Efficacy and tolerability of clobazam in adults with drug-refractory epilepsy

ObjectivesTo evaluate the effectiveness and tolerability of clobazam as an adjunctive treatment for adults with drug-resistant epilepsy.MethodsWe performed a single-center, retrospective chart review of patients ≥18 years of age with drug-resistant epilepsy who started clobazam between 2010 and 2018. Included patients had outpatient visits both before and ≥1 month after clobazam initiation. Epilepsy classification, seizure frequency before and after clobazam, duration of clobazam treatment, and adverse effects were analyzed.ResultsA total of 417 patients met inclusion criteria. Mean age was 37.5 years, and 54% of patients were female. Patients were on a mean of 2.4 antiepileptic drugs at time of initiation of clobazam. Epilepsy types were focal (56.8%), Lennox-Gastaut syndrome (LGS) (21.1%), generalized (15.1%), and unclassified (7.0%). At the first follow-up visit ≥1 month after clobazam initiation, 50.3% of patients had >50% reduction in seizure frequency, and 20.5% were seizure-free. Of the initial cohort, 17.1% were followed >1 year and were seizure-free at last follow-up. Response rates did not differ between different epilepsy classifications. Fifty-one percent of patients experienced ≥1 side effect, most commonly lethargy/fatigue (30.7%) or mood changes (10.8%). A total of 178 (42.6%) patients discontinued clobazam, most commonly due to adverse effects (55%).ConclusionsClobazam is effective and safe as a long-term adjunctive therapy for adults with drug-resistant epilepsy; efficacy in off-label use is similar to that in LGS.Classification of evidenceThis study provides Class IV evidence that clobazam is an effective treatment for adults with drug-resistant epilepsy, independent of epilepsy classification.

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Vagus nerve stimulation in drug-resistant epilepsy: the efficacy and adverse effects in a 5-year follow-up study in Iran

Neurological Sciences ◽

10.1007/s10072-016-2661-3 ◽

2016 ◽

Vol 37 (11) ◽

pp. 1773-1778 ◽

Cited By ~ 12

Author(s):

Hossein Pakdaman ◽

Ali Amini Harandi ◽

Mehdi Abbasi ◽

Mohammad Karimi ◽

Mohammad Ali Arami ◽

...

Keyword(s):

Adverse Effects ◽

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Drug Resistant ◽

Follow Up Study ◽

Drug Resistant Epilepsy

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Case Report: 1-Year Follow-Up of Vagus Nerve Stimulation in a Dog With Drug-Resistant Epilepsy

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.708407 ◽

2021 ◽

Vol 8 ◽

Author(s):

Junya Hirashima ◽

Miyoko Saito ◽

Hirotaka Igarashi ◽

Satoshi Takagi ◽

Daisuke Hasegawa

Keyword(s):

Adverse Effects ◽

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Drug Resistant ◽

Stimulation Parameters ◽

Term Evaluation ◽

Drug Resistant Epilepsy

A vagus nerve stimulation (VNS) system was surgically implanted to treat drug-resistant epilepsy in a 5-year-old male Shetland Sheepdog. At regular visits during a 1-year follow-up, treatment efficacy and adverse effects were assessed, and programmable stimulation parameters were adjusted to optimize stimulation intensity while avoiding adverse effects. The frequency of generalized tonic–clonic seizures was reduced by 87% after the initiation of VNS. The owner reported that the dog regained his personality, and the quality of life of both the dog and owner improved. The only adverse effect of VNS was a cough that was controlled by adjusting stimulation parameters. There were no surgical complications or other issues with the VNS device. This is the first long-term evaluation of VNS therapy in a dog, and the results obtained suggest that gradual adjustments of VNS parameters facilitate optimum VNS dosing.

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Magnesium as an Effective Adjunct Therapy for Drug Resistant Seizures

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

10.1017/s0317167100013457 ◽

2012 ◽

Vol 39 (3) ◽

pp. 323-327 ◽

Cited By ~ 15

Author(s):

Peter A. Abdelmalik ◽

Nina Politzer ◽

Peter L. Carlen

Keyword(s):

