scholarly journals Antiepileptic drugs with nootropic effect is the best choice if you need a comprehensive treatment for comorbid disorders

2021 ◽  
Vol 17 (7) ◽  
pp. 27-35
Author(s):  
Yu.I. Goransky ◽  
V.M. Hertsev ◽  
M.Yu. Serhieieva
Keyword(s):  
Antiepileptic Drugs ◽  
Cognitive Impairments ◽  
Optimal Choice ◽  
Comprehensive Treatment ◽  
Traumatic Injuries ◽  
Beneficial Effects ◽  
Combined Use ◽  
Patients With Epilepsy ◽  
Methods Of Treatment ◽  
Nootropic Effect

The article presents the results of a review devoted to the search for optimal methods of treatment in patients with epilepsy with concomitant cognitive impairments. It has been established that antiepileptic drugs with a nootropic effect are the most optimal choice in terms of compliance with the therapy, as well as reducing the frequency of side effects in the case of monotherapy in comparison with the combined use of nootropics and antiepileptic drugs. Levetiracetam is one of the drugs of choice with proven beneficial effects on cognitive function in patients with epilepsy. Due to high safety profile, it can be recommended for use in elderly patients with epilepsy, including for the termination of status epilepticus, and can also be used in cases of combination of Alzheimer’s disease with epilepsy. A promising direction for further researches is to study the possibilities of using levetiracetam in traumatic injuries of the nervous system.

Comparison of Psychiatric Disorders Between Levetiracetam Combined With Lacosamide and Perampanel

2021 ◽  
Author(s):  
Satoru Matsunuma ◽  
Shigeki Sunaga ◽  
Akira Hoshiai ◽  
Takao Arai ◽  
Hiroyuki Jimbo ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Antiepileptic Drugs ◽  
Medical Records ◽  
Medical Center ◽  
Combined Use ◽  
Number Of Patients ◽  
Significant Difference ◽  
Patients With Epilepsy ◽  
Time To Onset ◽  
Dose Dependent

Abstract Background The number of patients with epilepsy receiving perampanel or lacosamide as an add-on treatment following levetiracetam treatment has increased. Although levetiracetam causes psychiatric disorders, it is unclear whether they occur with the combined use of these antiepileptic drugs.Objective To determine the frequency of psychiatric disorders in patients using lacosamide or perampanel as an add-on therapy to levetiracetam. Setting A single-center retrospective cohort study. Methods Patients who received levetiracetam, lacosamide, and perampanel between April 1, 2014 and April 30, 2019 in Hachioji Medical Center were selected. They were classified into the levetiracetam+lacosamide or levetiracetam+perampanel group. Medical records from the start of combination therapy contained patient background and the incidence of psychiatric disorders. Main outcome measure Onset of psychiatric disorders. Results Forty-four patients used levetiracetam+lacosamide and 50 used levetiracetam+perampanel. The incidence of psychiatric disorders was significantly lower (p = 0.000047) with levetiracetam+lacosamide (6.8%) than with levetiracetam+perampanel (46%). The time to the onset of psychiatric disorders was within 1 month of dose initiation or increase in one case (33.3%) with levetiracetam+lacosamide and 16 cases (76.2%) with levetiracetam+perampanel. The median time to onset was 56 and 6.5 days with levetiracetam+lacosamide and levetiracetam+perampanel, respectively. There was no significant difference in antiepileptic drug dosages owing to the presence or absence of psychiatric disorders. Conclusion As the frequency of psychiatric disorders was higher with levetiracetam+perampanel therapy, levetiracetam+lacosamide may be preferable. These disorders tended to develop within 1 month of therapy and were not dose-dependent. Antiepileptic drugs should be cautiously prescribed to avoid psychiatric disorders.

scholarly journals Models for predicting treatment efficacy of antiepileptic drugs and prognosis of treatment withdrawal in epilepsy patients

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Shijun Yang ◽  
Bin Wang ◽  
Xiong Han
Keyword(s):  
Antiepileptic Drugs ◽  
Statistical Models ◽  
Prediction Models ◽  
External Validation ◽  
Machine Learning Algorithms ◽  
Treatment Withdrawal ◽  
Patient Treatment ◽  
Recent Developments ◽  
Progression Of Disease ◽  
Patients With Epilepsy

AbstractAlthough antiepileptic drugs (AEDs) are the most effective treatment for epilepsy, 30–40% of patients with epilepsy would develop drug-refractory epilepsy. An accurate, preliminary prediction of the efficacy of AEDs has great clinical significance for patient treatment and prognosis. Some studies have developed statistical models and machine-learning algorithms (MLAs) to predict the efficacy of AEDs treatment and the progression of disease after treatment withdrawal, in order to provide assistance for making clinical decisions in the aim of precise, personalized treatment. The field of prediction models with statistical models and MLAs is attracting growing interest and is developing rapidly. What’s more, more and more studies focus on the external validation of the existing model. In this review, we will give a brief overview of recent developments in this discipline.

