Antiepileptic Drugs In Patients Research Articles

Long-term response and response patterns to antiepileptic drugs in patients with newly diagnosed epilepsy

ObjectiveThis study investigated the long-term response and response patterns to antiepileptic drugs (AEDs) in patients with newly diagnosed epilepsy. MethodsPatients who had been newly diagnosed with epilepsy and had at least 3-year follow-up records were enrolled. Their long-term response and response patterns to AEDs were retrospectively analyzed. Patients were divided into two groups, a controlled group and an uncontrolled group, according to whether 3-year seizure freedom (3YSF) was achieved. Multiple logistic regression analyses were used to identify risk factors associated with a poor drug response. ResultsOf the 472 patients with epilepsy, 180 achieved immediate seizure control, 36 achieved early seizure control, 118 achieved late seizure control, and 138 did not achieve 3YSF. Patients who achieved 3YSF (334/472, 70.8%) were categorized into the controlled group. Among them, 53.9% (180/334) achieved 3YSF immediately, 10.8% (36/334) achieved 3YSF within 6 months, and 35.3% (118/334) achieved 3YSF after 6 months. Also in this group, 228 (228/472, 48.3%), 84 (84/472, 17.8%), 15 (15/472, 3.2%), and 7 (7/472, 1.5%) patients achieved 3YSF on the first, second, third, and fourth regimen, respectively. Multivariate analyses showed that multiple seizure types (odds ratio [OR] = 3.903, 95% confidence interval [CI]: 2.098–7.264; P < 0.001] and polytherapy (OR = 5.093, 95% CI: 3.183–8.149; P < 0.001) were independent risk factors for a poor drug response. ConclusionThe 3YSF rate in this cohort was 70.8%. More than half of the patients achieved long-term remission immediately after treatment. The probability of attaining 3YSF decreased with the increase in number of drug regimens, especially in patients who experienced failure of two treatment regimens.

Pharmacological Medical Treatment of Epilepsy in Patients with Dementia: A Systematic Review.

Patients with dementia have an increased risk of developing epilepsy, especially in patients with vascular dementia and Alzheimer's disease. In selecting the optimal anti- epileptic drug (AED), the possible side effects such as drowsiness and worsening of cognitive function should be taken into consideration, together with co-morbidities and type of epilepsy. The current systematic review investigates the efficacy, tolerability, and changes in cognitive function after administration of AED in patients with dementia and epilepsy. We searched six databases, including MEDLINE and CENTRAL, checked reference lists, contacted experts, and searched Google Scholar to identify studies reporting randomized trials. Studies identified were independently screened, data extracted, and quality appraised by two researchers. A narrative synthesis was used to report findings. We included one study with 95 patients with Alzheimer's disease randomized to either levetiracetam, lamotrigine, or phenobarbital. No significant differences were found for efficacy, but patients receiving levetiracetam showed an improvement in mini-mental state examination scores and had fewer adverse events. High-quality evidence in the form of randomized controlled trials to guide clinicians in choosing an AED in patients with dementia and concomitant epilepsy remains scarce. However, levetiracetam has previously been shown to possibly improve cognition in patients with both mild cognitive impairment and Alzheimer's disease, is better tolerated in the elderly population, and has no clinically relevant interaction with either cholinesterase inhibitors or NMDA receptor antagonists.

Efficacy of antiepileptic drugs in glioma patients with epilepsy: a systematic review.

