilepsy Center, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, United States of America.
| | - Rachel Kuperman
- Eysz, Inc., 107 Sandringham Road, Piedmont, CA 94611, United States of America.
| |
Collapse
|
9
|
Yu L, Feng J, Yu Z, Dai H. Trends of anti-seizure medication use in pediatric patients in six cities in China from 2013 to 2018. Epilepsy Res 2020; 167:106448. [PMID: 32916644 DOI: 10.1016/j.eplepsyres.2020.106448] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/17/2020] [Accepted: 08/18/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to describe the prevalence of the use and prescribing patterns of anti-seizure medications (ASMs) over a six-year period, and to provide real-world evidence on medicine utilization of pediatric patients with epilepsy in China. METHODS ASM prescriptions for pediatric patients written from 2013 to 2018 were extracted from the database of the Hospital Prescription Analysis Cooperative Project. Trends of ASM use were analyzed by total prescriptions, cost, age, sex, ASM class and specific ASM. Prescribing patterns of ASMs were also analyzed. RESULTS A total of 44,675 ASM prescriptions were extracted for analysis in this study. Throughout the study period, a slight increase of ASM prescriptions was observed from 6170 in 2013 to 8211 in 2018. Children aged between 6 and 18 years, accounted for 78 % of total prescriptions every year. ASM use in boys was about 1.5 times higher than that in girls. Newer ASMs were prescribed more than older ASMs during this period. Sodium valproate was the most frequently prescribed ASM in 2013, and its use decreased in girls in 2016. Levetiracetam increased from 19.10 % in 2013 to 28.09 % in 2018 and became the most common ASM at the end of this study. Meanwhile, the use of oxcarbazepine increased from 19.31 % to 22.04 %, whereas the use of lamotrigine had declined from 18.43 % to 10.72 %. Monotherapy (66.24 %) was more frequently used than combined therapy, which included dual combination (25.80 %) and triple or more combinations (7.96 %). CONCLUSION There is an increased ASM prescription trend in childhood usage. Levetiracetam has replaced sodium valproate as the most frequently prescribed ASM in pediatric patients. Newer ASMs with fewer side effects and drug interactions are increasingly utilized, which is consistent with evolving recommendations by the medical community.
Collapse
Affiliation(s)
- Lingyan Yu
- Department of Pharmacy, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Jianhua Feng
- Department of Pediatrics, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Haibin Dai
- Department of Pharmacy, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China.
| |
Collapse
|
10
|
Gogou M, Pavlou E. Efficacy of antiepileptic drugs in the era of pharmacogenomics: A focus on childhood. Eur J Paediatr Neurol 2019; 23:674-684. [PMID: 31280948 DOI: 10.1016/j.ejpn.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/23/2019] [Accepted: 06/24/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND In recent years advances in the field of pharmacogenomics have expanded the concept for more individualized treatments. Our aim is to provide literature data about the relationship between genetic polymorphisms and efficacy of antiepileptic drugs in children. METHODS Pubmed was used as the main medical database source. Only original research papers were considered. No year-of-publication restriction was placed. Quality of evidence was assessed according to American Academy of Neurology guidelines. RESULTS A total of 12 cross-sectional and case-control studies fulfilled our selection criteria. ABCB1 gene was associated with drug responsiveness in 2 out of 6 studies and ABCC2 gene in 1 out of 1 studies. SCN1A gene was also associated with seizure control in 4 out of 5 studies. Cytochrome P450 genes were found to significantly affect drug responsiveness in 2 out of 4 studies, while polymorphisms of uridinediphosphateglucuronosyltransferaseUGT2B7 gene predisposed to drug-resistance in 1 out of 2 studies. CONCLUSION Variability in genes coding for sodium channels, drug transporters and cytochrome P450 enzymes can have a significant impact on response to antiepileptic drugs. Larger prospective studies with better stratification of samples are needed to shed light on these associations.
Collapse
Affiliation(s)
- Maria Gogou
- 2nd Department of Pediatrics, University General Hospital AHEPA, Thessaloniki, Greece.
| | - Evangelos Pavlou
- 2nd Department of Pediatrics, University General Hospital AHEPA, Thessaloniki, Greece
| |
Collapse
|
11
|
Association of Child Neurology-Indian Epilepsy Society Consensus Document on Parental Counseling of Children with Epilepsy. Indian J Pediatr 2019; 86:608-616. [PMID: 31177510 DOI: 10.1007/s12098-019-02946-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
Abstract
When a child is diagnosed with epilepsy, counseling regarding the same is done by the treating doctor. Most parents are frightened and have poor knowledge about epilepsy. Therapeutic advice including drug dosage, administration and side effects takes up the major part of physician's time, thereby neglecting important issues like home seizure management, follow up and others. These lacunae in knowledge require systematic patient and family education. To address these issues, an expert group meeting of pediatric neurologists and epileptologists in India along with social workers/epilepsy educators, legal experts, parents, and teachers was held. The various aspects regarding parental counseling in children with epilepsy were discussed and a consensus document was formulated. Here authors present the group consensus statement on counseling parents and caregivers of children with epilepsy. This document is intended to help physicians and pediatricians counsel the families when a child is diagnosed with epilepsy.
