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Rajakulendran S, Belluzzo M, Novy J, Sisodiya SM, Koepp MJ, Duncan JS, Sander JW. Late-life terminal seizure freedom in drug-resistant epilepsy: "Burned-out epilepsy". J Neurol Sci 2021; 431:120043. [PMID: 34753039 DOI: 10.1016/j.jns.2021.120043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 02/05/2023]
Abstract
The course of established epilepsy in late life is not fully known. One key question is whether the resolution of an epileptic diathesis is a natural outcome in some people with long-standing epilepsy. We investigated this with a view to generating a hypothesis. We retrospectively explored whether terminal seizure-freedom occurs in older people with previous drug-resistant epilepsy at the Chalfont Centre for Epilepsy over twenty years. Of the 226 people followed for a median period of 52 years, 39 (17%) achieved late-life terminal seizure-freedom of at least two years before death, which occurred at a median age of 68 years with a median duration of 7 years. Multivariate analysis suggests that a high initial seizure frequency was a negative predictor (p < 0.0005). Our findings indicate that the 'natural' course of long-standing epilepsy in some people is one of terminal seizure freedom. We also consider the concept of "remission" in epilepsy, its definition challenges, and the evolving terminology used to describe the state of seizure freedom. The intersection of ageing and seizure freedom is an essential avenue of future investigation, especially in light of current demographic trends. Gaining mechanistic insights into this phenomenon may help broaden our understanding of the neurobiology of epilepsy and potentially provide targets for therapeutic intervention.
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Affiliation(s)
- S Rajakulendran
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - M Belluzzo
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Department of Clinical Neurosciences, Neurology Unit, Santa Maria della Misericordia Hospital, Udine 33100, Italy
| | - J Novy
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital (Vaud University Hospital Center) and University of Lausanne, Lausanne, Switzerland
| | - S M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - M J Koepp
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - J S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
| | - J W Sander
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, Heemstede 2103SW, Netherlands; Department of Neurology, West China Hospital & Institute of Brain Science & Brain-inspired Technology, Sichuan University, Chengdu 610041, China.
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Thorpe J, Ashby S, Cross JH, Sander JW, Newton C, Hanna J, Sen A. The impact of COVID-19 on epilepsy care: Perspectives from UK healthcare workers. Epilepsy Behav Rep 2021; 16:100487. [PMID: 34697604 PMCID: PMC8527891 DOI: 10.1016/j.ebr.2021.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022] Open
Abstract
We surveyed UK healthcare workers (HCWs) involved in the care of people with epilepsy. During the pandemic, 70% of respondents held most consultations remotely. HCWs experienced increased mental strain and concern for colleagues/family members. HCWs reported being less confident in diagnosing epilepsy remotely. Clinicians were more reluctant to withdraw seizure medications during the pandemic.
The COVID-19 pandemic has created an immense pressure on healthcare providers, resulting in a shift to remote consultations and the redeployment of healthcare workers (HCWs). We present survey data from the United Kingdom (UK) HCWs to outline how changes in healthcare provision impact clinicians' wellbeing and ability to provide adequate care. We designed an online survey to gather the experiences of HCWs providing care to people with epilepsy. We received seventy-nine responses from UK-based HCWs, of whom 43% reported an impact on their mental health. Changes to service delivery have resulted in 71% of clinicians performing > 75% of their consultations remotely. Diagnosing and treating epilepsy has changed, with a fifth of respondents being significantly less confident in diagnosing epilepsy. Ultimately, these results show that COVID-19 has had an overall negative impact on HCWs and their ability to provide epilepsy care. These results must be considered when reorganizing health services to ensure optimal outcomes for people with epilepsy.
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Affiliation(s)
- J Thorpe
- SUDEP Action, 18 Newbury Street, Wantage OX12 8DA, UK.,Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - S Ashby
- SUDEP Action, 18 Newbury Street, Wantage OX12 8DA, UK
| | - J H Cross
- UCL NIHR BRC Great Ormond Street Institute of Child Health, London, UK.,Young Epilepsy, St Pier's Lane, Dormansland, Lingfield RH7 6P, UK
| | - J W Sander
- UCL Queen Square Institute of Neurology, Queen Square, London WC1N 3BG, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
| | - C Newton
- SUDEP Action, 18 Newbury Street, Wantage OX12 8DA, UK.,University Department of Psychiatry, University of Oxford, UK
| | - J Hanna
- SUDEP Action, 18 Newbury Street, Wantage OX12 8DA, UK
| | - A Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Wang F, Chen Z, Davagnanam I, Hoskote C, Ding D, Wang W, Yang B, Wang Y, Wang T, Li W, Sander JW, Kwan P. Comparing two classification schemes for seizures and epilepsy in rural China. Eur J Neurol 2018; 26:422-427. [PMID: 30414301 DOI: 10.1111/ene.13857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/05/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The International League against Epilepsy (ILAE) updated the classifications of seizures and epilepsies in 2017. The 2017 classifications were compared with the 1980s classifications in rural China. METHODS People with epilepsy receiving treatment under the National Epilepsy Control Programme were recruited from rural areas in China. Their seizures and epileptic syndrome were classified using the 1980s ILAE classification system and then re-classified according to the 2017 system. Differences in seizure, epilepsy and aetiology classifications were identified. RESULTS A total of 597 individuals (58% males, aged 6-78 years) were included. Amongst them 535 (90%) had a single seizure type, 57 (9.55%) had two types and five (0.84%) had three. There was complete agreement between the 1981 and 2017 classifications for the 525 individuals with focal seizures. Seizures originally classified as generalized in 10 of 65 individuals were re-classified as unknown in the 2017 classification. Compared to the 1980s classifications, the proportion of individuals with unknown seizures and unknown epilepsy increased from 1.2% (7/597) to 2.8% (17/597, P = 0.002), and unknown aetiology increased from 32% (189/597: 182 cryptogenic and seven unclassified) to 39% (230/597; P < 0.001) in the 2017 classifications. CONCLUSIONS The 1980s and 2017 classifications had 100% agreement in classifying focal seizures and epilepsy in rural China. A small but significant proportion of generalized seizures and epilepsy and aetiologies classified in the old classifications were re-classified to unknown in the new classifications. These results highlight the need for improvement in clinical evaluation of people with epilepsy in resource-poor settings.
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Affiliation(s)
- F Wang
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Z Chen
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - I Davagnanam
- Academic Department of Neuroradiology, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
| | - C Hoskote
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - D Ding
- Fudan University, Shanghai, China
| | - W Wang
- Beijing Neurosurgical Institute, Beijing, China
| | - B Yang
- Jiaozuo People's Hospital, Henan, China
| | - Y Wang
- Ningxia Medical University, Ningxia, China
| | - T Wang
- Jincheng Emergency Medical Rescue Center, Jincheng, China
| | - W Li
- Affiliated Second Hospital, Hebei Medical University, Hebei, China
| | - J W Sander
- NIHR University College London Hospitals, Biomedical Research Centre, UCL Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - P Kwan
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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4
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Stevelink R, Koeleman BPC, Sander JW, Jansen FE, Braun KPJ. Refractory juvenile myoclonic epilepsy: a meta-analysis of prevalence and risk factors. Eur J Neurol 2018; 26:856-864. [PMID: 30223294 PMCID: PMC6586162 DOI: 10.1111/ene.13811] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/12/2018] [Indexed: 01/12/2023]
Abstract
Background and purpose Juvenile myoclonic epilepsy (JME) is a common epilepsy syndrome for which treatment response is generally assumed to be good. We aimed to determine the prevalence and prognostic risk factors for refractoriness of JME. Methods We systematically searched PubMed and EMBASE and included 43 eligible studies, reporting seizure outcome after antiepileptic drug (AED) treatment in JME cohorts. We defined refractory JME as persistence of any seizure despite AED treatment and performed a random‐effects meta‐analysis to assess the prevalence of refractory JME and of seizure recurrence after AED withdrawal in individuals with well‐controlled seizures. Studies reporting potential prognostic risk factors in relation to seizure outcome were included for subsequent meta‐analysis of risk factors for refractoriness. Results Overall, 35% (95% confidence interval, 29–41%) of individuals (n = 3311) were refractory. There was marked heterogeneity between studies. Seizures recurred in 78% (95% confidence interval, 52–94%) of individuals who attempted to withdraw from treatment after a period of seizure freedom (n = 246). Seizure outcome by publication year suggested that prognosis did not improve over time. Meta‐analysis suggested six variables as prognostic factors for refractoriness, i.e. having three seizure types, absence seizures, psychiatric comorbidities, earlier age at seizure onset, history of childhood absence epilepsy and praxis‐induced seizures. Conclusion One‐third of people with JME were refractory, which is a higher prevalence than expected. Risk factors were identified and can be used to guide treatment and counselling of people with JME.
