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Latest & greatest articles for epilepsy
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the seizures of most patients with idiopathic GE are easily controlled with appropriate medication, presentation of TR epilepsy is rare. It is unclear how results in this population would translate to patients with similar syndromes but with nonrefractory disease. For adult and pediatric patients with Lennox-Gastaut syndrome (LGS), are these AEDs effective as adjunctive therapy in reducing seizure frequency (compared with no adjunctive therapy)? Level Recommendation Levels A and B For LGS, RFN use should (...) ) effective as adjunctive therapy in reducing seizure frequency? Level Recommendation* Level A For treatment-resistant adult focal epilepsy (TRAFE), immediate-release pregabalin (PGB) and perampanel (PER) are established as effective to reduce seizure frequency. Level B Lacosamide (LCM), eslicarbazepine (ESL), and extended-release topiramate use should also be considered to decrease seizure frequency in this population. Level A Vigabatrin (VGB) and rufinamide (RFN) should be considered established
Eslicarbazepine acetate (Zebinix) - treatment of partial-onset seizures, with or without secondary generalisation, in adults with newly diagnosed epilepsy Non Submission eslicarbazepine acetate 200mg and 800mg tablets (Zebinix ® ) SMC2090 Eisai Ltd 4 May 2018 ADVICE: in the absence of a submission from the holder of the marketing authorisation eslicarbazepine acetate (Zebinix ® ) is not recommended for use within NHS Scotland. Indication under review: As monotherapy in the treatment of partial (...) -onset seizures, with or without secondary generalisation, in adults with newly diagnosed epilepsy. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this setting. As a result we cannot recommend its use within NHSScotland. Advice context: No part of this advice may be used without the whole of the advice being quoted in full. This advice represents the view of the Scottish Medicines Consortium. It is provided to inform the considerations of Area
experience frequent seizures which are likely to have a severely negative impact on their physical and mental health. Many patients have neurodevelopmental problems and learning disabilities and uncontrolled epilepsy is thought to be a major contributing and exacerbating factor. • There is unmet need in the treatment of TSC-related epilepsy. Anti-epileptic medications are used as first-line treatment however it is estimated that approximately 60% of patients have seizures that are uncontrolled (...) TSC manifestations and neuropsychiatric comorbidities £41,134 Deterministic (one-way) sensitivity analysis (with PAS) Parameter ‘Lower’ value ICER ‘Upper’ value ICER Distribution of patients in epilepsy control categories – everolimus plus BSC £73,475 £22.768 % whose seizure type was secondary generalised: convulsive at 66 weeks - BSC (mean) £49,194 £9,458 Prevalence of SEGA in the 14-18 years of age group £30,784 Dominant Adverse event discontinuation - everolimus plus BSC £44,558 £15,983 % whose
Antiepileptic drugs as prophylaxis for postcraniotomy seizures. This is an updated version of the Cochrane Review previously published in Issue 3, 2015.The incidence of seizures following supratentorial craniotomy for non-traumatic pathology has been estimated to be between 15% to 20%; however, the risk of experiencing a seizure appears to vary from 3% to 92% over a five-year period. Postoperative seizures can precipitate the development of epilepsy; seizures are most likely to occur within (...) the first month of cranial surgery. The use of antiepileptic drugs (AEDs) administered pre- or postoperatively to prevent seizures following cranial surgery has been investigated in a number of randomised controlled trials (RCTs).To determine the efficacy and safety of AEDs when used prophylactically in people undergoing craniotomy and to examine which AEDs are most effective.For the latest update we searched the following databases on 26 June 2017: Cochrane Epilepsy Group Specialized Register
Effect of Cannabidiol on Drop Seizures in the Lennox-Gastaut Syndrome. Cannabidiol has been used for treatment-resistant seizures in patients with severe early-onset epilepsy. We investigated the efficacy and safety of cannabidiol added to a regimen of conventional antiepileptic medication to treat drop seizures in patients with the Lennox-Gastaut syndrome, a severe developmental epileptic encephalopathy.In this double-blind, placebo-controlled trial conducted at 30 clinical centers, we (...) randomly assigned patients with the Lennox-Gastaut syndrome (age range, 2 to 55 years) who had had two or more drop seizures per week during a 28-day baseline period to receive cannabidiol oral solution at a dose of either 20 mg per kilogram of body weight (20-mg cannabidiol group) or 10 mg per kilogram (10-mg cannabidiol group) or matching placebo, administered in two equally divided doses daily for 14 weeks. The primary outcome was the percentage change from baseline in the frequency of drop seizures
