Pub Date : 2022-06-30eCollection Date: 2022-06-01DOI: 10.14581/jer.22002
Dong Wook Kim, Ji Hyun Kim, Sang Kun Lee, Sang Ahm Lee, Ji Woong Lee, Min Young Kim, Dae-Won Seo
Background and purpose: Perampanel is approved for the adjunctive treatment of focal-onset seizures (FOS) with or without secondary generalized seizures. The FAME (Fycompa® as first Add-on to Monotherapy in patients with Epilepsy; NCT02726074) study evaluated the efficacy and safety of perampanel added to monotherapy in patients with FOS with or without secondary generalized seizures (SGS). Post hoc analyses of the FAME study assessed potential predictors of response and an in-depth evaluation of the safety and efficacy of perampanel.
Methods: Efficacy was assessed by reduction of total seizure frequency by ≥50%, ≥75% or 100%, and safety by incidence of treatment-emergent adverse events (TEAEs) and TEAEs leading to discontinuation. Univariate and multivariate logistic regression analyses for treatment response were performed.
Results: Most patients (82/85) received perampanel doses of 4-8 mg/day during maintenance therapy and the highest efficacy rates were achieved with 4 mg/day, irrespective of efficacy outcome. Doses of 4 or 6 mg/day in patients with FOS with SGS (n=16) produced comparable efficacy outcomes. In multivariate analysis, total perampanel dose was predictive of 50% and 75% response rates; longer total perampanel administration period with 50% response; and concomitant non-anti-seizure medication with a 100% response. Patients developed a TEAE more frequently during the 12-week titration period (60.2%) than the 24-week maintenance period (28.4%), including dizziness (45.5% vs. 9.1%), somnolence (10.2% vs. 0%), and headache (4.5% vs. 3.4%).
Conclusions: Post hoc analyses show that even low doses of perampanel may be effective and TEAEs are usually self-limited or well-tolerated.
背景和目的:Perampanel被批准用于伴或不伴继发性全面性癫痫发作的局灶性癫痫发作(FOS)的辅助治疗。FAME (Fycompa®)作为癫痫患者单药治疗的首个附加药物;NCT02726074)研究评估了perampanel加入单药治疗伴有或不伴有继发性全面性癫痫发作(SGS)的FOS患者的疗效和安全性。FAME研究的事后分析评估了反应的潜在预测因素,并对perampanel的安全性和有效性进行了深入评估。方法:通过总发作频率降低≥50%、≥75%或100%来评估疗效,通过治疗中出现的不良事件(teae)和导致停药的teae发生率来评估安全性。对治疗反应进行单因素和多因素logistic回归分析。结果:大多数患者(82/85)在维持治疗期间接受了4- 8mg /天的perampanel剂量,无论疗效结果如何,4mg /天的疗效最高。在伴有SGS的FOS患者(n=16)中,4或6mg /天的剂量产生了相当的疗效结果。在多变量分析中,perampanel总剂量可预测50%和75%的有效率;总给药时间更长,有效率50%;同时服用非抗癫痫药物,100%有效。患者在12周滴定期(60.2%)比24周维持期(28.4%)发生TEAE的频率更高,包括头晕(45.5% vs. 9.1%)、嗜睡(10.2% vs. 0%)和头痛(4.5% vs. 3.4%)。结论:事后分析表明,即使是低剂量的perampanel也可能有效,teae通常是自限性或耐受性良好的。
{"title":"Perampanel as First Adjunctive Treatment in Patients with Focal-Onset Seizures in the FAME Study: <i>Post hoc</i> Analyses of Dose-Related Efficacy, Safety and Clinical Factors Associated with Response.","authors":"Dong Wook Kim, Ji Hyun Kim, Sang Kun Lee, Sang Ahm Lee, Ji Woong Lee, Min Young Kim, Dae-Won Seo","doi":"10.14581/jer.22002","DOIUrl":"https://doi.org/10.14581/jer.22002","url":null,"abstract":"<p><strong>Background and purpose: </strong>Perampanel is approved for the adjunctive treatment of focal-onset seizures (FOS) with or without secondary generalized seizures. The FAME (Fycompa<sup>®</sup> as first Add-on to Monotherapy in patients with Epilepsy; NCT02726074) study evaluated the efficacy and safety of perampanel added to monotherapy in patients with FOS with or without secondary generalized seizures (SGS). <i>Post hoc</i> analyses of the FAME study assessed potential predictors of response and an in-depth evaluation of the safety and efficacy of perampanel.