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Andualem F, Melkam M, Tadesse G, Nakie G, Tinsae T, Fentahun S, Rtbey G, Takelle GM, Mengistie BA, Gedef GM. Quality of life and associated factors among people with epilepsy in Ethiopia: a systematic review and meta-analysis. BMC Public Health 2024; 24:1529. [PMID: 38844872 PMCID: PMC11157882 DOI: 10.1186/s12889-024-19018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/30/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Epilepsy is a global health and economic burden with major problems that have an impact on physical, psychological, and social activities. Quality of life (QoL) is often disturbed and can be influenced by many factors, like anti-seizure medication side effects, the sociocultural environment, and various disease-related factors. The aim of this systematic review and meta-analysis is to provide an overview of the most recent information available regarding the pooled prevalence of poor quality of life and associated factors among adult people with epilepsy in Ethiopia. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is an appropriate set of guidelines for reporting systematic reviews and meta-analyses. This systematic review and meta-analysis protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with CRD42024527914. To find publications for the systematic review and meta-analysis, we used both manual and electronic searches. The publications were searched by PubMed, MEDLINE, EMBASE, Cochrane Library, Scopus, and other grey publications were searched by Google Scholar. The Joanna Briggs Institute (JBI) for cross-sectional study quality assessment was employed to evaluate the methodological quality of the studies included in this review. The data was extracted in Microsoft Excel, and then it was exported into STATA 11.0 for analysis. A funnel plot and an objective examination of Egger's regression test were used to check for publication bias. RESULTS We have included 7 studies conducted in Ethiopia with 2123 study participants, of whom 1163 (54.78%) were male individuals, and 1196 (56.34%) of the participants were living without marriage (either single, divorced, or widowed). The pooled prevalence of poor quality of life among people with epilepsy in Ethiopia is 45.07 (95% CI: 39.73-50.42%). Further, in subgroup analysis regarding the assessment tool of poor quality of life of people with epilepsy, QOLIE-31 accounted for 50.05% (95%CI: 46.65-53.45) and WHO QOL BREF accounted for 39.72% (95%CI: 27.67-51.78). Among the associated factors, being unable to read and write, anxiey and depression were significantly linked to the quality of life of people with epilepsy. CONCLUSION This review found that there was a high pooled prevalence of poor quality of life related to people with epilepsy in Ethiopia. This study may provide further information to concerned bodies that do early screening and manage the quality of life of individuals with epilepsy. Also, screening and intervention for anxiety and depression problems should be considered in regular epilepsy care management.
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Affiliation(s)
- Fantahun Andualem
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, PO Box 196, Gondar, Ethiopia.
| | - Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Gebrieslassie Tadesse
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, PO Box 196, Gondar, Ethiopia
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Setegn Fentahun
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Gidey Rtbey
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Berihun Agegn Mengistie
- Department of General Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Getachew Muluye Gedef
- Department of General Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Zayed MA, Sultan S, Alsaab HO, Yousof SM, Alrefaei GI, Alsubhi NH, Alkarim S, Al Ghamdi KS, Bagabir SA, Jana A, Alghamdi BS, Atta HM, Ashraf GM. Stem-Cell-Based Therapy: The Celestial Weapon against Neurological Disorders. Cells 2022; 11:3476. [PMID: 36359871 PMCID: PMC9655836 DOI: 10.3390/cells11213476] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 09/01/2023] Open
Abstract
Stem cells are a versatile source for cell therapy. Their use is particularly significant for the treatment of neurological disorders for which no definitive conventional medical treatment is available. Neurological disorders are of diverse etiology and pathogenesis. Alzheimer's disease (AD) is caused by abnormal protein deposits, leading to progressive dementia. Parkinson's disease (PD) is due to the specific degeneration of the dopaminergic neurons causing motor and sensory impairment. Huntington's disease (HD) includes a transmittable gene mutation, and any treatment should involve gene modulation of the transplanted cells. Multiple sclerosis (MS) is an autoimmune disorder affecting multiple neurons sporadically but induces progressive neuronal dysfunction. Amyotrophic lateral sclerosis (ALS) impacts upper and lower motor neurons, leading to progressive muscle degeneration. This shows the need to try to tailor different types of cells to repair the specific defect characteristic of each disease. In recent years, several types of stem cells were used in different animal models, including transgenic animals of various neurologic disorders. Based on some of the successful animal studies, some clinical trials were designed and approved. Some studies were successful, others were terminated and, still, a few are ongoing. In this manuscript, we aim to review the current information on both the experimental and clinical trials of stem cell therapy in neurological disorders of various disease mechanisms. The different types of cells used, their mode of transplantation and the molecular and physiologic effects are discussed. Recommendations for future use and hopes are highlighted.
