scholarly journals Efficacy assessment of levetiracetam monotherapy in newly-diagnosed epilepsy in adults using epileptiform activity index

2020 ◽  
Vol 12 (2) ◽  
pp. 93-104
Author(s):  
V. A. Karlov ◽  
A. B. Kozhokaru ◽  
P. N. Vlasov ◽  
A. S. Samoilov ◽  
Yu. D. Udalov
Keyword(s):  
Treatment Efficacy ◽  
Focal Epilepsy ◽  
Activity Index ◽  
Epileptiform Activity ◽  
Dose Titration ◽  
Therapeutic Drug ◽  
Newly Diagnosed ◽  
Rate Decrease ◽  
Seizure Rate

Abstract. Levetiracetam (LEV) is one of the most commonly prescribed antiepileptic drugs (AED). However, there were no studies on its efficacy and safety in terms of the correlation with epileptiform activity index (EAI) performed among the Russian population.Aim. To evaluate the efficacy and tolerability of LEV monotherapy in patients with newly-diagnosed epilepsy using epileptiform activity index (EAI) assessment.Materials and methods. The study included 107 patients (46 (43.0%) male and 61 (57.0%) female) with focal epilepsy (FE) (39.3%; n=42) or idiopathic generalized epilepsy (IGE) (60.7%; n=65). At each visit, video-electroencephalographic (video-EEG) monitoring was performed (baseline and in 1, 3, 6, and 12 months of the therapy). Therapeutic drug monitoring was performed at dose titration in 1 month of the therapy or in case of therapy correction. Treatment efficacy was assessed using the criteria of seizure absence (medically induced remission), seizure rate decrease by >50% (responders), seizure rate decrease by <50% – insufficient efficacy, a composite index of efficacy/tolerability (retention on treatment), and seizure rate increase compared to baseline and/or development of a new type of seizures (aggravation). Adverse events (AE) were assessed using the scale for side effects in AED treatment (SIDAED).Results. Total EAI at baseline was 5.2-fold higher in patients with IGE compared to FE patients (23.4±3.0 and 4.5±0.97, respectively). After 1 month of LEV therapy, EAI decreased to 3.4±1.1 and 1.9±0.4 in patients with IGE and FE, respectively (p<0.01). The decrease continued during the whole follow-up period. Retention on monotherapy was achieved in 82.2% (n=88/107) patients; in 87.6% (n=57/65) patients with IGE and in 73.8% (n=31/42) with FE. The rate of serious AEs during the follow-up period was 8.4% (n=9).Conclusions. LEV is an effective drug of choice for the initial treatment of newly-diagnosed FE and IGE in monotherapy along with a significant decrease in EAI. EAI is an objective measure of LEV treatment efficacy.

scholarly journals The severity of seizures and epileptiform activity index in the assessment of antiepileptic treatment efficacy in patients with generalized tonic-clonic awakening seizures

2021 ◽  
Vol 13 (3) ◽  
pp. 192-199
Author(s):  
V. A. Karlov ◽  
A. B. Kozhokaru ◽  
P. N. Vlasov ◽  
A. S. Orlova
Keyword(s):  
Treatment Efficacy ◽  
Activity Index ◽  
Epileptiform Activity ◽  
Newly Diagnosed ◽  
Seizure Severity ◽  
Rate Decrease ◽  
Seizure Rate ◽  
Group 2 ◽  
Generalized Epilepsy ◽  
Group 1

