Efficacy and safety of eslicarbazepine acetate monotherapy for partial-onset seizures: Experience from a multicenter, observational study.

Eslicarbazepine acetate (ESL, Aptiom™) is a once-daily anticonvulsant, approved as adjunctive treatment of partial-onset seizures (POS). Historical-controlled trials investigating the use of ESL as monotherapy have demonstrated a favorable efficacy and tolerability profile in patients with POS. This prospective, non-interventional study recruited POS patients in 17 hospitals in Spain. After a 3-month baseline period, ESL therapy was initiated as 400mg QD and up-titrated to an optimal maintenance dose based on clinical response and tolerance. The incidence of seizures was assessed via seizure calendars and the nature and severity of adverse events (AEs) were also recorded. A total of 117 patients (aged 9-87years) enrolled in the study and were treated with ESL at either 400mg/day (3.4% patients), 800mg/day (61% patients), 1200mg/day (27.1% patients) or 1600mg/day (8.5% patients). At 3months, 82.0% (n=72) of patients achieved a ≥50% reduction in seizure frequency, compared to 79.7% (n=67) of patients at 6months and 83.0% (n=49) at 12months. Patients who suffered secondary generalized tonic-clonic (SGTC) seizures had seizure-free rates of 71% (n=27), 69.6% (n=29), and 72.7% (n=16) at 3, 6, and 12months, respectively. Overall, 18 patients (15.3%) reported AEs of instability and dizziness (n=9), somnolence (n=3), mild hyponatremia (n=3), headache (n=1), hypertriglyceridemia (n=1), and allergic reaction (n=1), which caused ESL discontinuation of ESL treatment. ESL is effective and well tolerated as monotherapy for patients with POS, which supports previous findings. Early use is supported by its frequent use as monotherapy in this study and lack of severe side effects.

Experiencia con eslicarbacepina en pacientes con hiponatremia secundaria a carbamacepina y oxcarbacepina / Experience with eslicarbazepine in patients with hiponatremia due to carbamazepine and oxcarbacepine

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Efectos locales del tratamiento transdérmico con rotigotina / Local effects of transdermal treatment with rotigotine

Introducción. La rotigotina es el primer agonista dopaminérgico transdérmico no ergótico utilizado en el tratamiento de la enfermedad de Parkinson. Presenta importantes ventajas, como una única administración diaria, ausencia de interacciones con alimentos, niveles plasmáticos estables y estimulación continua de receptores dopaminérgicos. Aunque sus efectos secundarios sistémicos son similares a los de otros agonistas dopaminérgicos, también produce diversos efectos locales derivados del sitio de aplicación, efectos que pretendemos analizar en este artículo. Pacientes y métodos. Se realizó un análisis retrospectivo de 165 pacientes tratados con rotigotina. Se descartaron aquéllos con lesiones intracraneales, patología psiquiátrica y demencia. Los pacientes fueron evaluados antes y tras dos, cuatro y seis meses de iniciar el tratamiento con rotigotina. Resultados. Se identificaron 94 varones y 71 mujeres, con una edad media de 65,2 años y una dosis media de rotigotina de 11,3 mg/día. Los efectos adversos locales afectaron a 21 pacientes y provocaron el abandono del tratamiento en dos casos por eritema y picor. Treinta pacientes se quejaron de problemas de adherencia del parche, sobre todo en los momentos de mayor calor, y 36 comunicaron la formación de arrugas. Ninguno de estos problemas se asoció a fluctuaciones motoras u otras complicaciones. Conclusiones. Las complicaciones locales de la rotigotina transdérmica son leves, pero frecuentes. Consideramos necesario tenerlas en cuenta para lograr un mejor tratamiento de los pacientes con enfermedad de Parkinson (AU)

