SUMMARY Background. The concept of rational polytherapy implies using a combination of antiepileptic drugs with synergistic effect, which in turn, may result in additive or reduced toxicity. This concept is not consensually accepted. Aim. To present evidence in favour and against rational polytherapy. Methods. Narrative literature review on PubMed and Medline databases using the following terms: epilepsy treatment, rational therapy/polytherapy, supraadditive treatment, drug-resistant epilepsy treatment. Cited references within selected articles were also evaluated. Results. Against rational therapy is the evidence of clinical efficacy of the use of antiepileptic drugs with the same mechanism of action and without increased side-effects. Rational therapy may fail because while the addition of one antiepileptic drug to others with the same or different mechanisms of action leads to additive therapeutic efficacy, it also leads to more side effects. The evidence for the robust, unique, true synergism found between valproate and lamotrigine is questionable because the two drugs together may lead to complex pharmacokinetic interactions jeopardizing a consistent interpretation of the data. Data from studies with antiepileptic drugs with multiple mechanisms of action may be questionable because the same mechanism of action might not be responsible for drug efficacy or toxicity in different patients. Favouring rational therapy is the evidence that genetic animal models of seizures and drug-related neurotoxicity are ideal to evaluate the efficacy and toxicity of drug combinations, and that the most successful experimental combination of two antiepileptic drugs would be the one with a single mechanism of action and the other with a multiple mechanism of action. Conclusion. Rational therapy is a sub-optimal, but worth being attempted strategy for the use of antiepileptic drugs in combination.
{"title":"Rational polytherapy: Myth or reality?","authors":"J. Pimentel, J. L. Lopes Lima","doi":"10.21307/jepil-2019-003","DOIUrl":"https://doi.org/10.21307/jepil-2019-003","url":null,"abstract":"SUMMARY Background. The concept of rational polytherapy implies using a combination of antiepileptic drugs with synergistic effect, which in turn, may result in additive or reduced toxicity. This concept is not consensually accepted. Aim. To present evidence in favour and against rational polytherapy. Methods. Narrative literature review on PubMed and Medline databases using the following terms: epilepsy treatment, rational therapy/polytherapy, supraadditive treatment, drug-resistant epilepsy treatment. Cited references within selected articles were also evaluated. Results. Against rational therapy is the evidence of clinical efficacy of the use of antiepileptic drugs with the same mechanism of action and without increased side-effects. Rational therapy may fail because while the addition of one antiepileptic drug to others with the same or different mechanisms of action leads to additive therapeutic efficacy, it also leads to more side effects. The evidence for the robust, unique, true synergism found between valproate and lamotrigine is questionable because the two drugs together may lead to complex pharmacokinetic interactions jeopardizing a consistent interpretation of the data. Data from studies with antiepileptic drugs with multiple mechanisms of action may be questionable because the same mechanism of action might not be responsible for drug efficacy or toxicity in different patients. Favouring rational therapy is the evidence that genetic animal models of seizures and drug-related neurotoxicity are ideal to evaluate the efficacy and toxicity of drug combinations, and that the most successful experimental combination of two antiepileptic drugs would be the one with a single mechanism of action and the other with a multiple mechanism of action. Conclusion. Rational therapy is a sub-optimal, but worth being attempted strategy for the use of antiepileptic drugs in combination.","PeriodicalId":15683,"journal":{"name":"Journal of Epileptology","volume":"53 1","pages":"27 - 34"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88245762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-01DOI: 10.21307/JEPIL-2019-0001
J. Matzen, F. Schmitt, M. Kreissl, J. Voges, H. Heinze, I. Galazky
SUMMARY Introduction. So far, cardiac sympathetic dysfunction, demonstrated in pharmacoresistant epilepsy patients with ictal bradycardia or asystole by I-123 metaiodobenzylguanidine (I-123 MIBG) imaging has been attributed to repeated occurrence of seizure activity. Aim. Discussion of the mechanisms of cardiac sympathetic dysfunction associated with ictal asystole under consideration of a case with new onset epilepsy. Materials and methods. We describe the occurrence of a cardiac asystole during a complex-partial seizure in an antiepileptic-drug-naïve patient with new-onset symptomatic epilepsy. Results. MIBG imaging showed reduced tracer accumulation in cardiac sympathetic nerve endings in this patient with right parietotemporal glioblastoma. Discussion and Conclusion. To our knowledge, this is the first report of impaired cardiac sympathetic function in new-onset symptomatic epilepsy without antiepileptic drug treatment. MIBG imaging should be considered in patients with ictal bradycardia or asystole.
