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.

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.

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.

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.

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.

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.

Electroencephalographic abnormalities in preschool children with language delay

Background: Most children seem to be slow in the initial days of learning language but some children continue to have problems. Studies show that speech and language development affects 5–10% of preschool children. A high proportion of electroencephalogram (EEG) abnormalities and epileptic syndromes has been found in children with severe language impairments in western studies. Aims and Objectives: This study aims to look at the rate of occurrence of EEG abnormalities in preschool children with language disorders in the local population. Materials and Methods: Fifty two preschool children (<5 years) who present with complaints of language delay/regression to Department of Audiology and speech pathology and psychiatry were included in the study. Children with concomitant hearing impairment, orofacial anomalies, and medical illness were excluded from the study. Ethical clearance was taken from the Institutional Ethical committee. After the initial assessment, International Classification of Diseases 10 was used to diagnose language dysfunction with or without co morbid neurological or psychiatric manifestations. EEG was done on the sample and the reports analyzed. Chi-square test was used to examine statistical significance between the presence of EEG abnormalities and other categorical variables, while independent t-test was used to examine the statistical significance with that of continuous variables such as age. Associations and differences were said to be significant when P < 0.05. Results: The mean age of the sample was 49.85 months. There was a higher number of male 32 (61.5%) in comparison to females 20 (38.5%). 42 (80.8%) children of the sample had abnormal EEG discharges such as spikes, sharp and wave pattern, focal and generalized. There was higher prevalence of EEG abnormalities in girls compared to boys (P = 0.008). Children with epilepsy had higher EEG abnormalities which was statistically significant (P = 0.031). Conclusion: EEG is an useful tool in assessing children with language delay and may be a trial of antiepileptic medications can help these children.

Depresión en pacientes con epilepsia. Experiencia en un hospital privado de Argentina / Depression in patients with epilepsy: experience in a private hospital in Argentina

Resumen Introducción: La depresión es el trastorno psiquiátrico más frecuente en pacientes con epilepsia, con una prevalencia estimada entre 35% y 60%, asociándose a un peor control de crisis epilép ticas. A pesar de la gran prevalencia de depresión, muchos pacientes no son diagnosticados, presentando una peor evolución clínica y calidad de vida. No existen estudios de prevalencia en nuestro medio. El objeti vo fue determinar la prevalencia de depresión en epilepsia y su relación con el control de crisis. Materiales y métodos: Es un estudio prospectivo, descriptivo y transversal de una cohorte de pacientes a los cuales se les realizó el Inventario de Depresión en Pacientes con Trastornos Neurológicos para Epilepsia (NDDI-E) y se analizaron datos de las historias clínicas. Resultados: Se incluyeron 121 pacientes, la prevalencia de depresión fue 43% (n:52), el 77% eran mujeres (p = 0.01). Del total de pacientes con depresión, el 63% fue diagnosticado en este estudio. La mayoría tuvo buen control de la crisis (70%) y no presentó depresión, mientras que la mayoría con mal (57%) y regular (63%) control de la crisis presentó depresión (p < 0.001). Discusión: La comorbilidad entre depresión y epilepsia es altamente prevalente, influyendo negativamen te en el control de las crisis epilépticas. La mayoría de los pacientes se encuentran subdiagnosticados. El tamizaje de la depresión mayor en aquellos con epilepsia es necesario, contribuyendo a la mejoría clínica.

Abstract Introduction: Depression is the most frequent psychiatric disorder in patients with epilepsy, with an estimated prevalence between 35% and 60%, associated with poorer control of epileptic seizures. Despite the high prevalence of depression, many patients are not diagnosed, presenting a worse clinical course and quality of life. There are no prevalence studies in our population. The main objective was to determinate the prevalence of depression in epilepsy and its relationship with seizure control. Materials and methods: It is a prospective, descriptive and cross-sectional study of a cohort of patients who underwent the Depression Inventory in Pa tients with Neurological Disorders for Epilepsy (NDDI-E) and the data from the medical records were analyzed. Results: A total of 121 patients were inluded, and the prevalence of depression was 43% (n:52), of whom 77% were women (p = 0.01). A 63% of patients with depression was diagnosed in this study. Most of them with good seizure control (70%) did not present depression, while the majority of those with poor (57%) and regular (63%) seizure control presented depression (p < 0.001). Discussion: Comorbidity between depression and epilepsy is highly prevalent, negatively influencing the control of epileptic seizures. Most patients are underdiagnosed. Screening for major depression in patients with epilepsy is necessary, contributing to the clinical improvement.

