Effect and Safety of Shihogyejitang for Drug Resistant Childhood Epilepsy

Objective. Herbal medicine has been widely used to treat drug resistant epilepsy. Shihogyejitang (SGT) has been commonly used to treat epilepsy. We investigated the effect and safety of SGT in children with drug resistant epilepsy.Design. We reviewed medical records of 54 patients with epilepsy, who failed to respond to at least two antiepileptic drugs and have been treated with SGT between April 2006 and June 2014 at the Department of Pediatric Neurology, I-Tomato Hospital, Korea. Effect was measured by the response rate, seizure-free rate, and retention rate at six months. We also checked adverse events, change in antiepileptic drugs use, and the variables related to the outcome.Results. Intent-to-treat analysis showed that, after six months, 44.4% showed a >50% seizure reduction, 24.1% including seizure-free, respectively, and 53.7% remained on SGT. Two adverse events were reported, mild skin rash and fever. Focal seizure type presented significantly more positive responses when compared with other seizure types at six months (p=0.0284, Fisher’s exact test).Conclusion. SGT is an effective treatment with excellent tolerability for drug resistant epilepsy patients. Our data provide evidence that SGT may be used as alternative treatment option when antiepileptic drug does not work in epilepsy children.

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The Prevalence of Drug-Resistant-epilepsy and its Associated Factors in Patients with Epilepsy

10.21203/rs.3.rs-137800/v1 ◽

2021 ◽

Author(s):

Parisa Mohammadzadeh ◽

Surena Nazarbaghi

Keyword(s):

Associated Factors ◽

Developmental Disorders ◽

Perinatal Care ◽

Tertiary Care ◽

Seizure Type ◽

Care Hospital ◽

Drug Resistant ◽

Significant Difference ◽

Drug Resistant Epilepsy ◽

Patients With Epilepsy

Abstract Background: Drug-resistant-epilepsy (DRE) is a major challenge in adult patients with epilepsy. The majority of previous studies evaluating the risk factors of DRE have been conducted in children. Therefore, this study aimed to investigate the prevalence of DRE and its associated factors in adults. Methods: All patients aged over 12 years with an established diagnosis of epilepsy since at least one year before the admission who were admitted with seizure to the neurology ward of a tertiary care hospital were consecutively included from 20th March 2014 to 19th March 2020. Patients were classified into two groups of DRE and non-DRE groups. The archived-files of the patients were retrospectively reviewed and the data were extracted and recorded in a pre-prepared checklist. Results: A total of 436 patients were investigated. The most common causes of epilepsy were idiopathic (53.9%), vascular (22.5%), and CP/developmental disorders (8.3%). There was no significant difference between DRE and non-DRE patients in terms of age, sex, seizure type (generalized/partial). Vascular causes were more prevalent in the non-DRE group, and idiopathic, post-traumatic/surgery, MS/degenerative, poor compliance, CP/developmental disorders, and space-occupying lesions were more prevalent in the DRE group. In multivariate regression analysis only the presence of CP/developmental disorders was independently associated with a higher probability of DRE (adjusted OR= 2.170, 95% CI = 1.017 to 4.633, p = 0.045).Conclusion: The prevalence of DRE is still considerably high. Therefore, considering its serious consequences, more investigations should be carried out to determine proper strategies for reducing its incidence. We found the history of CP/developmental disorders to be independently associated with DRE. Therefore, perinatal care to reduce the incidence of CP/developmental disorders and encouraging these patients to use their medications accurately may be helpful.

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Efficienc y of vag us nerve stim ulation in epilepsy (literat ure review and case report )

Russian Journal of Child Neurology ◽

10.17650/2073-8803-2019-14-2-7-17 ◽

2019 ◽

Vol 14 (2) ◽

pp. 7-17

Author(s):

O. A. Pylaeva ◽

V. A. Chadaev ◽

M. Yu. Bobylova ◽

K. Yu. Mukhin

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Vagus Nerve ◽

Antiepileptic Drugs ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Drug Resistant ◽

Treatment Resistant ◽

Drug Resistant Epilepsy ◽

Patients With Epilepsy

Despite significant advances in epileptology, approximately one-third of patients suffer from drug-resistant epilepsy. Numerous approaches are currently available to treat epilepsy; however, there are still many patients with treatment-resistant epilepsy, in whom antiepileptic drugs are ineffective and surgical treatment is impossible. Thus, searching for new effective antiepileptic drugs and alternative treatments (such as vagus nerve stimulation) for these patients remains highly relevant. This literature review covers the indications for and the efficacy and tolerability of vagus nerve stimulation in patients with epilepsy. We also report a case of successful treatment of a patient with drug-resistant epilepsy using this method.