Collapse
|
12
|
Kulhas Celik I, Dibek Misirlioglu E, Kocabas CN. Recent developments in drug hypersensitivity in children. Expert Rev Clin Immunol 2019; 15:723-733. [PMID: 31066307 DOI: 10.1080/1744666x.2019.1612241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction: Drug allergy is an important public health problem that causes 0.4-10.3% of hospital admissions in children. The epidemiology, clinical spectrum, diagnosis, and management of drug hypersensitivity reactions (DHRs) differ in pediatric and adult patients. However, the same algorithms used in adults have often been applied in the pediatric population due to a lack of evidence in the literature. Areas covered: In this review, we aimed to discuss recent developments in the area of pediatric DHRs based on the growing body of literature advancing our understanding of the epidemiology, clinical aspects, and diagnostic approaches to DHRs in children. Expert opinion: Misdiagnosis, under-diagnosis, and self-diagnosis are common problems related to drug allergies in children. Viral infections are particularly frequent in children and make diagnosis difficult. Identifying true DHR is a key step in the management of drug allergy in children. Therefore, a complete allergy work-up with standardized drug allergy tests is necessary. In order to eliminate non-standardized tests, future studies including larger numbers of children should be conducted to determine more accurate standardized tests for diagnosing DHRs in the pediatric population.
Collapse
Affiliation(s)
- Ilknur Kulhas Celik
- a Division of Pediatric Allergy and Immunology , University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital , Ankara , Turkey
| | - Emine Dibek Misirlioglu
- a Division of Pediatric Allergy and Immunology , University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital , Ankara , Turkey
| | - Can Naci Kocabas
- b Division of Pediatric Allergy and Immunology, Department of Children's Health and Diseases, Faculty of Medicine , Mugla Sitki Kocman University , Mugla , Turkey
| |
Collapse
|
13
|
Aliyu MH, Abdullahi AT, Iliyasu Z, Salihu AS, Adamu H, Sabo U, Garcia JP, Abdullahi SU, Mande A, Xian H, Yakasai HM, Schootman M, Ingles DJ, Patel AA, Yakasai A, Curry-Johnson S, Wudil UJ, DeBaun MR, Trevathan E. Bridging the childhood epilepsy treatment gap in northern Nigeria (BRIDGE): Rationale and design of pre-clinical trial studies. Contemp Clin Trials Commun 2019; 15:100362. [PMID: 31049462 PMCID: PMC6484289 DOI: 10.1016/j.conctc.2019.100362] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 01/26/2023] Open
Abstract
Epilepsy is the most common serious childhood neurological disorder. In the low- and middle-income countries (LMICs) of Africa, children with epilepsy suffer increased morbidity and mortality compared to their counterparts in high-income countries, and the majority do not receive treatment - the childhood epilepsy treatment gap. Reports of the childhood epilepsy treatment gap in Africa are likely underestimates; most surveys do not include several common childhood seizure types, including most types of non-convulsive epilepsy. Efforts to scale up childhood epilepsy care services in the LMICs of Africa must contend with a shortage of physicians and diagnostic technology [e.g., electroencephalograms (EEGs)]. One pragmatic solution is to integrate epilepsy care into primary care by task-shifting to community health extension workers. The aims of this project (BRIDGE) are to: 1) train, develop, and pilot task-shifted epilepsy care teams; 2) develop and pilot innovative childhood epilepsy screening and diagnostic paradigms adapted to the local Hausa language/culture in Kano, northern Nigeria; and, 3) quantify and map the childhood epilepsy treatment gap, using geographic information systems (GIS), to target limited resources to areas of greatest need. Task-shifted teams will diagnose and manage childhood epilepsy using an innovative epilepsy screening tools and diagnostic and management paradigms in environments with limited EEG access. If validated and demonstrated efficacious in clinical trials, this project can be taken to scale across broader areas of west Africa's LMICs that share language and culture. BRIDGE has the potential to enhance access to basic childhood epilepsy care and establish the foundation for childhood epilepsy clinical trials in west Africa.
