Clinical profile, etiological factors and outcome of children with status epilepticus admitted in tertiary hospital: a prospective study

Background: Status epilepticus (SE) is a medical emergency, and its neurological outcome is a concern to every pediatrician in developing countries. The incidence of convulsive SE in children is approximately 10�/100,000 per year, with the highest incidence in children less than one year of age. Approximately 30% of patients presenting with status epilepticus are having their first seizure. The objective of the study is to evaluate the clinical and etiological pattern of SE and its outcome in children admitted to PICU.Methods: This was a prospective study conducted among 50 patients aged 1 month to 12 years presenting with status epilepticus. The study was conducted over a period of one year from April 2022 to April 2023.Results: A majority of the patients were in the age group of 1-5 years (64%) and higher incidence of male children was observed (74%). Generalized tonic clonic seizure (GTCS) was predominant in 76% of the children and seizure duration was 10-20 minutes in 44% of the children. The most common etiologies were Meningoencephalitis (44%) and febrile seizures (20%). Nearly 70% of the children showed complete recovery with no neurological symptoms and 5 (10%) children died.Conclusions: Status epilepticus is a life-threatening emergency and timely management is essential to prevent morbidity and mortality. CNS infection is a major etiology and majority of the children showed good response with AED treatment.

DRUG-INDUCED CUTANEOUS REACTIONS: A PHARMACOVIGILANCE STUDY

Objective: Drug-induced cutaneous reactions are common problem in our country and can range from simple rash to severe reactions. Early recognition of these reactions enables early identification and withdrawal of offending drugs, thereby reducing morbidity and mortality. So present study aimed to assess clinical pattern of drug-induced cutaneous reactions in Dermatology OPD.Methods: This study was an open, non-comparative, non-interventional, observational study conducted on patients visiting dermatology department to see the clinical pattern of drug-induced cutaneous reactions. A total of 60 patients with suspected cutaneous adverse drug reactions were recruited. A detailed physical examination was done by a physician, including drug intake during 3 w preceding reactions and type of drug reactions.Results: Most frequently reported cutaneous drug reactions were Stevens-Johnson Syndrome (23%), Maculopapular rash (18%) Toxic Epidermal Necrolysis (15%) and were caused by antiepileptic drugs in 21(35%) patients, followed by antibiotics in 17(28.33%) cases, NSAID’s in 7(11.6%) cases, antitubercular drugs in 3(5%) and antiretroviral drugs in 3(5%) cases. A high proportioned of these reactions (50%) were moderate (31%) of these were severe because they require hospitalisation or increased the duration of stay in hospital or were life-threatening in (1%). Principal offending drug was phenytoin.Conclusion: A good knowledge of ADRs, a careful history taking and watchful approach while prescribing of drugs can prevent many of adverse drug reactions. These facts justify the development of an intensive programme of pharmacovigilance.

Progress in the Diagnosis and Treatment of Infantile Epileptic Spasm Syndrome / 罕见病研究

Infantile epileptic spasm syndrome (IESS) is a new concept proposed recently. IESS is a unique and age-specific refractory epilepsy syndrome. The recent advances in molecular biology, neuroimmunology and the in-depth study of anti-epileptic mechanism in antiepileptic drugs have led to the achievements in the definition and treatment of infantile epileptic spasm. At present, the use of traditional antiepileptic drugs is decreasing, while the use of new antiepileptic drugs is increasing. In this paper, based on the relevant literature in recent years, the authors discuss the pathogenesis, epidemiology, etiology, diagnosis, treatment, therapeutic drugs, clinical progress, efficacy, and safety of infantile epileptic spasm, hoping to introduce the latest status in research and achievements of IESS.

