Comparison of immunotherapy and prognosis of seizures caused by viral encephalitis and autoimmune encephalitis

2021 ◽  
Author(s):  
Xianjun Zhang ◽  
Yanbing Han ◽  
Xiaojuan Liu ◽  
Wenqiu Yang ◽  
Ting Wang ◽  
...  
Keyword(s):  
Antiepileptic Drugs ◽  
Lower Risk ◽  
Yunnan Province ◽  
Viral Encephalitis ◽  
Autoimmune Encephalitis ◽  
Seizure Outcome ◽  
Acute Encephalitis ◽  
Free Rate

Abstract Background: The immunotherapy that is more effective for seizures caused by viral encephalitis and autoimmune encephalitis and the long-term use of anti-epileptic drugs is not clear. We aimed to compare the immunotherapy and prognosis of seizures caused by viral encephalitis and autoimmune encephalitis.Methods: Clinical data of 121 patients with seizures caused by viral encephalitis and autoimmune encephalitis diagnosed and treated in the two largest tertiary general hospitals in the Yunnan Province were retrospectively collected to compare the immunotherapy used. Dynamic follow-up was performed to observe seizures and the use of antiepileptic drugs.Results: The seizure-free rates at 6 months and 12 months after the onset of viral encephalitis were 77.8% and 80.8%, respectively. In total, 79.1% of autoimmune encephalitis cases were seizure-free at 6 months after onset, and the seizure-free rate at 12 months was 91.9%. A total of 75.0% of viral encephalitis and 67.7% of autoimmune encephalitis patients discontinued antiepileptic drugs and were seizure-free at 12 months after onset. Patients with viral encephalitis treated with glucocorticoids alone had a lower risk of seizures after the acute phase than those treated with glucocorticoids combined with immunoglobulin (P < 0.05). The risk of seizures in patients with autoimmune encephalitis treated with glucocorticoids combined with immunoglobulin was lower than that in patients treated with glucocorticoids and immunoglobulin alone (P < 0.05).Conclusions: Immunotherapy may improve the seizure prognosis of patients with acute encephalitis. The prognosis of seizures due to viral encephalitis may be determined as early as 6 months after onset, while the seizure outcome of autoimmune encephalitis is further improved 12 months after onset.

scholarly journals Long-term risk of primary liver cancers in entecavir versus tenofovir treatment for chronic hepatitis B

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Te-Sheng Chang ◽  
Yao-Hsu Yang ◽  
Wei-Ming Chen ◽  
Chien-Heng Shen ◽  
Shui-Yi Tung ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Lower Risk ◽  
Entire Population ◽  
Liver Cancers ◽  
Cirrhotic Patients ◽  
Registry Database

AbstractIt remains controversial whether entecavir (ETV) and tenofovir disoproxil fumarate (TDF) is associated with different clinical outcomes for chronic hepatitis B (CHB). This study aimed to compare the long-term risk of ETV versus TDF on hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) in CHB patients from a large multi-institutional database in Taiwan. From 2011 to 2018, a total of 21,222 CHB patients receiving ETV or TDF were screened for eligibility. Patients with coinfection, preexisting cancer and less than 6 months of follow-up were excluded. Finally, 7248 patients (5348 and 1900 in the ETV and TDF groups, respectively) were linked to the National Cancer Registry database for the development of HCC or ICC. Propensity score matching (PSM) (2:1) analysis was used to adjust for baseline differences. The HCC incidence between two groups was not different in the entire population (hazard ratio [HR] 0.82; 95% confidence interval [CI] 0.66–1.02, p = 0.078) and in the PSM population (HR 0.83; 95% CI 0.65–1.06, p = 0.129). Among decompensated cirrhotic patients, a lower risk of HCC was observed in TDF group than in ETV group (HR 0.54; 95% CI 0.30–0.98, p = 0.043, PSM model). There were no differences between ETV and TDF groups in the ICC incidence (HR 1.84; 95% CI 0.54–6.29, p = 0.330 in the entire population and HR 1.04; 95% CI 0.31–3.52, p = 0.954 in the PSM population, respectively). In conclusion, treatment with ETV and TDF showed a comparable long-term risk of HCC and ICC in CHB patients.