Clinical study of new and conventional antiepileptic drugs with newly diagnosed partial epilepsy / 中国临床药理学与治疗学

AIM: To compare the early response to the new and traditional antiepileptic drugs (AEDs) in the treatment of partial epilepsy. METHODS: Patients from neurology Department of Huzhou Central Hospital between January 2013 and June 2018 were included; outcomes included time to first seizure, time to treatment failure and 6-month, 1- and 2-year seizure-free rates were compared. RESULTS: A total of 250 patients with partial epilepsy were divided into carbamazepine (CBZ) group (n =62), levetiracetam (LEV) group (n = 67), oxcarbazepine (OXC) group (n = 63), and lamotrigine (LTG) group (n = 58). In terms of time to first seizure after monotherapy, CBZ and OXC were equivalent (P = 0.635), while CBZ was superi- or to LTG (P LTG > OXC > LEV, and CBZ was superior to OXC and LEV (all P 0.05). A total of 25 patients had adverse reactions; with CBZ (19.3%) more often than LTG (8.6%), OXC (7.9%), or LEV (4.5%). CONCLUSION: Treatment response to CBZ is superior compared to that of OXC and LEV, especially in the early stages of treatment, and equivalent to that of LTG, but the incidence of side effects is higher as well.

Research progress on effects of high altitude hypoxia environment on antiepileptic drugs / 中国药理学通报

Hie high altitude hypoxic environment affects the pharmacokinetic process of rlnjgs by changing the body's gastrointestinal emptying rate, organ blood flow, drug plasma protein binding rate, dnjg metabolizing enzymes and transporter expression.Epilepsy is a brain disease that requires long-term medication.Most anti-epileptic drugs have a low therapeutic index and a narrow range of effective blood drug concentrations.'Ilierapeu- tic dnjg monitoring (TDM) is commonly used clinically to find the best individualized medication method for antiepileptic dnjgs.rI1iis article summarizes the commonly used anti-epileptic dnjgs and their treatment windows in clinical practice, and analyzes the influence of the pharmacokinetics of anti-epileptic dnjgs in the high altitude hypoxic environment, so as to provide reference for the clinical use of anti-epileptic drugs at high altitude.

Effects of altitude hypoxia on cerebral blood distribution of sodium valproate in mice / 中国药理学通报

Aim To investigate the effects of altitude hypoxia on serum sodium valproate eoncentration and eerebral blood distribution.Methods Male mice were divided into control group and plateau group.Each group was given sodium valproate orally and intrave¬nously, respectively.UFLC-MS/MS was used to deter¬mine the concentration of sodium valproate in plasma and brain, and Western blot was used to detect the ex¬pression of P-gp in BBB.Results Compared with the control group, the ratio of brain/blood drug concentra¬tion in plateau group was up-regulated by 44.0% , 57.9% , 176.8% and 184.5% at 10, 30, 60 and 120 min, respectively.The ratio of brain/blood drug con-centration increased by 33.9% , 50.6% and 125.6% at 60 min, 120 min and 240 min in plateau group, re¬spectively.Compared with the control group, the ex¬pression of P-gp protein in BBB of mice in altitude group was significantly down-regulated by 58.46% (P < 0.05 ).Conclusions Compared with the control group, the brain/blood drug concentration ratio of val¬proic acid increases in high altitude hypoxia environ¬ment.Meanwhile, it is found that P-gp expression lev-el decreased in the brain mierovessels of mice under high altitude hypoxia environment, and the cerebral and blood distribution of valproic acid in mic increases in high altitude hypoxia environment.

Research progress of anti-seizure medication combination therapy / 中华神经科杂志

Epilepsy is one of the most common and disabling chronic neurological diseases. About 70% of patients with epilepsy can be fully controlled by available anti-seizure medications, while the remaining 20%-30% are drug-resistant. Drug-resistant epilepsy is also known as refractory epilepsy, and refractory epilepsy usually requires a combination of anti-seizure medications. A reasonable combination of anti-seizure medications can reduce the frequency or even the freedom of seizures. To this end, this article summarized the general principles of anti-seizure medications combination therapy, tolerance and drug interaction, combination and synergism in human studies, and the application of non-ionic anti-seizure medications in combination therapy of refractory epilepsy by reviewing the literature, to improve clinicians′ understanding of combination therapy with anti-seizure medications for refractory epilepsy.