Collapse
Affiliation(s)
- Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Health Policy, Vanderbilt University, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aminu T Abdullahi
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Zubairu Iliyasu
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Auwal S Salihu
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Halima Adamu
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Umar Sabo
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Juanita Prieto Garcia
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shehu U Abdullahi
- Department of Pediatrics, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Aliyu Mande
- Department of Community Medicine, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Hong Xian
- Department of Epidemiology & Biostatistics, College for Public Health and Social Justice, Saint Louis University St. Louis, MO, USA
| | - Hafizu M Yakasai
- Centre for Nigerian Languages and Folklore, Bayero University, Kano, Nigeria
| | - Mario Schootman
- Department of Epidemiology & Biostatistics, College for Public Health and Social Justice, Saint Louis University St. Louis, MO, USA
| | - Donna J Ingles
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Archana A Patel
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abubakar Yakasai
- Department of Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano, Nigeria
| | - Stacy Curry-Johnson
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Usman J Wudil
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael R DeBaun
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edwin Trevathan
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
| | | |
Collapse
|
14
|
Carnovale C, Pozzi M, Mazhar F, Mosini G, Gentili M, Peeters GGAM, Clementi E, Radice S. Interactions Between Antiepileptic and Antibiotic Drugs: A Systematic Review and Meta-Analysis with Dosing Implications. Clin Pharmacokinet 2018; 58:875-886. [DOI: 10.1007/s40262-018-0720-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
15
|
Hypersensitivity Reactions to Antiepileptic Drugs in Children: Epidemiologic, Pathogenetic, Clinical, and Diagnostic Aspects. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1879-1891.e1. [DOI: 10.1016/j.jaip.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/17/2018] [Accepted: 07/04/2018] [Indexed: 01/15/2023]
|
16
|
Moavero R, Pisani LR, Pisani F, Curatolo P. Safety and tolerability profile of new antiepileptic drug treatment in children with epilepsy. Expert Opin Drug Saf 2018; 17:1015-1028. [PMID: 30169997 DOI: 10.1080/14740338.2018.1518427] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Treatment of pediatric epilepsy requires a careful evaluation of the safety and tolerability profile of antiepileptic drugs (AEDs) to avoid or minimize as much as possible adverse events (AEs) on various organs, hematological parameters, and growth, pubertal, motor, cognitive and behavioral development. AREAS COVERED Treatment-emergent AEs (TEAEs) reported in the literature 2000-2018 regarding second- and third-generation AEDs used in the pediatric age, with exclusion of the neonatal period that exhibits specific peculiarities, have been described on the basis of their frequency, severity/tolerability, and particular association with a given AED. EXPERT OPINION Somnolence/sedation and behavioral changes, like irritability and nervousness, are among the most commonly observed TEAEs associated with almost all AEDs. Lamotrigine, Gabapentin, Oxcarbazepine, and Levetiracetam appear to be the best-tolerated AEDs with a ≤2% withdrawal rate, while Tiagabine and Everolimus are discontinued in up to >20% of the patients because of intolerable TEAEs. For some AEDs, literature data are scanty to draw a high-level evidence on their safety and tolerability profile. The reasons are: insufficient population size, short duration of treatments, or lack of controlled trials. A future goal is that of identifying clearer, easier, and more homogeneous methodological strategies to facilitate AED testing in pediatric populations.
Collapse
Affiliation(s)
- Romina Moavero
- a Child Neurology and Psychiatry Unit, Systems Medicine Department , Tor Vergata University of Rome , Rome , Italy.,b Child Neurology Unit, Neuroscience and Neurorehabilitation Department , "Bambino Gesù", Children's Hospital, IRCCS , Rome , Italy
| | | | - Francesco Pisani
- d Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Paolo Curatolo
- a Child Neurology and Psychiatry Unit, Systems Medicine Department , Tor Vergata University of Rome , Rome , Italy
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Cognitive impairments are common in children with epilepsy. They may already be present before the onset of epilepsy or occur - and even progress - during its course. Many variables contribute to cognitive dysfunction. Those that can be targeted to prevent (further) cognitive impairment will be highlighted in this review. RECENT FINDINGS Ideally, but not yet realistically, epileptogenesis is prevented to avert seizures and cognitive impairments in high-risk patients. New and targeted treatments of progressive epileptogenic disorders and precision medicine approaches in genetic epilepsies are increasingly applied. Cognitive outcome benefits from early diagnosis and treatment of epileptic encephalopathy. Ongoing seizures may cause permanent and progressive changes in brain structure and connectivity, suggesting that early seizure control optimizes eventual cognitive functioning. Frequent interictal epileptiform discharges justify treatment in children with cognitive impairments that are otherwise unexplained. Cognitive adverse effects of antiepileptic drugs should be closely monitored and balanced against potential benefits. Finally, early surgical treatment in selected candidates will improve their cognitive outcome. SUMMARY Although important determinants of intellectual functioning - including the child's genetic and environmental background and the epileptogenic pathology - may not be modifiable, several variables that contribute to cognitive impairment can be targeted to improve outcome. Early etiological diagnosis, personalized therapies, presurgical evaluation, and strict control of seizures - or in some patients interictal discharges - can prevent (further) cognitive impairments.