BackgroundComprehensive data on the efficacy and tolerability of antiepileptic drugs (AED) treatment in glioma patients with epilepsy are currently lacking. In this systematic review, we specifically assessed the efficacy of AEDs in patients with a grade II-IV glioma.MethodsElectronic databases PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched up to June 2020. Three different outcomes for both mono- and polytherapy were extracted from all eligible articles: (i) seizure freedom; (ii) ≥50% reduction in seizure frequency; and (iii) treatment failure. Weighted averages (WA) were calculated for outcomes at 6 and 12 months.ResultsA total of 66 studies were included. Regarding the individual outcomes on the efficacy of monotherapy, the highest seizure freedom rate at 6 months was with phenytoin (WA = 72%) while at 12-month pregabalin (WA = 75%) and levetiracetam (WA = 74%) showed highest efficacy. Concerning ≥50% seizure reduction rates, levetiracetam showed highest efficacy at 6 and 12 months (WAs of 82% and 97%, respectively). However, treatment failure rates at 12 months were highest for phenytoin (WA = 34%) and pregabalin (41%). When comparing the described polytherapy combinations with follow-up of ≥6 months, levetiracetam combined with phenytoin was most effective followed by levetiracetam combined with valproic acid.ConclusionGiven the heterogeneous patient populations and the low scientific quality across the different studies, seizure rates need to be interpreted with caution. Based on the current limited evidence, with the ranking of AEDs being confined to the AEDs studied, levetiracetam, phenytoin, and pregabalin seem to be most effective as AED monotherapy in glioma patients with epilepsy, with levetiracetam showing the lowest treatment failure rate, compared to the other AEDs studied.

Discontinuation of preventive antiepileptic drugs in patients with intracerebral hemorrhage

BackgroundThe risk factors for seizures in patients with intracerebral hemorrhage (ICH) stroke and the effect of seizure prevention by anticonvulsant are not well understood. Limited studies have investigated the risk of seizure after discontinuing antiepileptic drugs in patients with ICH. This study aimed to investigate the role of valproic acid (VA) for seizure prevention and to access the risk of seizure after anticonvulsant withdrawal in patients with spontaneous ICH.MethodsBetween 2013 and 2015, 177 patients with ICH were enrolled in this 3-year retrospective study. Seizures were classified as early seizure (first seizure within 1 week of ICH), delayed seizure (first seizure after 1 week), and late seizure (any seizure after 1 week). Binary logistic regression was used to evaluate the relationship between baseline clinical factors and late seizures between study periods. VA was prescribed or discontinued based on the decision of the physician in charge.ResultsSeizures occurred in 24 patients, including early seizure in 6.78% (12/177) of the patients, delayed seizure in 7.27% (12/165) of the patients without early seizure, and late seizure in 9.60% (17/177) of the patients. Most seizures occurred within the first year. Binary logistic regression analysis showed ICH with cortex involvement as the independent risk factor for seizures. VA did not decrease the risk of seizures. Patients with ICH with cortical involvement using anticonvulsants for longer than 3 months did not have a decreased risk of seizures (odds ratio 1.86, 95% CI: 0.43–8.05).ConclusionsSpontaneous ICH with cortex involvement is the risk factor for seizure. Most seizures occurred within 1 year after stroke onset over a 3-year follow up. Discontinuation of antiepileptic drug within 3 months in patients does not increase the risk of seizure.

The correlation of sleep quality toward the drug compliance of epilepsy patient

ObjectiveTo find out the correlation between sleep quality and the drug compliance of antiepileptic drugs in epilepsy patients. MethodThis was an analytic observational study with a cross-sectional approach. The sample was taken from the interview process to epilepsy patients in Wahidin Sudiohusodo and its networking hospital. Primary data was done through PSQI (Pittsburgh Sleep Quality Index), while secondary data was obtained from medical records. Data were analyzed using Chi-Square. ResultThis study involved 48 samples, 24 samples with good quality of sleep, and 24 others with bad ones. There were 19 samples with good quality of sleep and drug compliance, five samples with good quality of sleep yet inadequate drug compliance, 11 with bad quality of sleep yet proper drug compliance, and 13 with bad quality of sleep and drug compliance. ConclusionThere was a significant correlation between sleep quality and drug compliance of antiepileptic drugs in a patient with epilepsy.