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Affiliation(s)
- R Stevelink
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht.,Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht
| | - B P C Koeleman
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht
| | - J W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.,UCL Institute of Neurology, NIHR University College London Hospitals Biomedical Research Centre, London.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK
| | - F E Jansen
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht
| | - K P J Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht
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5
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Shankar R, Henley W, Boland C, Laugharne R, McLean BN, Newman C, Hanna J, Ashby S, Walker MC, Sander JW. Decreasing the risk of sudden unexpected death in epilepsy: structured communication of risk factors for premature mortality in people with epilepsy. Eur J Neurol 2018; 25:1121-1127. [PMID: 29611888 DOI: 10.1111/ene.13651] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Good practice guidelines highlight the importance of making people with epilepsy aware of the risk of premature mortality in epilepsy particularly due to sudden unexpected death in epilepsy (SUDEP). The SUDEP and Seizure Safety Checklist ('Checklist') is a structured risk communication tool used in UK clinics. It is not known if sharing structured information on risk factors allows individuals to reduce SUDEP and premature mortality risks. The aim of this study was to ascertain if the introduction of the Checklist in epilepsy clinics led to individual risk reduction. METHODS The Checklist was administered to 130 consecutive people with epilepsy attending a specialized epilepsy neurology clinic and 129 attending an epilepsy intellectual disability (ID) clinic within a 4-month period. At baseline, no attendees at the neurology clinic had received formal risk advice, whereas all those attending the ID clinic had received formal risk advice on multiple occasions for 6 years. The Checklist was readministered 1 year later to each group and scores were compared with baseline and between groups. RESULTS Of 12 risk factors considered, there was an overall reduction in mean risk score for the general (P = 0.0049) but not for the ID (P = 0.322) population. Subanalysis of the 25% of people at most risk in both populations showed that both sets had a significant reduction in risk scores (P < 0.001). CONCLUSION Structured discussion results in behavioural change that reduces individual risk factors. This impact seems to be higher in those who are at current higher risk. It is important that clinicians share risk information with individuals as a matter of public health and health promotion.
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Affiliation(s)
- R Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - W Henley
- Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | - C Boland
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - R Laugharne
- Cornwall Partnership NHS Foundation Trust, Truro, UK.,Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, UK
| | | | - C Newman
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | | | - M C Walker
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK
| | - J W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, Buckinghamshire, UK.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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6
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Affiliation(s)
- M O'Donoghue
- Epilepsy Research Group, Institute of Neurology, London, England
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7
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Abstract
Non-convulsive status epilepticus may present as confusion, behavioural disturbances and psychiatric conditions. We present the case of a 17-year-old man who had episodes of non-convulsive status epilepticus as his only manifestation of epilepsy which was mis-diagnosed as a psychiatric condition for over 10 years. He has had almost complete resolution of his symptoms with the introduction of carbamazepine. Non-convulsive status epilepticus is probably commoner than previously thought, and should be considered as a possible diagnosis in all patients presenting with prolonged episodes of altered consciousness even without other manifestations of epilepsy.
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Affiliation(s)
- M C Walker
- National Society for Epilepsy, Institute of Neurology, London, England
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8
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Wassenaar M, Leijten FSS, de Haan GJ, Uijl SG, Sander JW. Electro-clinical criteria and surgical outcome: Is there a difference between mesial and lesional temporal lobe epilepsy? Acta Neurol Scand 2017. [PMID: 28626979 DOI: 10.1111/ane.12790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Mesial temporal lobe epilepsy syndrome (MTLE) with specific electrophysiological and clinical characteristics and hippocampal sclerosis (HS) on MRI is considered the prototype of a syndrome with good surgical prognosis. Ictal onset zones in MTLE have been found to extend outside the hippocampus and neocortical seizures often involve mesial structures. It can, thus, be questioned whether MTLE with HS is different from lesional temporal epilepsies with respect to electro-clinical characteristics and surgical prognosis. We assessed whether MTLE with HS is distinguishable from lesional TLE and which criteria determine surgical outcome. METHODS People in a retrospective cohort of 389 individuals with MRI abnormalities who underwent temporal lobectomy, were divided into "HS only" or "lesional" TLEs. Twenty-six presented with dual pathology and were excluded from further analysis. We compared surgical outcome and electro-clinical characteristics. RESULTS Over half (61%) had "HS only." Four electro-clinical characteristics (age at epilepsy onset, febrile seizures, memory dysfunction and contralateral dystonic posturing) distinguished "HS only" from "lesional" TLE, but there was considerable overlap. Seizure freedom 2 years after surgery (Engel class 1) was similar: 67% ("HS only") vs 69% ("lesional" TLE). Neither presence of HS nor electro-clinical criteria was associated with surgical outcome. CONCLUSIONS Despite small differences in electrophysiological and clinical characteristics between MTLE with HS and lesional TLE, surgical outcomes are similar, indicating that aetiology seems irrelevant in the referral for temporal surgery.
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Affiliation(s)
- M. Wassenaar
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
- Department of Neurology and Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - F. S. S. Leijten
- Department of Neurology and Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - G.-J. de Haan
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
| | - S. G. Uijl
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht The Netherlands
| | - J. W. Sander
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
- NIHR University College London Hospitals; Biomedical Research Centre; UCL Institute of Neurology; London UK
- Chalfont Centre for Epilepsy; Chalfont St Peter UK
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9
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Novy J, Bell GS, Peacock JL, Sisodiya SM, Sander JW. Epilepsy as a systemic condition: Link with somatic comorbidities. Acta Neurol Scand 2017; 136:352-359. [PMID: 28573736 DOI: 10.1111/ane.12779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND People with epilepsy have more concomitant medical conditions than the general population; these comorbidities play an important role in premature mortality. We sought to generate explanatory hypotheses about the co-occurrence of somatic comorbidities and epilepsy, avoiding causal and treatment-resultant biases. METHODS We collected clinical, demographic and somatic comorbidity data for 2016 consecutive adults with epilepsy undergoing assessment at a tertiary centre and in 1278 people with epilepsy in the community. Underlying causes of epilepsy were not classed as comorbidities. RESULTS Somatic comorbidities were more frequent in the referral centre (49%) where people more frequently had active epilepsy than in the community (36%). Consistent risk factors for comorbidities were found in both cohorts. Using multivariable ordinal regression adjusted for age, longer epilepsy duration and an underlying brain lesion were independently associated with a smaller burden of somatic conditions. The treatment burden, measured by the number of drugs to which people were exposed, was not an independent predictor. Shorter epilepsy duration was a predictor for conditions that conceivably harbour significant mortality risks. CONCLUSIONS Somatic comorbidities do not occur randomly in relation to epilepsy; having more severe epilepsy seems to be a risk factor. Independently from age, the early period after epilepsy onset appears to be at particular risk, although it is not clear whether this relates to an early mortality or to a later decrease in the burden of comorbidities. These results suggest that, for some people, epilepsy should be considered a systemic condition not limited to the CNS.
