1
|
Lim SN, Wu T, Chang CW, Johnny Tseng WE, Cheng MY, Hsieh HY, Lee CH, Lin WR, Liu CJ, Chen PR, Lin CN. Clinical impact of therapeutic drug monitoring for newer anti-seizure medications in patients with epilepsy: A real-world observation study. Biomed J 2023:100680. [PMID: 38036171 DOI: 10.1016/j.bj.2023.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/18/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The clinical value of therapeutic drug monitoring (TDM) for newer anti-seizure medications (ASMs) remains uncertain. This study aimed to assess the impact of newer ASM TDM on clinical decision making in patients with epilepsy. METHODS We retrospectively identified all plasma requests for newer ASM level measurement as part of routine clinical management in the outpatient departments of seven medical institutes across Taiwan between September 2016 and May 2019. Data collected from reviewed medical records included clinical and medication details, indications for TDM request, test results, interpretation, and impact on patient management. RESULTS A total of 682 visits with 1051 plasma samples were included. The most frequently analyzed ASMs were levetiracetam (36.1%), oxcarbazepine (18.4%), and lamotrigine (12.0%). Reasons for TDM included poorly controlled seizures (55.3%), concerns about drug-drug interactions (12.3%), and suspicion of drug overdose (10.6%). 68.8% of samples were within the orienting therapeutic range, even for patients with poorly controlled seizures. TDM for non-adherence concerns showed 54.3% below the orienting therapeutic range, while ASM-related adverse events assessment only 8.9% showed levels exceeding the orienting therapeutic range. Following TDM results, 64.2% of cases had medication adjustments, mainly dosage increases. Overall, 55.9% of newer ASM TDM visit showed improved outcomes, including reduced seizures (47.5%) and fewer ASM-related side effects (8.4%). CONCLUSIONS These findings suggest that appropriate utilization of TDM for newer ASMs provides clinical benefits in adjunct to complement clinical decision making in the management of epilepsy patients in a real-world clinical setting.
Collapse
Affiliation(s)
- Siew-Na Lim
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Tony Wu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Wei Chang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-En Johnny Tseng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiang-Yao Hsieh
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hong Lee
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wey-Ran Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Jing Liu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taiwan
| | - Po-Ru Chen
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taiwan
| | - Chia-Ni Lin
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
2
|
Lim SN, Wu T, Tseng WEJ, Chang CW, Hsieh HY, Cheng MY, Chiang HI, Lee CH, Lin WR, Liu CJ. Juvenile Myoclonic Epilepsy: Seizure and Social Outcomes in Taiwan. Healthcare (Basel) 2023; 11:healthcare11081197. [PMID: 37108031 PMCID: PMC10138449 DOI: 10.3390/healthcare11081197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Patients with juvenile myoclonic epilepsy (JME) may not achieve seizure freedom despite optimal treatment with antiseizure medications (ASMs). The aim of this study was to investigate the clinical and social features of patients with JME, and to determine the factors associated with outcomes. We retrospectively identified 49 patients with JME (25 females, mean age 27.6 ± 8.9 years) who were assessed at the Epilepsy Centre of Linkou Chang Gung Memorial Hospital in Taiwan. The patients were divided into two groups, those who were seizure-free and those with ongoing seizures according to their seizure outcome at the last follow-up for one year. Clinical features and social status were compared between these two groups. Twenty-four (49%) of the JME patients were seizure-free for at least one year, while 51% continued to experience seizures despite being treated with multiple ASMs. The presence of epileptiform discharges in the last electroencephalogram and seizures during sleep were significantly associated with worse seizure outcomes (p < 0.05). The patients who were seizure-free had a higher employment rate compared to those who continued to experience seizures (75% vs. 32%, p = 0.004). Despite receiving ASM treatment, a considerable proportion of the patients with JME continued to have seizures. Moreover, poor seizure control was associated with a lower employment rate, which may lead to negative socioeconomic consequences related to JME.
Collapse
Affiliation(s)
- Siew-Na Lim
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tony Wu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-En Johnny Tseng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan 333, Taiwan
| | - Chun-Wei Chang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsiang-Yao Hsieh
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Mei-Yun Cheng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsing-I Chiang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chih-Hong Lee
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wey-Ran Lin
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
| | - Chun-Jing Liu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan
| |
Collapse
|
3
|
Wang YC, Cheng MY, Hung PC, Kuo CY, Hsieh HY, Lin KL, Tu PH, Wu CT, Hsu PW, Wei KC, Chuang CC. Robot-Assisted Radiofrequency Ablation Combined with Thermodynamic Simulation for Epilepsy Reoperations. J Clin Med 2022; 11:jcm11164804. [PMID: 36013044 PMCID: PMC9409811 DOI: 10.3390/jcm11164804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
Repeat craniotomies to treat recurrent seizures may be difficult, and minimally invasive radiofrequency ablation is an alternative therapy. On the basis of this procedure, we aimed to develop a more reliable methodology which is helpful for institutions where real-time image monitoring or electrophysiologic guidance during ablation are not available. We used simulation combined with a robot-assisted radiofrequency ablation (S-RARFA) protocol to plan and execute brain epileptic tissue lesioning. Trajectories of electrodes were planned on the robot system, and time-dependent thermodynamics was simulated with radiofrequency parameters. Thermal gradient and margin were displayed on a computer to calculate ablation volume with a mathematic equation. Actual volume was measured on images after the ablation. This small series included one pediatric and two adult patients. The remnant hippocampus, corpus callosum, and irritative zone around arteriovenous malformation nidus were all treated with S-RARFA. The mean error percentage of the volume ablated between preoperative simulation and postoperative measurement was 2.4 ± 0.7%. No complications or newly developed neurologic deficits presented postoperatively, and the patients had little postoperative pain and short hospital stays. In this pilot study, we preliminarily verified the feasibility and safety of this novel protocol. As an alternative to traditional surgeries or real-time monitoring, S-RARFA served as successful seizure reoperation with high accuracy, minimal collateral damage, and good seizure control.
