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Rodríguez-Uranga JJ, Sánchez-Caro JM, Hariramani Ramchandani R. Treatment simplification to optimize cenobamate effectiveness and tolerability: A real-world retrospective study in Spain. Epilepsia Open 2024. [PMID: 38800945 DOI: 10.1002/epi4.12959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 04/16/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE This study aimed to explore the impact of co-antiseizure medication (co-ASM) optimization on the effectiveness and tolerability of adjunctive cenobamate (CNB) in patients with drug-resistant epilepsy in a real-world setting. METHODS This unicentric, retrospective, observational study included adults with focal-onset seizures who had received ≥2 previous ASMs. The main effectiveness endpoints included responder rates and seizure frequency reduction at 3, 6, and 12-month visits. The number of co-ASMs and defined daily dose (DDD) were analyzed at every visit. Safety endpoints included adverse drug reactions (ADRs). RESULTS Thirty-four patients with a median epilepsy duration of 22 years and a median of 15.5 seizures/month were analyzed. The median number of prior ASMs was 12, and the mean number of co-ASMs was 2.9 (SD 1). There was a reduction in seizure frequency/month from baseline to the last visit (p < 0.0001). Between baseline and the end of the study, the mean number of co-ASMs in the per-protocol (PP) population was reduced from 2.9 to 1.6 (p < 0.0001), and DDD was reduced from 3.6 to 1.4 (p < 0.0001). Sodium channel blockers (carbamazepine and lacosamide) and GABAergic drugs (clobazam) were the agents with the most significant reductions in DDD after 12 months. The percentage of patients in the PP population with ≥3 co-ASMs was reduced from 61.8% at baseline to 14.3% at 12 months; 1 patient was receiving CNB as monotherapy at the last visit. At the last visit, 85.7% of the PP population were ≥50% responders, and 33.3% were seizure-free. The percentage of patients with ADRs in the PP population was 71.9% at 3 months and 52.3% at 12 months. SIGNIFICANCE Following rational polytherapy, optimization of co-ASM management during CNB treatment allowed high seizure freedom rates despite meaningful reductions in co-medication, while also achieving both good tolerability and patient satisfaction scores in a highly drug-resistant population. PLAIN LANGUAGE SUMMARY Many patients with epilepsy still have seizures, even after being treated with several different epilepsy drugs. In this study of 34 patients from a Spanish clinic, we show that the epilepsy drug cenobamate can reduce the number of seizures in these patients, even after many other epilepsy drugs have failed. We also show that patients treated with cenobamate can reduce the dose or even stop taking certain other epilepsy drugs. This allows them to simplify their treatment and reduce adverse effects while still keeping control of their epilepsy.
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Connor GS, Labiner DM, Schabert VF, Weingarten M, Wade CT, Stern S, Becker DA. Greater need for treatment optimization in patients with epilepsy initiating adjunctive therapy: Results of a retrospective claims analysis of antiseizure medication drug load in the United States. Epilepsy Behav 2024; 152:109649. [PMID: 38277849 DOI: 10.1016/j.yebeh.2024.109649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND This retrospective, observational study used US claims data to assess changes in antiseizure medication (ASM) drug load for a cohort of patients with epilepsy. METHODS Adults (≥18 years) with a diagnosis of epilepsy (ICD-10 code G40.xxx) who started new adjunctive ASM treatment with one of 4 branded (brivaracetam, eslicarbazepine, lacosamide, perampanel) or 4 unbranded (carbamazepine, lamotrigine, levetiracetam, topiramate) ASMs between January 1, 2016 and December 31, 2020 were identified from IBM MarketScan® research databases (primary study population). Patients must have been continuously enrolled 360 days before the start of the new ASM (eligibility period). Follow-up was from the start of new ASM until Day 540 (∼18 months). The primary endpoint was concomitant ASM drug load, which included all ASMs except the new (comparator) ASM. A sensitivity analysis population included adults with epilepsy who were continuously enrolled for ≥ 180 days during at least one calendar year in the study period (2016-2020), whether or not the comparator ASM was new or existing during that period. Total ASM drug load, which included comparator ASM and concomitant ASMs, was assessed in the sensitivity analysis population. RESULTS In total, 21,332 patients were included in the primary study population, of which 5767 initiated branded ASMs and 15,565 initiated unbranded ASMs. A total of 392,426 patients were included in the sensitivity analysis population during at least one calendar year 2016-2020. Concomitant ASM drug load increased in the 360 days prior to new ASM start and slightly declined thereafter. Mean concomitant ASM drug load for the primary population was 1.6 (SD 1.8) at new ASM start. Concomitant drug load was higher among those starting branded ASM comparators compared to those starting unbranded comparators. Mean total ASM drug load for patients increased over time and was approximately double for patients exposed to branded ASMs (mean range 2.1 to 2.7) compared to that of patients exposed to any unbranded ASM (mean range 1.0 to 1.3). CONCLUSION Concomitant ASM drug load increased prior to addition of new ASM, with higher increases observed among patients starting branded vs unbranded ASMs, followed by slight decreases thereafter. Total drug load increased linearly among all patients. These findings underscore the need for ongoing ASM regimen evaluation and treatment optimization in patients with epilepsy.
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Aboumatar S, Ferrari L, Stern S, Wade CT, Weingarten M, Connor GS, Rosenfeld WE. Reductions in concomitant antiseizure medication drug load during adjunctive cenobamate therapy: Post-hoc analysis of a subset of patients from a phase 3, multicenter, open-label study. Epilepsy Res 2024; 200:107306. [PMID: 38340681 DOI: 10.1016/j.eplepsyres.2024.107306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Many patients with epilepsy require polytherapy, which increases their antiseizure medication (ASM) drug load, a measure that considers the doses of all ASMs a patient is taking. Changes in concomitant ASM drug load after adding cenobamate were evaluated post-hoc in a subset of the open-label, phase 3 study. METHODS Patients 18-70 years old with uncontrolled focal seizures taking 1-3 ASMs were enrolled. Total concomitant ASM drug load (not including cenobamate) was calculated by dividing the patient's prescribed dose for each ASM by its defined daily dose, per the World Health Organization, then summing the ratios. Changes in concomitant ASM drug load were measured from baseline in 3-month intervals up to 24 months by both total and class-specific ASM drug load. Subgroups of interest included: older adults (65-70 years), prior epilepsy-related surgery vs none, and baseline seizure frequency < 3 vs ≥ 3 seizures/28 days. RESULTS Data from 240 patients were available (mean age 41.8 years, mean baseline drug load 3.57). Following cenobamate initiation, the mean concomitant ASM drug load was reduced by 29.4 % at Month 12 % and 31.8 % at Month 24. Reductions occurred in all assessed ASM drug classes, with the largest reduction in benzodiazepines (55.2 % at Month 24). Each assessed subgroup exceeded a 30 % reduction in concomitant ASM drug load at Month 24. Over 24 months, maintenance of ≥ 50 % response occurred in 89.3 %, 86.4 %, and 90.6 % of patients with low (-0.25 to <0), moderate (-0.59 to -0.25), or high (-3.3 to -0.59) numerical reductions in concomitant ASM drug load from baseline, respectively, compared with 86.0 % in patients with no change in drug load; maintenance of 100 % response occurred in 80.7 %, 84.3 %, and 70.0 % of patients with low, moderate, or high numerical reductions in concomitant ASM drug load, compared with 82.0 % in patients with no change. CONCLUSIONS Adding cenobamate led to reduced mean concomitant ASM drug loads during 1 and 2 years of treatment. Reductions occurred regardless of ASM drug class, patient age, or epilepsy disease characteristics and did not impact maintenance of response rates.