{"title":"Ictal asystole with reduced cardiac sympathetic function in new-onset symptomatic epilepsy","authors":"J. Matzen, F. Schmitt, M. Kreissl, J. Voges, H. Heinze, I. Galazky","doi":"10.21307/JEPIL-2019-0001","DOIUrl":"https://doi.org/10.21307/JEPIL-2019-0001","url":null,"abstract":"SUMMARY Introduction. So far, cardiac sympathetic dysfunction, demonstrated in pharmacoresistant epilepsy patients with ictal bradycardia or asystole by I-123 metaiodobenzylguanidine (I-123 MIBG) imaging has been attributed to repeated occurrence of seizure activity. Aim. Discussion of the mechanisms of cardiac sympathetic dysfunction associated with ictal asystole under consideration of a case with new onset epilepsy. Materials and methods. We describe the occurrence of a cardiac asystole during a complex-partial seizure in an antiepileptic-drug-naïve patient with new-onset symptomatic epilepsy. Results. MIBG imaging showed reduced tracer accumulation in cardiac sympathetic nerve endings in this patient with right parietotemporal glioblastoma. Discussion and Conclusion. To our knowledge, this is the first report of impaired cardiac sympathetic function in new-onset symptomatic epilepsy without antiepileptic drug treatment. MIBG imaging should be considered in patients with ictal bradycardia or asystole.","PeriodicalId":15683,"journal":{"name":"Journal of Epileptology","volume":"13 1","pages":"43 - 47"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75873274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Jȩdrzejczak, B. Majkowska-Zwolińska, D. Ryglewicz, E. Nagańska, M. Mazurkiewicz-Bełdzińska
SUMMARY Introduction In 2014, a group of Polish epilepsy experts published recommendations for antiepileptic drug (AED) use in adults with epilepsy. Selection of AEDs was based on the registration and reimbursement status in Poland, evidence of efficacy, and the personal views and experiences of the epilepsy practitioners. Method In 2018 previous recommendations were reviewed by the ad hoc group consisting of the authors of the original paper and additional epilepsy experts. As a result of joint work and reaching a consensus, an updated version of these recommendations has been prepared. Discussion and recommendations This update focuses on the epileptic seizure type treatment recommendations for initial monotherapy and add-on treatment in adult patients. Some new relevant aspects of treatment with AEDs are addressed, including information on the safety of valproic acid (VPA) in women of childbearing potential.
