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Di Gennaro G, Lattanzi S, Mecarelli O, Saverio Mennini F, Vigevano F. Current challenges in focal epilepsy treatment: An Italian Delphi consensus. Epilepsy Behav 2024; 155:109796. [PMID: 38643659 DOI: 10.1016/j.yebeh.2024.109796] [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: 12/21/2023] [Revised: 03/18/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Epilepsy, a globally prevalent neurological condition, presents distinct challenges in management, particularly for focal-onset types. This study aimed at addressing the current challenges and perspectives in focal epilepsy management, with focus on the Italian reality. METHODS Using the Delphi methodology, this research collected and analyzed the level of consensus of a panel of Italian epilepsy experts on key aspects of focal epilepsy care. Areas of focus included patient flow, treatment pathways, controlled versus uncontrolled epilepsy, follow-up protocols, and the relevance of patient-reported outcomes (PROs). This method allowed for a comprehensive assessment of consensus and divergences in clinical opinions and practices. RESULTS The study achieved consensus on 23 out of 26 statements, with three items failing to reach a consensus. There was strong agreement on the importance of timely intervention, individualized treatment plans, regular follow-ups at Epilepsy Centers, and the role of PROs in clinical practice. In cases of uncontrolled focal epilepsy, there was a clear inclination to pursue alternative treatment options following the failure of two previous therapies. Divergent views were evident on the inclusion of epilepsy surgery in treatment for uncontrolled epilepsy and the routine necessity of EEG evaluations in follow-ups. Other key findings included concerns about the lack of pediatric-specific research limiting current therapeutic options in this patient population, insufficient attention to the transition from pediatric to adult care, and need for improved communication. The results highlighted the complexities in managing epilepsy, with broad consensus on patient care aspects, yet notable divergences in specific treatment and management approaches. CONCLUSION The study offered valuable insights into the current state and complexities of managing focal-onset epilepsy. It highlighted many deficiencies in the therapeutic pathway of focal-onset epilepsy in the Italian reality, while it also underscored the importance of patient-centric care, the necessity of early and appropriate intervention, and individualized treatment approaches. The findings also called for continued research, policy development, and healthcare system improvements to enhance epilepsy management, highlighting the ongoing need for tailored healthcare solutions in this evolving field.
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Affiliation(s)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome (Retired) and Past President of LICE, Italian League Against Epilepsy, Rome, Italy
| | - Francesco Saverio Mennini
- Faculty of Economics, Economic Evaluation and HTA (EEHTA), CEIS, University of Rome "Tor Vergata", Rome, Italy; Institute for Leadership and Management in Health, Kingston University London, London, UK.
| | - Federico Vigevano
- Head of Paediatric Neurorehabilitation Department, IRCCS San Raffaele, Rome, Italy.
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Nucera B, Perulli M, Alvisi L, Bisulli F, Bonanni P, Canafoglia L, Cantalupo G, Ferlazzo E, Granvillano A, Mecarelli O, Meletti S, Strigaro G, Tartara E, Assenza G. Use, experience and perspectives of high-density EEG among Italian epilepsy centers: a national survey. Neurol Sci 2024; 45:1625-1634. [PMID: 37932644 DOI: 10.1007/s10072-023-07159-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION High-density EEG (hdEEG) is a validated tool in presurgical evaluation of people with epilepsy. The aim of this national survey is to estimate diffusion and knowledge of hdEEG to develop a network among Italian epilepsy centers. METHODS A survey of 16 items (and 15 additional items) was distributed nationwide by email to all members of the Italian League Against Epilepsy and the Italian Society of Clinical Neurophysiology. The data obtained were analyzed using descriptive statistics. RESULTS A total of 104 respondents were collected from 85 centers, 82% from the Centre-North of Italy; 27% of the respondents had a hdEEG. The main applications were for epileptogenic focus characterization in the pre-surgical evaluation (35%), biomarker research (35%) and scientific activity (30%). The greatest obstacles to hdEEG were economic resources (35%), acquisition of dedicated personnel (30%) and finding expertise (17%). Dissemination was limited by difficulties in finding expertise and dedicated personnel (74%) more than buying devices (9%); 43% of the respondents have already published hdEEG data, and 91% of centers were available to participate in multicenter hdEEG studies, helping in both pre-processing and analysis. Eighty-nine percent of respondents would be interested in referring patients to centers with established experience for clinical and research purposes. CONCLUSIONS In Italy, hdEEG is mainly used in third-level epilepsy centers for research and clinical purposes. HdEEG diffusion is limited not only by costs but also by lack of trained personnel. Italian centers demonstrated a high interest in educational initiatives on hdEEG as well as in clinical and research collaborations.
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Affiliation(s)
- Bruna Nucera
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Franz Tappeiner Hospital, Via Rossini, 5-39012, Merano, Italy.
- Paracelsus Medical University, 5020, Salzburg, Austria.
| | - Marco Perulli
- Child Neurology and Psychiatry Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
| | - Lara Alvisi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Epilepsy Center, (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Epilepsy Center, (full member of the European Reference Network EpiCARE), Bologna, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Treviso, Italy
| | - Laura Canafoglia
- Department of Diagnostic and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gaetano Cantalupo
- Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- UOC Di Neuropsichiatria Infantile, AOUI Di Verona (full member of the European Reference Network EpiCARE), Verona, Italy
- Centro Ricerca Per Le Epilessie in Età Pediatrica (CREP), AOUI Di Verona, Verona, Italy
| | - Edoardo Ferlazzo
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli Hospital", Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Alice Granvillano
- Department of Diagnostic and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Umberto I Polyclinic, Sapienza University of Rome, Rome, Italy
| | - Stefano Meletti
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Gionata Strigaro
- Epilepsy Center, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore Della Carità", Novara, Italy
| | - Elena Tartara
- Epilepsy Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Via Álvaro del Portillo, 21, 00128, Rome, Italy
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Lattanzi S, Canafoglia L, Canevini MP, Casciato S, Cerulli Irelli E, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Ferlazzo E, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C. Adjunctive brivaracetam and sustained seizure frequency reduction in very active focal epilepsy. Epilepsia 2023; 64:2922-2933. [PMID: 38079181 DOI: 10.1111/epi.17740] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE This study aimed to explore the effectiveness of brivaracetam (BRV) according to baseline seizure frequency and past treatment history in subjects with focal epilepsy who were included in the Brivaracetam Add-On First Italian Network Study (BRIVAFIRST). METHODS BRIVAFIRST was a 12-month retrospective, multicenter study including adults prescribed adjunctive BRV. Study outcomes included sustained seizure response (SSR), sustained seizure freedom (SSF), and the rates of treatment discontinuation and adverse events (AEs). Baseline seizure frequency was stratified as <5, 5-20, and >20 seizures per month, and the number of prior antiseizure medications (ASMs) as <5 and ≥6. RESULTS A total of 994 participants were included. During the 1-year study period, SSR was reached by 45.8%, 39.3%, and 22.6% of subjects with a baseline frequency of <5, 5-20, and >20 seizures per month (p < .001); the corresponding figures for the SSF were 23.4%, 9.8%, and 2.8% (p < .001). SSR was reached by 51.2% and 26.5% participants with a history of 1-5 and ≥6 ASMs (p < .001); the corresponding rates of SSF were 24.7% and 4.5% (p < .001). Treatment discontinuation due to lack of efficacy was more common in participants with >20 seizures compared to those with <5 seizures per month (25.8% vs. 9.3%, p < .001), and in participants with history of ≥6 prior ASMs compared to those with history of 1-5 ASMs (19.6% vs. 12.2%, p = .002). There were no differences in the rates of BRV withdrawal due to AEs and the rates of AEs across the groups of participants defined according to the number of seizures at baseline and the number of prior ASMs. SIGNIFICANCE The baseline seizure frequency and the number of previous ASMs were predictors of sustained seizure frequency reduction with adjunctive BRV in subjects with focal epilepsy.
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Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Laura Canafoglia
- Department of Epileptology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Paola Canevini
- Epilepsy Center, Child Neuropsychiatry Unit, AAST Santi Paolo Carlo, Milan, Italy
- Department of Health Sciences, Università degli Studi, Milan, Italy
| | | | - Emanuele Cerulli Irelli
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Valentina Chiesa
- Epilepsy Center, Child Neuropsychiatry Unit, AAST Santi Paolo Carlo, Milan, Italy
| | | | - Giovanni De Maria
- Clinical Neurophysiology Unit, Epilepsy Center, Spedali Civili, Brescia, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Giovanni Falcicchio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University Hospital of Bari A. Moro, Bari, Italy
| | - Martina Fanella
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Massimo Gangitano
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University Hospital of Bari A. Moro, Bari, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Elisa Montalenti
- Epilepsy Center, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federico Piazza
- Rita Levi Montalcini Department of Neurosciences, University of Turin, Turin, Italy
| | - Chiara Pizzanelli
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Neurology Unit, Pisa University Hospital, Pisa, Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Eleonora Rosati
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Laura Tassi
- C. Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Strigaro G, Meletti S, Mecarelli O, Tassi L, Strigaro D, Bisulli F. EEG Glossary App: A first bilingual app for EEG terms. Epileptic Disord 2023; 25:799-800. [PMID: 37344922 DOI: 10.1002/epd2.20091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Gionata Strigaro
- Epilepsy Center, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
| | - Stefano Meletti
- Neurology Unit, OCB Hospital, Azienda Ospedaliera-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- Past President of LICE, Italian League Against Epilepsy, Rome, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Centre, ASST Niguarda Hospital, Milan, Italy
| | - Daniele Strigaro
- Institute of Earth Sciences, Department of Environment, Construction and Design, University of Applied Sciences of Southern Switzerland (SUPSI), Mendrisio, Switzerland
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
- Full Member of the European Reference Network EpiCARE
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Mecarelli O, Di Gennaro G, Vigevano F. Unmet needs and perspectives in management of drug resistant focal epilepsy: An Italian study. Epilepsy Behav 2022; 137:108950. [PMID: 36347069 DOI: 10.1016/j.yebeh.2022.108950] [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: 05/18/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Abstract
This study aimed to evaluate the consensus level between a representative group of Italian neurologists and people with Drug-Resistant Epilepsy (DRE) regarding a series of statements about different aspects involved in the management of epilepsy to identify the unmet needs of the People with Epilepsy (PwE) and the future perspectives for the management of this disease. This observational study was conducted using a classic Delphi technique. A 19-statement questionnaire was administered anonymously through an online platform to a panel of expert clinicians and a panel of PwE, analyzing three main topics of interest: drug resistance, access to care, and PwE's experience. The consensus was achieved on 8 of the 19 statements administered to the panel of medical experts and on 4 of the 14 submitted to the panel of PwE, particularly on the definition of DRE and its consequences on treatment, Quality of Life (QoL), and autonomy of PwE. Most of the items, however, did not reach a consensus and highlighted the lack of a shared univocal view on some topics, such as accessibility to care throughout the country and the role of emerging tools such as telemedicine, narrative medicine, and digital devices. In many cases, the two panels expressed different views on the statements. The results outlined many fields of possible intervention, such as the need for educational initiatives targeted at physicians and PwE - for example, regarding telemedicine, digital devices, and narrative medicine - as well as the spread of better knowledge about epilepsy among the general population, in order to reduce epilepsy stigma. Institutions, moreover, could take a cue from this survey to develop facilities aimed at enhancing PwE's autonomy and promoting more equal access to care throughout the country.
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Affiliation(s)
- Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome and Past President of LICE, Italian League Against Epilepsy, Rome, Italy.
| | | | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy.
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Strigaro G, Bisulli F, Assenza G, Mecarelli O, Grippo A, Meletti S, Alvisi L, Cantalupo G, Eleopra R, Guerra A, Lori S, Marinelli L, Tassi L, Tinuper P, Vigevano F. Traduzione e adattamento alla lingua italiana del glossario dei termini più comunemente usati dagli elettroencefalografisti clinici e proposta per il formato del referto EEG (Revisione IFCN 2017). Clin Neurophysiol Pract 2022; 7:325-365. [DOI: 10.1016/j.cnp.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/04/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
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Villani F, Cianci V, Di Bonaventura C, Di Gennaro G, Galimberti CA, Guerrini R, La Neve A, Mecarelli O, Pietrafusa N, Specchio N, Vigevano F, Perucca E. Use of cenobamate for the treatment of focal epilepsy: an Italian expert opinion paper. Expert Rev Neurother 2022; 22:935-940. [PMID: 36662573 DOI: 10.1080/14737175.2023.2171291] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/21/2023]
Abstract
INTRODUCTION Cenobamate is a new antiseizure medication (ASM) recently introduced in the USA for the treatment of adults with focal-onset seizures. In March 2021, the European Commission authorized its use for the adjunctive treatment of focal-onset seizures with or without secondary generalization (focal seizures with or without progression to bilateral tonic-clonic seizures, according to current ILAE terminology) in adults with epilepsy not adequately controlled despite the treatment with at least two ASMs. AREAS COVERED This review summarizes the mechanism of action, efficacy, and safety of Cenobamate. The authors provide their expert opinions on the use of this drug. EXPERT OPINION The aim of this paper is to report on the Italian preliminary experience with the use of cenobamate, focusing on treatment goals, optimal dosing and titration schedules, strategies to minimize adverse effects, and identification of suitable candidates for treatment. There was agreement that slow titration may improve tolerability, and that clinically significant benefit can be achieved in many patients at relatively low doses. A favorable response to relatively low doses of cenobamate could be an early predictor of ultimate responsiveness. Overall, cenobamate is a welcome new treatment for adults with focal seizures resistant to conventional ASMs.
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Affiliation(s)
- Flavio Villani
- Division of Clinical Neurophysiology and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio, Italy
| | - Carlo Di Bonaventura
- Epilepsy Centre, Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | | | | | - Renzo Guerrini
- Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University Hospital of Bari "A. Moro", Bari, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Nicola Pietrafusa
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicola Specchio
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federico Vigevano
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Emilio Perucca
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy, Department of Medicine (Austin Health), University of Melbourne, and Department of Neuroscience, Monash University, Melbourne, Australia
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Ricci L, Croce P, Pulitano P, Boscarino M, Zappasodi F, Narducci F, Lanzone J, Sancetta B, Mecarelli O, Di Lazzaro V, Tombini M, Assenza G. Levetiracetam Modulates EEG Microstates in Temporal Lobe Epilepsy. Brain Topogr 2022; 35:680-691. [PMID: 36098891 DOI: 10.1007/s10548-022-00911-2] [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: 05/09/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
To determine the effects of Levetiracetam (LEV) therapy using EEG microstates analysis in a population of newly diagnosed Temporal Lobe Epilepsy (TLE) patients. We hypothesized that the impact of LEV therapy on the electrical activity of the brain can be globally explored using EEG microstates. Twenty-seven patients with TLE were examined. We performed resting-state microstate EEG analysis and compared microstate metrics between the EEG performed at baseline (EEGpre) and after 3 months of LEV therapy (EEGpost). The microstates A, B, C and D emerged as the most stable. LEV induced a reduction of microstate B and D mean duration and occurrence per second (p < 0.01). Additionally, LEV treatment increased the directional predominance of microstate A to C and microstate B to D (p = 0.01). LEV treatment induces a modulation of resting-state EEG microstates in newly diagnosed TLE patients. Microstates analysis has the potential to identify a neurophysiological indicator of LEV therapeutic activity. This study of EEG microstates in people with epilepsy opens an interesting path to identify potential LEV activity biomarkers that may involve increased neuronal inhibition of the epileptic network.