Intractable Epilepsy ◽

Retrospective Chart Review ◽

Epileptic Seizures ◽

Controlled Study ◽

Seizure Freedom ◽

Drug Resistant ◽

Cns Depressant ◽

Drug Resistant Epilepsy ◽

Double Blinded

Objective:To explore the use of magnesium (Mg), an endogenous ion and enzymatic co-factor used in a variety of medical applications, for the treatment of epileptic seizures resistant to traditional medical therapy.Background:For almost a century, Mg has been used as prophylaxis and treatment of seizures associated with eclampsia. Mg is a CNS depressant, with numerous functions intracellularly and extracellularly. However, because of the availability of well studied anticonvulsant drugs, Mg has not been tested widely in the treatment of epileptic seizures.Methods:A retrospective chart review of 22 cases of drug resistant epilepsy, where a trial of empiric oral Mg supplementation (mainly in the form of Mg-oxide) was conducted.Results:Oral Mg supplementation was associated with a significant decrease in the number of seizure days per month, from 15.3 ± 13.2 (mean ± SD) to 10.2 ± 12.6 at first follow up (3-6 months, p=0.021), and to 7.8 ± 10.0 seizure days/month at second follow up (6-12 months, p=0.004). Thirty-six percent had a response rate of 75% or greater at second follow-up. Two patients reported seizure freedom. Most patients were well maintained on MgO 420mg twice a day, or in 2 cases, Mg Lactate, without significant adverse effects, the most frequent being diarrhea (4/22).Discussion:These results suggest that oral Mg supplementation may prove to be a worthwhile adjunctive medication in treating drug intractable epilepsy.Conclusions:A prospective, double-blinded, placebo controlled study is warranted to evaluate the potential of Mg for the treatment of drug-resistant seizures.

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Use of Vagus Nerve Stimulator on Children With Primary Generalized Epilepsy

Journal of Child Neurology ◽

10.1177/0883073818766599 ◽

2018 ◽

Vol 33 (7) ◽

pp. 449-452 ◽

Cited By ~ 4

Author(s):

William P. Welch ◽

Bilal Sitwat ◽

Yoshimi Sogawa

Keyword(s):

Vagus Nerve ◽

Seizure Frequency ◽

Chart Review ◽

Retrospective Chart Review ◽

Nerve Stimulator ◽

Vagus Nerve Stimulator ◽

Epilepsy Classification ◽

Primary Generalized Epilepsy ◽

Generalized Epilepsy

Objective: To describe the response to vagus nerve stimulator (VNS) in otherwise neurotypical children with medically intractable primary generalized epilepsy. Methods: Retrospective chart review of patients who underwent vagus nerve stimulator surgery between January 2011 and December 2015. Results: Eleven patients were identified. Median follow-up duration was 2.5 years (1.2-8.4 years). Prior to vagus nerve stimulator surgery, all patients had at least 1 seizure per week, and 7/11 (64%) had daily seizures. At 1-year follow-up after vagus nerve stimulator, 7/11 (64%) reported improved seizure frequency and 6/11 (55%) reported fewer than 1 seizure per month. Three patients (27%) reported complications related to vagus nerve stimulator surgery, and no patients required device removal. Significance: In children with medically intractable primary generalized epilepsy, vagus nerve stimulator is well tolerated and appears to lead to improvement in seizure frequency. Improvement was not attributable to epilepsy classification, age at vagus nerve stimulator implantation, output current, duty cycle, or follow-up duration.

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Seizure control does not predict hippocampal subfield volume change in children with focal drug-resistant epilepsy

The Neuroradiology Journal ◽

10.1177/19714009211049078 ◽

2021 ◽

pp. 197140092110490

Author(s):

Matthias W. Wagner ◽

Jovanka Skocic ◽

Elysa Widjaja

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Seizure Frequency ◽

Seizure Control ◽

Hippocampal Volume ◽

Drug Resistant ◽

Resonance Imaging ◽

Significant Difference ◽

Drug Resistant Epilepsy

Background and purpose Recurrent seizures have been reported to induce neuronal loss in the hippocampus. It is unclear whether seizure control influences hippocampal volume. The aims of this study were to determine if there was a change in total or subfield hippocampal volume over time in children with focal drug-resistant epilepsy, and whether seizure control influenced total or subfield hippocampal volumes. Methods Using FreeSurfer’s automated segmentation of brain magnetic resonance imaging scans, we calculated the total and subfield (including CA1, CA3, CA4, subiculum, presubiculum, parasubiculum, molecular layer and dentate gyrus) hippocampal volumes of children with non-lesional focal epilepsy. Seizure frequency and hippocampal volumes were assessed at baseline and follow-up. Patients were classified into those who were seizure free or have improvement in seizures (group 1) and those with no improvement in seizures (group 2) at follow-up. Results Thirty-seven patients were included, with mean age 10.31 ± 3.68 years at baseline. The interval between the two magnetic resonance imaging scans was 2.59 ± 1.25 years. There was no significant difference in the total and subfield hippocampal volumes for the whole cohort at follow-up compared to baseline (all P > 0.002). Seizure control of the two groups did not predict total or subfield hippocampal volume, after controlling for baseline volume, age, severity of seizure frequency at baseline and time interval between the magnetic resonance imaging scans (all P > 0.002). Conclusion We have found that total and subfield hippocampal volumes did not change, and seizure control did not predict hippocampal volumes at follow-up in children with drug-resistant epilepsy.