Collapse
|
18
|
Adjunctive Eslicarbazepine Acetate in Pediatric Patients with Focal Epilepsy: A Systematic Review and Meta-Analysis. CNS Drugs 2018; 32:189-196. [PMID: 29508243 DOI: 10.1007/s40263-018-0504-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND In the treatment of pediatric epilepsy, there is a critical demand for effective and safe therapeutic options to address patients' unmet clinical needs. Eslicarbazepine acetate is a novel once-daily antiepileptic drug and a third-generation single enantiomer member of the dibenzazepine family. OBJECTIVE The objective of this study was to evaluate the efficacy and safety of eslicarbazepine acetate as add-on treatment for focal-onset seizures in pediatric patients using meta-analytical techniques. METHODS Randomized, placebo-controlled, single- or double-blinded add-on trials of eslicarbazepine acetate in patients < 18 years of age with focal-onset seizures uncontrolled by concomitant stable antiepileptic drug regimens were identified through a systematic literature search. The assessed outcomes included the mean relative change and ≥ 50% reduction in the baseline seizure frequency, the incidence of treatment withdrawal, serious adverse events, and treatment-emergent adverse events. Risk ratio and weighted mean difference with 95% confidence intervals were estimated for dichotomous/continuous outcomes. RESULTS Two trials were included involving 386 participants (age range 2-18 years), 217 for eslicarbazepine acetate and 169 for placebo groups, respectively. At the dosage of 30 mg/kg/day, eslicarbazepine acetate-treated patients had a significantly greater reduction in baseline seizure frequency (weighted mean difference - 21.67, 95% confidence interval - 40.87 to - 2.46; p = 0.027) and 58 patients (44.6%) were seizure responders compared with 27 controls (29.7%) [risk ratio 1.48, 95% confidence interval 0.99-2.20; p = 0.055]. There were no differences in treatment withdrawal (risk ratio 1.24, 95% confidence interval 0.65-2.37; p = 0.513), serious adverse events (risk ratio 1.40, 95% confidence interval 0.69-2.86; p = 0.350), and treatment-emergent adverse events (risk ratio 1.07, 95% confidence interval 0.94-1.22; p = 0.313). CONCLUSIONS Adjunctive eslicarbazepine acetate could be an effective well-tolerated option in children and adolescents with focal-onset seizures uncontrolled by one or more concomitant anti-epileptic drugs.
Collapse
|
19
|
Egunsola O, Choonara I, Sammons HM, Whitehouse WP. Safety of antiepileptic drugs in children and young people: A prospective cohort study. Seizure 2018; 56:20-25. [DOI: 10.1016/j.seizure.2018.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/26/2017] [Accepted: 01/28/2018] [Indexed: 10/18/2022] Open
|
20
|
Belousova ED. [The decreased level of plasma carnitine in patients with epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:106-110. [PMID: 28745680 DOI: 10.17116/jnevro201711761106-110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Antiepileptic drugs (AEDs) have long been known to affect carnitine metabolism, dropping the plasma free carnitine. Valproate (VPA) was considered to be the strongest carnitine-reducing agent. VPA-induced hyperammonemic encephalopathy and hepatotoxicity are well known, and pre-existing carnitine deficiency can be a predisposing factor, especially in congenital metabolic disorders. Several studies have shown that carnitine supplementation in patients receiving VPA to result in subjective and objective improvements and to prevent VPA-induced hepatotoxicity and encephalopathy, in parallel with increases in carnitine serum concentrations. Level of free plasma carnitine <20 micromol/l (syn. carnitine deficiency) in patients with epilepsy (in 15-30% of cases) may occur not only with administration of VPA but with administration of other AEDs (phenobarbital, phenytoin, carbamazepine) and low nutritional intake of carnitine. Some findings indicate that the number of AEDs used is a risk factor for carnitine deficiency. It was established that body weight, height and multidrug therapy are significantly associated with low level of free plasma in epileptic patients. Carnitine deficiency can have severe consequences; but most epileptic patients suffering from it are asymptomatic. Although carnitine deficiency is not uncommon among patients receiving AEDs, it seems not necessary to routinely monitor carnitine levels in epileptic ambulatory patients, this is reasonable only in groups of risk. L-carnitine supplementation is clearly indicated in case of VPA-induced hepatotoxicity (i.v. administration) VPA overdose (i.v. administration), primary carnitine-transporter defect and is strongly recommended in specific secondary carnitine deficiency syndromes, symptomatic VPA-associated hyperammonemia, infants and young children receiving VPA, especially those younger than 2 years, patients with a complex neurologic disorder, who are receiving multiple AEDs, patients who have risk factors for hepatotoxicity and carnitine insufficiency. In the absence of double blind trials, clinical practice is based on empiric observation, clinical experience, and theory. Well-designed studies of specific and general uses of L-carnitine replacement therapy in patients with epilepsy are needed.