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Affiliation(s)
- Mohamed A. Zayed
- Physiology Department, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Physiology Department, Faculty of Medicine, Menoufia University, Menoufia 32511, Egypt
| | - Samar Sultan
- Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Regenerative Medicine Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Hashem O. Alsaab
- Department of Pharmaceutics and Pharmaceutical Technology, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | - Shimaa Mohammad Yousof
- Physiology Department, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Medical Physiology Department, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Ghadeer I. Alrefaei
- Department of Biology, College of Science, University of Jeddah, Jeddah 21589, Saudi Arabia
| | - Nouf H. Alsubhi
- Department of Biological Sciences, College of Science & Arts, King Abdulaziz University, Rabigh 21911, Saudi Arabia
| | - Saleh Alkarim
- Embryonic and Cancer Stem Cell Research Group, King Fahad Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Biology Department, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Embryonic Stem Cells Research Unit, Biology Department, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Kholoud S. Al Ghamdi
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Sali Abubaker Bagabir
- Genetic Unit, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Ankit Jana
- School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT) Deemed to be University, Campus-11, Patia, Bhubaneswar 751024, Odisha, India
| | - Badrah S. Alghamdi
- Department of Physiology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Hazem M. Atta
- Clinical Biochemistry Department, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Ghulam Md Ashraf
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, University City, Sharjah 27272, United Arab Emirates
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Chiari 1 Malformation and Epilepsy in Children: A Missing Relationship. J Clin Med 2022; 11:jcm11206182. [PMID: 36294502 PMCID: PMC9604608 DOI: 10.3390/jcm11206182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose: Once believed a result of pathophysiological correlations, the association between Chiari 1 malformation (CM1) and epilepsy has since been considered as a coincidence, due to missing etiologic or clinical matching points. At present, the problem is being newly debated because of the increasing number of CM1 diagnoses, often among children with seizures. No specific studies on this topic are available yet. The present study aimed at updating the information on this topic by reporting on a series of children specifically enrolled and retrospectively analyzed for this purpose. Methods: All children admitted between January 2015 and June 2020 for epilepsy and CM1 were considered (Group 1). They were compared with children admitted in the same period for symptoms/signs related to CM1 and/or syringomyelia (Group 2). Syndromic patients were excluded, as well as those with tumoral or other overt intracranial lesions. All patients received a complete preoperative work-up, including MRI and EEG. Symptomatic children with CM1/syringomyelia were operated on. The pertinent literature was reviewed. Results: Group 1 was composed of 29 children (mean age: 6.2 years) showing CM1 and epilepsy with several types of seizures. A share of 27% had CM1-related symptoms and syringomyelia. The mean tonsillar ectopia was 7.5 mm. Surgery was performed in 31% of cases. Overall, 62% of children are currently seizure-free (including 5/9 children who were operated on). Tonsillar herniation and syringomyelia regressed in 4/9 cases and 4/8 cases, improved in 4/9 cases and 3/8 