Efficacy Of Oxcarbazepine Research Articles

Efficacy and tolerability of oxcarbazepine in the treatment of focal epilepsy in neonates and infants under 3 months of age: A single-center retrospective analysis

ObjectiveThe neonatal and infantile period is the age group with the highest incidence of epilepsy, in which gene variants in sodium and potassium channels are an important etiology, so the sodium channel blocker class of antiseizure medications may be effective in the treatment of early onset epilepsy. This study aimed to summarize the efficacy and tolerability of oxcarbazepine (OXC) in the treatment of focal epilepsy in neonates and infants under 3 months of age. MethodsA retrospective analysis of children with focal epilepsy onset within 3 months of age and treated with OXC in a tertiary pediatric epilepsy center in China was conducted. The efficacy, tolerability and influencing factors of OXC were evaluated. ResultsA total of 50 patients were enrolled, with a median age of epilepsy onset of 11.5 (2, 42) days. There were 32 cases of early infantile developmental and epileptic encephalopathy, 10 cases of self-limited neonatal or neonatal-infantile epilepsy, and 8 cases of focal epilepsy that could not be classified as epileptic syndrome. The median age of application of OXC was 47 (31, 66) days. The median follow-up time was 16.5 (10, 25) months, with 7 deaths. Thirty-eight cases (76.0 %) were effective with OXC treatment, including 28 cases (56.0 %) achieved seizure freedom. Of the 34 cases whose pathogenesis involved genetic factors, 19 cases with sodium/ potassium channel gene variants had higher effective and seizure-free rates than those with other gene variants. The most common adverse event was transient hyponatremia. 2 cases had rash and 2 cases had abnormal electrocardiogram, 3 of which discontinued OXC. SignificanceThis single-center retrospective study suggests that OXC is effective and tolerable for the treatment of focal epilepsy in neonates and infants under 3 months of age. The efficacy of OXC is better in patients with sodium/ potassium channel gene variants.

EEG-Driven Prediction Model of Oxcarbazepine Treatment Outcomes in Patients With Newly-Diagnosed Focal Epilepsy.

Objective: Antiseizure medicine (ASM) is the first choice for patients with epilepsy. The choice of ASM is determined by the type of epilepsy or epileptic syndrome, which may not be suitable for certain patients. This initial choice of a particular drug affects the long-term prognosis of patients, so it is critical to select the appropriate ASMs based on the individual characteristics of a patient at the early stage of the disease. The purpose of this study is to develop a personalized prediction model to predict the probability of achieving seizure control in patients with focal epilepsy, which will help in providing a more precise initial medication to patients.Methods: Based on response to oxcarbazepine (OXC), enrolled patients were divided into two groups: seizure-free (52 patients), not seizure-free (NSF) (22 patients). We created models to predict patients' response to OXC monotherapy by combining Electroencephalogram (EEG) complexities and 15 clinical features. The prediction models were gradient boosting decision tree-Kolmogorov complexity (GBDT-KC) and gradient boosting decision tree-Lempel-Ziv complexity (GBDT-LZC). We also constructed two additional prediction models, support vector machine-Kolmogorov complexity (SVM-KC) and SVM-LZC, and these two models were compared with the GBDT models. The performance of the models was evaluated by calculating the accuracy, precision, recall, F1-score, sensitivity, specificity, and area under the curve (AUC) of these models.Results: The mean accuracy, precision, recall, F1-score, sensitivity, specificity, AUC of GBDT-LZC model after five-fold cross-validation were 81%, 84%, 91%, 87%, 91%, 64%, 81%, respectively. The average accuracy, precision, recall, F1-score, sensitivity, specificity, AUC of GBDT-KC model with five-fold cross-validation were 82%, 84%, 92%, 88%, 83%, 92%, 83%, respectively. We used the rank of absolute weights to separately calculate the features that have the most significant impact on the classification of the two models.Conclusion: (1) The GBDT-KC model has the potential to be used in the clinic to predict seizure-free with OXC monotherapy. (2). Electroencephalogram complexity, especially Kolmogorov complexity (KC) may be a potential biomarker in predicting the treatment efficacy of OXC in newly diagnosed patients with focal epilepsy.

