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Chanteux H, MacPherson M, Kramer H, Otoul C, Okagaki T, Rospo C, De Bruyn S, Watling M, Bani M, Sciberras D. Overview of preclinical and clinical studies investigating pharmacokinetics and drug-drug interactions of padsevonil. Expert Opin Drug Metab Toxicol 2024:1-15. [PMID: 38932723 DOI: 10.1080/17425255.2024.2373108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/23/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Padsevonil is an antiseizure medication candidate intended to benefit patients with drug-resistant epilepsy. Our investigations aimed at characterizing pharmacokinetics and drug-drug interaction (DDI) profile of padsevonil. RESEARCH DESIGN AND METHODS An overview of preclinical and clinical pharmacology studies conducted during padsevonil development is provided. RESULTS In preclinical studies, cytochrome (CYP) 3A4 was identified as the main P450 isoform involved in padsevonil metabolism, with potential minor contribution from CYP2C19. Padsevonil was shown to be a time-dependent CYP2C19-inhibitor, weak CYP3A4-inducer, weak inhibitor of P-gp/OCT1/MATE2-K, and potent OCT2-inhibitor. Initial clinical pharmacology studies in healthy participants showed that padsevonil had (i) good absorption, (ii) clearance mediated mainly by metabolism, and (iii) time-dependent kinetics. A study in genotyped participants confirmed the role of CYP2C19 in clearance and time-dependent kinetics; the major contribution of CYP3A4 was confirmed in DDI studies with CYP3A4-inducers (carbamazepine, oxcarbazepine) and -inhibitor (erythromycin). Padsevonil did not affect pharmacokinetics of valproate/lamotrigine/levetiracetam/oxcarbazepine or oral contraceptives. In a cocktail clinical study, padsevonil showed moderate CYP2C19 inhibition (omeprazole) and weak CYP3A4 induction (oral midazolam). No specific effects on CYP1A2 (caffeine), CYP2C9 (S-warfarin), and CYP2D6 (dextromethorphan) were observed. CONCLUSIONS The studies presented helped in understanding padsevonil disposition and risks of DDIs, which would inform dosing and prescribing. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov identifiers are NCT04131517, NCT03480243, NCT03695094, NCT04075409.
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Kan-Tor Y, Ness L, Szlak L, Benninger F, Ravid S, Chorev M, Rosen-Zvi M, Shimoni Y, Fisher RS. Comparing the efficacy of anti-seizure medications using matched cohorts on a large insurance claims database. Epilepsy Res 2024; 201:107313. [PMID: 38417192 DOI: 10.1016/j.eplepsyres.2024.107313] [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: 10/26/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/01/2024]
Abstract
Epilepsy is a severe chronic neurological disease affecting 60 million people worldwide. Primary treatment is with anti-seizure medicines (ASMs), but many patients continue to experience seizures. We used retrospective insurance claims data on 280,587 patients with uncontrolled epilepsy (UE), defined as status epilepticus, need for a rescue medicine, or admission or emergency visit for an epilepsy code. We conducted a computational risk ratio analysis between pairs of ASMs using a causal inference method, in order to match 1034 clinical factors and simulate randomization. Data was extracted from the MarketScan insurance claims Research Database records from 2011 to 2015. The cohort consisted of individuals over 18 years old with a diagnosis of epilepsy who took one of eight ASMs and had more than a year of history prior to the filling of the drug prescription. Seven ASM exposures were analyzed: topiramate, phenytoin, levetiracetam, gabapentin, lamotrigine, valproate, and carbamazepine or oxcarbazepine (treated as the same exposure). We calculated the risk ratio of UE between pairs of ASM after controlling for bias with inverse propensity weighting applied to 1034 factors, such as demographics, confounding illnesses, non-epileptic conditions treated by ASMs, etc. All ASMs exhibited a significant reduction in the prevalence of UE, but three drugs showed pair-wise differences compared to other ASMs. Topiramate consistently was associated with a lower risk of UE, with a mean risk ratio range of 0.68-0.93 (average 0.82, CI: 0.56-1.08). Phenytoin and levetiracetam were consistently associated with a higher risk of UE with mean risk ratio ranges of 1.11 to 1.47 (average 1.13, CI 0.98-1.65) and 1.15 to 1.43 (average 1.2, CI 0.72-1.69), respectively. Large-scale retrospective insurance claims data - combined with causal inference analysis - provides an opportunity to compare the effect of treatments in real-world data in populations 1,000-fold larger than those in typical randomized trials. Our causal analysis identified the clinically unexpected finding of topiramate as being associated with a lower risk of UE; and phenytoin and levetiracetam as associated with a higher risk of UE (compared to other studied drugs, not to baseline). However, we note that our data set for this study only used insurance claims events, which does not comprise actual seizure frequencies, nor a clear picture of side effects. Our results do not advocate for any change in practice but demonstrate that conclusions from large databases may differ from and supplement those of randomized trials and clinical practice and therefore may guide further investigation.