Long-term effectiveness and safety of antiepileptic drugs in children and adults

2021 ◽  
Vol 19 (2) ◽  
pp. 221-228
Author(s):  
Roza M. Shaimardanova ◽  
Rimma G. Gamirova
Keyword(s):  
Valproic Acid ◽  
Antiepileptic Drugs ◽  
Focal Epilepsy ◽  
City Hospital ◽  
Long Term Follow Up ◽  
Short And Long Term ◽  
Long Term Observation ◽  
Patients With Epilepsy

AIM: To conduct a retrospective comparative analysis of the efficacy and safety of epilepsy therapy with antiepileptic drugs. MATERIALS AND METHODS: The analysis of the treatment of 428 patients with epilepsy at the Childrens City Hospital No. 8 in Kazan, receiving antiepileptic drugs. RESULTS: It was found that valproic acid is more effective in the treatment of idiopathic generalized epilepsies compared to focal epilepsies (p = 0.0006). Valproate and carbamazepine were the most effective in the treatment of focal epilepsy with short- and long-term follow-up. Valproic acid is more effective than topiramate (p = 0.02), oxcarbazepine (p = 0.003), and levetiracetam (p = 0.003) in the treatment of focal epilepsy in short- and long-term follow-up. Carbamazepine is more effective than topiramate (p = 0.01), oxcarbazepine (p = 0.02), and levetiracetam (p = 0.001) in the treatment of focal epilepsy in long-term follow-up. It was revealed that more often they complained about side effects when using carbamazepine (63.2%). Levetiracetam was found to be better tolerated compared to valproate (p = 0.0006) and carbamazepine (p = 0.0006). Topiramate is better tolerated than carbamazepine (p = 0.02) and valproate (p = 0.03). Oxcarbazepine is better tolerated than carbamazepine in women (p = 0.04). CONCLUSIONS: When choosing an antiepileptic drug, it is necessary to be guided by the principle: first the basic, and then the drugs of the next generations, in the future, rely on information about the tolerability of the drug. It is necessary to evaluate the therapeutic effect of antiepileptic drugs with long-term observation, and use the criterion of complete absence of seizures as an indicator of the effectiveness of drugs.

Long-term seizure outcome following surgery for dysembryoplastic neuroepithelial tumor

2006 ◽  
Vol 104 (1) ◽  
pp. 62-69 ◽  
Author(s):  
Chow Huat Chan ◽  
Richard G. Bittar ◽  
Gavin A. Davis ◽  
Renate M. Kalnins ◽  
Gavin C. A. Fabinyi
Keyword(s):  
Outcome Data ◽  
Temporal Lobectomy ◽  
Class I ◽  
Surgical Removal ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Seizure Outcome ◽  
Short Term ◽  
Long Term Follow Up

Object Resection of dysembryoplastic neuroepithelial tumor (DNET) is thought to result in favorable seizure outcome, but long-term follow-up data are scarce. The authors present a review of 18 patients who underwent surgical removal of a DNET: 12 via temporal lobectomy and six via lesionectomy. Methods The mean long-term follow up was 10.8 years (median 10.4 years, range 7.8 to 14.8 years), and results obtained during this time period were compared with previously reported short-term (mean 2.7 years) seizure outcome data. In the current study, 66.7% patients had an Engel Class I outcome and 55.6% had an Engel Class IA outcome compared with 77.8% and 55.6%, respectively. Temporal lobectomy (Engel Class I, 83.3%; Engel Class IA, 66.7%) led to a better seizure outcome than lesionectomy (Engel Classes I and IA, 33.3%). Two patients (11.1%) required repeated operation and both had an incomplete lesionectomy initially. Conclusions Results indicated that complete resection of a DNET leads to a favorable seizure outcome, with epilepsy cure in those who had experienced early postoperative seizure relief. Long-term seizure outcome after surgery is predictable based on the result of short-term follow up.

Long-term seizure outcomes following amygdalohippocampectomy

2003 ◽  
Vol 98 (4) ◽  
pp. 751-763 ◽  
Author(s):  
H. Gregor Wieser ◽  
Marcos Ortega ◽  
Alon Friedman ◽  
Yasuhiro Yonekawa
Keyword(s):  
Mesial Temporal Lobe Epilepsy ◽  
Outcome Data ◽  
University Hospital ◽  
Seizure Outcome ◽  
Content Type ◽  
Selective Amygdalohippocampectomy ◽  
Class 1 ◽  
Fine Print