Collapse
Affiliation(s)
- Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Mei-Yun Cheng
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Neurology, Change Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Po-Cheng Hung
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Pediatric Neurology, Chang Gung Children’s Hospital, Taoyuan 333, Taiwan
| | - Cheng-Yen Kuo
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Pediatrics, Chang Gung Children’s Hospital, Taoyuan 333, Taiwan
| | - Hsiang-Yao Hsieh
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Neurology, Change Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Kuang-Lin Lin
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Pediatric Neurology, Chang Gung Children’s Hospital, Taoyuan 333, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kuo-Chen Wei
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Neurosurgery, New Taipei Municipal Tu Cheng Hospital, Chang Gung Medical Foundation, Taipei 236, Taiwan
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200 (ext. 2412)
| |
Collapse
|
4
|
Lim SN, Cheng MY, Hsieh HY, Chiang HI, Wu T. Treatment of pharmacoresistant sleep-related hypermotor epilepsy (SHE) with the selective AMPA receptor antagonist perampanel. Sleep Med 2021; 81:382-386. [PMID: 33831666 DOI: 10.1016/j.sleep.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 10/21/2022]
Abstract
This study aimed to evaluate the efficacy and tolerability of perampanel (PER) as adjunctive therapy in patients with pharmacoresistant sleep-related hypermotor epilepsy (SHE). Patients diagnosed with SHE who received PER treatment between 2016 and 2019 were included, and their data were reviewed retrospectively. Diagnosis was based on reports of patients or family members witnessing the events and clinical characteristics of seizures captured by video or during video-electroencephalography monitoring. Among 36 SHE patients, 20 with pharmacoresistant SHE (six female; mean age: 34.1 ± 9.0 years) who received PER as adjunctive therapy were included in this study. Fourteen out of the 20 patients received PER with mean length of PER exposure of 24.6 ± 15.7 months: 10 of them were responders and four non-responders. The remaining six patients discontinued PER for adverse events (n = 5) and patient choice (n = 1). Among the 10 responders, six (60%) reported seizure-free periods lasting ≥6 months. The most common PER-associated adverse event was dizziness (25%) followed by malaise (10%). Clinical experience with these patients demonstrated that PER might be considered as an add-on anti-seizure medication for patients with highly pharmacoresistant SHE.
Collapse
Affiliation(s)
- Siew-Na Lim
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiang-Yao Hsieh
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsing-I Chiang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Neurology, Xiamen Chang Gung Hospital, Xiamen, Fujian, China.
| |
Collapse
|
5
|
Wu T, Chuang YC, Huang HC, Lim SN, Hsieh PF, Lee WT, Cheng MY, Tsai MH, Jou SB, Chang CW, Hsieh HY, Du X, Hellot S, McClung C, Hung C. A prospective, multicenter, noninterventional study in Taiwan to evaluate the safety and tolerability of lacosamide as adjunctive therapy for epilepsy in clinical practice. Epilepsy Behav 2020; 113:107464. [PMID: 33152580 DOI: 10.1016/j.yebeh.2020.107464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE Lacosamide (LCM) was initially approved in Taiwan in March 2014 for use as adjunctive therapy for focal impaired awareness seizures and secondarily generalized seizures (SGS) in patients with epilepsy ≥16 years of age. The efficacy and tolerability of adjunctive LCM for the treatment of patients with focal seizures have been demonstrated in randomized, placebo-controlled trials. However, the trials do not reflect a flexible dose setting. This study (EP0063) was conducted to assess the safety and tolerability of LCM in real-world clinical practice in Taiwan. Effectiveness of LCM was also assessed as an exploratory objective. METHODS EP0063 was a multicenter, prospective, noninterventional study with an expected observation period of 12 months ± 60 days. Eligible patients were ≥16 years of age, had focal impaired awareness seizures and/or SGS (in line with approved indication in Taiwan at the time of the study), were taking at least one concomitant antiseizure medication (ASM), and had at least one seizure in the 3 months before baseline. Patients were prescribed LCM by their treating physician in the course of routine clinical practice. The primary safety variable was treatment-emergent adverse events (TEAEs) spontaneously reported to, or observed by, the treating physician. Based on safety data from previous studies of LCM and known side effects of other ASMs, certain TEAEs (including but not limited to cardiac and electrocardiogram, suicidality, and rash related terms) were analyzed separately. Effectiveness variables included Clinical Global Impression of Change (CGIC) and change in 28-day seizure frequency from baseline to 12 months (or final visit), and freedom from focal seizures. RESULTS A total of 171 patients were treated with LCM, of whom 139 (81.3%) completed the study. The Kaplan-Meier estimated 12-month retention was 82.9%. Patients had a mean (standard deviation [SD], range) age of 38.5 (14.0, 16-77) years, and 96 (56.1%) were male. Patients were taking a mean (SD, range) of 2.8 (1.1, 1-6) ASMs at baseline. Mean (SD, range) duration of LCM treatment was 288.7 (111.9, 2-414) days, and the mean (SD, range) daily dosage of LCM was 205.0 (82.7, 50.0-505.2) mg/day. Overall, 95 (55.6%) patients reported at least one TEAE, most commonly dizziness (33 [19.3%] patients). Drug-related TEAEs were reported in 74 (43.3%) patients, and drug-related TEAEs leading to discontinuation of LCM were reported in 14 (8.2%) patients. Two (1.2%) patients died during LCM treatment, which were considered not related to LCM. Two (1.2%) patients had suicidality-related TEAEs; these TEAEs were considered either not related to LCM or the relationship was not recorded. Rash-related TEAEs were reported in five (2.9%) patients (considered LCM-related in two patients). Based on the CGIC, at 12 months (or final visit), 109 (63.7%) patients were considered to have improved, 54 (31.6%) had no change, and the remaining eight (4.7%) were minimally worse. At 12 months (or final visit), the median percentage change in focal seizure frequency was -50.0. During the first 6 months of the study, 21 (12.3%) patients were free from focal seizures; 37 (21.6%) patients were free from focal seizures in the last 6 months of the study; and 14 (8.2%) were free from focal seizures for the full 12 months of the study. CONCLUSIONS Results of this prospective, noninterventional study suggest that adjunctive LCM was generally safe and well tolerated in this patient group in real-world practice in Taiwan. Effectiveness was also favorable, with more than 60% of patients considered to be improved by their physician at 12 months (or final visit).