cases, and remained stable in 1/9 and 1/8 cases, respectively. CM1 signs/symptoms regressed completely in 6/8 cases and improved or remained stable in one case in each of the two remaining patients. Group 2 consisted of 77 children (mean age: 8.9 years) showing symptoms of CM1 (75%) and/or syringomyelia (39%). The mean tonsillar ectopia was 11.8 mm. Non-specific EEG anomalies were detected in 13 children (17%). Surgery was performed in 76.5% of cases (18 children were not operated on because of oligosymptomatic). Preoperative symptoms regressed in 26%, improved in 50%, remained stable 22%, and worsened in 2%; CM1 radiologically regressed in 39%, improved in 37%, remained unchanged in 22%, and worsened in 2%; and syringomyelia/hydromyelia regressed in 61%, improved in 30%, and was stable in 9%. No statistically significant differences between the two groups were detected regarding the M/F ratio, presence of syringomyelia/hydromyelia, or CM1/syringomyelia outcome; moreover, no correlation occurred between seizure-free condition and PF decompression in Group 1, or between disappearance of EEG anomalies and PF decompression in Group 2. A significant difference between the two groups was noticed regarding the mean age at admission (p = 0.003), amount of tonsillar herniation (p < 0.00001), and PF decompression (p = 0.0001). Conclusions: These findings do not support clinical correlations between CM1 and epilepsy. Their course depends on surgery and antiepileptic drugs, respectively. The analysis of the literature does not provide evidence of a relationship between seizures and cerebellar anomalies such as CM1. Rather than being linked to a syndrome that could explain such an association, the connection between the two now has to be considered to be random.
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Turan GB, Özer Z, Özden B. The Effects of Perceived Stigma on the Concealment of Disease and Satisfaction with Life in Patients with Epilepsy: An Example in Eastern Turkey. Int J Clin Pract 2022; 2022:1064999. [PMID: 35685532 PMCID: PMC9159186 DOI: 10.1155/2022/1064999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Stigma and exclusion are common features of epilepsy in both developed and developing countries, and they cause a significant burden associated with the condition. At the same time, although it varies from country to country depending on cultural differences and economic conditions, having epilepsy causes significant social consequences. OBJECTIVE This study was conducted to examine the effects of perceived stigma on the concealment of disease and satisfaction with life in patients with epilepsy living in the east of Turkey. METHODS This cross-sectional and descriptive study was carried out with 150 patients who met the study criteria and who agreed to participate in the study between March and July 2021 in a university hospital in Elazığ, east of Turkey. The data were collected using a personal information form, an Epilepsy Stigma Scale (ESS), a Concealment of Epilepsy Scale (CES), and a Satisfaction with Life Scale (SWLS). RESULTS The total mean ESS score of the patients was 40.7 ± 9.04, the total CES mean score was 57.19 ± 12.57, and the total SWLS mean score was 6.68 ± 2.86. When the regression coefficients were examined, it was found that the ESS variable had a positive and significant effect on the CES, while the ESS and the CES had a negative and significant effect on satisfaction with life (p < 0.001). CONCLUSION It was found that the patients had high levels of perceived stigma and concealment of epilepsy and low satisfaction with life levels. It was also found that the patients concealed their disease for fear of stigma, which negatively affected their satisfaction with life.