Objective: to evaluate the role of seizure severity and epileptiform activity index (IEA) assessment in newly-diagnosed idiopathic generalized epilepsy with generalized tonic-clonic awakening seizures (GTCS).Material and methods. The study included 31 patients with newly-diagnosed generalized epilepsy with GTCS aged 14–52 years (mean age 25.06±9.3 years), which were divided into two groups depending on seizure severity: Group 1 (n=9, 29%) with <18 points, and Group 2 (n=22, 71%) with ≥18 points. Seizure severity was analysed by using National Hospital Seizure Severity Scale (NHS3). All patients underwent video-electroencephalography monitoring (8–24 hours) with IEA assessment at baseline and at 1, 3, 6 and 12 months after the beginning of treatment. Therapeutic efficacy was assessed using the criteria of seizure absence (medically induced remission), seizure rate decrease by >50% (responders), seizure rate decrease by <50% (insufficient efficacy), seizure rate increase and retention in treatment.Results. Total EAI at baseline was significantly higher in patients from Group 2 (p=0.019). Despite markedly reduced EAI level in both groups, in Group 1 (less than 18 points by NHS3) EAI was significantly lower compared to Group 2 (≥18 points) at all subsequent visits: visit 2 (p=0.038), visit 3 (p=0.035), visit 4 (p=0.047), and visit 5 (p=0.022).Conclusions. Assessing seizure severity may become an additional objective criterion while evaluating treatment efficacy.

scholarly journals Video-EEG monitoring in diagnostics and treatment efficacy evaluation in newly-diagnosed generalized epilepsy in adults

2021 ◽  
Vol 13 (1) ◽  
pp. 21-32
Author(s):  
A. B. Kozhokaru ◽  
V. A. Karlov ◽  
P. N. Vlasov ◽  
A. S. Orlova
Keyword(s):  
Seizure Frequency ◽  
Treatment Efficacy ◽  
Activity Index ◽  
Epileptiform Activity ◽  
Sleep Cycle ◽  
Cycle Duration ◽  
Eeg Monitoring ◽  
Newly Diagnosed ◽  
Group I ◽  
Generalized Epilepsy

Introduction. Video-electroencephalography (EEG) monitoring (VEEGM) is an indispensable functional method in epileptology. However, virtually no trials on assessing efficacy of antiepileptic drugs (AED) by using VEEGM are available.Objective: to improve efficacy of EEG-diagnostics and evaluate the epileptiform activity index (EAI) in newly-diagnosed idiopathic generalized epilepsy in adult patients receiving  alproic acid and levetiracetam.Material and methods. T here w ere e nrolled 130 p atients: 6 0 (46.2%) m ales a nd 7 0 (53.8%) f emales w ith n ewlydiagnosedidiopathic generalized epilepsy (IGE), aged 22.51±8.9 years. All patients underwent VEEGM with quantitative EAI analysis at baseline visit and 1 3, 6 and 12 months later after treatment. Each seizure episode developed during the VEEGM study were assessed for type, time of seizure onset, relation to wake-sleep cycle, duration, ictal EEG pattern followed by diagnosing epileptic syndrome. Valproic acid and levetiracetam were used for initial therapy in groups per 65 patients in each. Treatment efficacy was assessed using parameters such as retention on therapy, absence of seizures, decrease of seizure frequency by >50%, decrease of seizure frequency by <50% – insufficient efficacy.Results. It was found that seizures during baseline VEEGM were recorded in 43.1% (n=56) patients, who were assigned to group 1, whereas remaining 74 (56.9%) patients were assigned to group 2. EAI was significantly higher in patients with seizures recoded at baseline VEEGM, compared to those lacking seizure episodes during initial VEEGM (p<0,001), mean EAI was also higher in group I at second (p<0.001) and third (p<0.001) visits. EAI magnitude at 6 and 12 months of study became virtually comparable in all groups and did not depend on AED prescribed. Treatment efficacy was higher in patients with IGE, with no  eizures recorded during the initial VEEGM.Conclusion. Long-term VEEGM allows unbiased assessment of treatment dynamics based on EAI analysis. The first 6 months of initial treatment titration in represent most crucial period for patients with newly-diagnosed IGE.

scholarly journals Monotherapy with valproic acid for newly diagnosed epilepsy in adults