Collapse
Affiliation(s)
- E D Belousova
- Department of Psychoneurology and Epileptology ,Research and Clincal Institute of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| |
Collapse
|
21
|
|
22
|
Egunsola O, Sammons HM, Ojha S, Whitehouse W, Anderson M, Hawcutt D, Choonara I. Protocol for a prospective observational study of adverse drug reactions of anti-epileptic drugs in children in the UK. BMJ Paediatr Open 2017; 1:e000116. [PMID: 29637140 PMCID: PMC5862226 DOI: 10.1136/bmjpo-2017-000116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/13/2017] [Accepted: 07/13/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Epilepsy is a common chronic disease of children that can be treated with anti-epileptic drugs (AEDs). AEDs, however, have significant side effects. Newer AEDs are thought to have fewer side effects. There have, however, been few comparative studies of AED toxicity. The aim is to compare the safety profile of the most frequently used AEDs by performing a multicentre prospective cohort study. This protocol describes the planned study. DESIGN A multicentre prospective cohort study of children on AED treatment in hospitals across the UK. Ethical approval will be obtained. SAMPLE SIZE Three thousand children on treatment for epilepsy will be recruited from paediatric clinics. It is expected that this sample size will have the potential to compare toxicity between the most frequently used AEDs. DURATION OF STUDY 24 months. OUTCOME MEASURE Adverse drug reactions (ADRs) to AEDs. These will be identified by the use of a validated questionnaire, the Paediatric Epilepsy Side Effect Questionnaire. They will be evaluated using the Naranjo algorithm. Preventability will be assessed using the Schumock and Thornton scale. DISCUSSION Toxicity of individual AEDs when given as monotherapy and polytherapy will be determined. Additionally, discontinuation rates due to ADRs will be determined. The data will assist clinicians in choosing AEDs with the least toxicity.
Collapse
Affiliation(s)
- Oluwaseun Egunsola
- Department of Child Health, School of Medicine, University of Nottingham, Derby, UK
| | - Helen M Sammons
- Department of Child Health, School of Medicine, University of Nottingham, Derby, UK.,Department of Paediatrics, North Devon District Hospital, Nottingham, UK
| | - Shalini Ojha
- Department of Child Health, School of Medicine, University of Nottingham, Derby, UK
| | - William Whitehouse
- Department of Child Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Dan Hawcutt
- University of Liverpool, Alder Hey Children's Hospital, Liverpool, UK
| | - Imti Choonara
- Department of Child Health, School of Medicine, University of Nottingham, Derby, UK
| |
Collapse
|
23
|
Antiepileptic drug use in Italian children over a decade. Eur J Clin Pharmacol 2016; 73:241-248. [DOI: 10.1007/s00228-016-2168-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/21/2016] [Indexed: 12/16/2022]
|
24
|
Döring JH, Lampert A, Hoffmann GF, Ries M. Thirty Years of Orphan Drug Legislation and the Development of Drugs to Treat Rare Seizure Conditions: A Cross Sectional Analysis. PLoS One 2016; 11:e0161660. [PMID: 27557111 PMCID: PMC4996488 DOI: 10.1371/journal.pone.0161660] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Epilepsy is a serious chronic health condition with a high morbidity impairing the life of patients and afflicted families. Many epileptic conditions, especially those affecting children, are rare disorders generating an urgent medical need for more efficacious therapy options. Therefore, we assessed the output of the US and European orphan drug legislations. METHODS Quantitative analysis of the FDA and EMA databases for orphan drug designations according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria. RESULTS Within the US Orphan Drug Act 40 designations were granted delivering nine approvals, i.e. clobazam, diazepam viscous solution for rectal administration, felbamate, fosphenytoin, lamotrigine, repository corticotropin, rufinamide, topiramate, and vigabatrin. Since 2000 the EMA granted six orphan drug designations whereof two compounds were approved, i.e. rufinamide and stiripentol. In the US, two orphan drug designations were withdrawn. Orphan drugs were approved for conditions including Lennox-Gastaut syndrome, infantile spasms, Dravet syndrome, and status epilepticus. Comparing time to approval for rufinamide, which was approved in the US and the EU to treat rare seizure conditions, the process seems faster in the EU (2.2 years) than in the US (4.3 years). CONCLUSION Orphan drug development in the US and in the EU delivered only few molecular entities to treat rare seizure disorders. The development programs focused on already approved antiepileptic drugs or alternative pharmaceutical formulations. Most orphan drugs approved in the US are not approved in the EU to treat rare seizures although some were introduced after 2000 when the EU adopted the Orphan Drug Regulation.
