Antiepileptic Medication Regimens Research Articles

Personalized support programs with innovative digital tools to manage and monitor patients suffering from epilepsy: EpiOnApp case study

Epilepsy is one of the most common serious chronic neurological diseases affecting around 50 million people globally and 500,000 patients in Italy. It causes uncontrollable, unprovoked, and unpredictable seizures that reduce the quality of life of those afflicted.
 It is widely recognized that the most important strategy for controlling seizures and enhance well-being includes receiving and adhering to anti-seizure medications as well as making appropriate lifestyle adjustments. However it is estimated that 30–60% of patients do not adhere to their antiepileptic medication regimens. EpiOnApp is a digital Patients Support Program (PSP) designed to empower patients with epilepsy who are taking Cenobamate for their chronic condition to take control of their health care pathway, from inception throughout the duration of the treatment, and to have a meaningful dialogue with their neurologist by sharing health records and emotional states. Moreover, as patients may have limited mobility, they can order their therapy and have it home delivered in a very easy way, and they can benefit from continuous human support through the figure of a dedicated Care Manager. The advantage for the neurologist is that the platform stores seizure data, facilitating the drug titration and better assessing at the time of the follow-up visit. The efficacy of the program is currently being evaluated. So far, the level of satisfaction expressed by patients and neurologists shows that a well-designed and tailored PSP can address the challenge of improving long-term adherence, helping people with epilepsy through the on-boarding and initial treatment period, reducing discontinuation, and ultimately, delivering a better health outcome.

Biomarkers Obtained by Transcranial Magnetic Stimulation of the Motor Cortex in Epilepsy.

Epilepsy is associated with numerous neurodevelopmental disorders. Transcranial magnetic stimulation (TMS) of the motor cortex coupled with electromyography (EMG) enables biomarkers that provide measures of cortical excitation and inhibition that are particularly relevant to epilepsy and related disorders. The motor threshold (MT), cortical silent period (CSP), short interval intracortical inhibition (SICI), intracortical facilitation (ICF), and long interval intracortical inhibition (LICI) are among TMS-derived metrics that are modulated by antiepileptic drugs. TMS may have a practical role in optimization of antiepileptic medication regimens, as studies demonstrate dose-dependent relationships between TMS metrics and acute medication administration. A close association between seizure freedom and normalization of cortical excitability with long-term antiepileptic drug use highlights a plausible utility of TMS in measures of anti-epileptic drug efficacy. Finally, TMS-derived biomarkers distinguish patients with various epilepsies from healthy controls and thus may enable development of disorder-specific biomarkers and therapies both within and outside of the epilepsy realm.

Assessment of Patients' Adherence to Antiepileptic Medications at Dessie Referral Hospital, Chronic Follow-Up, South Wollo, Amhara Region, North East Ethiopia.

An epileptic seizure is a clinical event presumed to result from an abnormal and excessive neuronal discharge. The clinical symptoms are paroxysmal and may include impaired consciousness and motor, sensory, autonomic, or psychic events perceived by the subject or an observer. Epilepsy occurs when 2 or more epileptic seizures occur unprovoked by any immediately identifiable cause. And in the majority of patients with epilepsy, antiepileptic drugs effectively control their illness. However, more than 30% of people with epilepsy do not attain full seizure control, even with the best available treatment regimen. The aim of this study is to assess self-reported adherence in adult patients with epilepsy and to identify potential barriers for nonadherence to antiepileptic drug treatment in Dessie Referral Hospital. A hospital based cross-sectional study was conducted using structured questionnaires including Morisky medication adherence scale and analysis was conducted descriptively using SPSS version 20. The level of nonadherence to antiepileptic medication regimens was 34.1%. The major reason for missing medication was forgetfulness 53.5%. And the most common side effect was sedation 56.2%. Conclusion. Majority of epileptic patients in Dessie Referral Hospital was adherent to their AEDs treatment and among the determinants of adherence assessed the level of education and the side effect of drugs showed statistical significance.