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Affiliation(s)
| | - Zülfünaz Özer
- Department of Nursing, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
| | - Beyan Özden
- Firat University Health Sciences Institute, Nursing Department, Elazığ, Turkey
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Suo GH, Zheng YQ, Wu YJ, Tang JH. Effects of levetiracetam and oxcarbazepine monotherapy on intellectual and cognitive development in children with benign epilepsy with centrotemporal spikes. Acta Neurol Belg 2021; 121:1265-1273. [PMID: 33590471 PMCID: PMC8443489 DOI: 10.1007/s13760-021-01613-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/26/2021] [Indexed: 11/21/2022]
Abstract
Levetiracetam (LEV) and oxcarbazepine (OXC) are commonly used in the treatment of epilepsy, but their efficacy and safety have seldom been compared for the treatment of children with benign epilepsy with centrotemporal spikes (BECTS). We thus assessed the efficacy of LEV and OXC monotherapy in the treatment of children with BECTS, and the effect of this treatment on children’s intelligence and cognitive development. This was a randomized, single-center trial. Children with BECTS were randomized (1:1) into LEV and OXC groups, and were assessed at 1, 3 and 6 months after treatment. The primary outcomes were the frequency of seizures and changes in intelligence and cognitive function. Secondary outcomes were electroencephalogram (EEG) results and safety. Seventy children were enrolled and randomized to the LEV group or the OXC group, and 32 of the 35 children in each group completed the study. After 6 months, the effective treatment rate of the OXC group was significantly higher than that of the LEV group (78.12 vs. 53.12%, p = 0.035). However, no significant inter-group difference was observed in EEG improvement (p = 0.211). In terms of intelligence and cognitive development, children in the OXC group exhibited significantly improved choice reaction time, mental rotation, and Wisconsin Card Sorting Test results (all p < 0.05). Both LEV and OXC were well tolerated, with 18.75 and 21.88% of children reporting mild adverse events (p = 0.756). OXC monotherapy was more effective than LEV for children with BECTS. In addition, children with OXC monotherapy had higher improvements in children’s intelligence and cognitive function than those with LEV monotherapy.
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CDDO-Me Attenuates Astroglial Autophagy via Nrf2-, ERK1/2-SP1- and Src-CK2-PTEN-PI3K/AKT-Mediated Signaling Pathways in the Hippocampus of Chronic Epilepsy Rats. Antioxidants (Basel) 2021; 10:antiox10050655. [PMID: 33922531 PMCID: PMC8145743 DOI: 10.3390/antiox10050655] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Clasmatodendrosis is an autophagic astroglial death showing extensive swollen cell bodies with vacuoles and disintegrated/beaded processes. This astroglial degeneration is closely relevant to the synchronous epileptiform discharges. However, the underlying molecular mechanisms and the roles of clasmatodendrosis in spontaneous seizure activity are still unknown. The 2-cyano-3,12-dioxo-oleana-1,9(11)-dien-28-oic acid methyl ester (CDDO-Me; RTA 402) is one of the activators for nuclear factor-erythroid 2-related factor 2 (Nrf2) that is a redox-sensitive transcription factor. In the present study, we explored the effects of CDDO-Me on clasmatodendrosis in chronic epilepsy rats, which could prevent epilepsy-related complications. In the present study, clasmatodendritic astrocytes showed reduced Nrf2 expression and its nuclear accumulation, which were restored by CDDO-Me. CDDO-Me also abrogated heat shock protein 25 (HSP25) upregulation in clasmatodendritic astrocytes by regulating extracellular signal-related kinases 1/2 (ERK1/2)-specificity protein 1 (SP1)- and Src-casein kinase 2 (CK2)-phosphatase and tensin homolog deleted on chromosome 10 (PTEN)-phosphatidylinositol-3-kinase (PI3K)-AKT-glycogen synthase kinase 3β (GSK3β)-bax-interacting factor 1 (Bif-1)-mediated signaling pathways in chronic epilepsy rats. In addition, CDDO-Me ameliorated spontaneous seizure duration, but not seizure frequency and behavioral seizure severity. Therefore, our findings suggest that clasmatodendrosis may affect seizure duration in chronic epilepsy rats, and that CDDO-Me may attenuate autophagic astroglial degeneration by regulating various signaling pathways.