Collapse
Affiliation(s)
- Jan Henje Döring
- Pediatric Neurology and Metabolic Medicine, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
- Center for Rare Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Anette Lampert
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Georg F. Hoffmann
- Pediatric Neurology and Metabolic Medicine, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
- Center for Rare Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Markus Ries
- Pediatric Neurology and Metabolic Medicine, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
- Center for Rare Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| |
Collapse
|
25
|
Stagi S, Lasorella S, Piccorossi A, Iapadre G, Verrotti A. Cessation of epilepsy therapy in children. Expert Rev Neurother 2016; 16:549-59. [DOI: 10.1586/14737175.2016.1168296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
26
|
Xiao F, An D, Chen S, Ren J, Zhou D. Clinical and Electroencephalographic (EEG) Features Associated With Refractoriness in Benign Childhood Epilepsy With Centrotemporal Spikes. J Child Neurol 2015; 30:1591-7. [PMID: 25792427 DOI: 10.1177/0883073815575367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/02/2015] [Indexed: 02/05/2023]
Abstract
The aim of this study is to identify clinical or electroencephalographic (EEG) features associated with refractoriness to the initial antiepileptic drug in typical benign childhood epilepsy with centrotemporal spikes. A total of 87 children with typical benign childhood epilepsy with centrotemporal spikes were retrospectively reviewed in the analyses. The patients were subdivided into 2 groups: patients whose seizures were controlled with monotherapy and patients requiring 2 medications. Sixty-three children achieved seizure freedom with monotherapy, whereas 24 received 2 medications for seizure control. Diffusing foci at the follow-up EEG and delayed treatment (duration >1 year) are 2 main risk factors associated with more refractory cases (P < .001). Delayed diagnosis (37.1%) and nonadherence to treatment (57.2%) contributed to delayed treatment. Our findings suggested that diffusing foci on EEG and delayed treatment are associated with more frequent seizures and refractoriness in benign childhood epilepsy with centrotemporal spikes. Diagnostic delays and nonadherence hindered timely care, which may represent opportunities for improved intervention.
Collapse
Affiliation(s)
- Fenglai Xiao
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, People's Republic of China
| | - Dongmei An
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, People's Republic of China
| | - Sihan Chen
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, People's Republic of China
| | - Jiechuan Ren
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital, SiChuan University, Chengdu, Sichuan, People's Republic of China
| |
Collapse
|
27
|
Abstract
Most children with new-onset epilepsy achieve seizure freedom with appropriate antiepileptic drugs (AEDs). However, nearly 20 % will continue to have seizures despite AEDs, as either monotherapy or in combination. Despite the growing market of new molecules over the last 20 years, the proportion of drug-resistant epilepsies has not changed. In this review, we report the evidence of efficacy and safety based on phase III randomized controlled clinical trials (RCTs) of AEDs currently used in the paediatric population. We conducted a literature search using the PubMed database and the Cochrane Database of Systematic Reviews. We also analysed the RCTs of newer AEDs whose efficacy in adolescents and adults might suggest possible use in children. Most of the phase III trials on AEDs in children have major methodological limitations that considerably limit meaningful conclusions about comparative efficacy between old and new molecules. Since the efficacy of new drugs has only been reported versus placebo, the commonly held opinion that new and newer AEDs have a better safety profile than old ones does not appear to be supported by evidence. Despite limited solid evidence, pharmacological management has improved over the years as a consequence of increased awareness of some degree of specificity of treatment in relation to different epilepsy syndromes and attention to adverse events. Future research should be directed taking these factors, as well as the diversity of epilepsy, into consideration.