Aggression as psychiatric side effect of newer AEDs in patients with epilepsy: Cross-sectional study based on Buss-Perry Aggression Questionnaire

PurposeAggression-irritability is the most commonly encountered antiepileptic-drug-induced psychiatric adverse effects. In this cross-sectional study, we tried to assess antiepileptic-drug-induced aggression in patients with epilepsy (PWE) with a standardized rating scale. MethodsTwo hundred sixty-six consecutive outpatients receiving treatment for epilepsy with antiepileptic drugs (AEDs) were initially examined, and the effects of the investigated drugs in regard to aggression were investigated using the Buss-Perry Aggression Questionnaire (BAQ). We compared BAQ scores as a function of a specific class of AEDs, levetiracetam (LEV), lacosamaide (LCM), perampanel (PER), and carbamazepine (CBZ), and determined whether AED type had a relationship with aggression. Additionally, the association of BAQ score with other clinico-demographic variables was also assessed. ResultsOne-way ANOVA revealed that the LEV group had a significantly higher mean BAQ score as compared to the CBZ (P = 0.001) and LCM (P = 0.029) groups for total score. In subscale analysis, the LEV group had higher scores than the CBZ group for the physical aggression (p = 0.01), verbal aggression (p = 0.02) and hostility (p = 0.01) subscales, while the LEV group had a significantly higher mean score than the LCM group for hostility (p = 0.025). In multiple regression analysis, LEV had a statistically significant impact on increased total BAQ score (B = 0.119, p = 0.049). In contrast, CBZ (B = −0.191, p = 0.002), older age at epilepsy onset (B = −0.269, p = 0.000) and female gender (B = −0.210, p = 0.000) had a significant association with lower total BAQ score. ConclusionsOur results indicate that LEV is associated with increased aggression, while CBZ and LCM showed effects to reduce aggression.

The Korean Society for Neuro-Oncology (KSNO) Guideline for Antiepileptic Drug Usage of Brain Tumor: Version 2021.1.

BackgroundTo date, there has been no practical guidelines for the prescription of antiepileptic drugs (AEDs) in brain tumor patients in Korea. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, had begun preparing guidelines for AED usage in brain tumors since 2019.MethodsThe Working Group was composed of 27 multidisciplinary medical experts in Korea. References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of the keywords.ResultsThe core contents are as follows. Prophylactic AED administration is not recommended in newly diagnosed brain tumor patients without previous seizure history. When AEDs are administered during peri/postoperative period, it may be tapered off according to the following recommendations. In seizure-naïve patients with no postoperative seizure, it is recommended to stop or reduce AED 1 week after surgery. In seizure-naïve patients with one early postoperative seizure (<1 week after surgery), it is advisable to maintain AED for at least 3 months before tapering. In seizure-naïve patients with ≥2 postoperative seizures or in patients with preoperative seizure history, it is recommended to maintain AEDs for more than 1 year. The possibility of drug interactions should be considered when selecting AEDs in brain tumor patients. Driving can be allowed in brain tumor patients when proven to be seizure-free for more than 1 year.ConclusionThe KSNO suggests prescribing AEDs in patients with brain tumor based on the current guideline. This guideline will contribute to spreading evidence-based prescription of AEDs in brain tumor patients in Korea.

Lissencephaly in an epilepsy cohort: Molecular, radiological and clinical aspects.