{"title":"Recommendations of the Polish Society of Epileptology for the treatment of epileptic seizure in adult patients in Poland: an update","authors":"J. Jȩdrzejczak, B. Majkowska-Zwolińska, D. Ryglewicz, E. Nagańska, M. Mazurkiewicz-Bełdzińska","doi":"10.21307/jepil-2019-002","DOIUrl":"https://doi.org/10.21307/jepil-2019-002","url":null,"abstract":"SUMMARY Introduction In 2014, a group of Polish epilepsy experts published recommendations for antiepileptic drug (AED) use in adults with epilepsy. Selection of AEDs was based on the registration and reimbursement status in Poland, evidence of efficacy, and the personal views and experiences of the epilepsy practitioners. Method In 2018 previous recommendations were reviewed by the ad hoc group consisting of the authors of the original paper and additional epilepsy experts. As a result of joint work and reaching a consensus, an updated version of these recommendations has been prepared. Discussion and recommendations This update focuses on the epileptic seizure type treatment recommendations for initial monotherapy and add-on treatment in adult patients. Some new relevant aspects of treatment with AEDs are addressed, including information on the safety of valproic acid (VPA) in women of childbearing potential.","PeriodicalId":15683,"journal":{"name":"Journal of Epileptology","volume":"37 1","pages":"9 - 16"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76463622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alendia Hartshorn, Yasser Shahrour, A. Andrew, K. Bujarski
SUMMARY Background. Video-EEG (VEEG) monitoring is a vital diagnostic tool, but there are no guidelines for withdrawal of antiepileptic drugs (AEDs). Aim. The main objectives of this study were to understand the different withdrawal strategies used in the EMU, how strategies are chosen, and the efficacy and safety of different withdrawal strategies in producing seizures. Materials and methods. We retrospectively analyzed 95 consecutive patients and measured time to first seizure, incidence of status epilepticus, and need for rescue medications. Results. We found that AED withdrawal strategies can be divided into four categories based on level of aggressiveness. The main factors which impacted choice of strategy was number of AEDs on admission and frequency of pre-admission seizures. Abrupt cessation of medications was correlated with longer time to first seizure compared to other methods (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.20–0.65, p = 0.0007). Patients remaining on medications had shorter time to first seizure (HR 2.98, 95% CI 1.22–7.24, p = 0.016). Withdrawal technique was not correlated with need for rescue medications (OR 5.0, 95% CI 0.77–43, p = 0.20). No patients had status epilepticus in the study. Conclusions. Pre-admission seizure frequency and number of AEDs are the main factors which drive choice of withdrawal strategy on the epilepsy monitoring unit (EMU). Counterintuitively, least aggressive strategy is associated with highest risk of seizures. Results of this analysis suggest that disease factors, not choice of withdrawal strategy, determine seizure frequency on the EMU.
摘要背景。视频脑电图(VEEG)监测是一种重要的诊断工具，但目前尚无抗癫痫药物(aed)的停药指南。的目标。本研究的主要目的是了解EMU中使用的不同戒断策略，如何选择策略，以及不同戒断策略在产生癫痫发作中的有效性和安全性。材料和方法。我们回顾性分析了95例连续患者，并测量了首次癫痫发作的时间、癫痫持续状态的发生率和对抢救药物的需求。结果。我们发现，AED退出策略可以根据攻击性程度分为四类。影响策略选择的主要因素是入院时AEDs的数量和入院前癫痫发作的频率。与其他方法相比，突然停药与首次发作时间较长相关(风险比(HR) 0.36, 95%可信区间(CI) 0.20-0.65, p = 0.0007)。继续服用药物的患者首次发作的时间较短(HR 2.98, 95% CI 1.22-7.24, p = 0.016)。戒断技术与抢救用药需求无关(OR 5.0, 95% CI 0.77-43, p = 0.20)。研究中没有患者出现癫痫持续状态。结论。入院前癫痫发作频率和抗癫痫药数量是影响癫痫监测单元(EMU)停药策略选择的主要因素。与直觉相反，最不激进的策略与癫痫发作的风险最高有关。分析结果表明，疾病因素，而不是停药策略的选择，决定了EMU上癫痫发作的频率。
{"title":"Determinants of medication withdrawal strategy in the epilepsy monitoring unit","authors":"Alendia Hartshorn, Yasser Shahrour, A. Andrew, K. Bujarski","doi":"10.21307/JEPIL-2018-006","DOIUrl":"https://doi.org/10.21307/JEPIL-2018-006","url":null,"abstract":"SUMMARY Background. Video-EEG (VEEG) monitoring is a vital diagnostic tool, but there are no guidelines for withdrawal of antiepileptic drugs (AEDs). Aim. The main objectives of this study were to understand the different withdrawal strategies used in the EMU, how strategies are chosen, and the efficacy and safety of different withdrawal strategies in producing seizures. Materials and methods. We retrospectively analyzed 95 consecutive patients and measured time to first seizure, incidence of status epilepticus, and need for rescue medications. Results. We found that AED withdrawal strategies can be divided into four categories based on level of aggressiveness. The main factors which impacted choice of strategy was number of AEDs on admission and frequency of