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Affiliation(s)
- Yoav Kan-Tor
- AI for Healthcare and Life Sciences Department, IBM Research, Haifa, Israel
| | - Lior Ness
- AI for Healthcare and Life Sciences Department, IBM Research, Haifa, Israel
| | - Liran Szlak
- AI for Healthcare and Life Sciences Department, IBM Research, Haifa, Israel
| | - Felix Benninger
- Department of Neurology, Rabin Medical Center, Petach Tikva, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Ravid
- AI for Healthcare and Life Sciences Department, IBM Research, Haifa, Israel
| | - Michal Chorev
- AI for Healthcare and Life Sciences Department, IBM Research, Haifa, Israel; Centre for Applied Research, IBM Australia, Melbourne, Australia
| | - Michal Rosen-Zvi
- AI for Healthcare and Life Sciences Department, IBM Research, Haifa, Israel; Faculty of Medicine, The Hebrew University, Jerusalem, Israel
| | - Yishai Shimoni
- AI for Healthcare and Life Sciences Department, IBM Research, Haifa, Israel
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Sathyanarayana A, El Atrache R, Jackson M, Cantley S, Reece L, Ufongene C, Loddenkemper T, Mandl KD, Bosl WJ. Measuring Real-Time Medication Effects From Electroencephalography. J Clin Neurophysiol 2024; 41:72-82. [PMID: 35583401 PMCID: PMC9669285 DOI: 10.1097/wnp.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Evaluating the effects of antiseizure medication (ASM) on patients with epilepsy remains a slow and challenging process. Quantifiable noninvasive markers that are measurable in real-time and provide objective and useful information could guide clinical decision-making. We examined whether the effect of ASM on patients with epilepsy can be quantitatively measured in real-time from EEGs. METHODS This retrospective analysis was conducted on 67 patients in the long-term monitoring unit at Boston Children's Hospital. Two 30-second EEG segments were selected from each patient premedication and postmedication weaning for analysis. Nonlinear measures including entropy and recurrence quantitative analysis values were computed for each segment and compared before and after medication weaning. RESULTS Our study found that ASM effects on the brain were measurable by nonlinear recurrence quantitative analysis on EEGs. Highly significant differences ( P < 1e-11) were found in several nonlinear measures within the seizure zone in response to antiseizure medication. Moreover, the size of the medication effect correlated with a patient's seizure frequency, seizure localization, number of medications, and reported seizure frequency reduction on medication. CONCLUSIONS Our findings show the promise of digital biomarkers to measure medication effects and epileptogenicity.
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Affiliation(s)
- Aarti Sathyanarayana
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, U.S.A.;
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, U.S.A.;
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, U.S.A.;
| | - Rima El Atrache
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Michele Jackson
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Sarah Cantley
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Latania Reece
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Claire Ufongene
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Tobias Loddenkemper
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, U.S.A.;
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, U.S.A.; and
| | - Kenneth D. Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, U.S.A.;
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, U.S.A.;
| | - William J. Bosl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, U.S.A.;
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, U.S.A.;
- Department of Health Professions, University of San Francisco, San Francisco, California, U.S.A
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Ben-Menachem E, Schmitz B, Kälviäinen R, Thomas RH, Klein P. The burden of chronic drug-refractory focal onset epilepsy: Can it be prevented? Epilepsy Behav 2023; 148:109435. [PMID: 37748414 DOI: 10.1016/j.yebeh.2023.109435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023]
Abstract
Despite the many therapeutic options for epilepsy available today, a third of patients still have poorly controlled epilepsy. Over the years, their transition through lines of treatment exposes them to increased risk of disease progression, mortality, morbidity, mental distress, and not least significantly impaired quality of life (QoL). The present review explores the multiple factors contributing to the impairment of health-related QoL in PWE-including both seizure-related and non seizure-related. The analysis aims to identify potential areas of intervention and strategies for a more holistic approach to epilepsy care and inform policy-makers and healthcare providers in their approach to this condition.
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Affiliation(s)
| | - Bettina Schmitz
- Neurology/Center for Epilepsy, Stroke Unit and Neurological Rehabilitation, Vivantes Humboldt Hospital, Berlin, Germany.
| | | | - Rhys H Thomas
- Department of Neurology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle-Upon-Tyne NE1 4LP, United Kingdom; Translational and Clinical Research Institute, Henry Wellcome Building, Framlington Place, Newcastle-Upon-Tyne NE2 4HH, United Kingdom.
| | - Pavel Klein
- Department of Neurology, George Washington University, Boston, United States.