Collapse
Affiliation(s)
- Tony Wu
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan; Department of Neurology, Xiamen Changgung Hospital, No. 123 Xiafei Road, Haicang District, Xiamen, China.
| | - Yao-Chung Chuang
- Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung Branch, No. 123, Dapi Road, Niaosong District, Kaohsiung 833, Taiwan.
| | - Hui-Chun Huang
- Department of Neurology, China Medical University Hospital, No. 2, Yude Road, North District, Taichung 404, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Peiyuan F Hsieh
- Neurological Institute, Division of Epilepsy, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung 407, Taiwan.
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei 100, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Meng-Han Tsai
- Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung Branch, No. 123, Dapi Road, Niaosong District, Kaohsiung 833, Taiwan.
| | - Shuo-Bin Jou
- Department of Neurology, MacKay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Zhongshan District, Taipei 104, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Hsiang-Yao Hsieh
- Department of Neurology, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Guishan District, Taoyuan 333, Taiwan.
| | - Xinlu Du
- UCB Pharma, 14 Taikoo Wan Road, Taikoo, Hong Kong, China
| | - Scarlett Hellot
- UCB Pharma, Alfred-Nobel-Straße 10, 40789 Monheim am Rhein, Germany.
| | - Carrie McClung
- UCB Pharma, 8010 Arco Corporate Drive, Raleigh, NC 27617, USA.
| | - Connie Hung
- UCB Pharma, 12th Floor-2, No.88, Dunhua North Road, Songshan District, Taipei 10551, Taiwan.
| |
Collapse
|
6
|
Li HT, Lee CH, Wu T, Cheng MY, Tseng WEJ, Chang CW, Hsieh HY, Chiang HI, Lin CY, Chang BL, Lin WR, Lim SN. Clinical, Electroencephalographic Features and Prognostic Factors of Cefepime-Induced Neurotoxicity: A Retrospective Study. Neurocrit Care 2020; 31:329-337. [PMID: 30756319 DOI: 10.1007/s12028-019-00682-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The incidence of cefepime-induced neurotoxicity (CIN) has been previously underestimated, and there have only been sporadic reports from critical neurological settings. The present study aimed to investigate the potential factors associated with disease development, electroencephalography (EEG) sub-classification, and outcome measures. METHODS The 10-year medical records of patients who underwent EEG between 2007 and 2016 at a tertiary medical center in Taiwan, and developed encephalopathy after cefepime therapy were retrospectively reviewed. Age- and sex-matched controls were included for further analysis. Demographic data, the occurrence of clinical seizures, non-convulsive status epilepticus (NCSE), use of antiepileptic drugs (AEDs), receiving maintenance or urgent hemodialysis, EEG findings, and functional outcomes were analyzed. The Chi-square test and a logistic regression model were applied to survey significant prognostic factors relating to mortality. RESULTS A total of 42 CIN patients were identified, including 25 patients from wards and 17 from intensive care units; their mean age was 75.8 ± 11.8 years. Twenty-one patients (50%) had chronic kidney disease, and 18 (43%) had acute kidney injury. Among these patients, 32 (76%) received appropriate cefepime dose adjustment. Three patients had a normal renal function at the time of CIN onset. The logistic regression model suggested that maintenance hemodialysis and longer duration of cefepime use were independently associated with the development of CIN, with odds ratios of 3.8 and 1.2, respectively. NCSE was frequently noted in the CIN patients (64%). Generalized periodic discharge with or without triphasic morphology was the most common EEG pattern (38%), followed by generalized rhythmic delta activity and generalized spike-and-waves. AEDs were administered to 86% of the patients. A total of 17 patients (40%) did not survive to hospital discharge. Adequate cefepime dose adjustment and early cefepime discontinuation led to a better prognosis. CONCLUSIONS CIN was associated with high mortality and morbidity rates. Neurotoxic symptoms could still occur when the cefepime dose was adjusted, or in patients with normal renal function. Patients with maintenance hemodialysis or a longer duration of cefepime therapy tended to develop CIN. Early recognition of abnormal EEG findings allowed for the withdrawal of the offending agent, resulting in clinical improvements and a better prognosis at discharge.
Collapse
Affiliation(s)
- Han-Tao Li
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chih-Hong Lee
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Tony Wu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Mei-Yun Cheng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Wei-En Johnny Tseng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chun-Wei Chang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Hsiang-Yao Hsieh
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Hsing-I Chiang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Chih-Yin Lin
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Bao-Luen Chang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan
| | - Wey-Ran Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, 333, Taiwan
| | - Siew-Na Lim
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, 5 Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan.
| |
Collapse
|
7
|
Hsieh HY, Chang CW, Cheng MY, Yan JL, Lim SN, Tseng WEJ, Chiang HI, Li HT, Chang BL, Lee CH, Lin CY, Wu T, Chang CN. Aggressive cytoreduction and multiple subpial cortical transections may obtain good surgical outcomes in refractory epilepsy with multiple epileptic foci. Biomed J 2020; 44:346-352. [PMID: 34183308 PMCID: PMC8358210 DOI: 10.1016/j.bj.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 11/25/2022] Open
Abstract
Backgrounds Epilepsy surgery is the most efficacious therapeutic modality for patients with medical refractory epilepsy, especially resective surgery. However, the variable etiologies and multiple epileptic foci are usually associated with the outcomes. The aim of this study was to demonstrate that combination of different intervention procedures might be an alternative option for patients of refractory epilepsy. Methods We retrospectively analyzed pre-operative and post-surgical outcomes in 30 patients who received epilepsy surgery between January 1, 2010 and December 31, 2014 at Chang Gung Memorial Hospital (CGMH), Linkou, according to Engel's classification. Results Twenty-six of the 30 patients (86.7%) had good outcomes, sum of class I and class II after epilepsy surgery. The good outcome rate of our complicated group was 80.0% (12/15), compared to 93.3% (14/15) in the simple group, but no significant differences between the two groups (p = 0.569). Four patients whose epileptic foci involved eloquent area and received multiple subpial cortical transection, and good outcome rate was 75% (3/4). At last, six patients had previously failed epilepsy surgery and received a reoperation, with a good outcome rate of 83.3% (5/6). Conclusion After complete pre-surgical evaluation and combined interventional procedures, the patients with refractory epilepsy had satisfactory outcomes and few neurological complications. Moreover, re-operation can improve the outcome in some patients who previously failed epilepsy surgery.
