Potassium Bromide in the Treatment of Pediatric Refractory Epilepsy

2019 ◽  
Vol 34 (10) ◽  
pp. 582-585 ◽  
Author(s):  
Kazuo Kodama ◽  
Taku Omata ◽  
Yoshimi Watanabe ◽  
Hiromi Aoyama ◽  
Yuzo Tanabe
Keyword(s):  
Adverse Effects ◽  
Seizure Frequency ◽  
Refractory Epilepsy ◽  
Focal Epilepsy ◽  
Dravet Syndrome ◽  
Generalized Seizures ◽  
Clonic Seizures ◽  
Moderate Effect ◽  
Generalized Epilepsy ◽  
Free Status

Objective: We evaluated potassium bromide’s (KBr’s) efficacy and tolerability for pediatric refractory epilepsy. Methods: We retrospectively reviewed the records of 42 patients treated with KBr in our hospital between 2008 and 2016 (age: 4 months to 19 years; mean: 6.2 years). Thirteen of them had 2 seizure types. The treatment durations ranged from 1 month to 6 years (mean: 15.0 months). Results: KBr had an excellent effect (seizure-free status) in 3 patients (7.1%), a moderate effect (>50% reduction in seizure frequency from the pretreatment baseline) in 21 patients (50.0%), and no effect (<50% reduction in seizure frequency from the pretreatment baseline) in 18 patients (42.9%). The effective daily doses ranged from 20 to 80 mg/kg (mean: 50.0 mg/kg). KBr was effective in 59.1% patients with generalized epilepsy (n = 22), 55.6% patients with focal epilepsy (n = 18), and both patients with Dravet syndrome. An excellent or moderate effect was found in 72.2% patients with tonic seizures (n = 18), 66.6% patients with generalized tonic-clonic seizures (n = 6), 75.0% patients with secondary generalized seizures (n = 4), 46.2% patients with focal seizures (n = 13), and 20% patients with infantile spasms (n = 10) but no patients with myoclonic seizures (n = 2). Adverse effects including drowsiness, excitement, and rashes were reported in 13 patients (31.0%). Conclusions: These findings suggest that KBr is particularly effective for tonic seizures, generalized tonic-clonic seizures, and secondary generalized seizures. Although the adverse effects need further attention, KBr should be considered for pediatric refractory epilepsy.

scholarly journals Retention Rate and Efficacy of Perampanel with a Slow Titration Schedule in Adults

2020 ◽  
pp. 1-7
Author(s):  
Mazen Basheikh ◽  
R. Mark Sadler
Keyword(s):  
Seizure Frequency ◽  
Retention Rate ◽  
Responder Rate ◽  
Dose Titration ◽  
Seizure Freedom ◽  
Chart Audit ◽  
Generalized Seizures ◽  
Included Patient ◽  
Generalized Epilepsy

ABSTRACT: Rationale: The manufacturer of perampanel (PER) suggests an initial adult dose of 2–4 mg/day and an upward dose titration of 2 mg at no more frequently than 1- or 2-week intervals when used with enzyme-enhancing antiepileptic drugs (AEDs) or nonenzyme-enhancing AEDs, respectively. The general practice in our clinic is an initial dose of PER 2 mg/day and titrated by 2 mg/4 weeks to an initial target of 6 mg/day. Methods: Retrospective chart audit of patients starting PER in an adult epilepsy clinic between September 2013 and November 2016 with at least one 6-month follow-up visit was reviewed. Data collection included patient demographics, seizure characteristics, past and concurrent therapy, monthly seizure frequency before PER and at 6-month visit, and characteristics of PER discontinuation. Efficacy of treatment was assessed with the Engel classification and 50% responder rate. Results: N = 102 patients; mean age = 40 years and 54% females. Focal onset seizures 85%, generalized 13%, and unknown 2%. Median prior AED exposure = 6 (range 3–20); median concomitant AED use = 2 (range 1–5). Follow-up range was 6–37 months. The median seizure frequency/month prePER treatment was 6 (range 0–30) for focal onset seizures and 1 (range 0–6) for generalized seizures. The retention rate amongst all patients at 6 months was 78.4%. At 6-month follow-up, 36% of all patients achieved Engel class I (seizure freedom) (30.7% of patients with focal onset seizures and 63.6% with generalized epilepsy). The 50% responder rate was 52% and 82% for focal and generalized epilepsy, respectively. Conclusion: PER has a good retention rate when titrated slowly and thus encouraging seizure freedom results in an otherwise medically refractory epilepsy population.