pre-admission seizures. Abrupt cessation of medications was correlated with longer time to first seizure compared to other methods (hazard ratio (HR) 0.36, 95% confidence interval (CI) 0.20–0.65, p = 0.0007). Patients remaining on medications had shorter time to first seizure (HR 2.98, 95% CI 1.22–7.24, p = 0.016). Withdrawal technique was not correlated with need for rescue medications (OR 5.0, 95% CI 0.77–43, p = 0.20). No patients had status epilepticus in the study. Conclusions. Pre-admission seizure frequency and number of AEDs are the main factors which drive choice of withdrawal strategy on the epilepsy monitoring unit (EMU). Counterintuitively, least aggressive strategy is associated with highest risk of seizures. Results of this analysis suggest that disease factors, not choice of withdrawal strategy, determine seizure frequency on the EMU.","PeriodicalId":15683,"journal":{"name":"Journal of Epileptology","volume":"1 1","pages":"15 - 19"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90729034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Introduction. Finding an effective epilepsy treatment has been a challenge in medicine for centuries. It is especially difficult to treat drug-resistant epilepsy, which accounts for 20–30% of epilepsy cases, even after the introduction of numerous new anti-epileptic drugs (AEDs). This gives an incentive to search for therapies other than pharmacotherapy, e.g. the ketogenic diet (KD). Aim. The present review paper aims to present the current state of knowledge regarding the effectiveness of the KD, its mechanism of action, indications, method of treatment and potential adverse effects. Material and method. The review covers relevant most recent (up to March 2018) papers using PubMed and Medline databases. Results and discussion. The history of the KD dates back to ancient times. It was believed to be very promising at the beginning of the last century, but then was temporarily ‘forgotten’ and has been undergoing a second renaissance since around 1990. It is currently recognised in most countries. The KD is administered mainly to children but over the last few years there have been attempts to use it in adults as well. The theoretical basis of the diet consists in the fact that it ‘mimics’ the metabolic state of an organism subject to fasting by replacing the basic source of energy for the brain, that is glucose, with ketone bodies, which are a product of fat breakdown. In spite of scientific progress, the exact mechanism underlying the KD is still not known. Its effectiveness, at first mainly as an add-on therapy, and in some cases as the first-line monotherapy, is rated quite highly (<50% seizure reduction in <50% patients; of which in 20–30% of patients seizures are reduced by <90%). It can be used to treat all types of epileptic seizures after excluding contraindications. The KD, like any medical therapy for serious illnesses, may cause adverse effects. Most of them are mild, can be prevented, and if they occur, can be fairly easily treated Conclusion. The KD as add-on therapy or as monotherapy is a medical treatment of epilepsy administered under medical supervision.
{"title":"Ketogenic diet in epilepsy: an updated review","authors":"M. Dudzińska","doi":"10.21307/jepil-2018-004","DOIUrl":"https://doi.org/10.21307/jepil-2018-004","url":null,"abstract":"SUMMARY Introduction. Finding an effective epilepsy treatment has been a challenge in medicine for centuries. It is especially difficult to treat drug-resistant epilepsy, which accounts for 20–30% of epilepsy cases, even after the introduction of numerous new anti-epileptic drugs (AEDs). This gives an incentive to search for therapies other than pharmacotherapy, e.g. the ketogenic diet (KD). Aim. The present review paper aims to present the current state of knowledge regarding the effectiveness of the KD, its mechanism of action, indications, method of treatment and potential adverse effects. Material and method. The review covers relevant most recent (up to March 2018) papers using PubMed and Medline databases. Results and discussion. The history of the KD dates back to ancient times. It was believed to be very promising at the beginning of the last century, but then was temporarily ‘forgotten’ and has been undergoing a second renaissance since around 1990. It is currently recognised in most countries. The KD is administered mainly to children but over the last few years there have been attempts to use it in adults as well. The theoretical basis of the diet consists in the fact that it ‘mimics’ the metabolic state of an organism subject to fasting by replacing the basic source of energy for the brain, that is glucose, with ketone bodies, which are a product of fat