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Affiliation(s)
- J. Novy
- Department of Clinical and Experimental Epilepsy; UCL Institute of Neurology; National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre; Queen Square London
- Chalfont Centre for Epilepsy; Chalfont St Peter UK
- Department of Clinical Neurosciences; Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne; Lausanne Switzerland
| | - G. S. Bell
- Department of Clinical and Experimental Epilepsy; UCL Institute of Neurology; National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre; Queen Square London
- Chalfont Centre for Epilepsy; Chalfont St Peter UK
| | - J. L. Peacock
- National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas’ NHS Foundation Trust and King's College London; London UK
- Division of Health and Social Care Research; King's College London; London UK
| | - S. M. Sisodiya
- Department of Clinical and Experimental Epilepsy; UCL Institute of Neurology; National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre; Queen Square London
- Chalfont Centre for Epilepsy; Chalfont St Peter UK
| | - J. W. Sander
- Department of Clinical and Experimental Epilepsy; UCL Institute of Neurology; National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre; Queen Square London
- Chalfont Centre for Epilepsy; Chalfont St Peter UK
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
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10
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Berghuis B, de Haan GJ, van den Broek MPH, Sander JW, Lindhout D, Koeleman BPC. Epidemiology, pathophysiology and putative genetic basis of carbamazepine- and oxcarbazepine-induced hyponatremia. Eur J Neurol 2016; 23:1393-9. [PMID: 27333872 DOI: 10.1111/ene.13069] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/13/2016] [Indexed: 12/13/2022]
Abstract
The use of carbamazepine (CBZ) and oxcarbazepine (OXC) as first-line antiepileptic drugs in the treatment of focal epilepsy is limited by hyponatremia, a known adverse effect. Hyponatremia occurs in up to half of people taking CBZ or OXC and, although often assumed to be asymptomatic, it can lead to symptoms ranging from unsteadiness and mild confusion to seizures and coma. Hyponatremia is probably due to the antidiuretic properties of CBZ and OXC that are, at least partly, explained by stimulation of the vasopressin 2 receptor/aquaporin 2 pathway. No known genetic risk variants for CBZ- and OXC-induced hyponatremia exist, but likely candidate genes are part of the vasopressin water reabsorption pathway.
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Affiliation(s)
- B Berghuis
- Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands
| | - G-J de Haan
- Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands
| | - M P H van den Broek
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands.,UCL Institute of Neurology, NIHR UCL Hospitals Biomedical Research Centre, London, UK
| | - D Lindhout
- Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, The Netherlands.,Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B P C Koeleman
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
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11
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Wassenaar M, Leijten FSS, Sander JW, Uijl SG, Egberts ACG. Anti-epileptic drug changes and quality of life in the community. Acta Neurol Scand 2016; 133:421-6. [PMID: 26370534 DOI: 10.1111/ane.12478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Changes in anti-epileptic drug (AED) regimens may indicate unsatisfactory treatment results such as insufficient seizure control or adverse effects. This inference underlies epilepsy management and research, yet current studies often do not account for AED changes. We assessed AED change patterns and their association with quality of life (QoL), as main outcome measure, in a community-based setting. METHODS We assessed a cohort of 248 people with epilepsy identified from community pharmacy records from whom we retrieved AED dispensing history. We assessed all changes in AED use during the 2 years prior to the index date and current QoL using the validated Dutch QOLIE-31 questionnaire. RESULTS Thirty-one per cent had at least one AED change during the study period, either in drug type or dose. People who changed showed significantly lower QoL (QOLIE score 73 vs 79), especially those who intensified their treatment. Each additional change was associated with a further reduction of 4.9 points in QoL score. CONCLUSIONS AED changes are common practice, even in people with long-standing epilepsy. Frequent changes, as objective measure of epilepsy severity, are associated with a progressively lower QoL. Changes, even in dose, should be monitored in daily clinical practice and used as a red flag that may require adjustments in epilepsy management. This may include earlier referral to a specialized centre for a more thorough evaluation or counselling. AED changes can also be used as an outcome marker in epilepsy research as a proxy of QoL for better translation of drug-efficacy results to general practice.
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Affiliation(s)
- M. Wassenaar
- Stichting Epilepsie Instellingen Nederland (SEIN) Heemstede; Heemstede Netherlands
- Department of Neurology and Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht Netherlands
| | - F. S. S. Leijten
- Department of Neurology and Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht Netherlands
| | - J. W. Sander
- Stichting Epilepsie Instellingen Nederland (SEIN) Heemstede; Heemstede Netherlands
- Biomedical Research Centre; UCL Institute of Neurology; NIHR University College London Hospitals; London UK
- Epilepsy Society; Chalfont St Peter UK
| | - S. G. Uijl
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht Netherlands
| | - A. C. G. Egberts
- Department of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences; Utrecht University; Utrecht Netherlands
- Department of Clinical Pharmacy; University Medical Center Utrecht; Utrecht Netherlands
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12
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Giussani G, Canelli V, Bianchi E, Erba G, Franchi C, Nobili A, Sander JW, Beghi E. Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study. Eur J Neurol 2016; 23:1218-27. [DOI: 10.1111/ene.13005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- G. Giussani
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - V. Canelli
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - E. Bianchi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - G. Erba
- Department of Neurology; SEC, University of Rochester; Rochester NY USA
| | - C. Franchi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - A. Nobili
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - J. W. Sander
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; London UK
| | - E. Beghi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
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Doran Z, Shankar R, Keezer MR, Dale C, McLean B, Kerr MP, Devapriam J, Craig J, Sander JW. Managing anti-epileptic drug treatment in adult patients with intellectual disability: a serious conundrum. Eur J Neurol 2016; 23:1152-7. [DOI: 10.1111/ene.13016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Z. Doran
- Cornwall Partnership NHS Foundation Trust; Cornwall UK
| | - R. Shankar
- Cornwall Partnership NHS Foundation Trust; Cornwall UK
- Exeter Medical School; Truro UK
| | - M. R. Keezer
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; London UK
| | - C. Dale
- Cornwall Partnership NHS Foundation Trust; Cornwall UK
| | | | | | - J. Devapriam
- Leicestershire Partnership NHS Trust; Leicester UK
| | - J. Craig
- Belfast Health and Social Care Trust; Belfast UK
| | - J. W. Sander
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; London UK
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
- Epilepsy Society; Chalfont St Peter Buckinghamshire UK
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Lamberts RJ, Blom MT, Novy J, Belluzzo M, Seldenrijk A, Penninx BW, Sander JW, Tan HL, Thijs RD. Increased prevalence of ECG markers for sudden cardiac arrest in refractory epilepsy. J Neurol Neurosurg Psychiatry 2015; 86:309-13. [PMID: 24946773 PMCID: PMC4345521 DOI: 10.1136/jnnp-2014-307772] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIM People with epilepsy are at increased risk of sudden cardiac arrest (SCA) due to ECG-confirmed ventricular tachycardia/fibrillation, as seen in a community-based study. We aimed to determine whether ECG-risk markers of SCA are more prevalent in people with epilepsy. METHODS In a cross-sectional, retrospective study, we analysed the ECG recordings of 185 people with refractory epilepsy and 178 controls without epilepsy. Data on epilepsy characteristics, cardiac comorbidity, and drug use were collected, and general ECG variables (heart rate (HR), PQ and QRS intervals) assessed. We analysed ECGs for three markers of SCA risk: severe QTc prolongation (male >450 ms, female >470 ms), Brugada ECG pattern, and early repolarisation pattern (ERP). Multivariate regression models were used to analyse differences between groups, and to identify associated clinical and epilepsy-related characteristics. RESULTS People with epilepsy had higher HR (71 vs 62 bpm, p<0.001) and a longer PQ interval (162.8 vs 152.6 ms, p=0.001). Severe QTc prolongation and ERP were more prevalent in people with epilepsy (QTc prolongation: 5% vs 0%; p=0.002; ERP: 34% vs 13%, p<0.001), while the Brugada ECG pattern was equally frequent in both groups (2% vs 1%, p>0.999). After adjustment for covariates, epilepsy remained associated with ERP (ORadj 2.4, 95% CI 1.1 to 5.5) and severe QTc prolongation (ORadj 9.9, 95% CI 1.1 to 1317.7). CONCLUSIONS ERP and severe QTc prolongation appear to be more prevalent in people with refractory epilepsy. Future studies must determine whether this contributes to increased SCA risk in people with epilepsy.