for counseling and testing. We developed NGS panels, performing clinical interpretation with a multidisciplinary team. We held an educational workshop for paediatricians and nurses. We sent questionnaires to referring paediatricians and families. We analysed investigation costs for 16 neonatal epilepsy patients. Of 96 patients, a genetic diagnosis was made in 34% of patients with seizure onset < 2 years, and 4% > 2 years, with turnaround time of 21 days. Pathogenic variants were seen in SCN8A, SCN2A, SCN1A (...) Incorporating epilepsy genetics into clinical practice: a 360Â°evaluation We evaluated a new epilepsy genetic diagnostic and counseling service covering a UK population of 3.5 million. We calculated diagnostic yield, estimated clinical impact, and surveyed referring clinicians and families. We costed alternative investigational pathways for neonatal onset epilepsy. Patients with epilepsy of unknown aetiology onset < 2 years; treatment resistant epilepsy; or familial epilepsy were referred
Stiripentol add-on therapy for focal refractory epilepsy. This is an updated version of the Cochrane review last published in 2015 (Issue 10). For nearly 30% of people with epilepsy, seizures are not controlled by current treatments. Stiripentol is a new antiepileptic drug (AED) that was developed in France and was approved by the European Medicines Agency (EMA) in 2007 for the treatment of Dravet syndrome as an adjunctive therapy with valproate and clobazam, with promising effects.To evaluate (...) -on trials of stiripentol in people with focal refractory epilepsy.Review authors independently selected trials for inclusion and extracted data. Outcomes investigated included 50% or greater reduction in seizure frequency, seizure freedom, adverse effects, treatment withdrawal and changes in quality of life.On the basis of our selection criteria, we included no new studies in the present review. Only one study was included from the earlier review (32 children with focal epilepsy). This study adopted
Exploring the perception of women with epilepsy about pregnancy concerns: a qualitative study Epilepsy is a common neurological disorder in pregnancy, which is associated with increased maternal and fetal adverse outcomes. This study aimed to explore the reproductive healthcare needs of women with epilepsy before, during and after childbirth.This was a qualitative study using a content analysis method. The study population was marital women with epilepsy in reproductive age (15-45 years (...) for women with epilepsy, (2) doubt about the advantages and disadvantages of breastfeeding, (3) stigma as a block to the treatment of the postpartum depression, and (4) playing the motherhood role under the shadow of self-esteem to lack of self-esteem.In the prenatal, natal and postnatal duration, because of supportive system disruption and not receiving proper consultation, participants were often worried about not being able to get favorable conditions for safe pregnancy and controlling process
Clonazepam add-on therapy for refractory epilepsy in adults and children. Epilepsy affects about 50 million people worldwide, nearly a quarter of whom have drug-refractory epilepsy. People with drug-refractory epilepsy have increased risks of premature death, injuries, psychosocial dysfunction, and a reduced quality of life.To assess the efficacy and tolerability of clonazepam when used as an add-on therapy for adults and children with refractory focal onset or generalised onset epileptic (...) seizures, when compared with placebo or another antiepileptic agent.We searched the following databases on 14 September 2017: Cochrane Epilepsy Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online (CRSO), MEDLINE (Ovid 1946 to 14 September 2017), ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP).Double-blind randomised controlled studies of add-on clonazepam in people with refractory focal
Epilepsy in Children After Pandemic Influenza Vaccination To determine if pandemic influenza vaccination was associated with an increased risk of epilepsy in children.Information from Norwegian registries from 2006 through 2014 on all children <18 years living in Norway on October 1, 2009 was used in Cox regression models to estimate hazard ratios for incident epilepsy after vaccination. A self-controlled case series analysis was used to estimate incidence rate ratios in defined risk periods (...) after pandemic vaccination.In Norway, the main period of the influenza A subtype H1N1 pandemic was from October 2009 to December 2009. On October 1, 2009, 1 154 113 children <18 years of age were registered as residents in Norway. Of these, 572 875 (50.7%) were vaccinated against pandemic influenza. From October 2009 through 2014 there were 3628 new cases of epilepsy (incidence rate 6.09 per 10 000 person-years). The risk of epilepsy was not increased after vaccination: hazard ratio: 1.07; 95