breakdown. In spite of scientific progress, the exact mechanism underlying the KD is still not known. Its effectiveness, at first mainly as an add-on therapy, and in some cases as the first-line monotherapy, is rated quite highly (<50% seizure reduction in <50% patients; of which in 20–30% of patients seizures are reduced by <90%). It can be used to treat all types of epileptic seizures after excluding contraindications. The KD, like any medical therapy for serious illnesses, may cause adverse effects. Most of them are mild, can be prevented, and if they occur, can be fairly easily treated Conclusion. The KD as add-on therapy or as monotherapy is a medical treatment of epilepsy administered under medical supervision.","PeriodicalId":15683,"journal":{"name":"Journal of Epileptology","volume":"39 1","pages":"27 - 47"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81389201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bartłomiej Gmaj, J. Majkowski, Jan Szczypilski, J. Jȩdrzejczak, Beata Majkowska-Zwolilska, M. Wojnar, J. Gawłowicz, P. Januszko, S. P. Park, Ewa Nagalska, Simon Ziemka, Dorota Wolylczyk-Gmaj
Summary Introduction. Depressive symptoms are very frequent in the population of patients with epilepsy. Comorbidity between depression and epilepsy is estimated in the range of 9–62%. There are no epidemiological studies in Poland thus far in that area and there is no translated and validated screening tool for depression dedicated for persons with epilepsy (PWEs). In this study we intended to validate the Polish version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), which is a short and accurate scale used in many countries for assessment of depressive symptoms in PWEs. Aim. The purpose of the study was to validate the Polish version of NDDI-E scale in the sample of PWEs. Material and methods. The consecutive 257 patients with epilepsy (PWEs) who met inclusion and exclusion criteria, were recruited by neurologists-epileptologists during their routine outpatient visits in the period from November 2016 to February 2017. The respondents completed the Polish translated version of NDDI-E scale and were assessed with the MINI-International Neuropsychiatric Interview (MINI, depression module). Results. After excluding assessments with missing data, we analyzed data of 253 subjects. Sixty-four patients (25.1%) had current major depressive disorder (MDD) according to the MINI criteria. The Cronbach’s coefficient for the NDDI-E was 0.822. Receiver operating characteristic analyses showed an area under the curve of 0.882 (p < 0.001; asymptotic 95% confidence intervals ranged from 0.832 to 0.932). The cut-off point of 9 corresponded to sensitivity of 0.766 and specificity of 0.858. Conclusion. The Polish version of NDDI-E scale after validation with a cut-off 9 points may be a useful tool for diagnosing depression in a Polish population of PWEs.
{"title":"Validation of the Polish version of the Neurological Disorders Depression Inventory for Epilepsy (P-NDDI-E)","authors":"Bartłomiej Gmaj, J. Majkowski, Jan Szczypilski, J. Jȩdrzejczak, Beata Majkowska-Zwolilska, M. Wojnar, J. Gawłowicz, P. Januszko, S. P. Park, Ewa Nagalska, Simon Ziemka, Dorota Wolylczyk-Gmaj","doi":"10.21307/JEPIL-2018-007","DOIUrl":"https://doi.org/10.21307/JEPIL-2018-007","url":null,"abstract":"Summary Introduction. Depressive symptoms are very frequent in the population of patients with epilepsy. Comorbidity between depression and epilepsy is estimated in the range of 9–62%. There are no epidemiological studies in Poland thus far in that area and there is no translated and validated screening tool for depression dedicated for persons with epilepsy (PWEs). In this study we intended to validate the Polish version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), which is a short and accurate scale used in many countries for assessment of depressive symptoms in PWEs. Aim. The purpose of the study was to validate the Polish version of NDDI-E scale in the sample of PWEs. Material and methods. The consecutive 257 patients with epilepsy (PWEs) who met inclusion and exclusion criteria, were recruited by neurologists-epileptologists during their routine outpatient visits in the period from November 2016 to February 2017. The respondents completed the Polish translated version of NDDI-E scale and were assessed with the MINI-International Neuropsychiatric Interview (MINI, depression module). Results. After excluding assessments with missing data, we analyzed data of 253 subjects. Sixty-four patients (25.1%) had current major depressive disorder (MDD) according to the MINI criteria. The Cronbach’s coefficient for the NDDI-E was 0.822. Receiver operating characteristic analyses showed an area under the