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Affiliation(s)
- Sami Aboumatar
- Austin Epilepsy Care Center, 2200 Park Bend Drive, Building 2, Suite 203, Austin, TX 78758, USA.
| | - Louis Ferrari
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, USA
| | - Sean Stern
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, USA
| | - Clarence T Wade
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, USA
| | - Mindl Weingarten
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, USA
| | - Gregory S Connor
- Neurological Center of Oklahoma, 6585 South Yale Avenue, Suite 620, Tulsa, OK 74136, USA
| | - William E Rosenfeld
- Comprehensive Epilepsy Care Center for Children and Adults, 11134 Conway Road, St. Louis, MO 63131, USA
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Hwang S, An H, Shin DW, Lee HW. Retention Rates and Successful Treatment with Antiseizure Medications in Newly-Diagnosed Epilepsy Patients. Yonsei Med J 2024; 65:89-97. [PMID: 38288649 PMCID: PMC10827640 DOI: 10.3349/ymj.2022.0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Treatment for epilepsy primarily involves antiseizure medications (ASMs), which can be characterized using the clinical data warehouse (CDW) database. In this study, we compared retention rates and time to successful treatment for various ASMs to reflect both efficacy and adverse effects in patients with newly diagnosed epilepsy. MATERIALS AND METHODS We identified newly diagnosed epilepsy patients with ASM treatment for more than 12 months using CDW of a tertiary referral hospital. Clinical characteristics were compared between groups with successful and unsuccessful treatment. Cox regression analysis was performed to evaluate independent variables of age, sex, comorbidities, and attributes of ASM regimens. RESULTS Of 2515 eligible participants, 46.2% were successfully treated with the first ASM regimen, and 74.7% with all ASM regimens with the median time-to-treatment success of 14 months. Participants with second-generation ASM as the first ASM were more likely to be successfully treated with the first regimen compared to those with first-generation ASM (51.6% vs. 42.3%, p<0.001) and more successfully treated [hazard ratio (HR)=1.26; 95% confidence interval (CI): 1.15-1.39]. Overall, valproic acid was the most common ASM across a wide range of ages under 65 years, while levetiracetam in patients aged over 65 years or lamotrigine in female adult patients. Clinical factors associated with less favorable treatment outcomes included renal disease (HR=0.78; 95% CI: 0.66-0.92), liver disease (HR=0.65; 95% CI: 0.52-0.81), depression (HR=0.70; 95% CI: 0.57-0.84), and mechanical ventilation (HR=0.58; 95% CI: 0.50-0.67). CONCLUSION Second-generation ASMs have the advantage of more successful treatment with fewer ASM regimen changes compared with first-generation drugs. Various comorbid conditions as well as age and sex should be considered when selecting ASMs.
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Affiliation(s)
- Sungeun Hwang
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyungmi An
- Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Dong Woo Shin
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hyang Woon Lee
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
- Department of Medical Science, Ewha Womans University School of Medicine, Seoul, Korea
- Computational Medicine, System Health Science & Engineering, and Artificial Intelligence Convergence Graduate Programs, Ewha Womans University, Seoul, Korea.
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Becker DA, Demko SA. Dose reduction and discontinuation of concomitant antiseizure medications after initiating cenobamate: A retrospective review. Epilepsy Res 2023; 197:107242. [PMID: 37871541 DOI: 10.1016/j.eplepsyres.2023.107242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023]
Abstract
This retrospective chart review examined dose reductions and discontinuations of concomitant antiseizure medications (ASMs) following cenobamate initiation and maintenance in patients with epilepsy treated at MetroHealth (Cleveland, OH) between 9/1/2020-9/26/2022. Concomitant ASM dose adjustments and treatment-emergent adverse events (TEAEs) were assessed. Efficacy (100 % seizure reduction) was examined among patients who received cenobamate for ≥ 3 months at data cutoff (including titration). As of 9/26/2022, 95 patients received cenobamate (mean age, 45.9 years; 48.4 % female, median exposure 7.5 months). Five patients (5.3 %) discontinued (n = 1 withdrawal by patient; n = 1 noncompliance; n = 3 adverse event). Among the 90 patients taking cenobamate at data cutoff, 50 % (45/90) discontinued ≥ 1 concomitant ASM, most commonly clobazam (n = 18), levetiracetam (n = 10), and phenytoin (n = 7); 21 patients (23.3 %) had additional concomitant ASM dose reductions, most commonly phenytoin (n = 6) and clobazam (n = 4). Sixteen patients received cenobamate monotherapy. Among 79 patients who received cenobamate for ≥ 3 months at data cutoff, 51.9 % (41/79) were seizure-free for ≥ 3 months. Of the 41 seizure-free patients, 58.5 % (24/41) were taking 100 mg/day of cenobamate. Sixteen of the 95 cenobamate-treated patients (16.8 %) reported 22 TEAEs. The most common TEAE was fatigue (n = 7). These data suggest that cenobamate therapy may allow reduction or elimination of polytherapy in some patients.
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Affiliation(s)
- Danielle A Becker
- MetroHealth, 2500 MetroHealth Drive, Cleveland, OH 44109, USA; Department of Neurology, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Sarah A Demko
- MetroHealth, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
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Smith MC, Klein P, Krauss GL, Rashid S, Seiden LG, Stern JM, Rosenfeld WE. Dose Adjustment of Concomitant Antiseizure Medications During Cenobamate Treatment: Expert Opinion Consensus Recommendations. Neurol Ther 2022; 11:1705-1720. [PMID: 36057761 PMCID: PMC9588096 DOI: 10.1007/s40120-022-00400-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/15/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Our objective was to provide expert consensus recommendations to improve treatment tolerability through dose adjustments of concomitant antiseizure medications (ASMs) during addition of cenobamate to existing ASM therapy in adult patients with uncontrolled focal seizures. METHODS A panel of seven epileptologists experienced in the use of ASMs, including cenobamate, used a modified Delphi process to reach consensus. The panelists discussed tolerability issues with concomitant ASMs during cenobamate titration and practical strategies for dose adjustments that may prevent or mitigate adverse effects. The resulting recommendations consider concomitant ASM dose level and specify proactive (prior to report of an adverse effect) and reactive (in response to report of an adverse effect) dose adjustment suggestions based on concomitant ASM pharmacokinetic and pharmacodynamic interactions with cenobamate. Specific dose adjustment recommendations are provided. RESULTS We recommend proactively lowering the dose of clobazam, phenytoin, and phenobarbital due to their known drug-drug interactions with cenobamate, and lacosamide due to a pharmacodynamic interaction with cenobamate, to prevent adverse effects during cenobamate titration. Reactive lowering of a concomitant ASM dose is sufficient for other ASMs at standard dosing owing to quick resolution of adverse effects. For carbamazepine and lamotrigine doses exceeding the upper end of standard dosing (e.g., carbamazepine, greater than 1200 mg/day; lamotrigine, greater than 500 mg/day), we encourage consideration of proactive dose reduction at cenobamate 200 mg/day to prevent potential adverse effects. All dose reductions for adverse effects can be repeated every 2 weeks as dictated by the adverse effects. At cenobamate 200 mg/day, we recommend that patients be evaluated for marked improvement of seizures and further dose reductions be considered to reduce potentially unnecessary polypharmacy. CONCLUSION The primary goal of the recommended dose reductions of concomitant ASMs is to prevent or resolve adverse effects, thereby allowing cenobamate to reach the optimal dose to achieve the maximal potential of improving seizure control.