CORTICAL EXCITABILITY AND REFRACTORY EPILEPSY: A THREE-YEAR LONGITUDINAL TRANSCRANIAL MAGNETIC STIMULATION STUDY

2012 ◽  
Vol 23 (01) ◽  
pp. 1250030 ◽  
Author(s):  
RADWA A. B. BADAWY ◽  
GRAEME D. JACKSON ◽  
SAMUEL F. BERKOVIC ◽  
RICHARD A. L. MACDONELL
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Refractory Epilepsy ◽  
Cortical Excitability ◽  
Focal Epilepsy ◽  
Idiopathic Generalized Epilepsy ◽  
Generalized Epilepsy ◽  
Effective Medication ◽  
Over Time

Transcranial magnetic stimulation was used to study the effect of recurrent seizures on cortical excitability over time in epilepsy. 77 patients with firm diagnoses of idiopathic generalized epilepsy (IGE) or focal epilepsy were repeatedly evaluated over three years. At onset, all groups had increased cortical excitability. At the end of follow-up the refractory group was associated with a broad increase in cortical excitability. Conversely, cortical excitability decreased in all seizure free groups after introduction of an effective medication.

Safety and Efficacy of Brivaracetam in Pediatric Refractory Epilepsy: A Single-Center Clinical Experience

2019 ◽  
Vol 35 (2) ◽  
pp. 102-105 ◽  
Author(s):  
Sara McGuire ◽  
Gustavo Silva ◽  
Darshan Lal ◽  
Divya S. Khurana ◽  
Agustin Legido ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Chart Review ◽  
Refractory Epilepsy ◽  
Focal Epilepsy ◽  
Retrospective Chart Review ◽  
Average Dose ◽  
Limited Data ◽  
Duration Of Treatment ◽  
Seizure Reduction ◽  
The Mean

Brivaracetam is a new antiepileptic drug with limited data in children. The objective of this study was to assess the efficacy/tolerability of brivaracetam. This is a retrospective chart review of children/adolescents with refractory epilepsy treated with brivaracetam from 2016 to 2018. The primary outcome was seizure reduction (decrease in seizure frequency >50%). Twenty-three patients were identified. Mean age at initiation was 12.5 years. Fourteen were females. Epilepsy was focal in 11, generalized in 6, and mixed in 3. Average dose was 3.9 mg/kg/d. The mean duration of treatment was 8.2 months. Eight had greater than 50% decrease in seizure frequency, of which 7 had focal epilepsy, and 1 had Lennox-Gastaut/mixed epilepsy. Two had drowsiness and 3 behavioral complaints. One experienced tingling and dizziness. Our retrospective review suggests that brivaracetam is an effective therapy for refractory focal epilepsy in children older than 4 years of age.

scholarly journals Cannabis Treatment in Children with Epilepsy: Practices of Canadian Neurologists

2020 ◽  
Vol 47 (4) ◽  
pp. 511-518 ◽  
Author(s):  
Stephanie M. DeGasperis ◽  
Richard Webster ◽  
Daniela Pohl
Keyword(s):  
Online Survey ◽  
Focal Epilepsy ◽  
Poor Quality ◽  
Dravet Syndrome ◽  
Pediatric Epilepsy ◽  
Medical Cannabis ◽  
Idiopathic Generalized Epilepsy ◽  
Community Based ◽  
Drug Resistant Epilepsy ◽  
Generalized Epilepsy