Object. Analyses of the results of surgery for epilepsy are hindered by inconsistent classifications of seizure outcome, small numbers of patients, and short postoperative follow-up periods. The authors conducted a retrospective study with a reassessment of the long-term seizure outcomes in patients who underwent selective amygdalohippocampectomy (SelAH) for pharmacotherapy—resistant mesial temporal lobe epilepsy (MTLE) at the Zurich University Hospital from 1975 to 1999. Methods. Year-by-year data and the last available data on seizure outcomes were retrospectively assessed for 369 consecutively surgically treated patients who had participated in a follow-up period longer than 1 year as of 1999 and whose outcomes were classified according to the Engel scale and the proposed new International League Against Epilepsy (ILAE) scale. Patients were grouped into nonlesional and lesional MTLE groups depending on whether they harbored a gross anatomical lesion that caused the MTLE. Differentiation was made between curative and palliative operations. Complications related to surgery are reported for 453 patients who underwent SelAH and participated in more than 3 months of follow-up review. The last available outcome data according to the Engel scale were found to be generally similar to those of the new ILAE classification, with 66.9% of patients free from disabling seizures (Engel Class I) compared with 57.1% who were completely seizure and aura free (ILAE Class 1). The last available data on seizure outcome were not significantly different between patients in the lesional and nonlesional MTLE groups. In the lesional group, seizure outcomes were significantly better when patients underwent surgery early in the course of the disease. Overall, 70% of the patients received reductions in their antiepileptic drug treatment at the time of the last available follow-up review. Complications related to the surgical procedures were rare. Conclusions. The authors conclude that SelAH is a safe and effective surgical procedure for MTLE.

Early Pregnancy Risk Among Adolescents With ADHD: A Nationwide Longitudinal Study

2020 ◽  
pp. 108705471990023
Author(s):  
Mao-Hsiu Hua ◽  
Kai-Lin Huang ◽  
Ju-Wei Hsu ◽  
Ya-Mei Bai ◽  
Tung-Ping Su ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Sexual Behaviors ◽  
Lower Risk ◽  
Medication Use ◽  
Risky Sexual Behaviors ◽  
Adhd Medication ◽  
Pregnancy Risk ◽  
Increased Risk

Objective: ADHD potentially leads to risky sexual behaviors, and is considered a major risk factor for early pregnancy (EP). However, the association between ADHD and subsequent EP remains unknown. Method: Seven thousand five hundred five adolescents with ADHD and 30,020 age- and sex-matched individuals without ADHD were enrolled from 2001 to 2009 and were followed until the end of 2011. Adolescents who developed any pregnancy (at age ≤30 years) or EP (at age <20 years) during the follow-up period were identified. Results: Adolescents with ADHD were found to be prone to pregnancy (hazard ratio [HR] = 1.27) and EP (HR = 2.30) compared with those without ADHD. Long-term ADHD medication use was related to a lower risk of subsequent any pregnancy (HR = 0.72) and EP (HR = 0.69). Conclusion: Adolescents with ADHD had an increased risk of any pregnancy and EP compared with their non-ADHD counterparts. Long-term ADHD medication use was associated with a lower subsequent EP risk.

scholarly journals Long-term seizure outcome in patients with status epilepticus due to acute encephalitis

Seizure ◽  
2019 ◽  
Vol 69 ◽  
pp. 70-75
Author(s):  
Xiuxiu Leng ◽  
Fang Yuan ◽  
Jingjing Zhao ◽  
Changgeng Song ◽  
Zhihan Zhao ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Seizure Outcome ◽  
Acute Encephalitis

Long-term outcome of extratemporal epilepsy surgery among 154 adult patients

2008 ◽  
Vol 108 (4) ◽  
pp. 676-686 ◽  
Author(s):  
Alaa Eldin Elsharkawy ◽  
Friedrich Behne ◽  
Falk Oppel ◽  
Heinz Pannek ◽  
Reinhard Schulz ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Cox Regression ◽  
Adult Patients ◽  
Class I ◽  
Seizure Outcome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Factors Associated

Object The goal of this study was to evaluate the long-term outcome of patients who underwent extratemporal epilepsy surgery and to assess preoperative prognostic factors associated with seizure outcome. Methods This retrospective study included 154 consecutive adult patients who underwent epilepsy surgery at Bethel Epilepsy Centre, Bielefeld, Germany between 1991 and 2001. Seizure outcome was categorized based on the modified Engel classification. Survival statistics were calculated using Kaplan–Meier curves, life tables, and Cox regression models to evaluate the risk factors associated with outcomes. Results Sixty-one patients (39.6%) underwent frontal resections, 68 (44.1%) had posterior cortex resections, 15 (9.7%) multilobar resections, 6 (3.9%) parietal resections, and 4 (2.6%) occipital resections. The probability of an Engel Class I outcome for the overall patient group was 55.8% (95% confidence interval [CI] 52–58% at 0.5 years), 54.5% (95% CI 50–58%) at 1 year, and 51.1% (95% CI 48–54%) at 14 years. If a patient was in Class I at 2 years postoperatively, the probability of remaining in Class I for 14 years postoperatively was 88% (95% CI 78–98%). Factors predictive of poor long-term outcome after surgery were previous surgery (p = 0.04), tonic–clonic seizures (p = 0.02), and the presence of an auditory aura (p = 0.03). Factors predictive of good long-term outcome were surgery within 5 years after onset (p = 0.015) and preoperative invasive monitoring (p = 0.002). Conclusions Extratemporal epilepsy surgery is effective according to findings on long-term follow-up. The outcome at the first 2-year follow-up visit is a reliable predictor of long-term Engel Class I postoperative outcome.

