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Lallana S, Fonseca E, Quintana M, Abraira L, Campos-Fernández D, López-Maza S, Santamarina E, Toledo M, Salas-Puig J. Antiseizure medication withdrawal in adult patients with idiopathic generalized epilepsy: Performance of two seizure recurrence prediction models. Epilepsy Behav 2024; 153:109718. [PMID: 38428177 DOI: 10.1016/j.yebeh.2024.109718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/09/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Currently, there is a limited availability of tools to predict seizure recurrence after discontinuation of antiseizure medications (ASMs). This study aimed to establish the seizure recurrence rate following ASM cessation in adult patients with idiopathic generalized epilepsy (IGE) and to assess the predictive performance of the Lamberink and the Stevelink prediction models using real-world data. METHODS Retrospective longitudinal study in IGE patients who underwent ASM withdrawal in a tertiary epilepsy clinic since June 2011, with the latest follow up in January 2024. The minimum follow-up period was 12 months. Clinical and demographic variables were collected, and the seizure recurrence prediction models proposed by Lamberink and Stevelink were applied and evaluated. RESULTS Forty-seven patients (mean age 33.15 ± 8 [20-55] years; 72.35 % women) were included. During the follow-up period, seizures recurred in 25 patients (53.2 %). Median time to recurrence was 8 months [IQR 3-13.5 months], and 17 patients (68 %) relapsed within the first year. None of the relapsing patients developed drug-resistant epilepsy. The only significant risk factor associated with recurrence was a seizure-free period of less than 2 years before discontinuing medication (91.7 % vs 40 %, p =.005). The Stevelink prediction model at both 2 (p =.015) and 5 years (p =.020) achieved statistical significance, with an AUC of 0.72 (95 % CI 0.56-0.88), while the Lamberink model showed inadequate prognostic capability. CONCLUSION In our real-world cohort, a seizure-free period of at least 2 years was the only factor significantly associated with epilepsy remission after ASM withdrawal. Larger studies are needed to accurately predict seizure recurrence in IGE patients.
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Affiliation(s)
- Sofía Lallana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Daniel Campos-Fernández
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Samuel López-Maza
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Szaflarski JP, Besson H, D'Souza W, Faught E, Klein P, Reuber M, Rosenow F, Salas-Puig J, Soto Insuga V, Steinhoff BJ, Strzelczyk A, Bourikas D, Daniels T, Floricel F, Friesen D, Laloyaux C, Villanueva V. Effectiveness and tolerability of brivaracetam in patients with epilepsy stratified by comorbidities and etiology in the real world: 12-month subgroup data from the international EXPERIENCE pooled analysis. J Neurol 2024:10.1007/s00415-024-12253-z. [PMID: 38436680 DOI: 10.1007/s00415-024-12253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To assess the effectiveness and tolerability of brivaracetam (BRV) in adults with epilepsy by specific comorbidities and epilepsy etiologies. METHODS EXPERIENCE/EPD332 was a pooled analysis of individual patient records from several non-interventional studies of patients with epilepsy initiating BRV in clinical practice. Outcomes included ≥ 50% reduction from baseline in seizure frequency, seizure freedom (no seizures within prior 3 months), continuous seizure freedom (no seizures since baseline), BRV discontinuation, and treatment-emergent adverse events (TEAEs) at 3, 6, and 12 months. Analyses were performed for all adult patients (≥ 16 years of age) and stratified by comorbidity and by etiology at baseline (patients with cognitive/learning disability [CLD], psychiatric comorbidity, post-stroke epilepsy, brain tumor-related epilepsy [BTRE], and traumatic brain injury-related epilepsy [TBIE]). RESULTS At 12 months, ≥ 50% seizure reduction was achieved in 35.6% (n = 264), 38.7% (n = 310), 41.7% (n = 24), 34.1% (n = 41), and 50.0% (n = 28) of patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE, respectively; and continuous seizure freedom was achieved in 5.7% (n = 318), 13.7% (n = 424), 29.4% (n = 34), 11.4% (n = 44), and 13.8% (n = 29), respectively. During the study follow-up, in patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE, 37.1% (n = 403), 30.7% (n = 605), 33.3% (n = 51), 39.7% (n = 68), and 27.1% (n = 49) of patients discontinued BRV, respectively; and TEAEs since prior visit at 12 months were reported in 11.3% (n = 283), 10.0% (n = 410), 16.7% (n = 36), 12.5% (n = 48), and 3.0% (n = 33), respectively. CONCLUSIONS BRV as prescribed in the real world is effective and well tolerated among patients with CLD, psychiatric comorbidity, post-stroke epilepsy, BTRE, and TBIE.
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Affiliation(s)
- Jerzy P Szaflarski
- University of Alabama at Birmingham (UAB) Heersink School of Medicine Department of Neurology and UAB Epilepsy Center, Birmingham, AL, USA.
| | | | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | | | - Victor Soto Insuga
- Pediatric Neurology, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | - Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork and Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | - Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, EpiCARE member, Valencia, Spain
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Villanueva V, Laloyaux C, D'Souza W, Faught E, Klein P, Reuber M, Rosenow F, Salas-Puig J, Insuga VS, Strzelczyk A, Szaflarski JP, Chinn C, Daniels T, Floricel F, Friesen D, Sendersky V, Besson H, Steinhoff BJ. Effectiveness and Tolerability of 12-Month Brivaracetam in the Real World: EXPERIENCE, an International Pooled Analysis of Individual Patient Records. CNS Drugs 2023; 37:819-835. [PMID: 37684497 PMCID: PMC10501958 DOI: 10.1007/s40263-023-01033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Real-world evidence studies of brivaracetam (BRV) have been restricted in scope, location, and patient numbers. The objective of this pooled analysis was to assess effectiveness and tolerability of brivaracetam (BRV) in routine practice in a large international population. METHODS EXPERIENCE/EPD332 was a pooled analysis of individual patient records from multiple independent non-interventional studies of patients with epilepsy initiating BRV in Australia, Europe, and the United States. Eligible study cohorts were identified via a literature review and engagement with country lead investigators, clinical experts, and local UCB Pharma scientific/medical teams. Included patients initiated BRV no earlier than January 2016 and no later than December 2019, and had ≥ 6 months of follow-up data. The databases for each cohort were reformatted and standardised to ensure information collected was consistent. Outcomes included ≥ 50% reduction from baseline in seizure frequency, seizure freedom (no seizures within 3 months before timepoint), continuous seizure freedom (no seizures from baseline), BRV discontinuation, and treatment-emergent adverse events (TEAEs) at 3, 6, and 12 months. Patients with missing data after BRV discontinuation were considered non-responders/not seizure free. Analyses were performed for all adult patients (≥ 16 years), and for subgroups by seizure type recorded at baseline; by number of prior antiseizure medications (ASMs) at index; by use of BRV as monotherapy versus polytherapy at index; for patients who switched from levetiracetam to BRV versus patients who switched from other ASMs to BRV; and for patients with focal-onset seizures and a BRV dose of ≤ 200 mg/day used as add-on at index. Analysis populations included the full analysis set (FAS; all patients who received at least one BRV dose and had seizure type and age documented at baseline) and the modified FAS (all FAS patients who had at least one seizure recorded during baseline). The FAS was used for all outcomes other than ≥ 50% seizure reduction. All outcomes were summarised using descriptive statistics. RESULTS Analyses included 1644 adults. At baseline, 72.0% were 16-49 years of age and 92.2% had focal-onset seizures. Patients had a median (Q1, Q3) of 5.0 (2.0, 8.0) prior antiseizure medications at index. At 3, 6, and 12 months, respectively, ≥ 50% seizure reduction was achieved by 32.1% (n = 619), 36.7% (n = 867), and 36.9% (n = 822) of patients; seizure freedom rates were 22.4% (n = 923), 17.9% (n = 1165), and 14.9% (n = 1111); and continuous seizure freedom rates were 22.4% (n = 923), 15.7% (n = 1165), and 11.7% (n = 1111). During the whole study follow-up, 551/1639 (33.6%) patients discontinued BRV. TEAEs since prior visit were reported in 25.6% (n = 1542), 14.2% (n = 1376), and 9.3% (n = 1232) of patients at 3, 6, and 12 months, respectively. CONCLUSIONS This pooled analysis using data from a variety of real-world settings suggests BRV is effective and well tolerated in routine clinical practice in a highly drug-resistant patient population.
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Affiliation(s)
- Vicente Villanueva
- Refractory Epilepsy Unit, Hospital Universitario y Politécnico La Fe, EpiCARE member, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | | | - Wendyl D'Souza
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Australia
| | | | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD, USA
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Frankfurt am Main, Germany
| | | | - Victor Soto Insuga
- Pediatric Neurology, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Frankfurt am Main, Germany
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham (UAB) Heersink School of Medicine, Department of Neurology and UAB Epilepsy Center, Birmingham, AL, USA
| | | | | | | | | | | | | | - Bernhard J Steinhoff
- Kork Epilepsy Center, Kehl-Kork and Medical Faculty, University of Freiburg, Freiburg, Germany
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Peraita-Adrados R, Salas-Puig J. [In memoriam. Anne Beaumanoir (1923-2022)]. Rev Neurol 2022. [PMID: 35548917 DOI: 10.33588/rn.7410.2022130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - J Salas-Puig
- Hospital Universitario Vall d'Hebron, Barcelona, España
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Abraira L, Salas-Puig J, Quintana M, Seijo-Raposo IM, Santamarina E, Fonseca E, Toledo M. Overnight switch from levetiracetam to brivaracetam. Safety and tolerability. Epilepsy Behav Rep 2021; 16:100504. [PMID: 34901817 PMCID: PMC8640256 DOI: 10.1016/j.ebr.2021.100504] [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: 07/21/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022] Open
Abstract
Brivaracetam has a more selective action to SV2A binding site than levetiracetam. Neuropsychological adverse events improved in 76% of patients that switched. An overnight switch is well-tolerated in our relatively small Spanish sample.