</p><p><strong>Methods: </strong>Efficacy was assessed by reduction of total seizure frequency by ≥50%, ≥75% or 100%, and safety by incidence of treatment-emergent adverse events (TEAEs) and TEAEs leading to discontinuation. Univariate and multivariate logistic regression analyses for treatment response were performed.</p><p><strong>Results: </strong>Most patients (82/85) received perampanel doses of 4-8 mg/day during maintenance therapy and the highest efficacy rates were achieved with 4 mg/day, irrespective of efficacy outcome. Doses of 4 or 6 mg/day in patients with FOS with SGS (n=16) produced comparable efficacy outcomes. In multivariate analysis, total perampanel dose was predictive of 50% and 75% response rates; longer total perampanel administration period with 50% response; and concomitant non-anti-seizure medication with a 100% response. Patients developed a TEAE more frequently during the 12-week titration period (60.2%) than the 24-week maintenance period (28.4%), including dizziness (45.5% vs. 9.1%), somnolence (10.2% vs. 0%), and headache (4.5% vs. 3.4%).</p><p><strong>Conclusions: </strong><i>Post hoc</i> analyses show that even low doses of perampanel may be effective and TEAEs are usually self-limited or well-tolerated.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/97/jer-22002.PMC9289380.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40572815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-30eCollection Date: 2022-06-01DOI: 10.14581/jer.22003
Ji Hyun Kim, Dong Wook Kim, Sang Kun Lee, Dae-Won Seo, Ji Woong Lee, Min Young Kim, Sang Ahm Lee
Background and purpose: FAME (Fycompa® as first Add-on to Monotherapy in patients with Epilepsy; NCT02726074), a previously reported single-arm, phase IV study, showed that perampanel improved seizure control as first add-on to failed anti-seizure medication (ASM) monotherapy in 85 South Korean patients aged ≥12 years with focal-onset seizures (FOS) with/without focal to bilateral tonic-clonic seizures. We present results of three post hoc analyses of FAME that further assessed the efficacy and safety of perampanel.
Methods: Patients were stratified by low- (4, 6 mg/day) versus high- (8, 10, 12 mg/day) dose maintenance perampanel, perampanel added to first- versus second-line ASM monotherapy, and concomitant background ASM monotherapy and perampanel dose. The primary endpoint was the proportion of patients with a ≥50% reduction in total seizure frequency during the 24-week maintenance period. Safety was assessed by the descriptive incidence of treatment-emergent adverse events (TEAEs).
Results: In post hoc analyses, 50% responder rates were significantly higher for low- versus high-dose maintenance perampanel (88.6% vs. 40.0%; p<0.001) and when added to first- versus second-line ASM monotherapy (83.5% vs. 33.3%; p=0.013). By concomitant background ASM and perampanel maintenance dose, 50% responder rates were 100% for perampanel 4 mg/day added to carbamazepine, oxcarbazepine, lamotrigine, or valproic acid, and 85% when added to levetiracetam. Add-on perampanel improved 75% and seizure-free responder rates, and median percent changes from baseline seizure frequency per 28 days. Perampanel was well tolerated when added to ASM monotherapy, with dizziness being the most common TEAE.
Conclusions: Post hoc analyses of FAME provide supportive data for the use of perampanel as an effective and well-tolerated first add-on treatment to a broad spectrum of ASM monotherapies in patients with FOS.