ABSTRACT:Background:Medical cannabis has recently emerged as a treatment option for children with drug-resistant epilepsy. Despite the fact that many pediatric epilepsy patients across Canada are currently being treated with cannabis, little is known about the attitudes of neurologists toward cannabinoid treatment of children with epilepsy.Methods:A 21-item online survey was distributed via email to 148 pediatric neurologists working in hospitals and community clinics across Canada. Questions were related to clinical practice and demographics.Results:This survey achieved a response rate of 38% (56 Canadian neurologists). These neurologists were treating 668 pediatric epilepsy patients with cannabinoids. While 29% of neurologists did not support cannabis treatment in their patients, 34% prescribed cannabis, and 38% referred to another authorizing physician, mostly to community-based non-neurologists. The majority of neurologists considered cannabis for patients with Dravet syndrome (68%) and Lennox–Gastaut syndrome (64%) after an average of three failed anticonvulsants. Twenty-seven percent considered it for patients with idiopathic generalized epilepsy, and 18% for focal epilepsy. No neurologist used cannabis as a first-line treatment. All neurologists had at least one hesitation regarding cannabis treatment in pediatric epilepsy. The most common one was poor evidence (66%), followed by poor quality control (52%) and high cost (50%).Conclusions:The majority of Canadian pediatric neurologists consider using cannabis as a treatment for epilepsy in children. With many gaps in evidence and high patient-driven demand for cannabis therapy, this survey provides immediate information from the “wisdom of the crowd,” to aid neurologists until further evidence is available.

Variations in Seizure Frequency During Pregnancy and Postpartum by Epilepsy Type

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013056
Author(s):  
P. Emanuela Voinescu ◽  
Alexa N Ehlert ◽  
Camden P Bay ◽  
Stephanie Allien ◽  
Page B Pennell
Keyword(s):  
Frontal Lobe ◽  
Seizure Frequency ◽  
Postpartum Period ◽  
Focal Epilepsy ◽  
Post Partum ◽  
Frontal Lobe Epilepsy ◽  
Seizure Freedom ◽  
Pregnancy And Postpartum ◽  
Individual Participant ◽  
Generalized Epilepsy

Objective:To assess whether increased seizure frequency during pregnancy and post-partum is influenced by epilepsy type, seizure location, and antiseizure medications.Methods:Clinical data was collected in a longitudinal prospective database of pregnant women with epilepsy at Brigham and Women’s Hospital. Within each individual participant, baseline seizure frequency was calculated for the 9 months preconception, and it was determined if seizure frequency increased during pregnancy or the postpartum period. Seizure frequency was calculated for each 4-week interval during pregnancy. Generalized estimating equations for logistic regression were applied.Results:Ninety-nine patients contributing 114 pregnancies were included from 2013-2018. Increased seizure frequency occurred more often during pregnancies of women with focal versus generalized epilepsy (21.1% vs 5.3%, OR 4.70; 95% CI (1.00, 22.00); p = 0.0497). Among women with focal epilepsy, increased seizure frequency occurred more often in those with frontal lobe epilepsy (OR 8.00; 95 % CI (2.19, 29.21); p = 0.0017). There was no difference in seizure worsening in the postpartum period between focal and generalized (11.1% vs 9.1%, p=0.4478), or frontal and other focal (18.8% vs 6.0%; p=0.1478) epilepsy groups. Pregnancies on polytherapy had higher odds of seizure worsening compared to monotherapy (OR = 8.36, 95% CI = (2.07, 33.84), p = 0.0029), regardless of the medication or epilepsy type. A lack of preconception seizure freedom was also associated with increased seizure frequency during pregnancy (OR = 6.418; p = 0.0076).Conclusion:Women with focal epilepsy have higher likelihood of seizure worsening during pregnancy compared to women with generalized epilepsy; frontal lobe epilepsy poses an especially elevated risk. Polytherapy and lack of preconception seizure freedom are additional predictors for an increased likelihood of seizure worsening.