Rufinamide add-on therapy for refractory epilepsy. Epilepsy is a central nervous system disorder (neurological disorder). Epilepticseizures are the result of excessive and abnormal cortical nerve cell electrical activity in the brain. Despite the development of more than 10 new antiepileptic drugs (AEDs) since the early 2000s, approximately a third of people with epilepsy remain resistant to pharmacotherapy, often requiring treatment with a combination of AEDs. In this review, we summarised (...) the current evidence regarding rufinamide, a novel anticonvulsant medication, which, as a triazole derivative, is structurally unrelated to any other currently used anticonvulsant medication, when used as an add-on treatment for refractory epilepsy. In January 2009, rufinamide was approved by the US Food and Drug Administration for treatment of children four years of age and older with Lennox-Gastaut syndrome. It is also approved as an add-on treatment for adults and adolescents with focal seizures.To
used Cox regression to analyze the risk of serious transport accidents between individuals with epilepsy and matched controls, and then stratified Cox regression to compare the risk during periods of medication with the risk during nonmedication period within the same individual with epilepsy. We adjusted for civil status, employment, education, living area, psychiatric disorders prior to the start of follow-up, and psychotropic medication.Compared to matched controls, individuals with epilepsy (...) Epilepsy, antiepileptic drugs, and serious transport accidents: A nationwide cohort study To investigate the association between epilepsy and antiepileptic drugs and serious transport accidents requiring emergency care or resulting in death.We identified 29,220 individuals 18 years or older with epilepsy without cerebral palsy or intellectual disability and 267,637 matched controls using Swedish registers. This nationwide cohort was followed from 2006 to 2013 for serious transport accidents. We
Cardiac arrhythmia and neuroexcitability gene variants in resected brain tissue from patients with sudden unexpected death in epilepsy (SUDEP) Sudden unexpected death in epilepsy (SUDEP) is the leading cause of epilepsy-related mortality in young adults. The exact mechanisms are unknown but death often follows a generalized tonic-clonic seizure. Proposed mechanisms include seizure-related respiratory, cardiac, autonomic, and arousal dysfunction. Genetic drivers underlying SUDEP risk are largely (...) identified mutually exclusive variants in genes involved in µ-opiod signaling, gamma-aminobutyric acid (GABA) and glutamate-mediated synaptic signaling, including ARRB2, ITPR1, GABRR2, SSTR5, GRIK1, CTNAP2, GRM8, GNAI2 and GRIK5. In SUDEP patients we also identified variants in genes associated with cardiac arrhythmia, including KCNMB1, KCNIP1, DPP6, JUP, F2, and TUBA3D, which were not present in living epilepsy controls. Our data shows that genomic analysis of brain tissue resected for seizure control
in mice lacking a copy of Ick.A variant, K305T (c.914A→C), cosegregated with epilepsy or polyspikes on EEG in 12 members of the family affected with juvenile myoclonic epilepsy. We identified 21 pathogenic ICK variants in 22 of 310 additional patients (7%). Four strongly linked variants (K220E, K305T, A615T, and R632X) impaired mitosis, cell-cycle exit, and radial neuroblast migration while promoting apoptosis. Tonic-clonic convulsions and polyspikes on EEG resembling seizures in human juvenile (...) Variant Intestinal-Cell Kinase in Juvenile Myoclonic Epilepsy. In juvenile myoclonic epilepsy, data are limited on the genetic basis of networks promoting convulsions with diffuse polyspikes on electroencephalography (EEG) and the subtle microscopic brain dysplasia called microdysgenesis.Using Sanger sequencing, we sequenced the exomes of six members of a large family affected with juvenile myoclonic epilepsy and confirmed cosegregation in all 37 family members. We screened an additional 310
Care delivery and self-management strategies for children with epilepsy. In response to criticism that epilepsy care for children has little impact, healthcare professionals and administrators have developed various service models and strategies to address perceived inadequacies.To assess the effects of any specialised or dedicated intervention for epilepsy versus usual care in children with epilepsy and in their families.We searched the Cochrane Epilepsy Group Specialized Register (27 (...) September 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 9) in the Cochrane Library, MEDLINE (1946 to 27 September 2016), Embase (1974 to 27 September 2016), PsycINFO (1887 to 27 September 2016) and CINAHL Plus (1937 to 27 September 2016). In addition, we also searched clinical trials registries for ongoing or recently completed trials, contacted experts in the field to seek information on unpublished and ongoing studies, checked the websites of epilepsy organisations