Introduction. Rotigotine is the first transdermal non-ergolinic dopaminergic agonist used in the treatment of Parkinson’s disease. It has several important advantages such as once-daily administration, absence of interactions with food, steady levels in plasma and continuous dopaminergic stimulation. Although its systemic side effects are similar to those seen in other dopaminergic agonists, rotigotine also has local side effects derived from the site of application. The aim of this paper is to review those local problems. Patients and methods. A retrospective analysis was carried out in order to identify the first 165 patients treated with rotigotine. Patients with intracranial lesions, psychiatric pathology or dementia were excluded. Patients were evaluated before and at two, four and six months after beginning treatment with rotigotine. Results. In all, 94 males and 71 females were identified, with an average age of 65.2 and an average rotigotine daily dose of 11.3 mg. Local side effects were present in 21 patients and they were usually mild. Two patients abandoned the treatment because of these local adverse events, presenting erythema and prurigo. Thirty patients complained about lack of adherence of the patch, specially when it was hot, and 36 about the formation of wrinkles in the patch. None of these problems was associated to motor fluctuations or other complications. Conclusions. Local complications of transdermal rotigotine are mild but frequent. We consider it is necessarily to take them into account to get a better treatment of patients suffering from Parkinson’s disease (AU)

[Local effects of transdermal treatment with rotigotine]. / Efectos locales del tratamiento transdérmico con rotigotina.

INTRODUCTION: Rotigotine is the first transdermal non-ergolinic dopaminergic agonist used in the treatment of Parkinson's disease. It has several important advantages such as once-daily administration, absence of interactions with food, steady levels in plasma and continuous dopaminergic stimulation. Although its systemic side effects are similar to those seen in other dopaminergic agonists, rotigotine also has local side effects derived from the site of application. The aim of this paper is to review those local problems. PATIENTS AND METHODS: A retrospective analysis was carried out in order to identify the first 165 patients treated with rotigotine. Patients with intracranial lesions, psychiatric pathology or dementia were excluded. Patients were evaluated before and at two, four and six months after beginning treatment with rotigotine. RESULTS: In all, 94 males and 71 females were identified, with an average age of 65.2 and an average rotigotine daily dose of 11.3 mg. Local side effects were present in 21 patients and they were usually mild. Two patients abandoned the treatment because of these local adverse events, presenting erythema and prurigo. Thirty patients complained about lack of adherence of the patch, specially when it was hot, and 36 about the formation of wrinkles in the patch. None of these problems was associated to motor fluctuations or other complications. CONCLUSIONS: Local complications of transdermal rotigotine are mild but frequent. We consider it is necessarily to take them into account to get a better treatment of patients suffering from Parkinson's disease.

Lacosamide for epileptic seizures in patients with co-morbidities and unusual presentations of epilepsy.

Numerous patients who are prescribed antiepileptic drugs (AEDs) for epileptic seizures are already receiving other agents for the treatment of co-morbid conditions, which frequently occur alongside epilepsy. This raises additional clinical considerations and makes the use of AEDs with good safety profiles and fewer drug-drug interactions attractive. Second and third-generation anticonvulsant drugs are associated with fewer pharmacological interactions and improved tolerability compared with first-generation drugs. Furthermore, second and third-generation anticonvulsant drugs are associated with linear pharmacokinetic profiles and differing mechanisms of action, making them ideal for pluripathological and polymedicated patients. In this report, we highlight the efficacy of one such agent, lacosamide, in five patients with co-morbidities and unusual presentations of epilepsy, including a patient with paraneoplastic encephalitis caused by microcytic lung carcinoma, one with a brain tumour and one with Alzheimer's disease, as well as a case of catamenial epilepsy and one of refractory convulsive status epilepticus. In all patients, lacosamide was associated with a substantial reduction in seizure frequency and effective control of seizure episodes. Treatment was generally well tolerated in all patients, indicating that lacosamide is an effective treatment option for a variety of patients with epileptic seizures.