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Affiliation(s)
- Michael C. Smith
- Department of Neurological Sciences, Section of Clinical Neurophysiology and Epilepsy, Rush Medical College, 1725 W. Harrison Street, Suite 885, Chicago, IL 60612 USA
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD USA
| | | | - Samiya Rashid
- Epilepsy and Neurology Specialists of San Diego, Encinitas, CA USA
| | | | - John M. Stern
- University of California at Los Angeles, Los Angeles, CA USA
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Seiden LG, Connor GS. The importance of drug titration in the management of patients with epilepsy. Epilepsy Behav 2022; 128:108517. [PMID: 35066388 DOI: 10.1016/j.yebeh.2021.108517] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/15/2022]
Abstract
The variable response to antiseizure medication (ASM) treatment and the numerous drug- and patient-related factors that must be considered when initiating therapy make drug titration to an optimal and tolerable dose an essential component in the pharmacologic treatment of patients with epilepsy. When initiating a new ASM, a "start low, go slow" titration approach is generally recommended and has been shown to reduce the risk of severe idiosyncratic reactions with certain medications and improve tolerability with regard to many frequently occurring central nervous system-related adverse effects (e.g., somnolence, dizziness). Many patients with epilepsy will require medication changes due to lack of efficacy or intolerability of the initial regimen. When this occurs, patients may be switched from one monotherapy to another or receive adjunctive therapy. When transitioning a patient from one ASM to another (referred to as monotherapy conversion or transitional polytherapy), there are several strategies for tapering the baseline ASM depending on the clinical scenario. Regardless of the particular strategy, the goal should be to discontinue the baseline ASM in order to prevent increased toxicity due to drug load. When adding on ASM therapy, flexible titration of the new ASM and adjustment of concomitant ASMs to achieve disease control with the lowest possible drug load (lowest numbers and lowest doses) may help improve tolerability of the add-on therapy. Communication with patients during the initiation of a new therapy may help patients adhere to the titration schedule, allowing them to reach their optimal maintenance dose.
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Affiliation(s)
- Lawrence G Seiden
- The Multiple Sclerosis Center of Atlanta, 3200 Downwood Circle NW, Suite 550, Atlanta, GA 30327, USA.
| | - Gregory S Connor
- Neurological Center of Oklahoma, 6585 South Yale Avenue, Suite 620, Tulsa, OK 74136, USA
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Connor GS, Williamson A. Effectiveness and safety of adjunctive cenobamate for focal seizures in adults with developmental disability treated in clinical practice. Epilepsy Behav Rep 2022; 18:100533. [PMID: 35345772 PMCID: PMC8956884 DOI: 10.1016/j.ebr.2022.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
92.9% (26/28 patients) continued cenobamate through 6 months, showing high retention. High responder rates/substantial focal seizure reduction occurred with cenobamate. 100% seizure reduction occurred in 48.2% of patients at 6 months. Adverse effects were often mitigated by concomitant antiseizure medication reduction.
Effectiveness and tolerability of adjunctive cenobamate for uncontrolled focal seizures in adults living with a developmental disability are not defined. Retrospective medical record review included adults ≥18 years old living with a developmental disability, either in a group home or with parents, and experiencing uncontrolled focal seizures despite stable doses of ≥1 antiseizure medication (ASM). Effectiveness was examined as percentage change in focal seizure frequency per month from the 2-month average before cenobamate to the average of months 5 and 6 while receiving cenobamate. Percentages of patients achieving responder rates in focal seizure frequency at 6 months of cenobamate treatment were examined. Adverse effects and concomitant ASM dosage adjustments were assessed. Of the 28 included patients, 26 (92.9%) continued cenobamate beyond 6 months. The responder rate of 100% seizure reduction (seizure-free) occurred in 48.2% of the patients who continued cenobamate for 6 months. Ten adverse effects were reported in 9 patients (32.1%), and 80% (8/10) were resolved by reducing concomitant ASM dosages. Two patients (7.1%) discontinued cenobamate due to adverse effects. Cenobamate resulted in substantial reduction in focal seizure frequency and was well tolerated.
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Affiliation(s)
- Gregory S. Connor
- Neurological Center of Oklahoma, 6585 South Yale Avenue, Suite 620, Tulsa, OK 74136, United States
- Corresponding author at: Neurological Center of Oklahoma, PLC, 6585 South Yale Avenue, Suite 620, Tulsa, OK 74136, United States.
| | - Amanda Williamson
- SK Life Science, Inc., 461 From Road, Fifth Floor, Paramus, NJ 07652, United States
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Li N, Li J, Chen Y, Chu C, Lin W. Treatment Outcome and Risk Factors of Adult Newly Diagnosed Epilepsy: A Prospective Hospital-Based Study in Northeast China. Front Neurol 2021; 12:747958. [PMID: 34777218 PMCID: PMC8581653 DOI: 10.3389/fneur.2021.747958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/06/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: The study was conducted to summarize the treatment outcomes of newly diagnosed epilepsy (NDE) and analyse the risk factors for refractory epilepsy (RE) in Northeast China. Methods: A total of 466 adult patients with NDE were consecutively enrolled in this programme. Clinical data were collected at baseline and each follow-up. Several scales concerning recognition and mood were also completed at the first visit. Results: Seizure-free status was achieved by 52% (n = 244) of the patients; however, 15% (n = 68) manifested RE. A total of 286 (61%) patients continued with the first ASM as monotherapy, among which 186 (40%) patients became seizure-free. Fifteen (22%) patients with RE became seizure-free following ASM adjustment and 34 patients (14%) had breakthrough seizures after being classified as seizure-free. One patient developed RE after attaining seizure-free status. Breakthrough seizures during the first expected interictal interval [Odds ratio (OR) = 5.81, 95% CI: 2.70–12.50], high seizure frequency at baseline (OR = 1.24, 95% CI: 1.04–1.49), younger age of onset (OR = 1.42, 95% CI: 1.12–1.79), and male sex (OR = 2.64, 95% CI: 1.26–5.53) were risk factors for RE. Significance: Treatment outcomes of the majority of NDE cases are good. New risk factors could help physicians more promptly and accurately identify patients who are likely to develop RE. Seizure-free state is not long enough to commence the withdrawal of ASMs. RE is not permanent and seizure-free may be achieved subsequently by appropriate drug adjustment.