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Vagus nerve stimulation for drug-resistant epilepsy

Practical Neurology ◽

10.1136/practneurol-2019-002210 ◽

2019 ◽

Vol 20 (3) ◽

pp. 189-198 ◽

Cited By ~ 1

Author(s):

Laura Pérez-Carbonell ◽

Howard Faulkner ◽

Sean Higgins ◽

Michalis Koutroumanidis ◽

Guy Leschziner

Keyword(s):

Vagus Nerve ◽

Seizure Frequency ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Therapeutic Option ◽

Drug Resistant ◽

Drug Resistant Epilepsy ◽

Randomised Controlled

Vagus nerve stimulation (VNS) is a neuromodulatory therapeutic option for drug-resistant epilepsy. In randomised controlled trials, VNS implantation has resulted in over 50% reduction in seizure frequency in 26%–40% of patients within 1 year. Long-term uncontrolled studies suggest better responses to VNS over time; however, the assessment of other potential predictive factors has led to contradictory results. Although initially designed for managing focal seizures, its use has been extended to other forms of drug-resistant epilepsy. In this review, we discuss the evidence supporting the use of VNS, its impact on seizure frequency and quality of life, and common adverse effects of this therapy. We also include practical guidance for the approach to and the management of patients with VNS in situ.

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Seizure frequency and social outcome in drug resistant epilepsy patients who do not undergo epilepsy surgery

Seizure ◽

10.1016/j.seizure.2011.04.010 ◽

2011 ◽

Vol 20 (7) ◽

pp. 580-582 ◽

Cited By ~ 8

Author(s):

Mar Carreño ◽

Juan Luis Becerra ◽

Joaquín Castillo ◽

Iratxe Maestro ◽

Antonio Donaire ◽

...

Keyword(s):

Seizure Frequency ◽

Epilepsy Surgery ◽

Drug Resistant ◽

Social Outcome ◽

Drug Resistant Epilepsy

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Long-term effectiveness and adverse effects of ketogenic diet therapy in infants with drug-resistant epilepsy treated at a single center in Argentina

Epilepsy Research ◽

10.1016/j.eplepsyres.2021.106793 ◽

2021 ◽

pp. 106793

Author(s):

Marisa Armeno ◽

Antonella Verini ◽

Eugenia Caballero ◽

Araceli Cresta ◽

Gabriela Reyes Valenzuela ◽

...

Keyword(s):

Adverse Effects ◽

Ketogenic Diet ◽

Diet Therapy ◽

Drug Resistant ◽

Single Center ◽

Drug Resistant Epilepsy

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Efficacy of limited hippocampal radiofrequency thermocoagulation for mesial temporal lobe epilepsy

Journal of Neurosurgery ◽

10.3171/2018.4.jns184 ◽

2019 ◽

Vol 131 (3) ◽

pp. 781-789 ◽

Cited By ~ 1

Author(s):

Ching-Yi Lee ◽

Han-Tao Li ◽

Tony Wu ◽

Mei-Yun Cheng ◽

Siew-Na Lim ◽

...

Keyword(s):

Adverse Effects ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Seizure Frequency ◽

Seizure Control ◽

Mesial Temporal Lobe Epilepsy ◽

Temporary Increase ◽

Drug Resistant ◽

Radiofrequency Thermocoagulation ◽

Mesial Temporal Lobe

OBJECTIVERadiofrequency thermocoagulation (RFTC), which has been developed for drug-resistant epilepsy patients, involves less brain tissue loss due to surgery, fewer surgical adverse effects, and generally good seizure control. This study demonstrates the effectiveness of RFTC performed at limited hippocampal locations.METHODSDaily seizure diaries were prospectively maintained for at least 6 months by 9 patients (ages 30–59 years) with drug-resistant mesial temporal lobe epilepsy (MTLE) before treatment with RFTC. The limited target for stereotactic RFTC was chosen based on intraoperative electroencephalography (EEG) recording and was initially tested with a Radionics electrode at a low temperature, 45°C, for 60 seconds. The therapeutic RFTC heating parameters were 78°C–80°C for 90 seconds. All patients who received the RFTC treatment underwent both MRI and EEG recording immediately postoperatively and at the 3-month follow-up. Monthly outpatient clinic visits were arranged over 6 months to document seizure frequency and severity to clarify the changes noted in imaging studies and EEG patterns.RESULTSTwo patients were excluded from our analysis because one had undergone multiple seizure surgeries and the other had a poor recording of seizure frequency, before the RFTC surgery. Five and two patients underwent left-sided and right-sided RFTC, respectively. None of the patients had generalized tonic-clonic attacks postoperatively, and no adverse effects or complications occurred. According to MRI data, the effect of coagulation was limited to less than 1.0 cm in diameter and perifocal edema was also in limited range. The seizure frequency within 6 months decreased postoperatively with a mean reduction in seizures of 78% (range 36%–100%). Only two patients had a temporary increase in seizure frequency within 2 weeks of the surgery, and over 50% of all patients showed a decrease in average seizure frequency.CONCLUSIONSThe study results confirm that limited RFTC provides a more effective surgery with similar seizure control but fewer complications than resective surgery for drug-resistant MTLE patients.

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