{"title":"Perampanel as First Add-On Therapy in Patients with Focal-Onset Seizures in the FAME Trial: <i>Post hoc</i> Analyses of Efficacy and Safety Related to Maintenance Dose and Background Antiepileptic Drug Therapy.","authors":"Ji Hyun Kim, Dong Wook Kim, Sang Kun Lee, Dae-Won Seo, Ji Woong Lee, Min Young Kim, Sang Ahm Lee","doi":"10.14581/jer.22003","DOIUrl":"10.14581/jer.22003","url":null,"abstract":"<p><strong>Background and purpose: </strong>FAME (Fycompa<sup>®</sup> as first Add-on to Monotherapy in patients with Epilepsy; NCT02726074), a previously reported single-arm, phase IV study, showed that perampanel improved seizure control as first add-on to failed anti-seizure medication (ASM) monotherapy in 85 South Korean patients aged ≥12 years with focal-onset seizures (FOS) with/without focal to bilateral tonic-clonic seizures. We present results of three <i>post hoc</i> analyses of FAME that further assessed the efficacy and safety of perampanel.</p><p><strong>Methods: </strong>Patients were stratified by low- (4, 6 mg/day) versus high- (8, 10, 12 mg/day) dose maintenance perampanel, perampanel added to first- versus second-line ASM monotherapy, and concomitant background ASM monotherapy and perampanel dose. The primary endpoint was the proportion of patients with a ≥50% reduction in total seizure frequency during the 24-week maintenance period. Safety was assessed by the descriptive incidence of treatment-emergent adverse events (TEAEs).</p><p><strong>Results: </strong>In <i>post hoc</i> analyses, 50% responder rates were significantly higher for low- versus high-dose maintenance perampanel (88.6% vs. 40.0%; <i>p</i><0.001) and when added to first- versus second-line ASM monotherapy (83.5% vs. 33.3%; <i>p</i>=0.013). By concomitant background ASM and perampanel maintenance dose, 50% responder rates were 100% for perampanel 4 mg/day added to carbamazepine, oxcarbazepine, lamotrigine, or valproic acid, and 85% when added to levetiracetam. Add-on perampanel improved 75% and seizure-free responder rates, and median percent changes from baseline seizure frequency per 28 days. Perampanel was well tolerated when added to ASM monotherapy, with dizziness being the most common TEAE.</p><p><strong>Conclusions: </strong><i>Post hoc</i> analyses of FAME provide supportive data for the use of perampanel as an effective and well-tolerated first add-on treatment to a broad spectrum of ASM monotherapies in patients with FOS.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/cb/jer-22003.PMC9289376.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40573406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-30eCollection Date: 2022-06-01DOI: 10.14581/jer.22007
Mohammad Amin Farzi
Lennox-Gastaut syndrome (LGS) is a pharmacoresistant epileptic encephalopathy. Herein reported is a case of LGS that combination therapy with levetiracetam, lamotrigine and valproate culminated in control of all seizure types and resolution of epileptic discharges in electroencephalography. This case indicates that logical combination therapy may provide seizure control and improvement of electroencephalographic pattern in patients with LGS even in cases at which epileptic surgery fails.
{"title":"Successful Treatment of Patient with Lennox-Gastaut Syndrome with Combination of Levetiracetam, Lamotrigine and Valproate after Failure of Corpus Callosotomy.","authors":"Mohammad Amin Farzi","doi":"10.14581/jer.22007","DOIUrl":"https://doi.org/10.14581/jer.22007","url":null,"abstract":"<p><p>Lennox-Gastaut syndrome (LGS) is a pharmacoresistant epileptic encephalopathy. Herein reported is a case of LGS that combination therapy with levetiracetam, lamotrigine and valproate culminated in control of all seizure types and resolution of epileptic discharges in electroencephalography. This case indicates that logical combination therapy may provide seizure control and improvement of electroencephalographic pattern in patients with LGS even in cases at which epileptic surgery fails.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/83/jer-22007.PMC9289379.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40573409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31eCollection Date: 2021-12-01DOI: 10.14581/jer.21025
Airenakho Emorinken, Oluwaseun Remi Agbadaola
Acute dystonic reactions are the most prevalent extrapyramidal adverse effects associated with metoclopramide. It could be mistaken for a variety of other conditions, such as seizures, tetanus, and encephalitis, to name a few possibilities. We present a case of a 26-year-old female misdiagnosed as having an epileptic seizure who was rushed to the emergency unit with an involuntary bilateral upward deviation of the eyes, spasm, stiffness, lateral deviation of the neck, and protrusion of the tongue. Symptoms occurred 36 hours after the commencement of metoclopramide, used to treat nausea and vomiting in the referring hospital. All the laboratory work was normal. The drug was discontinued and 5 mg of intravenous biperiden was administered. The symptoms subsided in about 10 minutes with no recurrence. Metoclopramide-induced acute dystonia not only creates an anxious environment for patients but may also be life-threatening. Due to the high probability of misdiagnosis, detailed drug history and a high index of suspicion are critical in making the correct diagnosis.