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Yang X, Xu G, Chong Z, Liang Y, Du J, Zhao L, Chen W. Lennox-Gastaut syndrome characterized by super-refractory status epilepticus treated with high-dose anesthetics: A case report. Medicine (Baltimore) 2023; 102:e35233. [PMID: 37773787 PMCID: PMC10545281 DOI: 10.1097/md.0000000000035233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 10/01/2023] Open
Abstract
RATIONALE Super-refractory status epilepticus is a serious illness with high morbidity and mortality, which is defined as an SE that continues or recurs 24 hours or more after the onset of anesthesia. Anesthetic agents can be either pro-convulsant or anticonvulsant or both. PATIENT CONCERNS Epilepsy occurred at the age of 3 years. At the age of 4 years, generalized tonic-clonic seizure occurred for the first time. The patient was hospitalized at the age of 27 and 28 years for treating status epilepticus. At the age of 33 years, antiepileptic drugs were stopped due to poor appetite. In an early morning, the patient was found delirious with reduced speech. DIAGNOSIS Occasionally, the patient blinked his eyelids, or deflected his eyeballs to 1 side. When propofol was lowered to 10 mL/H, the epileptic wave reduced obviously. Afterwards, the patient opened his eyes autonomously and his consciousness gradually recovered. The patient could answer questions, and the limbs had voluntary movements. The patient breathing also gradually recovered, and his urine gradually returned to pale yellow from green. After anesthetic was stopped for 10 days, the patient lost his consciousness again. The patient eyes turned upward frequently, which was relieved in 1 to 2 seconds with an attack once every 2 to 5 minutes. INTERVENTIONS Clonazepam was gradually reduced to 2 mg qn, and the patient gradually woke up during this process. The patient was also treated with levetiracetam 1.5 g bid, oxcarbazepine 0.6 g bid, topiramate 50 mg bid and valproate 0.4 g tid. OUTCOMES After 1 month follow-up, status epilepticus did not appear again. LESSONS Propofol aggravated the tonic seizures. As tonic seizures occur during natural sleep and after sleep induced by various narcotic drugs, the decrease of consciousness level induced by excessive sedation of narcotic drugs has been suggested as the reason for poor seizure control.
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Affiliation(s)
- Xiaoqian Yang
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng, Shandong Province, P.R. China
| | - Guangjun Xu
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng, Shandong Province, P.R. China
| | - Zonglei Chong
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, P.R. China
| | - Yangyang Liang
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng, Shandong Province, P.R. China
| | - Jingwei Du
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng, Shandong Province, P.R. China
| | - Lin Zhao
- Department of Neurology, Dong'e County People’s Hospital, Donge County, Liaocheng, Shandong Province, P.R. China
| | - Wei Chen
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng, Shandong Province, P.R. China
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Wirrell EC, Riney K, Specchio N, Zuberi SM. How have the recent updated epilepsy classifications impacted on diagnosis and treatment? Expert Rev Neurother 2023; 23:969-980. [PMID: 37676056 DOI: 10.1080/14737175.2023.2254937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Epilepsies are a diverse group of disorders which differ regarding prognosis for seizure control and associated comorbidities. Accurate classification is critical to choose the highest yield investigations and best therapeutic options and to provide the most accurate prognoses regarding the expected degree of seizure control, possible remission, and risk of associated comorbidities to patients and their families. This article reviews the recent updates in epilepsy classification to illustrate how accurate classification impacts care for persons with epilepsy. AREAS COVERED The authors discuss the ILAE 2017 Classification of the Epilepsies along with the modification of the classification for neonatal seizures and epilepsies. They also discuss the ILAE position papers on Epilepsy syndromes in neonates and infants and children of variable age and the Idiopathic Generalized Epilepsies. EXPERT OPINION Accurate epilepsy classification allows selection of the highest yield investigations, choice of optimal therapies, and accurate prognostication of seizures (likelihood of response to antiseizure treatments and likelihood of remission with age), as well as comorbidities (likelihood, type, and severity). As we move into the era of disease modifying therapy, early accurate identification of underlying causes with timely introduction of specific treatments will be crucial to lessen the severity of epilepsy, with improved seizure control and attenuation of associated comorbidities.
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Affiliation(s)
- Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, Australia and Faculty of Medicine, University of St Lucia, Brisbane, Queensland, Australia
| | - Nicola Specchio
- Clinical and Experimental Neurology, Bambino Gesu Children's Hospital, IRCCS, Full Member of European Reference Network on Rare and Complex Epilepsies (EpiCARE), Rome, Italy
| | - Sameer M Zuberi
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Royal Hospital for Children, Glasgow, UK
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Effectiveness and tolerability of adjunctive perampanel in the treatment of pediatric patients with uncontrolled epilepsy: A retrospective, single-center, real-world study. Epilepsy Behav 2022; 137:108961. [PMID: 36327645 DOI: 10.1016/j.yebeh.2022.108961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/06/2022] [Accepted: 10/15/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The main aim of this study was to assess the efficacy, safety, and tolerability of adjunctive perampanel (PER) in the treatment of children and adolescents with epilepsy. METHODS Pediatric patients who visited the pediatric epilepsy clinic of Henan Provincial People's Hospital between May 2020 and December 2021 were recruited. All participants were treated with PER as adjunctive therapy and were seen routinely (minimum: a baseline and 12-week visit). The efficacy and tolerability of adjunctive PER for the treatment of epilepsy were investigated. RESULTS One hundred and fourteen patients were enrolled, among whom 7 (6.1%) were lost to follow-up. At 12 weeks, the responder rate and the seizure-free rate were 56.1% (60/107) and 32.7% (35/107), respectively. The responder rate increased with the duration of PER administration and was significantly higher when PER was used as an early add-on (after ≤2 prior antiseizure medications (ASMs)) than a late add-on (after >2 prior ASMs). However, there was no significant difference in the treatment efficacy of adjunctive PER in patients with different epilepsy etiologies or types. Adverse events, including irritability, dizziness, somnolence, ataxic gait, weight gain, and tinnitus, were reported in thirty-two patients (29.9%). CONCLUSIONS In a routine clinical setting of pediatric patients with epilepsy, good effectiveness and tolerability of adjunctive PER were demonstrated. Notably, patients initiating PER as an early add-on showed a better seizure outcome than those initiating PER as a late add-on.