Brivaracetam is a newer antiseizure medication than levetiracetam. It has a more selective action on the synaptic vesicle glycoprotein 2A binding site, and it seems to provide a more favorable neuropsychiatric profile. The aim of this study was to assess the safety and tolerability of an overnight switch from levetiracetam to brivaracetam. This was a retrospective descriptive study including patients with epilepsy treated with levetiracetam, who switched due to inefficacy or previous adverse events (AEs). In total, forty-one patients were included (mean age 40.9 ± 17.8 years, women 48.8%). Focal epilepsy represented 75.6% (n = 31) of patients (structural cause [n = 25], unknown cause [n = 6]). Four patients had idiopathic generalized epilepsy, two had developmental and epileptic encephalopathy and four patients were unclassified. The reason to start brivaracetam was inefficacy in 53.7% (n = 22), AEs in 65.9% (25/27 neuropsychiatric) and both in 19.5% (n = 8). Brivaracetam-related AEs were reported in 24.4%. Neuropsychological AEs associated with the previous use of levetiracetam improved in 76% of patients. Treatment was discontinued in 19.5% patients. Patients’ reported seizure frequency improved, worsened and remained stable in 26.8%, 12.2%, and 61.0% of the cases, respectively. An overnight switching to brivaracetam is safe and well tolerated. This treatment can improve levetiracetam-related neuropsychiatric AEs.
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Affiliation(s)
- L Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - J Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - M Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - I M Seijo-Raposo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - E Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - E Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - M Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
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Villanueva V, Sánchez-Álvarez JC, Carreño M, Salas-Puig J, Caballero-Martínez F, Gil-Nagel A. Initiating antiepilepsy treatment: An update of expert consensus in Spain. Epilepsy Behav 2021; 114:107540. [PMID: 33243687 DOI: 10.1016/j.yebeh.2020.107540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022]
Abstract
Following publication in 2014 of the International League Against Epilepsy (ILAE) official report changing the definition of epilepsy, a number of questions remain unresolved in regard to deciding when to start treatment and to the choice of a particular antiseizure medication (ASM). This study uses a Delphi method to update consensus among a panel of experts on the initiation of epilepsy treatment in order to provide insight regarding those questions. The study was undertaken in four phases. Firstly, a multi-center steering committee met to review relevant bibliography and to draft a questionnaire. Secondly, a panel of neurologists specialized in epilepsy was selected and convened. Thirdly, an online survey was carried out in two rounds. Fourthly, the final results were discussed at a face-to-face meeting of the steering committee to draw conclusions. The final questionnaire focused on three independent sections: the decision to commence ASM in different clinical situations, the choice of initial monotherapy depending on the type of epilepsy and the patient's age/sex (including childbearing potential), and the choice of initial monotherapy depending on comorbidity. In these two latter sections, fourteen ASMs approved for monotherapy use by the EMA and available in Spain were considered. Regarding the decision as to when to commence treatment, the results show agreement exists to initiate treatment following a first generalized tonic-clonic seizure or a focal seizure if the electroencephalography (EEG) reveals epileptiform activity, if the MRI reveals a lesion, or when it occurs in elderly patients. With respect to the choice of initial monotherapy depending on the type of epilepsy and the patient's age/sex profile, it is agreed to avoid valproic acid (VPA) in women with childbearing potential, with levetiracetam (LEV) and lamotrigine (LTG) being the preferable options in generalized epilepsy. In focal epilepsy, the options are broader, particularly in men, and include the most recent ASMs approved for monotherapy. In the elderly, LEV, lacosamide (LCM), eslicarbazepine acetate (ESL) and LTG are considered the most suitable drugs for initiating treatment. With regard to comorbidities, the recommendation is to avoid enzyme inducing ASMs, with LEV, the most recent ASMs approved for monotherapy and LTG being the preferred options. In conclusion, as the ILAE definition states, there are different situations that lead to treatment initiation after a first seizure. When choosing the first ASM, the type of epilepsy, childbearing potential and drug-drug interaction are key factors.
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Affiliation(s)
- Vicente Villanueva
- Unidad Epilepsia Refractaria, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | | | - Mar Carreño
- Unidad de Epilepsia, Hospital Clínic, Barcelona, Spain
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Salas-Puig J, Sopelana D, Quintana M, Seijo-Raposo I, Abraira L, Fonseca E, Santamarina E, Toledo M. [Quality of life in adult patients with idiopathic generalised epilepsy. The EPILAK study]. Rev Neurol 2021; 72:195-202. [PMID: 33710609 DOI: 10.33588/rn.7206.2020518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Quality of life (QoL) is an important aspect in the treatment of patients with epilepsy. AIM To analyse the QoL using the Quality of Life in Epilepsy Inventory-10 (QOLIE-10) in adults with idiopathic generalised epilepsy and to study factors associated with a worse QoL. PATIENTS AND METHODS A cross-sectional, multicentre, observational study conducted by 141 neurologists in all the autonomous communities of Spain. Each researcher analysed the QOLIE-10 of two males and two females over 18 years of age with idiopathic generalised epilepsy seen consecutively in public or private practice. The results were standardised: 0 was the worst QoL and 100 was the best. RESULTS A total of 546 patients were analysed. Women: 51.1% (n = 279). Mean age: 36 ± 15.3 years old (18-87). Childhood absence seizures: 7.5% (n = 41); juvenile absence seizures: 9.2% (n = 50); juvenile myoclonic seizures: 29.8% (n = 163); only tonic-clonic seizures: 53.5% (n = 292). Monotherapy: 63.2% (n = 345). Seizure-free in the last year: 53.1% (n = 290). Psychiatric comorbidity: anxiety: 28.4% (n = 155); depression: 14.1% (n = 77); attention deficit: 10.1% (n = 55). Employment status: in active employment: 47.2% (n = 258); student: 20% (n = 109); housewife/husband: 7.3% (n = 40); pensioner: 10.2% (n = 56); unemployed: 14.3% (n = 78). Marital status: married or in a relationship: 49.1% (n = 268); single: 43.7% (n = 239). Mean score on the QOLIE-10: 71.4 ± 19.1. Being female (p = 0.006), greater frequency of seizures (p < 0.001), polytherapy (p < 0.001), psychiatric comorbidity (p < 0.001) and unemployment (p < 0.001) were significantly associated with a worse QoL. CONCLUSIONS The QoL of patients with idiopathic/genetic generalised epilepsy is affected by poor seizure control, psychiatric comorbidity and unemployment, and women are more affected than men.
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Affiliation(s)
- J Salas-Puig
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | - D Sopelana
- Hospital Universitario de Albacete, Albacete, España
| | - M Quintana
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | | | - L Abraira
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | - E Fonseca
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | - E Santamarina
- Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M Toledo
- Hospital Universitario Vall d'Hebron, Barcelona, España
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Vilaseca-Jolonch A, Abraira L, Quintana M, Sueiras M, Thonon V, Toledo M, Salas-Puig J, Fonseca E, Cordero E, Martínez-Ricarte F, Santamarina E. Tumor-associated status epilepticus: A prospective cohort in a tertiary hospital. Epilepsy Behav 2020; 111:107291. [PMID: 32702656 DOI: 10.1016/j.yebeh.2020.107291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Tumor-associated status epilepticus (TASE) follows a relatively benign course compared with SE in the general population. Little, however, is known about associated prognostic factors. METHODS We conducted a prospective, observational study of all cases of TASE treated at a tertiary hospital in Barcelona, Spain between May 2011 and May 2019. We collected data on tumor and SE characteristics and baseline functional status and analyzed associations with outcomes at discharge and 1-year follow-up. RESULTS Eighty-two patients were studied; 58.5% (n = 48) had an aggressive tumor (glioblastoma or brain metastasis). Fifty-one patients (62.2%) had a favorable outcome at discharge compared with just 30 patients (25.8%) at 1-year follow-up. Fourteen patients (17.1%) died during hospitalization. Lateralized period discharges (LPDs) on the baseline electroencephalography (EEG), presence of metastasis, and SE severity were significantly associated with a worse outcome at discharge. The independent predictors of poor prognosis at 1-year follow-up were SE duration of at least 21 h, an aggressive brain tumor, and a nonsurgical treatment before SE onset. Lateralized period discharges, super-refractory SE, and an aggressive tumor type were independently associated with increased mortality. CONCLUSIONS Status epilepticus duration is the main modifiable factor associated with poor prognosis at 1-year follow-up. Accordingly, patients with TASE, like those with SE of any etiology, should receive early, aggressive treatment.
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Affiliation(s)
- Andreu Vilaseca-Jolonch
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - María Sueiras
- Neurophysiology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Vanessa Thonon
- Neurophysiology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Esteban Cordero
- Neurosurgery Department, Vall d'Hebron Hospital, Department of Surgery, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Francisco Martínez-Ricarte
- Neurosurgery Department, Vall d'Hebron Hospital, Department of Surgery, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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Abraira L, Gramegna LL, Quintana M, Santamarina E, Salas-Puig J, Sarria S, Rovira A, Toledo M. Cerebrovascular disease burden in late-onset non-lesional focal epilepsy. Seizure 2019; 66:31-35. [DOI: 10.1016/j.seizure.2019.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022] Open
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Santamarina E, Alpuente A, Maisterra O, Sueiras M, Sarria S, Guzman L, Abraira L, Salas-Puig J, Toledo M. Perampanel: A therapeutic alternative in refractory status epilepticus associated with MELAS syndrome. Epilepsy Behav Case Rep 2019; 11:92-95. [PMID: 30834194 PMCID: PMC6384302 DOI: 10.1016/j.ebcr.2019.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 11/10/2022]
Abstract
To our knowledge, there are no reports of status epilepticus (SE) associated with mitochondrial diseases and treated with perampanel (PER). We present three cases of patients with refractory SE associated with MELAS syndrome who responded favorably to PER. All cases were diagnosed as non-convulsive SE (focal without impairment of level of consciousness). After an initial treatment with other anti-seizure drugs, PER was added in all cases (8, 16 and 12 mg) and cessation of SE was observed within the next 4-8 hours. All the cases involved a stroke-like lesion present on brain MRI. In our patients, PER was an effective option in SE associated with MELAS syndrome. Status epilepticus (SE) in MELAS is associated with a stroke-lesion and it is usually refractory. We present three cases of refractory SE and MELAS who responded favorably to Perampanel. Perampanel (PER) may be an effective option in SE associated with MELAS syndrome.