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Knutson DE, Smith JL, Ping X, Jin X, Golani LK, Li G, Tiruveedhula VVNPB, Rashid F, Mian MY, Jahan R, Sharmin D, Cerne R, Cook JM, Witkin JM. Imidazodiazepine Anticonvulsant, KRM-II-81, Produces Novel, Non-diazepam-like Antiseizure Effects. ACS Chem Neurosci 2020; 11:2624-2637. [PMID: 32786313 DOI: 10.1021/acschemneuro.0c00295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The need for improved medications for the treatment of epilepsy and chronic pain is essential. Epileptic patients typically take multiple antiseizure drugs without complete seizure freedom, and chronic pain is not fully managed with current medications. A positive allosteric modulator (PAM) of α2/3-containing GABAA receptors (5-(8-ethynyl-6-(pyridin-2-yl)-4H-benzo[f]imidazole[1,5-α][1,4]diazepin-3-yl) oxazole or KRM-II-81 (8) is a lead compound in a series of imidazodiazepines. We previously reported that KRM-II-81 produces broad-based anticonvulsant and antinociceptive efficacy in rodent models and provides a wider margin over motoric side effects than that of other GABAA receptor PAMs. The present series of experiments was designed to fill key missing gaps in prior preclinical studies assessing whether KRM-II-81 could be further differentiated from nonselective GABAA receptor PAMs using the anticonvulsant diazepam (DZP) as a comparator. In multiple chemical seizure provocation models in mice, KRM-II-81 was either equally or more efficacious than DZP. Most strikingly, KRM-II-81 but not DZP blocked the development of seizure sensitivity to the chemoconvulsants cocaine and pentylenetetrazol in seizure kindling models. These and predecessor data have placed KRM-II-81 into consideration for clinical development requiring the manufacture of kilogram amounts of good manufacturing practice material. We describe here a novel synthetic route amenable to kilogram quantity production. The new biological and chemical data provide key steps forward in the development of KRM-II-81 (8) as an improved treatment option for patients suffering from epilepsy.
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Affiliation(s)
- Daniel E. Knutson
- Department of Chemistry & Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - Jodi L. Smith
- Laboratory of Antiepileptic Drug Discovery, Peyton Manning Hospital for Children Ascension St. Vincent, Indianapolis, Indiana 46260, United States
| | - Xingjie Ping
- Department of Anatomy and Cell Biology, Indiana University/Purdue University, Indianapolis, Indiana 46202,United States
| | - Xiaoming Jin
- Department of Anatomy and Cell Biology, Indiana University/Purdue University, Indianapolis, Indiana 46202,United States
| | - Lalit K. Golani
- Department of Chemistry & Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - Guanguan Li
- Department of Chemistry & Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - V. V. N. Phani Babu Tiruveedhula
- Department of Chemistry & Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - Farjana Rashid
- Department of Chemistry & Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - Md Yeunus Mian
- Department of Chemistry & Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - Rajwana Jahan
- Department of Chemistry & Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - Dishary Sharmin
- Department of Chemistry & Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - Rok Cerne
- Laboratory of Antiepileptic Drug Discovery, Peyton Manning Hospital for Children Ascension St. Vincent, Indianapolis, Indiana 46260, United States
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Zaloška cesta 4, 1000 Ljubljana, Slovenia
| | - James M. Cook
- Department of Chemistry & Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - Jeffrey M. Witkin
- Department of Chemistry & Biochemistry, Milwaukee Institute for Drug Discovery, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
- Laboratory of Antiepileptic Drug Discovery, Peyton Manning Hospital for Children Ascension St. Vincent, Indianapolis, Indiana 46260, United States
- Departments of Neuroscience and Trauma Research, Ascension St. Vincent Hospital, Indianapolis, Indiana 46260, United States
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Witkin JM, Li G, Golani LK, Xiong W, Smith JL, Ping X, Rashid F, Jahan R, Cerne R, Cook JM, Jin X. The Positive Allosteric Modulator of α2/3-Containing GABA A Receptors, KRM-II-81, Is Active in Pharmaco-Resistant Models of Epilepsy and Reduces Hyperexcitability after Traumatic Brain Injury. J Pharmacol Exp Ther 2020; 372:83-94. [PMID: 31694876 PMCID: PMC6927408 DOI: 10.1124/jpet.119.260968] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022] Open
Abstract