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Affiliation(s)
- R J Lamberts
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - M T Blom
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - J Novy
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK
| | - M Belluzzo
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK Neurology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Trieste, Italy
| | - A Seldenrijk
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - B W Penninx
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - J W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK
| | - H L Tan
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - R D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK LUMC Leiden University Medical Center, Leiden, The Netherlands
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15
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Keezer MR, Bauer PR, Ferrari MD, Sander JW. The comorbid relationship between migraine and epilepsy: a systematic review and meta-analysis. Eur J Neurol 2014; 22:1038-47. [DOI: 10.1111/ene.12612] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/07/2014] [Indexed: 01/13/2023]
Affiliation(s)
- M. R. Keezer
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; Queen Square; London UK
| | - P. R. Bauer
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
| | - M. D. Ferrari
- Department of Neurology; Leiden University Medical Centre; Leiden The Netherlands
| | - J. W. Sander
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; Queen Square; London UK
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
- Epilepsy Society; Chalfont St Peter UK
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Wegner I, Wilhelm AJ, Lambrechts DAJE, Sander JW, Lindhout D. Effect of oral contraceptives on lamotrigine levels depends on comedication. Acta Neurol Scand 2014; 129:393-8. [PMID: 24571554 DOI: 10.1111/ane.12197] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate prospectively the influence of cyclic oral contraceptive (OC) use on lamotrigine (LTG) serum levels when used in combination therapy. METHODS Women with epilepsy using LTG in combination with valproate (VPA; n=7), carbamazepine (CBZ; n=3) or oxcarbazepine (OXC; n=1) were evaluated during two periods of 28 days cyclic OC use, monitoring antiepileptic drug (AED) levels every other day with the dried blood spot sampling method. Results were compared with women on LTG monotherapy and OCs (n=12). Pharmacokinetic analysis was performed using NONMEM software. RESULTS Mean study population value of LTG clearance estimated by the final model was 3.17 l/h. Introduction of covariates for comedication (VPA, CBZ, OXC and OC) significantly reduced the between-subject variability. A significant influence of OC comedication on LTG clearance was seen in both LTG monotherapy (clearance with OC 4.02±0.38 l/h, OC-free week 3.03±0.39 l/h) and in LTG-CBZ combination (clearance with OC 4.95±0.15 l/h, OC-free week 4.15±0.26 l/h). No influence of OC was found in LTG-VPA combination (clearance with OC 0.99±0.16 l/h, OC-free week 0.90±0.15 l/h). CONCLUSIONS Adding OCs to LTG monotherapy or the combination LTG-CBZ significantly increased the LTG clearance and thus reduced LTG serum levels. In the combination LTG-CBZ, OCs had a non-significant effect on CBZ clearance. No significant influence of cyclic OC use on LTG or VPA clearance was found when these AEDs were used in combination.
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Affiliation(s)
- I. Wegner
- SEIN - Stichting Epilepsie Instellingen Nederland; Zwolle The Netherlands
- Department of Medical Genetics; University Medical Centre Utrecht; Utrecht The Netherlands
| | - A. J. Wilhelm
- Department of Clinical Pharmacology and Pharmacy; VU Medical Centre; Amsterdam The Netherlands
| | | | - J. W. Sander
- SEIN - Stichting Epilepsie Instellingen Nederland; Zwolle The Netherlands
- UCL Institute of Neurology; NIHR University College London Hospitals Biomedical Research Centre; London UK
| | - D. Lindhout
- SEIN - Stichting Epilepsie Instellingen Nederland; Zwolle The Netherlands
- Department of Medical Genetics; University Medical Centre Utrecht; Utrecht The Netherlands
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17
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Sethi NK, Lamberts RJ, Gaitatzis A, Sander JW, Elger CE, Surges R, Thijs RD. Postictal generalized EEG suppression: An inconsistent finding in people with multiple seizures. Neurology 2014; 82:1480. [DOI: 10.1212/wnl.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hong Z, Li W, Qu B, Zou X, Chen J, Sander JW, Zhou D. Serum brain-derived neurotrophic factor levels in epilepsy. Eur J Neurol 2013; 21:57-64. [PMID: 23879572 DOI: 10.1111/ene.12232] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 06/05/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE To clarify the utility of serum brain-derived neurotrophic factor (BDNF) as a biomarker for epilepsy diagnosis and severity. METHODS Serum BDNF levels in 135 consecutive people with epilepsy meeting our criteria were assessed. Controls were 34 healthy individuals who over 12 months or longer had no complaints or signs of a neurological disorder. Serum BDNF concentrations were measured using Luminex technology. RESULTS Gender, but not age, was found to be a significant factor related to serum BDNF levels in controls and people with epilepsy. Serum BDNF levels in people with epilepsy (mean 8798.5, SE 321.5 pg/ml) were not different from those of controls (mean 8919.5, SE 709.0 pg/ml). A multiple linear regression analysis, however, suggests that seizure frequency (P < 0.001) and epilepsy duration (P = 0.025) negatively correlate with serum BDNF levels independently of other factors. When BDNF cut-off values of 6260 pg/ml were used, the sensitivity for distinguishing people with daily or more frequent seizures from those with fewer seizures was 80% and specificity was 90%. CONCLUSIONS It seems that the concentration of BDNF in serum is associated with disease severity in people with epilepsy and may be a helpful marker for severity.
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Affiliation(s)
- Z Hong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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20
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Abstract
OBJECTIVES Based on reports of antitumour properties of sodium-valproate, we hypothesised that valproate has a cancer-protective effect in people with epilepsy. We aimed to determine cancer risk in people with epilepsy using sodium-valproate. MATERIALS AND METHODS Continuous data for 2997 people with epilepsy who had been prescribed valproate for at least two years, and for 11,988 unexposed people were provided by the UK General Practice Research Database. Hazard ratios (HRs) for all cancers and individual cancers between the exposed and unexposed groups, with smoking and alcohol consumption and age as covariates, were calculated using the Cox proportional hazards method. RESULTS Exposure to valproate had no influence on the incidence of the composite of all cancers [HR: 1.19, 95% CI: 0.97-1.47, P = 0.10]; there was, however, a significant excess of colon cancers [HR: 3.95, 95% CI: 1.97-7.92, P = 0.001] and a trend towards an excess of prostate neoplasms [HR: 2.15, 95% CI: 0.92-5.02, P = 0.08] and in addition, a trend towards reduced incidence of breast cancer [HR: 0.40, 95% CI: 0.14-1.30, P = 0.08] in the exposed group. CONCLUSIONS The lack of an inverse association between valproate use and hazard ratios for all cancers and several individual cancer sites does not lend support for a cancer-protective role for valproate.
