Number Of Antiepileptic Drugs Research Articles

Association of Lamotrigine Plasma Concentrations with Efficacy and Toxicity in Patients with Epilepsy: A Retrospective Study.

There is limited evidence to support the currently suggested lamotrigine (LTG) therapeutic reference range of 2.5-15 mg/L for the treatment of seizures. The objective of this study was to evaluate the association of LTG plasma concentrations with the efficacy and toxicity of the treatment in patients with epilepsy. Patients whose LTG plasma concentration was measured between January 2013 and February 2022 were included. Efficacy was defined as seizure freedom for at least 6 months around the time of measured LTG concentration. Toxicity was defined as any LTG-related adverse drug effect documented in each patient's health record or when the reason for measuring the LTG concentration was toxicity. In addition, the dose-concentration relationship of LTG was assessed. In total, 549 concentrations from 259 patients with epilepsy were included. The most common reasons for therapeutic drug monitoring were suspected inefficacy (39%) and pregnancy (21%). The LTG plasma concentration was not associated with efficacy (adjusted odds ratio = 0.94; 95% confidence interval, 0.85-1.04). The LTG plasma concentration was positively associated with the incidence of toxicity after adjusting for age, sex, and number of antiepileptic drugs (odds ratio = 1.11; 95% confidence interval, 1.04-1.19). The daily dose had a significant linear correlation with the LTG plasma concentration (P < 0.001). The LTG plasma concentration was associated with toxicity, whereas no association with efficacy was found. A reference range of 2.5-10 mg/L may be considered to decrease the risk of toxicity while maintaining similar efficacy. Therapeutic drug monitoring may be useful when LTG-related toxicity is suspected and in cases of pharmacokinetic changes (eg, pregnancy and concomitant use of interacting drugs) that can influence the LTG plasma concentration.

Predictors of poor neurodevelopmental outcomes in neonates with clinically observed seizures: A prospective observational study in a tertiary care hospital of Bangladesh

Neonatal seizures can lead to long-term neurodevelopmental problems. This study aims to identify predictors of poor developmental outcomes in neonates with seizures to aid in early intervention and referral for follow-up and rehabilitation.This observational study was conducted in the Department of Neonatology and Institute of Paediatric Neurodisorder, Bangabandhu Sheikh Mujib Medical University. Among 75 study cases of neonatal seizure, 23 died, and 46 were follow-ups at 6 and 9 months after discharge. EEGs were performed on every patient with a comprehensive neurological examination and developmental evaluation using Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III).Three-fourths of neonates were born at term (76.1 %), and over half were male (56.5 %). The majority were appropriate for gestational age (79.7 %) and had an average birth weight of 2607 ± 696 g (±SD). Over half of the neonates (52.2 %) had adverse neurodevelopmental outcomes, with global developmental delay being the most common. Recurrent seizures, the number of anticonvulsants needed to control seizures, and abnormal Electroencephalograms were identified as independent predictors of adverse neurodevelopmental outcomes.The study highlights the need for early referral for follow-up and rehabilitation of neonates with seizures having abnormal electroencephalograms, recurrent seizures and requiring more anticonvulsants to control seizures.

Navigating Social Waters: Understanding Theory-of-Mind Challenges in Patients with Mesial Temporal Lobe Epilepsy.

Background: Temporal lobe epilepsy is a common neurological disease that affects many areas of patients' lives, including social competence. The aim of the study was to assess theory of mind in patients with temporal lobe epilepsy and to investigate the demographic and clinical factors associated with this function. Methods: A total of 65 participants took part in the study, which included 44 patients with epilepsy and 21 demographically matched healthy individuals. The following neuropsychological tests were used to examine theory of mind: the Faux Pas Test, the Hinting Task, the Emotion Comprehension Test, and a cognitive function screen, the Montreal Cognitive Assessment. Results: Patients with epilepsy scored lower on all measures of the theory-of-mind tests. Moreover, in the clinical group, numerous moderate and strong correlations were found between the theory-of-mind tests and education, age at onset of epilepsy, lateralization of epileptic focus, cognitive status, and, to a lesser degree, number of anti-epileptic drugs, frequency of seizures, and age. In contrast, in the control group, significant correlations were found mostly between the theory-of-mind tests and sex, and, to a lesser degree, age. Education and cognitive functioning were not associated. Conclusions: Patients with epilepsy experience difficulties in theory of mind, which may have a negative impact on the quality of their social relationships. The level of theory-of-mind abilities correlates with particular clinical and demographic indicators. Recognizing these issues allows clinicians to implement tailored interventions, potentially improving patients' quality of life.