Complicaciones neurológicas de la enfermedad de Wilson / Neurological complications of Wilson's disease

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Amnesia global transitoria poscoital recurrente / Recurrent post-coital transient global amnesia

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Zonisamide in managing impulse control disorders in Parkinson's disease.

Impulse control disorders (ICDs) are a set of behaviours that take place in a subgroup of patients with Parkinson's disease (PD). Although reduction or switch of dopamine agonists or decrease of levodopa are the common treatment, this does not always improve the compulsive behaviour. Zonisamide (ZNS) has proved effective for motor symptoms in PD and it may be also useful in the field of ICDs. The aim of our study is to evaluate the safety and efficacy of ZNS in PD patients with ICDs who did not improve following a reduction of either levodopa or dopamine agonists. Fifteen patients were initiated on 25 mg/day ZNS dosage, which was titrated to 200 mg/day, as tolerated. Severity of the behaviours was assessed by means of the Clinical Global Impression and the Barratt Impulsiveness Scale, while motor impairment was assessed by means of the Unified Parkinson's Disease Rating Scale (UPDRS). Demographic data, medication dose, treatment duration and adverse events were also collected and analyzed. There was a marked reduction in the severity of impulsive behaviours and global impulsiveness (mean change from baseline -5.8 to -4.8, respectively). UPDRS changed only marginally. ZNS was generally well tolerated. Our study suggests that ZNS may be effective for ICDs in PD. The lack of studies with other medications to treat these behaviours in PD and the potential beneficial effects of ZNS for motor complications make this drug important in the treatment of the disease.

Variation in almotriptan effectiveness according to different prophylactic treatments.

OBJECTIVE: To evaluate the effect of different migraine prophylaxis medications on subject responsiveness to almotriptan. BACKGROUND: There is evidence supporting an increase of responsiveness of symptomatic medications for migraine attacks by some prophylactic treatments although this has not been probed. METHODS: A total of 345 patients (230 women, mean age 37.3) with episodic or chronic migraine were classified according to the prophylaxis they were taking in the following groups: (1) no prophylactic medication; (2) propranolol; (3) topiramate; (4) flunarizine. Decrease in Analogical Visual Scale and pain-free at 2 hours after almotriptan intake was assessed at 2 months. Side effects and discontinuation or treatment were also assessed. RESULTS: Headache severity was reduced 4.2 in control group, 5.3 in propranolol group, 4.1 in topiramate group, and 4.0 in flunarizine group, whereas pain-free status was achieved in 37.3%, 48.7%, 36.1%, and 38.1% respectively. These two parameters were statistically significative between propranolol and control groups. Side effects were similar in all groups. CONCLUSIONS: Our results displayed a higher efficacy of almotriptan in propranolol group and we hypothesized it may be due to a common mechanism of action at serotoninergic receptors.

Zonisamide for migraine prophylaxis in patients refractory to topiramate.

INTRODUCTION: Topiramate is a sulfamate-substituted monosaccharide that has proven efficacy in reducing migraine attacks frequency and severity and has similar mechanisms of action and side effects profile to zonisamide. Although there are some studies suggesting a potential role of this drug in migraine prophylaxis, data are still scarce. We evaluate the efficacy and safety of zonisamide for migraine prevention in patients refractory to topiramate. METHODS: Sixty-three patients were initiated on 50 mg/d zonisamide dosage, which was titrated to 400 mg/d, as tolerated. Number of migraine attacks, headache severity (according to a 1- to 10-point visual analog scale), and use of acute medication were tested before and 2 and 6 months after the initiation of zonisamide. Demographic data, dose of the medication, duration of the treatment, and adverse events were also collected and analyzed. RESULTS: Statistically significant improvement in number of migraine attacks, headache severity, and use of acute medication reduction was obtained after the second month of zonisamide therapy and carried through month 6 of treatment. Fifteen patients reported adverse events, the most common of which was concentration difficulties. CONCLUSIONS: These results suggest that zonisamide is effective and well tolerated for migraine prevention in patients refractory to topiramate. With the exception of the inhibition of T-type calcium channels by zonisamide, its mechanisms of action seem to be very similar to topiramate's. We suggest the potential role of these channels in the pathophysiology of migraine.