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Affiliation(s)
- G Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India
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21
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Neligan A, Bell GS, Giavasi C, Johnson AL, Goodridge DM, Shorvon SD, Sander JW. Long-term risk of developing epilepsy after febrile seizures: a prospective cohort study. Neurology 2012; 78:1166-70. [PMID: 22459683 DOI: 10.1212/wnl.0b013e31824f807a] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We report the prospective follow-up of a cohort of people from the onset of febrile seizures for a median of 24 years to estimate the long-term risk of developing epilepsy. METHODS The National General Practice Study of Epilepsy is a large prospective community study of 1,195 people with a first suspected seizure followed from the 1980s, of whom 220 (18%) had febrile seizures. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) for subsequent epilepsy were calculated in 5-year age bands. RESULTS Follow-up information was obtained for 181 (83%) people with a mean follow-up for the whole cohort of 21.6 (SD 6.0) years. Of these, 175 (97%) were seizure-free in the preceding 5 years, whereas 171 (94%) were seizure-free and off antiepileptic drugs. Six percent developed epilepsy, but the risk of developing epilepsy in the cohort over the whole follow-up period was almost 10 times that of the general population (SIR 9.7, 95% CI 5.7-16.4). The SIR was significantly elevated in the 0- to 14-year age groups but not in the 15- to 19-year age group (SIR 4.5, 95% CI 0.6-32.1). CONCLUSION The risk of developing epilepsy in people who had febrile seizures seems to decrease with time. Further long-term studies are needed to confirm this.
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Affiliation(s)
- A Neligan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
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22
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Abstract
Complex partial seizures (CPS) are a form of localization-related seizures associated with serious comorbidities and risks. CPS can be difficult to treat and may remain refractory to treatment with antiepileptic drugs (AEDs). Refractory CPS (rCPS) can be hazardous because of the potential for severe dysfunction and bodily harm, sometimes with fatal consequences. Control of seizure activity is critical to the clinical management of CPS. Vigabatrin is a unique AED approved in both Europe and the United States as adjunctive therapy for adult patients with rCPS who have responded inadequately to several alternative treatments. This review focuses on appropriately controlled studies of vigabatrin conducted in Europe. Several double-blind studies randomized those with rCPS to treatment with vigabatrin vs placebo, and two evaluated durability of response to long-term, open-label vigabatrin. Endpoints included seizure frequency, treatment satisfaction, and adverse events (AEs). Efficacy outcomes demonstrated that vigabatrin add-on therapy significantly reduced the frequency of seizures. Long-term studies indicated durability of response and tolerability of vigabatrin therapy for up to several years. Treatment satisfaction data indicated a preference for vigabatrin vs placebo for both physicians and study participants. Vigabatrin was well-tolerated with generally mild AEs considered common to AEDs. Vision effects were not formally monitored in these studies. In European trials, vigabatrin was efficacious as adjunctive therapy for rCPS.
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Affiliation(s)
- E Ben-Menachem
- Department of Clinical Neuroscience, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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23
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Ngugi AK, Kariuki SM, Bottomley C, Kleinschmidt I, Sander JW, Newton CR. Incidence of epilepsy: a systematic review and meta-analysis. Neurology 2011; 77:1005-12. [PMID: 21893672 PMCID: PMC3171955 DOI: 10.1212/wnl.0b013e31822cfc90] [Citation(s) in RCA: 293] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 05/12/2011] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To estimate the pooled incidence of epilepsy from published studies and investigate sources of heterogeneity in the estimates. METHODS We searched online databases for incidence studies and used meta-analytic methods to analyze the data. RESULTS Thirty-three articles met the entry criteria. The median incidence of epilepsy was 50.4/100,000/year (interquartile range [IQR] 33.6-75.6), while it was 45.0 (IQR 30.3-66.7) for high-income countries and 81.7 (IQR 28.0-239.5) for low- and middle-income countries. Population-based studies had higher incidence estimates than hospital-based studies (p = 0.02) while retrospective study design was associated with lower estimates than prospective studies (p = 0.04). CONCLUSION We provide data that could potentially be used to assess the burden and analyze the trends in incidence of epilepsy. Our results support the need for large population-based incidence studies of epilepsy.
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Affiliation(s)
- Anthony K Ngugi
- Centre for Geographic Medicine Research-Coast, KEMRI, Kilifi 80108, Kenya.
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24
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Mu J, Liu L, Zhang Q, Si Y, Hu J, Fang J, Gao Y, He J, Li S, Wang W, Wu J, Sander JW, Zhou D. Causes of death among people with convulsive epilepsy in rural West China: a prospective study. Neurology 2011; 77:132-7. [PMID: 21653888 DOI: 10.1212/wnl.0b013e318223c784] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Epilepsy is a serious health problem associated with an increased risk of premature mortality. Few studies have investigated risk factors for this. Understanding these risks may enable the implementation of preventative measures to reduce premature mortality. METHODS A management program for convulsive forms of epilepsy has been in place at the primary health care level in rural West China since May 2005. Demographic data and putative causes of death of attendees of the program since inception to the end of December 2009 have been recorded. Case fatality (CF), the proportional mortality ratios (PMRs) for each cause, and standardized mortality ratios (SMRs) for each age and cause were estimated based on the 2007 Chinese rural population. RESULTS There were 106 reported deaths (70 male) among 3,568 people. CF was 2.97% during a median of 28 months' follow-up. The highest PMRs were for accidental death (59%) including drowning (45.1%); probable sudden unexpected death in epilepsy (SUDEP) (14.7%); status epilepticus (6.9%), and neoplasm (6.9%). The overall SMR was 4.92 (95% confidence interval 4.0-6.1); the risks were high in young people. The risk of drowning was 82-fold higher in the cohort than the general population. CONCLUSION In rural West China, the risk of premature death is nearly 5 times higher in people with convulsive epilepsy than in the general Chinese population and especially high among young people. Accidental death, including drowning, and probable SUDEP are the leading putative causes of death in people with convulsive epilepsy in rural West China.
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Affiliation(s)
- J Mu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China.
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Neligan A, Bell GS, Johnson AL, Goodridge DM, Shorvon SD, Sander JW. The long-term risk of premature mortality in people with epilepsy. Brain 2011; 134:388-95. [DOI: 10.1093/brain/awq378] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bell GS, Sinha S, Tisi JD, Stephani C, Scott CA, Harkness WF, McEvoy AW, Peacock JL, Walker MC, Smith SJ, Duncan JS, Sander JW. Premature mortality in refractory partial epilepsy: does surgical treatment make a difference? J Neurol Neurosurg Psychiatry 2010; 81:716-8. [PMID: 20478848 DOI: 10.1136/jnnp.2008.170837] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Epilepsy carries an increased risk of premature death. For some people with intractable focal epilepsy, surgery offers hope for a seizure-free life. The authors aimed to see whether epilepsy surgery influenced mortality in people with intractable epilepsy. METHODS The authors audited survival status in two cohorts (those who had surgery and those who had presurgical assessment but did not have surgery). RESULTS There were 40 known deaths in the non-surgical group (3365 person years of follow-up) and 19 in the surgical group (3905 person-years of follow-up). Non-operated patients were 2.4 times (95% CI 1.4 to 4.2) as likely to die as those who had surgery. They were 4.5 times (95% CI 1.9 to 10.9) as likely to die a probable epilepsy-related death. In the surgical group, those with ongoing seizures 1 year after surgery were 4.0 (95% CI 1.2 to 13.7) times as likely to die as those who were seizure-free or who had only simple partial seizures. Time-dependent Cox analysis showed that the yearly outcome group did not significantly affect mortality (HR 1.3, 95% CI 0.9 to 1.8). CONCLUSION Successful epilepsy surgery was associated with a reduced risk of premature mortality, compared with those with refractory focal epilepsy who did not have surgical treatment. To some extent, the reduced mortality is likely to be conferred by inducing freedom from seizures. It is not certain whether better survival is attributable only to surgery, as treatment decisions were not randomised, and there may be inherent differences between the groups.
