Abstract
Pharmacodynamic aggravation (PA) is an unpredictable increase in the frequency, the severity of existing seizures, and/or development of new seizure types despite rational (adequate for seizure type and epilepsy form) antiepileptic drug (AED) prescription. Many mechanisms and predictors of its development are still poorly understood.Objective: to analyze PA of seizures in patients with newly diagnosed focal epilepsy receiving monotherapy with sodium channel blockers with epileptiform activity index (EAI) assessment.Patients and methods. We enrolled 201 patients with newly diagnosed focal epilepsy aged 16—81 years. In twelve months, patients had five follow-up visits. At each visit, treatment tolerability and efficacy were assessed, taking into account changes in the type, severity, and frequency of seizures. Additionally, at each visit, video-electroencephalographic monitoring was performed with EAI assessment. PA of seizures occurred in patients on oxcarbazepine, carbamazepine, and lacosamide therapy.Results and discussion. Five patients with PA of seizures had increased total EAI and EAI before sleep at the second follow-up visit after sodium channel blockers prescription. Electroencephalographic correlates of PA occurred earlier than clinical manifestations. In patients with PA, the absolute increase in EAI was minimal in patients receiving oxcarbazepine, and lacosamide therapy was associated with a minimal relative increase in EAI. At the end of the follow-up, total EAI decreased by 54—80% relative to its initial value in all five patients. The difference in the total index during the first and last visits was statistically significant.Conclusion. Due to the low level of knowledge about PA of seizures, it seems necessary to consider its possibility in all cases of increased frequency, aggravation, or change in the type of seizures after the AED treatment initiation or an increase in its dose. It is also possible to use changes in total EAI and EAI before sleep as an early objective marker of PA in adults with focal epilepsy.
Highlights
Феномен фармакодинамической аггравации (ФА) заключается в непрогнозируемом учащении, утяжелении и/или возникновении новых типов приступов при условии правильного назначения противоэпилептического препарата (ПЭП)
Pharmacodynamic aggravation (PA) of seizures occurred in patients on oxcarbazepine, carbamazepine, and lacosamide therapy
In patients with PA, the absolute increase in epileptiform activity index (EAI) was minimal in patients receiving oxcarbazepine, and lacosamide therapy was associated with a minimal relative increase in EAI
Summary
Карлов В.А.1, Власов П.Н.1, Ажигова А.М.1, Кожокару А.Б.2, Орлова А.С.3 1ФГБОУ ВО «Московский государственный медико-стоматологический университет им. Цель исследования – проанализировать случаи ФА на фоне монотерапии впервые выявленной фокальной эпилепсии у взрослых блокаторами натриевых каналов с учетом индекса эпилептиформной активности. Five patients with PA of seizures had increased total EAI and EAI before sleep at the second follow-up visit after sodium channel blockers prescription. Цель исследования – проанализировать случаи ФА на фоне монотерапии впервые выявленной фокальной эпилепсии (ФЭ) у взрослых пациентов блокаторами натриевых каналов с учетом индекса эпилептиформной активности. Во время которого па- сией, фокальным гипермоторным началом и изменением циентам устанавливали диагноз на основании типа присту- осознанности с переходом в билатеральный тонико-клонипа и формы эпилепсии, наличия субклинических паттернов ческий во время 2-го визита, на фоне терапии КБЗ в суточи их продолжительности, с использованием анамнестиче- ной дозе 800 мг (9 мг/кг), отмечено появление нового типа ских данных и результатов видео-ЭЭГ-мониторинга; прово- приступов: с генерализованным началом → моторных →.
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