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Affiliation(s)
- Estevo Santamarina
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alicia Alpuente
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Olga Maisterra
- Neurovascular Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Sueiras
- EEG Unit, Department of Neurophysiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Lorena Guzman
- EEG Unit, Department of Neurophysiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
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Santamarina E, Abraira L, Toledo M, González-Cuevas M, Quintana M, Maisterra O, Sueiras M, Guzman L, Salas-Puig J, Sabín JÁ. Prognosis of post-stroke status epilepticus: Effects of time difference between the two events. Seizure 2018; 60:172-177. [DOI: 10.1016/j.seizure.2018.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/07/2018] [Accepted: 07/08/2018] [Indexed: 10/28/2022] Open
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Villanueva V, Montoya J, Castillo A, Mauri-Llerda JÁ, Giner P, López-González FJ, Piera A, Villanueva-Hernández P, Bertol V, Garcia-Escrivá A, Garcia-Peñas JJ, Garamendi I, Esteve-Belloch P, Baiges-Octavio JJ, Miró J, Falip M, Garcés M, Gómez A, Gil-López FJ, Carreño M, Rodriguez-Uranga JJ, Campos D, Bonet M, Querol R, Molins A, Tortosa D, Salas-Puig J. Perampanel in routine clinical use in idiopathic generalized epilepsy: The 12-month GENERAL study. Epilepsia 2018; 59:1740-1752. [PMID: 30062784 DOI: 10.1111/epi.14522] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To analyze the effectiveness and tolerability of perampanel across different seizure types in routine clinical care of patients with idiopathic generalized epilepsy (IGE). METHODS This multicenter, retrospective, 1-year observational study collected data from patient records at 21 specialist epilepsy units in Spain. All patients who were aged ≥12 years, prescribed perampanel before December 2016, and had a confirmed diagnosis of IGE were included. RESULTS The population comprised 149 patients with IGE (60 with juvenile myoclonic epilepsy, 51 generalized tonic-clonic seizures [GTCS] only, 21 juvenile absence epilepsy, 10 childhood absence epilepsy, 6 adulthood absence epilepsy, and one Jeavons syndrome). Mean age was 36 years. The retention rate at 12 months was 83% (124/149), and 4 mg was the most common dose. At 12 months, the seizure-free rate was 59% for all seizures (88/149); 63% for GTCS (72/115), 65% for myoclonic seizures (31/48), and 51% for absence seizures (24/47). Seizure frequency was reduced significantly at 12 months relative to baseline for GTCS (78%), myoclonic (65%), and absence seizures (48%). Increase from baseline seizure frequency was seen in 5.2% of patients with GTCS seizures, 6.3% with myoclonic, and 4.3% with absence seizures. Perampanel was effective regardless of epilepsy syndrome, concomitant antiepileptic drugs (AEDs), and prior AEDs, but retention and seizure freedom were significantly higher when used as early add-on (after ≤2 prior AEDs) than late (≥3 prior AEDs). Adverse events were reported in 50% of patients over 12 months, mostly mild or moderate, and irritability (23%), somnolence (15%), and dizziness (14%) were most frequent. SIGNIFICANCE In routine clinical care of patients with IGE, perampanel improved seizure outcomes for GTCS, myoclonic seizures, and absence seizures, with few discontinuations due to adverse events. This is the first real-world evidence with perampanel across different seizure types in IGE.
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Affiliation(s)
| | - Javier Montoya
- Lluis Alcanyis Hospital, Xátiva, Spain.,General University Hospital Valencia, Valencia, Spain
| | | | | | - Pau Giner
- University Hospital Dr Peset, Valencia, Spain
| | | | - Anna Piera
- University Hospital Clinic Valencia, Valencia, Spain
| | | | | | | | | | | | | | | | - Júlia Miró
- University Hospital Bellvitge, Barcelona, Spain
| | - Mercè Falip
- University Hospital Bellvitge, Barcelona, Spain
| | | | - Asier Gómez
- University Hospital and Polytechnic La Fe, Valencia, Spain
| | | | | | | | | | | | - Rosa Querol
- University Complex Infanta Cristina, Badajoz, Spain
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Abraira L, Sanabria A, Ortega G, Quintana M, Santamarina E, Salas-Puig J, Toledo M. [Social cognition and cognitive functions in patients with epilepsy treated with eslicarbazepine acetate]. Rev Neurol 2018; 66:361-367. [PMID: 29790568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Epilepsy is accompanied by cognitive disorders, frequently aggravated by the use of antiepileptic drugs, which can affect social empathy. AIM To analyse the impact of treatment with eslicarbazepine acetate (ESL) on social cognition and prefrontal cognitive functions in adults with focal epilepsy. PATIENTS AND METHODS We conducted a prospective single-centre study with patients aged between 18 and 65 years with focal seizures treated with ESL. The patients were evaluated in their baseline visit and at six months after starting ESL treatment by means of tasks designed for theory of mind, executive and attentional functions, auditory-verbal memory, quality of life, and anxiety and depression. RESULTS Forty-one patients were treated with ESL, and 30 completed the follow-up. A significant improvement was observed in the theory of mind tasks. In the analysis stratified by sex, the men showed greater improvement. A cognitive improvement was observed in the Wisconsin Card Sorting Test, Symbol Digit, Backward Digit Span and Stroop tests. No differences were found in the Quality of Life in Epilepsy-31 Inventory or in the Hospital Anxiety and Depression Scale. These results were independent of the reduction in the number of seizures and the ESL dosage. CONCLUSION Treatment with ESL could improve some aspects of theory of mind in patients with epilepsy, especially in men and independently of the control of seizures, with no changes in quality of life, anxiety or depression.
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Affiliation(s)
- L Abraira
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
| | - A Sanabria
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
- Fundacio ACE, Institut Catala de Neurociencies Aplicades, Barcelona, Espana
| | - G Ortega
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
- Fundacio ACE, Institut Catala de Neurociencies Aplicades, Barcelona, Espana
| | - M Quintana
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
| | | | - J Salas-Puig
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
| | - M Toledo
- Hospitals Vall d'Hebron, 08035 Barcelona, Espana
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Rodrigo L, Álvarez N, Fernández-Bustillo E, Salas-Puig J, Huerta M, Hernández-Lahoz C. Efficacy of a Gluten-Free Diet in the Gilles de la Tourette Syndrome: A Pilot Study. Nutrients 2018; 10:nu10050573. [PMID: 29735930 PMCID: PMC5986453 DOI: 10.3390/nu10050573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/24/2018] [Accepted: 05/04/2018] [Indexed: 02/06/2023] Open
Abstract
The Gilles de la Tourette syndrome (GTS) and Non-Coeliac Gluten Sensitivity (NCGS) may be associated. We analyse the efficacy of a gluten-free diet (GFD) in 29 patients with GTS (23 children; six adults) in a prospective pilot study. All of them followed a GFD for one year. The Yale Global Tics Severity Scale (YGTSS), the Yale-Brown Obsessive-Compulsive Scale—Self Report (Y-BOCS) or the Children’s Yale-Brown Obsessive-Compulsive Scale—Self Report (CY-BOCS), and the Cavanna’s Quality of Life Questionnaire applied to GTS (GTS-QOL) were compared before and after the GFD; 74% of children and 50% of adults were males, not significant (NS). At the beginning of the study, 69% of children and 100% of adults had associated obsessive-compulsive disorder (OCD) (NS). At baseline, the YGTSS scores were 55.0 ± 17.5 (children) and 55.8 ± 19.8 (adults) (NS), the Y-BOCS/CY-BOCS scores were 15.3, (standard deviation (SD) = 12.3) (children) and 26.8 (9.2) (adults) (p = 0.043), and the GTS-QOL scores were 42.8 ± 18.5 (children) and 64 ± 7.9 (adults) (p = 0.000). NCGS was frequent in both groups, with headaches reported by 47.0% of children and 83.6% of adults (p = 0.001). After one year on a GFD there was a marked reduction in measures of tics (YGTSS) (p = 0.001), and the intensity and frequency of OCD (Y-BOCS/CY-BOCS) (p = 0.001), along with improved generic quality of life (p = 0.001) in children and adults. In conclusion, a GFD maintained for one year in GTS patients led to a marked reduction in tics and OCD both in children and adults.
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Affiliation(s)
- Luis Rodrigo
- Gastroenterology Unit, Hospital Universitario Central de Asturias (HUCA), Avda. de Roma s/n, 33011 Oviedo, Spain.
| | - Nuria Álvarez
- Gastroenterology Unit, Hospital Universitario Central de Asturias (HUCA), Avda. de Roma s/n, 33011 Oviedo, Spain.
| | - Enrique Fernández-Bustillo
- Technical Department, Hospital Universitario Central de Asturias (HUCA), Avda. de Roma s/n, 33011 Oviedo, Spain.
| | - Javier Salas-Puig
- Neurology Service, Hospital del Valle de Hebrón, Paseo del Valle de Hebrón 119, 08035 Barcelona, Spain.
| | - Marcos Huerta
- Psychiatry Service, Mental Health Center, Pedro Pablo 42, 33209 Gijón, Spain.
| | - Carlos Hernández-Lahoz
- Neurology Service, Hospital Universitario Central de Asturias (HUCA), Avda. de Roma s/n, 33011 Oviedo, Spain.
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Toledo M, Molins A, Quintana M, Santamarina E, Martinez-Ricarte F, Martínez-Saez E, Salas-Puig J. Outcome of cancer-related seizures in patients treated with lacosamide. Acta Neurol Scand 2018; 137:67-75. [PMID: 28832891 DOI: 10.1111/ane.12809] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Lacosamide is an antiepileptic drug (AED), which has proven to be effective to control seizures, including acute conditions such as status epilepticus. The aim of this study is to describe the clinical experience with lacosamide in neuro-oncological patients. MATERIALS AND METHODS Multicenter retrospective study in patients with cancer-related seizures, who received lacosamide as an add-on therapy. RESULTS Forty-eight patients with benign and malignant tumors, including primary brain tumors, lymphomas, systemic cancer with central nervous system involvement, or paraneoplastic encephalitis, were included. Lacosamide was effective in the control of chronic seizures in patients with either benign or malignant tumors. The success rate was greater in malignant tumors, and drug-resistant epilepsies were more likely associated with benign tumors. Adverse events occurred in nearly 70% of patients, particularly in acute conditions and associated with the concomitant use of radio-/chemotherapy. Lacosamide-related adverse events were more likely somnolence and dizziness, which usually resolved after dose adjustment. After starting lacosamide, nearly half of the patients discontinued one of the baseline AEDs and decreased or discontinued dexamethasone. Fifteen patients with status epilepticus were treated with intravenous lacosamide, and 73% of them had their condition resolved without serious drug-related adverse events. CONCLUSION Lacosamide is an AED to consider in cases of cancer-related seizures. Lacosamide pharmacodynamics and pharmacokinetics allow the achievement of responder rates over 50% with no serious adverse effects, amelioration of side effects from other AEDs or radio-/chemotherapy, and no significant drug interactions. Furthermore, the intravenous formulation shows clear benefits in acute conditions such as status epilepticus.