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Affiliation(s)
- Nan Li
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jing Li
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yanyan Chen
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China.,Department of Neuroelectrophysiology, Changchun Six Hospital, Changchun, China
| | - Chaojia Chu
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- DDepartment of Neurology, The First Hospital of Jilin University, Changchun, China
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Rosenfeld WE, Abou-Khalil B, Aboumatar S, Bhatia P, Biton V, Krauss GL, Sperling MR, Vossler DG, Klein P, Wechsler R. Post hoc analysis of a phase 3, multicenter, open-label study of cenobamate for treatment of uncontrolled focal seizures: Effects of dose adjustments of concomitant antiseizure medications. Epilepsia 2021; 62:3016-3028. [PMID: 34633074 PMCID: PMC9292883 DOI: 10.1111/epi.17092] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 01/23/2023]
Abstract
Objective To report post hoc results on how adjustments to baseline antiseizure medications (ASMs) in a subset of study sites (10 US sites) from a long‐term, open‐label phase 3 study of adjunctive cenobamate affected tolerability, efficacy, and retention. Methods Patients with uncontrolled focal seizures taking stable doses of one to three ASMs were administered increasing doses of cenobamate (12.5, 25, 50, 100, 150, 200 mg/day) over 12 weeks at 2‐week intervals (target dose = 200 mg/day). Further increases to 400 mg/day by 50 mg/day biweekly increments were allowed during maintenance phase. Dose adjustments of cenobamate and concomitant ASMs were allowed. Data were assessed until last visit, at data cut‐off, on or after September 1, 2019. Results A total of 240 patients meeting eligibility criteria were assessed (median [max] exposure 30.2 [43.0] months), with 177 patients continuing cenobamate at data cut‐off. Most common baseline concomitant ASMs were lacosamide, levetiracetam, lamotrigine, zonisamide, and clobazam. For most baseline concomitant ASMs, ~70% of patients taking that ASM were continuing cenobamate at data cut‐off. Patients continuing cenobamate had greater mean ASM dose reductions and percent dose changes from baseline vs those who discontinued. Of patients continuing cenobamate, 24.6% discontinued one or more concomitant ASMs completely. Dose decreases for all concomitant ASMs generally occurred during titration or early maintenance phases and were mostly due to central nervous system (CNS)–related adverse events such as somnolence, dizziness, unsteady gait, and fatigue. Responder rates from ≥50% through 100% for patients continuing cenobamate were generally similar regardless of concomitant ASMs (of those most commonly taken), with ~81% being ≥50% responders and ~12% achieving 100% seizure reduction in the maintenance phase, which lasted up to 40.2 (median = 29.5) months. Significance Concomitant ASM dose reductions were associated with more patients remaining on cenobamate. This is likely due to efficacy and improved tolerability, with overall reduced concomitant drug burden in patients with uncontrolled seizures despite taking one to three baseline concomitant ASMs.
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Affiliation(s)
- William E Rosenfeld
- Comprehensive Epilepsy Care Center for Children and Adults, St. Louis, Missouri, USA
| | | | | | | | - Victor Biton
- Arkansas Epilepsy Program, Little Rock, Arkansas, USA
| | - Gregory L Krauss
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - David G Vossler
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland, USA
| | - Robert Wechsler
- Consultants in Epilepsy & Neurology, PLLC, Boise, Idaho, USA.,Idaho Comprehensive Epilepsy Center, Boise, Idaho, USA
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Dang YL, Foster E, Lloyd M, Rayner G, Rychkova M, Ali R, Carney PW, Velakoulis D, Winton-Brown TT, Kalincik T, Perucca P, O'Brien TJ, Kwan P, Malpas CB. Adverse events related to antiepileptic drugs. Epilepsy Behav 2021; 115:107657. [PMID: 33360400 DOI: 10.1016/j.yebeh.2020.107657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/04/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Adverse events (AEs) related to antiepileptic drugs (AEDs) may interfere with adequate dosing and patient adherence, leading to suboptimal seizure control, and relatedly, increased injuries, hospitalizations, and mortality. This study investigated the clinicodemographic factors associated with AEs related to AEDs as reported by the Liverpool Adverse Events Profile (LAEP), and explored the ability of LAEP to discriminate between epilepsy and psychogenic nonepileptic seizures (PNES). We hypothesized that female sex, mood disorders, AED-polytherapy, duration, and severity of epilepsy are associated with increased endorsement of AEs related to AEDs, and that endorsement of AEs related to AEDs would significantly differ between epilepsy and PNES patients. METHODS We prospectively enrolled adult patients admitted to two inpatient video-electroencephalogram monitoring units. Clinicodemographic variables and psychometric measures of depression, anxiety, and cognitive function were recorded. Patient-reported AE endorsement was obtained using the LAEP, which was reduced to four latent domains using exploratory structural equation modeling. General linear models identified variables associated with each domain. Logistic regression determined the ability of LAEP scores to differentiate between epilepsy and PNES. RESULTS 311 patients met inclusion criteria. Mean age was 38 years and 56% of patients were female. Network analysis demonstrated strong relationships between depression and anxiety with physical, sleep, psychiatric, and dermatological AE endorsement. Depression, female sex, and AED polytherapy were associated with greater AE endorsement. Epilepsy, compared to PNES, was associated with lower AE endorsement. Fewer prescribed AEDs and greater reported physical AE endorsement were associated with PNES diagnosis. SIGNIFICANCE There is a strong relationship between patient-reported AEs and psychiatric symptomatology. Those with PNES paradoxically endorse greater physical AEs despite receiving fewer AEDs. Patients who endorse AEs in clinical practice should be screened for comorbid depression or anxiety and treated accordingly.
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Affiliation(s)
- Yew Li Dang
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia
| | - Emma Foster
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.