Relation between rs2298771 genotype in voltage-gated sodium channels 1A polymorphism and antiepileptic drug response in children with epilepsy / 中华神经医学杂志

Objective:To investigate the relation between rs2298771 genotype in voltage-gated sodium channels 1A ( SCN1A) polymorphism and antiepileptic drug (AED) response in children with epilepsy. Methods:Sixty-two children with epilepsy admitted to Department of Neurology, Zhangjiakou First Hospital from June 2022 to December 2023 were divided into AED response group and AED resistance group ( n=31) according to their response to AED. In addition, 31 children with pharyngitis or mild gastroenteritis admitted to Department of Pediatrics at the same period were selected as control group. Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to analyze the rs2298771 genotype in SCN1A polymorphism, and differences in rs2298771 genotype and allele in SCN1A polymorphism were compared among the 3 groups. Relation between rs2298771 genotype in SCN1A polymorphism and AED response was analyzed. Multivariate Logistic regression was used to analyze the influencing factors for AED response in children with epilepsy. Results:(1) Significant differences in type of first seizure and AEDs were noted between AED response group and AED resistance group ( P<0.05); compared with the AED resistance group, the AED response group had significantly lower seizure frequency, significantly longer duration after last seizure, and statistically higher proportions of children with normal EEG or with one kind of AED ( P?0.05). (2) Compared with the control group and AED response group, the AED resistance group had significantly higher rs2298771 GC genotype and G allele, and statistically lower rs2298771 AA genotype and A allele in SCN1A polymorphism ( P?0.05). (3) In the AED response group, rs2298771 AA and AG genotype in SCN1A polymorphism were positively correlated with levetiracetam ( P?0.05); in AED resistance group, rs2298771 AG genotype in SCN1A polymorphism was positively correlated with topiramate and valproic acid ( P<0.05). (4) Multivariate Logistic regression analysis showed that duration after last seizure ( OR=3.249, 95% CI=1.097-9.621, P=0.033), rs2298771 genotype in SCN1A polymorphism ( OR=9.660, 95% CI=4.680-19.970, P=0.011) and seizure frequency ( OR=0.160, 95% CI=0.032-0.804, P=0.026) were independent influencing factors for AED response in children with epilepsy. Conclusion:Epilepsy children with shorter duration after last seizure, rs2298771 GG genotype in SCN1A polymorphism, and high seizure frequency are susceptible to AED resistance; especially, AG genotype is correlated with topiramate and valproic acid.

What do women with epilepsy know about pregnancy?

Background: Understanding the intersection of epilepsy and pregnancy, including knowledge gaps and healthcare access for women with epilepsy (WWE), is critical. This study evaluated WWE knowledge gaps and information needs concerning epilepsy's impact on their sexual and reproductive health during pregnancy and examined healthcare system factors affecting their access to information, aiming to identify areas for improvement in educational and healthcare strategies to enhance health management for WWE. Methods: From July 2022 to June 2023, 111 WWE aged 18 to 40 years were recruited from the family medicine and internal medicine outpatient departments at Steve Biko Academic Hospital, Tembisa Tertiary Hospital (TTH), and Kalafong Hospital. Interviews assessed various aspects related to epilepsy in pregnancy and contraceptive use. Results: The study found strong links between WWE, their demographics, and their awareness of pregnancy-related epilepsy issues. Participants from TTH showed notably higher awareness (85.5%) of risks from epilepsy and AED during pregnancy (p < 0.05). Age and education significantly influenced pregnancy planning and understanding of medication risks. Younger women (20­25 years) were more inclined towards future pregnancies, and those with more education were better informed about medication risks (p < 0.05); and 68.5% had received counselling on AED and contraceptive interactions, yet only 16.2% knew AED could reduce contraceptive effectiveness. Conclusion: The study reveals significant knowledge gaps in WWE regarding the impact of epilepsy and AED on pregnancy, suggesting tailored educational and counselling initiatives to improve WWE health outcomes and quality of life, advancing chronic disease management and public health objectives. Contribution: The study highlights substantial knowledge gaps in epilepsy during pregnancy among WWE, urging tailored counselling and information to empower informed decisions.