Efficacy and safety of a smartphone application-based treatment of ketogenic diet in pediatric refractory epilepsy.

We aimed to find predictors for smartphone application-based ketogenic diet (KD) treatment effectiveness and safety. The efficacy was evaluated according to the reduction in seizure frequency after the intervention of KD; safety was evaluated based on adverse effects. The ordinal logistic regression analysis was used to explore the influencing factors of efficacy. The study sample included 116 males and 65 females with a median age of 2.27 years. The baseline frequency of seizure was more than five times/day in 123 children, 50.83% of them received three or more antiepileptic drugs (AEDs). Seventy-two patients' KD initiation mode was outpatient, and 73 completed the 12-month follow-up. A total of 88 (48.62%) patients had reported a reduction in seizure ≥50%. Compared with 12 months, those who had received KD therapy for only 3 (P = 0.009) and 6 months (P = 0.005) were more likely to show negative outcomes. Outpatient initiation had better outcomes (P = 0.029) than inpatient initiation. For the number of AEDs applied, patients on two AEDs were more likely to achieve better outcomes (P = 0.001). Adverse events had been noted among 77 patients; BMI Z-score at KD initiation was associated with adverse effects (P = 0.003). Our study suggested that outpatient initiation and long-term treatment of KD should be encouraged. Our research shows that the KD is a helpful treatment for children with refractory epilepsy, reducing seizures by more than 50% in nearly half of the cases, with some experiencing complete seizure freedom. We used a smartphone app to improve communication between patients and their healthcare teams, resulting in a high retention, and app usage was linked to reduced adverse effects. We recommend early consideration of KD treatment for patients failing two AED, encourage outpatient initiation, and advocate for longer-term KD use.

Folic acid supplementation in women of childbearing age with epilepsy: No association with type or number of antiepileptic drugs.

For over two decades, a daily folic acid (FA) supplementation has been recommended for women of childbearing age with epilepsy. This recommendation is based on evidence that FA administration before conception and during pregnancy can decrease the risk of fetal malformations in the general population, improve cognitive development, and reduce the risk of autistic traits in children exposed in utero to antiepileptic drugs (AEDs). The aim of this study was to evaluate FA supplementation rate in nonpregnant women of childbearing age with epilepsy and its relation to AED type and number. We retrospectively reviewed the computerized database and the medical records of all the women who had a first visit to our outpatient epilepsy clinic (Shamir-Assaf Harofeh Medical Center, Zerifin, Israel) during a 10-year period (2012-2021). Only 61 (22%) of 282 nonpregnant women of childbearing age with epilepsy treated with AEDs received FA supplementation. Ninety-two (33%) of the women were treated with AED polytherapy, and 41 (15%) received valproic acid in monotherapy or polytherapy. FA supplementation rate was higher in women aged ≤40 versus >40 (25% vs. 8.5%) (p = .004). No correlation was found between FA supplementation and AED type or number. FA supplementation rate was low and was unaffected by AED treatment. Patient and physician-targeted interventions should be implemented to increase FA prescription and patient adherence.