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Affiliation(s)
- Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Pierpaolo Croce
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.
| | - Patrizia Pulitano
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marilisa Boscarino
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Filippo Zappasodi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.,Institute for Advanced Biomedical Technologies (ITAB), G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Flavia Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Jacopo Lanzone
- Neurorehabilitation Department, IRCCS Salvatore Maugeri Foundation, Institute of Milan, Milan, Italy
| | - Biagio Sancetta
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
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Lattanzi S, Ascoli M, Canafoglia L, Canevini MP, Casciato S, Cerulli Irelli E, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Manfredi Basili L, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongiorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Donato F, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Teresa Faedda M, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gasparini S, Gazzina S, Teresa Giallonardo A, Sean Giorgi F, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Kiferle L, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Meletti S, Milano C, Nilo A, Orlando B, Paladin F, Grazia Pascarella M, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Rosa Pisani L, Placidi F, Pollicino P, Porcella V, Puligheddu M, Quadri S, Paolo Quarato P, Quintas R, Renna R, Rum A, Michele Salamone E, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Elisabetta Vaudano A, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Sustained seizure freedom with adjunctive brivaracetam in patients with focal‐onset seizures. Epilepsia 2022; 63:e42-e50. [PMID: 35278335 PMCID: PMC9311068 DOI: 10.1111/epi.17223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic Department of Experimental and Clinical Medicine Marche Polytechnic University Ancona Italy
| | - Michele Ascoli
- Department of Medical and Surgical Sciences Magna Græcia University of Catanzaro Catanzaro Italy
| | - Laura Canafoglia
- Department of Epileptology Fondazione IRCCS Istituto Neurologico Carlo Besta Milan Italy
| | - Maria Paola Canevini
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
- Department of Health Sciences Università degli Studi Milan Italy
| | | | | | - Valentina Chiesa
- Epilepsy Center Child Neuropsychiatry Unit AAST Santi Paolo Carlo Milan Italy
| | | | - Giovanni De Maria
- Clinical Neurophysiology Unit, Epilepsy Center Spedali Civili Brescia Italy
| | - Giuseppe Didato
- Epilepsy Unit Fondazione IRCCS Istituto Neurologico "Carlo Besta" Milan Italy
| | | | - Giovanni Falcicchio
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Martina Fanella
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Massimo Gangitano
- Department of Biomedicine Neuroscience, and advanced Diagnostic (BIND) University of Palermo Palermo Italy
| | - Angela La Neve
- Department of Basic Medical Sciences Neurosciences and Sense Organs‐ University Hospital of Bari “A. Moro”
| | - Oriano Mecarelli
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Elisa Montalenti
- Epilepsy Center AOU Città della Salute e della Scienza di Torino Turin Italy
| | - Alessandra Morano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | - Federico Piazza
- Rita Levi Montalcini Department of Neurosciences University of Turin Turin Italy
| | - Chiara Pizzanelli
- Department of Clinical and Experimental Medicine Neurological Clinic University of Pisa Pisa, Pisa Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
| | | | - Eleonora Rosati
- Department Neurology 2 Careggi University Hospital Florence Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Centre Niguarda Hospital Milan Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences Policlinico Umberto I Sapienza University of Rome Italy
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10
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Lattanzi S, Canafoglia L, Canevini MP, Casciato S, Irelli EC, Chiesa V, Dainese F, De Maria G, Didato G, Di Gennaro G, Falcicchio G, Fanella M, Ferlazzo E, Gangitano M, La Neve A, Mecarelli O, Montalenti E, Morano A, Piazza F, Pizzanelli C, Pulitano P, Ranzato F, Rosati E, Tassi L, Di Bonaventura C, Alicino A, Ascoli M, Assenza G, Avorio F, Badioni V, Banfi P, Bartolini E, Basili LM, Belcastro V, Beretta S, Berto I, Biggi M, Billo G, Boero G, Bonanni P, Bongorno J, Brigo F, Caggia E, Cagnetti C, Calvello C, Cesnik E, Chianale G, Ciampanelli D, Ciuffini R, Cocito D, Colella D, Contento M, Costa C, Cumbo E, D'Aniello A, Deleo F, DiFrancesco JC, Di Giacomo R, Di Liberto A, Domina E, Dono F, Durante V, Elia M, Estraneo A, Evangelista G, Faedda MT, Failli Y, Fallica E, Fattouch J, Ferrari A, Ferreri F, Fisco G, Fonti D, Fortunato F, Foschi N, Francavilla T, Galli R, Gazzina S, Giallonardo AT, Giorgi FS, Giuliano L, Habetswallner F, Izzi F, Kassabian B, Labate A, Luisi C, Magliani M, Maira G, Mari L, Marino D, Mascia A, Mazzeo A, Milano C, Meletti S, Nilo A, Orlando B, Paladin F, Pascarella MG, Pastori C, Pauletto G, Peretti A, Perri G, Pezzella M, Piccioli M, Pignatta P, Pilolli N, Pisani F, Pisani LR, Placidi F, Pollicino P, Porcella V, Pradella S, Puligheddu M, Quadri S, Quarato PP, Quintas R, Renna R, Rizzo GR, Rum A, Salamone EM, Savastano E, Sessa M, Stokelj D, Tartara E, Tombini M, Tumminelli G, Vaudano AE, Ventura M, Viganò I, Viglietta E, Vignoli A, Villani F, Zambrelli E, Zummo L. Brivaracetam as add-on treatment in patients with post-stroke epilepsy: real-world data from the BRIVAracetam add-on First Italian netwoRk Study (BRIVAFIRST). Seizure 2022; 97:37-42. [DOI: 10.1016/j.seizure.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
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Tassi L, Specchio N, Mecarelli O, Tinuper P, Vigevano F, Perucca E. The 50th anniversary of the Italian League Against Epilepsy (Lega Italiana Contro l’Epilessia). Epilepsy Behav Rep 2022; 19:100553. [PMID: 35664663 PMCID: PMC9157453 DOI: 10.1016/j.ebr.2022.100553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022] Open
Abstract
We describe the 50-year history of the Italian League Against Epilepsy (LICE). LICE promotes high-quality epilepsy care, education and research into epilepsy. LICE maintains close relations with ILAE and other professional societies.
This article was prepared to outline the article collection submitted on behalf of Lega Italiana Contro l’Epilepsia, or LICE, for the 50th anniversary of the founding of the ILAE Italian Chapter, and provides a brief summary of the history, with its landmark achievements and challenges. LICE is a multidisciplinary, inclusive, educational, informative and multifaceted organization. Initially in 1955 and then formally in 1972, LICE was born in Milano, with the mission to devote itself to people suffering with epilepsy and by promoting appropriate treatment and care, integration into society, to promote and pursue all kinds of activities designed to achieve those aims. The LICE is currently composed of more than 1000 members including neurologists, pediatric neurologists, neurosurgeons, neurophysiologists, and neuropsychologists who function throughout Italy dealing mainly or exclusively with the diagnosis and treatment of people with epilepsy.
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Croce P, Ricci L, Pulitano P, Boscarino M, Zappasodi F, Lanzone J, Narducci F, Mecarelli O, Di Lazzaro V, Tombini M, Assenza G. Machine learning for predicting levetiracetam treatment response in temporal lobe epilepsy. Clin Neurophysiol 2021; 132:3035-3042. [PMID: 34717224 DOI: 10.1016/j.clinph.2021.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/13/2021] [Revised: 07/28/2021] [Accepted: 08/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the predictive power for seizure-freedom of 19-channels EEG, measured both before and after three months the initiation of the use of Levetiracetam (LEV), in a cohort of people after a new diagnosis of temporal-lobe epilepsy (TLE) using a machine-learning approach. METHODS Twenty-three individuals with TLE were examined. We dichotomized clinical outcome into seizure-free (SF) and non-seizure-free (NSF) after two years of LEV. EEG effective power in different frequency bands was compared using baseline EEG (T0) and the EEG after three months of LEV therapy (T1) between SF and NSF patients. Partial Least Square (PLS) analysis was used to test and validate the prediction of the model for clinical outcome. RESULTS A total of 152 features were extracted from the EEG recordings. When considering only the features calculated at T1, a predictive power for seizure-freedom (AUC = 0.750) was obtained. When employing both T0 and T1 features, an AUC = 0.800 was obtained. CONCLUSIONS This study provides a proof-of-concept pipeline for predicting the clinical response to anti-seizure medications in people with epilepsy. SIGNIFICANCE Future studies may benefit from the pipeline proposed in this study in order to develop a model that can match each patient to the most effective anti-seizure medication.
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Affiliation(s)
- Pierpaolo Croce
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy.
| | - Patrizia Pulitano
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Marilisa Boscarino
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Filippo Zappasodi
- Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy; Institute for Advanced Biomedical Technologies (ITAB), G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Jacopo Lanzone
- Department of Systems Medicine, Neuroscience, University of Rome Tor Vergata, Rome, Italy; Neurorehabilitation Department, IRCCS Salvatore Maugeri Foundation, Institute of Milan, Milan, Italy
| | - Flavia Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Oriano Mecarelli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128, Rome, Italy
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D’Aniello A, Giallonardo AT, Mecarelli O, Aguglia U, Assenza G, Meletti S, De Giorgis V, Bonanni E, Michelucci R, Cerminara C, Romeo A, De Liso P, Copetti M, Gentile A, Chiacchiaretta M, Di Gennaro G. Ampa study (a mirroring clinical practice study of perampanel in adults and adolescents) design: Real-world prospective study of perampanel as add-on therapy for focal-onset seizures. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ricci L, Croce P, Pulitano P, Boscarino M, Zappasodi F, Lanzone J, Narducci F, Tombini M, Di Lazzaro V, Mecarelli O, Assenza G. Use of machine learning for predicting levetiracetam treatment outcome in temporal lobe epilepsy: A pharmaco-EEG study. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lanzone J, Ricci L, Tombini M, Boscarino M, Mecarelli O, Pulitano P, Di Lazzaro V, Assenza G. The effect of Perampanel on EEG spectral power and connectivity in patients with focal epilepsy. Clin Neurophysiol 2021; 132:2176-2183. [PMID: 34284253 DOI: 10.1016/j.clinph.2021.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 01/17/2021] [Revised: 04/22/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Quantitative Encephalography (qEEG) depicts synthetically the features of EEG signal and represents a promising tool in the assessment of neurophysiological changes brought about by Anti-Seizure Medications (ASMs). In this study we characterized qEEG alterations related to add-on therapy with Perampanel (PER). PER is the only ASM presenting a direct glutamatergic antagonism, hence the characterization of PER induced EEG changes could help to better understand its large spectrum of efficacy. METHODS We analysed standard-19 channel-EEG from 25 People with Epilepsy (PwE) both before (T0) and after (T1) the introduction of PER as add-on treatment. Normal values were obtained in 30 healthy controls (HC) matched for sex and age. EEGs were analysed using Matlab™ and the EEGlab and Brainstorm toolkits. We extracted spectral power and connectivity (Phase locking Value) of EEG signal and then compared these features between T0 and T1 and across groups (PwE, HC), we also evaluated the correlations with clinical features. RESULTS PwE showed increased theta power (p = 0.036) after the introduction of PER but no significant change of EEG connectivity. We also found that PwE have reduced beta power (p = 0.012) and increased connectivity in delta (p = 0.013) and theta (p = 0.007) range as compared to HC, but no significant change was observed between T0 and T1 in PwE. Finally, we found that PwE classified as drug responders to PER have greater alpha power both at T0 and at T1 (p = 0.024) suggesting that this parameter may predict response to treatment. CONCLUSIONS PER causes slight increase of theta activity and does not alter connectivity as assessed by standard EEG. Moreover, greater alpha power could be a good marker of response to PER therapy, and potentially ASM therapy in general. SIGNIFICANCE Our results corroborate the hypothesis that pharmaco-EEG is a viable tool to study neurophysiological changes induced by ASM. Additionally, our work highlights the role of alpha power as a marker of ASM therapeutic response.
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Affiliation(s)
- Jacopo Lanzone
- Rehabilitation Unit, FERB Onlus Hospital, Trescore Balneario, Italy; Deparment of Systems Medicine, Neuroscience, University of Rome Tor Vergata, Rome, Italy.
| | - Lorenzo Ricci
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mario Tombini
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Marilisa Boscarino
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Oriano Mecarelli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Patrizia Pulitano
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giovanni Assenza
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
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Iannone LF, Arena G, Battaglia D, Bisulli F, Bonanni P, Boni A, Canevini MP, Cantalupo G, Cesaroni E, Contin M, Coppola A, Cordelli DM, Cricchiuti G, De Giorgis V, De Leva MF, De Rinaldis M, d'Orsi G, Elia M, Galimberti CA, Morano A, Granata T, Guerrini R, Lodi MAM, La Neve A, Marchese F, Masnada S, Michelucci R, Nosadini M, Pilolli N, Pruna D, Ragona F, Rosati A, Santucci M, Spalice A, Pietrafusa N, Striano P, Tartara E, Tassi L, Papa A, Zucca C, Russo E, Mecarelli O. Results From an Italian Expanded Access Program on Cannabidiol Treatment in Highly Refractory Dravet Syndrome and Lennox-Gastaut Syndrome. Front Neurol 2021; 12:673135. [PMID: 34093420 PMCID: PMC8173151 DOI: 10.3389/fneur.2021.673135] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/26/2021] [Accepted: 03/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Purified cannabidiol (CBD) was administered to highly refractory patients with Dravet (DS) or Lennox–Gastaut (LGS) syndromes in an ongoing expanded access program (EAP). Herein, we report interim results on CBD safety and seizure outcomes in patients treated for a 12-month period. Material and Methods: Thirty centers were enrolled from December 2018 to December 2019 within the open-label prospective EAP up to a maximum of 25 mg/kg per day. Adverse effects and liver function tests were assessed after 2 weeks; 1, 3, and 6 months of treatment; and periodically thereafter. Seizure endpoints were the percentage of patients with ≥50 and 100% reduction in seizures compared to baseline. Results: A total of 93 patients were enrolled and included in the safety analysis. Eighty-two patients [27 (32.9%) DS, 55 (67.1%) LGS] with at least 3 months of treatment have been included in the effectiveness analysis; median previously failed antiseizure medications was eight. Pediatric and adult patients were uniformly represented in the cohort. At 3-month follow-up, compared to the 28-day baseline period, the percentage of patients with at least a 50% reduction in seizure frequency was 40.2% (plus 1.2% seizure-free). Retention rate was similar according to diagnosis, while we found an increased number of patients remaining under treatment in the adult group. CBD was mostly coadministered with valproic acid (62.2%) and clobazam (41.5%). In the safety dataset, 29 (31.2%) dropped out: reasons were lack of efficacy [16 (17.2%)] and adverse events (AEs) [12 (12.9%)], and one met withdrawal criteria (1.1%). Most reported AEs were somnolence (22.6%) and diarrhea (11.9%), followed by transaminase elevation and loss of appetite. Conclusions: CBD is associated with improved seizure control also in a considerable proportion of highly refractory patients with DS and LGS independently from clobazam use. Overall, CBD safety and effectiveness are not dose-related in this cohort.