curve of 0.882 (p < 0.001; asymptotic 95% confidence intervals ranged from 0.832 to 0.932). The cut-off point of 9 corresponded to sensitivity of 0.766 and specificity of 0.858. Conclusion. The Polish version of NDDI-E scale after validation with a cut-off 9 points may be a useful tool for diagnosing depression in a Polish population of PWEs.","PeriodicalId":15683,"journal":{"name":"Journal of Epileptology","volume":"11 1","pages":"59 - 64"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83146565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Summary Introduction. Valproic acid is commonly used for the treatment of epilepsy, psychiatric disorders such as bipolar disorders, anxiety and prophylaxis migraine. Long-term use of valproic acid is related with metabolic disorders such as the increase of body weight and changes of lipid profiles which are contributed to cardiovascular events, however, these associations remain unclear, furthermore, the mechanisms of these effects have not been fully elucidated. Aim. To summarize and discuss the potential mechanisms of valproic acid-related changes of lipid profiles so as to get a better understanding of the side effects of valproic acid on lipid metabolism. Methods. Literature reviews were conducted through the survey of the literature utilizing the Pubmed electronic databases, with the aim to identify all literature regarding the metabolic effects of valproic acid. This review has been written to summarize the latest evidence of valproic acid’s effects on lipid profiles. Review and Discussion. The possible mechanisms of valproic acid-related changes of lipid profiles could be through insulin resistance and hyperinsulinemia in several ways, resulting in the alteration of lipogenesis and clearance of triglyceride and lipoproteins. Conclusion. The effect of valproic acid on lipid profiles is complex and there is a need for further investigation. Consequently the monitoring and follow up of lipid profiles from patients prescribed valproic acid is recommended.
{"title":"The potential mechanisms of effect of valproic acid on lipid profiles: an updated review","authors":"S. Jaeri, W. Islamiyah","doi":"10.21307/JEPIL-2018-005","DOIUrl":"https://doi.org/10.21307/JEPIL-2018-005","url":null,"abstract":"Summary Introduction. Valproic acid is commonly used for the treatment of epilepsy, psychiatric disorders such as bipolar disorders, anxiety and prophylaxis migraine. Long-term use of valproic acid is related with metabolic disorders such as the increase of body weight and changes of lipid profiles which are contributed to cardiovascular events, however, these associations remain unclear, furthermore, the mechanisms of these effects have not been fully elucidated. Aim. To summarize and discuss the potential mechanisms of valproic acid-related changes of lipid profiles so as to get a better understanding of the side effects of valproic acid on lipid metabolism. Methods. Literature reviews were conducted through the survey of the literature utilizing the Pubmed electronic databases, with the aim to identify all literature regarding the metabolic effects of valproic acid. This review has been written to summarize the latest evidence of valproic acid’s effects on lipid profiles. Review and Discussion. The possible mechanisms of valproic acid-related changes of lipid profiles could be through insulin resistance and hyperinsulinemia in several ways, resulting in the alteration of lipogenesis and clearance of triglyceride and lipoproteins. Conclusion. The effect of valproic acid on lipid profiles is complex and there is a need for further investigation. Consequently the monitoring and follow up of lipid profiles from patients prescribed valproic acid is recommended.","PeriodicalId":15683,"journal":{"name":"Journal of Epileptology","volume":"17 1","pages":"49 - 54"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74089793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Volkov, O. Volkova, Olga S. Tashkinova, E. Belousova
SUMMARY Background Effective treatment protocols development for West syndrome (WS) is scientifically and economically significant. Aim To evaluate the comparative short term efficacy and tolerability of tetracosactide at a dose of 0.03– 0.05 mg/kg and dexamethasone at a dose of 0.3–0.5 mg/kg both combined with valproate at a dose of 30–40 mg/kg/day for WS therapy. The regimen was: 1 injection daily for 10 days, following with 5 injections every other day, then 5 injections every two days, plus a valproate. Material and Methods 79 infants (Group 1) received tetracosactide, 18 infants (Group 2) – dexamethasone. The demographic data and the main characteristics of WS were similar in both groups. Results The efficacy of tetracosactide exceeded that of dexamethasone: there were more responders to therapy in Group 1: 92.4% vs 72% (p = 0.0017). Tetracosactide produced faster results: 50.5% of patients in Group 1 experienced cessation of infantile spasms within the first 5 days of therapy versus 38.7% of patients in Group 2; infantile spasms ceased in 34% of patients in Group 1 on day 6–10, versus 22.2% of patients in Group 2. 