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Affiliation(s)
- M. Toledo
- Epilepsy Unit; Neurologý Department; Hospital Universitario Vall d′Hebron; Barcelona Spain
| | - A. Molins
- Epilepsy Unit; Neurology Department; Hospital Universitari Vall d′Hebron; Girona Spain
| | - M. Quintana
- Epilepsy Unit; Neurologý Department; Hospital Universitario Vall d′Hebron; Barcelona Spain
| | - E. Santamarina
- Epilepsy Unit; Neurologý Department; Hospital Universitario Vall d′Hebron; Barcelona Spain
| | - F. Martinez-Ricarte
- Neurosurgery Department; Hospital Universitario Vall d′Hebron; Barcelona Spain
| | - E. Martínez-Saez
- Neuropathology Department; Hospital Universitario Vall d′Hebron; Barcelona Spain
| | - J. Salas-Puig
- Epilepsy Unit; Neurologý Department; Hospital Universitario Vall d′Hebron; Barcelona Spain
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Gómez-Ibáñez A, Serratosa J, Guillamón E, Garcés M, Giráldez B, Toledo M, Salas-Puig J, López-González F, Rodríguez-Uranga J, Castillo A, Mauri J, Camacho J, López-Gomáriz E, Giner P, Torres N, Palau J, Molins A, Villanueva V. Efficacy and safety of eslicarbazepine-acetate in elderly patients with focal epilepsy: Case series. Seizure 2017; 48:53-56. [DOI: 10.1016/j.seizure.2017.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/15/2017] [Accepted: 04/06/2017] [Indexed: 12/01/2022] Open
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Aller-Alvarez J, Menéndez-González M, Ribacoba-Montero R, Salvado M, Vega V, Suárez-Moro R, Sueiras M, Toledo M, Salas-Puig J, Álvarez-Sabin J. Myoclonic epilepsy in Down syndrome and Alzheimer disease. Neurología (English Edition) 2017. [DOI: 10.1016/j.nrleng.2014.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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Aller-Alvarez J, Menéndez-González M, Ribacoba-Montero R, Salvado M, Vega V, Suárez-Moro R, Sueiras M, Toledo M, Salas-Puig J, Álvarez-Sabin J. Epilepsia mioclónica en el síndrome de Down y en la enfermedad de Alzheimer. Neurologia 2017; 32:69-73. [DOI: 10.1016/j.nrl.2014.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022] Open
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Santamarina E, González-Cuevas GM, Sanchez A, Gracia RM, Porta I, Toledo M, Quintana M, Sueiras M, Guzmán L, Salas-Puig J. Prognosis of status epilepticus in patients requiring intravenous anesthetic drugs (a single center experience). Seizure 2017; 45:74-79. [DOI: 10.1016/j.seizure.2016.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 11/29/2016] [Accepted: 12/02/2016] [Indexed: 11/25/2022] Open
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Sala-Padro J, Toledo M, Santamarina E, Gonzalez-Cuevas M, Raspall-Chaure M, Sueiras-Gil M, Quintana M, Salas-Puig J. [Classification of idiopathic generalised epilepsies in patients over 16 years of age]. Rev Neurol 2017; 64:49-54. [PMID: 28074997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Idiopathic generalised epilepsies (IGE) are a set of electroclinical syndromes with different phenotypes. Our aim is to analyse those phenotypes in patients over 16 years of age. PATIENTS AND METHODS We conducted a retrospective analysis of a series of patients with IGE. They were classified as childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), epilepsy with tonic-clonic seizures only (TCSE), epilepsy with eyelid myoclonias and absences (EMA) and pure photogenic epilepsy (PE). RESULTS We included 308 patients, the majority females (56.8%), in our study. JME was the most prevalent (40.9%), followed by TCSE (30%), JAE (10%), EMA (8.7%), CAE (7.7%) and PE (1.6%). The types of seizures presented by the most patients were tonic-clonic (89.6%), myoclonic (45.4%), absence (31.4%), reflex seizures (13.3%), eyelid myoclonias (12.6%), non-epileptic psychogenic seizures (3.6%) and status epilepticus (1.9%). They all had generalised spike-and-wave discharges in the electroencephalogram (EEG). 19.2% presented asymmetrical discharges and 28.2% showed a photoparoxysmal response. We observed differences between syndromes in polytherapy (p < 0.0001), withdrawal of therapy (p = 0.01) and being seizure-free beyond the age of 50 (p = 0.004). CONCLUSIONS JME was the most frequent. Generalised tonic-clonic seizures were the type of seizures presented by the most patients, followed by myoclonic, absent and reflex seizures. The EEG showed a photoparoxysmal response in over a quarter of the patients, and one in five displayed asymmetrical anomalies. Differences were observed according to the syndrome in polytherapy, persistence of seizures and withdrawal of treatment.
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Affiliation(s)
- J Sala-Padro
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, Espana
| | - M Toledo
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, Espana
| | - E Santamarina
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, Espana
| | | | | | - M Sueiras-Gil
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, Espana
| | - M Quintana
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, Espana
| | - J Salas-Puig
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, Espana
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Villanueva V, Garcés M, López-González FJ, Rodriguez-Osorio X, Toledo M, Salas-Puig J, González-Cuevas M, Campos D, Serratosa JM, González-Giráldez B, Mauri JA, Camacho JL, Suller A, Carreño M, Gómez JB, Montoya J, Rodríguez-Uranga J, Saiz-Diaz R, González-de la Aleja J, Castillo A, López-Trigo J, Poza JJ, Flores J, Querol R, Ojeda J, Giner P, Molins A, Esteve P, Baigesr JJ. Erratum to "Safety, efficacy and outcome-related factors of perampanel over 12months in a real-world setting: The FYDATA study" [Epilepsy Res. 126 (2016) 201-210]. Epilepsy Res 2016; 129:174-175. [PMID: 28017504 DOI: 10.1016/j.eplepsyres.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- V Villanueva
- Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - M Garcés
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - M Toledo
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J Salas-Puig
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - D Campos
- Hospital Clínico Universitario, Valladolid, Spain
| | | | | | - J A Mauri
- Hospital Clínico Universitario, Zaragoza, Spain
| | - J L Camacho
- Hospital Clínico Universitario, Zaragoza, Spain
| | - A Suller
- Hospital Clínico Universitario, Zaragoza, Spain
| | - M Carreño
- Hospital Clinic Universitari, Barcelona, Spain
| | - J B Gómez
- Hospital Clinic Universitari, Barcelona, Spain
| | - J Montoya
- Hospital Lluis Alcanyis, Xátiva, Spain
| | | | - R Saiz-Diaz
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - A Castillo
- Consorcio Hospital General Universitario, Valencia, Spain
| | - J López-Trigo
- Consorcio Hospital General Universitario, Valencia, Spain
| | - J J Poza
- Hospital Universitario Donosti, Spain
| | - J Flores
- Hospital Nuestra Sẽnora Candelaria, Tenerife, Spain
| | - R Querol
- Hospital Universitario Infanta Cristina, Badajoz, Spain
| | - J Ojeda
- Hospital Universitario Infanta Sofia, Madrid, Spain
| | - P Giner
- Hospital Universitario Dr Peset, Valencia, Spain
| | - A Molins
- Hospital Universitario Josep Trueta, Girona, Spain
| | - P Esteve
- Hospital Verge de la Cinta, Tortosa, Spain
| | - J J Baigesr
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Toledo M, Sarria-Estrada S, Quintana M, Maldonado X, Martinez-Ricarte F, Rodon J, Auger C, Aizpurua M, Salas-Puig J, Santamarina E, Martinez-Saez E. Epileptic features and survival in glioblastomas presenting with seizures. Epilepsy Res 2016; 130:1-6. [PMID: 28073027 DOI: 10.1016/j.eplepsyres.2016.12.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/25/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The prognostic value of seizures in patients with glioblastoma is currently under discussion. The objective of this research was to study the risk factors associated with seizures occurring at the diagnosis of glioblastoma and the role of seizures as a predictive factor for survival. MATERIAL AND METHODS We prospectively analyzed the clinical data over the course of the disease, baseline MR imaging, and histological characteristics (p53 overexpression, the Ki67 proliferation index, and presence of the IDH1 R132H mutation), in glioblastomas treated in a single hospital from November 2012 to July 2014. The study follow-up cutoff point was October 2015. RESULTS In total, 56 patients were recruited (57% men, mean age 57 years). Median baseline score on the Karnofsky performance scale was 80. Complete tumor debulking followed by radiochemotherapy was achieved in 58.9%. Mean survival was 13.6 months. Epileptic seizures were the presenting symptom in 26.6% of patients, and 44.6% experienced seizures at some point during the course of the disease. On multivariate analysis, the single factor predicting shorter survival was age older than 60 years (hazard ratio 3.565 (95%CI, 1.491-8.522), p=0.004). Seizures were associated with longer survival only in patients younger than 60 years (p=0.035). Younger age, the IDH1 R132H mutation, and p53 overexpression (>40%) were related to seizures at presentation. Baseline MRI findings, including tumor size, and the Ki67 proliferation index were not associated with the risk of epileptic seizures or with survival. Prophylactic antiepileptic drugs did not increase survival time. CONCLUSIONS Seizures as the presenting symptom of glioblastoma predicted longer survival in adults younger than 60 years. The IDH1 R132H mutation and p53 overexpression (>40%) were associated with seizures at presentation. Seizures showed no relationship with the tumor size or proliferation parameters.