{"title":"Metoclopramide-induced Acute Dystonia Misdiagnosed as an Epileptic Seizure in a Lupus Patient.","authors":"Airenakho Emorinken, Oluwaseun Remi Agbadaola","doi":"10.14581/jer.21025","DOIUrl":"https://doi.org/10.14581/jer.21025","url":null,"abstract":"<p><p>Acute dystonic reactions are the most prevalent extrapyramidal adverse effects associated with metoclopramide. It could be mistaken for a variety of other conditions, such as seizures, tetanus, and encephalitis, to name a few possibilities. We present a case of a 26-year-old female misdiagnosed as having an epileptic seizure who was rushed to the emergency unit with an involuntary bilateral upward deviation of the eyes, spasm, stiffness, lateral deviation of the neck, and protrusion of the tongue. Symptoms occurred 36 hours after the commencement of metoclopramide, used to treat nausea and vomiting in the referring hospital. All the laboratory work was normal. The drug was discontinued and 5 mg of intravenous biperiden was administered. The symptoms subsided in about 10 minutes with no recurrence. Metoclopramide-induced acute dystonia not only creates an anxious environment for patients but may also be life-threatening. Due to the high probability of misdiagnosis, detailed drug history and a high index of suspicion are critical in making the correct diagnosis.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/50/jer-21025.PMC8767222.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39728233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31eCollection Date: 2021-12-01DOI: 10.14581/jer.21017
Edson Fernando Muller Guzzo, Gabriel de Lima Rosa, Rafael Padilha Bremm, Caroline Paula Meska, Carmen Regla Vargas, Adriana Simon Coitinho
Background and purpose: Oxidative stress (OS) is defined as an excessive production of reactive oxygen species that cannot be neutralized by the action of antioxidants, but also as an alteration of the cellular redox balance. The relationship between OS and epilepsy is not yet fully understood. The objective of this study was to evaluate the effect of dexamethasone on OS levels and memory in the kindling model induced by pentylenetetrazole.
Methods: The animals were divided in six groups: control group that received no treatment, vehicle group treated with vehicle, diazepam group, and groups treated with dexamethasone (1, 2 and 4 mg/kg). Treated animals received pentylenetetrazole in alternated days for 15 days. Inhibitory avoidance test was conducted in 2 hours and OS was evaluated after animal sacrifice.
Results: Regarding the treatment with dexamethasone, there was no significant difference when compared to the control groups in relation to the inhibitory avoidance test. On OS levels, there was a decrease in catalase activity levels in the hippocampus and an increase in thiobarbituric acid reactive substances and glutathione peroxidase levels in the hippocampus.
Conclusions: The anticonvulsant effect of dexametasone remains uncertain. Immunological mechanisms, with the release of cytokines and inflammatory mediators, seem to be the key to this process. The mechanisms that generate OS are probably related to the anticonvulsant effects found.
{"title":"Parameters of Oxidative Stress and Behavior in Animals Treated with Dexametasone and Submitted to Pentylenetetrazol Kindling.","authors":"Edson Fernando Muller Guzzo, Gabriel de Lima Rosa, Rafael Padilha Bremm, Caroline Paula Meska, Carmen Regla Vargas, Adriana Simon Coitinho","doi":"10.14581/jer.21017","DOIUrl":"https://doi.org/10.14581/jer.21017","url":null,"abstract":"<p><strong>Background and purpose: </strong>Oxidative stress (OS) is defined as an excessive production of reactive oxygen species that cannot be neutralized by the action of antioxidants, but also as an alteration of the cellular redox balance. The relationship between OS and epilepsy is not yet fully understood. The objective of this study was to evaluate the effect of dexamethasone on OS levels and memory in the kindling model induced by pentylenetetrazole.</p><p><strong>Methods: </strong>The animals were divided in six groups: control group that received no treatment, vehicle group treated with vehicle, diazepam group, and groups treated with dexamethasone (1, 2 and 4 mg/kg). Treated animals received pentylenetetrazole in alternated days for 15 days. Inhibitory avoidance test was conducted in 2 hours and OS was evaluated after animal sacrifice.</p><p><strong>Results: </strong>Regarding the treatment with dexamethasone, there was no significant difference when compared to the control groups in relation to the inhibitory avoidance test. On OS levels, there was a decrease in catalase activity levels in the hippocampus and an increase in thiobarbituric acid reactive substances and glutathione peroxidase levels in the hippocampus.</p><p><strong>Conclusions: </strong>The anticonvulsant effect of dexametasone remains uncertain. Immunological mechanisms, with the release of cytokines and inflammatory mediators, seem to be the key to this process. The mechanisms that generate OS are probably related to the anticonvulsant effects found.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/da/jer-21017.PMC8767226.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39866856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31eCollection Date: 2021-12-01DOI: 10.14581/jer.21024
Seolah Lee, Sang Kun Lee
Since the first documentation of slow alpha variants in Goodwin et al., there has been a single case report with an actual electroencephalography (EEG). However, any further case has not been reported since then, and neurologists are still unfamiliar with its presence due to its scarcity. Here, we present a rare case of 3:1 subharmonic alpha variant in a hope to acquaint EEG interpretations and speculate upon its benign nature.