Benzodiazepine partially reverses tonic-clonic seizures induced by thiocolchicoside

Seizures are a disorder caused by structural brain lesions, life-threatening metabolic derangements, or drug toxicity. The present study describes the behavior related to proconvulsant activity induced by thiocolchicoside (TCC) in rats and investigates the electrocorticographic patterns of this behavior and the effectiveness of classic antiepileptic drugs used to control these seizures. Forty-nine adult male Wistar rats were used and divided into two phases of our experimental design: 1) evaluation of seizure-related behavior and electrocorticographic patterns induced by TCC and 2) evaluation of the efficacy of classical antiepileptic drugs to control the proconvulsive activity caused by TCC. Our results showed that TCC induced tonic-clonic seizures that caused changes in electrocorticographic readings, characteristic of convulsive activity, with average amplitude greater than that induced by pentylenetetrazole. Treatment with anticonvulsants, especially diazepam, reduced the electrocorticographic outbreaks induced by TCC. The results suggested that TCC caused seizures with increased power in brain oscillations up to 40 Hz and that diazepam may partially reverse the effects.

Mandible bone density in adolescents with cerebral palsy using antiepileptic drugs / Densidade óssea da mandíbula em adolescentes com paralisia cerebral em uso de drogas antiepilépticas

Objective: The aim of this study was to assess the bone density of the mandible in adolescents with cerebral palsy (CP) treated with antiepileptic drugs using one beam computed tomography (CBCT). Methods: The study was carried out with 18 adolescents aged 12­18 years, undergoing routine dental treatment at the dental clinic of APCD-São Caetano do Sul. CBCT scans were of divided into two groups: G1 adolescents with CP using antiepileptic drugs and G2 normoactive adolescents. A single dentomaxillofacial radiologist assessed and evaluated the images using Dental Slice software and Image J. Fisher's exact tests as well as paired and unpaired Student's t-tests were performed. Results: Groups differed significantly with regard in the values of density (p < 0.001), with G1 presenting lower values compare to G2. G1 showed significantly lower density means on the right side, left side, and right/left sides of the mandible edge than G2 (p < 0.001). Conclusion: CP patients using antiepileptic drugs show evidence of bone mineral density loss of the mandible.(AU)

Objetivo: O objetivo deste estudo foi avaliar a densidade ótica óssea da mandíbula em adolescentes com paralisia cerebral (PC) tratados com drogas antiepilépticas por meio de tomográfica computadorizada de feixe cônico (TCFC). Métodos: O estudo foi realizado com 18 adolescentes de 12 a 18 anos, em tratamento odontológico de rotina na clínica odontológica da APCD-São Caetano do Sul. As TCFC foram divididas em dois grupos: G1 adolescentes com PC em uso de antiepilépticos e G2 adolescentes normoativos. Um único radiologista dentomaxilofacial assessou e avaliou as imagens usando usando os softwares Dental Slice e Image J. Os testes exatos de Fisher, bem como os testes t de Student pareados e não pareados foram realizados. Resultados: Os grupos diferiram significativamente quanto aos valores de densidade óptica (p <0,001), com o grupo G1 apresentando valores menores em relação ao G2. O grupo G1 apresentou médias de densidade óptica significativamente menores nos lados direito, esquerdo e direito / esquerdo da borda da mandíbula do que o G2 (p <0,001). Conclusão: Pacientes com PC em uso de drogas antiepilépticas apresentam evidências de perda de densidade óssea da mandíbula (AU)

Antiepileptic Drug Adherence and Its Associated Factors among Epilepsy Patients on Follow-ups at Emanuel Mental Specialized Hospital, Ethiopia