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Yang Y, Zeng Q, Cheng M, Niu X, Xiangwei W, Gong P, Li W, Ma J, Zhang X, Yang X, Yang Z, Sun D, Zhou S, Liao J, Jiang Y, Zhang Y. GABRB3-related epilepsy: novel variants, clinical features and therapeutic implications. J Neurol 2022; 269:2649-2665. [PMID: 34698933 DOI: 10.1007/s00415-021-10834-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study aimed to comprehensively examine the genetic and phenotypic aspects of GABRB3-related epilepsy and to explore the potential prospects of personalized medicine. METHODS Genetic testing was conducted in all epilepsy patients without acquired factors for epilepsy. Through the collaboration of multicenter in China, we analyzed the genotype-phenotype correlation and antiepileptic therapy of 26 patients with GABRB3-related epilepsy. RESULTS Thirteen GABRB3 variants were novel, and 25 were de novo. The seizure onset age ranged from 1 to 21 months (median age 3.75 months). Seizure types predominated including focal seizures (92.3%), generalized tonic-clonic seizures (23.1%), and epileptic spasms (15.4%). Clinical features included cluster seizures (80.8%), fever sensitivity (53.8%), and developmental delay (96.2%). Neuroimaging was abnormal in 10 patients, including dysplasia of the cerebral cortex, dysplasia of the frontal and temporal cortex, delayed myelination, and corpus callosum dysplasia. Eleven patients were diagnosed with developmental and epileptic encephalopathy (DEE), four with West syndrome, three with epilepsy of infancy with migrating focal seizures (EIMFS), one with epilepsy with myoclonic-atonic seizures (EMAS), one with Dravet syndrome, and one with febrile seizures plus (FS+). Seizures were controlled in 57.7% of patients by valproate, levetiracetam, or perampanel in the majority. CONCLUSIONS The clinical features of GABRB3-related epilepsy included seizure onset in early infancy, cluster seizures and fever sensitivity. Most patients manifest severe epilepsy phenotypes. Valproate, levetiracetam and perampanel seem to have positive effects on seizure control for patients with GABRB3 variants.
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Affiliation(s)
- Ying Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Qi Zeng
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Miaomiao Cheng
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Xueyang Niu
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Wenshu Xiangwei
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Pan Gong
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Wenhui Li
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Jiehui Ma
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430015, China
| | - Xiaoli Zhang
- Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaoling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Dan Sun
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430015, China
| | - Shuizhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Jianxiang Liao
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Yuwu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China.
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Abstract
IMPORTANCE Epilepsy affects approximately 65 million people worldwide. Persistent seizures are associated with a 20% to 40% risk of bodily injuries (eg, fractures, burns, concussions) over 12-month follow-up. The primary goal of epilepsy treatment is to eliminate seizures while minimizing adverse effects of antiseizure drugs (ASDs). OBSERVATIONS An epileptic seizure is defined as a sudden occurrence of transient signs and symptoms caused by abnormal and excessive or synchronous neuronal activity in the brain. Focal and generalized epilepsy are the 2 most frequent types of epilepsy; diagnosis is based on the type of seizures. There are 26 US Food and Drug Administration-approved medications for epilepsy, of which 24 have similar antiseizure efficacy for focal epilepsy and 9 have similar efficacy for generalized epilepsy. The decision to initiate an ASD should be individualized, but should be strongly considered after 2 unprovoked seizures or after 1 unprovoked seizure that occurred during sleep and/or in the presence of epileptiform activity on an electroencephalogram and/or in the presence of a structural lesion on the brain magnetic resonance imaging. The ASDs must be selected based on the seizure and epilepsy types, the epilepsy syndrome, and the adverse effects associated with the drug. For focal epilepsy, oxcarbazepine and lamotrigine are first-line therapy, while levetiracetam can be also considered if there is no history of psychiatric disorder. For generalized epilepsy, the selection of the ASD is based on the type of epilepsy syndrome and the patient's sex, age, and psychiatric history. Seizure freedom is achieved in approximately 60% to 70% of all patients. A total of 25% to 50% of patients also experience neurologic, psychiatric, cognitive, or medical disorders, such as mood, anxiety, and attention deficit disorders and migraines. For these patients, selecting an ASD should consider the presence of these disorders and concomitant use of medications to treat them. ASDs with cytochrome P450 enzyme-inducing properties (eg, carbamazepine, phenytoin) may worsen comorbid coronary and cerebrovascular disease by causing hyperlipidemia and accelerating the metabolism of concomitant drugs used for their treatment. They can also facilitate the development of osteopenia and osteoporosis. CONCLUSIONS AND RELEVANCE Epilepsy affects approximately 65 million people worldwide and is associated with increased rates of bodily injuries and mortality when not optimally treated. For focal and generalized epilepsy, selection of ASDs should consider the seizure and epilepsy types and epilepsy syndrome, as well as the patient's age and sex, comorbidities, and potential drug interactions.