The imidizodiazepine, 5-(8-ethynyl-6-(pyridin-2-yl)-4H-benzo[f]imidazo[1,5-a][1,4]diazepin-3-yl)oxazole (KRM-II-81), is selective for α2/3-containing GABAA receptors. KRM-II-81 dampens seizure activity in rodent models with enhanced efficacy and reduced motor-impairment compared with diazepam. In the present study, KRM-II-81 was studied in assays designed to detect antiepileptics with improved chances of impacting pharmaco-resistant epilepsies. The potential for reducing neural hyperactivity weeks after traumatic brain injury was also studied. KRM-II-81 suppressed convulsions in corneal-kindled mice. Mice with kainate-induced mesial temporal lobe seizures exhibited spontaneous recurrent hippocampal paroxysmal discharges that were significantly reduced by KRM-II-81 (15 mg/kg, orally). KRM-II-81 also decreased convulsions in rats undergoing amygdala kindling in the presence of lamotrigine (lamotrigine-insensitive model) (ED50 = 19 mg/kg, i.p.). KRM-II-81 reduced focal and generalized seizures in a kainate-induced chronic epilepsy model in rats (20 mg/kg, i.p., three times per day). In mice with damage to the left cerebral cortex by controlled-cortical impact, enduring neuronal hyperactivity was dampened by KRM-II-81 (10 mg/kg, i.p.) as observed through in vivo two-photon imaging of layer II/III pyramidal neurons in GCaMP6-expressing transgenic mice. No notable side effects emerged up to doses of 300 mg/kg KRM-II-81. Molecular modeling studies were conducted: docking in the binding site of the α1β3γ2L GABAA receptor showed that replacing the C8 chlorine atom of alprazolam with the acetylene of KRM-II-81 led to loss of the key interaction with α1His102, providing a structural rationale for its low affinity for α1-containing GABAA receptors compared with benzodiazepines such as alprazolam. Overall, these findings predict that KRM-II-81 has improved therapeutic potential for epilepsy and post-traumatic epilepsy. SIGNIFICANCE STATEMENT: We describe the effects of a relatively new orally bioavailable small molecule in rodent models of pharmaco-resistant epilepsy and traumatic brain injury. KRM-II-81 is more potent and generally more efficacious than standard-of-care antiepileptics. In silico docking experiments begin to describe the structural basis for the relative lack of motor impairment induced by KRM-II-81. KRM-II-81 has unique structural and anticonvulsant effects, predicting its potential as an improved antiepileptic drug and novel therapy for post-traumatic epilepsy.
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Affiliation(s)
- Jeffrey M Witkin
- Department of Neurologic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., R.C., X.J.); Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (J.M.W., G.L., L.K.G., F.R., R.J., J.M.C.); Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., X.J.); and Laboratory of Antiepileptic Drug Discovery, St. Vincent's Hospital, Indianapolis, Indiana (J.L.S.)
| | - Guanguan Li
- Department of Neurologic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., R.C., X.J.); Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (J.M.W., G.L., L.K.G., F.R., R.J., J.M.C.); Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., X.J.); and Laboratory of Antiepileptic Drug Discovery, St. Vincent's Hospital, Indianapolis, Indiana (J.L.S.)
| | - Lalit K Golani
- Department of Neurologic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., R.C., X.J.); Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (J.M.W., G.L., L.K.G., F.R., R.J., J.M.C.); Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., X.J.); and Laboratory of Antiepileptic Drug Discovery, St. Vincent's Hospital, Indianapolis, Indiana (J.L.S.)
| | - Wenhui Xiong
- Department of Neurologic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., R.C., X.J.); Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (J.M.W., G.L., L.K.G., F.R., R.J., J.M.C.); Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., X.J.); and Laboratory of Antiepileptic Drug Discovery, St. Vincent's Hospital, Indianapolis, Indiana (J.L.S.)
| | - Jodi L Smith
- Department of Neurologic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., R.C., X.J.); Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (J.M.W., G.L., L.K.G., F.R., R.J., J.M.C.); Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., X.J.); and Laboratory of Antiepileptic Drug Discovery, St. Vincent's Hospital, Indianapolis, Indiana (J.L.S.)
| | - Xingjie Ping
- Department of Neurologic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., R.C., X.J.); Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (J.M.W., G.L., L.K.G., F.R., R.J., J.M.C.); Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., X.J.); and Laboratory of Antiepileptic Drug Discovery, St. Vincent's Hospital, Indianapolis, Indiana (J.L.S.)