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Affiliation(s)
- Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Silvana Sarria-Estrada
- MR Unit, Institut Diagnostic per la Imatge, Neuroradiology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Xavier Maldonado
- Oncologic Radiotherapy Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Francisco Martinez-Ricarte
- Neurosurgery Department, Vall d́Hebron University Hospital,Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jordi Rodon
- Vall d́Hebron Oncology Institute, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Cristina Auger
- MR Unit, Institut Diagnostic per la Imatge, Neuroradiology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Miren Aizpurua
- Neuropathology Unit, Pathology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Elena Martinez-Saez
- Neuropathology Unit, Pathology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
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Toledo M, Gonzalez-Cuevas M, Miró-Lladó J, Molins-Albanell A, Falip M, Martinez AB, Fernandez S, Quintana M, Cambrodi R, Santamarina E, Salas-Puig J. Sleep quality and daytime sleepiness in patients treated with adjunctive perampanel for focal seizures. Epilepsy Behav 2016; 63:57-62. [PMID: 27566967 DOI: 10.1016/j.yebeh.2016.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to evaluate subjective sleep quality and daytime sleepiness in patients receiving adjunctive perampanel for focal seizures. METHODS We conducted a multicenter, prospective, interventional, open-label study in patients aged >16 with focal seizures who received adjunctive perampanel (flexible dosing: 2-12mg). Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness with the Epworth Sleepiness Scale (ESS) at baseline and 3 and 6months after initiating perampanel. Patients with modifications in their baseline AEDs or sleep medications were excluded. RESULTS In 72 patients with drug-resistant focal seizures, mean baseline PSQI score (±standard deviation) was 7.26 (±4.6), and ESS was 6.19 (±4.2). At 3months (median perampanel dose: 4mg), there was no significant mean change from baseline in ESS score (n=61) and a significant improvement in PSQI (-1.51 points; n=44; p=0.007), driven mainly by improved sleep efficiency (p=0.012). In the 31 patients with 6-month data, ESS (but not PSQI) improved significantly at 6months vs baseline (p=0.029). The only factor significantly correlated with sleep parameters was number of baseline AEDs (higher number correlated with worse daytime sleepiness). Seizure frequency was reduced significantly from baseline at 3 and 6months. In bivariate analysis, neither PSQI nor ESS was associated with seizure frequency, suggesting that the changes in daytime sleepiness and sleep quality may be independent of the direct effect on seizures. CONCLUSION Adjunctive perampanel did not worsen sleep quality or daytime sleepiness at 3months and reduced daytime sleepiness in patients continuing perampanel for 6months. Perampanel may be a suitable AED in patients with sleep disorders, in addition to refractory focal seizures.
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Affiliation(s)
- Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | | | - Julia Miró-Lladó
- Epilepsy Unit, Neurology Department, Bellvitge University Hospital, Barcelona, Spain
| | | | - Mercé Falip
- Epilepsy Unit, Neurology Department, Bellvitge University Hospital, Barcelona, Spain
| | | | | | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Roser Cambrodi
- Sleep Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Villanueva V, Garcés M, López-González F, Rodriguez-Osorio X, Toledo M, Salas-Puig J, González-Cuevas M, Campos D, Serratosa J, González-Giráldez B, Mauri J, Camacho J, Suller A, Carreño M, Gómez J, Montoya J, Rodríguez-Uranga J, Saiz-Diaz R, González-de la Aleja J, Castillo A, López-Trigo J, Poza J, Flores J, Querol R, Ojeda J, Giner P, Molins A, Esteve P, Baiges J. Safety, efficacy and outcome-related factors of perampanel over 12 months in a real-world setting: The FYDATA study. Epilepsy Res 2016; 126:201-10. [DOI: 10.1016/j.eplepsyres.2016.08.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 07/18/2016] [Accepted: 08/03/2016] [Indexed: 01/05/2023]
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Bartolini E, Falchi M, Zellini F, Parrini E, Grisotto L, Cosottini M, Posar A, Parmeggiani A, Ambrosetto G, Ferrari AR, Santucci M, Salas-Puig J, Barba C, Guerrini R. The syndrome of polymicrogyria, thalamic hypoplasia, and epilepsy with CSWS. Neurology 2016; 86:1250-9. [DOI: 10.1212/wnl.0000000000002526] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022] Open
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26
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Toledo M, Sarria-Estrada S, Quintana M, Maldonado X, Martinez-Ricarte F, Rodon J, Auger C, Salas-Puig J, Santamarina E, Martinez-Saez E. Prognostic implications of epilepsy in glioblastomas. Clin Neurol Neurosurg 2015; 139:166-71. [PMID: 26489387 DOI: 10.1016/j.clineuro.2015.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 09/04/2015] [Accepted: 10/05/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The role of seizures and antiepileptic treatments associated with glioblastoma is a current topic of discussion. The objective of this study is to characterize and establish implications of epilepsy associated with glioblastoma. PATIENTS AND METHODS We retrospectively analyzed the medical history, focused on epileptic features of 134 histologically diagnosed glioblastoma over a period of 4 years. RESULTS The sample group had an average age of 56 years and 66% were male. Complete tumor resection was performed in 66% and 64.2% received further radio-oncologic treatment. The average survival rate was 12.4 months and 11.5% survived to 5 years. Epileptic seizures were the presentation symptom in 27% of cases and 51% suffered seizures during the disease, 26% become drug-resistant. Focal evolving to a bilateral convulsive seizures were the most frequent type. Epileptic seizures at presentation independently predicted longer survival (p<0.001). Furthermore, a history of epilepsy or seizures during disease improved survival. Late onset seizures, recurrences or status epilepticus during the course of the disease indicated tumor progression or the final stages of life. Prophylactic antiepileptic drugs did not prevent seizures. Similarly, there was no difference in survival between patients who did not use antiepileptic drugs and those using valproate or levetiracetam. Patients under 60 years, full oncologic treatment and secondary glioblastomas were factors that improved survival (p<0.001). CONCLUSION Previous history of epilepsy or the onset of seizures as a presentation symptom in glioblastomas predict longer survival. Half of patients have seizures during the course of the disease. Antiepileptic drugs alone do not increase survival in glioblastoma patients.
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Affiliation(s)
- Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
| | - Silvana Sarria-Estrada
- MR Unit, Radiology Department, Institut Diagnostic per la Imatge, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Xavier Maldonado
- Oncologic Radiotherapy Department, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Francisco Martinez-Ricarte
- Neurosurgery Department, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jordi Rodon
- Vall d'Hebron Institut of Oncology, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Cristina Auger
- MR Unit, Radiology Department, Institut Diagnostic per la Imatge, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Javier Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Elena Martinez-Saez
- Neuropathology Unit, Pathology Department, Vall d́Hebron University Hospital, Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Fernández-Suárez E, Villa-Estébanez R, Garcia-Martinez A, Fidalgo-González JA, Zanabili Al-Sibbai AA, Salas-Puig J. [Prevalence, type of epilepsy and use of antiepileptic drugs in primary care]. Rev Neurol 2015; 60:535-542. [PMID: 26062825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Epilepsy is a disease with great social and economic impact. The prevalence should be used as the most important basis for planning the secondary and tertiary prevention. AIMS To identify patients with a diagnosis of epilepsy in a primary care center and determine the prevalence, demographic characteristics, type of epileptic syndrome and the use of antiepileptic drugs. PATIENTS AND METHODS Retrospective cross-sectional descriptive study. Included 196 patients with a diagnosis of epilepsy belonging to a primary care center and review the medical history, studying socio-demographic variables and clinical-pharmacological. RESULTS The prevalence of epilepsy: 8.4/1000 inhabitants. Mean age: 50.3 years. Sex: 52.6% men. SCOPE 79.6% urban. Family history of epilepsy: 14.8%. Type of epilepsy: symptomatic focal stroke (14.3%), idiopathic generalized (13.8%), focal cryptogenic (8.7%), not classified (31.1%). Average age at the beginning of seizures: 31.6 years. Neurological and/or psychiatric comorbidity: 62.8%. Last follow-up: 18.9% without antiepileptic treatment, 56.6% monotherapy and 24.5% polytherapy. Seizure-free: 76.5%. Drugs most frequently prescribed: valproic acid, carbamazepine, phenytoin, lamotrigine, levetiracetam. 78.6% without side effects. Exitus: 4.1%. CONCLUSIONS The prevalence of patients with epilepsy was 8.4/1000 inhabitants, most frequent etiology the symptomatic focal stroke. More than half of patients suffered neurological and/or psychiatric comorbidity. At the end of follow-up the great majority were seizure-free without adverse effects of the antiepileptic drug treatment.
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González-Cuevas M, Toledo M, Santamarina E, Sueiras-Gil M, Cambrodí-Masip R, Sarria S, Quintana M, Salas-Puig J. [Visual epileptic seizures. Signs and symptoms, and clinical implications]. Rev Neurol 2015; 60:257-262. [PMID: 25760720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Visual phenomena can be symptoms of epileptic seizures, although with an uncertain clinical meaning and relationship with the epileptogenic focus. AIMS To describe the clinical implications of visual epileptic seizures according to their signs and symptoms in adults. PATIENTS AND METHODS Data were collected consecutively over a period of one year from patients who reported visual signs and symptoms as the main manifestation of their seizures, and the visual symptoms are classified according to the characteristics of the description. RESULTS The sample consisted of 78 patients, with a mean age of 43.5 years. Focal epilepsy accounted for 97% of the cases. Of the 63% that were symptomatic epilepsies, 57% were vascular. The visual seizures were, in 81.9% of cases, the aura prior to the seizure, and 17.9% were isolated visual seizures. The coexistence of visual seizures and other types of seizure was associated to pharmacoresistance (p = 0.021). The visual symptoms reported were as follows: simple hallucinations (55.1%), illusions (23.1%), complex hallucinations (15.4%) and loss of vision (6.4%). The lobar localisation of the lesions was occipital (24.4%), temporoparietooccipital (21.8%), temporal (9%), parietal (3.8%) and frontal (1.3%). Occipital lesions were associated with simple visual hallucinations (p < 0.001), and visual illusions and complex visual hallucinations, with lesions affecting the temporoparietooccipital junction (p < 0.05). Of the 55.1% of patients with a unilateral lesion in the magnetic resonance scan, 33% reported symptoms in the contralateral visual hemifield. CONCLUSIONS Visual seizures mainly present as epileptic auras. Simple hallucinations are related with an occipital origin, whereas complex hallucinations are associated with more anterior regions of the brain. The appearance of lateralised visual phenomena suggests an origin located in the contralateral hemisphere.