scholarly journals Dravet Syndrome—The Polish Family’s Perspective Study

2021 ◽  
Vol 10 (9) ◽  
pp. 1903
Author(s):  
Justyna Paprocka ◽  
Anita Lewandowska ◽  
Piotr Zieliński ◽  
Bartłomiej Kurczab ◽  
Ewa Emich-Widera ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Adverse Effects ◽  
Support Group ◽  
Speech Therapy ◽  
Refractory Epilepsy ◽  
Dravet Syndrome ◽  
Channel Blockers ◽  
Sleep Abnormalities ◽  
Loss Of Appetite

Aim: The aim of the paper is to study the prevalence of Dravet Syndrome (DS) in the Polish population and indicate different factors other than seizures reducing the quality of life in such patients. Method: A survey was conducted among caregivers of patients with DS by the members of the Polish support group of the Association for People with Severe Refractory Epilepsy DRAVET.PL. It included their experience of the diagnosis, seizures, and treatment-related adverse effects. The caregivers also completed the PedsQL survey, which showed the most important problems. The survey received 55 responses from caregivers of patients with DS (aged 2–25 years). Results: Prior to the diagnosis of DS, 85% of patients presented with status epilepticus lasting more than 30 min, and the frequency of seizures (mostly tonic-clonic or hemiconvulsions) ranged from 2 per week to hundreds per day. After the diagnosis of DS, patients remained on polytherapy (drugs recommended in DS). Before diagnosis, some of them had been on sodium channel blockers. Most patients experienced many adverse effects, including aggression and loss of appetite. The frequency of adverse effects was related to the number of drugs used in this therapy, which had an impact on the results of the PedsQL form, particularly in terms of the physical and social spheres. Intensive care unit stays due to severe status epilepticus also had an influence on the results of the PedsQL form. Conclusions: Families must be counseled on non-pharmacologic strategies to reduce seizure risk, including avoidance of triggers that commonly induce seizures (including hyperthermia, flashing lights and patterns, sleep abnormalities). In addition to addressing seizures, holistic care for a patient with Dravet syndrome must involve a multidisciplinary team that includes specialists in physical, occupational and speech therapy, neuropsychology, social work.

Electroclinical Phenotype-Genotype Homogeneity in Drug-Resistant “Generalized” Tonic-Clonic Seizures of Early Childhood

2020 ◽  
pp. 155005942095373
Author(s):  
Anis Jukkarwala ◽  
Ramshekhar N. Menon ◽  
E. R. Sunesh ◽  
Ashalatha Radhakrishnan
Keyword(s):  
Genetic Testing ◽  
Dravet Syndrome ◽  
Drug Resistant ◽  
Presurgical Evaluation ◽  
Epileptiform Discharges ◽  
Mri Scans ◽  
Clonic Seizures ◽  
Magnetic Resonance Imaging Mri ◽  
Drug Resistant Epilepsy ◽  
Generalized Epilepsy