74.6% of patients in Group 1 experienced normalization of EEG on day 10, versus 33.3% of patients in Group 2 (p = 0.04). A higher percentage of patients treated with dexamethasone exhibited multiregional activity on EEG by day 10. Tolerability was similar in both groups. All adverse effects were of mild to moderate severity Conclusion Tetracosactide therapy in combination with average therapeutic doses of valproate proved to be more effective in treating WS than the combination of dexamethasone and valproate.
{"title":"The short-term efficacy of combined hormone therapy in West syndrome","authors":"I. Volkov, O. Volkova, Olga S. Tashkinova, E. Belousova","doi":"10.21307/JEPIL-2018-002","DOIUrl":"https://doi.org/10.21307/JEPIL-2018-002","url":null,"abstract":"SUMMARY Background Effective treatment protocols development for West syndrome (WS) is scientifically and economically significant. Aim To evaluate the comparative short term efficacy and tolerability of tetracosactide at a dose of 0.03– 0.05 mg/kg and dexamethasone at a dose of 0.3–0.5 mg/kg both combined with valproate at a dose of 30–40 mg/kg/day for WS therapy. The regimen was: 1 injection daily for 10 days, following with 5 injections every other day, then 5 injections every two days, plus a valproate. Material and Methods 79 infants (Group 1) received tetracosactide, 18 infants (Group 2) – dexamethasone. The demographic data and the main characteristics of WS were similar in both groups. Results The efficacy of tetracosactide exceeded that of dexamethasone: there were more responders to therapy in Group 1: 92.4% vs 72% (p = 0.0017). Tetracosactide produced faster results: 50.5% of patients in Group 1 experienced cessation of infantile spasms within the first 5 days of therapy versus 38.7% of patients in Group 2; infantile spasms ceased in 34% of patients in Group 1 on day 6–10, versus 22.2% of patients in Group 2. 74.6% of patients in Group 1 experienced normalization of EEG on day 10, versus 33.3% of patients in Group 2 (p = 0.04). A higher percentage of patients treated with dexamethasone exhibited multiregional activity on EEG by day 10. Tolerability was similar in both groups. All adverse effects were of mild to moderate severity Conclusion Tetracosactide therapy in combination with average therapeutic doses of valproate proved to be more effective in treating WS than the combination of dexamethasone and valproate.","PeriodicalId":15683,"journal":{"name":"Journal of Epileptology","volume":"35 1","pages":"55 - 61"},"PeriodicalIF":0.0,"publicationDate":"2018-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86169345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SUMMARY Background. Planned homebirth is an option available to a small minority of expecting mothers. Compared with hospital births, long-term risks of homebirths are poorly known. Aim To study very long-term outcome for death, seizure remission, and other neurological long-term comorbidities Material and Methods. A cohort of virtually all children (n = 230) in a geographically defined area with onset of epilepsy in or active epilepsy diagnosed prior to 1961–1964, and prospectively followed-up for 50 years. Results. The proportion of homebirths was 16% in blue collar families and 2% in white collar families (p = 0.007). No significant differences between homebirths and hospital births were found in the frequencies of either abnormal pregnancy (27% vs 27%, p > 0.99) or abnormal birth (32% vs 35%, p = 0.82). Premature mortality following homebirths was non-significantly higher than that following hospital births (41% vs 27%, p = 0.13). Homebirth did not significantly affect 5-year (38% vs 40%) or 10-year (38% vs 37%) remission. Neither was homebirth alone associated with neurological morbidity (2.1, 0.82–6.1, p = 0.137). Conclusion. Homebirth is an observable but non-significant risk factor of offspring mortality and neurological morbidity of an offspring with epilepsy. Blue collar families preferred homebirth to hospital birth for reasons which are not fully understood. Further research is needed in a prospective setting by applying modern standards of early identification of risk pregnancies and deliveries, carefully monitoring the health of expecting mothers, and anticipating referral to specialist services according to medical needs.