Neuropsychological side effects of anti-epileptic drugs in epilepsy patients: a cross sectional study

Background: Epilepsy is the fourth most common neurological disorder in world. Managing an epilepsy with anti-epileptic drugs (AEDs) either as monotherapy or polytherapy is necessary to reduce the deleterious effect of the disease and to provide neuroprotection. AEDs exert their negative effects on cognition by suppressing neuronal excitability or enhancing inhibitory neurotransmission. These neuropsychological side effects are found to be modest when the drug level is within the therapeutic concentration and used as monotherapy. Objectives were to assess the prevalence of neuropsychological side effects among epilepsy patients who were on antiepileptic drug therapy. Methods: An open label, cross-sectional, clinical study was conducted at a tertiary care hospital, 126 participants were recruited. Participants demographic data, detailed medical and seizure history followed by neuropsychological tests was performed. The prevalence was assessed based on the number of participants scoring <15th percentile in one or more tests. Results: Out of 126 participants who were recruited, 82 participants were on monotherapy and 44 participants were on polytherapy. Levetiracetam was the most commonly prescribed drug as monotherapy, followed by phenytoin, carbamazepine and valproate; whereas in polytherapy levetiracetam, clobazam followed by phenytoin were the commonly prescribed AED. The most common adverse effect was drowsiness, followed by headache, hypersensitivity reaction, giddiness, tremors, anxiety etc. The prevalence of neuropsychological side effects was 77.8%. The prevalence of impairment between monotherapy and polytherapy was statistically insignificant (p=0.727). Conclusions: In this study, levetiracetam was the most commonly prescribed drug and the most common adverse effect was drowsiness due to AEDs. The subgroup analyses between monotherapy and polytherapy did not show any statistically significant neuropsychological impairment when compared based on the gender, age groups, duration of epilepsy with medication and duration of current therapy.

Serum vitamin D status in children with epilepsy on antiepileptic drugs and its relation to the frequency of breakthrough seizures

Background: Epilepsy is the most common neurological disorder in children requiring long term drug therapy which are associated with vitamin D deficiency. Antiepileptic actions of vitamin D deficiency have been extensively studied in animal models but human data, particularly in children is lacking. Objectives were to study the levels of serum vitamin D in children with epilepsy on antiepileptic drugs and to study the correlation between levels of vitamin D and frequency of breakthrough seizures.Methods: hospital-based cross-sectional study. Participants: A total of 94 children with epilepsy were included in the study. Intervention: The patients were on a minimum of 6 months of antiepileptic drug therapy. Anthropometric measurements were taken and blood samples were analysed for vitamin D, serum calcium, phosphate, complete blood counts and renal profile.Results: The present study showed a statistically significant relationship between serum vitamin D deficiency and antiepileptic drugs (p value <0.001), the number of AEDs with patients on polytherapy ?2 AEDs having lower vitamin D levels (p value <0.001) and the duration of antiepileptic drugs (p value of 0.016). Linear regression analysis also showed a statistically significant relationship between serum vitamin D deficiency and seizure frequency (p value of <0.001, 95% confidence interval: -3.465, -2.275).Conclusions: Case studies and epidemiological data also support the evidence of connection between levels of serum vitamin D and epilepsy and the use of vitamin D3 as a potential therapy for human epilepsy. This study is conducted with an aim to highlight the role of vitamin D in children with epilepsy in seizure control.

Evaluation of ganglion cell complex and retinal nerve fiber layer thinning in epilepsy patients

Purpose: This study aimed to compare the perimacular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thickness measurements of epileptic and healthy individuals. Methods: The right eyes of 38 epileptic and 38 healthy individuals who had been using antiepileptic drugs (AEDs) for at least 1 year were included in the study. Central macular thickness, perimacular GCC thickness and volume, and peripapillary retinal nerve fiber layers were measured by optical coherence tomography (OCT) device. Perimacular 1, 3, and 6 mm circle diameters of Early Treatment of Diabetic Retinopathy Study (ETDRS) were selected for GCC measurements. Results: In epilepsy patients, GCC was significantly lower in the 3 mm superior quadrant and 6 mm in all quadrants compared to the control group (P < 0.05). RNFL was significantly thinner in epilepsy patients only in the temporal?inferior quadrant (P < 0.05). There was no significant difference between the patients who received AEDs as monotherapy and polytherapy (P > 0.05). Conclusion: We found that epilepsy patients had significant thinning in the GCC layers and temporal?inferior quadrant of RNFL compared to the control group. Our findings from the study show that early retinal changes in epilepsy patients, especially perimacular GCC layers, can be followed up with OCT.