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Affiliation(s)
- Luigi Francesco Iannone
- Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy
| | - Gabriele Arena
- Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy
| | - Domenica Battaglia
- Pediatric Neurology, Department of Woman and Child Health and Public Health, Child Health Area, A. Gemelli University Polyclinic Foundation, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Epilepsy Center (Reference Center for Rare and Complex Epilepsies - EpiCARE), Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Eugenio Medea, Scientific Institute, Treviso, Italy
| | - Antonella Boni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Child Neuropsichiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Maria Paola Canevini
- Department of Health Sciences, Epilepsy Center, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Elisabetta Cesaroni
- Child Neurology and Psychiatry Unit, G. Salesi Children's Hospital-University of Ancona, Ancona, Italy
| | - Manuela Contin
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Antonietta Coppola
- Department of Neuroscience, Reproductive, and Odontostomatological Sciences, Epilepsy Centre, University of Naples Federico II, Naples, Italy
| | - Duccio Maria Cordelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età Pediatrica, Bologna, Italy
| | - Giovanni Cricchiuti
- Department of Pediatrics, Epilepsy Center, Institute of Medicine, University Hospital of Udine, Udine, Italy
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Maria Fulvia De Leva
- Pediatric Neurology, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Marta De Rinaldis
- Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Scientific Institute Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) "E. Medea", Brindisi, Italy
| | - Giuseppe d'Orsi
- Epilepsy Centre - Clinic of Nervous System Diseases, Riuniti Hospital, Foggia, Italy
| | - Maurizio Elia
- Oasi Research Institute Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Troina, Italy
| | - Carlo Andrea Galimberti
- Epilepsy Center, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Alessandra Morano
- Neurology Unit, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Renzo Guerrini
- Pediatric Neurology, Neurogenetics, and Neurobiology Unit and Laboratories, A. Meyer Children's Hospital, Florence, Italy
| | - Monica A M Lodi
- Pediatric Neurology Unit, Epilepsy Center, Department of Neuroscience, "Fatebenefratelli e Oftalmico" Hospital, Milan, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Francesca Marchese
- Pediatric Neurology and Muscular Diseases Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) 'G. Gaslini' Institute, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, University of Genoa, Genoa, Italy
| | - Silvia Masnada
- Department of Pediatric Neurology, V. Buzzi Children's Hospital, Milan, Italy
| | - Roberto Michelucci
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto delle Scienze Neurologiche di Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Nicola Pilolli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Dario Pruna
- Pediatric Neurology and Epileptology Unit, Brotzu Hospital Trust, Cagliari, Italy
| | - Francesca Ragona
- Department of Pediatric Neuroscience, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Rosati
- Pediatric Neurology, Neurogenetics, and Neurobiology Unit and Laboratories, A. Meyer Children's Hospital, Florence, Italy
| | - Margherita Santucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Child Neuropsichiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alberto Spalice
- Child Neurology Division, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Nicola Pietrafusa
- Neurology Unit, Department of Neurosciences (N.S., M.T.), Bambino Gesù Children's Hospital, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) 'G. Gaslini' Institute, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, University of Genoa, Genoa, Italy
| | - Elena Tartara
- Epilepsy Center, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy
| | - Laura Tassi
- Claudio Munari" Epilepsy Surgery Centre, Azienda Socio Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Amanda Papa
- Child Neuropsychiatry Department, Maggiore della Carità University Hospital, Novara, Italy
| | - Claudio Zucca
- Clinical Neurophysiology Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Eugenio Medea, Scientific Institute, Lecco, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
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17
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Savastano E, Pulitano P, Faedda MT, Davì L, Vanacore N, Mecarelli O. Clinical and Electroencephalography Assessment of the Effects of Brivaracetam in the Treatment of Drug-Resistant Focal Epilepsy. Cureus 2021; 13:e15012. [PMID: 34131547 PMCID: PMC8197576 DOI: 10.7759/cureus.15012] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Our aim was to evaluate the clinical and electroencephalographic effects of brivaracetam (BRV) in patients with drug-resistant focal epilepsy. BRV is a new antiepileptic drug (AED) with a high affinity for vesicle protein 2A (SV2A) and recently approved as adjunctive therapy for focal onset seizures.
Methods: In this observational study of six-month duration, BRV (50-200 mg) was administered to 76 patients with drug-resistant focal epilepsy, who were ≥16-year-old and who suffered from daily, weekly, monthly and yearly recurrent seizures. At baseline and after six months of follow-up, we performed a neurological visit, neuropsychological tests: Quality of life in epilepsy-31 (QOLIE31), Epworth Sleepiness Scale (ESS), Intrapersonal Emotional Quotient (IEQ) and an electroencephalogram (EEG; inspective and quantitative analysis). Twenty-four patients underwent an overnight switch from levetiracetam (LEV) to BRV.
Results: Seizure frequency of the 54 patients remaining at six months was reduced >50% in 29.6% of cases (responders), <50% in 31.5% (non-responders 1), while it remained unchanged in 38.8% (non-responders 2). Twenty-nine percent of patients early discontinued BRV because of lack of efficacy or minor adverse effects (AEs) like irritability, asthenia or headache. Neuropsychological tests in 28 patients demonstrated a significant improvement in I-EPI scores (p=0.04). Comparable results have been found in the subgroup of patients who switched from LEV to BRV. The EEG quantitative analysis showed a significant reduction of alpha absolute power at six months (p=0.03). Theta band power resulted significantly superior in non-responders than in responders (p=0.03). Furthermore, the δ+θ/α+β index resulted more elevated in patients with AEs than in patients without.
Conclusions: BRV showed discrete results in terms of efficacy, safety and tolerability, with a good behavioural profile. BRV reduces the power of the alpha band, in correlation with its sedative effects but not with its minor efficacy. Furthermore, the increase in theta band power can be considered as a predictor of scarce response to treatment, while an increase in the δ+θ/α+β index could be a possible predictor of AEs occurrence.
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Affiliation(s)
- Ersilia Savastano
- UOC Neurologia, Ospedale Santo Bono-Pausilipon, Napoli, ITA.,UOC Neurofisiopatologia, Policlinico Umberto I, Rome, ITA
| | - Patrizia Pulitano
- Department of Human Neuroscience, Neurophysiopathology Unit, Policlinico Umberto I, Rome, ITA
| | - Maria Teresa Faedda
- Department of Human Neuroscience, Neurophysiopathology Unit, Policlinico Umberto I, Rome, ITA
| | - Leonardo Davì
- Department of Human Neuroscience, Neurophysiopathology Unit, Policlinico Umberto I, Rome, ITA
| | - Nicola Vanacore
- CNAPS Department (Promotion and Evaluation of Chronic Disease Prevention Policies), Istituto Superiore di Sanità (ISS), Rome, ITA
| | - Oriano Mecarelli
- Department of Human Neuroscience, Neurophysiopathology Unit, Policlinico Umberto I, University of Rome "Sapienza", Rome, ITA
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18
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Sales F, Delanty N, Mecarelli O, Holtkamp M, McMurray R, Loureiro R, Fernandes H, Villanueva V. Predictors of seizure freedom, response and retention after 12 months of treatment with eslicarbazepine acetate: A post-hoc analysis of the Euro-Esli study. Epilepsy Res 2021; 174:106653. [PMID: 34049227 DOI: 10.1016/j.eplepsyres.2021.106653] [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: 11/19/2020] [Revised: 04/22/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Eslicarbazepine acetate (ESL) is a once-daily antiseizure medication (ASM) that is approved in Europe and the USA for the treatment of focal-onset seizures. The Euro-Esli study, which included over 2000 patients, investigated the real-world effectiveness, safety and tolerability of ESL when used in everyday clinical practice in Europe. This post-hoc analysis of Euro-Esli employed univariate and multivariate binary logistic regression analyses to investigate the relationship between demographic and baseline characteristics (including epilepsy- and treatment-related factors) and the likelihood of seizure freedom, response and retention in adult patients with focal seizures after 12 months of ESL treatment in the real-world setting. Multivariate analysis revealed that the factors associated with seizure freedom and response at 12 months (N = 1054) were generally those characterising patients who were relatively early in their disease course and/or less refractory to treatment, such as older age at onset of epilepsy, absence of seizures at baseline and lower number of concomitant ASMs at baseline. Although it was not possible to construct a multivariate model to predict retention on ESL treatment at 12 months, when the univariate regression model was adjusted for age and epilepsy duration, the factors found to be significantly associated with retention at 12 months (N = 1559) comprised shorter duration of epilepsy, absence of any seizures at baseline, lower baseline seizure frequency (<5 vs. ≥ 5 seizures/month), lower number of previous ASMs, lower number of concomitant ASMs, and the absence of concomitant use of lamotrigine at baseline. These findings therefore identify baseline characteristics that are predictive of the effectiveness of ESL treatment in clinical practice, which may help clinicians choose appropriate ASM therapy for patients.
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Affiliation(s)
- Francisco Sales
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Norman Delanty
- Beaumont Hospital and School of Pharmacy and Biomolecular Sciences, FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Oriano Mecarelli
- Sapienza University, Policlinico Umberto I Hospital, Rome, Italy.
| | - Martin Holtkamp
- Epilepsy‑Center Berlin‑Brandenburg, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | | | - Rui Loureiro
- Bial - Portela & Cª, S.A., Coronado (S. Romão e S. Mamede), Portugal.
| | - Hélder Fernandes
- Bial - Portela & Cª, S.A., Coronado (S. Romão e S. Mamede), Portugal.
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19
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Contin M, Mohamed S, Santucci M, Lodi MAM, Russo E, Mecarelli O, Cbd Lice Italy Study Group. Cannabidiol in Pharmacoresistant Epilepsy: Clinical Pharmacokinetic Data From an Expanded Access Program. Front Pharmacol 2021; 12:637801. [PMID: 33746760 PMCID: PMC7966506 DOI: 10.3389/fphar.2021.637801] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/04/2020] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aim: Data on the clinical pharmacokinetics of cannabidiol (CBD) are scanty. We explored the effect of demographic and clinical variables on plasma concentrations of purified CBD in patients with Dravet (DS) and Lennox–Gastaut syndrome (LGS). Methods: The study design was an open, prospective, multicenter expanded access program (EAP). Venous blood samples were drawn from patients between 8 and 9 am, before the CBD morning dose, 12 h apart from the last evening dose, and then 2.5 h after their usual morning dose. Results: We collected 127 plasma samples (67-morning pre-dosing and 60 post-dosing) from 43 patients (24 females, 19 males), 27 with LGS and 16 with DS. Mean ± standard deviation age was 26 ± 15 years. Duration of CBD treatment averaged 4.2 ± 2.9 months at 13.2 ± 4.6 mg/kg/day. CBD median trough plasma concentration was 91 ng/ml; it doubled to 190 ng/ml 2.5 h post-dosing (p < 0.001). Cannabidiol trough plasma concentrations were linearly related to daily doses (r = 0.564, p < 0.001). Median trough CBD plasma concentration-to-weight-adjusted dose ratio (C/D) was 32% higher (p < 0.02) in plasma samples from subjects aged 18 and over than in those under 18. Sex and concomitant antiseizure medications (ASMs) were not associated with significant variations in CBD C/D, but caution is required due to the potential influence of confounders. Conclusion: These are the first data on CBD pharmacokinetics in children and adults with LGS or DS in a real-world setting. The most relevant finding was the higher CBD C/D in adults. In practice, reduced weight-normalized doses might be required with aging to achieve the same CBD plasma levels.
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Affiliation(s)
- Manuela Contin
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Susan Mohamed
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Margherita Santucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Child Neuropsichiatry, Bologna, Italy
| | - Monica Anna Maria Lodi
- Department of Neuroscience, Pediatric Neurology Unit and Epilepsy Center, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Cbd Lice Italy Study Group
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Child Neuropsichiatry, Bologna, Italy.,Department of Neuroscience, Pediatric Neurology Unit and Epilepsy Center, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy.,Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy.,Department of Human Neurosciences, Sapienza University, Rome, Italy
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20
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Roberti R, Casarella A, Iudice A, La Neve A, Beghi E, Capovilla G, Di Bonaventura C, Giorgi FS, Grosso S, Iannone LF, Romigi A, Specchio LM, Zaccara G, Mecarelli O, Russo E. Appropriate use of generic and branded antiseizure medications in epilepsy: Updated recommendations from the Italian League Against Epilepsy (LICE). Epilepsy Behav 2021; 116:107804. [PMID: 33581599 DOI: 10.1016/j.yebeh.2021.107804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/07/2020] [Revised: 12/03/2020] [Accepted: 01/14/2021] [Indexed: 02/05/2023]
Abstract
Generic drugs are increasingly used to treat many diseases including epilepsy. The growing importance of generic antiseizure medications (ASMs) has led the ASMs commission of the Italian League Against Epilepsy (LICE) to review current evidence in the literature about efficacy and safety of these products. Recommendations from other scientific organizations have also been considered to provide an update of the LICE position about their utilization (List of Recommendations). Compared with the previous literature review, randomized controlled trials assessing bioequivalence among branded drugs and generics are currently available. Although some contrasting results have been reported, brand-to-generic switching was effective and tolerable in real-life settings, with similar adverse event ratios. Based on these findings, LICE concluded that, conforming to the rigorous regulation of USA and EU markets, generic ASMs are not inferior to the respective branded, providing a cost advantage for patients starting or replacing monotherapy or add-on, and for those with incomplete seizure control. Branded-to-generic (and vice versa) switching is not recommended (although applicable) during seizure remission, as well as the generic-to-other generic switching. Other recommendations focus on the appropriateness of therapeutic drug monitoring (TDM) when switching is required, paying attention to avoiding the erroneous switch between modified and immediate-release formulations during dispensation. Finally, to support patients' compliance, they should be assured of generics' safety and efficacy and carefully informed with practical advice, particularly when the switching is associated with aspect modifications (e.g. color and shape changes) of the pill or the packaging.
