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Odhiambo M, Kariuki SM, Newton CR. Therapeutic monitoring of anti-seizure medications in low- and middle-income countries: a systematic review. Wellcome Open Res 2024; 6:92. [PMID: 37457427 PMCID: PMC10349269 DOI: 10.12688/wellcomeopenres.16749.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 07/18/2023] Open
Abstract
Background The treatment gap for epilepsy is large in low- and middle-income countries (LMICs) and the effectiveness and safety of the available anti-seizure medication (ASMs) is not fully understood. We systematically reviewed available evidence on therapeutic drug monitoring (TDM) of ASM in LMIC. Methods We searched four main databases (PubMed, Psych-Info, CINAHL and Embase) up to 31 st December 2020, with eligible articles screened using a PRISMA checklist and a set of exclusion and inclusion criteria. Full texts were examined to evaluate the extent and practice of TDM in LMICs. Analyses were performed using Stata 13 and descriptive statistics were used to pool median distribution of TDM across studies. Results Of the 6,309 articles identified in the initial search, 65 (1.0%) met the eligibility criteria. TDM of ASMs was mostly done to assess toxicity (42.8%), but rarely to monitor adherence (9.0%). TDM differed by economic status and infrastructural status with majority of the studies coming from Europe (53.8%) and upper-middle-income countries (87.6%). First generation ASMs (82.3%) were more likely to be monitored than second generation ASMs (17.6%) and carbamazepine was the most frequently monitored drug. Fluorescence Polarization Immunoassay (FPIA) was the most common technique used for TDM (41.5%) followed by High-Performance Liquid Chromatography (HPLC) (16.9%). In addition, FPIA was the cheapest method of TDM based on approximated costs ($1000, TDx system). Assay validation and quality control were reported variably, and reference ranges used during TDM of ASMs were relatively uniform. Conclusions TDM is mostly done to evaluate ASM toxicity, but rarely for other reasons such as evaluating adherence or assessing clinical efficacy. There is a need for more investment in comprehensive and targeted TDM in LMICs when initiating treatment, switching therapies, adding or removing ASM and evaluating treatment response and safety of both first generation and second generation ASMs.
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Affiliation(s)
- Mercy Odhiambo
- Neurosciences Unit, KEMRI Wellcome Trust Research Programme, KILIFI, 80108, Kenya
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, 80108, Kenya
| | - Symon M. Kariuki
- Neurosciences Unit, KEMRI Wellcome Trust Research Programme, KILIFI, 80108, Kenya
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, 80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Charles R. Newton
- Neurosciences Unit, KEMRI Wellcome Trust Research Programme, KILIFI, 80108, Kenya
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, 80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
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Abd El-Rahman AA, El-Shafei SMA, Shehab GMG, Mansour L, Abuelsaad ASA, Gad RA. Assessment of Biochemical and Neuroactivities of Cultural Filtrate from Trichoderma harzianum in Adjusting Electrolytes and Neurotransmitters in Hippocampus of Epileptic Rats. Life (Basel) 2023; 13:1815. [PMID: 37763219 PMCID: PMC10533195 DOI: 10.3390/life13091815] [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: 07/29/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Epilepsy is a serious chronic neurological disorder, which is accompanied by recurrent seizures. Repeated seizures cause physical injuries and neuronal dysfunction and may be a risk of cancer and vascular diseases. However, many antiepileptic drugs (AEDs) have side effects of mood alteration or neurocognitive function, a reduction in neuron excitation, and the inhibition of normal activity. Therefore, the present study aimed to evaluate the effect of secondary metabolites of Trichoderma harzianum cultural filtrate (ThCF) when adjusting different electrolytes and neurotransmitters in the hippocampus of epileptic rats. METHODS Cytotoxicity of ThCF against LS-174T cancer cells was assessed using a sulforhodamine B (SRB) assay. Quantitative estimation for some neurotransmitters, electrolytes in sera or homogenate of hippocampi tissues, and mRNA gene expression for ion or voltage gates was assessed by quantitative Real-Time PCR. RESULTS Treatment with ThCF reduces the proliferative percentage of LS-174T cells in a concentration-dependent manner. ThCF administration improves hyponatremia, hyperkalemia, and hypocalcemia in the sera of the epilepticus model. ThCF rebalances the elevated levels of many neurotransmitters and reduces the release of GABA and acetylcholine-esterase. Also, treatments with ThCF ameliorate the downregulation of mRNA gene expression for some gate receptors in hippocampal homogenate tissues and recorded a highly significant elevation in the expression of SCN1A, CACNA1S, and NMDA. CONCLUSION Secondary metabolites of Trichoderma (ThCF) have cytotoxic activity against LS-174T (colorectal cancer cell line) and anxiolytic-like activity through a GABAergic mechanism of action and an increase in GABA as inhibitory amino acid in the selected brain regions and reduced levels of NMDA and DOPA. The present data suggested that ThCF may inhibit intracellular calcium accumulation by triggering the NAADP-mediated Ca2+ signaling pathway. Therefore, the present results suggested further studies on the molecular pathway for each metabolite of ThCF, e.g., 6-pentyl-α-pyrone (6-PP), harzianic acid (HA), and hydrophobin, as an alternative drug to mitigate the side effects of AEDs.