Effect of antiepileptic drugs on bone metabolism in children using biochemical markers: a case control study

Background: Most epileptic patients are diagnosed and treated in childhood and adolescence and this period is crucial in attaining peak bone mass. Few studies are conducted on children showing long term effects of AEDs on bone metabolism. So, the present study was conducted to evaluate correlation of long-term uses of AEDs with changes in bone metabolism using biochemical marker.Methods: Total of 140 subjects divided into 70cases - Epileptic children aged 1 to 14 years who are on AEDs for at least 6months and 70 Controls- Children aged 1 to 14 years not on AEDs. Semi structured questionnaire was used to collect demographic data. Venous blood samples were collected and sent for laboratory investigations like Serum vitamin D, serum calcium, serum phosphorus, Parathyroid hormone and alkaline phosphatase levels.Results: Mean age of study population in cases was 7.74�43 years and in controls was7.65�72 years. Mean vitamin-D, calcium, phosphorus decreases while PTH and ALP increases with duration of treatment in epileptic children with a statistically significant difference between them (P<0.05). Mean serum vitamin D level in cases and in controls was with no statistical significant difference between two groups. Mean serum calcium, phosphorus, parathormone and alkaline phosphatase levels in cases and controls all had a statistically significant mean difference between two groups. Serum vitamin-D, serum calcium, serum phosphorus was low in patients treated with enzyme inducing when compared to non-enzyme inducing drugs in epileptic children with a statistically significant difference between them (P<0.05). Serum vitamin-D, serum calcium, serum phosphorus was high in patients on monotherapy when compared polytherapy in epileptic children with a statistically significant difference between them (P<0.05).Conclusions: Present study shows that children on AEDs for longer duration had low bone mineral parameters when compared to normal children. The study emphasizes that mineral levels need to be monitored in epileptic patients as they are at a higher risk of falling and bone fractures.

Study of association of vitamin D levels in children and adolescents on antiepileptics drug therapy

Background: Epilepsy is a common non-communicable disease that affects both young and the elderly, with a cumulative lifetime incidence of 3%. Bone health may be impacted by prolonged AED use, and the study aims to investigate the relationships between long-term antiepileptic usage, vitamin D levels, and other outcomes.Methods: Comparative observational research was conducted on 60 children with 30 healthy controls and 30 cases of antiepileptic drug users. Low vitamin D levels were identified based on monotherapy versus polytherapy, treatment duration, and severity of seizure control. 25-hydroxyvitamin D separated from its binding protein during incubation and competed with labelled vitamin D. A wash cycle was used to remove unbound material and a flash chemiluminescent reaction was started. The statistical analysis was done using R software 3.2.2 with a power of 90% and an alpha error of 5%.Results: An observational comparative study found no significant relationship between vitamin D levels and antiepileptic drug therapy in children aged 4-16 years. Vitamin D levels in AED-treated children with well-controlled seizures and those with poorly controlled seizures were found to be statistically significant, with 77% of patients and none of the controls being vitamin D deficient.Conclusions: Vitamin D deficiency is linked to antiepileptic medication, length of antiepileptic therapy, and increased risk of vitamin D insufficiency. It is important for pediatric neurologists and paediatricians to pay attention to the vitamin D status of children with epilepsy.

A REVIEW ON THE PHYTOPHARMACOLOGICAL PROPERTIES, UNANI AND MODERN PHARMACOLOGY OF BISFAYEJ (POLYPODIUM VULGARE LINN)