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Affiliation(s)
- Roberta Roberti
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Alessandro Casarella
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Alfonso Iudice
- Department of Clinical and Experimental Medicine, Section of Neurology, University of Pisa, Pisa, Italy
| | - Angela La Neve
- Department of Neurological and Psychiatric Sciences, Centre for Epilepsy, University of Bari, Bari, Italy
| | - Ettore Beghi
- Laboratory of Neurological Disorders, Department of Neuroscience, Institute for Pharmacological Research, IRCCS-Mario Negri Milan, Italy
| | - Giuseppe Capovilla
- Department of Mental Health, Epilepsy Center, C. Poma Hospital, Mantua, Italy and Fondazione Poliambulanza, Brescia, Italy
| | - Carlo Di Bonaventura
- Neurology Unit, Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Filippo S Giorgi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; Neurology, Pisa University Hospital, Pisa, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Pediatrics, University of Siena
| | - Luigi F Iannone
- Science of Health Department, School of Medicine, University of Catanzaro, Italy
| | - Andrea Romigi
- Department of Neurology, Mediterranean Neurological Institute, Pozzilli, Italy
| | | | | | - Oriano Mecarelli
- Neurology Unit, Human Neurosciences Department, Sapienza University, Umberto 1 Hospital, Rome, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University of Catanzaro, Italy.
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21
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Chesi P, Marini MG, Scarlata P, Mecarelli O. Epileptologists telling their experiences caring for patients with epilepsy. Seizure 2021; 85:19-25. [PMID: 33385785 DOI: 10.1016/j.seizure.2020.12.012] [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] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This research was focused on expert professionals in epilepsy care to understand their points of view on the care pathway and their living relationships with patients. METHODS Researchers prepared a semi-structured parallel chart and distributed it online among 21 Italian centres of care. Each health professional was prompted to write five narratives on cases of patients with epilepsy, subsequently analysed through narrative medicine methods. Next, a consensus meeting was held, to individualise an action plan based on the narratives. RESULTS Ninety-one parallel charts were collected from 25 epileptologists, who had a mean age of 50 years; their narratives concerned patients with a mean age of 37 years, with different types of epilepsy (53 % drug-resistant; 31 % unemployed). The limitations in the daily life of people with epilepsy (57 %), employment (42 %), caregiver burden (51 %), and the universal prevalence of fear were the primary topics that emerged. Attentive and reassuring care relationships were found to be the main element of coping (21 %). A new multi-factorial classification of epilepsies, integrating clinical with social and legal risk factors, was the main agreed action to face the issues identified. CONCLUSIONS The narrative medicine approach supplied a broader scenario of living with epilepsy, including the family and social impact and possible effects on the choices for care pathways. The epileptologists showed a strong motivation to care for patients with epilepsy and deep involvement in the care relationships; the use of parallel chart demonstrated to be an effective tool to preserve their wellbeing.
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Affiliation(s)
- P Chesi
- Health Care and Wellbeing Area, Fondazione ISTUD, Milan, Italy.
| | - M G Marini
- Health Care and Wellbeing Area, Fondazione ISTUD, Milan, Italy
| | - P Scarlata
- Medical Affairs Neurology, BIAL Italia, Milan, Italy
| | - O Mecarelli
- Department of Human Neuroscience, La Sapienza University and Centre for Epilepsy, Umberto I General Hospital, Rome, Italy
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22
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Enia G, Giussani G, Bianchi E, Mecarelli O, Beghi E. The management of epilepsy in clinical practice: Do the timing and severity of the disease influence the priorities of patients and the caring physicians? Data from the EPINEEDS study. Epilepsy Behav 2021; 114:107201. [PMID: 32739237 DOI: 10.1016/j.yebeh.2020.107201] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/25/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of this study was to assess the priorities of patients with epilepsy and their caring physicians with reference to the timing and severity of the disease. METHODS This is a national survey in which patients with epilepsy followed in 21 Italian epilepsy centers, and their caring physicians were asked to fill anonymous questionnaires to collect data on different aspects of the disease and their needs and priorities in its management. The collected information included demographics, clinical profile and diagnosis, treatment and outcome of epilepsy. The questions were designed to understand the expectations of the patients and their caring physicians and verify the degree of concordance between patient and doctor. The study population was divided in six prognostic categories: (1) Newly diagnosed epilepsy; (2) Absence of seizures for at least 2 years; (3) Absence of seizures for at least 1 year or occasional seizures; (4) Nondrug-resistant recurrent seizures; (5) drug-resistant seizures; (6) surgical candidate. RESULTS Of the 787 patients enrolled, 432 were women and 355 men aged 15 to 88 years (median 41 years). Disease duration ranged from 6 months to 75 years. The sample included 53 patients with newly diagnosed epilepsy, 283 without seizures for at least 2 years, 162 seizure-free for at least 1 year or with occasional seizures, 123 with nondrug-resistant recurrent seizures, 128 with drug-resistant seizures, and 38 surgical candidates. Significant differences were found between patients and physicians in terms of priorities and needs with reference to the management of the disease. While physicians tend to prioritize the information on the diagnosis and treatment of epilepsy depending on timing and severity, patients focus on the search of the cause, the side effects of drugs, and the effects of any new treatment on the control of seizures regardless of the prognostic category. In addition, physicians tend to undervalue the communication of specific information, like the risk of sudden unexpected death in epilepsy (SUDEP) or the existence of lay associations, which might be of special interest for selected categories of patients. SIGNIFICANCE Differences between patients with epilepsy and their caring physicians in terms of needs and priorities and suboptimal communication call for the implementation of programs aimed at addressing the factors deemed most relevant by patients and caregivers for the management of the disease.
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Affiliation(s)
- Gabriele Enia
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giorgia Giussani
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Elisa Bianchi
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Oriano Mecarelli
- Università "La Sapienza", Dipartimento di Neurologia e Psichiatria Policlinico Umberto I°, UOC Neurofisiopatologia e Malattie Muscolari, Italy
| | - Ettore Beghi
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
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23
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Lattanzi S, Canafoglia L, Canevini MP, Casciato S, Chiesa V, Dainese F, De Maria G, Didato G, Falcicchio G, Fanella M, Ferlazzo E, Fisco G, Gangitano M, Giallonardo AT, Giorgi FS, La Neve A, Mecarelli O, Montalenti E, Piazza F, Pulitano P, Quarato PP, Ranzato F, Rosati E, Tassi L, Di Bonaventura C. Adjunctive Brivaracetam in Focal Epilepsy: Real-World Evidence from the BRIVAracetam add-on First Italian netwoRk STudy (BRIVAFIRST). CNS Drugs 2021; 35:1289-1301. [PMID: 34476770 PMCID: PMC8642333 DOI: 10.1007/s40263-021-00856-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In randomized controlled trials, add-on brivaracetam (BRV) reduced seizure frequency in patients with drug-resistant focal epilepsy. Studies performed in a naturalistic setting are a useful complement to characterize the drug profile. OBJECTIVE This multicentre study assessed the effectiveness and tolerability of adjunctive BRV in a large population of patients with focal epilepsy in the context of real-world clinical practice. METHODS The BRIVAFIRST (BRIVAracetam add-on First Italian netwoRk STudy) was a retrospective, multicentre study including adult patients prescribed adjunctive BRV. Patients with focal epilepsy and 12-month follow-up were considered. Main outcomes included the rates of seizure-freedom, seizure response (≥ 50% reduction in baseline seizure frequency), and treatment discontinuation. The incidence of adverse events (AEs) was also considered. Analyses by levetiracetam (LEV) status and concomitant use of strong enzyme-inducing antiseizure medications (EiASMs) and sodium channel blockers (SCBs) were performed. RESULTS A total of 1029 patients with a median age of 45 years (33-56) was included. At 12 months, 169 (16.4%) patients were seizure-free and 383 (37.2%) were seizure responders. The rate of seizure freedom was 22.3% in LEV-naive patients, 7.1% in patients with prior LEV use and discontinuation due to insufficient efficacy, and 31.2% in patients with prior LEV use and discontinuation due to AEs (p < 0.001); the corresponding values for ≥ 50% seizure frequency reduction were 47.9%, 29.7%, and 42.8% (p < 0.001). There were no statistically significant differences in seizure freedom and seizure response rates by use of strong EiASMs. The rates of seizure freedom (20.0% vs. 16.6%; p = 0.341) and seizure response (39.7% vs. 26.9%; p = 0.006) were higher in patients receiving SCBs than those not receiving SCBs; 265 (25.8%) patients discontinued BRV. AEs were reported by 30.1% of patients, and were less common in patients treated with BRV and concomitant SCBs than those not treated with SCBs (28.9% vs. 39.8%; p = 0.017). CONCLUSION The BRIVAFIRST provided real-world evidence on the effectiveness of BRV in patients with focal epilepsy irrespective of LEV history and concomitant ASMs, and suggested favourable therapeutic combinations.
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Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy.
| | - Laura Canafoglia
- Department of Epileptology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Paola Canevini
- Epilepsy Center, Child Neuropsychiatry Unit, AAST Santi Paolo Carlo, Milan, Italy ,Department of Health Sciences, Università degli Studi, Milan, Italy
| | | | - Valentina Chiesa
- Epilepsy Center, Child Neuropsychiatry Unit, AAST Santi Paolo Carlo, Milan, Italy
| | | | - Giovanni De Maria
- Clinical Neurophysiology Unit, Epilepsy Center, Spedali Civili, Brescia, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Giovanni Falcicchio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University Hospital of Bari “A. Moro”, Bari, Italy
| | - Martina Fanella
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Giacomo Fisco
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Massimo Gangitano
- Department of Biomedicine, Neuroscience, and advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Anna Teresa Giallonardo
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Filippo Sean Giorgi
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy ,Neurology Unit, Pisa University Hospital, Pisa, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University Hospital of Bari “A. Moro”, Bari, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Elisa Montalenti
- Epilepsy Center, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Federico Piazza
- Department of Neurosciences, Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Federica Ranzato
- Epilepsy Center, UOC Neurology, AULSS, 8 Vicenza, Vicenza, Italy
| | - Eleonora Rosati
- Department Neurology 2, Careggi University Hospital, Florence, Italy
| | - Laura Tassi
- C. Munari” Epilepsy Surgery Centre, Niguarda Hospital, Milan, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Ricci L, Assenza G, Pulitano P, Simonelli V, Vollero L, Lanzone J, Mecarelli O, Di Lazzaro V, Tombini M. Measuring the effects of first antiepileptic medication in Temporal Lobe Epilepsy: Predictive value of quantitative-EEG analysis. Clin Neurophysiol 2020; 132:25-35. [PMID: 33248432 DOI: 10.1016/j.clinph.2020.10.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 06/06/2020] [Revised: 08/24/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the quantitative EEG responses in a population of drug-naïve patients with Temporal Lobe Epilepsy (TLE) after Levetiracetam (LEV) initiation as first antiepileptic drug (AED). We hypothesized that the outcome of AED treatment can be predicted from EEG data in patients with TLE. METHODS Twenty-three patients with TLE and twenty-five healthy controls were examined. Clinical outcome was dichotomized into seizure-free (SF) and non-seizure-free (NSF) after two years of LEV. EEG parameters were compared between healthy controls and patients with TLE at baseline (EEGpre) and after three months of AED therapy (EEGpre-post) and between SF and NSF patients. Receiver Operating Characteristic curves models were built to test whether EEG parameters predicted outcome. RESULTS AED therapy induces an increase in EEG power for Alpha (p = 0.06) and a decrease in Theta (p < 0.05). Connectivity values were lower in SF compared to NSF patients (p < 0.001). Quantitative EEG predicted outcome after LEV treatment with an estimated accuracy varying from 65.2% to 91.3% (area under the curve [AUC] = 0.56-0.93) for EEGpre and from 69.9% to 86.9% (AUC = 0.69-0.94) for EEGpre-post. CONCLUSIONS AED therapy induces EEG modifications in TLE patients, and such modifications are predictive of clinical outcome. SIGNIFICANCE Quantitative EEG may help understanding the effect of AEDs in the central nervous system and offer new prognostic biomarkers for patients with epilepsy.
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Affiliation(s)
- Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128 Rome, Italy.
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Patrizia Pulitano
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Valerio Simonelli
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Luca Vollero
- Unit of Computational Systems and Bioinformatics, Department of Engineering, Campus Bio-Medico University of Rome, Rome, Italy
| | - Jacopo Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Oriano Mecarelli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, via Álvaro del Portillo, 21, 00128 Rome, Italy
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Cenci C, Mecarelli O. Digital narrative medicine for the personalization of epilepsy care pathways. Epilepsy Behav 2020; 111:107143. [PMID: 32554233 DOI: 10.1016/j.yebeh.2020.107143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/03/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
Among neurological conditions, epilepsy is the disorder best suited to a narrative approach. In epilepsy, the disease, i.e., the condition from the clinical and therapeutic point of view, the illness, the personal experience and impact of the condition, and the sickness, the representations, and social imaginary of epilepsy, are strongly interdependent. Within this context, the Italian League Against Epilepsy (LICE) has launched a multiyear narrative program in Italy resulting in the foundation of a specific Study Group on Narrative Medicine in Epileptology. The Epimena Study is part of this program and involves the "Epilepsy Center, Department of Human Neurosciences, Sapienza University of Rome and Umberto 1° Hospital". The study consists of a pilot project whose aim is to assess the usefulness and feasibility of integrating narrative medicine methodologies into routine clinical practice through a digital platform. The carrying out of the study is based on the acquisition of narrative elements of the patient that the referring doctor uses, integrating them with clinical data, to share and customize the diagnostic-therapeutic pathway of patients. The Epimena Study preliminary results look encouraging. Over 12 months, 57% of the invited patients (37 out of a total of 65) decided to formalize their registration in the digital diary, and 46% responded to one or more narrative prompt generating the story of their experience. Every patient story was then analyzed according to a methodology (Illness Digital StoryMap - IDS) that made it possible to detect the existential impact of the disease and the perception of care. Patients' overall judgment on the project was positive. Through it, they were able to better focus on themselves, bringing out and communicating information to the physician that otherwise would not have been taken into consideration. The majority of patients involved believe that the methodology should be included in the regular clinical practice or in any case would like to continue using it. The data collected confirmed that the time spent on story sharing contributed objectively to a clinical practice of greater quality and effectiveness.
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Affiliation(s)
| | - Oriano Mecarelli
- Epilepsy Center, Department of Human Neurosciences, Sapienza University of Rome and Umberto 1° Hospital, Italy.