Central Neurocytoma

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 407-414 ◽  
Author(s):  
Jin Wook Kim ◽  
Dong Gyu Kim ◽  
In Kyeong Kim ◽  
Yong Hwy Kim ◽  
Seung Hong Choi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Central Neurocytoma ◽  
Tumor Control ◽  
Seizure Outcome

Abstract BACKGROUND: A thorough investigation of the long-term outcomes of central neurocytoma (CN) after different treatments is required to establish optimal management strategies. OBJECTIVE We retrospectively reviewed the long-term clinical outcomes of patients with CN according to various treatments and suggest treatment strategies based on 30 years of experience in a single institution. METHODS: Fifty-eight consecutive patients with CN were treated at our institution between 1982 and 2008. Patient demographics, overall survival, local control rates according to multimodal treatments, and functional outcomes were evaluated. The mean clinical and radiological follow-up periods were 119 months (range, 18-304 months) and 98 months (range, 13-245 months), respectively. RESULTS: The initial treatment modality was classified into 4 subgroups: operation only (34 patients), operation followed by radiation therapy (7 patients) or radiosurgery (7 patients), and radiosurgery alone (10 patients). The actuarial overall survival was 91% at 5 years and 88% at 10 years. The actuarial overall survival and local tumor control rate did not differ significantly according to the various treatments and the initial extent of the surgical resection. However, functional outcomes, such as the postoperative seizure outcome at the last follow-up, differed according to the surgical approach. CONCLUSION: The long-term clinical outcomes of CN after multimodal treatment seem to be excellent. Our study suggests that treatment strategies for CN should focus on the patient's quality of life, as well as on tumor control, because of the benign nature of CN.

scholarly journals Long-term seizure, cognitive, and psychiatric outcome following trans–middle temporal gyrus amygdalohippocampectomy and standard temporal lobectomy

2013 ◽  
Vol 119 (1) ◽  
pp. 16-23 ◽  
Author(s):  
Krzysztof A. Bujarski ◽  
Fuyuki Hirashima ◽  
David W. Roberts ◽  
Barbara C. Jobst ◽  
Karen L. Gilbert ◽  
...  
Keyword(s):  
Temporal Lobectomy ◽  
Middle Temporal Gyrus ◽  
Seizure Outcome ◽  
Middle Temporal ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Psychiatric Outcomes ◽  
Psychiatric Outcome

Object Previous comparisons of standard temporal lobectomy (STL) and selective amygdalohippocampectomy (SelAH) have been limited by inadequate long-term follow-up, variable definitions of favorable outcome, and inadequate consideration of psychiatric comorbidities. Methods The authors performed a retrospective analysis of seizure, cognitive, and psychiatric outcomes in a noncontemporaneous cohort of 69 patients with unilateral refractory temporal lobe epilepsy and MRI evidence of mesial temporal sclerosis after either an STL or an SelAH and examined seizure, cognitive, and psychiatric outcomes. Results The mean duration of follow-up for STL was 9.7 years (range 1–18 years), and for trans–middle temporal gyrus SelAH (mtg-SelAH) it was 6.85 years (range 1–15 years). There was no significant difference in seizure outcome when “favorable” was defined as time to loss of Engel Class I or II status; better seizure outcome was seen in the STL group when “favorable” was defined as time to loss of Engel Class IA status (p = 0.034). Further analysis revealed a higher occurrence of seizures solely during attempted medication withdrawal in the mtg-SelAH group than in the STL group (p = 0.016). The authors found no significant difference in the effect of surgery type on any cognitive and most psychiatric variables. Standard temporal lobectomy was associated with significantly higher scores on assessment of postsurgical paranoia (p = 0.048). Conclusions Overall, few differences in seizure, cognitive, and psychiatric outcome were found between STL and mtg-SelAH on long-term follow-up. Longer exposure to medication side effects after mtg-SelAH may adversely affect quality of life but is unlikely to cause additional functional impairment. In patients with high levels of presurgical psychiatric disease, mtg-SelAH may be the preferred surgery type.

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