Different herbs and their constituents are used for medicinal purposes by approximately 80 percent of the world population, which is evidenced by the rapidly growing global and national markets of herbal drugs. This review is aimed at presenting an overview of the medicinal properties of P. vulgare, its phytoconstituents and diverse pharmacological activities. To retrieve the information related to this drug, a thorough literature survey was undertaken using the various classical Unani and Herbal literature books viz., Al-Q?n?n fi’l Tibb, Makhzan al-Mufradat, Kanzul Advia Mufradah, Ilmul Adwiya Nafisi, Taj al-Mufradat, Indian Materia Medica, Indian Medicinal Plants among others. Further, for other traditional uses, phytoconstituents, pharmacological activities and research studies of the drug, various online bibliographic databases like Pub Med, Google Scholar, Science Direct, Web of Science and Scopus were meticulously searched. The keywords used for the search included “Polypodium vulgare”, “Bisfayej”, “Polypody root and rhizome”, “Phytoconstituents of Polypodium vulgare”. P vulgare is proven to possess neuro-psycho-pharmacological, CNS depressant and anti-epileptic activity through its anti-cholinesterase and 5-hydroxytryptamine (5-HT) stimulatory effect. Various clinical researches validate the use of P vulgare in the management of conditions such as Epilepsy, Arthritis, Leprosy, Melancholy and Alzheimer’s disease. Further studies are needed to unravel its other pharmacological activities.

Comparing the antiepileptic effects of atorvastatin, celecoxib, ashwagandha, clove oil, and Sodium valproate on chemo-shock induced seizures in male Wistar albino rats

Background: Antiepileptic potential of statins, COX inhibitors and other herbal medications are to be evaluated in experimental animals so that the most efficacious can be translated for human use as an adjunct to the commonly used anti-epileptic drugs. Methods: This experimental animal study grouped 30 male Wistar albino rats into 6 groups with each containing 5 rats of which one group was control, one was the standard drug and the other 4 were treatment groups which received Atorvastatin, Celecoxib, Ashwagandha and Clove oil. These drugs were administered 30 minutes prior to administering Pentylene-tetrazole which induced convulsions and the various seizure parameters were analysed. The blood samples of the animals were also assessed for anti-oxidant activity by measuring superoxide dismutase and catalase levels in the blood. Results: The onset of seizure was significantly delayed by Ashwagandha (2.55±0.94), similar to the latency shown by the standard drug (2.09±1.21). The duration of convulsions was very significantly reduced in all the 5 drug groups in comparison to the control (p<0.001). The clonic jerk duration was not reduced as effectively as the standard drug. The duration of recovery time amongst the various groups was also significant (p<0.05). The SOD and Catalase levels of no groups showed any possible association between the anti-epileptic efficacy of these drugs and the anti-oxidant enzyme levels. Conclusions: Ashwagandha has good anti-epileptic efficacy not less than the standard drug when the various drug groups were compared.

A prospective study of thyroid profile in children aged 1 month to 12 years of age with newly diagnosed seizure disorder started on first line antiepileptic drugs

Background: The study's primary aim was to determine the variation in the thyroid profile status in children with newly diagnosed seizure disorders started on first-line antiepileptic drugs. In addition, this study compares the incidence of hypothyroidism secondary to phenytoin, phenobarbitone, valproate and carbamazepine.Methods: A total of 60 children with newly diagnosed seizure disorders belonging to the age group of 1 month to 12 years were enrolled in the study. The children were subjected to a detailed history and neurological examination, and serum levels of T3, T4, and thyroid-stimulating hormone (TSH) were tested.Results: In this study, out of 60 children, the clinical signs and symptoms of hypothyroidism were present only in one subject (1.7%), and the remaining 59 had no signs and symptoms of hypothyroidism. The mean TSH value increased from baseline 1.62±1.17 to 3 months 2.2±1.38 and 6 months 2.78±149 (p value<0.05%). The incidence of subclinical hypothyroidism among the phenytoin group (n=33) was 6.06%. Among the sodium valproate group (n=23), the incidence was 8.6%, and among the carbamazepine group (n=4), the incidence was 25%.Conclusions: Antiepileptic drugs can alter thyroid function tests. In this study, there was no overt hypothyroidism noted. But subclinical hypothyroidism was reported in subjects using phenytoin, valproate and carbamazepine.

