1
|
Liu YT, Chen GT, Huang YC, Ho JT, Lee CC, Tsai CC, Chang CN. Effectiveness of dose-escalated topiramate monotherapy and add-on therapy in neurosurgery-related epilepsy: A prospective study. Medicine (Baltimore) 2020; 99:e23771. [PMID: 33350762 PMCID: PMC7769361 DOI: 10.1097/md.0000000000023771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Lesional and symptomatic causes of epilepsy are the most common neurological disorders of the brain. Topiramate effectively controls newly diagnosed epilepsy and refractory focal seizures, but high-dose topiramate does not improve seizure control. This study aimed to evaluate the clinical efficacy and safety of dose-escalated topiramate as first-line monotherapy and add-on therapy in patients with neurosurgery-related epilepsy. MATERIAL AND METHODS A total of 55 neurosurgical patients with epilepsy were divided into monotherapy and add-on therapy groups and both groups received topiramate via the dose-escalation method. The primary efficacy outcomes were seizure-free rate and seizure response rate. Adverse events and seizure frequency were recorded. RESULTS The seizure response rate in the first month of monotherapy was significantly better than that of add-on therapy (89% vs 65%, P < .05), but no significant differences were found in seizure response rates between the 2 groups after 2 months of treatment. Both monotherapy and add-on therapy were effective in controlling seizures, with mean seizure frequency of 0.725 vs 0.536 and seizure-free rate of 88% vs 78.6%. Both treatments showed good improvement of seizure frequency in patients without tumor. The efficacy of monotherapy was better than that of add-on therapy (80% vs 29.2%) in patients with body mass index (BMI) ≤24. However, add-on therapy was better than monotherapy (76.7% vs 21.4%) in patients with BMI > 24. Dizziness (25.5%) and headache (16.4%) were the most common adverse events. No severe adverse event such as cognitive impairment was observed. CONCLUSIONS Dose-escalated topiramate monotherapy and add-on therapy demonstrate good efficacy and safety, with fewer adverse events in seizure control in neurosurgical patients.
Collapse
Affiliation(s)
- Yu-Tse Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch and school of medicine
| | - Guo-Tai Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi Branch and school of medicine, Chang Gung University, Taiwan
| | - Yin-Cheng Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch and school of medicine
| | - Jih-Tsun Ho
- Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Branch and school of medicine
| | - Cheng-Chi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Branch and school of medicine
| | - Cheng-Chia Tsai
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi Branch and school of medicine, Chang Gung University, Taiwan
| | - Chen-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi Branch and school of medicine, Chang Gung University, Taiwan
| |
Collapse
|
2
|
Jafarpour H, Razavi A, Alaedini K, Sefidgarnia M, Hosseini Talari D. Topiramate-Induced Acute Psychotic Symptoms: A Case Report. CLINICAL NEUROPSYCHIATRY 2020; 17:34-35. [PMID: 34908964 PMCID: PMC8629074 DOI: 10.36131/clinicalnpsych20200104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 36-year-old man, married, nurse, presented with feeling fear and injury from imaginary creatures to a psychiatric clinic in Sari, Iran. Symptoms began two days before admission when tablet Topiramate was started due to the increasing intensity of chronic headache. About one hour after the first dose, Symptoms became apparent and resolved when he woke up. There was no hallucination and loss of consciousness. Next day, following use the same dose, the symptoms appeared. Eventually, Topiramate was discontinued and the patient did not experience similar symptoms in follow up.