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Affiliation(s)
- G S Bell
- Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, UK
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29
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Chen L, Zhou B, Li JM, Zhu Y, Wang JH, Sander JW, Stefan H, Zhou D. Clinical features of convulsive status epilepticus: a study of 220 cases in western China. Eur J Neurol 2009; 16:444-9. [PMID: 19170743 DOI: 10.1111/j.1468-1331.2008.02404.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Convulsive status epilepticus (CSE) is the most common and life-threatening form of status epilepticus (SE). The aim of this study was to describe the clinical features of CSE in western China. METHODS Convulsive status epilepticus patients hospitalized from January 1996 to October 2007 were prospectively observed. Logistic regression was used to identify predictors of prognosis. RESULTS The average age of CSE patients (n = 220) was 37.5 years (SD 20.31), 50% of the patients had a history of epilepsy. The primary cause of CSE was central nervous system infection (32.7%), followed by discontinuation or reduction of antiepileptic drugs (AEDs; 15.5%). The median duration of CSE was 5 h and median duration of seizures before treatment was 2 h; both were longer in rural patients than in urban patients (P < 0.05). The fatality rate on discharge was 15.9%. Logistic regression analysis showed the duration of CSE [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03-1.07], a history of epilepsy (OR 0.35, 95% CI 0.14-0.89), and respiratory depression (OR 5.96, 95% CI 2.49-14.24) were independent predictors of CSE prognosis. DISCUSSION Central nervous system infection and AEDs withdrawal in epilepsy patients were the most important causes of CSE. There is a large gap between antiepileptic therapy in China and European Status Epilepticus guidelines.
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Affiliation(s)
- L Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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30
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Neligan A, Holdright DR, Rugg-Gunn FJ, Sander JW. A case of mistaken mesial temporal identity. BMJ 2009; 338:b2258. [PMID: 19549648 DOI: 10.1136/bmj.b2258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A Neligan
- UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG
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Wang WZ, Jiang B, Liu HM, Li D, Lu CZ, Zhao YD, Sander JW. Minimally invasive craniopuncture therapy vs. conservative treatment for spontaneous intracerebral hemorrhage: results from a randomized clinical trial in China. Int J Stroke 2009; 4:11-6. [PMID: 19236490 DOI: 10.1111/j.1747-4949.2009.00239.x] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSES To evaluate the effects of minimally invasive craniopuncture therapy compared with conservative treatment in treating intracerebral hemorrhage (25-40 ml) in the basal ganglion. METHODS A multicenter, randomized control clinical trial comprised 465 cases of hemorrhage in the basal ganglion from 42 hospitals in China. Three hundred and seventy-seven patients with hemorrhage were randomly assigned to receive minimally invasive craniopuncture therapy (n=195) or conservative control treatment (n=182). The main indices of evaluation were the degree of neurological impairment at the 14th day after treatment, activities of daily living at the end of the 3rd month and the case fatality within 3 months. RESULTS Improvement of neurological function in the minimally invasive craniopuncture group was significantly better than that in the control group at the 14th day (chi(2)=7.93, P=0.02). At the end of the 3rd month, there was a significant difference between the two groups in activities of daily living score (chi(2)=23.13, P<0.001). The proportion of dependent survival patients (modified Rankin scale >2) in the craniopuncture group (40.9%) was significantly lower than that in the conservative group (63.0%) at the end of the 3rd month (chi(2)=16.95, P<0.01). There was no significant difference in the cumulative fatality rates within three months between the two groups [6.7% (13/195) in the craniopuncture group and 8.8% (16/182) in the conservative group]. CONCLUSIONS This minimally invasive craniopuncture technique can improve the independent survival of patients with small basal ganglion hemorrhage. It is a safe and practical technique in treating cerebral hemorrhage.
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Affiliation(s)
- Wen-Zhi Wang
- National Office for Cerebrovascular Diseases, Prevention and Control in China, Beijing, China.
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Wang WZ, Jiang B, Wu SP, Hong Z, Yang QD, Sander JW, Du XL, Bao QJ. Change in Stroke Incidence from a Population-Based Intervention Trial in Three Urban Communities in China. Neuroepidemiology 2007; 28:155-61. [PMID: 17536227 DOI: 10.1159/000103268] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Stroke has been the main cause of death in most urban residents in China since the 1990s. A community-based intervention trial carried out in China aimed to reduce the incidence and mortality of stroke. In 1991, two well-matched communities each with approximately 50,000 people were selected as intervention or control communities in the urban areas of Beijing, Shanghai and Changsha. Regular health education and health promotion activities were carried out between 1991 and 2000 in the intervention communities but no special action was taken in the control communities. Both fatal and nonfatal stroke cases were meticulously registered during the study in the two communities to assess the effect of long-term intervention. The trend in stroke incidence and the effect of intervention on stroke incidence were analyzed using a Poisson regression model adjusted for age, sex, year and city. Between 1991 and 2000, 2,273 first-ever stroke cases were registered in the intervention communities and 3,015 in the control communities. Geographic variation and changes in the incidence of stroke and its subtypes were found among these 3 cities. Through 10 years of intervention, incidence risks of all, ischemic and hemorrhagic strokes decreased by 11.4% (relative risk 0.8959; 95% confidence interval, CI, 0.8483-0.9460; p < 0.0001), 13.2% (relative risk 0.8676; 95% CI 0.8054-0.9345; p = 0.0002) and 7.2% (relative risk 0.9283; 95% CI 0.8517-1.0117; p = 0.0899), respectively, in the intervention compared with control communities. Accordingly, comprehensive community-based intervention measures could effectively reduce the incidence of stroke in the population.
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Affiliation(s)
- Wen-Zhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, PR China.
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Parrini E, Ramazzotti A, Dobyns WB, Mei D, Moro F, Veggiotti P, Marini C, Brilstra EH, Dalla Bernardina B, Goodwin L, Bodell A, Jones MC, Nangeroni M, Palmeri S, Said E, Sander JW, Striano P, Takahashi Y, Van Maldergem L, Leonardi G, Wright M, Walsh CA, Guerrini R. Periventricular heterotopia: phenotypic heterogeneity and correlation with Filamin A mutations. Brain 2006; 129:1892-906. [PMID: 16684786 DOI: 10.1093/brain/awl125] [Citation(s) in RCA: 232] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Periventricular heterotopia (PH) occurs when collections of neurons lay along the lateral ventricles or just beneath. Human Filamin A gene (FLNA) mutations are associated with classical X-linked bilateral periventricular nodular heterotopia (PNH), featuring contiguous heterotopic nodules, mega cisterna magna, cardiovascular malformations and epilepsy. FLNA encodes an F-actin-binding cytoplasmic phosphoprotein and is involved in early brain neurogenesis and neuronal migration. A rare, recessive form of bilateral PNH with microcephaly and severe delay is associated with mutations of the ADP-ribosylation factor guanine nucleotide-exchange factor-2 (ARFGEF2) gene, required for vesicle and membrane trafficking from the trans-Golgi. However, PH is a heterogeneous disorder. We studied clinical and brain MRI of 182 patients with PH and, based on its anatomic distribution and associated birth defects, identified 15 subtypes. Classical bilateral PNH represented the largest group (98 patients: 54%). The 14 additional phenotypes (84 patients: 46%) included PNH with Ehlers-Danlos syndrome (EDS), temporo-occipital PNH with hippocampal malformation and cerebellar hypoplasia, PNH with fronto-perisylvian or temporo-occipital polymicrogyria, posterior PNH with hydrocephalus, PNH with microcephaly, PNH with frontonasal dysplasia, PNH with limb abnormalities, PNH with fragile-X syndrome, PNH with ambiguous genitalia, micronodular PH, unilateral PNH, laminar ribbon-like and linear PH. We performed mutation analysis of FLNA in 120 patients, of whom 72 (60%) had classical bilateral PNH and 48 (40%) other PH phenotypes, and identified 25 mutations in 40 individuals. Sixteen mutations had not been reported previously. Mutations were found in 35 patients with classical bilateral PNH, in three with PNH with EDS and in two with unilateral PNH. Twenty one mutations were nonsense and frame-shift and four missense. The high prevalence of mutations causing protein truncations confirms that loss of function is the major cause of the disorder. FLNA mutations were found in 100% of familial cases with X-linked PNH (10 families: 8 with classical bilateral PNH, 1 with EDS and 1 with unilateral PH) and in 26% of sporadic patients with classical bilateral PNH. Overall, mutations occurred in 49% of individuals with classical bilateral PNH irrespective of their being familial or sporadic. However, the chances of finding a mutation were exceedingly gender biased with 93% of mutations occurring in females and 7% in males. The probability of finding FLNA mutations in other phenotypes was 4% but was limited to the minor variants of PNH with EDS and unilateral PNH. Statistical analysis considering all 42 mutations described so far identifies a hotspot region for PNH in the actin-binding domain (P < 0.05).
