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Objective:To evaluate the long-term safety, tolerability and efficacy of Lacosamide add-on therapy in Chinese children with partial-onset seizures.Methods:SP848 was a global multicenter single-arm study involving 60 Chinese children with partial-onset seizures with the age of 4-17 years who were managed by Lacosamide add-on therapy at seven hospitals across China from April 2018 to May 2019.After treatment with at least two kinds of anti-seizure medications simultaneously or sequentially, partial seizures were still poorly controlled and Lacosamide oral solution (syrup) or tablets were added.The minimum initial oral dose was 2 mg/(kg·d), and the maximum allowable dose was 12 mg/(kg·d)or 600 mg/d during the study period.The dose was adjusted according to the tolerance and seizure control level of partial-onset seizures children.Seizure frequency and the median percentage change in partial-onset seizures per 28 days from baseline to the final visit were recorded, including 50% responder rate and 75% responder rate.Results:A total of 60 Chinese children with the mean age of 9.18 (4.00-15.40) years were included in this interim analysis, involving 39 males and 21 females.The mean course of epilepsy was 5.04 (0.50-15.20) years.A total of 43 patients (71.7%) still have been treated.One patient (1.7%) has completed the 6-12 months of follow-up, and 14 patients (23.3%) have completed the follow-up for less than 6 months.The median change in the frequency of partial seizures every 28 days from baseline to the last visit was -2.91, with its median percentage as -25.46%, and the proportions of ≥50%, while ≥75% responder rate were 40.0% and 28.3%, respectively.A total of 52 patients (86.7%) had 265 treatment emergent adverse events (TEAE), 11 patients (18.3%) had 19 serious TEAE, 37 patients (61.7%) had 127 drug-related TEAE, and 11 patients (18.3%) had 16 TEAE leading to the discontinuation of the trial.The most common TEAE were upper respiratory tract infections (20 cases, 33.3%), followed by drowsiness (16 cases, 26.7%), dizziness (15 cases, 25.0%) and vomiting (13 cases, 21.7%). There were no abnormal changes in the electrocardiographic findings during the treatment.Conclusions:For Chinese patients with partial seizures who are older than the age of 4 years and poorly controlled by other drugs, Lacosamide is effective and well tolerated as an add-on therapy drug.The safety characteristics are consistent with those reported in children and adults.No new safety concerns are identified.
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Objective To investigate the risk factors of cognitive impairment associated with early post－acute stroke seizures (EPASS). Methods One hundred and sixty－eight eligible patients were recruited in the study. Patients were divided into cognitive impairment group and non－cognitive disorder group according to MMSE. General clinical data, severity of the stroke, location and extent of infarction, characteristics of epileptic seizures were compared between the two groups. Multivariate Logistic regression analysis was utilized to investigate the independent risk factors of EPASS related cognitive impairment. Results Multivariate logistic regression analysis showed that moderate to severe stroke (OR=4.386, P=0.006), cortical infarction (OR=6.430, P=0.012), general tonic clonic seizure (OR=8.189, P=0.004), seizure frequency≥1 time per day (OR=12.818, P＜0.001) were the independent risk factors for cognitive impairment in EPASS. Conclusions Patients with moderate to severe stroke, cortical infarction, general tonic clonic seizure and seizure frequency≥1 time per day may have a higher risk of cognitive impairment.
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Background: Seizures beginning in adult life are likely to be an identifiable cause as compared to those beginning in childhood which is more likely to be idiopathic. Aim and objectives: To study the clinical profile and analyze the etiological agents of New Onset Seizures. Materials and methods: This descriptive study was done in the Government HQRS Hospital and AIMSR, Chittoor, Andhra Pradesh to know the various etiologies in patients presented with newonset seizures. In these cases history and clinical examination and special investigations like CT brain, MRI brain, EEG, Serology, CSF analysis were done to find out the etiology. Results: Out of 100 patients, 55% were males, 45%were females with male to female ratio of 1.2:1. The majority of males were in 2nd decade and females were in 4th decade. Patients' age ranged from 18 years to 80 years, with the mean of 40.11 years with 77% of the patients were in the below 50 years. Alcohol withdrawal was the leading cause of seizures which account for 34% followed by idiopathic seizures (29%), neuro infection (16%), CVA 12% and metabolic (9%). Conclusion: Alcohol withdrawal is the most common cause of seizure in new-onset seizure patients who coming to Government HQRS Hospital and AIMSR Chittoor, Andhra Pradesh
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Epileptic seizures after stroke and post stroke epilepsy (PSE) are the main causes of elderly patients with epilepsy. More and more doctors and researchers have devoted to clinical and basic trails relevant to them, hoping obtain a scientific and unitive guideline for timely and effectively treatment. This review will focus on definition, pathogenesis, risk factors, attack types, clinical diagnosis and treatment as follows to improve the understanding of the clinical peers.