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Affiliation(s)
- Andres M Kanner
- Comprehensive Epilepsy Center and Epilepsy Division, Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Manuel Melo Bicchi
- Comprehensive Epilepsy Center and Epilepsy Division, Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida
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Spotnitz M, Ostropolets A, Castano VG, Natarajan K, Waldman GJ, Argenziano M, Ottman R, Hripcsak G, Choi H, Youngerman BE. Patient characteristics and antiseizure medication pathways in newly diagnosed epilepsy: Feasibility and pilot results using the common data model in a single-center electronic medical record database. Epilepsy Behav 2022; 129:108630. [PMID: 35276502 DOI: 10.1016/j.yebeh.2022.108630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Efforts to characterize variability in epilepsy treatment pathways are limited by the large number of possible antiseizure medication (ASM) regimens and sequences, heterogeneity of patients, and challenges of measuring confounding variables and outcomes across institutions. The Observational Health Data Science and Informatics (OHDSI) collaborative is an international data network representing over 1 billion patient records using common data standards. However, few studies have applied OHDSI's Common Data Model (CDM) to the population with epilepsy and none have validated relevant concepts. The goals of this study were to demonstrate the feasibility of characterizing adult patients with epilepsy and ASM treatment pathways using the CDM in an electronic health record (EHR)-derived database. METHODS We validated a phenotype algorithm for epilepsy in adults using the CDM in an EHR-derived database (2001-2020) against source records and a prospectively maintained database of patients with confirmed epilepsy. We obtained the frequency of all antecedent conditions and procedures for patients meeting the epilepsy phenotype criteria and characterized ASM exposure sequences over time and by age and sex. RESULTS The phenotype algorithm identified epilepsy with 73.0-85.0% positive predictive value and 86.3% sensitivity. Many patients had neurologic conditions and diagnoses antecedent to meeting epilepsy criteria. Levetiracetam incrementally replaced phenytoin as the most common first-line agent, but significant heterogeneity remained, particularly in second-line and subsequent agents. Drug sequences included up to 8 unique ingredients and a total of 1,235 unique pathways were observed. CONCLUSIONS Despite the availability of additional ASMs in the last 2 decades and accumulated guidelines and evidence, ASM use varies significantly in practice, particularly for second-line and subsequent agents. Multi-center OHDSI studies have the potential to better characterize the full extent of variability and support observational comparative effectiveness research, but additional work is needed to validate covariates and outcomes.
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Affiliation(s)
- Matthew Spotnitz
- Department of Biomedical Informatics, Columbia University Irving Medical Center, United States
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, United States
| | - Victor G Castano
- Department of Neurological Surgery, Columbia University Irving Medical Center, United States
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, United States
| | - Genna J Waldman
- Department of Neurology, Columbia University Irving Medical Center, United States
| | - Michael Argenziano
- Department of Neurological Surgery, Columbia University Irving Medical Center, United States
| | - Ruth Ottman
- Department of Neurology, Columbia University Irving Medical Center, United States; The Gertrude H. Sergievsky Center, Columbia University Vagelos College of Physicians and Surgeons, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, United States; Division of Translational Epidemiology, New York State Psychiatric Institute, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, United States
| | - Hyunmi Choi
- Department of Neurology, Columbia University Irving Medical Center, United States
| | - Brett E Youngerman
- Department of Neurological Surgery, Columbia University Irving Medical Center, United States.
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Adachi N, Ito M. Epilepsy in patients with schizophrenia: Pathophysiology and basic treatments. Epilepsy Behav 2022; 127:108520. [PMID: 34999502 DOI: 10.1016/j.yebeh.2021.108520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 11/03/2022]
Abstract
Schizophrenia is a chronic psychiatric disorder that may lead to epilepsy. However, there are limited findings on the issues. This narrative review aimed to provide a practical perspective on epilepsy in patients with schizophrenia using the current treatment systems for epilepsy. While there has been a debate on the relationship between epilepsy and schizophrenia, i.e., antagonism, affinity, and coincidence, recent large cohort studies have revealed a high frequency of epilepsy in patients with schizophrenia (4-5 times higher than that of general population). The high incidence observed is likely to be due to the bidirectionality between epilepsy and schizophrenia and additional schizophrenia-related conditions, e.g., antipsychotic drugs (APD), substance abuse, and head injury. As for symptomatology of epilepsy, only one small-size study showed that seizures of patients with schizophrenia are equivalent to those of patients without schizophrenia. Patients with schizophrenia exhibit the first seizure in their twenties or later, which are mostly focal seizures. Most of seizures in patients with schizophrenia can be controlled with conventional antiepileptic drugs. Few patients with schizophrenia develop treatment-resistant epilepsy. However, since drug interactions can be more complicated due to multiple conditions, such as pre-existing polypharmacy, heavy smoking, irregular eating, and comorbid metabolic disorders, cautious monitoring for clinical symptoms is required. To improve seizure control and adherence, non-pharmacological approaches are also recommended. Thus far, for seizure treatments in patients with schizophrenia, we have to use many empirical findings or substitute certain findings from population without schizophrenia because evidence is insufficient. The accumulation of clinical findings may contribute to the development of efficient treatment systems.
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Affiliation(s)
- Naoto Adachi
- Adachi Mental Clinic, Sapporo, Japan; Jozen Clinic, Sapporo, Japan.