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Affiliation(s)
- E Parrini
- Research Institute, I.R.C.C.S, Stella Maris Foundation, University of Pisa, Italy
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Depondt C, Yuen AWC, Bell GS, Mitchell T, Koepp MJ, Duncan JS, Sander JW. The long term retention of levetiracetam in a large cohort of patients with epilepsy. J Neurol Neurosurg Psychiatry 2006; 77:101-3. [PMID: 16361605 PMCID: PMC2117408 DOI: 10.1136/jnnp.2005.064626] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Levetiracetam (Lev) is a new antiepileptic drug with a distinct mechanism of action, shown in regulatory trials to be effective. These controlled trials do not always predict how useful a drug will be in day to day clinical practice. Retention rates can provide a better indication of efficacy and tolerability in everyday use. Patients attending a tertiary referral centre for epilepsy and who received Lev in the first 2 years of its marketing were assessed (n = 811) to determine continuation rates of treatment with this drug. At the last follow up, 65% of patients were still taking Lev, and the estimated 3 year retention rate was 58%. In total, 11% attained seizure freedom of at least 6 months. Patients taking greater numbers of concurrent antiepileptic drugs (AEDs) were more likely to discontinue Lev, and those reaching higher maximum daily dosages were less likely to discontinue Lev. The retention rate for Lev compares favourably with that of other new AEDs.
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Affiliation(s)
- C Depondt
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, UK
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Wang WZ, Wu JZ, Ma GY, Dai XY, Yang B, Wang TP, Yuan CL, Hong Z, Bell GS, Prilipko L, de Boer HM, Sander JW. Efficacy assessment of phenobarbital in epilepsy: a large community-based intervention trial in rural China. Lancet Neurol 2006; 5:46-52. [PMID: 16361022 DOI: 10.1016/s1474-4422(05)70254-4] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Many people with epilepsy need not experience further seizures if the diagnosis and treatment are correct. Most epilepsy patients have convulsions, which are usually fairly easy to diagnose. This study tested a model for treatment of people with convulsive forms of epilepsy at primary health-care level in rural areas of China. METHODS Patients with convulsive epilepsy were identified at primary care level and provided with phenobarbital monotherapy. Local physicians, who were provided with special training, carried out screening, treatment, and follow-up. A local neurologist confirmed the diagnoses. Efficacy was assessed from the percentage reduction in seizure frequency from baseline and the retention of patients on treatment. FINDINGS The study enrolled 2455 patients. In 68% of patients who completed 12 months' treatment, seizure frequency was decreased by at least 50%, and a third of patients were seizure free. 72% of patients who completed 24 months' treatment had reduction of seizure frequency of at least 50% and a quarter of patients remained seizure free. Probability of retention was 0.84 at 1 year, and 0.76 at 2 years. Medication was well tolerated and reported adverse events were mild; only 32 patients (1%) discontinued medication because of side-effects. INTERPRETATION This pragmatic study confirmed that this simple protocol was suitable for the treatment of convulsive forms of epilepsy in rural areas of China. Physicians with basic training could treat epilepsy patients with phenobarbital, with beneficial effects for most patients with convulsive seizures. Few cognitive or behavioural adverse events were noted, but formal psychometric testing was not done.
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Affiliation(s)
- W Z Wang
- Beijing Neurosurgical Institute, Beijing, People's Republic of China.
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Abstract
Most large-scale clinical trials of antiepileptic drugs (AEDs) are undertaken for regulatory purposes and generate basic data supporting the efficacy and safety of a new treatment. They do not, however, provide all the information required for physicians to know how well the drug will work in clinical practice. One valuable approach to generating more clinically meaningful information is to assess AED treatment retention rates, which reflect the combination of efficacy and tolerability in the real world, and have historically been low. Long-term retention rate data are available for levetiracetam (LEV), topiramate, gabapentin, and lamotrigine, and these data suggest that LEV is more likely to retain patients than other new AEDs. In a recent tertiary care study involving mainly refractory patients, 11% of participants became seizure-free on LEV and nearly two-thirds were retained on long-term treatment. High seizure freedom rates and good tolerability reported with LEV in clinical trials thus appear to translate into improved treatment retention rates in clinical practice.
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Affiliation(s)
- J W Sander
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
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Abstract
Most people with epilepsy can live outwardly normal lives, but fear about impending seizures, driving restrictions, lack of independence, employment and social problems, medication-related adverse effects and the presence of cognitive or psychiatric complications are all concerns readily identified by affected individuals. While seizure control is the overriding goal of treatment, it is essential to realize the importance that patients place on other aspects of daily functioning. While many of the concerns identified by patients can only be managed by improved social support, others (e.g. neuropsychological impairment, medication-related adverse events, cognitive impairment, sleep disturbance) may be amenable to therapy (if available) or to the selection of a more appropriate antiepileptic drug. Each antiepileptic drug has a unique pharmacodynamic and tolerability profile. Awareness by the treating clinician of the pharmacological profile of each drug may help to minimize unwanted treatment-related effects and possibly improve the outcome of treatment from an epilepsy patient's perspective. Therefore, in order to achieve true treatment success, clinicians need to understand how individuals perceive their disorder and, where possible, address those factors that adversely affect patient quality of life. For the person with epilepsy, successful treatment involves beneficial effects on social, vocational and psychological function. This extends beyond seizure control to freedom from the fear associated with seizures, confidence in pharmacological therapy and improvements in health-related quality of life.
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Affiliation(s)
- J W Sander
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
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Abstract
Seizures in the idiopathic generalized epilepsies (IGEs) usually remit completely with antiepileptic drugs (AEDs). Occasionally, however, they may be aggravated by AEDs. Before attributing exacerbation of seizures to an AED, alternative explanations need to be excluded. These include natural fluctuation of seizures, irregular compliance, maladjustment to the disease, comorbid illness, and development of tolerance. Aggravation may be due to a paradoxical reaction or drug-induced encephalopathy, sedative effects, or inappropriate use of a drug; and this need to be established, as it will guide management. An important caveat is that most data on aggravation of generalized seizures are based on anecdotal case reports or case series. Whether considering efficacy or aggravation, the interpretation of data from uncontrolled studies and case reports must be treated with caution. In practice, despite the fact that clear evidence is lacking, the possibility of seizure aggravation must be considered when treating people with IGEs. Predictive factors for seizure aggravation in a particular patient with a specific drug are yet to be fully defined. It is paramount to classify seizure type correctly in all patients. If this is not possible, a broad-spectrum AED should be used. Drugs that modulate Na+-channels and GABAergic drugs seem to be more prone to aggravating seizures, and therefore are best avoided in the initial management of IGE. Further studies are required to elucidate this phenomenon in full. It is interesting to speculate that paradoxical responses to AEDs may have pharmacogenetic value, serving as tools for a more precise and useful characterization of the epilepsies.