Outcome analysis of children with rolandic discharges on EEG: A real-world study

ObjectiveTo evaluate the efficacy of drugs for patients with central mid-temporal (rolandic) discharges detected by electroencephalogram (EEG). MethodsThis retrospective study enrolled 430 patients with rolandic discharges, who were treated at the Neuroelectrophysiology Center of the Children’s Hospital of Nanjing Medical University from February 2015 to February 2018. Patients were divided into three groups according to medication: levetiracetam (LEV), oxcarbazepine (OXC) and sodium valproate (VPA). All patients were followed up for at least 2 years, and the seizure frequency, EEG results and side effects of drugs were recorded. ResultsRolandic epilepsy (RE) occurred in 398/430 patients. Rolandic discharges were also found in those with febrile seizures, tic disorders, and attention deficit hyperactivity disorder. Thirty-one patients experienced only one seizure and no relapse, while 367 patients experienced more than two seizures (including 364 receiving drug treatment). The failure rate of LEV as initial therapy was significantly higher than those of OXC and VPA. The overall efficacy of OXC was higher than that of LEV. However, none of the three medications could control rolandic discharges. Moreover, the side effects of the three drugs were mild. ConclusionsRolandic discharges are common in children with RE and other diseases, such as febrile seizures, tic disorders, and attention deficit hyperactivity disorder. Patients with only one seizure need no treatment. Those with multiple seizures can be treated with OXC, LEV, and VPA. OXC serves as the initial antiepileptic drug with a lower failure rate and significant efficacy.

Comparison of oxcarbazepine efficacy and MHD concentrations relative to age and BMI: Associations among ABCB1, ABCC2, UGT2B7, and SCN2A polymorphisms.

Genetic polymorphisms are related to the concentration and efficacy of oxcarbazepine (OXC). 10-Hydroxycarbazepine (MHD) is the major pharmacologically active metabolite of OXC, and it exerts an antiepileptic effect. This study aimed to explore the connection between the MHD concentration and genes such as ATP-binding cassette B1 (ABCB1), ATP-binding cassette C2 (ABCC2), UDP-glucuronosyltransferase-2B7 and sodium voltage-gated channel alpha subunit 2 (SCN2A), which participate in the antiepileptic function of OXC.Total 218 Chinese epileptic patients, were stratified into different groups according to their age, body mass index (BMI) and OXC efficacy. The genotypes of 7 single nucleotide polymorphisms in all subjects were determined by polymerase chain reaction-improved multiple ligase detection reaction assay. The MHD plasma concentration was detected by high-performance liquid chromatography and then standardized through dosage and body weight.In general, the ABCC2 rs2273697 mutant (P = .026) required a significantly higher standardized MHD concentration. For age groups, carriers of the ABCC2 rs2273697 mutant showed a significantly higher standardized MHD concentration than noncarriers in the juvenile group (P = .033). In terms of BMI, a significantly higher standardized MHD concentration was found in the ABCB1 rs2032582 mutant of the normal weight group (P = .026). The SCN2A rs17183814 mutant required a significantly higher OXC maintenance (P = .014) in the low-weight group, while lower OXC maintenance dose (P = .044) and higher standardized MHD concentration (P = .007) in the overweight group.The ABCC2 rs2273697 polymorphism was significantly associated with MHD plasma concentration in the whole patient cohort and in patients stratified by different ages, this finding provides potential theoretical guidance for the rational and safe clinical use of OXC.

The onset of acute oxcarbazepine toxicity related to prescription of clarithromycin in a child with refractory epilepsy

The onset of acute oxcarbazepine toxicity related to prescription of clarithromycin in a child with refractory epilepsy