摘要背景。计划生育是少数待产母亲的一种选择。与在医院分娩相比，在家分娩的长期风险鲜为人知。目的研究死亡、癫痫发作缓解和其他神经系统长期合并症的长期预后。在1961-1964年之前诊断为癫痫发作或活动性癫痫的地理区域内几乎所有儿童(n = 230)的队列，前瞻性随访50年。结果。蓝领家庭的在家分娩比例为16%，白领家庭为2% (p = 0.007)。在家分娩和住院分娩在异常妊娠(27% vs 27%， p = 0.99)或异常分娩(32% vs 35%， p = 0.82)的频率上均无显著差异。家中分娩后的过早死亡率不显著高于医院分娩后的过早死亡率(41% vs 27%， p = 0.13)。在家分娩对5年(38%对40%)或10年(38%对37%)缓解没有显著影响。单独在家分娩也与神经系统疾病无关(2.1,0.82-6.1,p = 0.137)。结论。家庭出生是一个可观察到的但不显著的风险因素，后代死亡率和癫痫患儿的神经系统发病率。蓝领家庭更喜欢在家分娩而不是医院分娩，原因尚不完全清楚。需要在未来的环境中进行进一步的研究，应用现代标准，早期识别怀孕和分娩的风险，仔细监测孕妇的健康状况，并根据医疗需要预测转诊到专家服务机构。
{"title":"Long-term offspring epilepsy outcomes following planned assisted homebirth versus hospital birth","authors":"Matti Sillanpåå, M. Saarinen, P. Polo-Kantola","doi":"10.21307/JEPIL-2018-001","DOIUrl":"https://doi.org/10.21307/JEPIL-2018-001","url":null,"abstract":"SUMMARY Background. Planned homebirth is an option available to a small minority of expecting mothers. Compared with hospital births, long-term risks of homebirths are poorly known. Aim To study very long-term outcome for death, seizure remission, and other neurological long-term comorbidities Material and Methods. A cohort of virtually all children (n = 230) in a geographically defined area with onset of epilepsy in or active epilepsy diagnosed prior to 1961–1964, and prospectively followed-up for 50 years. Results. The proportion of homebirths was 16% in blue collar families and 2% in white collar families (p = 0.007). No significant differences between homebirths and hospital births were found in the frequencies of either abnormal pregnancy (27% vs 27%, p > 0.99) or abnormal birth (32% vs 35%, p = 0.82). Premature mortality following homebirths was non-significantly higher than that following hospital births (41% vs 27%, p = 0.13). Homebirth did not significantly affect 5-year (38% vs 40%) or 10-year (38% vs 37%) remission. Neither was homebirth alone associated with neurological morbidity (2.1, 0.82–6.1, p = 0.137). Conclusion. Homebirth is an observable but non-significant risk factor of offspring mortality and neurological morbidity of an offspring with epilepsy. Blue collar families preferred homebirth to hospital birth for reasons which are not fully understood. Further research is needed in a prospective setting by applying modern standards of early identification of risk pregnancies and deliveries, carefully monitoring the health of expecting mothers, and anticipating referral to specialist services according to medical needs.","PeriodicalId":15683,"journal":{"name":"Journal of Epileptology","volume":"146 1","pages":"7 - 14"},"PeriodicalIF":0.0,"publicationDate":"2018-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74848761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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