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Ji ZY, Huang YQ, He WZ. Sodium Valproate Combined With Topiramate vs. Sodium Valproate Alone for Refractory Epilepsy: A Systematic Review and Meta-Analysis. Front Neurol 2022; 12:794856. [PMID: 35069424 PMCID: PMC8766331 DOI: 10.3389/fneur.2021.794856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Among antiepileptic drugs (AEDs), sodium valproate alone or in the combination of topiramate (TPM) for treating refractory epilepsy was controversial. This meta-analysis aimed to systematically evaluate the clinical effects of these two regimens in this population. Methods: Relevant studies up to August 2021 were identified through systematic searches of CNKI, Wanfang, PubMed, and Embase databases. We assessed the effectiveness and the frequency of absence seizures, atonic seizures, and tonic-clonic seizures. The included literature's risk of bias was evaluated using the Cochrane Collaboration's Risk of Bias tool. Sensitivity analysis was conducted to confirm the results' stability. STATA 15.0 was utilized for all pooled analyses in the included studies. Results: Totally 10 articles were determined for our meta-analysis, involving 976 patients with epilepsy in total (combined group, n = 488; monotherapy group, n = 488). The results of this meta-analysis indicated that the total effective rate of sodium valproate combined with TPM was higher than that of sodium valproate alone (random-effect model: OR = 3.52; 95% CI 1.47 to 8.47; p < 0.001; I 2 = 73.8%). The frequency of absence seizures in the combined group was lower (fixed-effect model: WMD = -6.02; 95% CI -6.50 to -5.54; I 2 = 0.0%) than that in the monotherapy group, with a statistical difference (p < 0.05). The combined group had lower frequency of atonic seizures (WMD = -4.56, 95% CI -6.02 to -3.10; I 2 = 82.6%) and lower frequency of tonic-clonic seizures (WMD = -3.32; 95% CI -4.75 to -1.89; I 2 = 96.4%). In addition, the distinct difference of adverse events was non-existent between two groups. Conclusions: Sodium valproate combined with TPM was more effective than sodium valproate alone for epilepsy therapy. This meta-analysis provides feasibility data for a larger-scale study on AED therapy of refractory epilepsy and may contribute to better therapy strategies for epilepsy clinically.
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Affiliation(s)
- Zhen-Ye Ji
- The Second Department of Neurology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yi-Qian Huang
- Department of Internal Neurology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Wen-Zhen He
- Department of Internal Neurology, First Affiliated Hospital of Shantou University Medical College, Shantou, China
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Liang D, Gardella E, Kragholm K, Polcwiartek C, Sessa M. The Relationship Between Valproate and Lamotrigine/Levetiracetam Use and Prognosis in Patients With Epilepsy and Heart Failure: A Danish Register-Based Study. J Card Fail 2021; 28:630-638. [PMID: 34438055 DOI: 10.1016/j.cardfail.2021.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/08/2021] [Accepted: 07/28/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the hazard for all-cause mortality and mortality due to heart failure (HF) between valproate (VPA) and levetiracetam (LEV)/lamotrigine (LTG) users in patients aged ≥ 65 with comorbidities of epilepsy and HF. METHODS This was a cohort study using Danish registers during the period from January 1996 to July 2018. The study population included new users of LTG, LEV or VPA. A Cox regression model was used to compute crude and adjusted hazard ratios for the outcome, using an intention-to-treat approach. Average treatment effects (eg, 1-year absolute risks), risk differences and the ratio of risks were computed using the G-formula based on a Cox regression model for the outcomes at the end of the follow-up period. RESULTS We included 1345 subjects in the study population. VPA users (n = 696), when compared to LTG/LEV users (n = 649), had an increased hazard of mortality due to HF (hazard ratio [HR] 2.39; 95% CI 1.02-5.60) and to all-cause mortality (HR 1.37; 95% CI 1.01-1.85) in both crude and adjusted analyses. The 1-year absolute risks for all-cause mortality were 29% (95% CI 25%-33%) and 22% (95% CI 18%-26%) for VPA and LTG/LEV users. For mortality due to HF, 1-year absolute risks were 5% (95% CI 3%-7%) and 2% (95% CI 1%-4%) for VPA and LTG/LEV users. The average risk ratio, with LTG/LEV as the reference group, was 1.31 (95% CI 1.02-1.71) for all-cause mortality and 2.35 (95% CI 1.11-5.76) for HF mortality. CONCLUSION In older people with HF and epilepsy, treatment with VPA was associated with a higher risk of all-cause and HF mortality compared to treatment with LTG and LEV.