Female Sex Hormones and Epilepsy

The frequency of seizures in many female epilepsy patients can be affected by theirmenstruation cycle: a phenomenon known as ‘catamenial epilepsy’. This can beclassifi ed into three types-C1 (perimenstrual catamenial epilepsy), C2 (periovulatorycatamenial epilepsy), and C3 (inadequate luteal catamenial epilepsy). Hormonalcontraception can also affect the control of a seizure as well as the level of someantiepileptic medications, while some anticonvulsive agents can also reduce theeffi cacy of contraceptive pills. There is still limited evidence on the treatment ofcatamenial epilepsy, but a variety of therapeutic regimens can be tried includinghormonal therapy, modifi cation of antiepileptic medication regimen during themenstruation cycle, intermittent benzodiazepine, intermittent acetazolamide, or someinvestigative agents such as neuroactive steroid ganaxolone.

Efficacy of Neuromodulation Therapy with Vagus Nerve Stimulator in Patients with Drug-Resistant Epilepsy on Unchanged Antiepileptic Medication Regimen for 24 Months Following the Implant

To establish efficacy of vagus nerve stimulation (VNS) therapy in the treatment of intractable epilepsy, we compared outcome data from the baseline period to the maintenance period (7 to 24 months post-implant) by calculating the mean seizure frequency at 6-month intervals (7 to 12 months - first study period, 13 to 18 months - second study period, and 19 to 24 months - third study period), in 39 consecutive patients on unchanged antiepilepsy drug (AED) regimen for 24 months following the VNS implant. Of the 39 patients24 (61.5%) at first study period, 25 (64.1 %) at second study period and 25 (64.1 %) at third study period were responders (≥50% reduction in seizures). Twenty one (53.9 %) patients were responders in all three study periods. Incremental seizure control was seen in 15 of these 21 patients. Although 3 (7.7%), 4 (10.3 %) and 8 (20.5%) patients had a total (100%) seizure control at first, second and third study periods respectively, no patient remained seizure-free through all 3 study periods. Seven (17.9%) patients were partial responders (≥ 50% seizure reduction in two or less study periods). Eleven patients (28.2%) were non-responders (< 50% seizure reduction in all 3 study periods). Twenty three patients (59%) had partial epilepsy with and without secondarily generalization and 16 patients (41%) had primary generalized epilepsy. Eleven (47.8%) of the 23 patients with partial epilepsy and 10 (62.5%) of the 16 patients with generalized epilepsy were responders in all three study periods. We conclude that: 1) More than 60 % of patients on unchanged AED regimen continued to be responders at 24 months following the VNS implant. 2) A trend towards increasing responder rate with increasing duration of VNS therapy was observed.3) No major complications or side effects requiring discontinuation of VNS therapy were noted.

Seizure freedom in epilepsia partialis continua (EPC) through vagus nerve stimulation (VNS) therapy: A case report

Vagus nerve stimulation (VNS) is generally considered as a palliative treatment for patients with drug-resistant partial-onset epilepsy. We report a case in which a patient with drug-resistant epilepsia partialis continua (EPC), became seizure-free for 15 months with VNS combined with antiepileptic medication regimens. To our knowledge, similar cases have not been reported previously.

Changed constitution without change in brand name – The risk of generics in epilepsy

Lamotrigine (LTG) is an anti epileptic medication (AEM) for which blood levels are helpful for optimal dosing. In late 2010, patients attending an epilepsy clinic were becoming toxic without obvious cause. This paper reports altered levels without change in regimen and provides unexpected findings. Patients with elevated LTG blood levels were assessed to determine change in AEM regimen or generic substitution. Method of blood level determination was reviewed and the company (GlaxoSmithKline) contacted regarding change in source of medication. The sample comprised 18 patients; mean age 40±16 years, mean daily LTG dose 493±218 mg. Mean serum LTG concentrations from August 2010 to February 2011 [91.8±17.7 μmolL(-1), range 69.9-133.7 μmolL(-1)] were significantly higher than those from January 2010 to July 2010 [50.3±9.1 μmolL(-1), range 32-60.1 μmolL(-1)), p<0.0001]. All patients received parent product (Lamictal(®)) and the method of LTG blood level determination was unchanged. GlaxoSmithKline confirmed that Lamictal(®) was sourced from a different site. These results indicate that, even using a parent compound, AEM levels can fluctuate if the product source has changed, resulting in toxicity. It also highlights the value of determining AEM levels and the risks attached to generic substitution.