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Affiliation(s)
- Atef A. Abd El-Rahman
- Department of Agricultural Chemistry, Faculty of Agriculture, Minia University, El-Minya 61519, Egypt;
| | - Sally M. A. El-Shafei
- Department of Agricultural Chemistry, Faculty of Agriculture, Minia University, El-Minya 61519, Egypt;
| | - Gaber M. G. Shehab
- Department of Biochemistry, Faculty of Agriculture, Cairo University, Giza 12613, Egypt;
| | - Lamjed Mansour
- Department of Zoology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Abdelaziz S. A. Abuelsaad
- Immunology Division, Zoology Department, Faculty of Science, Beni-Suef University, Beni-Suef 62521, Egypt;
| | - Rania A. Gad
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, NAHDA University (NUB), Beni-Suef 62511, Egypt;
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Chu C, Li N, Zhong R, Zhao D, Lin W. Efficacy of Phenobarbital and Prognosis Predictors in Women With Epilepsy From Rural Northeast China: A 10-Year Follow-Up Study. Front Neurol 2022; 13:838098. [PMID: 35250838 PMCID: PMC8889069 DOI: 10.3389/fneur.2022.838098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/24/2022] [Indexed: 01/03/2023] Open
Abstract
Objective To investigate the efficacy of phenobarbital (PB), factors associated with it, reasons for early treatment termination, and mortality rates in adult women living in rural Northeast China. Methods A prospective study was conducted in seven counties of Jilin Province from 2010 to 2020. Adult women diagnosed with convulsive epilepsy were recruited into the study and baseline demographics recorded upon enrollment. Seizure frequency, prescribed drug dose, and adverse reactions were monitored monthly by door-to-door survey or telephone interview. Results A total of 1,333 women were included in the study. During the follow-up period, 169 participants (12.7%) were lost to follow-up, and 100 of them (7.5%) died. The percentage of seizure-free participants was 45.3% in the first year, 74.6% in the third year, and 96.6% in the 10th year. A higher baseline seizure frequency (OR = 1.005, 95% CI: 1.002–1.009), more frequent loss-of-consciousness seizures (OR = 1.620, 95% CI: 1.318–1.990), a higher daily dose of PB in the first year (OR = 1.018, 95% CI: 1.014–1.022), a younger age at onset (OR = 0.990, 95% CI: 0.982–0.998), and more severe drowsiness (OR = 1.727, 95% CI: 1.374–2.173) were associated with an increased risk of seizures in the first year, and the higher baseline seizure frequency was still associated with the occurrence of seizures in the third (OR = 1.007, 95% CI: 1.004–1.010) and fifth year (OR = 1.005, 95% CI: 1.002–1.008). Age at enrollment (HR = 0.983, 95% CI: 0.971–0.994) was the only factor that correlated with withdrawal from the study and with the death of the participant during the follow up period, but the correlation in each case was in opposite directions. Significance PB has high effectiveness, retention rate, mild side effects, and tolerability when used as a treatment for epilepsy in women from rural areas. Baseline seizure frequency is an important predictor of prognosis regardless of treatment duration. PB is still a valuable tool for the management of epilepsy in adult women from poverty-stricken areas.