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26
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Scala M, Zonneveld-Huijssoon E, Brienza M, Mecarelli O, van der Hout AH, Zambrelli E, Turner K, Zara F, Peron A, Vignoli A, Striano P. De novo ARHGEF9 missense variants associated with neurodevelopmental disorder in females: expanding the genotypic and phenotypic spectrum of ARHGEF9 disease in females. Neurogenetics 2020; 22:87-94. [PMID: 32939676 DOI: 10.1007/s10048-020-00622-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/17/2020] [Accepted: 07/21/2020] [Indexed: 11/24/2022]
Abstract
Individuals harboring pathogenic variants in ARHGEF9, encoding an essential submembrane protein for gamma-aminobutyric acid (GABA)-ergic synapses named collybistin, show intellectual disability (ID), facial dysmorphism, behavioral disorders, and epilepsy. Only few affected females carrying large chromosomal rearrangements involving ARHGEF9 have been reported so far. Through next-generation sequencing (NGS)-based panels, we identified two single nucleotide variants (SNVs) in ARHGEF9 in two females with neurodevelopmental features. Sanger sequencing revealed that these variants were de novo. The X-inactivation pattern in peripheral blood cells was random. We report the first affected females harboring de novo SNVs in ARHGEF9, expanding the genotypic and phenotypic spectrum of ARHGEF9-related neurodevelopmental disorder in females.
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Affiliation(s)
- Marcello Scala
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy. .,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
| | - Evelien Zonneveld-Huijssoon
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marianna Brienza
- Department of Human Neurosciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, Policlinico Umberto I Hospital, Sapienza University, Rome, Italy
| | - Annemarie H van der Hout
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elena Zambrelli
- Epilepsy Center - Sleep Medicine Center, San Paolo Hospital, Milan, Italy
| | - Katherine Turner
- Epilepsy Center - Sleep Medicine Center, San Paolo Hospital, Milan, Italy
| | - Federico Zara
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Unit of Medical Genetics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Angela Peron
- Child Neuropsychiatry Unit - Epilepsy Center, San Paolo Hospital, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Aglaia Vignoli
- Child Neuropsychiatry Unit - Epilepsy Center, San Paolo Hospital, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
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27
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Lanzone J, Cenci C, Tombini M, Ricci L, Tufo T, Piccioli M, Marrelli A, Mecarelli O, Assenza G. Glimpsing the Impact of COVID19 Lock-Down on People With Epilepsy: A Text Mining Approach. Front Neurol 2020; 11:870. [PMID: 32973656 PMCID: PMC7466558 DOI: 10.3389/fneur.2020.00870] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/23/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: To describe how the recent lock-down, related to SARS-COV-II outbreak in Italy, affected People With Epilepsy (PwE), we designed a survey focused on subjective reactions. Using Natural Language Processing (NLP), we analyzed words PwE and People without Epilepsy (PwoE) chose to express their reactions. Methods: As a subset of a larger survey, we collected from both PwE (427) and PwoE (452) single words (one per subject) associated to the period of lock down. The survey was spread thanks to the efforts of Italian league against epilepsy Foundation during the days of maximum raise of the pandemic. Data were analyzed via bag of word and sentiment analysis techniques in R. Results: PwoE and PwE showed significantly different distribution in word choice (X2, p = 4.904e−13). A subset of subject used positive words to describe this period, subjects with positive feelings about the lock down were more represented in the PwE group (X2, p = 0.045). Conclusion: PwoE developed reactive stress response to the restrictions enacted during lock-down. PwE, instead, chose words expressing sadness and concern with their disease. PwE appear to internalize more the trauma of lock down. Interestingly PwE also expressed positive feelings about this period of isolation more frequently than PwoE. Our study gives interesting insights on how People with Epilepsy react to traumatic events, using methods that evidence features that do not emerge with psychometric scales.
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Affiliation(s)
- Jacopo Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Tommaso Tufo
- Policlinico Gemelli Foundation University Hospital IRCSS, Rome, Italy
| | | | | | - Oriano Mecarelli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
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28
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Accogli A, Severino M, Riva A, Madia F, Balagura G, Iacomino M, Carlini B, Baldassari S, Giacomini T, Croci C, Pisciotta L, Messana T, Boni A, Russo A, Bilo L, Tonziello R, Coppola A, Filla A, Mecarelli O, Casalone R, Pisani F, Falsaperla R, Marino S, Parisi P, Ferretti A, Elia M, Luchetti A, Milani D, Vanadia F, Silvestri L, Rebessi E, Parente E, Vatti G, Mancardi MM, Nobili L, Capra V, Salpietro V, Striano P, Zara F. Targeted re-sequencing in malformations of cortical development: genotype-phenotype correlations. Seizure 2020; 80:145-152. [DOI: 10.1016/j.seizure.2020.05.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 05/29/2020] [Indexed: 12/25/2022] Open
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29
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Grippo A, Assenza G, Scarpino M, Broglia L, Cilea R, Galimberti CA, Lanzo G, Michelucci R, Tassi L, Vergari M, Di Lazzaro V, Mecarelli O. Electroencephalography during SARS-CoV-2 outbreak: practical recommendations from the task force of the Italian Society of Neurophysiology (SINC), the Italian League Against Epilepsy (LICE), and the Italian Association of Neurophysiology Technologists (AITN). Neurol Sci 2020; 41:2345-2351. [PMID: 32696088 PMCID: PMC7371961 DOI: 10.1007/s10072-020-04585-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/06/2020] [Indexed: 12/01/2022]
Abstract
Background During COVID-19 lockdown, non-urgent medical procedures were suspended. Grade of urgency of electroencephalography (EEG) may vary according to the clinical indication, setting, and status of infection of SARS-CoV-2 virus. “Italian Society of Clinical Neurophysiology” (SINC), “Italian League Against Epilepsy” (LICE), and the “Italian Association of Neurophysiology Technologists” (AITN) aimed to provide clinical and technical recommendation for EEG indications and recording standards in this pandemic era. Methods Presidents of SINC, LICE, and AITN endorsed three members per each society to formulate recommendations: classification of the degree of urgency of EEG clinical indications, management and behavior of physicians and neurophysiology technologists, hygiene and personal protection standards, and use of technical equipment. Results Scientific societies endorsed a paper conveying the recommendation for EEG execution in accordance with clinical urgency, setting (inpatients/outpatients), status of SARS-CoV-2 virus infection (positive, negative and uncertain), and phase of governmental restrictions (phase 1 and 2). Briefly, in phase 1, EEG was recommended only for those acute/subacute neurological symptoms where EEG is necessary for diagnosis, prognosis, or therapy. Outpatient examinations should be avoided in phase 1, while they should be recommended in urgent cases in phase 2 when they could prevent an emergency room access. Reduction of staff contacts must be encouraged through rescheduling job shifts. The use of disposable electrodes and dedicated EEG devices for COVID-19-positive patients are recommended. Conclusions During the different phases of COVID-19 pandemic, the EEG should be reserved for patients really benefiting from its execution in terms of diagnosis, treatment, prognosis, and avoidance of emergency room access.
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Affiliation(s)
- Antonello Grippo
- SODc Neurophysiopathology, AOU Careggi, Florence, Italy.,IRCCS Don Carlo Gnocchi Foundation, Florence, Italy
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Maenia Scarpino
- SODc Neurophysiopathology, AOU Careggi, Florence, Italy.,IRCCS Don Carlo Gnocchi Foundation, Florence, Italy
| | - Lidia Broglia
- UOC Neurology, San Filippo Neri Hospital, ASL Rome1, Rome, Italy
| | - Rosalia Cilea
- IRCSS Neurological Sciences, Bellaria, Bologna, Italy
| | | | | | | | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, ASST Niguarda Hospital, Milan, Italy
| | | | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciencies, Sapienza University of Rome, Rome, Italy
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30
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Assenza G, Lanzone J, Brigo F, Coppola A, Di Gennaro G, Di Lazzaro V, Ricci L, Romigi A, Tombini M, Mecarelli O. Epilepsy Care in the Time of COVID-19 Pandemic in Italy: Risk Factors for Seizure Worsening. Front Neurol 2020; 11:737. [PMID: 32719655 PMCID: PMC7350269 DOI: 10.3389/fneur.2020.00737] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [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: 04/28/2020] [Accepted: 06/16/2020] [Indexed: 12/27/2022] Open
Abstract
Objective: In early 2020, Italy struggled with an unprecedented health emergency related to the COVID-19 pandemic. Medical care of chronic neurological diseases, such as epilepsy, is being sorely neglected. In this national survey, we aimed at understanding the impact of COVID-19 lockdown on the care of people with epilepsy (PwE) and identifying PwE risk factors for seizure worsening to direct telemedicine efforts. Methods: We administered a 48-items online survey (published on April 11, 2020) including socio-demographic, epilepsy-related, and psychometric variables (BDI-II for depression, GAD-7 for anxiety, and PSQI for sleep) to PwE and people without epilepsy (PwoE). Regression analysis identified predictors of seizure worsening. Results: We collected responses from 456 PwE (344 females) and 472 PwoE (347 females). Outpatient examinations of PwE were postponed in 95% of cases. One-third of PwE complained of issues with epilepsy management, but only 71% of them reached the treating physician and solved their problems. PwE had worse depressive and anxiety symptoms (higher BDI-II and GAD-7 scores; p < 0.001) than PwoE. Sleep quality was equally compromised in both groups (47 and 42%). Sixty-seven PwE (18%) reported seizure worsening, which was best explained by the number of anti-seizure medications (ASM) of chronic therapy and the severity of sleep disorder. Conclusions: During the current COVID-19 pandemic, a significant percentage of PwE experienced difficulties in follow-up and a seizure number increase, in particular those chronically taking more ASMs and with poor sleep quality. This dramatic experience outlines the urgent need for validation and implementation of telemedicine services for epileptic patients in order to provide regular follow-up.
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Affiliation(s)
- Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Jacopo Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Francesco Brigo
- Division of Neurology, "Franz Tappeiner" Hospital, Merano, Italy
| | - Antonietta Coppola
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | | | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Andrea Romigi
- Sleep Medicine Center, IRCCS NEUROMED, Pozzilli, Italy
| | - Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Oriano Mecarelli
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
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31
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Brigo F, Lattanzi S, Giussani G, Tassi L, Pietrafusa N, Galimberti CA, Bragazzi NL, Mecarelli O. A cross-sectional survey among physicians on internet use for epilepsy-related information. Epilepsy Res 2020; 165:106393. [PMID: 32544785 DOI: 10.1016/j.eplepsyres.2020.106393] [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] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We investigated views towards the Internet in a sample of Italian healthcare specialists involved in epilepsy field, to identify factors associated with the attitude of being influenced by information found on the Internet. METHODS This study was a self-administered survey conducted in a group of members of the Italian Chapter of the International League Against Epilepsy (ILAE) in January 2018. RESULTS 184 questionnaires were analyzed. 97.8 % of responders reported to seek online information on epilepsy. The Internet was most frequently searched to obtain new information (69.9 %) or to confirm a diagnostic or therapeutic decision (37.3 %). The influence of consulting the Internet on clinical practice was associated with registration to social network(s) (OR: 2.94; 95 %CI: 1.28-6.76; p = 0.011), higher frequency of Internet use (OR: 3.66; 95 %CI: 1.56-9.21; p = 0.006) and higher confidence in reliability of online information (OR: 2.61; 95 %CI: 1.09-6.26; p = 0.031). No association was found with age, sex, years in epilepsy practice or easiness to find online information. CONCLUSION Internet is frequently used among healthcare professionals involved in the epilepsy to obtain information about this disease. The attitude of being influenced by the Internet for diagnostic and/or therapeutic decisions in epilepsy is independent on age and years of experience in epilepsy, and probably reflects an individual approach towards the Web.
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Affiliation(s)
- F Brigo
- Hospital Franz Tappeiner, Department of Neurology, Merano, Italy.
| | - S Lattanzi
- Marche Polytechnic University, Neurological Clinic, Department of Experimental and Clinical Medicine, Ancona, Italy
| | - G Giussani
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Laboratory of Neurological Disorders, Department of Neuroscience, Milan, Italy
| | - L Tassi
- Niguarda Hospital, 'Claudio Munari' Epilepsy Surgery Centre, Milan, Italy
| | - N Pietrafusa
- Bambino Gesù Children's Hospital, IRCCS, Department of Neuroscience, Rome, Italy
| | - C A Galimberti
- IRCCS C. Mondino National Neurological Institute, Epilepsy Centre, Pavia, Italy
| | - N L Bragazzi
- School of Public Health, University of Genoa, Department of Health Sciences (DISSAL), Genoa, Italy
| | - O Mecarelli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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32
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Minicucci F, Ferlisi M, Brigo F, Mecarelli O, Meletti S, Aguglia U, Michelucci R, Mastrangelo M, Specchio N, Sartori S, Tinuper P. Reply to Dr. Capovilla on "Reply to the article "Management of status epilepticus in adults. Position paper of the Italian League Against Epilepsy"". Epilepsy Behav 2020; 107:107048. [PMID: 32268969 DOI: 10.1016/j.yebeh.2020.107048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Fabio Minicucci
- Epilepsy Center, Neurophysiology Unit, Neurological Department, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Monica Ferlisi
- Division of Neurology A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesco Brigo
- Division of Neurology, "Franz Tappeiner" Hospital, Merano, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Oriano Mecarelli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Neurosciences and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Umberto Aguglia
- Epilepsy Center, Department of Medical and Surgical Sciences Regional, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Roberto Michelucci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy
| | - Massimo Mastrangelo
- Pediatric Neurology Unit, "V. Buzzi" Children's Hospital, Pediatrics Department, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Nicola Specchio
- Department of Neuroscience, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche, Bellaria Hospital, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Giussani G, Enia G, Bianchi E, Mecarelli O, Beghi E, Cagnetti C, Baldinelli S, Lattanzi S, La Neve A, Tappatà M, Francavilla T, De Maria G, Sofia V, Giuliano L, Mainieri G, Fatuzzo D, Belcastro V, Elia M, D'Orsi G, Lalla A, Salmaggi A, Brigo F, Magaudda A, Pisani F, Galletta S, Pisani LR, Raffaele M, Cosenza D, Villani FS, Quintas RM, Cervellione R, Borroni S, Meletti S, Ferrarese C, Barbella G, Di Francesco J, Bogliun G, Beretta S, Galimberti CA, Cantisani TA, Cecconi M, Celani MG, Papetti R, Giorgi FS, Aguglia U, Gasparini S, Ferlazzo E, Manganotti P, Crichiutti G, Bravar G. The management of epilepsy in clinical practice: Do the needs manifested by the patients correspond to the priorities of the caring physicians? Findings from the EPINEEDS Study. Epilepsy Behav 2020; 102:106641. [PMID: 31759314 DOI: 10.1016/j.yebeh.2019.106641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/06/2019] [Accepted: 10/01/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to assess the priorities of patients with epilepsy and caring physicians and the correspondence between these priorities. METHODS In this multicenter cross-sectional study, patients with epilepsy attending 21 Italian epilepsy centers and their caring physicians filled anonymously questionnaires on the needs and priorities in the management of the disease. Included were questions on patients' demographics, diagnosis, treatment, and outcome of epilepsy. The concordance between patients and their physicians was assessed on various aspects of the diagnosis and care of the disease. Patients' satisfaction with communication, services, and patient-doctor relationship was also assessed. RESULTS Included were 432 women and 355 men aged 15 to 88 years (median: 41 years). Disease duration ranged from 6 months to 75 years. A structural/metabolic etiology predominated (52.7%), followed by a (presumed) genetic etiology (33.0%). Seizure remission was present in 56.5% of cases. Comorbidities requiring chronic treatment were present in 27.5%, and comorbidities affecting self-sufficiency in 9.5%. Psychiatric comorbidity was present in 35.0%. Patients' priorities included discovery of the cause (89.1%), use of right drug (98.7%), use of a drug without chronic side effects (94.0%), and a life without restrictions (90.4%). Physicians' priorities included choice of right drug (83.5%) and use of drugs without chronic side effects (86.8%). Priorities varied with patients' age, sex, education, and occupation. Patient-doctor relationships were at least good in most cases. The information imparted was considered unsatisfactory by 21-44% of cases on seizure circumstances and complications, side effects of drugs, limitations of daily activities, and management of physiologic or pathologic conditions. Patients declared overall satisfaction, except for appointments (21.5%) and emergencies (30.8%). CONCLUSION Patients and physicians' priorities in the management of epilepsy overlap only in part. Patients are satisfied with their caring physicians and less satisfied with communication and management of routine and emergency problems.