Purpose Children with refractory focal to bilateral tonic-clonic seizures, despite normal high-resolution imaging, are often not subjected to genetic tests due to the costs involved and instead undergo multimodality presurgical evaluation targeted at delineating a focal onset. The objective of this study was to ascertain genotype-phenotype correlations in this group of patients. Method An online hospital database search was conducted for children who presented in 2019 with drug-resistant epilepsy dominated by nonlateralizing focal-onset/rapid generalized (bilateral) tonic-clonic seizures (GTCS), subjected to presurgical evaluation and subsequent genetic testing due to absence of a clear focus hypothesis. Results Phenotypic homogeneity was apparent in 3 children who had onset in infancy with drug-resistant GTCS (predominantly unprovoked and occasionally fever provoked) and subsequent delayed development. 3-Tesla magnetic resonance imaging (MRI) scans were negative and video EEG documented a homogeneous pattern of multifocal and/or generalized epileptiform discharges with phenomenology favoring probable focal-onset/generalized-onset bilateral tonic-clonic seizures. All 3 tested positive for SCN1A gene variants (heterozygous missense substitution variants in 2 children, one of which was novel and a novel duplication in one that led to frameshift and premature truncation of the protein), suggestive of SCN1A-mediated epilepsy. This electroclinical profile constituted 3 out of 25 patients with SCN1A-epilepsy phenotypes at our center. Conclusions These cases suggest that children with early-onset drug-resistant “generalized” epilepsy are likely to have a genetic basis although the presentation may not be typical of Dravet syndrome. Hence, genetic testing for SCN1A variants is recommended in children with drug-resistant MRI negative focal-onset/generalized-onset bilateral tonic-clonic seizures before subjecting them to exhaustive presurgical workup and to guide appropriate treatment and prognostication.

scholarly journals A Systematic Review on Lamotrigine Induced Skin Rashes

2021 ◽  
Vol 11 (1) ◽  
pp. 146-151
Author(s):  
T.T. Muhammed Anwar ◽  
P.P. Muhamed Faris ◽  
, Thansiha
Keyword(s):  
Adverse Effects ◽  
Adverse Reactions ◽  
First Line ◽  
Blurred Vision ◽  
Generalized Seizures ◽  
Anti Epileptic Drug ◽  
Generalized Epilepsy ◽  
Patients Experience ◽  
Paediatric Epilepsy ◽  
Line Drug

Lamotrigine is a newer anti-epileptic drug synthesised in 1980s and approved by USFDA in 1994. It is mainly used for treating paediatric epilepsy and one of the frequently prescribing newer anti- epileptic drugs in European countries. In English scenario, lamotrigine is suggested as monotherapy for recently identified partial seizures (localized seizure) in children as its first line drug. Lamotrigine is recommended for generalized seizures as second line drug and as add on therapy in intractable generalized epilepsy. It is a treatment option after sodium valproate and ethosuximide for petit-mal epilepsy. It can be used as either single or in combination with other anti-epileptic drugs. It has lot of adverse effects like other anti-epileptic drugs. Major adverse effect associated with lamotrigine is skin rashes in newly administered patients up to 8 weeks. About 3-10 % of the patients experience skin rashes in their therapy with lamotrigine. Lamotrigine doses should be titrated properly in combination with other anti-epileptic drugs especially with valproic acid. Other less common adverse effects with lamotrigine include dizziness, ataxia, blurred vision, headache, nausea and diplopia. Moreover, lamotrigine has a safe drug profile and effective in both children and adults for the treatment of various types of seizures. The dose escalation should be monitored regularly to avoid serious adverse reactions.

scholarly journals Efficacy of Lacosamide Therapy in Focal Onset Refractory Epilepsy of Childhood: A Single Center Experience

2021 ◽  
Author(s):  
Halil Ural Aksoy ◽  
Celil Yılmaz ◽  
Senem Ayça ◽  
Aslı Kübra Atasever ◽  
Muzaffer Polat ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Drug Interactions ◽  
Seizure Frequency ◽  
Refractory Epilepsy ◽  
Cross Sectional Study ◽  
Term Treatment ◽  
Efficacy And Safety ◽  
Cross Sectional ◽  
Focal Seizures ◽  
Long Term Treatment