| | - Michael Lloyd
- Department of Psychiatry, Alfred Health, Melbourne, Australia
| | - Genevieve Rayner
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Maria Rychkova
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Rashida Ali
- Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Patrick W Carney
- Department of Medicine, Monash University and Eastern Health, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Dennis Velakoulis
- Department of Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia
| | | | - Tomas Kalincik
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH), The University of Melbourne, Parkville, Australia
| | - Piero Perucca
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Terence J O'Brien
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Patrick Kwan
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Charles B Malpas
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Clinical Outcomes Research (CORe) Unit, Department of Medicine (RMH), The University of Melbourne, Parkville, Australia
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12
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Witt JA, Nass RD, Baumgartner T, von Wrede R, Elger CE, Surges R, Helmstaedter C. Does the accumulated antiepileptic drug load in chronic epilepsy reflect disease severity? Epilepsia 2020; 61:2685-2695. [PMID: 33058192 DOI: 10.1111/epi.16720] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To ascertain factors that are related to the antiepileptic drug load in epilepsy. METHODS In this cross-sectional study, we analyzed a large cohort of conservatively treated patients with epilepsy (n = 1135) and a smaller homogeneous group of presurgical patients with neuropathologically confirmed unilateral hippocampal sclerosis (n = 91). Considered clinical variables comprised (1) presence of an underlying cerebral lesion, (2) onset and (3) duration of epilepsy, (4) seizure frequency, (5) generalized or focal to bilateral tonic-clonic seizures, (6) ictal impairment of awareness, and (7) a history of convulsive status epilepticus. In the presurgical sample, we additionally considered (8) the degree of pathology (hippocampal neuronal cell densities) instead of (1) presence of a cerebral lesion and (9) an overall rating of epilepsy severity (GASE scale). Drug load was quantified as (a) the number of concomitant antiepileptic drugs (AEDs) and (b) the total defined daily dose (DDD). RESULTS Analyses disclosed only small correlations between clinical variables and drug load indices. In the conservatively treated cohort, the multiple regression analyses revealed that epilepsy onset, cerebral lesion, history of convulsive status epilepticus, and seizure frequency combined explained only 6%-10% of variance in drug load. Nearly the same variance (5%-8%) could be explained by duration of epilepsy alone. Degree of hippocampal pathology and the epilepsy severity ratings were not related to drug load indices. SIGNIFICANCE Clinical markers of epilepsy severity were only marginally associated with drug load. Findings rather indicate that patients seem to accumulate drugs due to the chronicity of epilepsy. Overall, the drug load remained largely unexplained. The findings nevertheless call for scrutinizing multidrug therapies in patients with long-lasting epilepsies.
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Affiliation(s)
| | - Robert D Nass
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Tobias Baumgartner
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn (UKB), Bonn, Germany
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13
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Franco V, Canevini MP, De Sarro G, Fattore C, Fedele G, Galimberti CA, Gatti G, La Neve A, Rosati E, Specchio LM, Striano S, Tinuper P, Perucca E. Does screening for adverse effects improve health outcomes in epilepsy? Neurology 2020; 95:e239-e246. [DOI: 10.1212/wnl.0000000000009880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 12/19/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo determine whether systematic screening for adverse effects of antiepileptic drugs (AEDs) reduces toxicity burden and improves health-related quality of life in patients with epilepsy.MethodsConsecutive patients with uncontrolled seizures aged ≥16 years and a high Adverse Event Profile (AEP) score were randomized to 2 groups and followed up for 18 months at 11 referral centers. AEP scores were made available to treating physicians at all visits in the intervention group, but not in the control group. Co–primary endpoints were changes in AEP scores and Quality of Life Inventory for Epilepsy-31 (QOLIE–31) scores.ResultsOf 809 enrolled patients able to complete the AEP questionnaire, 222 had AEP scores ≥45 and were randomized to the intervention (n = 111) or control group (n = 111). A total of 206 patients completed the 18-month follow-up. Compared with baseline, AEP scores decreased on average by 7.2% at 6 months, 12.1% at 12 months, and 13.8% at 18 months in the intervention group (p < 0.0001), and by 7.7% at 6 months, 9.2% at 12 months, and 12.0% at 18 months in controls (p < 0.0001). QOLIE-31 scores also improved from baseline to final visit, with a mean 20.7% increase in the intervention group and a mean 24.9% increase in the control group (p < 0.0001). However, there were no statistically significant differences in outcomes between groups for the 2 co–primary variables.ConclusionsContrary to findings from a previous study, systematic screening for adverse effects of AEDs using AEP scores did not lead to a reduced burden of toxicity over usual physician treatment.Italian Medicines Agency (AIFA) identifierFARM52K2WM_003.Clinicaltrials.gov identifierNCT03939507 (registered retrospectively in 2019; the study was conducted during the 2006–2009 period and registration of clinical trials was not a widely established practice when this study was initiated).Classification of evidenceThis study provides Class II evidence that the additional collection of formal questionnaires regarding adverse effects of AEDs does not reduce toxicity burden over usual physician treatment.
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Meschede C, Witt J, Brömling S, Moskau‐Hartmann S, Rademacher M, Surges R, Wrede R, Helmstaedter C. Changes in cognition after introduction or withdrawal of zonisamide versus topiramate in epilepsy patients: A retrospective study using Bayes statistics. Epilepsia 2020; 61:1481-1490. [DOI: 10.1111/epi.16576] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/16/2020] [Accepted: 05/17/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Carolin Meschede
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
| | | | - Sarah Brömling
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
| | | | | | - Rainer Surges
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
| | - Randi Wrede
- Department of Epileptology University Hospital Bonn (UKB) Bonn Germany
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Kumar S, Sarangi SC, Tripathi M, Gupta YK. Evaluation of adverse drug reaction profile of antiepileptic drugs in persons with epilepsy: A cross-sectional study. Epilepsy Behav 2020; 105:106947. [PMID: 32109858 DOI: 10.1016/j.yebeh.2020.106947] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/12/2020] [Accepted: 01/24/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Newer antiepileptic drugs (AEDs) are preferred over conventional AEDs with the perception of better safety profile and efficacy though there is a lack of confirmatory evidence. The present study assessed the adverse drug reactions' (ADRs) profile of AEDs prescribed in persons with epilepsy (PWE) as per the System Organ Class (SOC) and compared them on the basis of demographics and treatment pattern. MATERIAL AND METHODS This prospective, cross-sectional, and observational study was conducted in PWE attending Neurology Outpatient-Department from February 2016 to April 2019 who were presented with any ADR. World Health Organization-Uppsala Monitoring Centre (WHO-UMC) scale was used for the causality assessment of suspected ADRs. RESULTS Among the 1011 PWE on AEDs, male:female ratio was 622:389, adult:pediatric ratio 736:275, and conventional:newer AEDs ratio 624:387. Among monotherapy PWE (47.1%), commonly used AEDs were levetiracetam (34.4%), valproic acid (22.9%), carbamazepine (18.3%), phenytoin (11.9%), and other AEDs (12.5%). A total of 1990 ADRs (1.96 ADRs per PWE) were reported as per SOC; among them, newer vs. conventional AEDs did not reveal any significant difference; however, monotherapy vs. polytherapy showed differences in nervous system disorders (p = 0.01) and skin and subcutaneous tissue disorders (p = 0.005). Causality assessment revealed 0.3% certain, 27.3% probable, 61.3% possible, and 11.1% unlikely association of ADRs with AEDs. Depending on the ADRs, there was either withdrawal of AED (0.9%), reduction in dose (48.4%), or continuation in the same dose as before (50.7%). CONCLUSION The ADR analysis showed that newer AEDs were associated with a similar trend of ADRs as that of conventional AEDs. Thus, the choice among newer and conventional AEDs should preferably focus on the experience of better efficacy in addition to safety data.