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Affiliation(s)
- Chaojia Chu
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Nan Li
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Rui Zhong
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Danyang Zhao
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China
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Krauss GL, Ben-Menachem E, Wechsler RT, Patten A, Williams B, Laurenza A, Malhotra M. A multivariable prediction model of a major treatment response for focal-onset seizures: A post-hoc analysis of Phase III trials of perampanel. Epilepsy Res 2021; 174:106649. [PMID: 34022524 DOI: 10.1016/j.eplepsyres.2021.106649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/23/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although 50 % reduction in seizure frequency is a common efficacy endpoint in clinical trials of antiepileptic drugs (AEDs), 75 % or greater reductions may be required to improve patients' health-related quality of life. Identification of clinical factors that are associated with high responder rates may help to inform clinicians on which patients may optimally benefit from treatment. We evaluated potential predictive factors for achieving major treatment responses (≥75 % reduction in seizure frequency per 28 days from study baseline) in patients with drug-resistant focal-onset seizures, with/without focal to bilateral tonic-clonic (FBTC) seizures in perampanel trials designed for regulatory approval. METHODS Univariate analyses using logistic regression were performed using data from three double-blind, placebo-controlled Phase III studies of adjunctive perampanel (Studies 304 [NCT00699972], 305 [NCT00699582], 306 [NCT00700310]), and their open-label extension study (OLEx; Study 307 [NCT00735397]). For the double-blind studies, baseline seizure frequency, number of baseline AEDs, baseline seizure type, baseline concomitant enzyme-inducing AEDs (EIAEDs), baseline carbamazepine, lamotrigine, or valproic acid, age at diagnosis, time since diagnosis, etiology, and perampanel plasma concentration were included individually with study treatment. The same factors were included for the OLEx analysis except for plasma concentration and treatment. Variables found to be significant predictors for a major treatment response in univariate analyses were subsequently included in multivariable analyses using backwards and forwards selection. RESULTS In the double-blind studies, 175/1374 patients had a major response to placebo (n = 25) or perampanel (n = 150). The best predictors of a major treatment response in multivariable models with forwards and backwards selection were: the presence of FBTC seizures during baseline (P = 0.0002), higher perampanel plasma concentration (P < 0.0001), older age at diagnosis (P = 0.0024 and 0.0045, respectively), and lower baseline seizure frequency (P = 0.0364 and 0.0127, respectively). In the OLEx, 217/1090 patients had a major treatment response. The best predictors of a major treatment response in the final multivariable model, regardless of backwards or forwards selection, were a lower baseline seizure frequency (P = 0.0022), the absence of focal impaired awareness seizures during baseline (P = 0.0011), the presence of FBTC seizures during baseline (P = 0.0164), lower number(s) of baseline AEDs (P = 0.0002), the absence of EIAEDs during baseline (P = 0.0059), an older age at diagnosis (P = 0.0054), and absence of structural etiologies (P = 0.0138). SIGNIFICANCE These analyses of placebo-controlled and long-term extension trial data identified a number of potential predictive factors for patients with focal-onset seizures achieving a major treatment response. These factors may help guide clinicians when predicting a patient's response to treatment and optimizing individual treatment regimens.
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Affiliation(s)
- Gregory L Krauss
- Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Elinor Ben-Menachem
- Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, 413 90, Gothenburg, Sweden.
| | - Robert T Wechsler
- Idaho Comprehensive Epilepsy Center, 1499 West Hays Street, Boise, ID, 83702, USA.
| | - Anna Patten
- Eisai Ltd., Mosquito Way, Hatfield, Hertfordshire, AL10 9SN, UK.
| | - Betsy Williams
- Formerly: Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ, 07677, USA.
| | - Antonio Laurenza
- Formerly: Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ, 07677, USA.
| | - Manoj Malhotra
- Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ, 07677, USA.
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Ding D, Zhou D, Sander JW, Wang W, Li S, Hong Z. Epilepsy in China: major progress in the past two decades. Lancet Neurol 2021; 20:316-326. [PMID: 33743240 DOI: 10.1016/s1474-4422(21)00023-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 02/08/2023]
Abstract
China has approximately 10 million people with epilepsy. There is a vast epilepsy treatment gap in China, mainly driven by deficiencies in health-care delivery and social discrimination resulting from cultural beliefs about epilepsy. WHO's Global Campaign Against Epilepsy project in China showed that it was possible to treat epilepsy in primary care settings, which was a notable milestone. The China Association Against Epilepsy has been a necessary force to stimulate interest in epilepsy care and research by the medical and scientific community. Nearly 20 different anti-seizure medications are now available in China. Non-pharmacological options are also available, but there are still unmet needs for epilepsy management. The Chinese epilepsy research portfolio is varied, but the areas in which there are the most concentrated focus and expertise are epidemiology and clinical research. The challenges for further improvement in delivering care for people with epilepsy in China are primarily related to public health and reducing inequalities within this vast country.
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Affiliation(s)
- Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, UK; Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands.