A review of the use of zonisamide in Parkinson's disease.

Although zonisamide was previously only used to treat epilepsy, recently more applications have been forthcoming. Due to a good side effect profile, a lower frequency of interactions and a more comfortable posology, there are several studies regarding its uses in other pathologies such as migraine, neuropathic pain, essential tremor and various psychiatric diseases. A multicentered, randomized, double-blind, placebo-controlled study conducted in Japan suggested that zonisamide, as an add-on treatment, has efficacy in treating motor symptoms in patients with Parkinson's disease. In addition, other studies support the utility of zonisamide in other symptoms of this disease. The therapeutic doses of zonisamide for the treatment of Parkinson's disease are considerably lower than those for the treatment of epilepsy. This antiepileptic drug has been used in Japan for more than 15 years and so it is expected that it will be safe and well tolerated in patients with Parkinson's disease. However, the pharmacological mechanisms of the antiparkinsonian actions of zonisamide remain unclear and more basic investigation is warranted. The aim of this paper is to review the structure, mechanisms of action, pharmacokinetics and antiparkinsonian action of zonisamide.

[Neurological complications of inflammatory bowel disease]. / Complicaciones neurológicas de la enfermedad inflamatoria intestinal.

Although ulcerative colitis and Crohn's disease have traditionally been considered to be inflammatory diseases limited to the gastrointestinal tract, it has been shown that both pathologies are frequently accompanied by various extraintestinal disorders. There is an increasing evidence that they may also manifest in the nervous system, including the peripheral and the central parts. Although some of these neurological complications have been known for a long time, such as cerebrovascular disease, vasculitis and autoinmune processes including neuropathies and cerebral demyelination, others have been recently described. With the exception of some of this complications such as the thromboembolism, evidence for a casual relationship relies merely on single case reports or case series. In this article, we try to review the existing evidence on neurological manifestations of both variants of inflammatory bowel disease.

Complicaciones neurológicas de la enfermedad inflamatoria intestinal / Neurological complications of inflammatory bowel disease

Aunque la colitis ulcerosa y la enfermedad de Crohn se han considerado tradicionalmente como enfermedades limitadas a la mucosa del tubo digestivo, se ha demostrado que frecuentemente se acompañan de diferentes trastornos extraintestinales. Entre éstos, hay una evidencia creciente de que también se manifiestan en el sistema nervioso, tanto central como periférico. Aunque algunas de estas complicaciones neurológicas se conocen desde hace tiempo, como la enfermedad cerebrovascular, las vasculitis y los procesos de origen autoinmunitario, como las neuropatías o la desmielinización cerebral, otras sólo se han descrito recientemente. Con excepción de alguna de estas complicaciones, como la enfermedad tromboembólica, la mayoría de los datos de que disponemos proceden de casos clínicos individuales y series de casos. En este artículo pretendemos revisar la evidencia existente sobre las manifestaciones neurológicas de estas 2 variantes de la enfermedad inflamatoria intestinal

Although ulcerative colitis and Crohn's disease have traditionally been considered to be inflammatory diseases limited to the gastrointestinal tract, it has been shown that both pathologies are frequently accompanied by various extraintestinal disorders. There is an increasing evidence that they may also manifest in the nervous system, including the peripheral and the central parts. Although some of these neurological complications have been known for a long time, such as cerebrovascular disease, vasculitis and autoinmune processes including neuropathies and cerebral demyelination, others have been recently described. With the exception of some of this complications such as the thromboembolism, evidence for a casual relationship relies merely on single case reports or case series. In this article, we try to review the existing evidence on neurological manifestations of both variants of inflammatory bowel disease

Neurolépticos en el tratamiento de la migraña / Neuroleptics in the treatment of migraine

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