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Affiliation(s)
- Sachin Kumar
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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Kopciuch D, Barciszewska AM, Fliciński J, Zaprutko T, Kus K, Steinborn B, Nowakowska E. Analysis of pharmacotherapy regimen and costs in patients with drug-resistant epilepsy following vagus nerve stimulation therapy: a single-center study (Poland). Acta Neurol Belg 2020; 120:115-122. [PMID: 31721076 DOI: 10.1007/s13760-019-01236-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/05/2019] [Indexed: 11/30/2022]
Abstract
Approximately 30-40% of patients with drug-resistant epilepsy (DRE) who underwent vagus nerve stimulator (VNS) implantation achieve above 50% reduction in seizure frequency. VNS proves effective in reducing frequency of seizures in DRE patients, when combined with antiepileptic drugs (AEDs). This raises a question whether improvement of clinical parameters is achieved with VNS only or relies on combined therapy with AEDs. The aim of the study was the analysis of impact of VNS on clinical recovery of patients with DRE and the analysis of pharmacotherapy costs and drug regimen following VNS implantation in DRE patients. The study included all the patients who had VNS implanted at our department in the years 2014-2018. The patients would be followed up for 2 years after the VNS implantation date. The most commonly used drugs included levetiracetam, lacosamide, valproate, oxcarbazepine, and topiramate. Average cost of AEDs in year 1 following VNS implantation was between EUR 15.53 (CLB) and EUR 545.52 (TGB) and in year 2 between EUR 13.51 (NTZ) and EUR 779.44 (LAC). The greatest number of seizures affected the group of patients treated with three drugs. A statistically significant improvement in seizure frequency was observed in the group of patients treated with two and three drugs. With the rising costs of healthcare, the importance of economic efficiency is becoming increasingly relevant. VNS is a reasonable option for saving money in the healthcare system while ensuring measurable clinical and therapeutic outcomes over the long term.
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Affiliation(s)
- Dorota Kopciuch
- Department of Pharmacoeconomics and Social Pharmacy, Poznań University of Medical Sciences, Rokietnicka 7 St., 60-806, Poznan, Poland.
| | - Anna-Maria Barciszewska
- Department of Neurosurgery and Neurotraumatology, Poznań University of Medical Sciences, Poznan, Poland
- Department of Neurosurgery and Neurotraumatology, Heliodor Swiecicki Clinical Hospital, Poznan, Poland
| | - Jędrzej Fliciński
- Department of Developmental Neurology, Poznań University of Medical Sciences, Poznan, Poland
| | - Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Poznań University of Medical Sciences, Rokietnicka 7 St., 60-806, Poznan, Poland
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Poznań University of Medical Sciences, Rokietnicka 7 St., 60-806, Poznan, Poland
| | - Barbara Steinborn
- Department of Developmental Neurology, Poznań University of Medical Sciences, Poznan, Poland
| | - Elżbieta Nowakowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznań University of Medical Sciences, Rokietnicka 7 St., 60-806, Poznan, Poland
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Wang L, Chen S, Liu C, Lin W, Huang H. Factors for cognitive impairment in adult epileptic patients. Brain Behav 2020; 10:e01475. [PMID: 31863643 PMCID: PMC6955925 DOI: 10.1002/brb3.1475] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To analyze factors for cognitive impairment in epileptic patients. METHODS A total of 257 epileptic patients completed clinical memory scale (CMS) and 70 of them were further surveyed with mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), digital symbol test (DSy), verbal fluency test, digit span test (DSp), Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD). Monadic linear related analysis and multiple stepwise regression analysis were performed to evaluate the potential factors for cognitive impairment. RESULTS Educational level was correlated with scores of cognitive tests (p < .01), with a difference between the junior high school group and senior high school group (p < .01 or p < .05). Seizure frequency was negatively correlated with CMS scores (p < .01), with a difference between the group with a seizure frequency of less than once a year and other groups (p < .01). The kind of antiepileptic drugs (AEDs) was negatively correlated with CMS scores (p < .01), with a difference between the single-drug group and the group taking more than two kinds of AEDs (p < .01). Depression scores were negatively correlated with MMSE, MoCA, DSy, DSp (p < .01 or p < .05), disease duration negatively with DSy (p < .01), and age negatively with MoCA (p < .05). Seizure type was correlated with DSy, and general seizure fared worse in the tests than other seizure types (p < .05). CONCLUSION Educational level, seizure frequency, kinds of AEDs and depression can affect the cognitive function of epileptic patients. High educational level, good seizure control, single-drug treatment and healthy psychological state are protective factors for cognitive function of epileptic patients.
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Affiliation(s)
- Lei Wang
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China.,Department of Cardiac Surgery, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Shenggen Chen
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Changyun Liu
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Wanhui Lin
- Department of Neurology and Geriatrics, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Huapin Huang
- Department of Neurology, Union Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Molecular Neurology, Fuzhou, China
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Validation of the Azeri version of the Pediatric Epilepsy Side Effects Questionnaire. Childs Nerv Syst 2019; 35:2379-2383. [PMID: 31280354 DOI: 10.1007/s00381-019-04287-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Long-lasting use of antiepileptic drugs in children with epilepsy negatively influences their quality of life and compliance. The purpose of this study was validation of the Azeri version of the Pediatric Epilepsy Side Effects Questionnaire (PESQ). METHODS We collected the PESQ from caregivers of children with epilepsy. In order to screen for comorbid behavioral and emotional problems, the Strengths and Difficulties Questionnaire (SDQ) was used. Demographic and medical data were collected through patient charts. We conducted factor analysis and assessed internal consistency and construct validity of the PESQ. RESULTS Caregivers of 120 patients with different epileptic syndromes completed the PESQ (age range 2-18; mean age 9.8 ± 4.0; male 56.7%; polytherapy 24%). The factor loading in the principal component analysis confirmed five-factor structure of the PESQ. The internal consistency coefficient of the total side effects scale of the PESQ was strong (0.86). Children receiving polytherapy showed higher scores on all subscales and the total score of the PESQ, supporting its construct validity. The total scores of the PESQ and the SDQ strongly correlated. CONCLUSIONS The PESQ can be used as a reliable and valid measure assessing antiepileptic drug side effects across the epilepsy spectrum.