Response

I very much appreciate the comments of Romigi et al. regarding their recent experience with the use of oxcarbazepine in nocturnal frontal-lobe epilepsy. As they mentioned, carbamazepine is generally considered the first-choice treatment in nocturnal frontal-lobe epilepsy, with a proposed mechanism of action through the inhibitory effects of hyperfunctional, mutated neuronal acetylcholine receptors. With a similar chemical structure, oxcarbazepine likely shares such a mechanism of action in nocturnal frontal-lobe epilepsy, and topiramate might share also this mechanism of action. I agree that the observations of better efficacy with these antiepileptic drugs in nocturnal frontal-lobe epilepsy, compared with other antiepileptic drugs, are of significance, and such observations will likely help guide the design of studies to elucidate the pathophysiology of nocturnal frontal-lobe epilepsy. Oxcarbazepine in Nocturnal Frontal-Lobe Epilepsy: A Further Interesting ReportPediatric NeurologyVol. 39Issue 4PreviewWe read with great interest the article by Raju et al. [1] concerning the efficacy of oxcarbazepine in children with nocturnal frontal-lobe epilepsy. This study solicited a further interesting report. We recently observed a 13-year-old boy affected by untreated nocturnal frontal-lobe epilepsy, manifesting nocturnal paroxysmal arousals with dystonic and dyskinetic movements of the upper and lower limbs (2-3 episodes per night) since age 11 years. The patient experienced 3 generalized tonic-clonic seizures triggered by sleep deprivation in the 2 months before our evaluation. Full-Text PDF

Oxcarbazepine in Nocturnal Frontal-Lobe Epilepsy: A Further Interesting Report

We read with great interest the article by Raju et al. [1] concerning the efficacy of oxcarbazepine in children with nocturnal frontal-lobe epilepsy. This study solicited a further interesting report. We recently observed a 13-year-old boy affected by untreated nocturnal frontal-lobe epilepsy, manifesting nocturnal paroxysmal arousals with dystonic and dyskinetic movements of the upper and lower limbs (2-3 episodes per night) since age 11 years. The patient experienced 3 generalized tonic-clonic seizures triggered by sleep deprivation in the 2 months before our evaluation.

P4-309: Safety and efficacy of oxcarbazepine (Trileptal) in the treatment of hypersexuality in Alzheimer's disease patients residing in the community

P4-309: Safety and efficacy of oxcarbazepine (Trileptal) in the treatment of hypersexuality in Alzheimer's disease patients residing in the community

Oxcarbazepine in the maintenance treatment of bipolar disorder.

Some studies have suggested that oxcarbazepine has a role in preventing episode recurrence in bipolar affective disorder. This review attempted to investigate the existing evidence from randomised controlled trials for its use in the maintenance treatment of this illness. To review the efficacy of oxcarbazepine, relative to placebo and other agents, in the prevention of affective episodes of bipolar affective disorder. The efficacy of oxcarbazepine was considered in terms of episode recurrence, general and social functioning. Adverse effects, overall acceptability to participants and mortality were also considered. CCDANCTR-Studies and CCDANCTR-References were searched on 7/11/2007. Medline, CENTRAL, EMBASE and PsycINFO were searched in March 2007. Specialist journals and conference proceedings were handsearched. Reference lists of relevant papers and major textbooks of affective disorder were checked. Authors, experts in the field and pharmaceutical companies were contacted requesting information on published or unpublished trials. Randomised controlled trials comparing oxcarbazepine with placebo or alternative agents, where the stated intent of intervention was the maintenance treatment of bipolar affective disorder were sought. Participants with bipolar disorder, male and female, of all ages, were included. Data were extracted from the original reports individually by two review authors. The methodological quality of included studies was assessed individually by two review authors. The main outcomes were the efficacy of oxcarbazepine maintenance treatment in preventing or attenuating further episodes of bipolar affective disorder (including its efficacy in rapid cycling disorder), the acceptability of oxcarbazepine treatment to participants, the prevalence of side-effects, and mortality, if any, on oxcarbazepine treatment. Where appropriate, data concerning outcome measures and adverse effects were to be extracted from the studies and analysed using Review Manager software. Two randomised controlled trials were found that met the methodological criteria for inclusion in the review. However, they did not report data with sufficient clarity to allow their confident extraction for inclusion in the meta-analysis. Findings from the two studies were presented descriptively. There is an insufficient methodologically rigorous evidence base to provide guidance on the use of oxcarbazepine in the maintenance treatment of bipolar disorder. Given the need for more efficacious therapeutic agents, there is a need for good quality randomised controlled trials examining the therapeutic potential of this and related agents in bipolar disorder.