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Villanueva V, Serratosa JM, Guillamón E, Garcés M, Giráldez BG, Toledo M, Salas-Puig J, López González FJ, Flores J, Rodríguez-Uranga J, Castillo A, Mauri JA, Camacho JL, López-Gomáriz E, Giner P, Torres N, Palau J, Molins A. Long-term safety and efficacy of eslicarbazepine acetate in patients with focal seizures: results of the 1-year ESLIBASE retrospective study. Epilepsy Res 2014; 108:1243-52. [PMID: 24908564 DOI: 10.1016/j.eplepsyres.2014.04.014] [Citation(s) in RCA: 51] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/28/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Eslicarbazepine acetate (ESL) is a new antiepileptic drug (AED) licensed as adjunctive therapy in adults with partial-onset or focal seizures. OBJECTIVE To evaluate in a clinical practice setting the long-term efficacy and safety of ESL in patients with focal seizures. METHODS ESLIBASE was a retrospective study that included all patients with focal seizures who started ESL between January 2010 and July 2012 at 12 hospitals. ESL was prescribed individually according to real-life practice. Efficacy and safety were evaluated over 1 year. Switching from carbamazepine (CBZ) and oxcarbazepine (OXC) was assessed. RESULTS Three hundred and twenty-seven patients were included; 78% of patients were taking ≥2 other AEDs at baseline. Most (87%) began ESL because of poor seizure control and 13% because of adverse events (AEs) with CBZ or OXC. After 1 year, 237 patients (72.4%) remained on ESL. At 3, 6 and 12 months, the responder rate was 46.3%, 57.9%, and 52.5%, and 21.0%, 28.0%, and 25.3% of patients were seizure free. The responder rate significantly increased when ESL was combined with a non-sodium channel-targeting drug (non-SC drug) (66.7%) versus an SC drug (47.7%; p<0.001). At 12 months, 40.7% of patients had ≥1 AE; AEs led to treatment discontinuation in 16.2%. Dizziness, nausea, and somnolence were the most common AEs. The tolerability profile improved in >50% of the patients who switched from CBZ or OXC to ESL because of AEs. CONCLUSIONS ESL was well tolerated and effective in a real-world setting over 1 year. Side-effect profile improved when OXC and CBZ recipients were switched to ESL.
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Affiliation(s)
- V Villanueva
- Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - J M Serratosa
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - E Guillamón
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M Garcés
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - B G Giráldez
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - M Toledo
- Hospital Universitario Vall d́Hebron, Barcelona, Spain
| | - J Salas-Puig
- Hospital Universitario Vall d́Hebron, Barcelona, Spain
| | - F J López González
- Complejo Hospitalario Universitario Santiago, Santiago de Compostela, Spain
| | - J Flores
- Hospital Universitario Nuestra Señora Candelaria, Tenerife, Spain
| | - J Rodríguez-Uranga
- Instituto de Especialidades Neurológicas (IENSA), Clinica Sagrado Corazón, Sevilla, Spain
| | - A Castillo
- Consorcio Hospital General Universitario Valencia, Valencia, Spain
| | - J A Mauri
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J L Camacho
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - P Giner
- Hospital Universitario, Dr. Peset, Valencia, Spain
| | - N Torres
- Hospital Universitario, Dr. Peset, Valencia, Spain
| | - J Palau
- Hospital de Manises, Manises, Spain
| | - A Molins
- Hospital Universitario Dr. JosepTrueta, Girona, Spain
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Miró J, Aiguabella M, Veciana M, Juvany R, Santurino M, Leiva E, Salas-Puig J, Falip M. Low-dose sodium valproate in the treatment of idiopathic generalized epilepsies. Acta Neurol Scand 2014; 129:e20-3. [PMID: 24372179 DOI: 10.1111/ane.12216] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Most patients with idiopathic generalized epilepsies (IGEs) have good seizure control when on antiepileptic drugs. To analyze prospectively the response to low-dose sodium valproate (VPA) treatment (<1000 mg/day) together with plasma VPA levels in a cohort of patients with IGE. METHODS Patients with IGE were selected and followed for almost 2 years. In patients on VPA with no seizures in the last year, VPA dose was lowered to <1000 mg/day. Newly diagnosed patients with IGE started treatment on VPA directly on this low dose. RESULTS Fifty-four patients were included, with juvenile myoclonic epilepsy (JME) in 23 (42.6%), juvenile absence epilepsy (JAE) in 17 (31.5%), and generalized tonic-clonic seizures only (GTCS only) in 14 (25.9%). VPA at low dose was administered to 38 (70%) patients. Mean plasma VPA level was 44.21 mg/l (18-78; SD 15.18). Seizure relapse during the 2-year follow-up was observed in 8 (21%). A reduction in adverse events was observed (P < 0.048). The only factor related to efficacy of VPA at low dose was syndromic diagnosis. Low-dose VPA controlled 92.9% (13) of patients with GTCS only, 78.3% (18) of those with JME, and 29.5% (5) of those with JAE. CONCLUSIONS Low-dose VPA was a highly effective treatment for the majority of those with JME and GTCS only. The seizures in JAE tended to be more resistant to treatment, usually requiring higher doses of VPA or polytherapy.
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Affiliation(s)
- J. Miró
- Epilepsy Unit; Hospital Universitari de Bellvitge; Hospitalet de Llobregat Spain
- Cognition and Brain Plasticity Group; Bellvitge Biomedical Research Institute (IDIBELL); Hospitalet de Llobregat Spain
| | - M. Aiguabella
- Epilepsy Unit; Hospital Universitari de Bellvitge; Hospitalet de Llobregat Spain
- Neurology Department; Hospital de Sant Boi; Sant Boi Spain
| | - M. Veciana
- Epilepsy Unit; Hospital Universitari de Bellvitge; Hospitalet de Llobregat Spain
| | - R. Juvany
- Pharmacy Department; Hospital Universitari de Bellvitge; Hospitalet de Llobregat Spain
| | - M. Santurino
- Epilepsy Unit; Hospital Universitari de Bellvitge; Hospitalet de Llobregat Spain
| | - E. Leiva
- Pharmacy Department; Hospital Universitari de Bellvitge; Hospitalet de Llobregat Spain
| | - J. Salas-Puig
- Epilepsy Unit; Hospital Universitari de la Vall d'Hebron; Barcelona Spain
| | - M. Falip
- Epilepsy Unit; Hospital Universitari de Bellvitge; Hospitalet de Llobregat Spain
- Cognition and Brain Plasticity Group; Bellvitge Biomedical Research Institute (IDIBELL); Hospitalet de Llobregat Spain
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González-Cuevas M, Toledo M, Santamarina E, Sueiras-Gil M, Cambrodí-Masip R, Sarria S, Quintana M, Alvarez-Sabín J, Salas-Puig J. [Malformations of cortical development in adult patients with epilepsy: a series of 79 cases]. Rev Neurol 2014; 58:147-151. [PMID: 24504876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Malformations of cortical development (MCD) are an important cause of epilepsy, delayed psychomotor development or neurological deficits. AIM. To report on the long-term clinical course and differential characteristics of several groups of MCD in adults with epilepsy. PATIENTS AND METHODS Our sample consisted of patients over 16 years of age with MCD confirmed by magnetic resonance imaging, and epilepsy. The characteristics of the epilepsy, presence of neurological deficits, intellectual disability, history of perinatal pathology and electroencephalogram recordings were analysed. The patients were classified into three groups (G) in accordance with the Barkovich classification. RESULTS A total of 85 patients with MCD were identified from 2630 patients with epilepsy and 79 of them were finally included in the sample. Mean age: 37 years, 57% were females. Mean age at onset of the crises: 17.8 years, and 59.5% were medication resistant. The distribution of the cases according to the Barkovich classification was: G1 (alterations affecting neuronal proliferation): 59.5%; G2 (alterations affecting migration): 25.3%; and G3 (alterations affecting cortical organisation): 15.2%. Focal neurological deficit was observed in 19% and 34.2% had an intelligence quotient < 80. On analysing by groups, G3 was found to display a higher percentage of focal neurological and intelligence quotient deficits than G1 and G2 (p < 0.05). CONCLUSIONS Patients with MCD in G3 are more likely to have neurological deficit, intellectual disability and better control over their crises than patients from G1 and G2, most of whom present refractory epilepsy.
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Torres-Ferrús M, Toledo M, González-Cuevas M, Seró-Ballesteros L, Santamarina E, Raspall-Chaure M, Sueiras-Gil M, Cambrodí-Masip R, Sarria S, Álvarez-Sabín J, Salas-Puig J. [Aetiology and treatment of epilepsy in a series of 1,557 patients]. Rev Neurol 2013; 57:306-312. [PMID: 24052441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The aetiology of epilepsy is an important decisive factor in its treatment and prognosis. Diagnostic and therapeutic advances suggest that the causal distribution, treatment and prognosis of the population with epilepsy may have undergone some modification. AIM To describe the distribution of syndromes, aetiology and pharmacological treatment in patients with epilepsy. PATIENTS AND METHODS We conducted a cross-sectional descriptive study of patients with epilepsy who were treated consecutively in our epilepsy department. Demographic data were collected, together with information about syndromes, aetiology and pharmacological treatment at the time of eligibility. The data were analysed jointly and by age groups. RESULTS Altogether 1,557 patients were included, 54% of them males. Seventy-three per cent of the sample had focal epilepsy, which was secondary to a structural lesion in 56% of patients. Generalised epilepsies accounted for 20%. Five per cent were unclassifiable. By ages, vascular causation predominated in practically all the groups and its prevalence increased with age. The most commonly used antiepileptic drugs were valproic acid (29%), levetiracetam (27%) and carbamazepine (20%). Seventy per cent of the generalised epilepsies and 57% of the focal ones were on monotherapy treatment. CONCLUSIONS The prevalence by age groups was similar to that reported in developed countries, although a lower prevalence of cryptogenic epilepsies was observed. More than 60% of patients followed monotherapy and valproic acid was the most widely used.