| | - Farjana Rashid
- Department of Neurologic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., R.C., X.J.); Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (J.M.W., G.L., L.K.G., F.R., R.J., J.M.C.); Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., X.J.); and Laboratory of Antiepileptic Drug Discovery, St. Vincent's Hospital, Indianapolis, Indiana (J.L.S.)
| | - Rajwana Jahan
- Department of Neurologic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., R.C., X.J.); Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (J.M.W., G.L., L.K.G., F.R., R.J., J.M.C.); Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., X.J.); and Laboratory of Antiepileptic Drug Discovery, St. Vincent's Hospital, Indianapolis, Indiana (J.L.S.)
| | - Rok Cerne
- Department of Neurologic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., R.C., X.J.); Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (J.M.W., G.L., L.K.G., F.R., R.J., J.M.C.); Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., X.J.); and Laboratory of Antiepileptic Drug Discovery, St. Vincent's Hospital, Indianapolis, Indiana (J.L.S.)
| | - James M Cook
- Department of Neurologic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., R.C., X.J.); Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (J.M.W., G.L., L.K.G., F.R., R.J., J.M.C.); Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., X.J.); and Laboratory of Antiepileptic Drug Discovery, St. Vincent's Hospital, Indianapolis, Indiana (J.L.S.)
| | - Xiaoming Jin
- Department of Neurologic Surgery, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., R.C., X.J.); Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (J.M.W., G.L., L.K.G., F.R., R.J., J.M.C.); Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana (W.X., X.P., X.J.); and Laboratory of Antiepileptic Drug Discovery, St. Vincent's Hospital, Indianapolis, Indiana (J.L.S.)
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9
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Al-Eitan LN, Al-Dalalah IM, Mustafa MM, Alghamdi MA, Elshammari AK, Khreisat WH, Aljamal HA. Effects of MTHFR and ABCC2 gene polymorphisms on antiepileptic drug responsiveness in Jordanian epileptic patients. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:87-95. [PMID: 31354331 PMCID: PMC6572658 DOI: 10.2147/pgpm.s211490] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/27/2019] [Indexed: 01/09/2023]
Abstract
Background Epilepsy is one of the most common neurological diseases with unclear etiology where its genetic background and treatment regime still need further exploration. Objectives This study designed to evaluate the pharmacogenomics of MTHFR and ABCC2 genes, and their association with epilepsy susceptibility among Jordanian population. Methods A case-control study was conducted on Jordanian cohort of 296 epileptic patients and 299 healthy individuals. Custom platform array was used to genotype the genetic polymorphisms within MTHFR (rs1801133) and ABCC2 (rs717620, rs3740066, rs2273697) genes. Results This study revealed a significant genetic association of MTHFR rs1801133 polymorphism with susceptibility to generalized in general and generalized tonic-clonic epilepsy (GTCE)(p=0.018 and 0.01, respectively). Regarding ABCC2 gene, rs717620 was of linkage with generalized and GTCE subtypes (p=0.045 and 0.048, respectively), while rs717620 was associated with poor responder patients (p=0.036) with no linkage of the ABCC2 haplotypes. Conclusions MTHFR and ABCC2 polymorphisms showed an association with either epilepsy types in general or subtypes and treatment response among Jordanian population. This study also suggested that these gene polymorphisms have an important role in epilepsy development and drug effectiveness and could be of a great impact in the era of epilepsy diagnosis and treatment.