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Kharbanda PS, Baishya J. Remaining Alert to Sedation by Antiepileptic Drugs Just after Epilepsy Surgery. Neurol India 2019; 67:1054-1055. [PMID: 31512633 DOI: 10.4103/0028-3886.266285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Parampreet S Kharbanda
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitupam Baishya
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Helmstaedter C, Witt JA, Hoppe C. Evaluating the mediating role of executive functions for antiepileptic drugs' effects on IQ in children and adolescents with epilepsy. Epilepsy Behav 2019; 96:98-103. [PMID: 31121514 DOI: 10.1016/j.yebeh.2019.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/02/2019] [Accepted: 04/06/2019] [Indexed: 10/26/2022]
Abstract
Several studies suggest that antiepileptic drug (AED) treatment may permanently or reversibly affect intelligence (intelligence quotient [IQ]) in children and adolescents with epilepsy. Since AED treatment preferentially affects attention and executive functions, we evaluated the potentially mediating effect of executive functions in regard to the adverse effects of drug treatment on intelligence. In a retrospective observational study, 178 children and adolescents with refractory and mostly localization-related epilepsies were evaluated in regard to the interrelation of IQ (Wechsler Intelligence Scale for Children [WISC III] short-form), executive functions (EpiTrack-Junior®, a cognitive AED screening test), and drug treatment (drug load). The results indicate that a low IQ was evident in 23%, impaired executive functions in 59% of the patients. Executive functions correlated to IQ (r = 0.60) and the symbol digits and picture arrangement subtests (R2 = 0.46) in particular. Odds ratios for impaired executive functions compared to being off drug (33% impaired) increased from 2.0 with one drug (53% impaired) to 9.5 (83% impaired) with at least three drugs. A mediation analysis revealed that drug dependent differences in executive functions mediate the negative effect of the AED load on intelligence. Hence, executive functions appear to link adverse cognitive side effects of AED treatment to intelligence. Considering Catell's two factor model of intelligence, AEDs preferentially affect the aspects of fluid intelligence. The overall impact of AED on intelligence appears mild. It may become relevant, however, when drug-induced impairments persist over longer time intervals during sensitive developmental phases. This issue needs to be addressed in future longitudinal studies.
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Affiliation(s)
| | - Juri-Alexander Witt
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Christian Hoppe
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
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21
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Kharod P, Mishra D, Juneja M. Drug-resistant epilepsy in Indian children at a tertiary-care public hospital. Childs Nerv Syst 2019; 35:775-778. [PMID: 30758667 DOI: 10.1007/s00381-019-04084-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Drug-resistant epilepsy (DRE), a condition in which seizures persist and seizure freedom is unlikely to be attained with further manipulation of anti-epileptic drugs, occurs in around 20% of children with epilepsy. This study was conducted with the aim to study the profile of Indian children with resistant epilepsy, using the new consensus definition of DRE. METHODS All children who had been attending the Pediatric Neurology Clinic regularly for at least 6 months were reviewed between April and September 2015. Children fulfilling the ILAE Commission on Therapeutic Strategies Consensus Proposal definition of DRE were enrolled for the study. After informed consent, the records were reviewed and disease-related data was entered in the study form. The data were analyzed to determine etiological factors and treatment gaps in children with DRE. RESULTS Fifty children (12 females) with median (range) age of 90 (11-159) months and follow-up of 17.9 (8.5-20) months were enrolled. The mean (standard deviation) age at seizure onset and start of anti-epileptic drugs (AED) were 1.8 (2.11) and 2.1 (2.09) years, respectively. The median (range) number of anti-epileptic drugs that had been tried in these children was 5 (2-9), with drug side effects leading to discontinuation in 8 (16%) patients. Only two patients had tried ketogenic diet; vagal nerve stimulation and epilepsy surgery had not been tried by any family, despite recommendation by the physicians in 7 children. CONCLUSIONS Majority of Indian children with DRE have onset of epilepsy in early infancy, and are infrequently provided access to newer non-pharmacological measures.
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Affiliation(s)
- Prarthana Kharod
- Department of Pediatrics, Lok Nayak Hospital, Maulana Azad Medical College, University of Delhi, 2, BSZ Marg, New Delhi, Delhi, 110002, India. .,Department of Pediatrics, GCS Medical College, Ahmedabad, Gujarat, India.
| | - Devendra Mishra
- Department of Pediatrics, Lok Nayak Hospital, Maulana Azad Medical College, University of Delhi, 2, BSZ Marg, New Delhi, Delhi, 110002, India
| | - Monica Juneja
- Department of Pediatrics, Lok Nayak Hospital, Maulana Azad Medical College, University of Delhi, 2, BSZ Marg, New Delhi, Delhi, 110002, India
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22
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Baker C, Feinstein JA, Ma X, Bolen S, Dawson NV, Golchin N, Horace A, Kleinman LC, Meropol SB, Pestana Knight EM, Winterstein AG, Bakaki PM. Variation of the prevalence of pediatric polypharmacy: A scoping review. Pharmacoepidemiol Drug Saf 2019; 28:275-287. [PMID: 30724414 PMCID: PMC6461742 DOI: 10.1002/pds.4719] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE To examine the range of prevalence of pediatric polypharmacy in literature through a scoping review, focusing on factors that contribute to its heterogeneity in order to improve the design and reporting of quality improvement, pharmacovigilance, and research studies. METHODS We searched Ovid Medline, PubMed, EMBASE, CINAHL, Ovid PsycINFO, Cochrane CENTRAL, and Web of Science Core Collection databases for studies with concepts of children and polypharmacy, along with a hand search of the bibliographies of six reviews and 30 included studies. We extracted information regarding study design, disease conditions, and prevalence of polypharmacy. RESULTS Two hundred eighty-four studies reported prevalence of polypharmacy. They were more likely to be conducted in North America (37.7%), published after 2010 (44.4%), cross-sectional (67.3%), in outpatient settings (59.5%). Prevalence ranged from 0.9% to 98.4%, median 39.7% (interquartile range [IQR] 22.0%-54.0%). Studies from Asia reported the highest median prevalence of 45.4% (IQR 27.3%-61.0%) while studies from North America reported the lowest median prevalence of 30.4% (IQR 14.7%-50.2%). Prevalence decreased over time: median 45.6% before 2001, 38.1% during 2001 to 2010, and 34% during 2011 to 2017. Studies involving children under 12 years had a higher median prevalence (46.9%) than adolescent studies (33.7%). Inpatient setting studies had a higher median prevalence (50.3%) than studies in outpatient settings (38.8%). Community level samples, higher number and duration of medications defining polypharmacy, and psychotropic medications were associated with lower prevalence. CONCLUSIONS The prevalence of pediatric polypharmacy is high and variable. Studies reporting pediatric polypharmacy should account for context, design, polypharmacy definition, and medications evaluated.