The Usefulness of Nerve Conduction Studies in Objectively Assessing Oxaliplatin-Induced Peripheral Neuropathy

We read with great interest the recently published paper in your distinguished journal by Wang et al. [1], on the effect of oral glutamine in preventing oxaliplatin-induced peripheral neuropathy. The authors, among others, demonstrated an inconsistency between the electrophysiological findings and the subjective manifestations reported by patients. They report that, despite the clinical difference, the neurophysiological investigation did not show statistically significant differences between treatment groups. They also mention that, although sensory nerve conduction may be affected significantly after oxaliplatin-based treatment, the severity of clinical sensory neuropathy does not always correlate with findings of nerve conduction studies. Cascinu et al. [2] reached the same conclusion, demonstrating that sensory nerve conduction was significantly affected by oxaliplatin only in patients receiving placebo, but not in those receiving glutathione. The results of these studies raise the issue of whether nerve conduction studies are useful in objectively assessing chemotherapy-induced peripheral neuropathy (CIPN). In contrast to the results of Wang et al. [1], in our recently published study on the efficacy of oxcarbazepine in preventing oxaliplatin neurotoxicity, it was demonstrated that between-group (patients receiving oxcarbazepine versus control patients) longitudinal comparison of the median changes in amplitude of sensory action potentials (a-SAP) during chemotherapy revealed significant differences in two of the three sensory nerves tested, thereby favoring oxcarbazepine administration [3]. In line with existing knowledge on the topic of CIPN [4], the severity of clinical symptoms and signs correlated with our electrophysiological findings [5]. Furthermore, another study conducted by our group evidenced a significant longitudinal decrease in all the a-SAPs examined during therapy with the formal FOLFOX-4 regimen [5]. In our opinion, Wang et al. [1] should provide further explanation to justify this inconsistency. Their claim that the non–placebo controlled, unblinded study design might be the cause of this discrepancy is not sufficient. In their study, a subgroup of approximately one third of the patients underwent neurophysiological investigations; neither the technique nor the quantitative outcomes of the investigations were provided. In any case, we strongly support the view that nerve conduction studies are useful and capable of objectively assessing the extent of peripheral nerve damage secondary to chemotherapy administration and may also facilitate the identification of patients that manifest subclinical peripheral neuropathy prior to the onset of clinically significant neurotoxicity [6]. Our experience showed that a precise clinical evaluation, combined with a detailed electrophysiological assessment, could provide data regarding the characteristics of peripheral neuropathy during chemotherapy and may also predict the final neurological outcome of CIPN [7]. It is acknowledged that

High and low dosage oxcarbazepine versus naltrexone for the prevention of relapse in alcohol‐dependent patients

Oxcarbazepine (OXC) reduces high-voltage-activated calcium currents, thus reducing glutamatergic transmission at corticostriatal synapses. This effect on NMDA glutamatergic transmission may play a role against the increased glutamatergic transmission determined by alcohol withdrawal. To investigate the efficacy and safety of OXC in relapse prevention we compared OXC at different dosages with Naltrexone (NAL) in a 90 days randomised open-label trial. Craving and psychiatric symptoms improvements were the secondary endpoints. Eighty-four detoxified alcohol dependent subjects currently meeting clinical criteria for alcohol dependence were randomised into three groups: 27 patients received 50 mg of naltrexone, 29 received 1500-1800 mg of oxcarbazepine (OXC high), 28 patients 600-900 mg of oxcarbazepine (OXC low). Craving (VAS; OCDS) and withdrawal (AWRS) rating scales were applied; psychiatric symptoms were evaluated through the SCL-90-R. A significantly larger number of subjects remained alcohol free in the OXC high group (58.6%) with respect to both the OXC low (42.8%) and the NAL groups (40.7%). Comparing the OCDS total scores at the end of the treatment, the improvement was significantly greater for the NAL group with respect to the OXC low group. The reduction of the Hostility-Aggression subscore of the SCL-90-R was significantly greater in the OXC high group than that of the other groups. Dual diagnosis patients had a better outcome when treated with OXC high. OXC at a dosage of 1500-1800 mg/day might be beneficial in terms of alcohol relapse prevention. The low dosage formulation did not show the same trend, but it still remain in the same range as NAL. The mechanism involved in the efficacy of oxcarbazepine in relapse prevention could be less related to craving and more connected to the treatment of the comorbid psychiatric symptomatology and the alcohol protracted withdrawal syndrome.