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MESH Headings
- Adolescent
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Anticonvulsants/therapeutic use
- Brain Injuries/complications
- Brain Neoplasms/complications
- Cross-Sectional Studies
- Encephalitis/complications
- Epilepsies, Partial/drug therapy
- Epilepsies, Partial/epidemiology
- Epilepsies, Partial/etiology
- Epilepsy/classification
- Epilepsy/drug therapy
- Epilepsy/epidemiology
- Epilepsy/etiology
- Epilepsy, Generalized/drug therapy
- Epilepsy, Generalized/epidemiology
- Epilepsy, Generalized/etiology
- Female
- Hemangioma, Cavernous, Central Nervous System/complications
- Hospitals, University
- Humans
- Hypoxia, Brain/complications
- Intracranial Arteriovenous Malformations/complications
- Male
- Meningeal Neoplasms/complications
- Middle Aged
- Spain/epidemiology
- Stroke/complications
- Tuberous Sclerosis/complications
- Young Adult
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Kasteleijn-Nolst Trenité DGA, Schmitz B, Janz D, Delgado-Escueta AV, Thomas P, Hirsch E, Lerche H, Camfield C, Baykan B, Feucht M, Martínez-Juárez IE, Duron RM, Medina MT, Rubboli G, Jerney J, Hermann B, Yacubian E, Koutroumanidis M, Stephani U, Salas-Puig J, Reed RC, Woermann F, Wandschneider B, Bureau M, Gambardella A, Koepp MJ, Gelisse P, Gurses C, Crespel A, Nguyen-Michel VH, Ferlazzo E, Grisar T, Helbig I, Koeleman BPC, Striano P, Trimble M, Buono R, Cossette P, Represa A, Dravet C, Serafini A, Berglund IS, Sisodiya SM, Yamakawa K, Genton P. Consensus on diagnosis and management of JME: From founder's observations to current trends. Epilepsy Behav 2013; 28 Suppl 1:S87-90. [PMID: 23756490 DOI: 10.1016/j.yebeh.2012.11.051] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [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] [Received: 11/17/2012] [Accepted: 11/20/2012] [Indexed: 10/26/2022]
Abstract
An international workshop on juvenile myoclonic epilepsy (JME) was conducted in Avignon, France in May 2011. During that workshop, a group of 45 experts on JME, together with one of the founding fathers of the syndrome of JME ("Janz syndrome"), Prof. Dr. Dieter Janz from Berlin, reached a consensus on diagnostic criteria and management of JME. The international experts on JME proposed two sets of criteria, which will be helpful for both clinical and scientific purposes. Class I criteria encompass myoclonic jerks without loss of consciousness exclusively occurring on or after awakening and associated with typical generalized epileptiform EEG abnormalities, with an age of onset between 10 and 25. Class II criteria allow the inclusion of myoclonic jerks predominantly occurring after awakening, generalized epileptiform EEG abnormalities with or without concomitant myoclonic jerks, and a greater time window for age at onset (6-25years). For both sets of criteria, patients should have a clear history of myoclonic jerks predominantly occurring after awakening and an EEG with generalized epileptiform discharges supporting a diagnosis of idiopathic generalized epilepsy. Patients with JME require special management because their epilepsy starts in the vulnerable period of adolescence and, accordingly, they have lifestyle issues that typically increase the likelihood of seizures (sleep deprivation, exposure to stroboscopic flashes in discos, alcohol intake, etc.) with poor adherence to antiepileptic drugs (AEDs). Results of an inventory of the different clinical management strategies are given. This article is part of a supplemental special issue entitled Juvenile Myoclonic Epilepsy: What is it Really?
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Raspall-Chaure M, Lainez E, Toledo M, Salas-Puig J, Macaya-Ruiz A, Roig-Quilis M. [Reversible encephalopathy caused by valproic acid in an adolescent with idiopathic generalised epilepsy]. Rev Neurol 2012; 55:663-668. [PMID: 23172093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Encephalopathy due to valproic acid (VPA) is a rare complication leading to a disorder that affects the patient's mental status to a greater or lesser extent and which can be accompanied by a paradoxical worsening of the seizures. The diagnosis is obvious when it appears within the context of hyperammonemia or a liver pathology, but can be difficult to diagnose if it appears in isolation in patients who show no other signs of intoxication due to VPA. CASE REPORT We report the case of an adolescent who suffered idiopathic generalised epilepsy and presented sub-acute cognitive impairment and a worsening of his pattern of seizures some months after starting treatment with VPA. These manifestations were accompanied by a slowing of the baseline electroencephalogram (EEG) tracing; no biochemical signs of overdosage or toxicity that could be attributed to the drug or any other possible aetiology were observed. Withdrawing VPA resulted in a swift improvement in the patient's mental status and in the control of his seizures. Likewise, EEG recordings also returned to normal. CONCLUSIONS Encephalopathy due to VPA should be considered in patients who present a deterioration of their neurological status, whether associated to an aggravation of their seizures or not, despite the absence of any analytical signs suggestive of VPA toxicity or overdosage. If liver functioning is not affected, withdrawal of the drug will determine the disappearance of the symptoms and will also allow confirmation of the diagnosis.
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Affiliation(s)
- Miquel Raspall-Chaure
- Servicio de Neurología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, España.
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Sánchez-Álvarez J, Gil-Nagel A, Casas-Fernández C, Mauri-Llerda J, Salas-Puig J, Sancho-Rieger J. Epilepsia resistente a fármacos antiepilépticos: recomendaciones de actuación diagnóstica y terapéutica en España. Neurologia 2012; 27:575-84. [DOI: 10.1016/j.nrl.2011.09.005] [Citation(s) in RCA: 4] [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] [Received: 09/01/2011] [Accepted: 09/05/2011] [Indexed: 10/15/2022] Open
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Sánchez-Álvarez J, Mauri-Llerda J, Gil-Nagel A, Casas-Fernández C, Salas-Puig J, Lahuerta J, Sancho-Rieger J. Consensus-recommended diagnostic and therapeutic guidelines for drug-resistant epilepsy in Spain (Consenso RATE-España). Neurología (English Edition) 2012. [DOI: 10.1016/j.nrleng.2011.09.004] [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: 11/16/2022] Open
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Sánchez-Álvarez JC, Mauri-Llerda JA, Gil-Nagel A, Casas-Fernández C, Salas-Puig J, Lahuerta J, Sancho-Rieger J. Consensus-recommended diagnostic and therapeutic guidelines for drug-resistant epilepsy in Spain (Consenso RATE-España). Neurologia 2011; 27:481-90. [PMID: 22078652 DOI: 10.1016/j.nrl.2011.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 09/06/2011] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To ascertain the opinions of an Epilepsy Expert Group and prepare a consensus document on the definition of drug-resistant epilepsy (DRE) according to the International League Against Epilepsy (ILAE) and the different healthcare levels for the patient with epilepsy in Spain. MATERIAL AND METHODS The study was conducted using the Delphi method, by means of successive rounds of questionnaires. A scientific committee prepared a preliminary document and fourteen associated questions, which were sent by e-mail to the panel of experts. They included items related to the concept of DRE, health care levels and the route between these levels for patients with DRE. RESULTS A total of 41 experts answered the questionnaire. They agreed regarding the necessity and applicability of the DRE definition according to the ILAE, the need for an expert panel on epilepsy, specialist epilepsy clinics, and clinical epilepsy units stratified depending on the level of activities they carried out. There was moderate consensus on the resources and activity of the clinical units of reference and there was no consensus on the referral of patients who have suffered an epileptic seizure to an epilepsy clinic. CONCLUSIONS The expert panel agreed with the definition of DRE according to the ILAE and on referring patients with DRE for a detailed study in an epilepsy clinic or epilepsy clinical unit. They highlighted the need for video-EEG monitoring in the study of patients with DRE and the need to propose other forms of treatment in selected patients.
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Affiliation(s)
- J C Sánchez-Álvarez
- Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico Universitario San Cecilio, Granada, España.
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Sierra-Marcos A, Toledo M, Quintana M, Edo M, Centeno M, Santamarina E, Sueiras M, Rovira R, Salas-Puig J, Alvarez-Sabin J. Diagnosis of epileptic syndrome after a new onset seizure and its correlation at long-term follow-up: Longitudinal study of 131 patients from the emergency room. Epilepsy Res 2011; 97:30-6. [DOI: 10.1016/j.eplepsyres.2011.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 06/01/2011] [Accepted: 06/26/2011] [Indexed: 10/18/2022]
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Sarria S, Toledo M, Santamarina E, Salas-Puig J, Rovira A. [Mesial temporal sclerosis in a case of en coup de sabre linear scleroderma ]. Rev Neurol 2011; 53:316. [PMID: 21796609] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- S Sarria
- Hospital Universitari Vall d'Hebron, 08035 Barcelona, Espana
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Granda-Méndez J, Toledo M, Flores-Flores A, Santamarina E, Sarria S, Salas-Puig J. [Intravenous lacosamide in monotherapy in a case of complex partial epileptic status]. Rev Neurol 2011; 53:61-64. [PMID: 21678328] [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: 05/30/2023]
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Salas-Puig J. [A new proposal for the classification of epileptic seizures and epilepsies by the International League Against Epilepsy (ILAE)]. Rev Neurol 2011; 52:513-514. [PMID: 21484721] [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: 05/30/2023]
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Rodriguez-Rodriguez S, Salas-Puig J, Alvarez-Carriles JC, Temprano-Fernandez T, Anton-Gonzalez C, Garcia-Martinez A. [Development of Lennox-Gastaut syndrome in adulthood]. Rev Neurol 2011; 52:257-263. [PMID: 21341220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Lennox-Gastaut syndrome (LGS) is an epileptic encephalopathy that starts in childhood and has an unknown pathophysiological mechanism. Studies on the progress of LGS reveal a poor prognosis. PATIENTS AND METHODS A retrospective study of 1629 patients with epilepsy was conducted. Patients included in the study were those with an age of onset during childhood, tonic seizures and atypical absences (who might also suffer from other types of seizures); electroencephalogram (EEG) showing generalised slow spike-wave and generalised fast activity; mental retardation and a follow-up time of at least 10 years. RESULTS The sample consisted of 12 patients, 9 of whom were males. Follow-up time: 20 years. Onset of seizures: 3 years. Cryptogenic LGS: 67%; symptomatic: 33%. Frequency of the seizures at onset: daily (83.3%) or weekly (16.7%). Types of seizures: tonic and atypical absences (100%); drop-attacks (83%); generalised tonic-clonic (75%); myoclonias (41.7%); partial (8.3%) and pseudo-epileptic (8.3%). EEG with slow background activity, generalised slow spike-wave and generalised fast activity: 100%. Fifty percent of the patients had at least one epileptic status. They used an average of 7.5 different antiepileptic drugs. At the end of the follow-up 33% were suffering from seizures on a daily basis; 17% were weekly and 42% monthly. A total of 8.3% were free from seizures. All of them were following combination therapy: 17% in bitherapy and 83% with an average of 3.8 drugs (range: 3-5). A total of 92% suffered from severe or very severe mental retardation. Fifty percent required neuroleptic drugs due to behavioural disorders. CONCLUSIONS Despite the fact that the diagnosis of LGS is serious, we observed a decrease in the number of seizures after several years of development, although the antiepileptic combination therapy remains constant. The mental retardation and behavioural disorders lead to a poor functional prognosis.