Poster 397 Severe Agitation After Intrathecal Baclofen Pump Placement in a Child With Cerebral Palsy: A Case Report

zure disorder who developed Sydenham chorea. Program Description: The patient developed chorea that was initially thought to be seizure related. Workup was unremarkable except for positive anti-streptolysin O titer and identification of erythema marginatum rash. The patient was given a dose of intramuscular penicillin, then was treated with intravenous immunoglobulin, and was transferred to acute inpatient rehabilitation to recover functional independence and strength. The chorea relapsed, however, and patient was administered a 5-day course of intravenous methylprednisolone with good results. A week after completing the methylprednisone, the chorea again worsened. In addition, the patient was experiencing frequent partial and absence type seizure activity and began having frequent periods of dysarthria and dysphagia. The following day, he had 2 generalized seizures. Upon transfer back to the acute care hospital, intravenous phosphenytoin was given, which effectively treated the seizure activity and, surprisingly, also greatly reduced the problematic chorea. Setting: Acute inpatient rehabilitation hospital. Results: Once seizure activity was effectively controlled, the patient was able to swallow and talk again. The chorea also decreased and did not relapse. Two days later, the patient was discharged home but required outpatient physical and occupational therapy. Discussion: The clinical course for Sydenham chorea in this case was vastly more drawn out and complicated than expected. It is suspected that the underlying seizure disorder in combination with the development of Sydenham chorea contributed to the clinical course. It is plausible that the patient’s seizure threshold may have been lowered due to the Sydenham chorea. Conclusions: Medical and rehabilitation management for individuals with known seizure disorder who develop Sydenham chorea is not well defined in the present literature. Based on this particular case presentation, consideration should be made for a more aggressive antiepileptic medication regimen in patients with an underlying seizure disorder who are being treated for Sydenham chorea.

Ictal asystole

A 67-year-old man with a longstanding history of seizure disorder since 1978 was admitted to our hospital with syncope. While visiting his wife at our hospital, he was sitting and reading in a chair next to her when he suddenly slumped over in his chair and dropped his book. Upon awakening, he remained disoriented for 30 minutes with multiple episodes of emesis. There were neither tonic-clonic movements nor loss of bowel or bladder control. He denied any missed doses or changes to his antiepileptic medication regimen (carbamazepine), as had occurred with prior recurrences of seizures. On admission, physical examination and laboratory evaluation were both unremarkable, including an appropriate carbamazepine level. He was then monitored with continuous telemetry and video electroencephalogram (EEG) (Figure 1), during which a witnessed syncopal event occurred.

Unplanned Medication‐Related Hospital Readmission following Transfer to a Residential Care Facility

ABSTRACTBackgroundAnecdotal evidence suggests that current medication arrangements following discharge from hospital to residential care facilities sometimes lead to medication delays and errors, which may result in adverse outcomes.AimTo describe a case where delays in initiating a revised antiepileptic medication regimen may have contributed to adverse clinical outcomes for a patient requiring unplanned hospital readmission.Clinical detailsA 41‐year‐old man was admitted to hospital from a residential care facility with seizures and hyponatraemia. Multiple changes were made to the patient's antiepileptic medication regimen and he was discharged on Day 11 (a Sunday). Following discussion with the residential care facility and their designated community pharmacy, it was agreed that the community pharmacy would dispense his medications and pack them into a dose administration aid, and the residential care facility would organise for a new medication chart to be written by a general practitioner. The hospital doctor prepared a discharge summary and a copy of the discharge prescription was faxed to the community pharmacy. The patient was discharged from hospital with no medications. 3 days later he was readmitted to hospital with seizures, falls and a subdural haemorrhage. On review, the revised antiepileptic regimen had not been implemented at the residential care facility. The patient spent a further 11 days in hospital before returning to the residential care facility.ConclusionTransferring patients from hospital to residential care poses challenges to continuity of care. Improved discharge planning processes to ensure continuity of medication administration on discharge to a residential care facility are urgently needed.

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

A Report of Successful Treatment of Psychosis in Epilepsy With Risperidone

The complexity of treatments for persons with epilepsy

The purpose of this study was to describe the types of antiepileptic medication regimens and the types of actions required to take medications for a group of patients with epilepsy. The Epilepsy Medication and Treatment Complexity Index (EMTCI) was used to gather information about medications and treatments. The sample of 314 reported on 585 epilepsy medications. The majority (56%) were on more than one treatment. On average, an individual took 1.86 medications per day (range, 1–6) and 7.98 pills per day (range, 1–36 pills). Most medications (54%) were taken twice a day. The most common special instruction was taking different doses on the same day. Taking more than one tablet per dose was the most common administrative action. Data presented here raise interesting areas for further research as well as important clinical implications.