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Seizures due to neurocysticercosis (NCC) is a neglected human-to-human transmitted disorder and an emerging problem worldwide. A substantial portion of recent onset seizures is known to be attributed to NCC in Taenia solium (T. solium) endemic areas where populations which neither raise pigs nor eat pig meat are also at risk. High prevalence of NCC causing epilepsy has been reported in the underdeveloped areas of Southeast Asia (SEA) however, only fragmentary information on its incidence is available in countries like Malaysia. In Malaysia T. solium infection was previously thought to be infrequent due to Muslim population majority and the religious prohibition of consuming pork, but it is not totally absent. There is an evident lack of knowledge and awareness of the actual burden, routes of transmission, and the impact of NCC in this region. The problem is assumed to be more prevalent particularly in cities because of the frequent inflow of possibly T. solium infected individuals or carriers among those who migrate from neighboring endemic countries to Malaysia. The issue of imported cases that are likely to be emerging in Malaysia is highlighted here. An accurate quantification of regional burdens of epilepsy due to NCC in Malaysia is warranted considering the disease emergence in its neighboring countries. It is suggested that the importance of NCC be recognized through quantification of its burden, and also to collect epidemiological data for its subsequent elimination in line of World Health Organization's mission for control of cysticercosis as a neglected tropical disease. In this review the need as well as a strategy for neuro-care center screening of epilepsy cases, and various issues with possible explanations are discussed. It is also proposed that NCC be declared as a reportable disease which is one of the eradicable public health problems in SEA.
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Seizures due to neurocysticercosis (NCC) is a neglected human-to-human transmitted disorder and an emerging problem worldwide. A substantial portion of recent onset seizures is known to be attributed to NCC in Taenia solium (T. solium) endemic areas where populations which neither raise pigs nor eat pig meat are also at risk. High prevalence of NCC causing epilepsy has been reported in the underdeveloped areas of Southeast Asia (SEA) however, only fragmentary information on its incidence is available in countries like Malaysia. In Malaysia T. solium infection was previously thought to be infrequent due to Muslim population majority and the religious prohibition of consuming pork, but it is not totally absent. There is an evident lack of knowledge and awareness of the actual burden, routes of transmission, and the impact of NCC in this region. The problem is assumed to be more prevalent particularly in cities because of the frequent inflow of possibly T. solium infected individuals or carriers among those who migrate from neighboring endemic countries to Malaysia. The issue of imported cases that are likely to be emerging in Malaysia is highlighted here. An accurate quantification of regional burdens of epilepsy due to NCC in Malaysia is warranted considering the disease emergence in its neighboring countries. It is suggested that the importance of NCC be recognized through quantification of its burden, and also to collect epidemiological data for its subsequent elimination in line of World Health Organization's mission for control of cysticercosis as a neglected tropical disease. In this review the need as well as a strategy for neuro-care center screening of epilepsy cases, and various issues with possible explanations are discussed. It is also proposed that NCC be declared as a reportable disease which is one of the eradicable public health problems in SEA.
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BACKGROUND: The aim of this study was to establish the incidence, predictive factors, characteristics, and clinical outcomes of acute symptomatic seizures (ASS) after acute ischemic stroke (AIS). METHODS: In total, 2,528 consecutive patients with first-ever AIS were included. Patients with a history of epilepsy or provoked seizures due to tumor, head trauma, brain surgery, or high fever were excluded. Onset seizure (OS) and ASS were defined as seizures occurring within 24 hours and 7 days after AIS, respectively. The incidence of ASS, type of seizures, presence of late unprovoked seizure (LUS), MRI, and electroencephalogram were analyzed. RESULTS: ASS and OS occurred in 23 patients (0.9%) and 15 patients (0.6%), respectively; 20 of the patients with ASS (87.0%) had partial seizures and 4 (17.4%) developed status epilepticus. The incidence rates of ASS were 1.3%, 0.3%, and 0.2% in AIS caused by large-artery atherosclerosis, small-vessel occlusion, and cardioembolism, respectively. Of the 23 patients with ASS, the cortex was involved in 19 (82.6%), 16 patients (69.6%) had medium-sized to large lesions, the anterior circulation territory was involved in 21 patients (91.3%), and 4 patients (17.4%) developed MRI-confirmed hemorrhagic transformation of the lesions. Epileptiform discharges were observed in 9 (45%) of the 20 patients with ASS. Three of the 23 patients with ASS (13.0%) developed LUS. CONCLUSIONS: The incidence of ASS was 0.9% and was highest in the large-artery atherosclerosis group. The development of ASS was significantly associated with cortical involvement, medium-sized to large lesions, and lesions in the anterior circulation territory. Three of 23 patients (13%) developed LUS.