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Shichuo Li
- China Association against Epilepsy, Beijing, China
| | - Zhen Hong
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
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Singh G, Singhal S, Sharma S, Paul BS, Bansal N, Chaudhary A, Sharma S, Bansal RK, Goraya JS, Setia RK, Sander JW. Clinical characteristics of epilepsy in resource-limited communities in Punjab, Northwest India. Epilepsia Open 2020; 5:582-595. [PMID: 33336129 PMCID: PMC7733663 DOI: 10.1002/epi4.12439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/26/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To describe clinical characteristics of a community-based epilepsy cohort from resource-limited communities in Punjab, Northwest India. METHODS The cohort was gathered following a two-stage screening survey. We cross-sectionally examined and followed up the cohort for one year. A panel of neurologists assigned seizure types, syndromes, and putative etiologies and categorized drug responsiveness. RESULTS The cohort of 240 included 161 (67.1%) men, 109 (45.4%) illiterates and 149 (62.1%) unemployed. Current age was >18 years in 155 (64.6%) but age at epilepsy onset was <18 years in 173 (72.1%). Epilepsies due to structural and metabolic causes were diagnosed in 99 (41.3%), but syndromic assignments were not possible in 97 (40.4%). After one year, drug-resistant epilepsy was established in 74 (30.8%). Perinatal events (n = 35; 14.6%) followed by CNS infections (n = 32; 13.3%) and traumatic brain injury (n = 12; 5.0%) were common risk factors. Most of those with CNS infections (n = 19; 63.3%), perinatal antecedents (n = 23; 76.7%), and other acquired risk factors (n = 27; 90.0%) presented with epilepsy due to structural and metabolic causes. Perinatal events were the putative etiology for nearly 40.7% of generalized epilepsies due to structural and metabolic causes and 28.2% of all epilepsies with onset <10 years. SIGNIFICANCE Existing classifications schemes should be better suited to field conditions in resource-limited communities in low- and middle-income countries. The finding of drug-resistant epilepsy in nearly at least a third in a community-based sample underscores an unmet need for enhancing services for this segment within healthcare systems. Perinatal events, CNS infections, and head injury account for a third of all epilepsies and hence preventative interventions focusing on these epilepsy risk factors should be stepped up.
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Affiliation(s)
- Gagandeep Singh
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
- Department of NeurologyDayanand Medical CollegeLudhianaIndia
- NIHR University College London Hospitals Biomedical Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Sachi Singhal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Suman Sharma
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | | | - Namita Bansal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Anurag Chaudhary
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | - Sarit Sharma
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | | | | | | | - Josemir W. Sander
- NIHR University College London Hospitals Biomedical Research CentreUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St PeterUK
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
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Mortality implications and factors associated with nonengagement in a public epilepsy care initiative in a transient population. Epilepsy Behav 2020; 112:107438. [PMID: 32977110 DOI: 10.1016/j.yebeh.2020.107438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Community-based, public care programs are a requisite to close the epilepsy treatment gap in disadvantaged communities in low- and middle-income countries (LMICs). Potential beneficiaries may, however, choose not to engage in these programs. AIMS The aim of the study was to describe factors associated with and mortality consequences of nonacceptance of a public epilepsy care initiative. METHODS In this cross-sectional study, we contacted 207 (36%) people out of 575 who screened positive for epilepsy during a population-based survey of 59,509 people. They were invited for neurological evaluation and care provision (including antiseizure medications (ASMs)) but chose not to engage. Structured questionnaires and qualitative interviews were conducted to determine reason for their nonengagement. Factors associated with nonengagement were evaluated by univariate and multivariate analysis. We conducted verbal autopsies for those who had died. RESULTS Ten (5%) of the 207 individuals died since the initial screening; six with epilepsy-related causes. Of those who could be contacted (n = 48), 40 (19%) were confirmed to have epilepsy. Nonengaging individuals were likely to be older (odds ratio (OR): 1.02; 95% confidence interval (CI), 1.01, 1.11), locals (OR: 4.32; 95% CI, 1.55, 12.03), and earn less than US$ 78/month (OR: 3.6; 95% CI, 1.62, 8.06). Reasons for not engaging included a belief that epilepsy is inconsequential, loss of daily wages owing to healthcare facility visit and physical infirmity. CONCLUSIONS Nonacceptance of a community-based public epilepsy care initiative is associated with high premature mortality, mostly attributed to epilepsy-related causes. Older age, ethnic status, and economic deprivation are factors associated with nonacceptance, though the underlying reasons may be varied.