2020 ◽  
Vol 4 (9) ◽  
pp. 552-559
Author(s):  
A.B. Kozhokaru ◽  
◽  
A.S. Orlova ◽  
V.I. Shmyrev ◽  
E.S. Akarachkova ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Adverse Events ◽  
Focal Epilepsy ◽  
Activity Index ◽  
Epileptiform Activity ◽  
Total Duration ◽  
Idiopathic Epilepsy ◽  
Seizure Type ◽  
Newly Diagnosed ◽  
Generalized Epilepsy

Background: valproic acid (VA) is a classic, well-proven medication for the epilepsy treatment, but there have not been enough studies to evaluate its effecacy and tolerability in correlation with the epileptiform activity index (EAI) during initial monotherapy. Aim: to evaluate the efficacy and tolerability of monotherapy with VA medications in patients with newly diagnosed epilepsy. Patients and Methods: 63 patients (including 37 (58.7%) men) with focal epilepsy (FE; 24 (38.1%)) and idiopathic (genetic) generalized epilepsy (IGE; 39) over the age of 18 years (average age — 31.49±12.29 years) were included in the single-arm study (61.9%)). All patients at each visit (initially, after 1, 3, 6 and 12 months of therapy) had EEG-video monitoring with an evaluation of EAI (total; before sleep; during sleep; during fragmented awakenings; after sleep). Therapy efficacy was evaluated considering the frequency of seizures: no seizures (medically induced remission); reduced frequency by more than 50% (responders) / less than 50% (lack of effect); therapy retention; increased frequency of seizures relative to the basic level; emergence of a new seizure type (aggravation). Total duration of the study was 12 months. Results: total EAI in patients with IGE before treatment was 2.7 times higher than in patients with FE (37.41 and 13.69, respectively). 1 month after the treatment initiation, it decreased to 4.08 and 2.56 in IGE and FE, respectively (p<0.001), and continued to decrease during the entire follow-up period. Monotherapy retention was achieved in 51 (81%) patients, including 15 (62.5%) with FE and 36 (92.3%) with IGE. Intolerable adverse events developed in only 6 (9.8%) patients. Conclusion: VA is an effective medicine for the initial treatment of FE and IGE in monotherapy. KEYWORDS: idiopathic epilepsy, genetic generalized epilepsy, focal epilepsy, epileptiform activity index, valproic acid, monotherapy, adverse events. FOR CITATION: Kozhokaru A.B., Orlova A.S., Shmyrev V.I. et al. Monotherapy with valproic acid for newly diagnosed epilepsy in adults. Russian Medical Inquiry. 2020;4(9):552–559. DOI: 10.32364/2587-6821-2020-4-9-552-559.

scholarly journals Modern possibilities of antiepileptic therapy at the start of treatment of focal epilepsy

2021 ◽  
Vol 13 (1S) ◽  
pp. 74-78
Author(s):  
P. N. Vlasov
Keyword(s):  
Focal Epilepsy ◽  
Activity Index ◽  
Epileptiform Activity ◽  
Newly Diagnosed ◽  
Antiepileptic Therapy ◽  
Adolescents And Adults

The report presents data on the evaluation of efficacy and tolerability, as well as the dynamics of epileptiform activity index in adolescents and adults with newly diagnosed focal epilepsy during lacosamide therapy.

scholarly journals Pharmacodynamic sodium channel blockers-induced seizure aggravation in patients with newly diagnosed focal epilepsy

2021 ◽  
Vol 13 (4) ◽  
pp. 43-51
Author(s):  
V. A. Karlov ◽  
P. N. Vlasov ◽  
A. M. Azhigova ◽  
A. B. Kozhokaru ◽  
A. S. Orlova
Keyword(s):  
Sodium Channel ◽  
Focal Epilepsy ◽  
Epileptiform Activity ◽  
Clinical Manifestations ◽  
Seizure Type ◽  
Channel Blockers ◽  
Newly Diagnosed ◽  
Sodium Channel Blockers ◽  
Absolute Increase