Collapse
Affiliation(s)
- Hamed Jafarpour
- Medical Student, Student Research Committee, Addiction Institute and Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Razavi
- Medical Student, Student Research Committee, Addiction Institute and Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kamal Alaedini
- Psychiatry and Behavioral Sciences Research Centre, Addiction Institute and Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Sefidgarnia
- Psychiatry and Behavioral Sciences Research Centre, Addiction Institute and Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Davood Hosseini Talari
- Assistant Professor of Psychosomatic Medicine, Department of Psychiatry, School of Medicine, Rouhani Hospital Babol University of Medical Sciences, Babol, Iran.,Corresponding author Davood Hosseini Talari, number: +989113571346
| |
Collapse
|
3
|
Viteva E, Zahariev Z. Comparative effectiveness of add-on therapy with newer-generation antiepileptic drugs in Bulgarian patients with refractory epilepsy. Epilepsy Behav 2018; 87:137-145. [PMID: 30097339 DOI: 10.1016/j.yebeh.2018.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The objective of this study is to perform an open, prospective study on various aspects of comparative effectiveness of newer-generation antiepileptic drugs as add-on therapy in Bulgarian patients with drug-resistant epilepsy. METHODS The study was performed with the participation of 1259 patients with epilepsy who attended the Clinic of Neurology at the University Hospital in Plovdiv, Bulgaria for regular visits and completed diaries about seizure frequency, severity, and adverse events. RESULTS Oxcarbazepine was used in 82 patients, topiramate in 120 patients, lamotrigine in 73 patients, levetiracetam in 135 patients, pregabalin in 47 patients, tiagabine in 43 patients, gabapentin in 18 patients, lacosamide in 12 patients, and retigabine in 6 patients. During the first 24 months of study, improvement of seizure severity and frequency was most frequent in patients on treatment with pregabalin and levetiracetam and rarest in those on treatment with oxcarbazepine. The retention rate of patients on pregabalin and tiagabine was significantly lower compared to the retention rate of patients on most of the other antiepileptic drugs. The frequency of adverse events was higher in patients on treatment with tiagabine and pregabalin. CONCLUSION Despite some similar characteristics of newer-generation antiepileptic drugs' effectiveness, levetiracetam stands out with better dynamic improvement of seizure severity and frequency and satisfactory tolerability; typical for pregabalin is a very good dynamic improvement of seizure severity and frequency mainly in patients with focal seizures, but a lower tolerability, and the main advantage of oxcarbazepine is a good tolerability, efficacy, however, is less satisfactory.
Collapse
Affiliation(s)
- Ekaterina Viteva
- Department of Neurology, Medical University - Plovdiv, Bulgaria, 15A Vasil Aprilov str., 4002 Plovdiv, Bulgaria.
| | - Zahari Zahariev
- Department of Neurology, Medical University - Plovdiv, Bulgaria, 15A Vasil Aprilov str., 4002 Plovdiv, Bulgaria
| |
Collapse
|
4
|
Moura LMVR, Westover MB, Kwasnik D, Cole AJ, Hsu J. Causal inference as an emerging statistical approach in neurology: an example for epilepsy in the elderly. Clin Epidemiol 2016; 9:9-18. [PMID: 28115873 PMCID: PMC5221551 DOI: 10.2147/clep.s121023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The elderly population faces an increasing number of cases of chronic neurological conditions, such as epilepsy and Alzheimer's disease. Because the elderly with epilepsy are commonly excluded from randomized controlled clinical trials, there are few rigorous studies to guide clinical practice. When the elderly are eligible for trials, they either rarely participate or frequently have poor adherence to therapy, thus limiting both generalizability and validity. In contrast, large observational data sets are increasingly available, but are susceptible to bias when using common analytic approaches. Recent developments in causal inference-analytic approaches also introduce the possibility of emulating randomized controlled trials to yield valid estimates. We provide a practical example of the application of the principles of causal inference to a large observational data set of patients with epilepsy. This review also provides a framework for comparative-effectiveness research in chronic neurological conditions.
Collapse
Affiliation(s)
- Lidia MVR Moura
- Massachusetts General Hospital, Department of Neurology, Epilepsy Service, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - M Brandon Westover
- Massachusetts General Hospital, Department of Neurology, Epilepsy Service, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David Kwasnik
- Massachusetts General Hospital, Department of Neurology, Epilepsy Service, Boston, MA, USA
| | - Andrew J Cole
- Massachusetts General Hospital, Department of Neurology, Epilepsy Service, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - John Hsu
- Massachusetts General Hospital, Mongan Institute, Boston, MA, USA
- Harvard Medical School, Department of Medicine, Boston, MA, USA
- Harvard Medical School, Department of Health Care Policy, Boston, MA, USA
| |
Collapse
|
5
|
Zhao H, Carney KE, Falgoust L, Pan JW, Sun D, Zhang Z. Emerging roles of Na⁺/H⁺ exchangers in epilepsy and developmental brain disorders. Prog Neurobiol 2016; 138-140:19-35. [PMID: 26965387 DOI: 10.1016/j.pneurobio.2016.02.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/03/2016] [Accepted: 02/27/2016] [Indexed: 12/15/2022]
Abstract
Epilepsy is a common central nervous system (CNS) disease characterized by recurrent transient neurological events occurring due to abnormally excessive or synchronous neuronal activity in the brain. The CNS is affected by systemic acid-base disorders, and epileptic seizures are sensitive indicators of underlying imbalances in cellular pH regulation. Na(+)/H(+) exchangers (NHEs) are a family of membrane transporter proteins actively involved in regulating intracellular and organellar pH by extruding H(+) in exchange for Na(+) influx. Altering NHE function significantly influences neuronal excitability and plays a role in epilepsy. This review gives an overview of pH regulatory mechanisms in the brain with a special focus on the NHE family and the relationship between epilepsy and dysfunction of NHE isoforms. We first discuss how cells translocate acids and bases across the membrane and establish pH homeostasis as a result of the concerted effort of enzymes and ion transporters. We focus on the specific roles of the NHE family by detailing how the loss of NHE1 in two NHE mutant mice results in enhanced neuronal excitability in these animals. Furthermore, we highlight new findings on the link between mutations of NHE6 and NHE9 and developmental brain disorders including epilepsy, autism, and attention deficit hyperactivity disorder (ADHD). These studies demonstrate the importance of NHE proteins in maintaining H(+) homeostasis and their intricate roles in the regulation of neuronal function. A better understanding of the mechanisms underlying NHE1, 6, and 9 dysfunctions in epilepsy formation may advance the development of new epilepsy treatment strategies.