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Mogal Z, Aziz H. Epilepsy treatment gap and stigma reduction in Pakistan: A tested public awareness model. Epilepsy Behav 2020; 102:106637. [PMID: 31805506 DOI: 10.1016/j.yebeh.2019.106637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/28/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
High epilepsy treatment gap (ETG) and stigma remain a major issue globally. Addressing the basic problems is necessary, for advances in management to be effective. According to the 1987 population-based study, prevalence of active epilepsy in Pakistan is 0.98% with 98.1% ETG in rural and 72.5% in urban population and the presence of stigma. These dismal figures were a stimulus for our reported activities. Recognizing the problems faced by 2.2 million people with epilepsy (PWE) in the country, a group of volunteers mostly from the medical community has attempted to address these issues with an ongoing sustained awareness program over the last 18 years, working within the constraints of prevailing healthcare system, with gratifying results. In 2001, under a nongovernmental organization (NGO), the Comprehensive Epilepsy Control Programme of Pakistan (CECP) was launched to address the various paucities in knowledge, attitude, and practice about epilepsy; especially ETG and stigma. The CECP has two primary components: Epilepsy Support Pakistan (CECP-ESP) for awareness and mass education and National Epilepsy Centre (CECP-NEC) for holistic management of PWE, professional education, and research. Both work in tandem, and there is an overlap of their activities. This article only evaluates the outcome of sustained awareness activities of the CECP-ESP, through direct and indirect measures after 5 years of its initiation. A significant reduction in ETG and stigma exclusively through public awareness has been possible. This model can be easily replicated by any country, with involvement of the local population.
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Affiliation(s)
- Zarine Mogal
- National Epilepsy Centre, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Pakistan.
| | - Hasan Aziz
- National Epilepsy Centre, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Pakistan
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Treatment response and predictors in patients with newly diagnosed epilepsy in Ethiopia: a retrospective cohort study. Sci Rep 2019; 9:16254. [PMID: 31700030 PMCID: PMC6838070 DOI: 10.1038/s41598-019-52574-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/21/2019] [Indexed: 12/03/2022] Open
Abstract
Epilepsy is a chronic neurological disease with a variable therapeutic response. To design effective treatment strategies for epilepsy, it is important to understand treatment responses and predictive factors. However, limited data are available in Africa, including Ethiopia. The aim of this study was therefore to assess treatment response and identify prognostic predictors among patients with epilepsy at Jimma university medical center, Ethiopia. We conducted a retrospective cohort study of 404 newly diagnosed adult epilepsy patients receiving antiepileptic treatment between May 2010 and May 2015. Demographic, clinical, and outcome data were collected for all patients with a minimum follow-up of two years. Cox proportional hazards model was used to identify predictors of poor seizure remission. Overall, 261 (64.6%) of the patients achieved seizure remission for at least one year. High number of pre-treatment seizures (adjusted hazard ratios (AHR) = 0.64, 95% CI: 0.49–0.83) and poor adherence (AHR = 0.57, 95% CI: 0.44–0.75) were significant predictors of poor seizure remission. In conclusion, our study showed that only about two-thirds of patients had achieved seizure remission. The high number of pre-treatment seizures and non-adherence to antiepileptic medications were predictors of poor seizure remission. Patients with these characteristics should be given special attention.
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Mousavi-Hasanzadeh M, Rezaeian-Varmaziar H, Shafaat O, Jand A, Palizvan MR. The effect of co-administration of pentylenetetrazole with pilocarpine: New modified PTZ models of kindling and seizure. Pharmacol Biochem Behav 2019; 182:7-11. [PMID: 31082418 DOI: 10.1016/j.pbb.2019.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Drug resistance is a major problem in the treatment of epilepsy. There is a critical need for new epilepsy models to evaluate antiepileptic compounds. Pentylenetetrazole- (PTZ) and pilocarpine-induced seizures are well-established models of human epilepsy. Generally, PTZ or pilocarpine has been used to produce seizures in experimental models. In this study, we explored the possibility of creating new epilepsy and seizure models by co-administration of PTZ and pilocarpine. METHODS The protocol was divided into three parts: A) Kindling experiments: the animals received PTZ or co-administration doses of PTZ and pilocarpine every other day for a period of 26 days. B) Seizure experiments, for induction of seizure, the animals received one dose of PTZ, pilocarpine or co-administration doses of PTZ and pilocarpine. C) Evaluation of antiepileptic drugs: the animals received phenytoin or sodium valproate 20 min before injection of PTZ, pilocarpine or co-administration doses of PTZ and pilocarpine. RESULTS The co-administration of pilocarpine and PTZ could induce seizure, which has behavioral similarity between electrical and chemical kindling. Pilocarpine (50 mg/kg) + PTZ (37.5 mg/kg) was the appropriate dose for kindling induction. Animals with this dose reached the stage five seizures significantly faster than those with PTZ alone. Unlike the seizure induced by PTZ, or pilocarpine, induction of seizure by PTZ + pilocarpine was resistant to phenytoin and sodium valproate treatment. As compared to the PTZ model of kindling, this model visualized the seizure behavior better and had resistance to two most popular antiepileptic drugs. CONCLUSION Our results indicated that co-administration of pilocarpine and PTZ could provide a new modified model of seizure and kindling resisting to phenytoin and sodium valproate.