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Salvado-Figueras M, Guzman-Garcia L, Toledo M, Salas-Puig J, Lorenzo-Bosquet C, Cuberas-Borros G, Sueiras-Gil M, Rovira R, Sarria S, Rovira A. [Focal hyperperfusion associated to ictal periodic lateralised epileptiform discharges]. Rev Neurol 2011; 52:188-189. [PMID: 21287496] [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: 05/30/2023]
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Rodrigo L, Alvarez N, Salas-Puig J, Hernández-Lahoz C. Angelman syndrome and celiac disease. Rev Esp Enferm Dig 2010; 102:450-451. [PMID: 20617869 DOI: 10.4321/s1130-01082010000700011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Flores-Flores A, Sueiras-Gil M, Toledo M, Garcia B, Lorenzo-Bosquet C, Rovira A, Cuberas-Borros G, Auger-Acosta C, Salas-Puig J. [Non-convulsive status epilepticus secondary to subarachnoid haemorrhage as the presenting symptom of a cerebral amyloid angiopathy]. Rev Neurol 2010; 50:279-282. [PMID: 20217646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Cerebral amyloid angiopathy is a frequent cause of haemorrhagic cerebrovascular disease in persons over the age of 65 and, sometimes, the initial symptoms can be epilepsy-like. CASE REPORT A 62-year-old female with no relevant past history who was admitted to hospital due to non-convulsive status epilepticus, auditory hallucinations and ideomotor apraxia; an electroencephalogram performed on the patient revealed periodic lateralised epileptiform discharges in the right parietooccipital region. Susceptibility-weighted magnetic resonance imaging showed a sub-acute focal subarachnoid haemorrhage in the right parietotemporal region and cortico-subcortical microbleeding in different stages of the progression of the disease that were compatible with cerebral amyloid angiopathy. A critical simple single-photon emission tomography scan was performed and findings revealed an area of hyperperfusion in the same region. Antiepileptic treatment was established with clinical, neurophysiological and scintigraphic resolution. CONCLUSIONS The article reports a case with non-convulsive status epilepticus as the initial symptom of cerebral amyloid angiopathy. It also highlights the usefulness of sequences of susceptibility-weighted magnetic resonance imaging and the physiopathogenesis of periodic lateralised epileptiform discharges as an element of epileptic activity is discussed.
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Affiliation(s)
- Alan Flores-Flores
- Servicio de Neurología, Hospital Universitari Vall d'Hebron. Barcelona, España.
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Ribacoba R, Menéndez-González M, Calleja S, Salas-Puig J, de la Vega V. Partial motor status epilepticus as a clinical manifestation of carotid stenosis. Int Arch Med 2010; 3:18. [PMID: 20815934 PMCID: PMC2942812 DOI: 10.1186/1755-7682-3-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 09/06/2010] [Indexed: 11/10/2022] Open
Abstract
Limb shaking (LS) is often confused with focal motor seizures. Distinguishing between both is crucial, because LS may represent an indicator of severe carotid occlusive disease and patients are at high risk of stroke. We report the case of a patient with occlusive carotid stenosis without definite stroke who develops partial motor status epilepticus (SE). Clinical, neuroimaging and electroencephalographic findings are provided. We conclude that focal motor seizures should be distinguished from LS based on clinical and electroencephalographic findings.
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Ribacoba R, Menéndez M, Salas-Puig J. [Refractory epilepsy and crossed cerebellar diaschisis]. Neurologia 2009; 24:211-213. [PMID: 19418301] [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: 05/27/2023] Open
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Salas-Puig J, Gil-Nagel A, Serratosa JM, Sánchez-Alvarez JC, Elices E, Villanueva V, Carreño M, Alvarez-Carriles J, Porcel J. Self-reported memory problems in everyday activities in patients with epilepsy treated with antiepileptic drugs. Epilepsy Behav 2009; 14:622-7. [PMID: 19435588 DOI: 10.1016/j.yebeh.2009.01.015] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 12/18/2008] [Accepted: 01/21/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The goal of this study was to assess everyday memory complaints in a large cohort of patients with epilepsy treated with antiepileptic drugs and to determine demographic, clinical, and emotional state factors associated with patients' self-perception of memory disturbances. METHODS This cross-sectional epidemiological study was carried out in routine clinical practice using the Questionnaire of Memory Efficiency (QME) and the Hospital Anxiety and Depression Scale (HADS). RESULTS Six hundred sixty-one patients were recruited. The time since epilepsy diagnosis was 17.3 years (SD=12.5); the number of seizures in the past year 13.8 (SD=4.8); the proportion of patients free of seizures in the last year 42.5%; the proportion of patients with partial seizures 73.2%; and the proportion of patients on monotherapy 56.3%. Total QME score was 110.0 (SD=18.6). Depression and anxiety scores and polytherapy explained 38.7% of the QME variance. CONCLUSIONS Subjective memory functioning in this cohort of patients with epilepsy was relatively good. Complaints expressed by these patients are explained mainly by the presence of depressive and anxiety symptoms.
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Affiliation(s)
- J Salas-Puig
- Neurology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Temprano T, Salas-Puig J, Calleja-Puerta S, Zanabili Al-Sibbai AA, Lahoz CH. [Post-stroke epilepsy]. Rev Neurol 2009; 48:171-177. [PMID: 19226483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIMS To study the characteristics and clinical course of the seizures in patients with post-stroke epilepsy, to evaluate the clinical behaviour of the epilepsy depending on the early or late onset of the seizures, and to analyse the effectiveness of antiepileptic treatment. PATIENTS AND METHODS Since 1990, a total of 1400 patients have been analysed at the epilepsy service. Epilepsy was diagnosed as having a vascular origin in 69, and after suffering a stroke 41. A retrospective study was conducted with the following eligibility criteria: suffering a stroke and, later, at least one crisis as a result of the first event. RESULTS Mean age at the time of the stroke: 54.7 +/- 20.5 years (range: 3-85 years). FOLLOW-UP 7.6 years (53.7% over 5 years). Type of stroke: ischaemic, 75.6%, and haemorrhagic 24.4%. Aetiology of the stroke: atherothrombotic, 29.2%, and cardioembolic, 24.4%. Mean interval between the stroke and the first seizure: 18 months (range: 0-17 years) (six patients the same day the stroke occurred, all of which were haemorrhagic). Type of seizures: secondarily generalised partial, 60.9%; generalised primary, 21.9%; and partial, 17.1%. Single crisis: 19.5%. Early seizures, 36.6%, and late, 63.4%. In all, 19.1% of the patients suffered a single crisis after the stroke. TREATMENT phenytoin (43.9%), carbamazepine (19.5%) and lamotrigine (19.5%). Fourteen patients required combination therapy. At the end of the follow-up 53.7% were free of seizures. CONCLUSIONS In the analysis that was performed, an association was found between a cardioembolic aetiology and late onset of the seizures. On comparing the type of seizures, early versus late, the courses paralleled each other in the two types of patients. A little over half the patients were free of seizures.
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Affiliation(s)
- T Temprano
- Servicio de Neurología, Hospital Universitario Central de Asturias, 33006 Oviedo, Asturias, España.
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Villanueva V, Gil-Nágel A, Elices E, Serratosa JM, Sánchez-Alvarez JC, Carreño M, Salas-Puig J, Porcel J. Validation of the Spanish version of the Side Effect and Life Satisfaction Inventory in patients with epilepsy. Epilepsy Behav 2009; 14:96-101. [PMID: 18814854 DOI: 10.1016/j.yebeh.2008.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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] [Received: 07/30/2008] [Revised: 09/03/2008] [Accepted: 09/05/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The goal of the study described here was to obtain psychometric validation of the Spanish version of the 38-item Side Effects and Life Satisfaction (SEALS) Inventory. METHODS A cross-cultural adaptation of the inventory was performed. A total of 595 patients with epilepsy were included in a multicenter cross-sectional study. The SEALS Inventory was completed, together with the Hospital Anxiety and Depression Scale and SF-12 Health Survey. RESULTS The mean SEALS score was 60.7. SEALS presented high internal consistency, with a Cronbach alpha coefficient of 0.93, and good test-retest reliability, with an intraclass correlation coefficient of 0.92. The pattern of correlations with the Hospital Anxiety and Depression Scale and SF-12 Health Survey indicated good convergent and divergent validity. SEALS scores discriminated patients according to epilepsy-related factors, emotional disturbances, and the generic quality of life. CONCLUSION The Spanish version of the SEALS Inventory is a valid psychometric instrument. It may be used in routine clinical practice and in clinical trials in patients with epilepsy to capture the cognitive and behavioral aspects of quality of life.
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Affiliation(s)
- Vicente Villanueva
- Neurology Department, University Hospital La Fe de Valencia, Valencia, Spain.
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