{"title":"A Rare Case of 3:1 Alpha Variant.","authors":"Seolah Lee, Sang Kun Lee","doi":"10.14581/jer.21024","DOIUrl":"https://doi.org/10.14581/jer.21024","url":null,"abstract":"<p><p>Since the first documentation of slow alpha variants in Goodwin et al., there has been a single case report with an actual electroencephalography (EEG). However, any further case has not been reported since then, and neurologists are still unfamiliar with its presence due to its scarcity. Here, we present a rare case of 3:1 subharmonic alpha variant in a hope to acquaint EEG interpretations and speculate upon its benign nature.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/b2/jer-21024.PMC8767220.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39728232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31eCollection Date: 2021-12-01DOI: 10.14581/jer.21018
Shinu Singla, Ravindra K Garg, Rajesh Verma, Hardeep S Malhotra, Imran Rizvi, Neeraj Kumar, Ravi Uniyal, Shweta Pandey, Anit Parihar, Praveen Sharma
Background and purpose: Solitary calcified neurocysticercosis (NCC) on the computed tomography (CT) scan of brain in patients of epilepsy is common finding in endemic regions. Factors causing seizures in such cases are debatable. Immature calcification may be the causative factor for seizure recurrence. Thus, we aimed to study predictors of seizure recurrence specific to morphological characteristics on CT scan.
Methods: Patients with solitary calcified NCC on CT scan brain and active seizures were prospectively included. The protocol included clinical evaluation, contrast-enhanced CT scan of the brain, and electroencephalogram (EEG) at baseline and 9th month of 1-year follow-up in all patients. Seizure recurrence after 1 week of enrolment was recorded.
Results: One hundred twenty patients with a mean age of 23.33±12.81 years were included with a final follow-up of 109 patients and 35 patients had seizure recurrence. On univariate analysis, seizure frequency of more than 1 episode/month (45.7% vs. 25.7%, p=0.037; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.05-5.68), perilesional edema on CT head (45% vs. 10.8%, p<0.001; OR, 6.95; 95% CI, 2.58-18.7), lower density (HU) of lesion on CT head (139.85±76.54 vs. 204.67±135.9 HU p=0.009) and abnormal EEG at presentation (p<0.001; OR, 18.25; 95% CI, 2.15-155.13) were significantly associated with seizure recurrence. On multivariate analysis, presence of perilesional edema on CT head (p=0.001; OR, 6.854; 95% CI, 2.26-20.77), density of lesion on CT (HU) (p=0.036; OR, 0.995; 95% CI, 0.99-1) and abnormal EEG (p=0.029; OR, 12.125; 95% CI, 1.29-113.74) were independently associated with seizure recurrence.
Conclusions: The presence of perilesional edema, HU of calcification on CT brain, and abnormal EEG suggest an increased risk of seizure recurrence in patients of epilepsy with solitary calcified NCC.