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Affiliation(s)
- Giorgia Giussani
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Gabriele Enia
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Elisa Bianchi
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Oriano Mecarelli
- Dipartimento Neuroscienze Umane, Sapienza Università di Roma, Italy
| | - Ettore Beghi
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
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Minicucci F, Ferlisi M, Brigo F, Mecarelli O, Meletti S, Aguglia U, Michelucci R, Mastrangelo M, Specchio N, Sartori S, Tinuper P. Management of status epilepticus in adults. Position paper of the Italian League against Epilepsy. Epilepsy Behav 2020; 102:106675. [PMID: 31766004 DOI: 10.1016/j.yebeh.2019.106675] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 08/29/2019] [Revised: 09/30/2019] [Accepted: 10/30/2019] [Indexed: 01/15/2023]
Abstract
Since the publication of the Italian League Against Epilepsy guidelines for the treatment of status epilepticus in 2006, advances in the field have ushered in improvements in the therapeutic arsenal. The present position paper provides neurologists, epileptologists, neurointensive care specialists, and emergency physicians with updated recommendations for the treatment of adult patients with status epilepticus. The aim is to standardize treatment recommendations in the care of this patient population.
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Affiliation(s)
- Fabio Minicucci
- Epilepsy Center, Unit of Neurophysiology, Neurological Department, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Monica Ferlisi
- Division of Neurology A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Francesco Brigo
- Division of Neurology, "Franz Tappeiner" Hospital, Merano, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Oriano Mecarelli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Neurosciences and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, OCB Hospital, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
| | - Umberto Aguglia
- Epilepsy Center, Department of Medical and Surgical Sciences Regional, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Roberto Michelucci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy.
| | - Massimo Mastrangelo
- Pediatric Neurology Unit, "V. Buzzi" Children's Hospital, Pediatrics Department, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Nicola Specchio
- Department of Neuroscience, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche, Bellaria Hospital, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
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Maschio M, Aguglia U, Avanzini G, Banfi P, Buttinelli C, Capovilla G, Casazza MML, Colicchio G, Coppola A, Costa C, Dainese F, Daniele O, De Simone R, Eoli M, Gasparini S, Giallonardo AT, La Neve A, Maialetti A, Mecarelli O, Melis M, Michelucci R, Paladin F, Pauletto G, Piccioli M, Quadri S, Ranzato F, Rossi R, Salmaggi A, Terenzi R, Tisei P, Villani F, Vitali P, Vivalda LC, Zaccara G, Zarabla A, Beghi E. Management of epilepsy in brain tumors. Neurol Sci 2019; 40:2217-2234. [PMID: 31392641 DOI: 10.1007/s10072-019-04025-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 06/24/2019] [Accepted: 07/20/2019] [Indexed: 12/15/2022]
Abstract
Epilepsy in brain tumors (BTE) may require medical attention for a variety of unique concerns: epileptic seizures, possible serious adverse effects of antineoplastic and antiepileptic drugs (AEDs), physical disability, and/or neurocognitive disturbances correlated to tumor site. Guidelines for the management of tumor-related epilepsies are lacking. Treatment is not standardized, and overall management might differ according to different specialists. The aim of this document was to provide directives on the procedures to be adopted for a correct diagnostic-therapeutic path of the patient with BTE, evaluating indications, risks, and benefits. A board comprising neurologists, epileptologists, neurophysiologists, neuroradiologists, neurosurgeons, neuro-oncologists, neuropsychologists, and patients' representatives was formed. The board converted diagnostic and therapeutic problems into seventeen questions. A literature search was performed in September-October 2017, and a total of 7827 unique records were retrieved, of which 148 constituted the core literature. There is no evidence that histological type or localization of the brain tumor affects the response to an AED. The board recommended to avoid enzyme-inducing antiepileptic drugs because of their interference with antitumoral drugs and consider as first-choice newer generation drugs (among them, levetiracetam, lamotrigine, and topiramate). Valproic acid should also be considered. Both short-term and long-term prophylaxes are not recommended in primary and metastatic brain tumors. Management of seizures in patients with BTE should be multidisciplinary. The panel evidenced conflicting or lacking data regarding the role of EEG, the choice of therapeutic strategy, and timing to withdraw AEDs and recommended high-quality long-term studies to standardize BTE care.
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Affiliation(s)
- Marta Maschio
- Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuliano Avanzini
- Department of Neurophysiology and Experimental Epileptology, Carlo Besta Neurological Institute, Milan, Italy
| | - Paola Banfi
- Neurology Unit, Department of Emergency, Medicine Epilepsy Center, Circolo Hospital, Varese, Italy
| | - Carla Buttinelli
- Department of Neuroscience, Mental Health and Sensory Organs, University of Rome "La Sapienza", Rome, Italy
| | - Giuseppe Capovilla
- Department of Mental Health, Epilepsy Center, C. Poma Hospital, Mantua, Italy
| | | | - Gabriella Colicchio
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonietta Coppola
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Epilepsy Centre, University of Naples Federico II, Naples, Italy
| | - Cinzia Costa
- Neurological Clinic, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Filippo Dainese
- Epilepsy Centre, UOC Neurology, SS. Giovanni e Paolo Hospital, Venice, Italy
| | - Ornella Daniele
- Epilepsy Center-U.O.C. Neurology, Policlinico Paolo Giaccone, Experimental Biomedicine and Clinical Neuroscience Department (BioNeC), University of Palermo, Palermo, Italy
| | - Roberto De Simone
- Neurology and Stroke Unit, Epilepsy and Sleep Disorders Center, St. Eugenio Hospital, Rome, Italy
| | - Marica Eoli
- Molecular Neuro-Oncology Unit, IRCCS-Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Angela La Neve
- Department of Neurological and Psychiatric Sciences, Centre for Epilepsy, University of Bari, Bari, Italy
| | - Andrea Maialetti
- Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Oriano Mecarelli
- Neurology Unit, Human Neurosciences Department, Sapienza University, Umberto 1 Hospital, Rome, Italy
| | - Marta Melis
- Department of Medical Sciences and Public Health, Institute of Neurology, University of Cagliari, Monserrato, Cagliari, Italy
| | - Roberto Michelucci
- Unit of Neurology, Bellaria Hospital, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Paladin
- Epilepsy Center, UOC Neurology, Ospedale Santi Giovanni e Paolo, Venice, Italy
| | - Giada Pauletto
- Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marta Piccioli
- UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - Stefano Quadri
- USC Neurology, Epilepsy Center, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federica Ranzato
- Epilepsy Centre, Neuroscience Department, S. Bortolo Hospital, Vicenza, Italy
| | - Rosario Rossi
- Neurology and Stroke Unit, San Francesco Hospital, 08100, Nuoro, Italy
| | | | - Riccardo Terenzi
- Epilepsy Consultation Room, Neurology Unit, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Paolo Tisei
- Neurophysiology Unit, Department of Neurology-University "La Sapienza", S. Andrea Hospital, Rome, Italy
| | - Flavio Villani
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milan, Italy
| | - Paolo Vitali
- Neuroradiology and Brain MRI 3T Mondino Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Gaetano Zaccara
- Regional Health Agency of Tuscany, Via P Dazzi 1, 50141, Florence, Italy
| | - Alessia Zarabla
- Center for Brain Tumor-Related Epilepsy, UOSD Neuro-Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Ettore Beghi
- Department of Neurosciences, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Scarpino M, Carrai R, Lolli F, Lanzo G, Spalletti M, Audenino D, Callegarin C, Celani MG, Lombardi M, Marrelli A, Mecarelli O, Minardi C, Minicucci F, Motti L, Politini L, Valzania F, Vitelli E, Peris A, Amantini A, Grippo A. Electroencephalogram and somatosensory evoked potential evaluation for good and poor neurological prognosis after cardiac arrest: a prospective multicenter cohort trial (ProNeCA). Future Neurology 2019. [DOI: 10.2217/fnl-2018-0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Aim: Hypoxic-ischemic-encephalopathy is a severe and frequent neurological complication of successful cardiopulmonary-resuscitation after cardiac arrest. Prognosticating neurological outcomes in patients with hypoxic-ischemic-encephalopathy is challenging and recent guidelines suggest a multimodal approach. Only few studies have analyzed the prognostic power of the association between instrumental tests and, in addition, most of them were monocentric, retrospective and evaluating only poor outcome. Methods/design: We designed a multicenter prospective cohort study to assessing the prognostic power of the association of electroencephalogram and somatosensory evoked potentials for the prediction of both poor and good neurological outcomes at different times after cardiac arrest. Discussion: The results of our study will provide a high level of evidence for the use of neurophysiological evaluation in the current clinical practice.
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Affiliation(s)
| | - Riccardo Carrai
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | - Francesco Lolli
- Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università degli studi di Firenze, Italy
| | - Giovanni Lanzo
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | - Maddalena Spalletti
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | | | - Claudio Callegarin
- UO Neurologia e Neurofisiopatologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Maria Grazia Celani
- UO Neurofisiopatologia, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | | | - Alfonso Marrelli
- UOC Neurofisiopatologia, Ospedale San Salvatore, L’Aquila, Italy
| | - Oriano Mecarelli
- UOC Neurofisiopatologia, Policlinico Umberto primo, Università La Sapienza, Roma, Italy
| | | | - Fabio Minicucci
- UO Neurofisiopatologia, Ospedale San Raffaele IRCCS, Milano, Italy
| | - Luisa Motti
- UO Neurofisiopatologia Arcispedale. Santa Maria Nuova, Reggio nell’Emilia, Italy
| | | | - Franco Valzania
- Neurofisiopatologia Interventiva, Osp Civile di Baggiovara, Modena, Italy
| | | | - Adriano Peris
- SODc Cure intensive per il trauma ed i supporti extracorporei, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | - Aldo Amantini
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Firenze, Italy
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Mula M, Zaccara G, Galimberti CA, Ferrò B, Canevini MP, Mascia A, Mecarelli O, Michelucci R, Pisani LR, Specchio LM, Striano S, Perucca E. Validated outcome of treatment changes according to International League Against Epilepsy criteria in adults with drug-resistant focal epilepsy. Epilepsia 2019; 60:1114-1123. [PMID: 30866058 PMCID: PMC6850288 DOI: 10.1111/epi.14685] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 12/04/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/28/2022]
Abstract
Objective Although many studies have attempted to describe treatment outcomes in patients with drug‐resistant epilepsy, results are often limited by the adoption of nonhomogeneous criteria and different definitions of seizure freedom. We sought to evaluate treatment outcomes with a newly administered antiepileptic drug (AED) in a large population of adults with drug‐resistant focal epilepsy according to the International League Against Epilepsy (ILAE) outcome criteria. Methods This is a multicenter, observational, prospective study of 1053 patients with focal epilepsy diagnosed as drug‐resistant by the investigators. Patients were assessed at baseline and 6, 12, and 18 months, for up to a maximum of 34 months after introducing another AED into their treatment regimen. Drug resistance status and treatment outcomes were rated according to ILAE criteria by the investigators and by at least two independent members of an external expert panel (EP). Results A seizure‐free outcome after a newly administered AED according to ILAE criteria ranged from 11.8% after two failed drugs to 2.6% for more than six failures. Significantly fewer patients were rated by the EP as having a “treatment failure” as compared to the judgment of the investigator (46.7% vs 62.9%, P < 0.001), because many more patients were rated as “undetermined outcome” (45.6% vs 27.7%, P < 0.001); 19.3% of the recruited patients were not considered drug‐resistant by the EP. Significance This study validates the use of ILAE treatment outcome criteria in a real‐life setting, providing validated estimates of seizure freedom in patients with drug‐resistant focal epilepsy in relation to the number of previously failed AEDs. Fewer than one in 10 patients achieved seizure freedom on a newly introduced AED over the study period. Pseudo drug resistance could be identified in one of five cases.
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Affiliation(s)
- Marco Mula
- Institute of Medical and Biomedical Education, St George's University of London and Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals National Health Service Foundation Trust, London, UK
| | | | | | | | - Maria Paola Canevini
- Department of Health Sciences, University of Milan, Epilepsy Center, San Paolo Hospital, Milan, Italy
| | | | - Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Roberto Michelucci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia Ospedale Bellaria, Bologna, Italy
| | - Laura Rosa Pisani
- Neurology Unit, Cutrona-Zodda Hospital, Barcellona Pozzo di Gotto, Italy
| | | | - Salvatore Striano
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, School of Medicine, Federico II Epilepsy Center, University of Naples, Naples, Italy
| | - Emilio Perucca
- Clinical Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia and Clinical Trial Center, IRCCS Mondino Foundation, Pavia, Italy
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Brigo F, Lattanzi S, Kinney MO, Bragazzi NL, Tassi L, Nardone R, Mecarelli O. Online behavior of people visiting a scientific website on epilepsy. Epilepsy Behav 2019; 90:79-83. [PMID: 30522058 DOI: 10.1016/j.yebeh.2018.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/16/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 12/15/2022]
Abstract
We investigated the online behavior of Internet users consulting the website of the Italian Chapter of the International League Against Epilepsy (Lega Italiana Contro l'Epilessia [LICE]). We obtained the visualization statistics of the LICE website using AWStats (https://awstats.sourceforge.io/) and Google Trends (https://trends.google.com/trends/), and compared the statistics of years 2010, 2014, and 2017. The following variables were analyzed: number of unique visitors and visits, visit duration, the day of week and rush hours, most downloaded documents, most viewed pages, keyphrases and keywords used for online searches, origins of searches, and geographic trends of Google searches related to the LICE. The total numbers of unique visitors, visits and page views remained quite stable over time. Most visits (70 to 76.7%) lasted less than 30 s. The most frequent keyphrases and keywords used for online searches were related to clinical guidelines and driving license. Among the most frequently downloaded documents were general guides on epilepsy. The pages with the list of epilepsy centers endorsed by the LICE and those with the list of LICE guidelines were among those most frequently viewed, together with educational videos. Most users directly accessed the website without being referred from external links. No information on geographic origin of Google searches was available. The visualization statistics suggested two distinct populations of visitors. The first one is likely represented by physicians who seek specialist information on diagnosis and management of epilepsy, including guidelines. The second population is represented by lay people who seek accessible and easily comprehensible information to better understand epilepsy and know which centers are best for its management.