37 Cognitive Disengagement Syndrome (CDS; Sluggish Cognitive Tempo) in Pediatric Epilepsy

Objective:Cognitive disengagement syndrome (CDS; previously known as “sluggish cognitive tempo” or SCT) refers to a set of behavioral symptoms characterized by slowed thinking/behavior, daydreaming, and mental fogginess or confusion. It has been described as related to, yet separate from, symptoms associated with Attention-deficit Hyperactivity Disorder (ADHD) inattention. There is a paucity of research on CDS within pediatric epilepsy populations despite substantial risk factors inherent to the disorder and a large proportion of patients with comorbid ADHD. This study therefore describes CDS as reported by parents for a large sample of children with epilepsy. Relationship between epilepsy variables (e.g., number of antiepileptic drugs [AEDs], seizure frequency, seizure type) and CDS symptoms was explored. Additionally, considering the negative association between CDS and academic performance in other populations, the relationship between parentrated CDS and academic risk factors was examined.Participants and Methods:Participants included 151 children with epilepsy (mean age = 11y, range 6-18y; 55% male; IQ&gt;70), referred for outpatient neuropsychological assessment. As part of routine clinical care, parents completed the Penny Sluggish Cognitive Tempo Scale (SCT) and the Colorado Learning Difficulties Questionnaire (CLDQ). Scores and basic demographic information were extracted from an IRB approved clinical database; the IRB granted approval for retrospective chart review to extract additional medical variables. Parent report of CDS included total CDS score and three subdomains: Sleepy/Sluggish, Low Initiation, and Daydreamy. Higher scores represent greater parent-reported difficulties. Independent samples t-tests compared the participants’ means on total CDS and each subdomain to the normative sample. Analysis of variance was conducted to determine differential impact of seizure type (Generalized, Focal, or Multifocal) on total CDS and each subdomain. Correlations between other medical variables, scores on the CLDQ, and parent ratings on the SCT were examined.Results:Parents of children with epilepsy rated overall CDS total and subdomain scores as significantly higher compared to the normative means with highest elevation in symptoms of Low Initiation (p = &lt;.001). Total CDS was associated with increased parent-reported academic difficulties; however, of the three subdomains, only Low Initiation was significantly associated with concerns for academic functioning. Number of AEDs was associated with increased symptoms on the Sleepy/Sluggish subdomain only. Seizure frequency was associated with total CDS and Sleepy/Sluggish symptoms, though this finding is likely mediated by increased number of AEDs for those with more frequent seizures. Seizure type was not associated with significant differences in Total CDS or CDS subdomains.Conclusions:Children with epilepsy are at increased risk for experiencing slowed thinking and cognitive disengagement. Low initiation is particularly elevated in pediatric epilepsy populations, which may lead to increased academic difficulties. Potential interventions targeting low initiation may therefore have benefit in the academic setting for children with epilepsy, regardless of epilepsy type.

Fatal eosinophilic myocarditis and submassive hepatic necrosis in lamotrigine induced DRESS syndrome

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare but severe and sometimes fatal adverse drug reaction that is known to occur with a number of antiepileptic drugs. It often follows a prolonged clinical course, which can worsen even after discontinuing the causative drug and administering steroid treatment. Failure to promptly identify the delayed involvement of vital organs, such as the heart and liver, may result in irreversible organ failure and death. We report a case of a presumed sudden death of a young woman who had a documented history of a protracted intermittent hypersensitivity reaction to lamotrigine. Postmortem examination revealed the presence of eosinophilic myocarditis and submassive hepatic necrosis diagnostic of fatal DRESS syndrome that progressed despite early discontinuation of the medication and improvement of dermatologic and hematologic symptoms following steroid therapy.

Clinical outcomes following responsive neurostimulation implantation: a single center experience.