Pharmacodynamic aggravation (PA) is an unpredictable increase in the frequency, the severity of existing seizures, and/or development of new seizure types despite rational (adequate for seizure type and epilepsy form) antiepileptic drug (AED) prescription. Many mechanisms and predictors of its development are still poorly understood.Objective: to analyze PA of seizures in patients with newly diagnosed focal epilepsy receiving monotherapy with sodium channel blockers with epileptiform activity index (EAI) assessment.Patients and methods. We enrolled 201 patients with newly diagnosed focal epilepsy aged 16—81 years. In twelve months, patients had five follow-up visits. At each visit, treatment tolerability and efficacy were assessed, taking into account changes in the type, severity, and frequency of seizures. Additionally, at each visit, video-electroencephalographic monitoring was performed with EAI assessment. PA of seizures occurred in patients on oxcarbazepine, carbamazepine, and lacosamide therapy.Results and discussion. Five patients with PA of seizures had increased total EAI and EAI before sleep at the second follow-up visit after sodium channel blockers prescription. Electroencephalographic correlates of PA occurred earlier than clinical manifestations. In patients with PA, the absolute increase in EAI was minimal in patients receiving oxcarbazepine, and lacosamide therapy was associated with a minimal relative increase in EAI. At the end of the follow-up, total EAI decreased by 54—80% relative to its initial value in all five patients. The difference in the total index during the first and last visits was statistically significant.Conclusion. Due to the low level of knowledge about PA of seizures, it seems necessary to consider its possibility in all cases of increased frequency, aggravation, or change in the type of seizures after the AED treatment initiation or an increase in its dose. It is also possible to use changes in total EAI and EAI before sleep as an early objective marker of PA in adults with focal epilepsy.

scholarly journals Oxcarbazepine as the initial monotherapy of focal epilepsy in adolescents and adults

2021 ◽  
Vol 13 (3) ◽  
pp. 67-74
Author(s):  
T. N. Pushkar ◽  
A. M. Azhigova ◽  
P. N. Vlasov ◽  
A. B. Kozhokaru
Keyword(s):  
Side Effects ◽  
Treatment Effectiveness ◽  
Focal Epilepsy ◽  
Activity Index ◽  
Retention Rate ◽  
Epileptiform Activity ◽  
Initial Therapy ◽  
Sustained Remission ◽  
Fold Reduction ◽  
Frequency Changes

Oxcarbazepine (OXC) is an antiepileptic drug (AED) used in children and adults as initial and adjunctive therapy for focal epilepsy (FE). It has been used in Russia since 2007; however, only a few studies have been published on its use in Russian patients to date.Objective: to assess the effectiveness and tolerability of OXC as initial therapy for FE in adults and adolescents, as well as to study epileptiform activity index (EAI) changes during treatment and its relationship with treatment effectiveness and tolerability.Patients and methods. We evaluated treatment effectiveness and tolerability and EAI in 89 adults with newly diagnosed FE aged 15–75 years for 12 months. Patients were divided into three subgroups according to the OXC treatment regimen. Side Effects of Anti-Epileptic Drugs (SIDAED) scale was used to assess treatment tolerability. Retention rate and seizure frequency changes were used to evaluate treatment effectiveness. EAI changes were assessed with video electroencephalography monitoring (4–24 h) during each visit (baseline, after 1, 3, 6, and 12 months).Results and discussion. The retention rate in patients on OXC monotherapy after 12 months was 71.9%, almost one-half of them (46.1%) achieved sustained remission. More than half of patients (52.9%) were prescribed 1200 mg/day of OXC, 12.3% – <1200 mg/day, and only in 6.7% of patients the dose exceeded 1200 mg/day. Side effects were observed in 9% of the cases. A 2.54-fold reduction in mean EAI index was observed during follow-up representing treatment effectiveness.Conclusion. OXC, as the initial AED for FE, has demonstrated high treatment effectiveness and tolerability. In addition, total EAI 2.5-fold reduction allows its usage as an additional quantitative marker of OXC treatment effectiveness.

scholarly journals Early Therapeutic Drug Monitoring for Isoniazid and Rifampin among Diabetics with Newly Diagnosed Tuberculosis in Virginia, USA