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Affiliation(s)
- J Chaves
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom
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Gaitatzis A, Sander JW. Response: Comorbidity of Epilepsy. Epilepsia 2005. [DOI: 10.1111/j.1528-1167.2005.18505_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE To examine the influence of various factors on the risk of sudden unexpected death in epilepsy (SUDEP). METHODS The authors investigated 154 cases in which a postmortem examination was performed. Each case had four controls with epilepsy from the community, matched for age and geographic location. Backward stepwise conditional logistic regression analysis was performed and odds ratios for risk and protection were determined. RESULTS The risk of SUDEP was increased with a history of generalized tonic-clonic seizures in the previous 3 months (odds ratio [OR]: 13.8, 95% CI: 6.6 to 29.1). The presence of supervision at night was found to be protective (OR: 0.4, 95% CI: 0.2 to 0.8) when a supervising individual shared the same bedroom or when special precautions such as a listening device were employed (OR: 0.1, 95% CI: 0.0 to 0.3). CONCLUSION This work lends support to the view that SUDEP is a seizure-related phenomenon and that control of tonic-clonic seizures is important in its prevention. Nocturnal supervision seems to protect against SUDEP.
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Affiliation(s)
- Y Langan
- Department of Clinical and Experimental Epilepsy, RakeInstitute of Neurology, London, UK
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Panayiotopoulos CP, Benbadis SR, Covanis A, Dulac O, Duncan JS, Eeg-Olofsson O, Ferrie CD, Grünewald RA, Kasteleijn-Nolst Trenité DGA, Koutroumanidis M, Martinovic Z, Newton RW, Parker APJ, Salas-Puig J, Sander JW, Shorvon S, Watanabe K, Whitehouse WP, Youroukos S. Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2005; 64:172-4; author reply 172-4. [PMID: 15645539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
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Holloway RG, French JA, Kanner A, Gronseth G, Krauss GL, French JA, Panayiotopoulos CP, Benbadis SR, Covanis A, Dulac O, Duncan JS, Eeg-Olofsson O, Ferrie CD, Grunewald RA, Kasteleijn-Nolst Trenite DG, Koutroumanidis M, Martinovic Z, Newton RW, Parker APJ, Salas-Puig J, Sander JW, Shorvon S, Watanabe K, Whitehouse WP, Youroukos S, French JA. Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new onset epilepsy: Report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2005. [DOI: 10.1212/wnl.64.1.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
OBJECTIVES Death certificates are an unreliable source of information on cause of death, and mortality due to epilepsy can thus be underestimated. METHODS We investigated people with epilepsy who had died, and attempted to identify factors that influence inclusion of epilepsy on the death certificate; eight factors were hypothesised and entered into a univariate logistic regression model. RESULTS Epilepsy was on the death certificate of 16/243 (7%) people who had had epilepsy. Factors that influenced whether or not epilepsy appeared on the certificate were seizure frequency, antiepileptic drug treatment, cause of death, and certifying physician. Factors that did not seem to influence the inclusion of epilepsy were presence of convulsive seizures, occurrence of seizures during follow up, and age at death. CONCLUSIONS We have estimated the degree of unreliability of death certificates (as currently used in the UK) as a source of information on cause of death in epilepsy. We have found that epilepsy may not appear on death certificates even if people had active epilepsy.
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Affiliation(s)
- G S Bell
- Neuroepidemiology Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, WC1N 3BG, UK
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Abstract
Better information of the natural history of epilepsy has important implications for understanding the underlying neurobiology, evaluating treatment strategies, and planning healthcare resources. The traditional pessimistic view has been dispelled by results from modern community based prospective studies, showing that over 60% of newly diagnosed patients will enter remission upon treatment. Recent outcome studies suggest that medical intractability may be predicted after failure of two antiepileptic drugs. Poor prognostic factors include a high initial seizure density, symptomatic aetiology, and presence of structural cerebral abnormalities, all of which can be identified early on. Among patients who have entered remission, many will remain seizure-free after antiepileptic drug treatment is withdrawn, suggesting that the underlying seizure generating factor has remitted. Whether some of these patients have entered remission "spontaneously" is contentious because, with effective pharmacotherapy for epilepsy in use for over 100 years, the natural history of untreated epilepsy is largely unknown. Circumstantial evidence, mostly arising from resource poor countries where antiepileptic drug treatment is not readily available, indicates that spontaneous remission may occur in up to 30% of cases. Observations from these complementary sources suggest that, at the population level, prognosis of newly diagnosed epilepsy may be broadly categorised into three groups: remission without treatment, remission with treatment only, and persistent seizures despite treatment. As understanding of the prognostic factors improves, the potential of a "prognostic group specific" management approach should be explored so that effective treatments may be used in a more rational and targeted fashion.
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Affiliation(s)
- P Kwan
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Abstract
Several studies have assessed the prevalence of psychiatric disorders in epilepsy. They are characterized by considerable heterogeneity, because of differences in the population setting and type of study. A non-systematic review of the literature allows us to draw some useful, although not definite, conclusions. Six per cent of people with epilepsy in the general population appear to suffer from a psychiatric disorder, while this rises to 10-20% in populations with temporal lobe and/or refractory epilepsy. Mood disorders are the most common culprit (24-74%), particularly depression (30%), followed by anxiety disorders (10-25%), psychoses (2-7%) and personality disorders (1-2%). This comorbidity appears to be related to endogenous and exogenous (including iatrogenic) factors and to the severity and chronicity of epilepsy. Conditions such as schizophrenia-like psychosis of epilepsy and interictal dysphoric disorder are represented only in epilepsy. Adequate recognition and treatment of psychiatric conditions in epilepsy is essential for patient management because of their considerable burden in morbidity and quality of life.
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Affiliation(s)
- A Gaitatzis
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, and The National Hospital for Neurology and Neurosurgery, London, UK
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Affiliation(s)
- G Singh
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
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Abstract
PURPOSE To identify research priorities in epilepsy for developing nations. METHODS A panel discussion with audience participation at the Indo-U.K. Workshop on Epilepsy. This included short presentations by panelists, the presentation of a research proposal, and debate on research priorities. RESULTS The need to focus on primary-care populations; to use a multi-centre random block design; to incorporate rural areas and a service component; to study incidence, natural history, and aetiology; to focus on problems, such as cysticercosis, and to adopt a comprehensive public health-centred approach in doing so; to study disorders of local interest, such as hot water epilepsy; to pilot both pharmacological and nonpharmacological interventions; to incorporate comprehensive measures of cognition, behaviour, and psychosocial outcome in all studies; and to examine the role of novel diagnostic tools (imaging for example) and therapy (surgery for example) on cost were all outlined as priority areas. DISCUSSION There is a felt need for greater and better-quality research output from the developing world. The development of uniform research protocols, the twinning of developed and developing nations for research, and training of developing nations' personnel are likely to increase research output in the years that come.
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Affiliation(s)
- E S Krishnamoorthy
- T S Srinivasan Institute of Neurological Sciences and Research, Public Health Centre, Chennai, India.
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Abstract
PURPOSE To review the factors influencing prognosis of epilepsy in this era of antiepileptic drugs and surgical treatment. METHODS Systematic review of peer-reviewed literature. RESULTS The prognosis depends on many factors; aetiology, age of onset, number of seizures at onset, the natural history of the condition, and the influence of treatment. However, between 70 and 80% of people developing epilepsy will go into long-term remission, usually within the first 5 years. DISCUSSION Prognosis in epilepsy is the prospect of attaining complete seizure freedom once a pattern of recurrent epileptic seizures has been established. Well-designed prospective cohort studies using standard outcome measures need to be conducted, especially in non-Western cultures.
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Affiliation(s)
- J W Sander
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom
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