Responsive neurostimulation (RNS) is an implantable device for persons with medically refractory focal-onset epilepsy. We report a single-center experience for RNS outcomes with special focus on stereoelectroencephalography (sEEG) for seizure onset localization. We performed retrospective review of patients with drug resistant focal epilepsy implanted with the RNS System for a minimum of six months between July 2014 and July 2019. Records were reviewed for demographic data, epilepsy duration, seizure frequency, number of prior antiepileptic drugs (AEDs), number of AEDs at RNS System implantation, prior epilepsy surgery or device use, previous seizure localization with sEEG, and RNS system information. Clinical response was defined as a 50% reduction in seizures. Differing response rates were calculated using Fisher Exact test. 30 patients met inclusion criteria. Seventeen (57%) underwent previous sEEG. Average clinical follow up was 3.0 years. Overall response rate was 70%. Median seizure reduction was 74.5%. Response rate was 82.3% for patients with sEEG compared to 53.8% without (p = 0.08); 37.5% for prior epilepsy surgery compared to 81.8% without (p = 0.02); 70% for mesial temporal onset; 50% for previous vagal nerve stimulator compared to 77.3% without (p = 0.13). Our response rates match or surpass outcome metrics of previous studies. Although limited by small study size, subpopulation analyses show positive response rates in patients with previous sEEG versus no sEEG and in temporal versus extratemporal pathology. Additional research is needed to evaluate efficacy of RNS in patients with previous epilepsy surgery, and utility of sEEG in this population.

A hospital-based retrospective study: early recognition of neuronal surface antibodies by clinical manifestations and CSF inflammation indicators in patients with unexplained epilepsy

Background There is a lack of actual and comprehensive data on the detection rate of neuronal surface antibodies in patients with unexplained epilepsy in China. Thus, we attempted to analyze the differences in clinical manifestations, cerebrospinal fluid (CSF) characteristics, seizure types and other aspects of antibody-positive and negative patients, to identify suspected antibody-positive epilepsy patients. Methods In total, 137 inpatients with unexplained epilepsy were consecutively included, and neuronal surface antibodies (NSAbs) were detected by serological and/or CSF evaluations. The clinical features and seizure characteristics were analyzed between the NSAb-positive and negative patients. In addition, patients were divided into four groups based on CSF and blood antibody titers. CSF cell count and protein content were analyzed in relation to antibody titers. Results There were 45 (32.8%) patients tested positive for antibodies. Multivariate analyses revealed that age, mental status changes or memory deterioration, CSF protein, CSF cell count, treatment, days of hospitalization, outcome, duration of symptoms before hospitalization, status epilepticus, and number of antiepileptic drugs were significantly associated with the NSAb-positive group and changes in inflammatory indicators in routine CSF analysis were associated with antibody titers. Conclusions A relatively high proportion of patients with unexplained epilepsy have positive NSAbs. Patients with the above clinical characteristics need to be highly suspected of NSAbs positivity and should be tested for antibodies in time to assist treatment. The decrease of CSF cell count and protein content has suggestive value for the decrease of antibody titer, which should be evaluated in the follow-up.

Nano Emulsion: The Targeted Drug Delivery in the Therapy of Epilepsy

Around the world, 50 million people suffer with epilepsy; it significantly burdens society in terms of finances, society, and health. Our comprehension of the pathophysiological processes causing the illness and the factors affecting its prognosis has significantly advanced during the last ten years. Around a third of patients are still resistive to medical intervention, despite the fact that the number of antiepileptic drugs has expanded dramatically over the past 20 years. The ability of nanotech-based anti-epileptic drug (AED) administration methods to cross the blood brain barrier, increase specificity, and have the capacity for extended brain administration of drugs have lately attracted interest. Nanotechnology appears to be a promising and innovative development in this area. Nano emulsions have a mean droplet size of 20 to 200 nm and remain kinetically stable dispersions of two incompatible liquids with the assistance of an emulsifier or emulsifiers. The effectiveness of NEs as a delivery system for Central Nervous System-active medications used in effective regimens against difficult-to-treat CNS conditions.