背景与目的:癫痫患者的CT扫描显示孤立性钙化神经囊虫病(NCC)在流行地区很常见。在这种情况下引起癫痫发作的因素是有争议的。未成熟的钙化可能是癫痫复发的原因。因此,我们的目的是研究癫痫发作复发的预测因素,具体到CT扫描的形态学特征。方法:前瞻性纳入CT扫描的单发钙化NCC伴活动性癫痫发作患者。该方案包括所有患者的临床评估、脑CT增强扫描和基线和1年随访第9个月的脑电图(EEG)。记录入组1周后癫痫复发情况。结果:纳入120例患者,平均年龄23.33±12.81岁,最终随访109例,癫痫复发35例。单因素分析中,癫痫发作频率大于1次/月(45.7% vs. 25.7%, p=0.037;优势比[OR], 2.06;95%可信区间[CI], 1.05-5.68)、CT头部病灶周围水肿(45% vs. 10.8%, pp=0.009)和首发时脑电图异常(pp=0.001;或者,6.854;95% CI, 2.26-20.77), CT上病变密度(HU) (p=0.036;或者,0.995;95% CI, 0.99-1)和脑电图异常(p=0.029;或者,12.125;95% CI, 1.29-113.74)与癫痫复发独立相关。结论:病灶周围水肿、CT脑钙化HU、脑电图异常提示孤立性钙化NCC患者癫痫复发风险增加。
{"title":"Predictors of Seizure Recurrence in Solitary Calcified Neurocysticercosis in Relation to Computed Tomography Scan: Prospective Observational Study.","authors":"Shinu Singla, Ravindra K Garg, Rajesh Verma, Hardeep S Malhotra, Imran Rizvi, Neeraj Kumar, Ravi Uniyal, Shweta Pandey, Anit Parihar, Praveen Sharma","doi":"10.14581/jer.21018","DOIUrl":"https://doi.org/10.14581/jer.21018","url":null,"abstract":"<p><strong>Background and purpose: </strong>Solitary calcified neurocysticercosis (NCC) on the computed tomography (CT) scan of brain in patients of epilepsy is common finding in endemic regions. Factors causing seizures in such cases are debatable. Immature calcification may be the causative factor for seizure recurrence. Thus, we aimed to study predictors of seizure recurrence specific to morphological characteristics on CT scan.</p><p><strong>Methods: </strong>Patients with solitary calcified NCC on CT scan brain and active seizures were prospectively included. The protocol included clinical evaluation, contrast-enhanced CT scan of the brain, and electroencephalogram (EEG) at baseline and 9th month of 1-year follow-up in all patients. Seizure recurrence after 1 week of enrolment was recorded.</p><p><strong>Results: </strong>One hundred twenty patients with a mean age of 23.33±12.81 years were included with a final follow-up of 109 patients and 35 patients had seizure recurrence. On univariate analysis, seizure frequency of more than 1 episode/month (45.7% vs. 25.7%, <i>p</i>=0.037; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.05-5.68), perilesional edema on CT head (45% vs. 10.8%, <i>p</i><0.001; OR, 6.95; 95% CI, 2.58-18.7), lower density (HU) of lesion on CT head (139.85±76.54 vs. 204.67±135.9 HU <i>p</i>=0.009) and abnormal EEG at presentation (<i>p</i><0.001; OR, 18.25; 95% CI, 2.15-155.13) were significantly associated with seizure recurrence. On multivariate analysis, presence of perilesional edema on CT head (<i>p</i>=0.001; OR, 6.854; 95% CI, 2.26-20.77), density of lesion on CT (HU) (<i>p</i>=0.036; OR, 0.995; 95% CI, 0.99-1) and abnormal EEG (<i>p</i>=0.029; OR, 12.125; 95% CI, 1.29-113.74) were independently associated with seizure recurrence.</p><p><strong>Conclusions: </strong>The presence of perilesional edema, HU of calcification on CT brain, and abnormal EEG suggest an increased risk of seizure recurrence in patients of epilepsy with solitary calcified NCC.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/93/26/jer-21018.PMC8767223.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39866857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31eCollection Date: 2021-12-01DOI: 10.14581/jer.21020
Kanij Fatema, Mizanur Rahman, Mohammad Monir Hossain, Shaheen Akhter, Dewan Afsana Shomee, Sohela Akhter, Mazharul Mannan
Background and purpose: West syndrome is an epileptic encephalopathy of infancy. According to guidelines, adrenocorticotrophic hormone (ACTH) is probably effective for the short-term management of infantile spasm, but there is little uniformity in treatment due to variable response. This study has been done to evaluate the efficacy of pulse methylprednisolone as compared to ACTH in children with West syndrome.
Methods: Children between 3 months to 24 months with the diagnosis of West syndrome were included and ACTH and pulse methyl prednisolone followed by oral prednisolone were given after randomization. Total duration of treatment was 6 weeks in both groups.
Results: Total 87 children were enrolled; 12 patients lost in follow up. Finally, 43 received ACTH and 32 received pulse methylprednisolone. In pulse methylprednisolone group, 28.13% showed 50-80% response, 28.13% showed 80-99% response and 21.87% patients showed 100% response. In ACTH group, 41.86% showed 50-80% response, 25.58% showed 80-99% response and only 3 (6.97%) patients showed 100% response. Methylprednisolone treatment regimen did not cause significant or persistent adverse effects.
Conclusions: Pulse methylprednisolone followed by oral prednisolone for 6 weeks is as effective as ACTH. Thus, methylprednisolone therapy can be an important alternative to ACTH.