Objective: Treatment of childhood refractory epilepsy is a challenge for clinicians. Lacosamide is a new generation antiepileptic drug which is being used for focal onset seizures of adults and children. Efficacy and safety of the drug for adults have been demonstrated in various studies. The aim of this retrospective cross-sectional study is to evaluate the efficacy and safety of lacosamide in childhood refractory focal seizures in our clinic. Methods: We examined the medical records of 14 patients treated with lacosamide in our clinic between January 2016 and January 2020 in terms of demographic, etiological, neuroimaging findings, responses to treatment, adverse effects and drug-drug interactions. We evaluated the patients as responders to treatment whose seizure frequency decreased ≥%50 after 6 months of lacosamide treatment. Results: In 12 patiens (%85.7) seizure frequency decreased ≥%50 (p<0.001) while 5 of them (%35.7) was seizure free. Despite to the long term treatment one patient did not response to lacosamide treatment, and 1 patient’s treatment stopped due to aggravation of seizure after initiation of lacosamide treatment. Clinical adverse effects were observed in 3 (%21.4) patients. Cardiac adverse effects or drug-drug interactions were not observed in any patient. Conclusion: As a result of our study, we think that lacosamide is an effective and reliable treatment option for refractory focal seizures of childhood similar to the results of the studies cited in the literature. We also think that further investigations are needed to evaluate its efficacy in focal and different type of seizures of childhood.

scholarly journals Russian experience of using perampanel in daily clinical practice. Preliminary report

2016 ◽  
Vol 24 (1) ◽  
pp. 7-14
Author(s):  
Pavel Vlasov ◽  
Vladimir Karlov ◽  
Irina Zhidkova ◽  
Aleksandr Chervyakov ◽  
Oleg Belyaev ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Seizure Frequency ◽  
Focal Epilepsy ◽  
Daily Clinical Practice ◽  
Sign Test ◽  
Neuronal Membrane ◽  
Competitive Antagonist ◽  
Generalized Seizures ◽  
Symptomatic Epilepsy ◽  
Male Patients

Summary Introduction. Perampanel (PER) (Fycompa) 5′-(2-cyanophenyl)-1′-phenyl-2,3′-bipyridinyl-6′(1′H)-on is the newest antiepileptic drug and is the first-in-class selective non-competitive antagonist of ionotropic AMPA glutamate receptors of the postsynaptic neuronal membrane. The aim was to summarize Russian experience in using PER in daily clinical practice, and for this purpose the results of its use as an add-on treatment for focal epilepsy were assessed retrospectively Material and Method. The results of the study of PER efficacy and safety in 52 patients with refractory focal epilepsy are presented. Mean age was 28.9 ± 14.0 years; proportion of male patients was 56%, duration of the disease over 10 years - 69.2%, symptomatic epilepsy - 76.9%, with frontal - 46.2% and temporal - 44.2% localization of epileptic lesion. Majority of patients - 71.2% started PER treatment after 3 preceding lines of therapy Results. The baseline seizure frequency of all types was 127.3 ± 82.3 per month; secondary generalized seizures - 6.7 ± 1.9 per month. After PER was added, a significant decrease in seizure frequency was observed already during the first month, to 52.1 ± 29.3 seizures per month (Sign test, p = 0.00001) for seizures of all types and to 3.7 ± 1.7 (Sign test, p = 0.00001) for secondary generalized seizures. In an overwhelming majority of cases, duration of PER treatment was more than 6 months. In 58% of patients, seizure frequency decreased by more than 50% (responders). Seizure-free status for all seizure types was observed in 9% of cases at 12 month, and absence of secondary generalized seizures only was achieved in 31% of patients. Adverse events were observed in 30.1% of patients: aggression - 11.5% and drowsiness - 9.6%, with all other AEs observed more rarely. PER dose was reduced due to side effects in 7 patients (13.5%), and in 4 patients (7.7%) PER was discontinued. Average PER dose in adult patients was as low as 6 mg. Conclusions. PER was effective in the treatment of refractory forms of focal epilepsy, reducing seizure frequency on average by 76% by the second month of treatment. In addition to a good clinical effect, PER demonstrated a rather acceptable and predictable safety profile.

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