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Affiliation(s)
| | | | - Omid Shafaat
- Students Research Committee, Faculty of Medicine, Arak University of Medical Sciences, Arak, IR, Iran; Department of Neurology and Interventional Neuroradiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aboulfazl Jand
- Department of Physiology, Faculty of Medicine, Arak University of Medical Sciences, Arak, IR, Iran
| | - Mohammad Reza Palizvan
- Department of Physiology, Faculty of Medicine, Arak University of Medical Sciences, Arak, IR, Iran.
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Hauser WA. An unparalleled assessment of the global burden of epilepsy. Lancet Neurol 2019; 18:322-324. [PMID: 30773429 DOI: 10.1016/s1474-4422(19)30042-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Affiliation(s)
- W Allen Hauser
- Sergievsky Center, Columbia University, New York, NY 10032, USA.
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Sun W, Wang J, Ding D, Zhang Q, Wang T, Hong Z. Blood concentration, efficacy, and adverse events of phenobarbital: A prospective study in rural China. Epilepsy Behav 2019; 90:247-251. [PMID: 30563756 DOI: 10.1016/j.yebeh.2018.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/17/2018] [Accepted: 10/08/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This study evaluated the relationship between blood concentration of phenobarbital (PB) and its efficacy as well as adverse events in people with epilepsy in rural China. METHODS People with epilepsy being treated with PB monotherapy were recruited and followed up for averagely 2.5 years. Data of clinical characteristics were collected using a standardized questionnaire by face-to-face interviews both at baseline and follow-up. Plasma concentration of PB was detected by the high-performance liquid chromatography. RESULTS Data on treatment response and PB blood concentration was obtained from 225 subjects. Among them, 119 (52.9%) were recognized as effective cases and 106 (47.1%) as ineffective cases. In the effective group, the blood concentration of 95% subjects ranged from 1.22 μg/ml to 41.36 μg/ml with a median at 13.18 μg/ml (IQR = 8.32-20.19 μg/ml). The PB concentration of 95% of the subjects in the ineffective group ranged from 2.73 μg/ml to 70.16 μg/ml with a median at 19.80 μg/ml (IQR = 11.30-30.40 μg/ml), which was significantly higher than that of the effective group (p < 0.001). Multivariate logistic regression analysis showed that PB concentration ≥26.38 μg/ml was related to a 4.5-fold (95% confidence interval [CI], 1.85-11.08) higher risk of inefficacy. A receiver operation characteristic curve was performed to determine the cutoff value of concentration for PB efficacy at 19.02 μg/ml. SIGNIFICANCE Blood concentration may be an important indicator for clinical decision making when PB monotherapy cannot achieve a good efficacy and more attention should be paid on it in clinical practice especially in resource-poor settings.
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Affiliation(s)
- Wanbing Sun
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianhong Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Ding Ding
- Institute of Neurology, WHO Collaborating Center for Research and Training in Neuroscience, Huashan Hospital, Fudan University, Shanghai, China.
| | - Qing Zhang
- Department of Neurology, Ningxia Medical University Affiliated Hospital, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Taiping Wang
- Jincheng Emergency Center, Shanxi Province, China
| | - Zhen Hong
- Institute of Neurology, WHO Collaborating Center for Research and Training in Neuroscience, Huashan Hospital, Fudan University, Shanghai, China
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Wilmshurst JM, Guekht A, Secco M, Helen Cross J, Perucca E. Advocacy for children with epilepsy: Leveraging the WHA resolution. Advocacy Task Force, Commission of Pediatrics, International League Against Epilepsy. Epilepsia Open 2018; 3:167-174. [PMID: 29881796 PMCID: PMC5983105 DOI: 10.1002/epi4.12220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 12/24/2022] Open
Abstract
In May 2015 the World Health Assembly (WHA) approved the Resolution on the Global Burden of Epilepsy. This report addresses how the Resolution can be leveraged to improve the care of children with epilepsy worldwide. Children with epilepsy have unique needs and face unique challenges from stigma at all levels of society. Children lack a voice to lobby for their own needs, including their right to have access to education. Effective leadership and governance should be enhanced through the support of stakeholders empowered to counsel, advise, and lobby for appropriate care. National health care plans should integrate primary and specialist care, and they need to be adapted to local specificities. Antiepileptic medicines should be widely accessible in appropriate, sustained, and affordable ways. Public awareness initiatives are needed to improve the inclusion of affected children in society and to reduce stigma. Cost-effective interventions are also needed to address preventable causes of epilepsy. Without greater investment in research, evidence-based interventions cannot be implemented. Through all of this, civil society must be engaged to ensure that the multivariate dimensions from the clinic to the community are addressed to fulfil the needs of children with epilepsy.