Collapse
Affiliation(s)
- Hsiang-Yao Hsieh
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Jiun-Lin Yan
- Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-En Johnny Tseng
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Program in Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsing-I Chiang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Tao Li
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Bao-Luen Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hong Lee
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih Yin Lin
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Neurology, Xiamen Chang Gung Hospital, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chen-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Neurosurgery, Xiamen Chang Gung Hospital, China; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
8
|
Lin CY, Lim SN, Chiangn HI, Cheng MY, Chang CW, Tseng WEJ, Hsieh HY, Li HT, Wu T. Effectiveness and safety of perampanel in adults with mesial temporal epilepsy: A single-center postmarketing study in Taiwan. Medicine (Baltimore) 2019; 98:e17171. [PMID: 31626082 PMCID: PMC6824632 DOI: 10.1097/md.0000000000017171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Mesial temporal lobe epilepsy (MTLE) is a common epilepsy syndrome often refractory to antiepileptic drug (AED) treatment. The purpose of this study was to evaluate the effectiveness and tolerability of perampanel (PER) as add-on treatment for patients of MTLE.We pooled retrospective data from adult patients with MTLE, from a tertiary center in Taiwan, who were prescribed PER between March 2016 and December 2016. The retention, responder, and seizure-free rate as well as the treatment emergent adverse events were assessed after 6 months of PER adjunctive treatment in this single-center postmarketing study.Review of medical records revealed that adequate data were available for 44 patients who were being administered PER (mean age: 42.0 ± 13.3 years, 24 females; baseline mean seizure frequency: 5.4 per 28 days). Twelve patients exhibited hippocampal sclerosis (HS). Open-label PER was added to ongoing medications. Twelve patients withdrew because of ineffectiveness (n = 6) or adverse effects (n = 6). The retention rate was 72.7% at 6 months. On final evaluation, with a mean PER dose of 5.7 mg/day for 6 months, a ≥50% reduction in seizure frequency was observed in 46.9% of the patients, and 5 patients became seizure-free. The effectiveness was similar for patients with or without HS. Twenty-three patients (52.3%) experienced adverse effects. The most common adverse effects were dizziness, ataxia, and irritability.Our results suggest that PER, at doses of 2 to 12 mg/day, reduces seizure frequency effectively with acceptable safety profiles for adults with MTLE.
Collapse
|
9
|
Tseng WEJ, Lim SN, Chen LA, Jou SB, Hsieh HY, Cheng MY, Chang CW, Li HT, Chiang HI, Wu T. Correlation of vocals and lyrics with left temporal musicogenic epilepsy. Ann N Y Acad Sci 2018; 1423:188-197. [PMID: 29542128 DOI: 10.1111/nyas.13594] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/19/2017] [Accepted: 12/11/2017] [Indexed: 01/10/2023]
Abstract
Whether the cognitive processing of music and speech relies on shared or distinct neuronal mechanisms remains unclear. Music and language processing in the brain are right and left temporal functions, respectively. We studied patients with musicogenic epilepsy (ME) that was specifically triggered by popular songs to analyze brain hyperexcitability triggered by specific stimuli. The study included two men and one woman (all right-handed, aged 35-55 years). The patients had sound-triggered left temporal ME in response to popular songs with vocals, but not to instrumental, classical, or nonvocal piano solo versions of the same song. Sentimental lyrics, high-pitched singing, specificity/familiarity, and singing in the native language were the most significant triggering factors. We found that recognition of the human voice and analysis of lyrics are important causal factors in left temporal ME and provide observational evidence that sounds with speech structure are predominantly processed in the left temporal lobe. A literature review indicated that language-associated stimuli triggered ME in the left temporal epileptogenic zone at a nearly twofold higher rate compared with the right temporal region. Further research on ME may enhance understanding of the cognitive neuroscience of music.
Collapse
Affiliation(s)
- Wei-En J Tseng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Program in Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Lu-An Chen
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shuo-Bin Jou
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsiang-Yao Hsieh
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Han-Tao Li
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsing-I Chiang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
10
|
Chiang HI, Lim SN, Hsieh HY, Cheng MY, Chang CW, Johnny Tseng WE, Li HT, Lin CY, Wu T. Preliminary Asian experience of using perampanel in clinical practice. Biomed J 2018; 40:347-354. [PMID: 29433838 PMCID: PMC6138609 DOI: 10.1016/j.bj.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/21/2017] [Accepted: 09/18/2017] [Indexed: 11/15/2022] Open
Abstract
Background To analyze the efficacy and safety of perampanel over a 3-month period in a sample of Asian people with epilepsy. Methods The efficacy and safety of perampanel as an adjunctive therapy for patients with epilepsy were retrospectively reviewed and analyzed. Patients were categorized according to seizure type, concomitant antiepileptic drug usage, and perampanel dosage. Results A total of 210 patients were included in the study and 131 patients completed 3 months of perampanel treatment. The average dosage of perampanel was 5.31 mg/day, and the 50% responder rate (≥50% seizure frequency reduction) in all patients was 45.8%, with a 27.5% seizure-free rate. For focal seizures, focal to bilateral tonic-clonic seizures, and primary generalized seizures, the 50% responder rates were respectively 29.4%, 49.5%, and 36.4%. In total, 39.5% of patients experienced adverse events within 3 months of observation period, and the rate of drug withdrawal due to adverse events was 8.6%. Dizziness, ataxia, irritability/aggression were the most common adverse events. Conclusions The efficacy and safety of perampanel in a real-world setting with Asian patients is comparable to that in clinical trials that have included fewer Asian patients.