Association of serum magnesium levels with seizure disorder; experience from central India

Magnesium is the fourth most abundant cation in the body. It has several functions in the human body including its role as a cofactor for more than 300 enzymatic reactions. Mg is a potential modulator of seizure activity because of its ability to antagonize the excitatory calcium influx through the N-methyl-D-aspartate receptor. Low magnesium levels in people with refractory epilepsy can increase the frequency of seizures. Hence in our study we aim to study the association of serum magnesium levels with seizure disorders and compare it with matched controls. In our study 154 adult individuals were included with seizure patients to control ratio of 1:1. Serum Magnesium levels was estimated in all individuals and levels were compared between patients of seizure disorder and healthy controls. Mean serum magnesium level was significantly lower in patients of seizure disorder as compared to controls (p&amp;#60;0.01). We, also observed significantly lower calcium level amongst cases as compared to controls (p&amp;#60;0.05). The mean magnesium level within 24 hours of seizures was 1.47±0.50 mg/dl whereas as the duration since seizures increased, mean magnesium level increased. In our study we found significant association between seizures and serum magnesium levels, as low magnesium has been implicated in refractory seizures which are resistant to anti-epileptic drugs and magnesium supplementation in such patients may result in decrease in number of anti-epileptic drugs and better control of seizures.

P300 event-related potentials in people with epilepsy: clinico-neurophysiologic study

BackgroundThere is increasing evidence that prolonged or recurrent seizures can cause or exacerbate cognitive impairment (CI) in memory, attention, orientation, and visuospatial and abstraction disabilities, all of which can jeopardize educational progress and achievement throughout life. The objectives of our study are to assess the cognitive functions in people with epilepsy (PwE) using P300 event-related potentials (ERPs), and correlate each P300 components with six explanatory variables (epilepsy type, seizure type, NHS3 score- seizure severity, disease duration, age at first seizure, and the number of anticonvulsant medications).MethodsOne hundred and two PwE [52 with focal epilepsy and 50 with generalized epilepsy, as classified by the International League Against Epilepsy in 2017]. They underwent electroencephalography (EEG) and P300. The Montreal Cognitive Assessment (MoCA) scale was used to assess baseline cognitive functions.ResultsEpileptic patients showed significant latency prolongation and amplitude reduction of P300 as compared to non-epileptic population. Longer P300 latency and lower amplitude were seen in patients with abnormal EEG records. P300 latency was longer in patients using poly-therapy. P300 components correlated well with age at presentation and disease duration but not with NHS3. According to epilepsy type, 50.98% of PwE had focal epilepsy and 49.02% had generalized epilepsy, 85.29% of them had abnormal EEG recording. Considering seizure type, 47.06% had a generalized tonic–clonic seizure, 38.24% had a focal to bilateral tonic–clonic seizure, 20.59% had a myoclonic seizure, 12.75% had a focal with impaired awareness seizure, 3.92% had a focal aware seizure, and 2.94% had an absence seizure. Seventy-seven PwE had one type of seizure, while 25 had more than one type of seizure. The NHS3 score was higher in those with a single seizure type than in those with multiple seizure types.ConclusionAll seizure types had an abnormal P300 component, indicating cognitive function deficits. P300 may be a promising objective method for assessing cognitive function in PwE. The number of antiepileptic drugs used, the presence of EEG abnormalities, the age at presentation, and the duration of the disease are the factors that best correlate with cognitive impairment (CI).

Pharmacotherapy of epilepsy: new solutions to old problems

The literature review provides an update on recent advances in antiepileptic pharmacotherapy. The article considers the mechanisms of action of the drugs, the range of efficacy, side effects and enzyme-inducing properties, potential teratogenicity.&#x0D; A review of the literature revealed some of the problems of patients with epilepsy remaining unresolved to this day. Despite an increase in the number of anticonvulsants in recent years, one-third of patients are pharmacoresistant to antiepileptic therapy and continue to suffer from seizures. The hope for reducing the proportion of patients with uncontrolled seizures rests on future therapeutic developments, including targeted therapies aimed at the molecular mechanisms underlying the epilepsy pathogenesis. Clinical outcomes in patients with epilepsy could also significantly improve with advances in the development of new highly accurate diagnostic and treatment methods, the identification of biomarkers for drug development, as well as routine clinical follow-up and the introduction of truly innovative disease-modifying therapies.