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Affiliation(s)
- Jo M Wilmshurst
- Department of Paediatric Neurology Red Cross War Memorial Children's Hospital Neuroscience Institute, University of Cape Town Cape Town South Africa
| | - Alla Guekht
- Department of Neurology, Neurosurgery and Genetics Russian National Research Medical University and Moscow Research and Clinical Center for Neuropsychiatry Moscow Russia
| | - Mary Secco
- Epilepsy Southwestern Ontario Western University International Bureau for Epilepsy London Ontario Canada
| | - J Helen Cross
- Developmental Neurosciences Programme UCl Great Ormond Street Institute of Child health London U.K.,Young Epilepsy Lingfield U.K
| | - Emilio Perucca
- Department of Internal Medicine and Therapeutics University of Pavia Pavia Italy.,Clinical Trial Center C. Mondino National Neurological Institute Pavia Italy
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Xia L, Ou S, Pan S. Initial Response to Antiepileptic Drugs in Patients with Newly Diagnosed Epilepsy As a Predictor of Long-term Outcome. Front Neurol 2017; 8:658. [PMID: 29276500 PMCID: PMC5727350 DOI: 10.3389/fneur.2017.00658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 11/22/2017] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate the correlation between initial response to antiepileptic drugs (AEDs) and long-term outcomes after 3 years in patients with newly diagnosed epilepsy. Methods This prospective study included 204 patients with newly diagnosed epilepsy, who were followed-up for at least 36 months. The long-term seizure freedom at 36 months (36MSF) was evaluated in patients with seizure freedom 6 months (6MSF) or 12 months (12MSF) after initial treatment vs those with no seizure freedom after the initial 6 months (6MNSF) or 12 months (12MNSF). Univariate analysis and a multiple logistic regression model were used to analyze the association of potential confounding variables with the initial response to AEDs. Results The number of patients with 36MSF was significantly higher for patients that had 6MSF (94/131, 71.8%) than those that had 6MNSF [16/73, 21.9%; χ2 = 46.862, p < 0.0001, odd ratio (OR) = 9.051]. The number of patients with 36MSF was significantly higher in patients that had 12MSF (94/118 79.7%) than those that had 12MNSF (19/86, 22.1%; χ2 = 66.720, p < 0.0001, OR = 13.811). The numbers of patients that had 36MSF were not significantly different between patients that experienced 6MSF and 12MSF or between patients that had 6MNSF and 12MNSF. Abnormalities observed in magnetic resonance imaging or computed tomography and the number of seizures before treatment correlated with poor initial 6-month response to AEDs. Significance The initial 6-month response to AEDs is a valuable predictor of long-term response in patients with newly diagnosed epilepsy. The number of seizures before treatment and brain-imaging abnormalities are two prognostic predictors of initial 6-month seizure freedom.
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Affiliation(s)
- Lu Xia
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuchun Ou
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Songqing Pan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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Jiang YL, Yuan F, Yang F, Sun XL, Yang XA, Song L, Jiang W. Prognostic analysis for short - and long-term outcomes of newly diagnosed epilepsy. Seizure 2017; 47:92-98. [DOI: 10.1016/j.seizure.2017.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/28/2022] Open
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Elafros MA, Bui E, Birbeck GL. Medication side effects among people with epilepsy taking phenobarbital in Zambia. Epilepsy Res 2014; 108:1680-4. [PMID: 25219354 DOI: 10.1016/j.eplepsyres.2014.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/14/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
Phenobarbital remains one of the most widely used antiepileptic drugs worldwide, yet there are limited data regarding side effects associated with its use in routine clinical care settings in low-income countries. Available data suggests that phenobarbital is as effective as other first-line drugs for treating tonic-clonic seizures, but side effect reports differ widely between high and low-income settings. A better understanding of phenobarbital side effect profile and severity in low-income settings is warranted given its role in efforts to decrease the epilepsy treatment gap. We used the Liverpool adverse events profile (LEAP) to assess side effects in consecutive patients with epilepsy on phenobarbital seeking care in rural Zambia. Data regarding age, gender, medication dose, and medication adherence were also collected. T-tests and Spearman's correlation coefficient were used to assess predictors of LEAP score and medication adherence. Thirty-five patients receiving a mean dose of 2.1mg/kg/day (SD: 2.78 mg/kg/day) of phenobarbital were assessed. All participants reported at least one side effect in the previous four weeks with a median of 6 symptoms (IQR: 4-8) and a mean side effects score of 28/76 (SD: 5.38). Over half reported sleepiness and dizziness. Memory problems and depression were also common (both 46%). Total LAEP score was not associated with age (p=0.88), gender (p=0.17), or phenobarbital dose (p=0.13). Medication adherence was not associated with side effects total score (p=0.56). Rural Zambian adults taking phenobarbital at doses recommended by the World Health Organization report a significant number of side effects. The most common side effects reported were similar to those reported in high-income countries. The significant burden of phenobarbital-associated side effects in this African cohort is in contrast to data from non-randomized clinical trials in China that reported phenobarbital to be well-tolerated with few side effects. Additional investigations regarding phenobarbital side effects during routine care in low income settings is warranted.