Collapse
Affiliation(s)
- Hsing-I Chiang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Siew-Na Lim
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsiang-Yao Hsieh
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Mei-Yun Cheng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan; Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chun-Wei Chang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wei-En Johnny Tseng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Han-Tao Li
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chin-Yin Lin
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tony Wu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital, Linkou, Taiwan.
| |
Collapse
|
11
|
Li HT, Wu T, Lin WR, Tseng WEJ, Chang CW, Cheng MY, Hsieh HY, Chiang HI, Lee CH, Chang BL, Lim SN. Clinical correlation and prognostic implication of periodic EEG patterns: A cohort study. Epilepsy Res 2017; 131:44-50. [DOI: 10.1016/j.eplepsyres.2017.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 02/03/2017] [Accepted: 02/09/2017] [Indexed: 12/19/2022]
|
12
|
Lin SY, Yang CC, Wu YM, Tseng CK, Wei KC, Chu YC, Hsieh HY, Wu TH, Pai PC, Hsu PW, Chuang CC. Evaluating the impact of hippocampal sparing during whole brain radiotherapy on neurocognitive functions: A preliminary report of a prospective phase II study. Biomed J 2016; 38:439-49. [PMID: 25994802 DOI: 10.4103/2319-4170.157440] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Whole brain radiotherapy (WBRT) is the treatment of choice for patients with brain metastases. However, neurocognitive functions (NCFs) decline due to impaired hippocampal neurogenesis might occur thereafter. It is hypothesized that conformal hippocampal avoidance during the course of WBRT (HA-WBRT) might provide meaningful NCF preservation. Our study aims to demonstrate the impact of delivering HA-WBRT on NCF changes in patients receiving WBRT. METHODS Twenty-five patients who were referred for prophylactic cranial irradiation (PCI) or treating oligometastatic brain disease were enrolled in the study. Before the HA-WBRT course, all participants should receive baseline neurocognitive assessment, including memory, executive functions, and psychomotor speed. The primary endpoint was delayed recall, as determined by the change/decline in verbal memory [Wechsler Memory Scale - 3rd edition (WMS III)- Word List score] from the baseline assessment to 4 months after the start of HA-WBRT. RESULTS Only three patients belonged to the clinical setting of PCI; the remaining 22 patients had oligometastatic brain disease. Regarding neurocognitive outcomes, no statistically significant differences were found between various NCF scores obtained at baseline and at post-radiotherapy intervals, in immediate verbal memory and non-verbal memory, except for delayed recall memory on Word List (F = 5.727, p = 0.048). CONCLUSIONS Functional preservation by hippocampal sparing during WBRT could largely be achieved in this study, which also suggests that HA-WBRT should be a feasible technique preserving neurocognitive functions while maintaining intracranial control.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
13
|
Lim SN, Lee CY, Lee ST, Tu PH, Chang BL, Lee CH, Cheng MY, Chang CW, Tseng WEJ, Hsieh HY, Chiang HI, Wu T. Low and High Frequency Hippocampal Stimulation for Drug-Resistant Mesial Temporal Lobe Epilepsy. Neuromodulation 2016; 19:365-72. [PMID: 27072376 PMCID: PMC5074270 DOI: 10.1111/ner.12435] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/23/2015] [Accepted: 02/28/2016] [Indexed: 11/26/2022]
Abstract
Objective Electrical stimulation of the hippocampus offers the possibility to treat patients with mesial temporal lobe epilepsy (MTLE) who are not surgical candidates. We report long‐term follow‐up results in five patients receiving low or high frequency hippocampal stimulation for drug‐resistant MTLE. Materials and Methods The patients underwent stereotactic implantation of quadripolar stimulating electrodes in the hippocampus. Two of the patients received unilateral electrode implantation, while the other three received bilateral implantation. Stimulation of the hippocampal electrodes was turned ON immediately after the implantation of an implantable pulse generator, with initial stimulation parameters: 1 V, 90–150 μs, 5 or 145 Hz. The frequency of seizures was monitored and compared with preimplantation baseline data. Results Two men and three women, aged 27–61 years were studied, with a mean follow‐up period of 38.4 months (range, 30–42 months). The baseline seizure frequency was 2.0–15.3/month. The five patients had an average 45% (range 22–72%) reduction in the frequency of seizures after hippocampal stimulation over the study period. Low frequency hippocampal stimulation decreased the frequency of seizures in two patients (by 54% and 72%, respectively). No implantation‐ or stimulation‐related side effects were reported. Conclusions Electrical stimulation of the hippocampus is a minimally invasive and reversible method that can improve seizure outcomes in patients with drug‐resistant MTLE. The optimal frequency of stimulation varied from patient to patient and therefore required individual setting. These experimental results warrant further controlled studies with a large patient population to evaluate the long‐term effect of hippocampal stimulation with different stimulation parameters.