Lissencephaly is a rare malformation of cortical development due to abnormal transmantle migration resulting in absent or reduced gyration. The lissencephaly spectrum consists of agyria, pachygyria and subcortical band heterotopia. In this study we compared genetic aetiology, neuroradiology, clinical phenotype and response to antiepileptic drugs in patients with epilepsy and lissencephaly spectrum malformations. The study group consisted of 20 patients - 13 males and 7 females, aged 18 months to 21yearsat the time of data collection. Genetic testing was performed by oligonucleotide array comparative genomic hybridization (microarray), multiplex ligation-dependent probe amplification (MLPA), targeted gene panels and whole exome/genome sequencing. All neuroradiological investigations were re-evaluated and the malformations were classified by the same neuroradiologist. Clinical features and response to anti-epileptic drugs (AEDs) were evaluated by retrospective review of medical records. In eleven patients (55%) mutations in PAFAH1B1 (LIS1) or variable microdeletions of 17p13.3 including the PAFAH1B1 gene were detected. Four patients (20%) had tubulin encoding gene mutations (TUBA1A, TUBG1 and TUBGCP6). Mutations in DCX, DYNC1H1, ADGRG1 and WDR62 were identified in single patients. In one patient, a possibly pathogenic intragenic deletion in TRIO was detected. A clear radiologic distinction could be made between tubulinopathies and PAFAH1B1 related lissencephaly. The majority of the patients had therapy resistant epilepsy and epileptic spasms was the most prominent seizure type. The best therapeutic response to seizure control in our cohort was obtained by the ketogenic diet, vigabatrin, clobazam, phenobarbital and valproate. The most common genetic aetiologies in our cohort of 20 individuals with epilepsy and lissencephaly spectrum were intragenic deletions or single nucleotide mutations in PAFAH1B1 or larger deletions in 17p13.3, encompassing PAFAH1B1, followed by mutations in tubulin encoding genes. Radiological findings could reliably predict molecular results only in agyria with a posterior to anterior gradient. Radiological and molecular findings did not correlate consistently with severity of clinical outcome or therapeutic response.

Evaluation of the Protective Effect of Ademetionine, Cytoflavin, and Dihydroquercetetine on Blood Enzymes Activity in Rats Treated with High Doses of Sodium Valproate.

We evaluated the protective effect of ademetionine, cytoflavin, and dihydroquercetin on activity of serum enzymes in rats treated with high doses of sodium valproate for 28 days. Ademetionine and cytoflavin produced the greatest protective effect, the effect of dihydroquercetin was less pronounced. In rats treated with ademetionine, AST activity decreased as soon as on day 7 and remained at this level until the end of the experiment; ALT, alkaline phosphatase, and γ-glutamyl transferase activities decreased on days 21 and 28 of the study. Cytoflavin produced similar effects, the effect of dihydroquercetin was observed on days 21 and 28 for AST, ALT, alkaline phosphatase and on day 28 for γ-glutamyl transferase. These results substantiate the use of hepatoprotective drugs in case of long-term treatment with anticonvulsants in patients with epilepsy.

NCMP-08. EFFICACY OF ANTIEPILEPTIC DRUGS IN GLIOMA PATIENTS WITH EPILEPSY: A SYSTEMATIC REVIEW

Abstract BACKGROUND Epilepsy is a common symptom in glioma patients, requiring antiepileptic drug (AED) treatment. However, comprehensive data on the efficacy and tolerability of AED treatment is currently lacking. In this systematic review we specifically assessed the efficacy of AEDs in patients with a grade II-IV glioma. METHODS Electronic databases PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane library were searched up to April 2020. Three different outcomes were extracted from all eligible articles: (I) seizure freedom; (II) ≥50% reduction in seizure frequency; and (III) treatment failure. To overcome variation with respect to sample sizes, weighted averages (WA) were calculated for outcomes at 6 and 12 months. RESULT A total of 64 studies were included. For monotherapy, the 6-months seizure freedom rate was highest for phenytoin (WA=72%), whereas the 12-months seizure freedom rate was highest for pregabalin (WA=75%). For achieving ≥ 50% seizure reduction, levetiracetam was the most effective AED at 6 and 12 months, with WA of 82 and 97% respectively. Considering the provided polytherapy combinations, levetiracetam combined with phenytoin was most effective followed by levetiracetam with valproic acid. Seizure freedom rates with polytherapy at 6 months and 12 months were highest for combinations with phenytoin and topiramate, respectively. For achieving a ≥ 50% seizure reduction, combinations with perampanel were found to be the most effective at 6 and 12 months. CONCLUSION Based on the current literature, phenytoin, levetiracetam and pregabalin are most effective as AED monotherapy in glioma patients with epilepsy. Well-controlled prospective studies are needed to help further guide clinician’s treatment choices.