Collapse
Affiliation(s)
- Hanshu Zhao
- Department of Neurology, The First Affiliated Hospital of the Harbin Medical University, Harbin, China.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Karen E Carney
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Lindsay Falgoust
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jullie W Pan
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Dandan Sun
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA.,Veterans Affairs Pittsburgh Health Care System, Geriatric Research, Educational and Clinical Center, Pittsburgh, PA 15213, USA
| | - Zhongling Zhang
- Department of Neurology, The First Affiliated Hospital of the Harbin Medical University, Harbin, China
| |
Collapse
|
6
|
Moura LMVR, Carneiro TS, Cole AJ, Hsu J, Vickrey BG, Hoch DB. Association between addressing antiseizure drug side effects and patient-reported medication adherence in epilepsy. Patient Prefer Adherence 2016; 10:2197-2207. [PMID: 27826186 PMCID: PMC5096772 DOI: 10.2147/ppa.s119973] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIM Adherence to treatment is a critical component of epilepsy management. This study examines whether addressing antiepileptic drug (AED) side effects at every visit is associated with increased patient-reported medication adherence. PATIENTS AND METHODS This study identified 243 adults with epilepsy who were seen at two academic outpatient neurology settings and had at least two visits over a 3-year period. Demographic and clinical characteristics were abstracted. Evidence that AED side effects were addressed was measured through 1) phone interview (patient-reported) and 2) medical records abstraction (physician-documented). Medication adherence was assessed using the validated Morisky Medication Adherence Scale-4. Complete adherence was determined as answering "no" to all questions. RESULTS Sixty-two (25%) patients completed the interviews. Participants and nonparticipants were comparable with respect to demographic and clinical characteristics; however, a smaller proportion of participants had a history of drug-resistant epilepsy than nonparticipants (17.7% vs 30.9%, P=0.04). Among the participants, evidence that AED side effects were addressed was present in 48 (77%) medical records and reported by 51 (82%) patients. Twenty-eight (45%) patients reported complete medication adherence. The most common reason for incomplete adherence was missed medication due to forgetfulness (n=31, 91%). There was no association between addressing AED side effects (neither physician-documented nor patient-reported) and complete medication adherence (P=0.22 and 0.20). DISCUSSION AND CONCLUSION Among patients with epilepsy, addressing medication side effects at every visit does not appear to increase patient-reported medication adherence.
Collapse
Affiliation(s)
- Lidia M V R Moura
- Department of Neurology
- Correspondence: Lidia M V R Moura, Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Wang 739D, Boston, MA 02114, USA, Tel +1 617 726 3311, Fax +1 617 726 9250, Email
| | | | | | - John Hsu
- Mongan Institute for Health Policy, Department of Medicine, Massachusetts General Hospital
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | |
Collapse
|
7
|
Rundle-Thiele D, Head R, Cosgrove L, Martin JH. Repurposing some older drugs that cross the blood-brain barrier and have potential anticancer activity to provide new treatment options for glioblastoma. Br J Clin Pharmacol 2015; 81:199-209. [PMID: 26374633 DOI: 10.1111/bcp.12785] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 12/16/2022] Open
Abstract
Glioblastoma is a brain neoplasm with limited 5-year survival rates. Developments of new treatment regimens that improve patient survival in patients with glioblastoma are needed. It is likely that a number of existing drugs used in other conditions have potential anticancer effects that offer significant survival benefit to glioblastoma patients. Identification of such drugs could provide a novel treatment paradigm.
Collapse
Affiliation(s)
| | - Richard Head
- Future Industries Institute, Research and Innovation Portfolio, University of South Australia, Adelaide, SA, Australia
| | - Leah Cosgrove
- CSIRO, Human and Nutrition Flagship, Adelaide, SA, Australia
| | - Jennifer H Martin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| |
Collapse
|
8
|
Commentary. J Neurosci Rural Pract 2014; 5:149-50. [PMID: 24966553 PMCID: PMC4064180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|