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Affiliation(s)
- David Liang
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Elena Gardella
- Department of Epilepsy Genetics, Danish Epilepsy Centre Filadelfia, Dianalund, Denmark, and University of Southern Denmark, Odense, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
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Xu C, Pan L, Zhang Y, Zhang J, Sun Q, Fang W. Assessing carbamazepine and oxcarbazepine-associated Stevens-Johnson syndrome/toxic epidermal necrolysis: Data mining the public version of the FDA adverse event reporting system. Int J Clin Pract 2021; 75:e14273. [PMID: 33908133 DOI: 10.1111/ijcp.14273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 04/20/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS Stevens-Johnson syndrome and toxic epidermal necrolysis are viewed as the most severe drug-induced types of cutaneous adverse reactions, with high rates of morbidity and mortality. We aimed to examine carbamazepine- and oxcarbazepine-associated Stevens-Johnson syndrome or toxic epidermal necrolysis, by data mining the US Food and Drug Administration Adverse Event Reporting System (FAERS). METHODS Reports in FAERs were analysed, from the first quarter of 2004 to the last quarter of 2019. Pharmacovigilance tools were employed for the quantitative detection of signals, where a signal represents a drug-associated adverse event, including the reporting odds ratio, proportional reporting ratio, an information component given by a Bayesian confidence propagation neural network, and the empirical Bayes geometric mean. RESULTS The total number of reports identified as Stevens-Johnson syndrome or toxic epidermal necrolysis associated with carbamazepine or oxcarbazepine included in this study was 1231. FAERS reports associated with carbamazepine were 1048, including Stevens-Johnson syndrome (n = 668) and toxic epidermal necrolysis(n = 380). FAERS reports associated with oxcarbazepine were 183, including 142 Stevens-Johnson syndrome and 41 toxic epidermal necrolysis reports. The risk for Stevens-Johnson syndrome is higher than for toxic epidermal necrolysis and carbamazepine is associated with a higher risk than oxcarbazepine. CONCLUSIONS The results of our study are consistent with clinical observations, suggesting the necessity for further clinical research on Stevens-Johnson syndrome and toxic epidermal necrolysis associated with carbamazepine or oxcarbazepine.
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Affiliation(s)
- Caibing Xu
- Department of Pharmacy, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Department of Pharmacy, Chongqing Three Gorges Central Hospital, Chongqing, P.R. China
| | - Lingyun Pan
- Department of Pharmacy, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Department of Pharmacy, Chongqing Three Gorges Central Hospital, Chongqing, P.R. China
| | - Yuxia Zhang
- Department of Pharmacy, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Department of Pharmacy, Chongqing Three Gorges Central Hospital, Chongqing, P.R. China
| | - Jinghua Zhang
- Department of Pharmacy, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Department of Pharmacy, Chongqing Three Gorges Central Hospital, Chongqing, P.R. China
| | - Qiuyan Sun
- Department of Pharmacy, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Department of Pharmacy, Chongqing Three Gorges Central Hospital, Chongqing, P.R. China
| | - Wei Fang
- Department of Pharmacy, Chongqing University Three Gorges Hospital, Chongqing, P.R. China
- Department of Pharmacy, Chongqing Three Gorges Central Hospital, Chongqing, P.R. China
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15
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Brock DC, Demarest S, Benke TA. Clinical Trial Design for Disease-Modifying Therapies for Genetic Epilepsies. Neurotherapeutics 2021; 18:1445-1457. [PMID: 34595733 PMCID: PMC8609073 DOI: 10.1007/s13311-021-01123-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 02/04/2023] Open
Abstract
Although trials with anti-seizure medications (ASMs) have not shown clear anti-epileptogenic or disease-modifying activity in humans to date, rapid advancements in genomic technology and emerging gene-mediated and gene replacement options offer hope for the successful development of disease-modifying therapies (DMTs) for genetic epilepsies. In fact, more than 26 potential DMTs are in various stages of preclinical and/or clinical development for genetic syndromes associated with epilepsy. The scope of disease-modification includes but is not limited to effects on the underlying pathophysiology, the condition's natural history, epilepsy severity, developmental achievement, function, behavior, sleep, and quality of life. While conventional regulatory clinical trials for epilepsy therapeutics have historically focused on seizure reduction, similarly designed trials may prove ill-equipped to identify these broader disease-modifying benefits. As we look forward to this pipeline of DMTs, focused consideration should be given to the challenges they pose to conventional clinical trial designs for epilepsy therapeutics. Just as DMTs promise to fundamentally alter how we approach the care of patients with genetic epilepsy syndromes, DMTs likewise challenge how we traditionally construct and measure the success of clinical trials. In the following, we briefly review the historical and preclinical frameworks for DMT development for genetic epilepsies and explore the many novel challenges posed for such trials, including the choice of suitable outcome measures, trial structure, timing and duration of treatment, feasible follow-up period, varying safety profile, and ethical concerns.
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Affiliation(s)
- Dylan C Brock
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
- Children's Hospital Colorado, Aurora, CO, 80045, USA.