Ex vivo radiosensitivity is increased in non-cancer patients taking valproate

BackgroundValproate (VPA) is a commonly prescribed antiepileptic drug for patients experiencing epileptic seizures due to brain tumors. VPA increases radiation sensitivity in various tumor cells in vitro due to complex mechanisms. This could make tumors more vulnerable to ionizing radiation or overcome radioresistance. Yet, clinical data on possible improvement of tumor control by adding VPA to tumor therapy is controversial. Potentially radiosensitizing effects of VPA on healthy tissue remain unclear. To determine individual radiosensitivity, we analyzed blood samples of individuals taking VPA.MethodsEx vivo irradiated blood samples of 31 adult individuals with epilepsy were studied using 3-color fluorescence in situ hybridization. Aberrations in chromosomes 1, 2 and 4 were analyzed. Radiosensitivity was determined by the mean breaks per metaphase (B/M) and compared to age-matched (2:1) healthy donors.ResultsThe patient cohort (n = 31; female: 38.7%) showed an increase of their average B/M value compared to healthy individuals (n = 61; female: 56.9%; B/M: 0.480 ± 0.09 vs. 0.415 ± 0.07; p = .001). The portion of radiosensitive (B/M > 0.500) and distinctly radiosensitive individuals (B/M > 0.600) was increased in the VPA group (54.9% vs. 11.3 and 9.7% vs. 0.0%; p < .001). In 3/31 patients, radiosensitivity was determined prior to and after VPA treatment and radiosensitivity was increased by VPA-treatment.ConclusionsIn our study, we confirmed that patients treated with VPA had an increased radiosensitivity compared to the control group. This could be considered in patients taking VPA prior to the beginning of radiotherapy to avoid toxic side effects of VPA-treatment.

The phenotype and treatment of SCN2A-related developmental and epileptic encephalopathy.

We aimed to delineate the phenotypic spectrum of SCN2A-related developmental and epileptic encephalopathy (DEE) and determine the effectiveness of various treatment modalities, including sodium channel blockers and the ketogenic diet. Eleven patients with SCN2A-related DEE were included in the study. The characteristics of SCN2A mutations, electroclinical features, clinical course, and response to treatment modalities were analysed. The 11 patients were aged between 0.4 and 9.7 years. The onset of seizures ranged from neonate (six patients) to infant (four patients), to childhood (one patient). Epilepsy presented as Ohtahara syndrome, West syndrome, epilepsy of infancy with migrating focal seizures (EIMFS), and focal epilepsy in neonatal- to infantile-onset patients. The only childhood-onset patient in our study presented with focal epilepsy with autism. Neonatal-to infantile-onset patients had drug-resistant epilepsy (9/10), however, sodium channel blockers were effective in all treated patients (9/9). The ketogenic diet (6/8) and high-dose steroid treatment (4/5) were also effective. The seizures in the childhood-onset patient worsened during treatment with sodium channel blockers. All mutations in neonatal- to infantile-onset patients were missense mutations, whereas the mutation in the childhood-onset patient was a truncation mutation. These results support earlier observations regarding the epilepsy syndromes and response to antiepileptic drugs in patients with SCN2A-related DEE.

Knowledge of some aspects of the influence of antiepileptic drugs in patients with epilepsy

Substantial intensity of side effects and low tolerance of drugs are reflected directly on the quality of patients' lives. In common with positive therapeutic results, antiepileptic drugs have a toxic impact on an organism of human including drug dependency and they can lead to fatality in different conditions (in case of overdose, drugs abuse, heightened sensitivity of organism).