Collapse
Affiliation(s)
- Siew-Na Lim
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Bao-Luen Chang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Hong Lee
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Wei Chang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wei-En Johnny Tseng
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiang-Yao Hsieh
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsing-I Chiang
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Section of Epilepsy, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
14
|
Tseng WEJ, Wu T, Cheng MY, Wang PN, Toh CH, Lin WR, Chang CW, Hsieh HY, Chiang HI, Lim SN. Preemptive therapy with ganciclovir and cytomegalovirus hyperimmune globulin delayed the onset of Epstein-Barr virus-associated post-transplant acute limbic encephalitis. J Neurol Sci 2015; 359:124-6. [PMID: 26671100 DOI: 10.1016/j.jns.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/27/2015] [Accepted: 11/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Wei-En Johnny Tseng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Nan Wang
- Division of Hematology/Oncology, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wey-Ran Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Wei Chang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiang-Yao Hsieh
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsing-I Chiang
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Siew-Na Lim
- Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| |
Collapse
|
15
|
Lee CH, Lin JJ, Lin KJ, Chang BL, Hsieh HY, Chen WH, Lin KL, Fung HC, Wu T. Caspr2 antibody limbic encephalitis is associated with Hashimoto thyroiditis and thymoma. J Neurol Sci 2014; 341:36-40. [DOI: 10.1016/j.jns.2014.03.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 12/24/2022]
|
16
|
Hong CF, Hsieh HY, Chen CT, Huang HC. Development of a Semiselective Medium for Detection of Nalanthamala psidii, Causal Agent of Wilt of Guava. Plant Dis 2013; 97:1132-1136. [PMID: 30722420 DOI: 10.1094/pdis-12-12-1193-re] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Guava wilt, caused by Nalanthamala psidii, has become an important disease of guava (Psidium guajava) in Taiwan since the 1970s. This study was conducted to develop a semiselective medium for detecting N. psidii in soil and in tissues of diseased guava trees. Among 9 carbon and 21 nitrogen compounds tested in a modified Czapek-Dox medium, the most effective carbon and nitrogen sources for mycelial growth of N. psidii were sucrose and glycine, respectively. Among eight fungicides tested, iprodione at 5 μg ml-1 and azoxystrobin at 1 μg ml-1 were the most effective fungicides for detection of N. psidii in artificially infested soil or in naturally infected guava debris. Based on the requirement for carbon and nitrogen sources and response to fungicides, a semiselective medium designated as modified sucrose-glycine semiselective medium (mSGSSM) was developed for isolation of N. psidii, using the modified Czapek-Dox medium containing 3% sucrose, 0.3% glycine, iprodione at 5 μg ml-1, azoxystrobin at 1 μg ml-1, streptomycin at 200 μg ml-1, and neomycin at 200 μg ml-1. Colonies of N. psidii on mSGSSM at 30°C for 5 to 10 days were white to orange with sparse aerial hyphae. N. psidii was detected more accurately and efficiently on mSGSSM than on other media, including potato dextrose agar, modified Nash-Snyder medium, and modified Czapek-Dox medium. This semiselective medium is effective in detection of N. psidii from various parts of diseased guava trees and in soil; therefore, it would be a useful medium for etiological, ecological, and epidemiological studies of guava wilt.
Collapse
Affiliation(s)
- C F Hong
- Fengshan Tropical Horticultural Experiment Branch, Taiwan Agricultural Research Institute, Fengshan 83052, Kaohsiung, Taiwan
| | - H Y Hsieh
- Fengshan Tropical Horticultural Experiment Branch, Taiwan Agricultural Research Institute, Fengshan 83052, Kaohsiung, Taiwan
| | - C T Chen
- Fengshan Tropical Horticultural Experiment Branch, Taiwan Agricultural Research Institute, Fengshan 83052, Kaohsiung, Taiwan
| | - H C Huang
- Emeritus Principal Research Scientist, Agriculture and Agri-Food Canada, Lethbridge, Alberta, Canada
| |
Collapse
|
17
|
Hsieh HY, Fung HC, Wang CJ, Chin SC, Wu T. Epileptic seizures in neurofibromatosis type 1 are related to intracranial tumors but not to neurofibromatosis bright objects. Seizure 2011; 20:606-11. [PMID: 21621428 DOI: 10.1016/j.seizure.2011.04.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 03/16/2011] [Accepted: 04/22/2011] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate the relationship between intracranial lesions and epileptic seizures in neurofibromatosis type 1 (NF1) patients. BACKGROUND NF1 is one of the most common autosomal dominant neurocutaneous disorders, and epilepsy is more prevalent in NF1 patients than in the general population. Epileptic seizures were found to be related to various types of intracranial lesions in NF1 patients. METHODS The clinical characteristics of NF1 (1986-2006 in Chung-Gung Memorial Hospital), diagnosed on the basis of the criteria of the National Institutes of Health Consensus Conference (1988), were reviewed by 2 neurologists. We diagnosed epileptic seizures of NF1 patients on the basis of clinical appearances and a history of antiepileptic drugs. Magnetic resonance images were also evaluated by 2 neuroradiologists to confirm the locations of brain tumors or neurofibromatosis bright objects (NBOs). The locations of NBOs were classified into 4 categories: cortex and hippocampus, subcortical white matter, basal ganglia, and infratentorial area. The association between the location of the lesions and the occurrence of seizure in NF1 patients was analyzed statistically. RESULTS The medical records of 630 NF1 patients were reviewed. In this cohort, 37 (5.87%) NF1 patients had epileptic seizures. The patients include 22 males (59.5%) and 15 females (40.5%). The mean seizure onset age was 14.8 years (2 months to 72 years). The most common seizure pattern was partial onset seizures, 3 simple partial seizures, and 14 complex partial seizures. Other seizure types found include 15 primary generalized seizures (2 absence seizures and 13 generalized tonic-clonic seizures), 2 infantile spasms, and 3 unclassified. A total of 172 (23 with epilepsy and 149 without epilepsy) NF1 patients underwent MRI examinations. NBOs were identified in 16 (69.6%) epilepsy patients and in 108 (72.5%) patients without epilepsy. The location or the number of these intracranial lesions does not show significant correlation with the occurrence of epilepsy in our cohort. Among 11 NF1 patients with intracranial tumors, 4 patients had seizures (36.36%), vs. 19 out of 161 NF1 patients (11.80%) without tumors. CONCLUSION The occurrence of epileptic seizures in NF1 patients is related to intracranial tumors but not to NBOs.