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Affiliation(s)
- Melissa A Elafros
- Michigan State University, International Neurologic & Psychiatric Epidemiology Program (INPEP), East Lansing, MI, USA; Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Esther Bui
- Sunnybrook Health Sciences Centre, Department of Medicine, Toronto, Ontario, Canada
| | - Gretchen L Birbeck
- Chikankata Hospital, Epilepsy Care Team, Mazabuka, Zambia; University of Rochester, Department of Neurology, Epilepsy Division, Rochester, NY, USA; University of Rochester, Department of Public Health, Rochester, NY, USA.
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Anti-epileptic effect of Ganoderma lucidum polysaccharides by inhibition of intracellular calcium accumulation and stimulation of expression of CaMKII α in epileptic hippocampal neurons. PLoS One 2014; 9:e102161. [PMID: 25010576 PMCID: PMC4092074 DOI: 10.1371/journal.pone.0102161] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 06/15/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the mechanism of the anti-epileptic effect of Ganoderma lucidum polysaccharides (GLP), the changes of intracellular calcium and CaMK II α expression in a model of epileptic neurons were investigated. Method Primary hippocampal neurons were divided into: 1) Control group, neurons were cultured with Neurobasal medium, for 3 hours; 2) Model group I: neurons were incubated with Mg2+ free medium for 3 hours; 3) Model group II: neurons were incubated with Mg2+ free medium for 3 hours then cultured with the normal medium for a further 3 hours; 4) GLP group I: neurons were incubated with Mg2+ free medium containing GLP (0.375 mg/ml) for 3 hours; 5) GLP group II: neurons were incubated with Mg2+ free medium for 3 hours then cultured with a normal culture medium containing GLP for a further 3 hours. The CaMK II α protein expression was assessed by Western-blot. Ca2+ turnover in neurons was assessed using Fluo-3/AM which was added into the replacement medium and Ca2+ turnover was observed under a laser scanning confocal microscope. Results The CaMK II α expression in the model groups was less than in the control groups, however, in the GLP groups, it was higher than that observed in the model group. Ca2+ fluorescence intensity in GLP group I was significantly lower than that in model group I after 30 seconds, while in GLP group II, it was reduced significantly compared to model group II after 5 minutes. Conclusion GLP may inhibit calcium overload and promote CaMK II α expression to protect epileptic neurons.
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Wilmshurst JM, Kakooza-Mwesige A, Newton CR. The challenges of managing children with epilepsy in Africa. Semin Pediatr Neurol 2014; 21:36-41. [PMID: 24655403 PMCID: PMC5496661 DOI: 10.1016/j.spen.2014.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Children with epilepsy who reside in the African continent are faced with some of the greatest challenges of receiving adequate care. The burden of disease is exacerbated by the high incidence of acquired causes and the large treatment gap. Skilled teams to identify and care for children with epilepsy are lacking. Many patients are managed through psychiatric services, thus potentially compounding the stigma associated with the condition. Little data exist to assess the true proportion of comorbidities suffered by children with epilepsy, the assumption is that this is high, further aggravated by delayed interventions and adverse responses to some of the more commonly used antiepileptic drugs.
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Affiliation(s)
- Jo M Wilmshurst
- Department of Pediatric Neurology, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
| | - Angelina Kakooza-Mwesige
- Department of Pediatrics and Child Health, Mulago Hospital/College of Health Sciences, Makere University, Kampala, Uganda
| | - Charles R Newton
- Centre for Geographic Medicine Research-Coast, Kenya Medical Research, Institute and Wellcome Trust Research Programme, Kilifi, Kenya; Neurosciences Unit, UCL-Institute of Child Health, London, United Kingdom; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Shorvon SD, Goodridge DMG. Longitudinal cohort studies of the prognosis of epilepsy: contribution of the National General Practice Study of Epilepsy and other studies. Brain 2013; 136:3497-510. [DOI: 10.1093/brain/awt223] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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