Medication adherence is a fundamental determinant of effective treatment. However, people with epilepsy have poor compliance with their treatment because of the chronic nature of the disease. Limited studies have been conducted to address antiepileptic medication adherence in Africa, including Ethiopia. Thus, the aim of this study was to assess antiepileptic drug adherence and its asociated factors among patients with epilepsy attending outpatient department of Amanuel Mental Specialized Hospital. METHODS: A cross-sectional study design was conducted on 439 patients with epilepsy in Amanuel Mental Specialized Hospital. Medication adherence reporting scale-5 (MARS-5) was used to assess adherence to antiepileptic drugs. The Oslo social support, Jacob perceived stigma scale, and hospital anxiety and depression scale (HADS) were the instruments used to assess associated factors. Simple and multiple linear regression analysis models were fitted. Then, the adjusted unstandardized beta (ß) coefficient at a 95% confidence level was used. RESULTS: The mean (SD) score of antiepileptic medication adherence was 16.38(±3.76) with 95%CI:(16.03, 16.72). Depressive symptoms (ß= -1.35, 95% CI: (-2.04, -0.65)), anxiety symptoms (ß=-1.12,95%CI:(-1,79, -0.44), perceived stigma (ß= -1.64, 95% CI: -2.16, -1.12), being single (ß=-0.67, 95%CI: -1.20, -0.14), presence of seizure per month (ß=-2.11,95% CI: (-2.81, -1.41) and antiepileptic drug adverse effect (ß=-0.07,95%CI: -0.11, -0.03) were factors associated with anti-epileptic medication adherence. CONCLUSION: The results suggest that the mean score of adherences to antiepileptic drugs was poor as compared to other settings. Antiepileptic medication adherence screening tool should be included in the patient's treatment protocol

Hematological consequences of antiepileptic drug therapy among children with epilepsy

Epilepsy is a chronic neurologic disease that comes third after cerebrovascular and Alzheimer's disease. Anti-epileptic drugs may affect certain hematological parameters of epileptic patients. Few researches investigated hematological adverse effects of antiepileptic drugs in Libya. Thus, the aim was to evaluate hematological parameters in epileptic children who are on antiepileptic drugs. This retrospective study included 83 pediatric patients with epilepsy recruited from Benghazi Children Hospital, Department of Neurology, from December 2017 to April 2018. Data collected included demographic characteristics, types of epilepsy, anti-epileptic drugs and serum hematological parameters. Hematological parameters recorded included: hemoglobin, hematocrit, platelet, mean cell volume, mean cell hemoglobin, mean cell hemoglobin concentration and white blood cell count. In all treated patients, regardless of the number of antiepileptic drugs therapy used, the average levels of hematological parameters were significantly lower in treated group compared to control group (11.64 gm per dl, 34.53%, 27.74 pg and 33.13 gm per dl, respectively). A significant increase (12.12109 per l) in white blood cell counts in treated group was found. Average hemoglobin, hematocrit and mean cell hemoglobin concentration levels were significantly lower in patients on poly-therapy compared to mono-therapy and control groups. Average white blood cell counts were significantly increased in patients on anti-epileptic drugs. In sodium valproate users, levels of hematological parameters were significantly decreased but significantly increased in white blood cell counts. In diazepam users, significant increases in white blood cells and platelet but no difference in other parameters observed. There were no differences in all hematological parameters among patients using carbamazepine except for platelet counts (significantly decreased). In conclusion, there is substantial effect of the anti-epileptic drugs, especially sodium valproate, on hematological parameters of children despite the effects were not critical as the changes were still in the normal range.

Pharmacological management of post-traumatic seizures in a South African paediatric intensive care unit

Background. Traumatic brain injury (TBI) is a common cause of paediatric intensive care unit (PICU) admissions in South Africa. Optimal care of these patients includes the prevention and control of post-traumatic seizures (PTS) in order to minimise secondary brain injury. Objectives. To describe the demographics of children admitted to a South African PICU, to describe the characteristics of PTS, and to describe the prophylactic and therapeutic management of PTS within the unit. Method. A 3-year retrospective chart review was conducted at the PICU of the Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Johannesburg, from 1 July 2015 to 30 June 2018. Results. Seventy-eight patients were admitted to the PICU, all with severe TBI. A total of 66 patient files were available for analysis. The median age of admission was 6 years (interquartile range (IQR) 4 - 9) with the majority of trauma secondary to mechanical injury (89%). Prophylactic anti-epileptic drugs (AEDs) were initiated in 44 (79%) patients. Early PTS occurred in 11 (25%) patients who received prophylaxis and 4 (33%) who did not. Three (5%) patients developed late PTS, resulting in an overall incidence of PTS of 43%. The most common seizure type was generalised tonic clonic (82%). Children diagnosed with PTS were a median of 2 years younger than those without PTS, with increased prevalence of seizures (83% v. 38%) in children below 2 years of age. Maintenance therapy was initiated in all patients consistent with recommended dosages. Of the total 167 anti-epileptic levels taken during maintenance, only 56% were within target range. Of the initial 78 patients, 8 died (10%). The median length of stay was 7 (IQR 5 - 12) and 8 (IQR 8 - 24) days longer in ICU and hospital respectively, in children with PTS. Conclusion. PTS is a frequent complication of severe TBI in children. There was considerable variation in the approach to both prophylaxis and maintenance therapy of PTS in terms of choice of agent, dosage, frequency of drug monitoring and approach to subtherapeutic levels. It is clear that more high-level studies are required in order to better inform these practices

Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center / Tendências no padrão de prescrição de drogas antiepilépticas em idosos internados em um centro terciário brasileiro

ABSTRACT Background: Data on prescribing patterns of antiepileptic drugs (AEDs) to older adult inpatients are limited. Objective: To assess changes in prescribing patterns of AEDs to older adult inpatients with late-onset epilepsy between 2009-2010 and 2015-2019, and to interpret any unexpected patterns over the 2015-2019 period. Methods: Patients aged ≥60 years with late-onset epilepsy from a tertiary center were selected. Demographic data, seizure characteristics and etiology, comorbidities, and comedications were analyzed, in addition to prescription regimens of inpatients taking AEDs to treat epilepsy. AED regimens were categorized into two groups: group 1 included appropriate AEDs (carbamazepine, oxcarbazepine, valproic acid, gabapentin, clobazam, lamotrigine, levetiracetam, topiramate, and lacosamide); and group 2 comprised suboptimal AEDs (phenytoin and phenobarbital). Multivariate logistic regression analysis was performed to identify risk factors for prescription of suboptimal AEDs. Results: 134 patients were included in the study (mean age: 77.2±9.6 years). A significant reduction in the prescription of suboptimal AEDs (from 73.3 to 51.5%; p<0.001) was found; however, phenytoin remained the most commonly prescribed AED to older adult inpatients. We also found an increase in the prescription of lamotrigine (from 5.5 to 33.6%) and levetiracetam (from 0 to 29.1%) over time. Convulsive status epilepticus (SE) and acute symptomatic seizures associated with remote and progressive etiologies were risk factors for the prescription of suboptimal AEDs. Conclusions: Phenytoin was the main suboptimal AED prescribed in our population, and convulsive SE and acute symptomatic seizures associated with some etiologies were independent risk factors for phenytoin prescription. These results suggest ongoing commitment to reducing the prescription of suboptimal AEDs, particularly phenytoin in Brazilian emergence rooms.

RESUMO Introdução: Os dados referentes à prescrição de drogas antiepilépticas (DAE) em pacientes idosos hospitalizados são limitados. Objetivo: Avaliar as mudanças no padrão de prescrição de DAE em idosos hospitalizados com epilepsia de início tardio, entre 2009-2010 e 2015-2019, e interpretar quaisquer padrões inesperados no período de 2015-2019. Métodos: Foram selecionados pacientes com ≥60 anos com epilepsia de início tardio admitidos em um centro terciário. Analisamos os dados demográficos, as características e etiologia das crises, as comorbidades e as comedicações. Foram avaliados os esquemas de prescrição das DAE no tratamento de epilepsia para pacientes internados. Os regimes de DAE foram categorizados em dois grupos: o grupo 1 incluiu as DAE apropriadas (carbamazepina, oxcarbazepina, ácido valproico, gabapentina, clobazam, lamotrigina, levetiracetam, topiramato e lacosamida); e o grupo 2 compreendeu as DAE subótimas (fenitoína e fenobarbital). A análise de regressão logística multivariada foi realizada para identificar fatores de risco para prescrição de DAE subótimas. Resultados: Foram incluídos 134 pacientes (idade média: 77,2±9,6 anos). Encontramos uma redução significativa do uso das DAE subótimas (73,3 para 51,5%; p<0.001); entretanto, a fenitoína permaneceu sendo a DAE mais prescrita para os idosos hospitalizados. Também encontramos um aumento na prescrição da lamotrigina (5,5 para 33,6%) e do levetiracetam (0 para 29,1%) no período. O estado de mal epiléptico (EME) convulsivo e as crises agudas sintomáticas que estiveram associadas a etiologias remotas e progressivas foram fatores de risco para prescrição de DAE subótimas. Conclusões: A fenitoína foi a principal DAE subótima prescrita em nossa população, e o EME convulsivo e as crises agudas sintomáticas associadas a algumas etiologias foram fatores independentes de risco para a prescrição da fenitoína. Esses resultados sugerem a necessidade de compromisso contínuo para reduzir a prescrição de DAE subótimas, particularmente a fenitoína nas salas de emergência brasileiras.