Attention-deficit/hyperactivity disorder medication and seizures Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of seizures, but there is uncertainty about whether ADHD medication treatment increases risk among patients with and without preexisting seizures.We followed a sample of 801,838 patients with ADHD who had prescribed drug claims from the Truven Health MarketScan Commercial Claims and Encounters databases to examine whether ADHD medication (...) increases the likelihood of seizures among ADHD patients with and without a history of seizures. First, we assessed overall risk of seizures among patients with ADHD. Second, within-individual concurrent analyses assessed odds of seizure events during months when a patient with ADHD received ADHD medication compared with when the same individual did not, while adjusting for antiepileptic medications. Third, within-individual long-term analyses examined odds of seizure events in relation to the duration
Lacosamide (Vimpat) - partial-onset seizures Published 12 March 2018 Statement of Advice: lacosamide, 50mg, 100mg, 150mg, 200mg tablets, 10mg/mL syrup and 10mg/mL solution for intravenous infusion (Vimpat ® ) SMC No 1324/18 UCB Pharma Limited 9 February 2018 ADVICE: in the absence of a submission from the holder of the marketing authorisation lacosamide (Vimpat ® ) is not recommended for use within NHS Scotland. Indication under review: As monotherapy in the treatment of partial-onset seizures (...) with or without secondary generalisation in adolescents and children from 4 years of age with epilepsy. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this setting. As a result we cannot recommend its use within NHSScotland. Advice context: No part of this advice may be used without the whole of the advice being quoted in full. This advice represents the view of the Scottish Medicines Consortium. It is provided to inform the considerations of Area Drug
Behavioral interventions as a treatment for epilepsy: A multicenter randomized controlled trial To evaluate the effect of a stress-reduction intervention in participants with medication-resistant epilepsy.Adults with medication-resistant focal epilepsy (n = 66) were recruited from 3 centers and randomized to 1 of 2 interventions: (1) progressive muscle relaxation (PMR) with diaphragmatic breathing, or (2) control focused-attention activity with extremity movements. Following an 8-week baseline (...) period, participants began 12 weeks of double-blind treatment. Daily self-reported mood and stress ratings plus seizure counts were completed by participants using an electronic diary, and no medication adjustments were permitted. The primary outcome was percent reduction in seizure frequency per 28 days comparing baseline and treatment; secondary outcomes included stress reduction and stress-seizure interaction.In the 66 participants in the intention-to-treat analysis, seizure frequency was reduced
Nephrolithiasis and Nephrocalcinosis FromÂ Topiramate Therapy in Children WithÂ Epilepsy Adults treated with topiramate may develop nephrolithiasis, but its frequency in children on topiramate is unknown. Topiramate inhibits renal carbonic anhydrase, which can lead to renal tubular acidosis and hypercalciuria. We studied 40 consecutive children who initiated topiramate therapy for seizures between January 1997 and February 2003, followed for a mean of 36 months.Serum electrolytes, urinary
Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden. To investigate associations between Apgar score at five and 10 minutes across the entire range of score values (from 0 to 10) and risks of childhood cerebral palsy or epilepsy, and to analyse the effect of changes in Apgar scores from five to 10 minutes after birth in infants born ≥37 completed weeks.Population based cohort study in Sweden, including 1 213 470 non-malformed live (...) singleton infants, born at term between 1999 and 2012. Data on maternal and pregnancy characteristics and diagnoses of cerebral palsy and epilepsy were obtained by individual record linkages of nationwide Swedish registries.Apgar scores at five and 10 minutes.Cerebral palsy and epilepsy diagnosed up to 16 years of age. Adjusted hazard ratios were calculated, along with 95% confidence intervals.1221 (0.1%) children were diagnosed as having cerebral palsy and 3975 (0.3%) as having epilepsy. Compared