Kidney Stones in Epileptic Children Receiving Ketogenic Diet: Frequency and Risk Factors.

Although it is a valuable option for children with drug-resistant epilepsy, ketogenic diet (KD) therapy is associated with several side effects. The frequency of kidney stones and risk factors for their development in epileptic children receiving KD is unclear. The aim of this study was to determine the frequency and risk factors for the development of renal stones in children receiving KD therapy. A total of 95 patients receiving KD were identified. Of these, seven patients were excluded from the study due to the duration of KD being less than 12 months. The remaining 88 children were enrolled in the study. Renal stones were detected in 15 patients (17%), of which 12 (73.3%) received potassium citrate treatment. Two (13.3%) patients needed lithotripsy despite receiving potassium citrate treatment, and one of these, who received potassium citrate treatment for 5 months, developed acute vesicourethral reflux and underwent surgery. No patient discontinued KD due to renal stone development. The serum uric acid concentrations and urine calcium/creatinine ratio did not change significantly over the 24-month follow-up period. Age, gender, etiology, age at seizure onset, duration of KD, mobility status, use of topiramate or zonisamide, and the number of antiepileptic drugs used were not significantly different between patients with and without kidney stones. Renal stone appears to be a common adverse effect of KD therapy. Although adequate hydration and potassium citrate treatment are effective in most patients, lithotripsy and surgery may be required in a minority of patients.

873 Next Generation Sequencing of Gliomas to Identify Predictors of Postoperative Seizures

INTRODUCTION: Seizures are common in patients who have undergone resection of diffuse gliomas. As genetic characterization of gliomas has improved, how a tumors mutational profile influences the risk of postoperative epileptogenesis is currently unknown. METHODS: A retrospective review of patients who underwent resection of gliomas with next generation sequencing of tumors at a single institution was performed. Logistic regression, Fisher’s Exact Test, and linear regression were performed to identify factors associated with development of postoperative seizures, seizure frequency, seizure type, and number of antiepileptic drugs (AEDs). RESULTS: 140 patients with tumor tissue genotyped via next generation sequencing from 2017-2020 are included in this interim analysis (this cohort includes both newly diagnosed and recurrent tumors). Glioblastomas comprised the majority (59.3%) of tumors, followed by astrocytomas (18.6%), oligodendrogliomas (13,6%), and IDH-mutant diffuse gliomas (8.6%). Fifty-two (37.1%) patients had a seizure after tumor resection, median age at seizure onset was 56.5 years, and patients were on a median of 2 AEDs for their seizures. 75.0% of these patients experienced multiple seizures with 57.1% being simple partial seizures. Multivariate analysis of the most common mutations revealed that CDKN2B/CDKN2A mutation was significantly associated with postoperative seizures (OR 2.47, 95% CI 1.02 – 6.27, p = 0.0487), while NF1 mutation and 1p/19q codeletion were not. The common GBM copy number variant Polysomy 7/monosomy 10 was associated with use of fewer AEDs (β = -0.81, p &lt;0.0001). Analysis of mutations most common in low grade tumor samples found no significant associations with seizure development. CONCLUSIONS: CDKN2B/CDKN2A mutations are associated with more postoperative seizures. Further analysis of this cohort may yield more relationships between genetic markers and seizures, including time to onset of seizures, which can inform operative planning and postoperative management.