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Affiliation(s)
- Courtney Baker
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - James A. Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Xuan Ma
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Shari Bolen
- Center for Health Care Research and Policy, MetroHealth, Cleveland, OH
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH
| | - Neal V. Dawson
- Center for Health Care Research and Policy, MetroHealth, Cleveland, OH
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH
| | - Negar Golchin
- School of Pharmacy, University of Washington, Seattle, WA
| | - Alexis Horace
- Department of Clinical Sciences, University of Louisiana at Monroe College of Pharmacy, Monroe, LA
| | - Lawrence C. Kleinman
- UH Rainbow The Center for Child Health and Policy, University Hospitals, Cleveland, OH and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Sharon B. Meropol
- UH Rainbow The Center for Child Health and Policy, University Hospitals, Cleveland, OH and School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University School of Medicine
| | | | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy and Department of Epidemiology, University of Florida, Gainesville, FL
| | - Paul M. Bakaki
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
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23
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High incidence of persistent subtherapeutic levels of the most common AEDs in children with epilepsy receiving polytherapy. Epilepsy Res 2018; 148:107-114. [DOI: 10.1016/j.eplepsyres.2018.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/14/2018] [Accepted: 09/15/2018] [Indexed: 11/18/2022]
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24
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Kumar S, Ramanujam B, Chandra PS, Dash D, Mehta S, Anubha S, Appukutan R, Rana MK, Tripathi M. Randomized controlled study comparing the efficacy of rapid and slow withdrawal of antiepileptic drugs during long-term video-EEG monitoring. Epilepsia 2017; 59:460-467. [DOI: 10.1111/epi.13966] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Shambhu Kumar
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Bhargavi Ramanujam
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - PS Chandra
- Department of Neurosurgery; All India Institute of Medical Sciences; New Delhi India
| | - Deepa Dash
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Santosh Mehta
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Sharma Anubha
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Renjith Appukutan
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Manit Kumar Rana
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
| | - Manjari Tripathi
- Department of Neurology; All India Institute of Medical Sciences; New Delhi India
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25
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Krauss G, Biton V, Harvey JH, Elger C, Trinka E, Soares da Silva P, Gama H, Cheng H, Grinnell T, Blum D. Influence of titration schedule and maintenance dose on the tolerability of adjunctive eslicarbazepine acetate: An integrated analysis of three randomized placebo-controlled trials. Epilepsy Res 2017; 139:1-8. [PMID: 29127848 DOI: 10.1016/j.eplepsyres.2017.10.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 10/03/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the influence of titration schedule and maintenance dose on the incidence and type of treatment-emergent adverse events (TEAEs) associated with adjunctive eslicarbazepine acetate (ESL). METHODS Data from three randomized, double-blind, placebo-controlled trials were analyzed. Patients with refractory partial-onset seizures were randomized to maintenance doses of ESL 400, 800, or 1200mg QD (dosing was initiated at 400 or 800mg QD) or placebo. The incidence of TEAEs was analyzed during the double-blind period (2-week titration phase; 12-week maintenance phase), according to the randomized maintenance dose and the titration schedule. RESULTS 1447 patients were included in the analysis. During the first week of treatment, 62% of patients taking ESL 800mg QD had ≥1 TEAE, vs 35% of those taking 400mg QD and 32% of the placebo group; dizziness, somnolence, nausea, and headache were numerically more frequent in patients taking ESL 800mg than those taking ESL 400mg QD. During the double-blind period, the incidences of common TEAEs were lower in patients who initiated ESL at 400mg vs 800mg QD. For the 800 and 1200mg QD maintenance doses, rates of TEAEs leading to discontinuation were lower in patients who began treatment with 400mg than in those who began taking ESL 800mg QD. CONCLUSIONS Initiation of ESL at 800mg QD is feasible. However, initiating treatment with ESL 400mg QD for 1 or 2 weeks is recommended, being associated with a lower incidence of TEAEs, and related discontinuations. For some patients, treatment may be initiated at 800mg QD, if the need for more immediate seizure reduction outweighs concerns about increased risk of adverse reactions during initiation.
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Affiliation(s)
- Gregory Krauss
- The Johns Hopkins University, Department of Neurology, Meyer 2-147, 600 N Wolfe St, Baltimore, MD 21287, USA.
| | - Victor Biton
- Arkansas Epilepsy Program, Clinical Trials Inc., 2 Lile Ct #100, Little Rock, AR 72205, USA.
| | - Jay H Harvey
- Department of Neurology and Neurotherapeutics, Division of Epilepsy, UT Southwestern Medical Center, 5323 Harry Hines Blvd., MC 8508, Dallas, Texas 75390-8508, USA.
| | - Christian Elger
- Department of Epileptology, University of Bonn Medical Centre, Sigmund-Freud-Straße 25, 53127 Bonn, Germany.
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University and Centre for Cognitive Neuroscience, Ignaz Harrerstrasse 79, 5020 Salzburg, Austria.
| | - Patrício Soares da Silva
- BIAL-Portela & Ca, S.A., Avenida da Siderurgia Nacional, 4745-457 São Mamede do Coronado, Portugal.
| | - Helena Gama
- BIAL-Portela & Ca, S.A., Avenida da Siderurgia Nacional, 4745-457 São Mamede do Coronado, Portugal.
| | - Hailong Cheng
- Sunovion Pharmaceuticals Inc., 84 Waterford Dr, Marlborough, MA 01752, USA.
| | - Todd Grinnell
- Sunovion Pharmaceuticals Inc., 84 Waterford Dr, Marlborough, MA 01752, USA.
| | - David Blum
- Sunovion Pharmaceuticals Inc., 84 Waterford Dr, Marlborough, MA 01752, USA.
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26
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Witt JA, Helmstaedter C. How can we overcome neuropsychological adverse effects of antiepileptic drugs? Expert Opin Pharmacother 2017; 18:551-554. [DOI: 10.1080/14656566.2017.1309025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Juri-Alexander Witt
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
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27
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Toledo M, Gonzalez-Cuevas M, Miró-Lladó J, Molins-Albanell A, Falip M, Martinez AB, Fernandez S, Quintana M, Cambrodi R, Santamarina E, Salas-Puig J. Sleep quality and daytime sleepiness in patients treated with adjunctive perampanel for focal seizures. Epilepsy Behav 2016; 63:57-62. [PMID: 27566967 DOI: 10.1016/j.yebeh.2016.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to evaluate subjective sleep quality and daytime sleepiness in patients receiving adjunctive perampanel for focal seizures. METHODS We conducted a multicenter, prospective, interventional, open-label study in patients aged >16 with focal seizures who received adjunctive perampanel (flexible dosing: 2-12mg). Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness with the Epworth Sleepiness Scale (ESS) at baseline and 3 and 6months after initiating perampanel. Patients with modifications in their baseline AEDs or sleep medications were excluded. RESULTS In 72 patients with drug-resistant focal seizures, mean baseline PSQI score (±standard deviation) was 7.26 (±4.6), and ESS was 6.19 (±4.2). At 3months (median perampanel dose: 4mg), there was no significant mean change from baseline in ESS score (n=61) and a significant improvement in PSQI (-1.51 points; n=44; p=0.007), driven mainly by improved sleep efficiency (p=0.012). In the 31 patients with 6-month data, ESS (but not PSQI) improved significantly at 6months vs baseline (p=0.029). The only factor significantly correlated with sleep parameters was number of baseline AEDs (higher number correlated with worse daytime sleepiness). Seizure frequency was reduced significantly from baseline at 3 and 6months. In bivariate analysis, neither PSQI nor ESS was associated with seizure frequency, suggesting that the changes in daytime sleepiness and sleep quality may be independent of the direct effect on seizures. CONCLUSION Adjunctive perampanel did not worsen sleep quality or daytime sleepiness at 3months and reduced daytime sleepiness in patients continuing perampanel for 6months. Perampanel may be a suitable AED in patients with sleep disorders, in addition to refractory focal seizures.
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Affiliation(s)
- Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | | | - Julia Miró-Lladó
- Epilepsy Unit, Neurology Department, Bellvitge University Hospital, Barcelona, Spain
| | | | - Mercé Falip
- Epilepsy Unit, Neurology Department, Bellvitge University Hospital, Barcelona, Spain
| | | | | | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Roser Cambrodi
- Sleep Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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