Amino acid metabolism characteristics of Banxia Baizhu Tianma Decoction in realizing drug withdrawal based on transcriptomic analysis / 中国中药杂志

This study aimed to demonstrate the effect of Banxia Baizhu Tianma Decoction(BBTD) on realizing withdrawal of anti-epileptic drugs and explore the relationship between BBTD and the amino acid metabolism by transcriptomic analysis in the rat model of epilepsy induced by lithium chloride-pilocarpine. The rats with epilepsy were divided into a control group(Ctrl), an epilepsy group(Ep), a BBTD & antiepileptic drug integrative group(BADIG), and an antiepileptic drug withdrawal group(ADWG). The Ctrl and Ep were given ultrapure water by gavage for 12 weeks. The BADIG was given BBTD extract and carbamazepine solution by gavage for 12 weeks. The ADWG was given carbamazepine solution and BBTD extract by gavage for the former 6 weeks, and then only given BBTD extract for the latter 6 weeks. The therapeutic effect was evaluated by behavioral observation, electroencephalogram(EEG), and hippocampal neuronal morphological changes. High-throughput sequencing was used to obtain amino acid metabolism-related differen-tial genes in the hippocampus, and the mRNA expression in the hippocampus of each group was verified by real-time quantitative polymerase chain reaction(RT-qPCR). The hub genes were screened out through protein-protein interaction(PPI) network, and Gene Ontology(GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analysis were performed. Two ceRNA networks, namely circRNA-miRNA-mRNA and lncRNA-miRNA-mRNA, were constructed for ADWG vs BADIG. The experimental results showed that compared with those in Ep, rats in ADWG were significantly improved in the behavioral observation, EEG, and hippocampal neuronal impairment. Thirty-four amino acid metabolism-related differential genes were obtained by transcriptomic analysis, and the sequencing results were confirmed by RT-qPCR. Eight hub genes were obtained through PPI network, involving several biological processes, molecular functions, and signal pathways related to amino acid metabolism. Finally, the circRNA-miRNA-mRNA ternary transcription network of 17 circRNA, 5 miRNA, and 2 mRNA, and a lncRNA-miRNA-mRNA ternary network of 10 lncRNA, 5 miRNA, and 2 mRNA were constructed in ADWG vs BADIG. In conclusion, BBTD can effectively achieve the withdrawal of antiepileptic drugs, which may be related to the transcriptomic regulation of amino acid metabolism.

Electro-responsive drug delivery system for epilepsy therapy / 中国药理学与毒理学杂志

OBJECTIVE Temporal lobe epilepsy is a common neurological disease caused by abnormal syn-chronized discharge in the brain and it is mainly treated through long-term use of anti-epileptic drugs(AEDs).This project is supposed to provide an electro-responsive and brain-targeted drug delivery system(DDS)for on-demand drug release,which could promptly block the transmis-sion of epileptic discharges.METHODS The DDS was fab-ricated by co-polymerization of dopamine and pyrrole,together with conjugation of brain-targeted peptide.A number of characterization including electron microscopy,thermogravimetric analysis,dynamic light scattering and other methods were conducted to evaluate the physio-chemical properties of the nanomaterials.In vitro study based on a home-made electric device and high perfor-mance liquid chromatography was performed to record drug release profiles.Three epileptic models including acute,continuous and spontaneous models were estab-lished for the evaluation of therapeutic efficacy.RESULTS Our polymeric DDS has a nanoscale size(ca.80 nm)and could load AEDs such as phenytoin(drug loading capacity 20.4%).The hybrid nanomaterials can improve the brain delivery efficiency through a combination of receptor-mediated transcytosis and near-infrared-enabled brain transport.In vitro study proved that the DDS could release phenytoin in the electric field in a sensitive(50 μA),quick(30 s)and sustained(>3 times)manner.In vivo study demonstrated excellent anti-epileptic effects in a lower dose(20%).Biosafety study further verified that our strategy has limited damage.CONCLUSION For on-demand seizure control,we have developed a nano-engineered DDS with the capability of electro-responsive drug release and brain-targeted accumula-tion.The DDS could increase the AEDs accumulation at epileptic region and release the AEDs in response to the epileptic discharges.Such strategy could timely inhib-it the epileptic seizure.Our work provides a promising approach to"smart"therapy of epilepsy and sheds light on development of pharmacotherapy of other brain disorders.