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Network meta-analysis of antiepileptic drugs in focal drug-resistant epilepsy

Epilepsy Research ◽

10.1016/j.eplepsyres.2020.106433 ◽

2020 ◽

Vol 167 ◽

pp. 106433

Author(s):

Tong Yao Hu ◽

Hai-Qiang Wang ◽

Wen Ping Zhang ◽

Ruo Fei Tian ◽

Ge Sheng Lei ◽

...

Keyword(s):

Antiepileptic Drugs ◽

Meta Analysis ◽

Drug Resistant ◽

Drug Resistant Epilepsy

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Efficacy of Vagal Nerve Stimulation for Drug-Resistant Epilepsy: Is it the Stimulation or Medication?

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.46 ◽

2017 ◽

Vol 44 (5) ◽

pp. 532-537 ◽

Cited By ~ 8

Author(s):

Jaylynn Arcand ◽

Karen Waterhouse ◽

Lizbeth Hernandez-Ronquillo ◽

Aleksander Vitali ◽

Jose F. Tellez-Zenteno

Keyword(s):

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Drug Resistant ◽

Idiopathic Generalized Epilepsy ◽

Drug Resistant Epilepsy ◽

Generalized Epilepsy ◽

Patients With Epilepsy ◽

Seizure Classification

AbstractBackground: Vagus nerve stimulation (VNS) therapy has been widely recognized as an alternative for the treatment of drug-resistant epilepsy, although modification of antiepileptic drugs (AEDs) during VNS treatment could explain the improvement in patients. Methods: We retrospectively assessed the efficacy of VNS in 30 adult patients with epilepsy treated with >6 months of follow-up. The criteria for implantation were the following: (1) not a candidate for resective epilepsy surgery, (2) drug-resistant epilepsy, (3) impairment of quality of life, (4) no other option of treatment, and (5) patients with idiopathic generalized epilepsy who fail to be controlled with appropriate AEDs. We assessed sociodemographics, seizure etiology, seizure classification, and AEDs used during treatment with VNS. We assessed adverse effects and efficacy. Responder rate was defined as >50% seizure improvement from baseline. Results: Thirty patients (females, 18; males, 12; age, 35.1±13.3 years) were included. After 6, 12, 24, and 36 months of follow-up, the response rates were: 13/30 (43%), 13/27 (48%), 9/22 (41%), and 8/16 (50%), respectively; none was seizure free. Fifty-seven percent, 33%, 59%, and 81% of patients had changes of medication type or dose at 6, 12, 24, and 36 months respectively. In the majority of patients, the change of medication consisted of an increase in the dose of AEDs. Conclusions: Our study shows that VNS is an effective therapy, although significant changes in medications were done along with the therapy; therefore, the real effect of VNS could be controversial.

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Vagal nerve stimulation for drug-resistant epilepsy: Efficacy and adverse events in an epilepsy centre with long-term follow-up

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.1945 ◽

2017 ◽

Vol 381 ◽

pp. 691 ◽

Cited By ~ 1

Author(s):

G. Timárová ◽

G.A. Ramos Rivera ◽

M. Kolníková ◽

M. Novotný ◽

A. Šteňo ◽

...

Keyword(s):

Adverse Events ◽

Nerve Stimulation ◽

Vagal Nerve ◽

Vagal Nerve Stimulation ◽

Drug Resistant ◽

Long Term Follow Up ◽

Drug Resistant Epilepsy

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Topiramate Effectiveness as Add-on Therapy in Bulgarian Patients with Drug-resistant Epilepsy

Folia Medica ◽

10.3897/folmed.62.e50175 ◽

2020 ◽

Vol 62 (4) ◽

pp. 712-722

Author(s):

Ekaterina Viteva ◽

Zahari Zahariev

Keyword(s):

