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Shiraishi H, Teramoto T, Yokoshiki S, Tohyama J, Ueda Y, Egawa K, Sato N, Manabe A, Kato M. Efficacy of sirolimus for epileptic seizures in childhood associated with focal cortical dysplasia type II. Brain Dev 2023; 45:343-347. [PMID: 36870920 DOI: 10.1016/j.braindev.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE The efficacy of the mechanistic target of rapamycin inhibitor, sirolimus, was recently reported for patients more than 6 years of age by Kato et al. We evaluated the efficacy and safety of sirolimus in a 2-year-old patient with recurrent focal seizures with impaired consciousness after focal cortical dysplasia (FCD) type IIa resection. METHODS The patient was a 2-year-old girl who had recurrent seizures after undergoing FCD resection at 4 months of age. The initial dose of sirolimus was 0.5 mg/day and was gradually increased using the trough blood concentration before oral administration as an index, and evaluation was performed at 92 weeks. RESULTS The trough blood level of sirolimus was increased to 6.1 ng/mL and maintenance therapy was started at 40 weeks. Focal seizures with impairment of consciousness with tonic extension of the limbs decreased. No critically serious adverse events occurred. CONCLUSION Sirolimus was effective against epileptic seizures from FCD type II even for a child under 5 years of age. There were no critically serious adverse events and administration could be continued.
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Affiliation(s)
- Hideaki Shiraishi
- Department of Pediatrics, Hokkaido University Hospital, Hokkaido 060-8648, Japan.
| | - Tsuyoshi Teramoto
- Hokkaido University Hospital Clinical Research and Medical Innovation Center, Research and Development Division, Hokkaido 060-8648, Japan; University of Toyama Hospital, Center for Clinical Research, Toyama 930-0194, Japan
| | - Saki Yokoshiki
- Hokkaido University Hospital Clinical Research and Medical Innovation Center, Research and Development Division, Hokkaido 060-8648, Japan
| | - Jun Tohyama
- Department of Child Neurology, National Hospital Organization Nishi-Niigata Chuo National Hospital, Niigata 950-2085, Japan
| | - Yuki Ueda
- Department of Pediatrics, Hokkaido University Hospital, Hokkaido 060-8648, Japan
| | - Kiyoshi Egawa
- Department of Pediatrics, Hokkaido University Hospital, Hokkaido 060-8648, Japan
| | - Norihiro Sato
- Hokkaido University Hospital Clinical Research and Medical Innovation Center, Research and Development Division, Hokkaido 060-8648, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University Hospital, Hokkaido 060-8648, Japan
| | - Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Tokyo 142-8555, Japan.
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Kato M, Kada A, Shiraishi H, Tohyama J, Nakagawa E, Takahashi Y, Akiyama T, Kakita A, Miyake N, Fujita A, Saito AM, Inoue Y. Sirolimus for epileptic seizures associated with focal cortical dysplasia type II. Ann Clin Transl Neurol 2022; 9:181-192. [PMID: 35040598 PMCID: PMC8862414 DOI: 10.1002/acn3.51505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 01/16/2023] Open
Abstract
Objective To determine whether sirolimus, a mechanistic target of rapamycin (mTOR) inhibitor, reduces epileptic seizures associated with focal cortical dysplasia (FCD) type II. Methods Sixteen patients (aged 6–57 years) with FCD type II received sirolimus at an initial dose of 1 or 2 mg/day based on body weight (FCDS‐01). In 15 patients, the dose was adjusted to achieve target trough ranges of 5–15 ng/mL, followed by a 12‐week maintenance therapy period. The primary endpoint was a lower focal seizure frequency during the maintenance therapy period. Further, we also conducted a prospective cohort study (RES‐FCD) in which 60 patients with FCD type II were included as an external control group. Results The focal seizure frequency reduced by 25% in all patients during the maintenance therapy period and by a median value of 17%, 28%, and 23% during the 1–4‐, 5–8‐, and 9–12‐week periods. The response rate was 33%. The focal seizure frequency in the external control group reduced by 0.5%. However, the background characteristics of external and sirolimus‐treated groups differed. Adverse events were consistent with those of mTOR inhibitors reported previously. The blood KL‐6 level was elevated over time. Interpretation The reduction of focal seizures did not meet the predetermined level of statistical significance. The safety profile of the drug was tolerable. The potential for a reduction of focal seizures over time merit further investigations.
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Affiliation(s)
- Mitsuhiro Kato
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Akiko Kada
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hideaki Shiraishi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Jun Tohyama
- Department of Child Neurology, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yukitoshi Takahashi
- National Hospital Organization, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Noriko Miyake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Human Genetics, Research Institute National Center for Global Health and Medicine, Tokyo, Japan
| | - Atsushi Fujita
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Akiko M Saito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yushi Inoue
- National Hospital Organization, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
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