Oxcarbazepine in bipolar disorder: a critical review of the literature

Oxcarbazepine (OXC) is a keto-congener of carbamazepine, which has fewer side effects and drug interactions. However, the efficacy of OXC in treating bipolar disorder is not as well established as that of carbamazepine. This article is a systematic literature review of all studies regarding OXC and bipolar disorders, with particular attention to papers published in the last 6 years. Using the terms ‘oxcarbazepine and bipolar disorder’, ‘oxcarbazepine and mania’ or ‘oxcarbazepine and bipolar depression’, a computer-aided search of MEDLINE for the years 2000 – 2006 has been conducted. Since its introduction as an antiepileptic drug in early 2000, clinical research regarding the potential role of OXC in the treatment of bipolar disorder remains limited. There is a lack of double-blind, placebo-controlled studies. Studies recently published have small samples of patients, with insufficient follow-up periods and other methodological weaknesses. The efficacy of OXC in bipolar disorder has not been widely studied. Some authors recommend using OXC as monotherapy or as add-on therapy in refractory mania, although results are not conclusive. It is unknown whether OXC has efficacy in the maintenance treatment of bipolar disorder. OXC can be particularly useful as an add-on treatment in bipolar disorder patients for whom previous treatments have failed, or in patients who have difficulty tolerating adequate dosages of standard approved treatments.

Oxcarbazepine in the Treatment of Bipolar Disorder: A Review

To review the data on the efficacy of oxcarbazepine (OXC) in bipolar disorder (BD) and to provide recommendations for clinicians on the use of this medication in treating BD. Using the terms oxcarbazepine and bipolar disorder, oxcarbazepine and mania, or oxcarbazepine and bipolar depression, we conducted a computer-aided search of MEDLINE for the years 1950 to 2005. Case reports, retrospective chart reviews, open prospective studies, and double-blind studies reported the efficacy and effectiveness of OXC in treating BD. The data indicate that OXC has efficacy in treating acute mania and may be a useful add-on in treating acute bipolar depression and in BD prophylaxis. OXC is generally well-tolerated. We recommend using OXC as monotherapy or as add-on therapy in refractory mania, but we recommend it be used predominantly as an add-on treatment for other phases of BD in patients who have not improved with well-established treatments or in patients who have difficulty tolerating adequate dosages.

P1-446: Safety & efficacy of oxcarbazepine in the treatment of hypersexuality in Alzheimer’s disease patients residing in a special care unit in an assisted living facility

P1-446: Safety & efficacy of oxcarbazepine in the treatment of hypersexuality in Alzheimer’s disease patients residing in a special care unit in an assisted living facility

Use of Oxcarbazepine to Treat a Pediatric Patient With Resistant Complex Regional Pain Syndrome

We describe a 12-year-old patient with severe, protracted complex regional pain syndrome type I. His pain did not respond to gabapentin, amitriptyline, physical therapy, opioids, or nonsteroidal drugs. Sympathetic or regional block was not attempted because of persistent bacteremia and severe local sepsis. His pain responded dramatically to the addition of oxcarbazepine, with rapid improvement in his symptoms and functional status. We suggest that oxcarbazepine might be a useful adjunct in the treatment of gabapentin-resistant complex regional pain syndrome type I in children and should be considered. Perspective Oxcarbazepine’s antinociceptive effect is mediated via sodium channel inhibition in neuropathic models and by inhibition of substance P and prostaglandins in anti-inflammatory models. The efficacy of oxcarbazepine in this patient might be attributable to these mechanisms or possibly to synergism with either gabapentin or the anti-inflammatory effects produced by amitriptyline.

Oxcarbazepine in Alcohol Relapse Prevention

Our case observations attempted to evaluate the tolerability and efficacy of oxcarbazepine in relapse prevention in patients, who had repeatedly relapsed after detoxification and who had also failed to respond to acamprosate. Ten high-risk alcoholics were treated with oxcarbazepine and followed up for more than three months. We assessed craving with the OCDS. Seven patients remained abstinent and two patients reduced drinking under oxcarbazepine. Subjective craving was reduced. Treatment had to be discontinued in four patients due to side effects. Although uncontrolled case observations can only be interpreted with caution, oxcarbazepine seems to deserve further investigation and may hold the potential for preventing alcohol relapse in previously treatment-resistant alcoholics. Side effects may have occurred due to a rather fast initial increase of the oxcarbazepine dosage.