Collapse
Affiliation(s)
- Anna Rosati
- Paediatric Neurology Unit, Children's Hospital A. Meyer, University of Firenze, Viale Pieraccini 24, 50139, Florence, Italy
| | - Salvatore De Masi
- Clinical Trial Office, Children's Hospital A. Meyer, Viale Pieraccini 24, 50139, Florence, Italy
| | - Renzo Guerrini
- Paediatric Neurology Unit, Children's Hospital A. Meyer, University of Firenze, Viale Pieraccini 24, 50139, Florence, Italy.
| |
Collapse
|
28
|
Adverse events, placebo and nocebo effects in placebo-treated paediatric patients with refractory focal epilepsies. Analysis of double-blind studies. Epilepsy Res 2014; 108:1685-93. [DOI: 10.1016/j.eplepsyres.2014.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/13/2014] [Indexed: 12/18/2022]
|
29
|
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
| | | |
Collapse
|
30
|
Dong C, Zhao W, Li W, Lv P, Dong X. Anti-epileptic effects of neuropeptide Y gene transfection into the rat brain. Neural Regen Res 2014; 8:1307-15. [PMID: 25206425 PMCID: PMC4107651 DOI: 10.3969/j.issn.1673-5374.2013.14.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 04/24/2013] [Indexed: 02/04/2023] Open
Abstract
Neuropeptide Y gene transfection into normal rat brain tissue can provide gene overexpression, which can attenuate the severity of kainic acid-induced seizures. In this study, a recombinant adeno-associated virus carrying the neuropeptide Y gene was transfected into brain tissue of rats with kainic acid-induced epilepsy through stereotactic methods. Following these transfections, we verified overexpression of the neuropeptide Y gene in the epileptic brain. Electroencephalograms showed that seizure severity was significantly inhibited and seizure latency was significantly prolonged up to 4 weeks after gene transfection. Moreover, quantitative fluorescent PCR and western blot assays revealed that the mRNA and protein expression of the N-methyl-D-aspartate receptor subunits NR1, NR2A, and NR2B was inhibited in the hippocampus of epileptic rats. These findings indicate that neuropeptide Y may inhibit seizures via down-regulation of the functional expression of N-methyl-D-aspartate receptors.
Collapse
Affiliation(s)
- Changzheng Dong
- Faculty of Graduate Studies, Hebei Medical University, Shijiazhuang 050051, Hebei Province, China
| | - Wenqing Zhao
- Faculty of Graduate Studies, Hebei Medical University, Shijiazhuang 050051, Hebei Province, China ; Department of Functional Neurosurgery, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Wenling Li
- Department of Functional Neurosurgery, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Peiyuan Lv
- Department of Neurology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Xiufang Dong
- Department of Neurology, First Hospital of Xingtai, Xingtai 054000, Hebei Province, China
| |
Collapse
|
31
|
A myriad of adverse effects are possible with the long-term use of antiepileptic drugs. DRUGS & THERAPY PERSPECTIVES 2014. [DOI: 10.1007/s40267-013-0084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
32
|
Siniscalchi A, Gallelli L, Russo E, De Sarro G. A review on antiepileptic drugs-dependent fatigue: pathophysiological mechanisms and incidence. Eur J Pharmacol 2013; 718:10-6. [PMID: 24051268 DOI: 10.1016/j.ejphar.2013.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/29/2013] [Accepted: 09/04/2013] [Indexed: 02/04/2023]
Abstract
Fatigue represents a common side effect of several drugs, however, the underlying mechanisms have not been well identified. A depression of the central nervous system (CNS) and/or changes in peripheral processes have been associated with the development of fatigue. Antiepileptic drugs (AEDs), generally decreasing CNS excitability, are used in the treatment of seizures as well as other neurological and psychiatric diseases. Fatigue is certainly a common AEDs' side effect, although a high degree of variability exists depending on both patients' characteristics and the drug used. Here, we delineate the pathophysiological central and peripheral mechanisms by which AEDs may cause fatigue also reviewing the available clinical data in order to assess a possible AEDs rank and highlight each AEDs related risk. It appears that drugs acting on the GABAergic system have the highest incidence (with tiagabine exception) of fatigue followed by Gabapentin and Levetiracetam whereas drugs mainly inhibiting sodium channels (Carbamazepine, Eslicarbazepine, Lamotrigine, Phenytoin and Valproate) have the lowest. However, the dose used, AEDs related side effects and patients' characteristics might influence the degree of fatigue observed.