Comparative study of Pre and Post-operative Drug Costs in Patients with Refractory Epilepsy Undergoing Hemispherectomy and Temporal Lobectomy at the National Children’s Hospital Dr. Carlos Sáenz Herrera

Introduction: Refractory epilepsy can be defined as a failure of adequate trials of antiepileptic drug programs tolerated and appropriately chosen and used (either as monotherapy or in combination) to achieve sustained freedom from seizures. Surgical procedures for the control of epileptic seizures have spread throughout the world, however, large medical centers have mainly focused on studying and analyzing the clinical results of their surgical interventions. For this reason, this study aims to analyze the cost of pre and post-surgical anticonvulsant medications in patients. Objective: To analyze the relationship between preoperative cost / postoperative cost of antiepileptic drugs in patients undergoing hemispherectomy or temporary lobectomy at the National Children’s Hospital (Hospital Nacional de Niños-HNN). Materials and methods: This study is a retrospective, descriptive, quantitative and longitudinal type of a series of patients who were operated in the Epilepsy Monitoring and Surgery Unit (UMCE) of Costa Rica, between November 2000 and December 2018. Information on the history of medications is obtained from patients before and after having undergone hemispherectomy or temporal lobectomy to assess whether or not there is an economic saving in this aspect when comparing both periods of time. Results: 69 patients have undergone hemispherectomy and temporal lobectomy since the creation of the UMCE in November 2000. Of these, 18 (26%) underwent hemispherectomy and 51 (74%) underwent temporary lobectomy. A sample of 31 patients (45%) were obtained, which met the inclusion criteria. The average age of initiation of treatment at the HNN was 5.5 years old (66 months) and the average age at which they underwent surgery was 10.8 years old (130 months). There was one patient in the sample who received 9 anticonvulsant medications before undergoing the surgical procedure and the average number of medications used pre-surgically was 4.45 anticovulsivants per patient. The average postoperative medication was 2.35 anticonvulsivants per patient. The average monthly preoperative cost was $50.17, while the postoperative period was $31.26, with a difference of $18.91. A total of 9 patients in the sample increased the monthly postoperative cost. The total savings per month in the patients included in the sample was $586.36 and extrapolated to the population of 69 patients resulting in a saving of $1,305.14 per month. The projection according to the life expectancy of the patients in the sample translates into a saving of $409,188.59 while the projection to the 69 patients would result in a saving of $910,774.60 for the Caja Costarricense del Seguro Social (CCSS - Costa Rican Social Security Fund). Discussion: The effectiveness of these two surgeries in suitably selected patients is reflected in the economic savings represented by antiepileptic drugs administered after these surgical procedures. Conclusion: we consider that in this center the patients who have been operated have meant a saving for the Caja Costarricense del Seguro Social (CCSS) since they have diminished or completely eliminated the anti-epileptic medical treatment

Predictive Factors for Seizures and Efficacy of Antiepileptic Drugs in Patients with Aneurysmal Subarachnoid Hemorrhage

Objectives. To identify factors that predict the occurrence of seizures in patients with aneurysmal subarachnoid hemorrhage (SAH) and to evaluate the efficacy of antiepileptic drugs (AEDs) in preventing in-hospital seizures among patients who undergo clip occlusion of ruptured intracranial aneurysms. Methods. In this retrospective study, the medical charts of 205 patients admitted for aneurysmal SAH in Philippine General Hospital (PGH) and who underwent craniotomy and clipping of aneurysm from January 2011 to June 2014 were reviewed. Demographic, radiologic, and clinical factors were converted into categorical variables and their association with the occurrence of seizures analyzed. The incidence of seizures among patients who received an AED (AED cohort) and those who did not receive an AED (No AED cohort) were compared. Secondarily, the effects of seizures and AED use on early postoperative outcomes were determined using the Glasgow Outcome Scale (GOS) on the day of discharge. Results. Among 205 patients with aneurysmal SAH, 31 (15.1%) developed seizures. 21 (10.2%) had seizures at onset of SAH and only seven (3.4%) had in-hospital seizures. Aneurysm re-rupture (OR 5.26, p-value 0.045) and the presence of a parenchymal clot (OR 2.90, p-value 0.043) were independent predictors for seizure occurrence. There was no significant difference in the incidence of seizures in the AED cohort and in the No AED cohort (4/100, 4% vs. 3/99, 3%, p-value 0.714). AED use was associated with a higher proportion of patients with a discharge GOS score of 3 or less (28.0% vs 12.1%, p-value 0.005). Conclusion. The results of the study do not support the routine use of AEDs in patients with aneurysmal SAH.