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Affiliation(s)
- Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Hospital Franz Tappeiner, Department of Neurology, Merano, Italy.
| | - Simona Lattanzi
- Marche Polytechnic University, Neurological Clinic, Department of Experimental and Clinical Medicine, Ancona, Italy
| | - Michael O Kinney
- Department of Neurology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, County Antrim, UK
| | - Nicola Luigi Bragazzi
- School of Public Health, University of Genoa, Department of Health Sciences (DISSAL), Genoa, Italy
| | - Laura Tassi
- Niguarda Hospital, 'Claudio Munari' Epilepsy Surgery Centre, Milan, Italy
| | - Raffaele Nardone
- Hospital Franz Tappeiner, Department of Neurology, Merano, Italy; Paracelsus Medical University, Department of Neurology, Christian Doppler Klinik, Salzburg, Austria
| | - Oriano Mecarelli
- 'Sapienza' University of Rome, Human Neuroscience Department, Rome, Italy
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Pellegrino G, Mecarelli O, Pulitano P, Tombini M, Ricci L, Lanzone J, Brienza M, Davassi C, Di Lazzaro V, Assenza G. Eslicarbazepine Acetate Modulates EEG Activity and Connectivity in Focal Epilepsy. Front Neurol 2018; 9:1054. [PMID: 30619030 PMCID: PMC6297144 DOI: 10.3389/fneur.2018.01054] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 07/10/2018] [Accepted: 11/20/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction: Eslicarbazepine acetate (ESL) is an antiepileptic drug approved as monotherapy or add-on for the treatment of epilepsy with seizures of focal onset. ESL owns a good profile in terms of efficacy and tolerability, but its effects on EEG activity and connectivity are unknown. The purpose of this study was to investigate EEG activity and connectivity changes after ESL treatment in persons with focal epilepsy (PFE). Material and Methods: We performed a multicentre, longitudinal, retrospective, quantitative EEG study on a population of 22 PFE, and a group of 40 controls. We investigated the ESL-related changes of EEG power spectral activity and global connectivity [phase locking value (PLV), amplitude envelope correlation (AEC) and amplitude envelope correlation of orthogonalized signals (Ortho-AEC)] for standard frequency bands (delta to gamma). Seizure frequency was evaluated to assess ESL efficacy in our cohort. Results: ESL significantly enhanced both global power spectral density and connectivity for all frequency bands, similarly for all connectivity measures. When compared to the control group, Post-ESL power was significantly higher in theta and gamma band. Pre-ESL connectivity values were significantly lower than control for all frequency bands. Post-ESL connectivity increased and the gap between the two groups was no longer significant. ESL induced a 52.7 ± 41.1% reduction of seizure frequency, with 55% of clinical responders (reduction of seizures ≥50%). Discussion: ESL therapy induces significant enhancement of brain activity and connectivity. Post-ESL connectivity profile of epilepsy patients was similar to the one of healthy controls.
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Affiliation(s)
| | - Oriano Mecarelli
- Department of Human Neurosciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Patrizia Pulitano
- Department of Human Neurosciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Mario Tombini
- Neurology Department, Campus Biomedico University of Rome, Rome, Italy
| | - Lorenzo Ricci
- Neurology Department, Campus Biomedico University of Rome, Rome, Italy
| | - Jacopo Lanzone
- Neurology Department, Campus Biomedico University of Rome, Rome, Italy
| | - Marianna Brienza
- Department of Human Neurosciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Chiara Davassi
- Department of Human Neurosciences, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | | | - Giovanni Assenza
- Neurology Department, Campus Biomedico University of Rome, Rome, Italy
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Verrotti A, Striano P, Iapadre G, Zagaroli L, Bonanni P, Coppola G, Elia M, Mecarelli O, Franzoni E, Liso PD, Vigevano F, Curatolo P. The pharmacological management of Lennox-Gastaut syndrome and critical literature review. Seizure 2018; 63:17-25. [DOI: 10.1016/j.seizure.2018.10.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/11/2018] [Accepted: 10/25/2018] [Indexed: 12/29/2022] Open
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Lai S, Molfino A, Mecarelli O, Pulitano P, Morabito S, Pistolesi V, Romanello R, Zarabla A, Galani A, Frassetti N, Aceto P, Lai C. Neurological and Psychological Changes in Hemodialysis Patients Before and After the Treatment. Ther Apher Dial 2018; 22:530-538. [PMID: 29931746 DOI: 10.1111/1744-9987.12672] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/03/2017] [Accepted: 01/08/2018] [Indexed: 12/13/2022]
Abstract
Neurological, psychological, and cognitive disorders in chronic kidney disease may contribute to poor quality of life in these patients. The aim of this study was to assess the electroencephalographic, psychological, and cognitive changes before and after hemodialysis (HD) compared with healthy controls (HC). Sixteen HD patients and 15 HC were enrolled. Electroencephalogram (EEG), Minnesota multiphasic personality inventory (MMPI-2) Satisfaction profile (SAT-P), and Neuropsychological test Global z-scores (NPZ5) were performed before (T0) and after (T1) HD treatment and in HC. Renal function, inflammatory markers and mineral metabolism indexes were also evaluated. Patients did not show significant differences before and after HD in the absolute and relative power of band of EEG, except in Theta/Alpha index (P < 0.001). At T1, HD patients showed significant differences in Beta, Delta and Theta band, in addition to Theta/alpha index, with respect to HC. Moreover, HD patients showed significant differences in specific MMPI-2 clinical and content scales, SAT-P domains and NPZ5 tests of memory and concentration with respect to HC. We also observed significant correlations between renal function, mineral metabolism, inflammatory markers and psychocognitive alterations. In our sample EEG abnormalities tend to reduce, but not significantly, after HD treatment and differences remain present with respect to HC. In HD patients cognitive and psychological alterations were associated with reduced quality of life and correlated with mineral metabolism and inflammation. Modification in EEG and in psychological and cognitive parameters should be assessed in a larger HD population to confirm our observation.
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Affiliation(s)
- Silvia Lai
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessio Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Oriano Mecarelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pulitano
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Santo Morabito
- Department of Nephrology and Urology, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Valentina Pistolesi
- Department of Nephrology and Urology, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Roberto Romanello
- Department of Neurology and Psychiatry, Catholic University of Sacred Heart, Rome, Italy
| | - Alessia Zarabla
- Center for Tumor-related Epilepsy, UOSD Neurology, Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandro Galani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicla Frassetti
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Paola Aceto
- Department of Anesthesiology and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinic Psychology, Sapienza University of Rome, Rome, Italy
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Brigo F, Lattanzi S, Giussani G, Tassi L, Pietrafusa N, Galimberti CA, Nardone R, Bragazzi NL, Mecarelli O. Italian Wikipedia and epilepsy: An infodemiological study of online information-seeking behavior. Epilepsy Behav 2018; 81:119-122. [PMID: 29454607 DOI: 10.1016/j.yebeh.2018.01.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 11/16/2022]
Abstract
Wikipedia is the most commonly accessed source of health information by both healthcare professionals and the lay public worldwide. We aimed to evaluate information-seeking behavior of Internet users searching the Italian Wikipedia for articles related to epilepsy and its treatment. Using Pageviews Analysis, we assessed the total and mean monthly views of articles from the Italian Wikipedia devoted to epilepsy, epileptic syndromes, seizure type, and antiepileptic drugs (AEDs) from January 1, 2015 to October 31, 2017. We compared the views of the article on epilepsy with those of articles focusing on Alzheimer's disease, migraine, multiple sclerosis, syncope, and stroke and adjusted all results for crude disease prevalence. With the only exception of the article on multiple sclerosis, the adjusted views for the Italian Wikipedia article on epilepsy were higher than those for the other neurological disorders. The most viewed articles on seizure type were devoted to tonic-clonic seizure, typical absence seizure, tonic convulsive seizures, and clonic convulsive seizures. The most frequently accessed articles on epilepsy syndromes were about temporal lobe epilepsy and Lennox-Gastaut syndrome. The most frequently viewed articles on AEDs were devoted to valproic acid, carbamazepine, and levetiracetam. Wikipedia searches seem to mirror patients' fears and worries about epilepsy more than its actual epidemiology. The ultimate reasons for searching online remain unknown. Epileptologists and epilepsy scientific societies should make greater efforts to work jointly with Wikipedia to convey more accurate and up-to-date information about epilepsy.
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Affiliation(s)
- Francesco Brigo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Hospital Franz Tappeiner, Department of Neurology, Merano, Italy.
| | - Simona Lattanzi
- Marche Polytechnic University, Neurological Clinic, Department of Experimental and Clinical Medicine, Ancona, Italy
| | - Giorgia Giussani
- IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', Laboratory of Neurological Disorders, Department of Neuroscience, Milan, Italy
| | - Laura Tassi
- Niguarda Hospital, 'Claudio Munari' Epilepsy Surgery Centre, Milan, Italy
| | - Nicola Pietrafusa
- Bambino Gesù Children's Hospital, IRCCS, Department of Neuroscience, Rome, Italy
| | | | - Raffaele Nardone
- Hospital Franz Tappeiner, Department of Neurology, Merano, Italy; Paracelsus Medical University, Department of Neurology, Christian Doppler Klinik, Salzburg, Austria
| | - Nicola Luigi Bragazzi
- School of Public Health, University of Genoa, Department of Health Sciences (DISSAL), Genoa, Italy
| | - Oriano Mecarelli
- 'Sapienza' University of Rome, Human Neuroscience Department, Rome, Italy
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Assenza G, Mecarelli O, Lanzone J, Assenza F, Tombini M, Di Lazzaro V, Pulitano P. The ROME (Retrospective Observational Multicenter study on Eslicarbazepine) study: Efficacy and behavioural effects of Eslicarbazepine acetate as adjunctive therapy for adults with partial onset seizures in real life. Seizure 2018; 58:35-40. [PMID: 29649684 DOI: 10.1016/j.seizure.2018.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/11/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Eslicarbazepine acetate (ESL) is a third-generation member of the dibenzazepine family approved in 2009 by the European Medicines Agency with the indication of adjunctive therapy in adult people with partial-onset seizures (PPOS). We aimed at assessing the ESL impact on seizure frequency and quality of life in PPOS with a particular attention to sleepiness and depression. METHODS We evaluated 50 adult PPOS (>18 years; 48 ± 14 years-old; 23 males) treated with adjunctive ESL for ≥2months with a retrospective multi-centric design. Clinical files of the last 2 years were reviewed checking for monthly seizure frequency, treatment retention rate, adverse drug reactions (ADRs), concomitant anti-epileptic drugs and behavioural scales for sleepiness (Stanford Sleepiness Scale, SSS, and Epworth Sleepiness Scale, ESS), depression (Beck Depression Inventory-II, BDI) and overall quality of life (QOLIE-31). RESULTS At the end of 96 ± 28 days of ESL treatment, the mean seizure reduction was 56%; 60% of patients had seizure reduction above 50%, with a 31% of the whole population becoming seizure free. We reported 16 ADRs with 4 hyponatremia. Retention rate was 76%. Patient reported less sleepiness after ESL (SSS, p = 0.031; ESS, p = 0.0000002). Before ESL, 38% of patients had pathologic BDI scores, which normalized in most of them (73%) after ESL (BDI improvement, p = 0.000012). These scores resulted in an amelioration of quality of life (QOLIE-31, p = 0.000002). CONCLUSIONS ESL is a safe and effective anti-epileptic drug in a real life scenario, with an excellent behavioural profile for the overall quality of life and, in particular, for sleepiness and depression.
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Affiliation(s)
- G Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - O Mecarelli
- Department of Neurology and Psychiatry, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - J Lanzone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - F Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - M Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - V Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - P Pulitano
- Department of Neurology and Psychiatry, Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
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Johannesen KM, Gardella E, Linnankivi T, Courage C, de Saint Martin A, Lehesjoki AE, Mignot C, Afenjar A, Lesca G, Abi-Warde MT, Chelly J, Piton A, Merritt JL, Rodan LH, Tan WH, Bird LM, Nespeca M, Gleeson JG, Yoo Y, Choi M, Chae JH, Czapansky-Beilman D, Reichert SC, Pendziwiat M, Verhoeven JS, Schelhaas HJ, Devinsky O, Christensen J, Specchio N, Trivisano M, Weber YG, Nava C, Keren B, Doummar D, Schaefer E, Hopkins S, Dubbs H, Shaw JE, Pisani L, Myers CT, Tang S, Tang S, Pal DK, Millichap JJ, Carvill GL, Helbig KL, Mecarelli O, Striano P, Helbig I, Rubboli G, Mefford HC, Møller RS. Defining the phenotypic spectrum of SLC6A1 mutations. Epilepsia 2018; 59:389-402. [PMID: 29315614 DOI: 10.1111/epi.13986] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Pathogenic SLC6A1 variants were recently described in patients with myoclonic atonic epilepsy (MAE) and intellectual disability (ID). We set out to define the phenotypic spectrum in a larger cohort of SCL6A1-mutated patients. METHODS We collected 24 SLC6A1 probands and 6 affected family members. Four previously published cases were included for further electroclinical description. In total, we reviewed the electroclinical data of 34 subjects. RESULTS Cognitive development was impaired in 33/34 (97%) subjects; 28/34 had mild to moderate ID, with language impairment being the most common feature. Epilepsy was diagnosed in 31/34 cases with mean onset at 3.7 years. Cognitive assessment before epilepsy onset was available in 24/31 subjects and was normal in 25% (6/24), and consistent with mild ID in 46% (11/24) or moderate ID in 17% (4/24). Two patients had speech delay only, and 1 had severe ID. After epilepsy onset, cognition deteriorated in 46% (11/24) of cases. The most common seizure types were absence, myoclonic, and atonic seizures. Sixteen cases fulfilled the diagnostic criteria for MAE. Seven further patients had different forms of generalized epilepsy and 2 had focal epilepsy. Twenty of 31 patients became seizure-free, with valproic acid being the most effective drug. There was no clear-cut correlation between seizure control and cognitive outcome. Electroencephalography (EEG) findings were available in 27/31 patients showing irregular bursts of diffuse 2.5-3.5 Hz spikes/polyspikes-and-slow waves in 25/31. Two patients developed an EEG pattern resembling electrical status epilepticus during sleep. Ataxia was observed in 7/34 cases. We describe 7 truncating and 18 missense variants, including 4 recurrent variants (Gly232Val, Ala288Val, Val342Met, and Gly362Arg). SIGNIFICANCE Most patients carrying pathogenic SLC6A1 variants have an MAE phenotype with language delay and mild/moderate ID before epilepsy onset. However, ID alone or associated with focal epilepsy can also be observed.