Adverse Events ◽

Seizure Frequency ◽

Dynamic Assessment ◽

University Hospital ◽

Drug Resistant ◽

Seizure Severity ◽

Impaired Awareness ◽

Eeg Recordings ◽

Drug Resistant Epilepsy ◽

Stable Improvement

Introduction: There are no reliable prospective studies on the effectiveness of topiramate in Bulgarian adult patients with drug-resistant epilepsy. Aim: The aim of the study was to conduct an open, prospective study on various aspects of topiramate (TPM) effectiveness in Bulgarian patients with drug-resistant epilepsy.  Patients and methods: The study included patients with epilepsy who attended the Clinic of Neurology at the University Hospital in Plovdiv, Bulgaria. Patients completed diaries for seizure frequency, seizure severity, and adverse events. There were regular documented visits at 3 or 6 months during the first year of TPM treatment and at 6 months afterwards, with a dynamic assessment of seizure fre-quency, severity, adverse events, and EEG recordings.  Results: TPM was used as an add-on treatment in 120 patients (69 males, mean age 37 years). There was a relatively mild and stable dynamic improvement of seizure severity, a satisfactory seizure frequency reduction in 37% of participants, a stable mean seizure fre-quency reduction (47%) from month 6 to month 24 of treatment and a stable responder rate (48-51%) during the same period. New seizure types (focal with impaired awareness with/without evolution to bilateral tonic-clonic seizures) occurred in 5 patients. There were adverse events (dizziness/vertigo, irritability, speech disturbances, memory impairment, concentration problems, tremor, loss of appe-tite and weight, weakness, numbness, bradypsychia, confusion, visual hallucinations, sleepiness, insomnia, headache, itching, unstable gait, nausea, and vomiting) in 20% of patients.  Conclusions: TPM treatment is associated with low and stable improvement of seizure severity, good and stable improvement of sei-zure frequency, possible worsening of seizure control and appearance of new seizure types, good safety and tolerability.

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Drug Resistant Epilepsy Among Patients Attended The Neurosciences Hospital

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v13i1.138 ◽

2019 ◽

Vol 13 (1) ◽

pp. 108-115

Author(s):

Nael Husain Zaer

Keyword(s):

Drug Resistance ◽

Medical History ◽

Refractory Epilepsy ◽

Seizure Freedom ◽

Drug Resistant ◽

Past Medical History ◽

Number Of Patients ◽

Drug Resistant Epilepsy ◽

Patients With Epilepsy

Background: Drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules to achieve sustained seizure freedom. Up to 30% of patients referred to clinics with a diagnosis of pharmaco-resistant epilepsy may have been misdiagnosed, and many can be helped by optimizing their treatment.Pseudoresistance, in which seizures persist because the underlying disorder has not been adequately or appropriately treated, must be ruled out or corrected before drug treatment can be considered to have failed. Objectives: The objectives of this study were to determine the causes of drug failure in patients with epilepsy and to differentiate between drug resistant epilepsy and pseudoresistant epilepsy. Type of the study: This is a retrospective study. Method: It is conducted in Baghdad governorate at the epilepsy clinic in the neurosciences hospital during the period from the 1st of February through July 2013. Two hundred patients with refractory epilepsy were involved. These patients attended the epilepsy clinic during 2011 and 2012. The data was collected from the files of the patients including age, gender, weight, history of presenting illness, type of seizure, drugs used, duration of disease, EEG and imaging findings, compliance and follow up. Results: Drug resistance epilepsy constituted a prevalence of 24% (128) as the total number of patients with epilepsy attending the hospital during the same period was 527.The mean age of patients with refractory epilepsy was 25 years. Male were 56.5% (113/200) and urban residents were 70.5% (141/200). The study revealed that 64% (128/200) of refractory epilepsy was attributed to drug resistance; while the remaining proportion was pseudoresistance 36% (72/200). The main cause of pseudoresistance was poor compliance 36.1% (26/72).The most common type of seizure in the sampled patients was generalized tonic clonic seizures in 51.5% (103/200).Compliance was found to be statistically associated with abnormal EEG finding, past medical history (hypertension, cardiac diseases, encephalitis, diabetes mellitus and any significant history) and quality of follow up. The follow-up was found to be statistically associated with the family history, past medical history( encephalitis and hypertension) and compliance of patient. Conclusion:A considerable number of patientsdiagnosed as cases of drug resistant epilepsy had another explanation causing drug failure.The study recommends the application of consensus definition for drug resistant epilepsy and periodic evaluation of patients with drug resistant epilepsy to exclude pseudoresistance.