| | - Scott Demarest
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Tim A Benke
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Departments of Neurology, Pharmacology, and Otolaryngology, University of Colorado School of Medicine, CO, 80045, Aurora, USA
- Children's Hospital Colorado, Aurora, CO, 80045, USA
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16
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Smegal LF, Sebold AJ, Hammill AM, Juhász C, Lo WD, Miles DK, Wilfong AA, Levin AV, Fisher B, Ball KL, Pinto AL, Comi AM. Multicenter Research Data of Epilepsy Management in Patients With Sturge-Weber Syndrome. Pediatr Neurol 2021; 119:3-10. [PMID: 33813331 PMCID: PMC8162684 DOI: 10.1016/j.pediatrneurol.2021.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Epilepsy in typical Sturge-Weber syndrome (SWS) is common, and many questions remain regarding the treatment outcomes. We analyzed a large multicenter database with focus on neurological drug treatment in different demographic and SWS characteristic groups. METHODS A total of 268 patients with brain involvement and a history of seizures were selected from a research data registry generated from a multicenter cross-sectional questionnaire. We examined associations between medication use and binary variables such as sex, ethnicity, and brain, skin, and eye involvement laterality. We analyzed group differences in mean number of antiseizure medications and age at diagnosis, enrollment, and seizure onset and examined differences in median SWS neurological scores in groups of interest. RESULTS The most frequently used medications were levetiracetam (48.1%), low-dose aspirin (44.8%), oxcarbazepine (39.9%), and phenobarbital (14.9%). Lamotrigine was more frequently used in adults than in children (P = 0.001). History of neurosurgery was associated with no current antiseizure medication use (P = 0.001), whereas bilateral brain involvement and family history of seizures were associated with using a higher number of antiseizure medications (P = 0.002, P = 0.027, respectively). Subjects with bilateral brain involvement and early seizure onset were associated with using a higher number of antiseizure medications (P = 0.002) and phenobarbital use (0.003). CONCLUSIONS Levetiracetam, low-dose aspirin, and oxcarbazepine were the most frequently used medications. More severely affected patients were frequently on a greater number of antiseizure medications. Surgery for epilepsy was associated with the ability to discontinue antiseizure medication. Longitudinal studies are needed to further investigate medication use in patients with SWS.
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Affiliation(s)
- Lindsay F. Smegal
- Department of Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland
| | - Alison J. Sebold
- Department of Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland
| | - Adrienne M. Hammill
- Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Csaba Juhász
- Departments of Pediatrics, Neurology, and Neurosurgery, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit, Michigan
| | - Warren D. Lo
- Neurology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Daniel K. Miles
- Department of Neurology, Pediatric Epilepsy, New York University Langone Health, New York, New York
| | - Angus A. Wilfong
- Neurology, Barrow Neurological Institute, Phoenix Children’s Hospital, Phoenix, Arizona
| | - Alex V. Levin
- Pediatric Ophthalmology and Ocular Genetics, Flaum Eye Institute, Golisano Children’s Hospital, University of Rochester, Rochester, New York
| | | | | | - Anna L. Pinto
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anne M. Comi
- Department of Neurology, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Pediatrics, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland,Communications should be addressed to: Dr. Comi; Department of Neurology; Hugo Moser Kennedy Krieger Research Institute; Rm 553, Kennedy Krieger Outpatient Bldg, 801 North Broadway; Baltimore, MD 21205. (A.M. Comi)
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Seo JG, Cho YW, Kim KT, Kim DW, Yang KI, Lee ST, Byun JI, No YJ, Kang KW, Kim D. Pharmacological Treatment of Epilepsy in Elderly Patients. J Clin Neurol 2020; 16:556-561. [PMID: 33029960 PMCID: PMC7542002 DOI: 10.3988/jcn.2020.16.4.556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
The incidence and prevalence of epilepsy are highest in elderly people, and the etiologies of epilepsy in the elderly differ from those in other age groups. Moreover, diagnosing and treating epilepsy in elderly people may be challenging due to differences in clinical characteristics and physiological changes associated with aging. This review focuses on the pharmacological treatment of epilepsy in elderly patients.
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Affiliation(s)
- Jong Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Yong Won Cho
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
| | - Keun Tae Kim
- Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Wook Kim
- Department of Neuroloy, Konkuk University School of Medicine, Seoul, Korea
| | - Kwang Ik Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Soon Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Young Joo No
- Department of Neurology, Samsung Noble County, Yongin, Korea
| | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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Gedela S, Freedman DA, Gedela S, Glynn P, Salvator A, Patel AD. Safety and Efficacy of Supratherapeutic Doses of Clobazam. J Child Neurol 2019; 34:735-738. [PMID: 31215313 DOI: 10.1177/0883073819856834] [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] [Indexed: 01/04/2023]
Abstract
Clobazam is a commonly used long-acting benzodiazepine approved by the US Food and Drug Administration (FDA) to treat seizures associated with Lennox Gastaut syndrome. The FDA approved maximum dosage of clobazam is 1 mg/kg/d or a total of 40 mg a day. Many providers exceed this dosage but there is limited data on the safety, tolerability, and efficacy of supratherapeutic doses. We reviewed retrospective data at our institution and compared patients on supratherapeutic doses to patients on therapeutic doses. A total of 133 patients met inclusion criteria (65 supratherapeutic, 67 therapeutic). There was no statistically significant difference in terms of seizure control, health care utilization, or side effects between patients on supratherapeutic doses and those on therapeutic doses. This study lends further support to the safety and tolerability of supratherapuetic doses of clobazam.
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Affiliation(s)
- Sravya Gedela
- 1 Department of Pediatrics and Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel A Freedman
- 1 Department of Pediatrics and Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Satyanarayana Gedela
- 1 Department of Pediatrics and Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter Glynn
- 1 Department of Pediatrics and Neurology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ann Salvator
- 2 Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anup D Patel
- 1 Department of Pediatrics and Neurology, Nationwide Children's Hospital, Columbus, OH, USA
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Jędrzejczak J, Majkowska-Zwolińska B, Ryglewicz D, Nagańska E, Mazurkiewicz-Bełdzińska M. Recommendations of the Polish Society of Epileptology for the treatment of epileptic seizure in adult patients in Poland: an update. JOURNAL OF EPILEPTOLOGY 2019. [DOI: 10.21307/jepil-2019-002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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