Collapse
Affiliation(s)
- Antonio Siniscalchi
- Department of Neuroscience, Neurology Division, Annunziata Hospital, Cosenza, Italy
| | | | | | | |
Collapse
|
33
|
Zaccara G, Giovannelli F, Maratea D, Fadda V, Verrotti A. Neurological adverse events of new generation sodium blocker antiepileptic drugs. Meta-analysis of randomized, double-blinded studies with eslicarbazepine acetate, lacosamide and oxcarbazepine. Seizure 2013; 22:528-36. [PMID: 23623245 DOI: 10.1016/j.seizure.2013.03.016] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 03/28/2013] [Accepted: 03/29/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Analysis of overall tolerability and neurological adverse effects (AEs) of eslicarbazepine acetate (ESL), lacosamide (LCM) and oxcarbazepine (OXC) from double-blind, placebo-controlled trials. Indirect comparisons of patients withdrawing because of AEs, and the incidence of some vestibulocerebellar AEs between these three antiepileptic dugs (AEDs). METHODS We searched MEDLINE for all randomized, double-blind, placebo-controlled trials investigating therapeutic effects of fixed oral doses of ESL, LCM and OXC in patients with drug resistant epilepsy. Withdrawal rate due to AEs, percentages of patients with serious AEs, and the proportion of patients experiencing any neurological AE, nausea and vomiting were assessed for their association with the experimental drug. Analyses were performed between recommended daily doses of each AED according to the approved summary of product characteristics (SPC). Risk differences were used to evaluate the association of any AE [99% confidence intervals (CIs)] or study withdrawals because of AEs (95% CIs) with the experimental drug. Indirect comparisons between withdrawal rate and AEs dizziness, coordination abnormal/ataxia and diplopia were estimated according to network meta-analysis (Net-MA). RESULTS Eight randomized, placebo-controlled, double-blind trials (4 with ESL, 3 with LCM, and 1 with OXC) were included in our analysis. At high doses (OXC 1200mg, ESL 1200mg and LCM 400mg) there was an increased risk of AE-related study withdrawals compared to placebo for all drugs. Several AEs were associated with the experimental drug. Both number and frequency of AEs were dose-related. At high recommended doses, patients treated with OXC withdrew from the experimental treatment significantly more frequently than patients treated with ESL and LCM. Furthermore, the AEs coordination abnormal/ataxia and diplopia were significantly more frequently observed in patients treated with OXC compared to patients treated with LCM and ESL. CONCLUSIONS The overall tolerability of AEDs and the incidence of several neurological AEs were clearly dose-dependent. Indirect comparisons between these AEDs, taking into account dose-effect, showed that OXC may be associated with more frequent neurological AEs than LCM and ESL.
Collapse
Affiliation(s)
- Gaetano Zaccara
- U.O. Neurologia, Azienda Sanitaria di Firenze, Firenze, Italy.
| | | | | | | | | |
Collapse
|
34
|
Electroacupuncture-induced attenuation of experimental epilepsy: a comparative evaluation of acupoints and stimulation parameters. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:149612. [PMID: 23589718 PMCID: PMC3622388 DOI: 10.1155/2013/149612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 11/10/2012] [Accepted: 12/15/2012] [Indexed: 11/26/2022]
Abstract
The efficacy of electroacupuncture (EA) on epilepsy remains to be verified because of previous controversies that might be due to the complexity of the effects induced by different acupoints and stimulation approaches adopted. Therefore, we investigated the effects of EA on epilepsy to determine the specific acupoints and optimal stimulation parameters in this work. Experimental epilepsy was induced by injecting kainic acid to the lateral cerebral ventricle of adult male SD rats. EA with a low-frequency (10 Hz/1 mA) or high-frequency (100 Hz/1 mA) current was applied to the epileptic model for 30 minutes starting at 0.5 hour after the injection. Four pairs of acupoints were tested, that is, Shuigou (DU26) + Dazhui (DU14), Jinsuo (DU8) + Yaoqi (EXB9), Neiguan (PC6) + Quchi (LI11), and Fenglong (ST40) + Yongquan (KI1). We found that (1) low- or high-frequency EA at different acupoints reduced epileptic seizures (P < 0.05
versus the control) with an exception of low-frequency EA at Neiguan (PC6) and Quchi (LI11); (2) low-frequency EA induced a better effect at Fenglong (ST40) plus Yongquan (KI1) than that of the other acupoints (P < 0.05); (3) there is no significant difference in the effects of high-frequency EA at these acupoints; and (4) the high-frequency EA elicited a greater effect than that of low-frequency EA in all groups (P < 0.05), with an exception at Jinsuo (DU8) + Yaoqi (EXB9). The EA-induced attenuation appeared 1–1.5 hours after EA with no appreciable effect in the first hour after EA in either the EEG or the behavioral tests. We conclude that EA attenuation of epileptic seizures is dependent on the stimulation parameters and acupoints and that the delay in appearance of the EA effect could be a reflection of the time required by the EA signal to regulate neural function in the central nervous system.
Collapse
|