Clinical features and outcomes of women with epilepsy who withdraw anti-seizure medications in early pregnancy / 中华神经科杂志

Objective:To explore anti-seizure medication (ASM) treatment patterns, seizures, maternal and fetal outcomes and offspring outcomes of pregnant women with epilepsy (PWWE) who withdraw ASM in the first trimester of pregnancy.Methods:A retrospective analysis was performed on the PWWE database registered in West China Hospital, Sichuan University from January 2009 to October 2022. Patients who withdrew ASM therapy in the first trimester and those who maintained ASM therapy throughout pregnancy were included. Withdrawal in the first trimester was defined as discontinuation of ASM between 0 and 3 months of pregnancy. Sixty-five PWWE (withdrawal group) who withdraw ASM in the first trimester were included, and 130 PWWE (maintained-therapy group) who took ASM throughout pregnancy in West China Hospital during the same period were matched 1∶2. Demographic characteristics, ASM, seizures, maternal and fetal outcomes within 1 year were compared between the 2 groups. In the subgroup analysis, the withdrawal group was divided into a full withdrawal group ( n=53) and a resumption group ( n=12) according to whether the ASM was resumed in the second and third trimesters of pregnancy, and the 2 groups were stratified and compared. Results:In the withdrawal group, the proportion of patients with bachelor degree below [72.3% (47/65) vs 54.6% (71/130), χ 2=5.68, P=0.017], family income less than 5 000 yuan per capita [44.6% (29/65) vs 18.5% (24/130), χ 2=14.98, P<0.001], a family history of epilepsy [12.3% (8/65) vs 3.1% (4/130), χ 2=4.90, P=0.027], and a second pregnancy [43.1% (28/65) vs 26.2% (34/130), χ 2=5.72, P=0.017] was higher than in the maintained-therapy group. The proportion of patients who received multiple ASM was lower in the withdrawal group than in the maintained-therapy group [16.9% (11/65) vs 38.5% (50/130), χ 2=9.35, P=0.002]. In the withdrawal group, the rate of seizures with tonic-clonic seizures during pregnancy [50.8% (33/65) vs 31.5% (41/130), χ 2=6.81, P=0.009] and seizure exacerbation during pregnancy [32.3% (21/65) vs 9.2% (12/130), χ 2=16.41, P<0.001] was higher. The preterm birth rate in the withdrawal group was lower than that in the maintained-therapy group [4.6% (3/65) vs 19.2% (25/130), χ 2=101.70, P<0.001]. The rate of seizure exacerbation during pregnancy was higher in the resumption group than in the full withdrawal group [7/12 vs 26.4% (14/53), χ 2=3.22, P=0.073]. Conclusions:PWWE with a family history of epilepsy and a second pregnancy were more likely to withdraw ASM during pregnancy. After withdrawal, the seizures during pregnancy were significantly worse, but the preterm birth rate of offspring was relatively reduced.

Clinical characteristics and drug efficacy evaluation of voltage-gated potassium channel-related genetic epilepsy / 中国药理学通报

Aim To analyze the genotype-phenotype characteristics of voltage-gated potassium channels (Kv) associated genetic epilepsy and evaluate the efficacy of anti-seizure medications(ASMs). Methods PubMed database was searched and patients meeting the inclusion criteria were included for analysis. We divided the patients into “benign”, “encephalopathic” and other phenotypes according to the clinical characteristics. We performed descriptive statistical analysis of patients' mutated genes, clinical phenotype and drug efficacy, and used logistic regression to explore the influencing factors of treatment outcome. Results Data of 474 children were included for analysis. There were significant differences among different phenotypes in mutated genes, source of mutations and so on. In terms of clinical characteristics, there were also significant differences between patients with different phenotypes in age of onset, combined developmental delay and so on. In terms of monotherapy, phenobarbital was the most common treatment choice for children with “benign” phenotype, and sodium channel blockers (SCBs) were the most common treatment choice for children with “encephalopathy” phenotype, and the efficacy of SCBs monotherapy was superior to that of other ASMs. Multivariate Logistic analysis of the children receiving monotherapy showed that whether the children were combined with developmental delay and whether SCBs were used were significant factors influencing the efficacy of drug therapy. Conclusions Patients with the “benign” and “encephalopathic” phenotypes differ in several aspects of genetic variation, clinical characteristics, and drug selection. These results suggest that SCBs may be one of the recommended options for monotherapy.