Inter-ictal fatigue and antiepileptic drugs in patients with epilepsy.

Fatigue is a frequently reported symptom in patients with epilepsy (PWE) while the pathophysiology, causes and effects on the disease are not yet fully understood. Fatigue may occur as a side effect of antiepileptic drugs (AEDs); however, it varies greatly depending on both the characteristics of the patients and the AEDs used. The aim of this study was to investigate the relation between fatigue, clinical features and AEDs and doses used in monotherapy in PWE. Ninety consecutive patients with the diagnosis of epilepsy, treated as monotherapy were included in the study. Demographic data, seizure type and frequency, AEDs and their doses were recorded. Fatigue severity scale (FSS) was used in the evaluation of fatigue. Cases of fatigue were defined by a FSS score ≥ 4. The mean age of the patients (57 females, 33 males) was 33 ± 12.7years and the mean disease duration was 11.7 ± 9.1years. Used as monotherapy, AEDs included carbamazepine (n = 29, 32.2%), valproic acid (n = 28, 31.1%), levetiracetam (n = 23, 25.6%) and lamotrigine (n = 10, 11.1%). Fatigue was reported by 52.2% of patients (FSS score ≥ 4). It was found that patients with fatigue had more seizures in the last year than those without (p = 0.031). There was no relation between fatigue and AEDs. The doses of carbamazepine and levetiracetam were significantly correlated with the scores of FSS (p = 0.042 and p = 0.023, respectively), and there was no correlation between the doses of valproic acid and lamotrigine and the scores of FSS. The results of our study showed that; approximately half of the patients with epilepsy had fatigue. Although the relation between AEDs and fatigue was not detected, it was pointed out that AED doses may play a role in the development of fatigue.

Epilepsy in brain metastasis: an emerging entity.

The purpose of this review is to highlight advances in the management of seizures in brain metastases from solid tumors. The highest risk for seizures is in patients with melanoma and lung cancer. There is lack of data on the efficacy of antiepileptic drugs (AEDs), but interactions between enzyme-inducing AEDs and anticancer agents must be avoided. Levetiracetam and valproic acid are the most appropriate drugs. Prophylaxis with AEDs for patients with brain metastases without a history of seizures is not recommended. Total resection of a brain metastasis allows complete seizure control. Seizures may represent an adverse effect of stereotactic radiosurgery or of high-dose chemotherapy. New preclinical and clinical studies should define the risk of brain metastasis in light of the new treatment options in the different tumor types. New clinical trials should be designed in patients with brain metastases in terms of treatment or prophylaxis of seizures.