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Scott K. Heysell ◽  
Jane L. Moore ◽  
Debbie Staley ◽  
Denise Dodge ◽  
Eric R. Houpt
Keyword(s):  
Therapeutic Drug Monitoring ◽  
Drug Monitoring ◽  
Prolonged Treatment ◽  
Therapeutic Drug ◽  
Diabetic Patients ◽  
Newly Diagnosed ◽  
Tb Treatment ◽  
A Value ◽  
Drug Concentrations

Slow responders to tuberculosis (TB) treatment in Virginia have prolonged treatment duration and consume more programmatic resources. Diabetes is an independent risk factor for slow response and low serum anti-TB drug concentrations. Thus, a statewide initiative of early therapeutic drug monitoring (TDM) for isoniazid and rifampin at 2 weeks after TB treatment was piloted for all diabetics with newly diagnosed TB. During the period of early TDM, 12/01/2011–12/31/2012, 21 diabetics hadC2 hrconcentrations performed and 16 (76%) had a value below the expected range for isoniazid, rifampin, or both. Fifteen had follow-up concentrations after dose adjustment and 12 (80%) increased to within the expected range (including all for rifampin). Of 16 diabetic patients with pulmonary TB that had early TDM, 14 (88%) converted their sputum culture to negative in <2 months. Early TDM for diabetics was operationally feasible, may speed response to TB therapy, and can be considered for TB programs with high diabetes prevalence.

Intensified Infliximab Induction is Associated with Improved Response and Decreased Colectomy in Steroid-Refractory Paediatric Ulcerative Colitis

2019 ◽  
Vol 13 (8) ◽  
pp. 982-989 ◽  
Author(s):  
Peter C Church ◽  
Shaun Ho ◽  
Ajay Sharma ◽  
Diane Tomalty ◽  
Karen Frost ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Activity Index ◽  
Mucosal Healing ◽  
Therapeutic Drug ◽  
Physician Global Assessment ◽  
Rates Of Return ◽  
Steroid Dependent ◽  
Dosing Regimens ◽  
Steroid Refractory

Abstract Background Infliximab pharmacokinetics in steroid-refractory [SR] ulcerative colitis [UC] suggest a need for higher dosing, but data concerning efficacy of intensification in this setting are lacking in children and inconsistent overall. Methods Paediatric patients [N = 125] treated with infliximab for SR or steroid-dependent UC were retrospectively reviewed. Outcomes [clinical response and remission, colectomy, mucosal healing, safety] with standard vs intensified induction [mean induction dose ≥7 mg/kg or interval ≤5 weeks between doses 1 and 3] were compared. Results Among 125 patients [median age 14 years, median UC duration 0.7 years, 74 SR], 73 [58%] received standard induction and 52 [42%] received intensified induction. Overall, 73 [58%] achieved remission (judged by physician global assessment [PGA] and paediatric UC activity index [PUCAI]≤10]. Among patients in remission, 7 [10%] experienced secondary loss of response by a median of 0.7 [IQR 0.4–1.0] years. Of the 74 SR patients, 17 [23%] underwent colectomy, and of the 51 steroid-dependent patients, 12 [24%] underwent colectomy. Intensified induction in SR patients was associated with a higher chance of remission (hazard ratio [HR] 3.2, p = 0.02) and a lower chance of colectomy [HR 0.4, p = 0.05], but did not improve outcomes in steroid-dependent patients. During follow-up, 46/73 [63%] patients in remission had regimen individualization, with similar rates of return to standard dosing after 1 year between those with initial intensified or standard induction. Follow-up endoscopy, performed in 35/73 patients in remission, demonstrated mucosal healing for 66%. Adverse events were rare, despite use of intensified regimens. Conclusions These data suggest a benefit from intensified infliximab induction specifically among children with steroid-refractory UC. Prospective studies comparing dosing regimens and incorporating therapeutic drug monitoring should be undertaken.

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