Simultaneous Estimation and Validation of Four Antiepileptic Drugs from Bulk and Formulations Using Reverse Phase HPLC

Abstract Epilepsy is a disorder of the central nervous system, in which the nerve cell activity in the brain is disturbed causing seizures. The objective was to develop an RP-HPLC method for consistent simultaneous quantitation of four antiepileptic drugs Levetiracetam (LVT), Lamotrigine (LTG), Phenobarbital (PBT) and Phenytoin (PTY). An isocratic method was developed on C18 column in JASCO HPLC using 5 mM potassium phosphate buffer (pH 6) and acetonitrile as the mobile phase at a flow rate of 1ml/min and detected at 230 nm using UV detector. The mean retention time for LVT, LTG, PBT and PTY were found as 2.55, 3.55, 4.65 and 5.99 minutes respectively. The method was validated as per ICH guidelines and was found to be acceptable. The %RSD value was <2.0 % thus stating the developed method was precise for the drugs in the given range. The accuracy values were within 85-115% of the recovery range. The specificity of the method was evaluated by an assay of marketed formulation, and it showed a percent content between 90-110% w/w for all the four drugs. The proposed analytical method was simple, accurate and robust and was precisely able to resolve the four major antiepileptic drugs. Hence, the current method can be applied successfully for routine examination of these drugs

Drug-induced Stevens-Johnson syndrome: A case series

Stevens-Johnson syndrome (SJS) can be defined as a rare, serious disorder of the skin and mucous membrane characterized by widespread vesiculobullous rash with epidermal sloughing and necrosis involving mainly eyes, oral cavity, and skin. SJS can be diagnosed if there is <10% of the skin involvement. SJS occurs as an idiosyncratic reaction to various medications. Among them, the most common are antimicrobial agents (AMAs), antiepileptics, and non-steroidal anti-inflammatory drugs (NSAIDs). SJS is one of the dermatological emergencies for which initial treatment can only be supportive like fluids and nasogastric or parenteral feeding and symptomatic measures like analgesic mouth rinse for mouth ulcer. Beyond this, no treatment for SJS is approved. Cases of drug-induced SJS as diagnosed by Skin and VD department were included in the study. Interpretations were drawn out from that data and causality assessment was done according to the WHO-UMC causality assessment. Total four cases of drug-induced SJS were available. two cases of male patients and two of female patients. Out of them, three cases were by NSAIDs induced and one case was anti-epileptic (phenytoin) induced. In the present study, it was found that three of the cases of drug-induced SJS were caused NSAIDs and one case by anti-epileptic. According to the WHO-UMC Causality assessment, three cases were probable and one was unclassified.

Pregnancy with epilepsy and antiepileptic drug therapy on fetomaternal outcome

Background: Pregnancy women with epilepsy may have higher chances of obstetric complications, aggregative seizures, major congenital malformations, and abnormal deliveries. Monotherapy or polytherapy of anti-epileptic drugs are usually associated with adverse outcomes in pregnant women with epilepsy. Aim and Objectives: The aim of the study was to evaluate the effect of epilepsy and antiepileptic drug (AED) therapy on the fetomaternal outcome in pregnant women. Material and Methods: A total of 46 pregnant women with epileptic seizures between 18 and 35 years with mean age of 26.46 years were included in the study. The demographic, clinical, and obstetrical data were collected from the medical records. The AED monotherapy and polytherapy with drug dosage details were noted. The details of mode of delivery, outcome of seizures in post-natal period and fetal outcome were gathered. Results: About 65.21% cases were under AED polytherapy and 34.78% cases were under AED monotherapy. Majority cases had carbamazepine (CBZ) and sodium valproate mono and polytherapy. Majority had normal vaginal delivery (65.11%). Single or in combination use of sodium valproate, CBZ, and phenytoin are associated with major congenital malformations (9%). Postpartum hemorrhage was observed in 6.52% cases and postpartum seizure occurrence was observed in 8.69% cases. Conclusion: A well planned pregnancy, continuous monitoring for congenital malformations and fetal growth restriction is necessary in pregnant women under AED therapy for better maternal and fetal outcome.