P2-346 Safety and efficacy of oxcarbazepine in the treatment of hypersexuality in Alzheimer's disease patients residing in the community

P2-346 Safety and efficacy of oxcarbazepine in the treatment of hypersexuality in Alzheimer's disease patients residing in the community

Anticonvulsants: Efficacy and tolerability of oxcarbazepine in the treatment of neuropathic pain

The objective of this trial was to evaluate the safety, tolerability, and efficacy of oxcarbazepine in the treatment of painful neuropathies. This was an open-label, nine-week trial, consisting of a one-week prospective Screening Phase followed by an eight-week Treatment Phase. Treatment with oxcarbazepine was initiated at 150 mg/day and the daily dose was increased on a 2-3 days basis to tolerability over four weeks, up to 1200 mg/day. This was followed by a four-week fixed-dose Maintenance Phase during which patients were maintained on oxcarbazepine. The primary efficacy variable was the change in the weekly pain rating scale assessed on the VAS of the short-form McGill Pain Questionnaire (SF-MPQ) between the Screening Phase and the Treatment Phase. In addition, the short-form 36 Quality of life (SF-36 QOL) was completed at the baseline visit and at the end of the treatment phase. All analysis were performed on the intent-to-treat population. Twenty patients were enrolled in the trial. The mean daily oxcarbazepine dose during the Maintenance Phase was 870 mg. The mean VAS score dropped from 69.85 during the Screening Phase to 29.45 at the end of the trial (p <0.0001), for a mean reduction of - 40.40 (42.16 %). Moreover there were significant improvements in the total pain score and present pain intensity scores from the SF-MPQ and SF-36 QOL. Oxcarbazepine was well tolerated with the most common adverse events consisting of dizziness, and gastric symptoms. The results suggest that oxcarbazepine administered as monotherapy is an efficacious and safe option for the symptomatic treatment of pain associated with neuropathies. These results will need to be confirmed in large, double-blind, placebo controlled, randomized clinical trials

Anticonvulsants: Oxcarbazepine relieves pain and paresthesias in idiopathic painful sensory neuropathy

We conducted an open-label pilot study to assess the safety and efficacy of oxcarbazepine on the severity of sensory symptoms in patients with painful sensory neuropathy (PSN). A total of 10 patients (7 female) with idiopathic painful neuropathy of at least 3 months duration enrolled in the study. Data are reported from 9 patients; one withdrew early. The mean age was 61.3 years (range: 47-70). The study consisted of a 2-4 week screening phase, a 4-week titration phase, 12-week maintenance phase, and a 2-week dose-tapering phase. Oxcarbazepine was initiated at 150 mg BID for 1 week, increased to 300 mg BID at week 2, 450 mg BID at week 3, and 600 mg BID at week 4. Dose adjustments were allowed during the 4-week titration phase. The following assessments were performed: VAS, NSC (Neuropathy Symptom and Change), neurologic exam, vital signs, and recording of any adverse events. The mean and median changes in VAS scores were -32 mm and -48 mm, respectively (p < 0.04). The mean change from baseline to last visit in overall severity score for the 9 questions of the sensory component of the NSC was -5.7 points (p=0.02). Significant decreases of at least 1 point were noted in severity of paresthesias (p=0.031), spontaneous sharp pains (p=0.031), and spontaneous burning discomfort (p=0.016). Five patients discontinued before completion due to adverse events. One was considered unrelated to study drug and two improved with dose reduction but chose to withdraw regardless. Oxcarbazepine is effective in reducing neuropathic pain in PSN. The NSC is a useful outcome measure in trials of interventions for neuropathic pain because it allows for semi-quantitative assessment of change among characteristic neuropathic pain symptoms. A double blind study of the effect of oxcarbazepine on positive sensory symptoms in idiopathic PSN is warranted

Oxcarbazepine, risperidone and atenolol overdose with benign outcome

Despite only sparse data suggest the efficacy of oxcarbazepine (Oxz) in treating mood disorders, APA guidelines for the treatment of bipolar disorder consider Oxz an alternative in lieu of lithium or valproate (APA, 2002). The Texas Consensus Conference Panel on Medication Treatment of Bipolar Disorder recommends the use of Oxz instead of carbamazepine in the algorithm for the treatment of bipolar disorder (Suppes et al., 2002). Since suicide is a frequent complication of bipolar disorder, voluntary overdoses with this drug will become frequent.