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“Ictal” Bradyarrhythmias in Patients with Drug-Resistant Epilepsy: Results of Long-Term Heart Rhythm Monitoring

Kardiologiia ◽

10.18087/cardio.2020.12.n1379 ◽

2021 ◽

Vol 60 (12) ◽

pp. 90-96

Author(s):

S. E. Serdyuk ◽

K. V. Davtyan ◽

S. G. Burd ◽

E. S. Mishina ◽

O. M. Drapkina ◽

...

Keyword(s):

Heart Rhythm ◽

Epileptic Seizures ◽

Channel Blockers ◽

Drug Resistant ◽

Disorder Of Consciousness ◽

Functional Changes ◽

Long Duration ◽

Drug Resistant Epilepsy ◽

Patients With Epilepsy

Aim To determine the type and incidence of ictal bradyarrhythmias in patients with drug-resistant types of epilepsy by long-term electrocardiogram (ECG) monitoring.Material and methods Subcutaneous ECG monitors programed for recording pauses >3 sec and episodes of bradycardia ≤45 bpm were implanted in 193 patients with persistent epileptic seizures without organic pathology of the myocardium. Recording was activated by the patient/family at the onset of epileptic seizure. The follow-up period was 36 months with visits to the clinic every three months.Results For 36 months of monitoring, 6494 ECG fragments were recorded. Ictal bradycardia was observed in 6.7 % of patients, including ictal asystole in 2.6 % of patients. Episodes of bradycardia and asystole during epileptic seizures were transient and developed significantly more frequently in men, patients with long duration of the disease, bilateral tonic-clonic or focal seizures with disorder of consciousness, during sleep, on the background of treatment with several antiepileptic agents, mostly from the group of potassium channel blockers.Conclusion Bradyarrhythmias accompanying epileptic seizures are transient and reproducible from seizure to seizure. They reflect functional changes in the myocardium and do not determine the life prediction for patients with epilepsy without organic pathology of the heart.

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ABCB1 Polymorphisms and Drug-Resistant Epilepsy in a Tunisian Population

Disease Markers ◽

10.1155/2019/1343650 ◽

2019 ◽

Vol 2019 ◽

pp. 1-16

Author(s):

Malek Chouchi ◽

Hedia Klaa ◽

Ilhem Ben-Youssef Turki ◽

Lamia Hila

Keyword(s):

Treatment Response ◽

Antiepileptic Drugs ◽

Gene Polymorphisms ◽

Tunisian Population ◽

Drug Resistant ◽

Population Genetic Analysis ◽

Interindividual Variations ◽

Treatment Failure Rate ◽

Epileptic Patients ◽

Drug Resistant Epilepsy

Background. Epilepsy is one of the most common neurological disorders with about 30% treatment failure rate. An interindividual variations in efficacy of antiepileptic drugs (AEDs) make the treatment of epilepsy challenging, which can be attributed to genetic factors such as ATP-Binding Cassette sub-family B, member1 (ABCB1) gene polymorphisms. Objective. The main objective of the present study is to evaluate the association of ABCB1 C1236T, G2677T, and C3435T polymorphisms with treatment response among Tunisian epileptic patients. Materials and Methods. One hundred epileptic patients, originated from north of Tunisia, were recruited and categorized into 50 drug-resistant and 50 drug-responsive patients treated with antiepileptic drugs (AEDs) as per the International League Against Epilepsy. DNA of patients was extracted and ABCB1 gene polymorphisms studied using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results. The C1236T, G2677T, and C3435T polymorphisms were involved into AED resistance. Significant genotypic (C1236T TT (p≤0.001); G2677T TT (p=0.001); C3435T TT (p≤0.001)) and allelic associations (C1236T T (3.650, p≤0.001); G2677TT (1.801, p=0.044); C3435T T (4.730, p≤0.001)) with drug resistance epilepsy (DRE) were observed. A significant level of linkage disequilibrium (LD) was also noted between ABCB1 polymorphisms. Patients with the haplotypes CT and TT (C1236T-G2677T); GT, TC, and TT (G2677T-C3435T); CT and TT (C1236T-C3435T); CTT, TTC, TGT, and TTT (C1236T-G2677T-C3435T) were also significantly associated to AED resistance. Conclusions. The response to antiepileptics seems to be modulated by TT genotypes, T alleles, and the predicted haplotypes for the tested SNPs in our population. Genetic analysis is a valuable tool for predicting treatment response and thus will contribute to personalized medicine for Tunisian epileptic patients.

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