Study on drug utilization evaluation of anti epileptic drugs

INTRODUCTION: Drug utilization evaluation (DUE) also referred as drug utilization reviews (DUR) or medication utilization evaluation (MUE) are defined as an authorized, structured, ongoing review of healthcare provider prescribing, pharmacist dispensing, and patient use of medication. Anti-epileptic drugs (AEDs) are those which are used for epilepsy and also for other neurological disorders. METHODOLOGY: A prospective observational questionnaire based cross sectional study in 200 patients of various departments receiving at least one AEDs. The subjects were included in the study only after they met the criteria for the study and after properly filling a informed consent form. The data was obtained by a questionnaire format and it is evaluated for utilization patterns, medication adherence. The cost of AEDs were calculated to evaluate total costs on each drug. RESULTS: Out of 200 patients, 140 were male and 60 were female. The age group 11- 20 years were found prominent with epilepsy. The average number of AEDs per patient was found to be 1.54. Among all the drugs prescribed phenytoin was the most common drug prescribed 148 (47.89%) for the treatment, followed by lorazepam 59 (19.09 %) and sodium valproate 27 (8.73 %). Maximum of the patients are high in utilization patterns and also in medication adherence. The chi-square value was 1.1373 and 1.3886 for medication adherence and utilization patterns respectively. CONCLUSION: Medication adherence was also high in patients which was found using morisky medication adherence scale. The utilization pattern was also 82 % by the patients. The cost effectiveness was done by comparing the costs of drugs prescribed during the study. It was found that topiramate is having high cost which can be burden to patient to adhere the therapy.

Correlation of Vitamin D Level and Bone Mineral Density in Epilepsy Children Who Received Oral Antiepileptic Drug

BACKGROUND: Vitamin D plays an essential role in achieving adequate bone mineralization. Antiepileptic drug (AED) will cause a change in calcium serum levels and bone mineral density (BMD) through increase catabolism of Vitamin D in the liver, as well as having a direct effect on the bone. AIM: The aimed of this study was to know the correlation of Vitamin D [25(OH)D] level and BMD in epilepsy children who received oral AED. METHODS: This cross-sectional study was conducted from May to September 2016. Subjects were collected using consecutive sampling in 1−11-year-old epilepsy children who went to the pediatric Neurology and Endocrinology outpatient clinic at Sanglah Hospital. Age, sex, body weight, body height, type and number of AED used, and duration of treatment were recorded. Measurement of 25(OH)D level and BMD was performed. Pearson test was used to analyze the strength of correlation based on normality test result. RESULTS: Thirty subjects were collected, male (19/63.33%), mean age was 7.22 years, mean treatment duration was 1.71 years. Type of AED was inducer AED (18/60%) and non-inducer AED (12/40%). Mean Vitamin D level was 27.19 ng/mL and mean BMD was 0.78 g/cm2. Partial correlation test of Vitamin D level with BMD after controlling age found r = 0.118 with p = 0.54. CONCLUSION: There was weak correlation between Vitamin D level and BMD in epilepsy children who received oral AED, but the correlation analysis was not sufficient to prove the relationship.

Evaluation of intravenous lorazepam dosing strategies and the incidence of refractory status epilepticus

IntroductionStatus epilepticus (SE) is a neurological emergency associated with high mortality if not identified and treated promptly. For the emergent treatment of SE, the recommended intravenous (IV) lorazepam dose is 0.1 mg/kg/dose, up to a maximum of 4 mg. It has been shown that lorazepam is commonly under dosed in SE, but there is conflicting data on whether this has a negative impact on patient outcomes. This study assessed any dose less than 4 mg to help identify the effects of under dosing lorazepam in SE. MethodsThis was a retrospective cohort study of patients admitted to a quaternary health system between October 1, 2017 and September 30, 2019 that experienced SE and were initially treated with IV lorazepam. Patients were divided into two cohorts, less than 4 mg or 4 mg, based on the initial one-time dose of lorazepam received. The primary outcome was the proportion of patients that progressed to refractory status epilepticus (RSE) that received an initial IV lorazepam dose of 4 mg compared to less than 4 mg for the treatment of SE. Secondary outcomes evaluated include length of stay, mortality, time in SE, number of seizures, cumulative lorazepam dose prior to urgent therapy, number of lorazepam doses prior to urgent therapy, time to urgent therapy, appropriately dosed urgent therapy, and number of antiepileptic drugs given in SE. ResultsOne hundred twenty patients were included in this study (107 patients received less than 4 mg and 13 patients received 4 mg). All patients included in the study were greater than 40 kg. The primary outcome of progression to RSE was observed in a significantly greater proportion of patients in the less than 4 mg group compared to the 4 mg group (93 [87%] vs. 8 [62%], p = 0.03). There was no difference in hospital or intensive care unit length of stay. However, there was an increased rate of in-hospital mortality in patients who received 4 mg compared to less than 4 mg (5 [39%] vs. 12[11%], p = 0.02). DiscussionThe majority of patients in the study received less than the recommended dose of IV lorazepam for SE. Patients who received less than 4 mg experienced an increased progression to RSE, which supports current guideline recommended dosing. While there was an increased rate of mortality in patients who received 4 mg compared to less than 4 mg, time in SE was prolonged in the patient population and severity of illness was only available for a limited number of patients included.