Benign Convulsions with Mild Gastroenteritis

Benign convulsions with mild gastroenteritis (CwG) are a well-known type of benign seizures that occur in infants and children aged between 6 months and 3 years and are associated with acute (viral) gastroenteritis. The pathogens found in the stool of CwG patients are mostly rotavirus or norovirus, which can result in mild dehydration. Short-lasting seizures (≤ 5 minutes) occur in clusters within 24 hours, without provoking features such as fever, abnormal laboratory findings in the blood (e.g., hypoglycemia, hyponatremia, or hypocalcemia), or abnormal results in the cerebrospinal fluid (e.g., central nervous system infection). Electroencephalography in CwG patients shows normal or mildly abnormal findings, and brain imaging findings are normal. Affected children develop normally before and after the seizures. The occurrence of seizures does not require the repeated use of first- or second-line intravenous antiepileptic drugs in the acute stage or daily antiepileptic drug medications, since they usually do not recur and have a good prognosis. Patients with CwG rarely have a family history of epilepsy. Although the mean interval between enteric symptom onset and seizure onset in CwG is roughly 2 days, some patients can experience seizures before enteric symptoms, meaning that clinicians should exercise caution during early winter and spring, when the prevalence of CwG is especially high. Additionally, reports of CwG in Korea are roughly as common as in Japan and other East Asian countries, and pediatricians should therefore be familiar with its clinical characteristics and take care not to overprescribe antiepileptic drugs in patients with CwG. Keywords: Seizures; Gastroenteritis; Norovirus; Rotavirus; Infant

Hyperlipidemia in patients newly treated with anticonvulsants: A population study.

To determine the incidence of hyperlipidemia after first anticonvulsant treatment for seizures, using a large US administrative claims database. We obtained data from the MarketScan Commercial and Medicare databases for 2005-2009 for all adult patients newly treated with an anticonvulsant for seizures who had no previous history of hyperlipidemia or treatment with a lipid-lowering agent. We divided the population based upon whether they were treated with an enzyme-inducing anticonvulsant (phenytoin, carbamazepine, phenobarbital, primidone) or a noninducing anticonvulsant (all others). The primary outcome measure was a new diagnosis of hyperlipidemia during subsequent follow-up. We accounted for a large number of demographic and clinical covariates. Of 11374 subjects, 8778 (77%) were prescribed noninducers and 2596 (23%) were prescribed inducers. New hyperlipidemia diagnoses were seen in 14.6% of the patients started on inducing anticonvulsants and 10.7% of the patients started on noninducing anticonvulsants (P<.001). Both hyperlipidemia and the use of inducers were significantly associated with older age and male gender. After accounting for covariates, inducer prescription was still associated with 23% higher odds of a subsequent diagnosis of hyperlipidemia (odds ratio = 1.225, 95% confidence interval = 1.066-1.408, P<.001). The use of enzyme-inducing anticonvulsants in patients with newly diagnosed epilepsy was associated with a significant increase in subsequent diagnoses of hyperlipidemia, suggesting that the lipid-elevating properties of these agents are of genuine clinical importance. This adds to the body of data demonstrating that these agents are likely associated with additional hassle, cost, and morbidity.

Changes in Real-world Practice Patterns of Antiepileptic Drugs for Status Epilepticus: A Nationwide Observational Study in Japan.

Intravenous (i.v.) phenytoin/fosphenytoin is recommended as the second-line therapy of antiepileptic drugs in patients with status epilepticus (SE). i.v. Levetiracetam is regarded as an effective and safe equivalent with i.v. phenytoin/fosphenytoin. However, i.v. levetiracetam is not covered by public health insurance for SE in most countries. For this study, we performed the real-world practice pattern survey of antiepileptic drugs for status epilepticus using the nationwide inpatient database. We used the Japanese Diagnosis Procedure Combination inpatient database in Japan and identified all cases of emergency admission attributable to status epilepticus from March 2011 through March 2018. We described the patient characteristics and practice pattern of antiepileptic drugs. The analysis conducted for this study examined 31,472 cases. As the second-line therapy, the use of i.v. levetiracetam increased rapidly from 2016; 35% of cases received i.v. levetiracetam in 2017. By contrast, the use of i.v. phenytoin/fosphenytoin decreased from 2016. In-hospital mortality decreased year-by-year. No year-by-year change was observed for deaths within 24 h, length of hospital stay, drug-induced hepatitis, or drug-induced eruption. Although the use of levetiracetam for treatment of SE is not compensated by public health insurance in Japan, i.v. levetiracetam use is increasing dramatically as the second-line SE therapy. We propose that health insurance coverage be extended to include i.v. levetiracetam treatment for SE.