{"title":"Pulse Methylprednisolone with Oral Prednisolone versus Adrenocorticotropic Hormone in Children with West Syndrome: a Randomized Controlled Trial.","authors":"Kanij Fatema, Mizanur Rahman, Mohammad Monir Hossain, Shaheen Akhter, Dewan Afsana Shomee, Sohela Akhter, Mazharul Mannan","doi":"10.14581/jer.21020","DOIUrl":"10.14581/jer.21020","url":null,"abstract":"<p><strong>Background and purpose: </strong>West syndrome is an epileptic encephalopathy of infancy. According to guidelines, adrenocorticotrophic hormone (ACTH) is probably effective for the short-term management of infantile spasm, but there is little uniformity in treatment due to variable response. This study has been done to evaluate the efficacy of pulse methylprednisolone as compared to ACTH in children with West syndrome.</p><p><strong>Methods: </strong>Children between 3 months to 24 months with the diagnosis of West syndrome were included and ACTH and pulse methyl prednisolone followed by oral prednisolone were given after randomization. Total duration of treatment was 6 weeks in both groups.</p><p><strong>Results: </strong>Total 87 children were enrolled; 12 patients lost in follow up. Finally, 43 received ACTH and 32 received pulse methylprednisolone. In pulse methylprednisolone group, 28.13% showed 50-80% response, 28.13% showed 80-99% response and 21.87% patients showed 100% response. In ACTH group, 41.86% showed 50-80% response, 25.58% showed 80-99% response and only 3 (6.97%) patients showed 100% response. Methylprednisolone treatment regimen did not cause significant or persistent adverse effects.</p><p><strong>Conclusions: </strong>Pulse methylprednisolone followed by oral prednisolone for 6 weeks is as effective as ACTH. Thus, methylprednisolone therapy can be an important alternative to ACTH.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/00/jer-21020.PMC8767225.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39866858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31eCollection Date: 2021-12-01DOI: 10.14581/jer.21023
Jung-Won Choi, Jung-Won Shin
The use of anesthetics is inevitable to suppress seizure activity in refractory status epilepticus (RSE). Hypotension, which is a critical side effect observed when treating RSE using a higher dosage of anesthetics that enhance γ-aminobutyric acid (GABA) activity, often requires vasopressor agents. Concomitant treatment with N-methyl-D-aspartate (NMDA) receptor antagonists, such as ketamine, could be effective in prolonged refractory SE, while maintaining stable blood pressure owing to the blockage of catecholamine reuptake in the systemic circulation. We report two cases of patients who had RSE with hemodynamic instability treated promptly with an early combination of ketamine and low-dose midazolam. The combination treatment effectively suppressed epileptic discharge with less hemodynamic side effects; moreover, a low dose of midazolam was required when combined with ketamine therapy. The initial combination of a third-line therapy that blocks NMDA receptors with enhanced GABAergic activity could be useful in RSE. Further studies are necessary in many variable etiologies of SE.
在难治性癫痫持续状态(RSE)中,使用麻醉剂抑制癫痫发作是不可避免的。低血压是使用高剂量增强γ-氨基丁酸(GABA)活性的麻醉剂治疗RSE时观察到的一个关键副作用,通常需要血管加压剂。与n -甲基- d -天冬氨酸(NMDA)受体拮抗剂(如氯胺酮)联合治疗可有效治疗长期难治性SE,同时由于儿茶酚胺在体循环中的再摄取受阻而维持稳定的血压。我们报告了两例伴有血流动力学不稳定的RSE患者,早期及时联合氯胺酮和低剂量咪达唑仑治疗。联合用药能有效抑制癫痫放电,血流动力学副作用小;此外,当与氯胺酮联合治疗时,需要低剂量的咪达唑仑。阻断NMDA受体和增强gaba能活性的三线治疗的初始联合可能对RSE有用。SE的多种病因需要进一步研究。
{"title":"Early Combination Therapy of Ketamine and Midazolam in Patients with Refractory Status Epilepticus in Hemodynamic Unstable State.","authors":"Jung-Won Choi, Jung-Won Shin","doi":"10.14581/jer.21023","DOIUrl":"https://doi.org/10.14581/jer.21023","url":null,"abstract":"<p><p>The use of anesthetics is inevitable to suppress seizure activity in refractory status epilepticus (RSE). Hypotension, which is a critical side effect observed when treating RSE using a higher dosage of anesthetics that enhance γ-aminobutyric acid (GABA) activity, often requires vasopressor agents. Concomitant treatment with N-methyl-D-aspartate (NMDA) receptor antagonists, such as ketamine, could be effective in prolonged refractory SE, while maintaining stable blood pressure owing to the blockage of catecholamine reuptake in the systemic circulation. We report two cases of patients who had RSE with hemodynamic instability treated promptly with an early combination of ketamine and low-dose midazolam. The combination treatment effectively suppressed epileptic discharge with less hemodynamic side effects; moreover, a low dose of midazolam was required when combined with ketamine therapy. The initial combination of a third-line therapy that blocks NMDA receptors with enhanced GABAergic activity could be useful in RSE. Further studies are necessary in many variable etiologies of SE.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/e9/jer-21023.PMC8767219.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39728231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31eCollection Date: 2021-12-01DOI: 10.14581/jer.21019
Young Jun Ko, Il Han Yoo, Jiwon Lee, Jeehun Lee, Mi-Sun Yum, Tae-Sung Ko, Hunmin Kim, Hee Hwang, Soo Yeon Kim, Jong-Hee Chae, Ji-Eun Choi, Ki Joong Kim, Byung Chan Lim
Background and purpose: This study was aimed to describe focal epilepsy features of SCN1A mutation-positive Dravet syndrome patients.