Alexithymia and related factors among patients with epilepsy

ObjectiveAlexithymia is a psychiatric symptom characterized by difficulties in emotion recognition, expression, and regulation. The purpose of our study was to investigate the prevalence of alexithymia among patients with epilepsy (PWE) and related factors. MethodsBy the means of a cross-sectional study, we consecutively recruited PWE who visited the First Hospital of Jilin University. The demographical information and clinical data were collected. Toronto Alexithymia Scale-20 (TAS-20), Emotion Regulation Questionnaire (ERQ), Kilifi Stigma Scale for Epilepsy (KSSE), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Generalized Anxiety Disorder-7 (GAD-7), and Nurses' Global Assessment of Suicide Risk scale (NGASR) scales were applied to assess alexithymia, emotion regulation strategies, and the presence of comorbid psychiatric symptoms. ResultsA total of 203 PWE were included. The differences in education, monthly per capita income of the family, and the number of antiepileptic drugs were statistically significant among these three groups with alexithymia, possible alexithymia, and non-alexithymia (p < 0.05). Toronto Alexithymia Scale-20 scores were significantly and positively correlated with BMI (rho = 0.143, p = 0.042). Expression suppression, stigma, and generalized anxiety were independent risk factors for alexithymia (R2 = 0.471, F = 19.075, p < 0.001). ConclusionsA high prevalence of alexithymia (18.7%) was found in PWE. Alexithymia is primarily influenced by the emotional regulation strategies, anxiety, and stigma among PWE. It tends to be a mood symptom or personality trait rather than a direct result of epilepsy.

Epilepsy and a woman – a woman has been found!

Currently, the number of antiepileptic drugs (AEDs) has been growing. While choosing the most optimal AEDs by criteria of their efficacy, tolerability and retention time on therapy, many clinical factors, individual biological characteristics of any certain patient, as well as socio-economic aspects should be taken into account, including those associated with the burden on the health care system. In practice, a doctor is primarily focused on the best clinical result while health care is obliged to take costs into account. Calculating the ratio of benefits and costs associated with pharmacotherapy is not complete without comparing the cost of original and reproduced AEDs. For many, sometimes very weighty, reasons, an idea that the original AEDs are preferable in terms of clinical expectations from their use with a significant economic disadvantage (cost) has been established. In this paradigm, reproduced AEDs are always perceived as a compromise in which an acceptable result can be obtained at moderate cost, which is true for the generalized group of reproduced AEDs. However, there are many examples when AEDs do not differ from the reference agents. In particular, Seizar from the Alkaloid company (Republic of North Macedonia) has been recently in wide use in Russia as an alternative to the original lamotrigine. On October 5–6, 2021, the II International Conference “Epilepsy and Women” was held in Belgrade, wherein the leading experts from Serbia and Russia presented reports on the effectiveness and quality of care for epilepsy at the symposiums “Childhood with Seizar”, “Preparing for adulthood with Seizar”, “Assessment of the benefits and prospects of using Seizar at all stages of women’s life with epilepsy”, “Epilepsy and comorbidity – universal opportunities”. Here, we summarize selected messages presented during the conference.