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Affiliation(s)
- Laith N Al-Eitan
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan.,Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Islam M Al-Dalalah
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamed M Mustafa
- Department of Neuroscience, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Afrah K Elshammari
- Queen Rania Hospital for Children, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Wael H Khreisat
- Queen Rania Hospital for Children, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Hanan A Aljamal
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan
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10
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Moghtadaei M, Otoukesh B, Pazoki-Toroudi H, Boddouhi B, Yeganeh A. Evaluation of inflammatory response in patients undergoing surgical treatment for early and delayed femoral fractures. Arch Med Sci 2019; 15:141-145. [PMID: 30697264 PMCID: PMC6348352 DOI: 10.5114/aoms.2016.63013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 08/21/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION It has been shown that long bone fractures are correlated with the inflammatory response. In the initial injury, surgical reduction and fixation of fractures induce the immunoinflammatory response. This study aimed to evaluate serum variation of inflammatory markers in patients undergoing surgical treatment for early and delayed femoral fractures. MATERIAL AND METHODS This study aimed to evaluate serum variation of inflammatory markers in patients undergoing surgical treatment for early and delayed femoral fractures. The patients were randomly divided into two groups using the method of block randomization including early surgery (within 24 h) and delayed surgery (after 48 h). Serum levels of inflammatory markers in both groups including interleukin (IL)-1, 5, 6, tumor necrosis factor α (TNF-α) and interferon γ (IFN-γ) were determined using specific kits. From each patient 10 ml blood was collected for cytokine assay in their serum. RESULTS Our findings suggest that serum levels of IL-8 were markedly decreased from 12 h until 48 h postoperatively (p < 0.05). Moreover, the results indicated that serum levels of TNF-α were significantly increased in the early hours, but after 48 h a decreasing trend was detected (p < 0.05). Furthermore, serum levels of IL-10, IFN-γ, and IL-6 were significantly increased from 12 h until 48 h postoperatively (p < 0.05). CONCLUSIONS The inflammatory status of the patient may be a useful adjunct in clinical decisions. With an improved understanding of the molecular basis of the inflammatory response, and by identifying relevant clinical markers of inflammation, surgeons can better manage the timing of surgical stabilization.
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Affiliation(s)
- Mehdi Moghtadaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran
| | - Babak Otoukesh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran
| | - Hamidreza Pazoki-Toroudi
- Physiology Research Center, Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahram Boddouhi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran
| | - Ali Yeganeh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, Iran
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11
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Gity M, Arabkheradmand A, Taheri E, Shakiba M. Diagnostic investigation of breast magnetic resonance imaging in malignant and benign mass lesions. Arch Med Sci 2018; 14:1061-1069. [PMID: 30154889 PMCID: PMC6111366 DOI: 10.5114/aoms.2016.62281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Breast magnetic resonance imaging (BMRI) has been identified as a valuable modality in the diagnosis of breast cancer and monitoring the response to chemotherapy. The aim of this study was to evaluate the relative importance of different descriptors of breast masses in contrast-enhanced breast MRI. MATERIAL AND METHODS In a database of pathologically proven breast lesions, in total 433 masses in 312 patients detected by contrast-enhanced breast MRI were selected. All images were assessed according to the MRI BI-RADS lexicon and those with significant positive MRI findings (BI-RADS categories 3, 4, 5) were enrolled in the study. RESULTS Mean age of patients was 45.09 ±10.5 years. The most frequent BI-RADS score was 4 (60.7%), followed by 3 (27%). Among the morphologic descriptors of the enhancing masses, the findings most strongly associated with malignancy included spiculated margin (60.6%) and irregular shape (38%). Considering the dynamic descriptors, a wash-out pattern in the time-intensity curve was the most powerful finding associated with malignancy (27.9%). Among all breast MRI descriptors, the best odds ratio (OR) in association with malignancy was noted for speculated margin (OR = 10.2) followed by wash-out or plateau curves (OR = 6.1), size greater than 1 cm (OR = 4.3) and irregular shape (OR = 3.1). CONCLUSIONS It seems that morphologic descriptors of MRI BI-RADS for enhancing masses are quite specific, while dynamic descriptors of the masses are highly sensitive. Appropriate consideration and combination of different BI-RADS findings could help in better characterization of enhancing masses on breast MRI, lowering the rate of false positive reports and avoiding unnecessary biopsies.
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Affiliation(s)
- Masoumeh Gity
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Arabkheradmand
- Department of Surgery, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Taheri
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
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