Methods: A total of 82 SCN1A mutation-positive patients were reviewed retrospectively (39 boys and 43 girls). Seizure type and electroencephalography (EEG) findings were investigated according to the stage, disease onset, and steady state (after age 2 years). Long-term video EEG data were used to classify the seizure type.
Results: Focal seizures at onset and the steady state were found in 54.9% (45/82) and 90% (63/70) of patients, respectively. Afebrile focal seizures were an initial seizure in about one fourth of the patients (22/82, 26.8%). Of 48 seizures captured during long-term video EEG monitoring of 30 patients, 19 seizures were classified as focal onset (39.6%). Of the 19 focal seizures, 12 were either focal motor or focal non-motor seizures, and seven were focal onset bilateral tonic-clonic seizure. Focal epileptiform discharges were more frequent than generalized epileptiform discharges at seizure onset and during the clinical course on conventional EEG (3.7% vs. 0%, 52.9% vs. 32.9%, respectively).
Conclusions: Our study provides a comprehensive description of focal epilepsy features of SCN1A mutation-positive Dravet syndrome patients. Recognizing these features as defining the clinical spectrum of Dravet syndrome may lead to earlier genetic diagnosis and tailored management.
{"title":"The Role of Focal Epilepsy Features in Defining <i>SCN1A</i> Mutation-positive Dravet Syndrome as Generalized and Focal Epilepsy.","authors":"Young Jun Ko, Il Han Yoo, Jiwon Lee, Jeehun Lee, Mi-Sun Yum, Tae-Sung Ko, Hunmin Kim, Hee Hwang, Soo Yeon Kim, Jong-Hee Chae, Ji-Eun Choi, Ki Joong Kim, Byung Chan Lim","doi":"10.14581/jer.21019","DOIUrl":"https://doi.org/10.14581/jer.21019","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study was aimed to describe focal epilepsy features of <i>SCN1A</i> mutation-positive Dravet syndrome patients.</p><p><strong>Methods: </strong>A total of 82 <i>SCN1A</i> mutation-positive patients were reviewed retrospectively (39 boys and 43 girls). Seizure type and electroencephalography (EEG) findings were investigated according to the stage, disease onset, and steady state (after age 2 years). Long-term video EEG data were used to classify the seizure type.</p><p><strong>Results: </strong>Focal seizures at onset and the steady state were found in 54.9% (45/82) and 90% (63/70) of patients, respectively. Afebrile focal seizures were an initial seizure in about one fourth of the patients (22/82, 26.8%). Of 48 seizures captured during long-term video EEG monitoring of 30 patients, 19 seizures were classified as focal onset (39.6%). Of the 19 focal seizures, 12 were either focal motor or focal non-motor seizures, and seven were focal onset bilateral tonic-clonic seizure. Focal epileptiform discharges were more frequent than generalized epileptiform discharges at seizure onset and during the clinical course on conventional EEG (3.7% vs. 0%, 52.9% vs. 32.9%, respectively).</p><p><strong>Conclusions: </strong>Our study provides a comprehensive description of focal epilepsy features of <i>SCN1A</i> mutation-positive Dravet syndrome patients. Recognizing these features as defining the clinical spectrum of Dravet syndrome may lead to earlier genetic diagnosis and tailored management.</p>","PeriodicalId":73741,"journal":{"name":"Journal of epilepsy research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/07/jer-21019.PMC8767227.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39866859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}