Collapse
Affiliation(s)
- Hsiang-Yao Hsieh
- Department of Neurology, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
18
|
Wu WW, Lu KC, Wang CW, Hsieh HY, Chen SY, Chou YC, Yu SY, Chen LJ, Tu KN. Growth of multiple metal/semiconductor nanoheterostructures through point and line contact reactions. Nano Lett 2010; 10:3984-3989. [PMID: 20809607 DOI: 10.1021/nl101842w] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Forming functional circuit components in future nanotechnology requires systematic studies of solid-state chemical reactions in the nanoscale. Here, we report efficient and unique methods, point and line contact reactions on Si nanowires, fabricating high quality and quantity of multiple nanoheterostructures of NiSi/Si and investigation of NiSi formation in nanoscale. By using the point contact reaction between several Ni nanodots and a Si nanowire carried out in situ in an ultrahigh vacuum transmission electron microscopy, multiple sections of single-crystal NiSi and Si with very sharp interfaces were produced in a Si nanowire. Owing to the supply limited point contact reaction, we propose that the nucleation and growth of the sugar cane-type NiSi grains start at the middle of the point contacts between two Ni nanodots and a Si nanowire. The reaction happens by the dissolution of Ni into the Si nanowire at the point contacts and by interstitial diffusion of Ni atoms within a Si nanowire. The growth of NiSi stops as the amount of Ni in the Ni nanodots is consumed. Additionally, without lithography, utilizing the line contact reaction between PS nanosphere-mediated Ni nanopatterns and a nanowire of Si, we have fabricated periodic multi-NiSi/Si/NiSi heterostructure nanonowires that may enhance the development of circuit elements in nanoscale electronic devices. Unlike the point contact reaction, silicide growth starts at the contact area in the line contact reaction; the different silicide formation modes resulting from point and line contact reactions are compared and analyzed. A mechanism on the basis of flux divergence is proposed for controlling the growth of the nano-multiheterostructures.
Collapse
Affiliation(s)
- W W Wu
- Department of Materials Science and Engineering, National Chiao Tung University, Hsinchu 300, Taiwan.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Hsieh HY, Lo WT, Liu DC, Su WC. Influence of hydrographic features on larval fish distribution during the south-westerly monsoon in the waters of Taiwan, western North Pacific Ocean. J Fish Biol 2010; 76:2521-2539. [PMID: 20557606 DOI: 10.1111/j.1095-8649.2010.02643.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The spatial distribution patterns of fish larvae and the relationships with hydrographic conditions in the waters surrounding Taiwan were studied in August 2004 when the south-westerly monsoon prevailed. A total of 6566 fish larvae were identified, belonging to 80 families, 129 genera and 230 species. Cluster analysis revealed two station groups, one associated with the South China Sea Surface Current (SCSSC) and the other with the Kuroshio Current (KC). The SCSSC group was characterized by mostly coastal and neritic species, and the KC group was predominated by oceanic species. Larger fish larvae were generally more abundant in the neritic waters west of Taiwan where the SCSSC prevails than in the waters east of Taiwan where the KC prevails. The combination of chlorophyll a, zooplankton and nitrite best explained the relationship of larval fish distribution and environmental variables, implying that the distribution of fish larvae in summer was closely linked to the food source. The changing of monsoons potentially affects the succession of water masses and the transport and assemblage of fish larvae in this study area.
Collapse
Affiliation(s)
- H Y Hsieh
- Institute of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
| | | | | | | |
Collapse
|
20
|
Lee YY, Lee MY, Chen IA, Tsai YT, Sung CY, Hsieh HY, Lim SN, Hung PW, Wu T. Long-term video-EEG monitoring for paroxysmal events. Chang Gung Med J 2009; 32:305-312. [PMID: 19527610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Long term video-electroencephalography monitoring (VEM) has been widely used for the diagnosis, classification, and management of seizures. Few studies have systemically examined its safety issues and clinical utility. This prospective study investigates the general clinical application of long term VEM in the management of paroxysmal events. METHODS This study cohort consisted of patients admitted to the inpatient VEM unit at Chang Gung Memorial Hospital (Lin-Kou). Standard 19 channel scalp electroencephalography (EEG), electrocardiography (ECG), and simultaneous video images were recorded continuously for 2 full days. Patient characteristics, and clinical, video-EEG and safety data were obtained and analyzed. The diagnosis and management of paroxysmal events before VEM were compared with those after VEM. RESULTS Habitual events were recorded in 54.3% of the 129 patients, and VEM had a yield rate of 76% (events recorded or newly recorded interictal discharges) indetermining the nature of the events. Eleven patients had seizure clusters, but there was no status epilepticus or electrode-related injury. After VEM, the diagnostic categories were changed in 41.1% of the patients, and 40.3% had revisions in management. CONCLUSIONS Long term VEM is a safe diagnostic tool providing a high diagnostic yield rate and directing adjustment of management for patients with paroxysmal events.
Collapse
Affiliation(s)
- Ying-Ying Lee
- Epilepsy Section, Department of Neurology, Chang Gung Memorial Hospital, Taipei, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Hsieh HY, Wu T, Wang CJ, Chin SC, Chen YR. Neurological complications involving the central nervous system in neurofibromatosis type 1. Acta Neurol Taiwan 2007; 16:68-73. [PMID: 17685129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To investigate the neurological complications and characteristics of intracranial lesions in patients with neurofibromatosis type 1 (NF1) in Taiwan. BACKGROUND Neurofibromtosis type 1 is a common autosomal dominant disorder characterized by cafe au lait spots, peripheral neurofibromas, Lisch nodules, and axillary freckling. Intracranial lesions such as optic gliomas and neurofibromatosis bright objects (NBOs) are common. METHODS Patients with the diagnosis of NF1 based on criteria from the National Institutes of Health Consensus Conference (1988) between Jan. 1, 1983 and Oct. 30, 2005 were retrospectively evaluated at the Chung-Gung Memorial Hospital (CGMH). Case histories were analyzed for neurological complications of epilepsy, stroke, and pituitary as well as other intracranial lesions. Magnetic resonance imaging (MRI) examinations were also focused on the number, distribution, and change of NBOs as well as intracranial pathology including optic pathway or brain gliomas. RESULTS The study population included 69 patients (28 females and 41 males) mean 25.1 +/- 15.0 years. Brain MRIs for 24 patients identified 1 meningioma, 1 optic glioma, and 4 other intracranial gliomas. In total, 14 patients had 52 NBOs. The most common anatomical sites for the NBOs were the globus pallidus and thalamus (15.4%), followed by the cerebellum and subcortical white matter (11.5%). The most commoly identified neurological complications were epilepsy (8.7%) and cerebral infarction (7.2%). These complications, however, were not correlated with intracranial lesions. CONCLUSIONS Neurofibromatosis bright objects are frequent neuroimaging findings in patients with NF1, and are at high risk of transforming into tumors. The incidences of epilepsy and young-onset cerebral infarction in NF1 patients in this study are higher than those in the general population. Neuroimaging studies are thus essential for NF1 patients to determine the extent of neurological complications; although the imaging findings may not be completely correlated with the clinical manifestations.