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Affiliation(s)
- Katrine M Johannesen
- The Danish Epilepsy Center Filadelfia, Dianalund, Denmark.,Institute for Regional Health Services Research, University of Southern Denmark, Odense, Denmark
| | - Elena Gardella
- The Danish Epilepsy Center Filadelfia, Dianalund, Denmark.,Institute for Regional Health Services Research, University of Southern Denmark, Odense, Denmark
| | - Tarja Linnankivi
- Department of Child Neurology, Children's Hospital, Helsinki University Hospital Helsinki, University of Helsinki, Helsinki, Finland
| | - Carolina Courage
- The Folkhälsan Institute of Genetics, University of Helsinki, Helsinki, Finland.,Research Programs Unit, Molecular Neurology and Neuroscience Center, Helsinki, Finland
| | - Anne de Saint Martin
- Department of Pediatrics, Pediatric Neurology, University Hospital of Strasbourg, Strasbourg, France.,Reference Center for Rare Epilepsies, Strasbourg, France
| | - Anna-Elina Lehesjoki
- The Folkhälsan Institute of Genetics, University of Helsinki, Helsinki, Finland.,Research Programs Unit, Molecular Neurology and Neuroscience Center, Helsinki, Finland
| | - Cyril Mignot
- Department of Genetics, Center for Rare causes of Intellectual Disabilities and UPMC Research Group "Intellectual Disabilities and Autism", Paris, France
| | | | - Gaetan Lesca
- Departments of Genetics, Lyon University Hospitals, Lyon, France.,Claude Bernard Lyon I University, Lyon, France.,Lyon Neuroscience Research Center, CNRS UMRS5292, INSERM U1028, Lyon, France
| | - Marie-Thérèse Abi-Warde
- Department of Pediatrics, Pediatric Neurology, University Hospital of Strasbourg, Strasbourg, France.,Reference Center for Rare Epilepsies, Strasbourg, France
| | - Jamel Chelly
- Department of Translational Medicine and Neurogenetics, Institut Génétique Biologie Moléculaire Cellulaire (IGBMC), Illkirch, France.,Laboratory of Genetic Diagnosis, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Amélie Piton
- Department of Translational Medicine and Neurogenetics, Institut Génétique Biologie Moléculaire Cellulaire (IGBMC), Illkirch, France.,Laboratory of Genetic Diagnosis, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - J Lawrence Merritt
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Lance H Rodan
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Wen-Hann Tan
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lynne M Bird
- Division of Genetics, Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA, USA
| | - Mark Nespeca
- Division of Neurology, Rady Children's Hospital, University of California, San Diego, CA, USA
| | - Joseph G Gleeson
- Rady Children's Institute for Genomic Medicine, Howard Hughes Medical Institute, University of California, San Diego, CA, USA
| | - Yongjin Yoo
- Department of Biomedical Sciences, Seoul National University School of Medicine, Seoul, South Korea
| | - Murim Choi
- Department of Biomedical Sciences, Seoul National University School of Medicine, Seoul, South Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University School of Medicine, Seoul, South Korea
| | | | | | - Manuela Pendziwiat
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Judith S Verhoeven
- Department of Neurology, Academic Center for Epileptology, Heeze, The Netherlands
| | - Helenius J Schelhaas
- Department of Neurology, Academic Center for Epileptology, Heeze, The Netherlands
| | | | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Nicola Specchio
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marina Trivisano
- Neurology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Yvonne G Weber
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tüebingen, Tüebingen, Germany
| | - Caroline Nava
- Department of Genetics, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Universities, UPMC Univ Paris 06, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - Boris Keren
- Department of Genetics, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Universities, UPMC Univ Paris 06, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - Diane Doummar
- Assistance Publique-Hôpitaux de Paris, Neuropediatric Services, Hospital Armand Trousseau, Paris, France
| | - Elise Schaefer
- Medical Genetics, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sarah Hopkins
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Holly Dubbs
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Jessica E Shaw
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Laura Pisani
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Candace T Myers
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Sha Tang
- Division of Clinical Genomics, Ambry Genetics, Aliso Viejo, CA, USA
| | - Shan Tang
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Deb K Pal
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - John J Millichap
- Epilepsy Center and Division of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gemma L Carvill
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Oriano Mecarelli
- Department of Neurology and Psychiatry, Neurophysiopathology and Neuromuscular Diseases, University of Sapeinza, Rome, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health, University of Genoa 'G. Gaslini" Institute, Genova, Italy
| | - Ingo Helbig
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany.,Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Guido Rubboli
- The Danish Epilepsy Center Filadelfia, Dianalund, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Heather C Mefford
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Rikke S Møller
- The Danish Epilepsy Center Filadelfia, Dianalund, Denmark.,Institute for Regional Health Services Research, University of Southern Denmark, Odense, Denmark
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Pulitano P, Franco V, Mecarelli O, Brienza M, Davassi C, Russo E. Effects of eslicarbazepine acetate on lipid profile and sodium levels in patients with epilepsy. Seizure 2017; 53:1-3. [DOI: 10.1016/j.seizure.2017.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/29/2022] Open
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Carrai R, Grippo A, Valzania F, Lombardi M, Vitelli E, Mecarelli O, Politini L, Minardi C, Costa P, Amantini A. O80 Neurophysiological prognosis in comatose patients after cardiac arrest: The italian multicentric study (PRONECA) – preliminary data-. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.07.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Michelucci R, Pulitano P, Di Bonaventura C, Binelli S, Luisi C, Pasini E, Striano S, Striano P, Coppola G, La Neve A, Giallonardo AT, Mecarelli O, Serioli E, Dazzo E, Fanciulli M, Nobile C. The clinical phenotype of autosomal dominant lateral temporal lobe epilepsy related to reelin mutations. Epilepsy Behav 2017; 68:103-107. [PMID: 28142128 PMCID: PMC5378904 DOI: 10.1016/j.yebeh.2016.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 06/14/2016] [Revised: 11/10/2016] [Accepted: 12/12/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To describe the clinical phenotype of 7 families with Autosomal Dominant Lateral Temporal Lobe Epilepsy (ADLTE) related to Reelin (RELN) mutations comparing the data with those observed in 12 LGI1-mutated pedigrees belonging to our series. METHODS Out of 40 Italian families with ADLTE, collected by epileptologists participating in a collaborative study of the Commission for Genetics of the Italian League against Epilepsy encompassing a 14-year period (2000-2014), 7 (17.5%) were found to harbor heterozygous RELN mutations. The whole series also included 12 (30%) LGI1 mutated families and 21 (52.5%) non-mutated pedigrees. The clinical, neurophysiological, and neuroradiological findings of RELN and LGI1 mutated families were analyzed. RESULTS Out of 28 affected individuals belonging to 7 RELN mutated families, 24 had sufficient clinical data available for the study. In these patients, the epilepsy onset occurred at a mean age of 20years, with focal seizures characterized by auditory auras in about 71% of the cases, associated in one-third of patients with aphasia, visual disturbances or other less common symptoms (vertigo or déjà-vu). Tonic-clonic seizures were reported by almost all patients (88%), preceded by typical aura in 67% of cases. Seizures were precipitated by environmental noises in 8% of patients and were completely or almost completely controlled by antiepileptic treatment in the vast majority of cases (96%). The interictal EEG recordings showed epileptiform abnormalities or focal slow waves in 80% of patients, localized over the temporal regions, with marked left predominance and conventional 1,5T MRI scans were not contributory. By comparing these findings with those observed in families with LGI1 mutations, we did not observe significant differences except for a higher rate of left-sided EEG abnormalities in the RELN group. SIGNIFICANCE Heterozygous RELN mutations cause a typical ADLTE syndrome, indistinguishable from that associated with LGI1 mutations.
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Affiliation(s)
- Roberto Michelucci
- IRCCS - Institute of Neurological Sciences of Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy
| | - Patrizia Pulitano
- Department of Neurology and Psychiatry, University of Rome “Sapienza”, Policlinico Umberto 1° Hospital, Roma, Italy
| | | | - Simona Binelli
- C. Besta Foundation Neurological Institute, Milano, Italy
| | | | - Elena Pasini
- IRCCS - Institute of Neurological Sciences of Bologna, Unit of Neurology, Bellaria Hospital, Bologna, Italy.
| | - Salvatore Striano
- Department of Neurological Sciences, Federico II University, Napoli, Italy
| | - Pasquale Striano
- Muscular and Neurodegenerative Disease Unit, Institute “G. Gaslini,” University of Genova, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry, Medical School, University of Salerno, Italy
| | | | | | - Oriano Mecarelli
- Department of Neurology and Psychiatry, University of Rome “Sapienza”, Policlinico Umberto 1° Hospital, Roma, Italy
| | - Elena Serioli
- Section of Padua, Institute of Neurosciences, Consiglio Nazionale delle Ricerche, Padova, Italy
| | - Emanuela Dazzo
- Section of Padua, Institute of Neurosciences, Consiglio Nazionale delle Ricerche, Padova, Italy
| | | | - Carlo Nobile
- Section of Padua, Institute of Neurosciences, Consiglio Nazionale delle Ricerche, Padova, Italy
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Lai S, Mecarelli O, Pulitano P, Romanello R, Davi L, Zarabla A, Mariotti A, Carta M, Tasso G, Poli L, Mitterhofer AP, Testorio M, Frassetti N, Aceto P, Galani A, Lai C. Neurological, psychological, and cognitive disorders in patients with chronic kidney disease on conservative and replacement therapy. Medicine (Baltimore) 2016; 95:e5191. [PMID: 27902586 PMCID: PMC5134816 DOI: 10.1097/md.0000000000005191] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Chronic kidney disease (CKD) is a highly prevalent condition in the world. Neurological, psychological, and cognitive disorders, related to CKD, could contribute to the morbidity, mortality, and poor quality of life of these patients. The aim of this study was to assess the neurological, psychological, and cognitive imbalance in patients with CKD on conservative and replacement therapy.Seventy-four clinically stable patients affected by CKD on conservative therapy, replacement therapy (hemodialysis (HD), peritoneal dialysis (PD)), or with kidney transplantation (KT) and 25 healthy controls (HC), matched for age and sex were enrolled. Clinical, laboratory, and instrumental examinations, as renal function, inflammation and mineral metabolism indexes, electroencephalogram (EEG), psychological (MMPI-2, Sat P), and cognitive tests (neuropsychological tests, NPZ5) were carried out.The results showed a significant differences in the absolute and relative power of delta band and relative power of theta band of EEG (P = 0.008, P < 0.001, P = 0.051), a positive correlation between relative power of delta band and C-reactive protein (CRP) (P < 0.001) and a negative correlation between estimated glomerular filtration rate (eGFR) (P < 0.001) and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) (P < 0.001), in all the samples. Qualitative analysis of EEG showed alterations of Grade 2 (according to Parsons-Smith classification) in patients on conservative therapy, and Grade 2-3 in KT patients. The scales of MMPI-2 hysteria and paranoia, are significantly correlated with creatinine, eGFR, serum nitrogen, CRP, 1,25-(OH)2D3, intact parathyroid hormone (iPTH), phosphorus, and cynical and hysterical personality, are correlated with higher relative power of delta (P = 0.016) and theta band (P = 0.016). Moreover, all NPZ5 scores showed a significant difference between the means of nephropathic patients and the means of the HC, and a positive correlation with eGFR, serum nitrogen, CRP, iPTH, and vitamin D.In CKD patients, simple and noninvasive instruments, as EEG, and cognitive-psychological tests, should be performed and careful and constant monitoring of renal risk factors, probably involved in neuropsychological complications (inflammation, disorders of mineral metabolism, electrolyte disorders, etc.), should be carried out. Early identification and adequate therapy of neuropsychological, and cognitive disorders, might enable a better quality of life and a major compliance with a probable reduction in the healthcare costs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Luca Poli
- Department of General and Specialised Surgery “PARIDE STEFANINI”
| | | | - Massimo Testorio
- Department of Obstetrical-Gynecological Sciences and Urologic Sciences, Sapienza University of Rome
| | | | - Paola Aceto
- Department of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, A. Gemelli, Rome
| | - Alessandro Galani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Carlo Lai
- Department of Dynamic and Clinic Psychology, Sapienza University of Rome, Rome, Italy
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Verrusio W, Ettorre E, Vicenzini E, Vanacore N, Cacciafesta M, Mecarelli O. The Mozart Effect: A quantitative EEG study. Conscious Cogn 2015; 35:150-5. [DOI: 10.1016/j.concog.2015.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/14/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
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Vecchio F, Miraglia F, Valeriani L, Scarpellini MG, Bramanti P, Mecarelli O, Rossini PM. Cortical Brain Connectivity and B-Type Natriuretic Peptide in Patients With Congestive Heart Failure. Clin EEG Neurosci 2015; 46:224-9. [PMID: 24997011 DOI: 10.1177/1550059414529765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 10/26/2013] [Accepted: 02/28/2014] [Indexed: 11/16/2022]
Abstract
The brain has a high level of complexity and needs continuous oxygen supply. So it is clear that any pathological condition, or physiological (aging) change, in the cardiovascular system affects functioning of the central nervous system. We evaluated linear aspects of the relationship between the slowness of cortical rhythms, as revealed by the modulation of a graph connectivity parameter, and congestive heart failure (CHF), as a reflection of neurodegenerative processes. Eyes-closed resting electroencephalographic (EEG) data of 10 patients with CHF were recorded by 19 electrodes positioned according the international 10-20 system. Graph theory function (normalized characteristic path length λ) was applied to the undirected and weighted networks obtained by lagged linear coherence evaluated by eLORETA software, therefore getting rid of volumetric propagation influences. The EEG frequency bands of interest were: delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), beta 2 (20-30 Hz), and gamma (30-40 Hz). The analysis between B-type natriuretic peptide (BNP) values and λ showed positive correlation in delta, associated with a negative correlation in alpha 2 band. Namely, the higher the severity of the disease (as revealed by the BNP vales), the higher the λ in delta, and lower in alpha 2 band. Results suggest that delta and alpha λ indices are good markers of the severity of CHF.
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Affiliation(s)
- Fabrizio Vecchio
- Brain Connectivity laboratory, IRCCS San Raffaele Pisana, Rome, Italy
| | | | - Lavinia Valeriani
- Casa di cura San Raffaele Montecompatri e Rocca di Papa, Rome, Italy
| | | | | | | | - Paolo M Rossini
- Brain Connectivity laboratory, IRCCS San Raffaele Pisana, Rome, Italy Dept of Neurology, Catholic University "Sacro Cuore" Rome, Italy
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