Collapse
Affiliation(s)
- Hsiang-Yao Hsieh
- Section of Epilepsy, Department of Neurology, Chang Gung University and Memorial Hospital, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
22
|
Chen IA, Hung SW, Chen YH, Lim SN, Tsai YT, Hsiao CL, Hsieh HY, Wu T. Contact heat evoked potentials in normal subjects. Acta Neurol Taiwan 2006; 15:184-91. [PMID: 16995598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Laser-evoked potentials are widely used to investigate nociceptive pathways. The newly developed contact heat stimulator for evoking brain response has the advantages of obtaining reliable scalp potentials and absence of cutaneous lesions. This study aimed to identify the most appropriate stimulation site with consistent cortical responses, and to correlate several parameters of the contact heat evoked potentials (CHEPs) with age, gender, and body height in normal subjects. CHEPs were recorded at Cz with a contact heat stimulator (Medoc, Israel) in 35 normal controls. The subjects were asked to keep eyes open and remain alert. The baseline temperature was 32 degrees C, and stimulation peak heat intensity of 51 degrees C was applied to five body sites: bilateral forearm, right dorsum hand, right peroneal area, and right dorsum foot. Reproducible CHEPs were recorded more frequently when stimulated at volar forearm (62.5%) than at the lower limbs (around 40%). The first negative peak latency (N1) was 370.1 +/- 20.3 ms, first positive peak latency (P1) was 502.4 +/- 33.0 ms, and peak to peak amplitude was 10.2 +/- 4.9 microV with stimulation of the forearm. Perceived pain intensity was not correlated with the presence or amplitude of CHEPs. No gender or inter-side differences were observed for N1 latency and N1-P1 amplitude. Also, no correlation was noted between N1 and age or body height. These results support future clinical access of CHEPs as a diagnostic tool.
Collapse
Affiliation(s)
- I-An Chen
- Epilepsy Section, Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
alpha-N-Acetylgalactosaminidase from Clostridium perfringens is an exoglycosidase that degrades the human blood type A epitope. A highly purified preparation of alpha-N-acetylgalactosaminidase was obtained from C. perfringens by salt precipitation, gel filtration, ion-exchange chromatography, chromatofocusing, and high-pressure liquid chromatography. The final preparation was homogeneous by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, with a molecular mass of 72.1 kDa. The enzyme was highly selective for terminal N-acetyl-alpha-D-galactosamine residues. No other substantial glycosidase activities, specifically neuraminidase, were detected. The pH optimum of the enzyme was between 6.5 and 7.0, and activity was unaffected by ionic strength. No protease activity was detected and enzyme activity was stable at 4 degrees C for 12 months. ELISA experiments demonstrated activity against blood type A epitope.
Collapse
Affiliation(s)
- H Y Hsieh
- Department of Pathology, University of Missouri-Columbia, 65212, USA
| | | | | | | |
Collapse
|
24
|
Abstract
We report an extremely rare case of Ewing's sarcoma (ES) of the humerus in a Chinese neonate. Plain radiography and magnetic resonance imaging showed extensive neoplastic involvement of the humeral diaphysis and adjacent soft tissues, confirmed on histology and immunohistochemistry as being due to ES. This is the first report of congenital ES in a long bone. Since ultrasound at 20 weeks gestation showed a normal fetal skeleton, the ES may have begun to develop in the late middle or third trimester.
Collapse
Affiliation(s)
- H Y Hsieh
- Department of Pediatrics, Chang Gung University, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Savides TJ, Jensen DM, Cohen J, Randall GM, Kovacs TO, Pelayo E, Cheng S, Jensen ME, Hsieh HY. Severe upper gastrointestinal tumor bleeding: endoscopic findings, treatment, and outcome. Endoscopy 1996; 28:244-8. [PMID: 8739741 DOI: 10.1055/s-2007-1005436] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND STUDY AIMS The aim of the present study was to review endoscopic findings, treatment, and clinical outcomes in patients with severe upper gastrointestinal bleeding due to tumors. PATIENTS AND METHODS A retrospective analysis was made of prospectively gathered data on all patients with severe upper gastrointestinal bleeding who were admitted to two large referral centers during a 45-month period. RESULTS Nine hundred thirty-five patients had severe upper gastrointestinal bleeding, of whom 42 (5%) were found to have tumors. Histologically, nearly all of the tumors were of a malignant type. Fifty-two percent of the patients had acute severe upper gastrointestinal bleeding as the initial presentation of their tumor. The most common tumor was gastric adenocarcinoma, and all of these cases were at advanced stages. Endoscopic hemostasis with thermal probes or epinephrine injection, or both, was carried out in seven patients (17%), with successful hemostasis in all of the tumors. Regardless of the treatment given, patients with upper gastrointestinal tumor bleeding, had a 30-day surgery rate of 43%, a 30-day rebleed rate of 33%, a 30-day mortality rate of 10%, and a 1-year mortality rate of 89%. CONCLUSIONS Most tumors that cause severe upper gastrointestinal bleeding are of a malignant histologic type and are already at an advanced stage. Endoscopic hemostasis of bleeding upper gastrointestinal tumors is safe and initially effective, and may provide time for elective surgical palliation. Regardless of therapy, upper gastrointestinal tumors with severe bleeding have a poor one-year survival.
Collapse
Affiliation(s)
- T J Savides
- Dept. of Medicine, UCLA Center for the Health Sciences, USA
| | | | | | | | | | | | | | | | | |
Collapse
|