scholarly journals Synergistic attenuation of ovariectomy-induced bone loss by combined use of fish oil and 17β-oestradiol

2017 ◽  
Vol 117 (4) ◽  
pp. 479-489 ◽  
Author(s):  
Youri Jin ◽  
Myoungsook Lee ◽  
Yongsoon Park
Keyword(s):  
Transcription Factor ◽  
Bone Loss ◽  
Protective Efficacy ◽  
Recovery Period ◽  
Serum Levels ◽  
Protective Mechanism ◽  
Beneficial Effects ◽  
Combined Use ◽  
Related Transcription Factor ◽  
Turnover Markers

AbstractOestrogen and n-3 PUFA, especially EPA and DHA, have been reported to have beneficial effects on bone loss. Thus, the purpose of the present study was to investigate the synergistic bone-protective mechanism of combined treatments of EPA+DHA supplementation and oestrogen injection in ovariectomised rats. Rats were fed a modified American Institute of Nutrition-93G diet with 0 %, 1 % or 2 % n-3 PUFA (EPA+DHA) relative to the total energy intake for 12 weeks. Rats were surgically ovariectomised at week 8, and after a 1-week recovery period rats were injected with either 17β-oestradiol-3-benzoate (E2) or maize oil for the last 3 weeks. Combined use of n-3 PUFA and E2 synergistically increased femoral cortical bone volume, bone mineral content and the bone expression of runt-related transcription factor 2 (RUNX2), but decreased the bone expression of IL-1β. Both n-3 PUFA and E2 decreased the bone expressions of IL-7, TNF-α and PPAR-γ, and increased the bone expression of oestrogen receptor-α. n-3 PUFA in the presence of E2 and E2 alone significantly decreased the bone expressions of IL-1β and IL-6 and increased the bone expression of RUNX2. E2 significantly decreased the serum levels of bone turnover markers and the bone expression of receptor activator of NF-κB ligand, but decreased the bone expression of osteoprotegerin. The combined use of n-3 PUFA and E2 exerted synergistic bone-protective efficacy through up-regulation of RUNX2, an essential transcription factor for bone formation, as well as the suppression of bone-resorbing cytokine IL-1β.

scholarly journals Effect and Safety of Shihogyejitang for Drug Resistant Childhood Epilepsy

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Jinsoo Lee ◽  
Kwanghyun Son ◽  
Gwiseo Hwang ◽  
Moonju Kim
Keyword(s):  
Adverse Events ◽  
Antiepileptic Drugs ◽  
Retention Rate ◽  
Seizure Type ◽  
Drug Resistant ◽  
Exact Test ◽  
Alternative Treatment Option ◽  
Drug Resistant Epilepsy ◽  
Intent To Treat ◽  
Patients With 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.

scholarly journals Cognitive impairments in patients with treatment resistant epilepsy and complex rehabilitation

2021 ◽  
Vol 8 (2) ◽  
pp. 123-129
Author(s):  
Volodymyr Korostiy ◽  
Iryna Blazhina
Keyword(s):  
Quality Of Life ◽  
Cognitive Decline ◽  
Cognitive Training ◽  
Affective Disorders ◽  
Depressive Disorders ◽  
Cognitive Impairments ◽  
Control Group ◽  
Quality Of Life Scale ◽  
Patients With Epilepsy

Background. The study of features of comorbid pathology in patients with epilepsy is of particular interest due to the high prevalence of this pathology and a significant impact on the quality of life of patients and their social adaptation. Aim. The aim of the research was to detect versatile cognitive impairments and affective disorders in epilepsy, and to study the results of cognitive training and psychoeducation. Materials and methods. The theoretical analysis of modern scientific researches in the field of cognitive and affective impairments during epilepsy was carried out. We studied the features of clinical and psychopathological manifestations in patients, suffering from epilepsy. The study covered 146patients (85 men and 61 women) who were in inpatient care. The following psychodiagnostic techniques were used: the MOCA test, the Toronto Cognitive Assessment (TorCA), the MiniMult test, the Münsterberg test, the quality of life scale, the Hamilton scale of depression and anxiety. Results. This publication offers the results of a study of cognitive and affective disorders the quality of life in patients who suffer from epilepsy and the results of online cognitive training and psychoeducation. We found cognitive decline in 88% of patients with epilepsy and improvement of cognitive functions by methods of non-pharmacological correction. Conclusions. Affective and cognitive disorders significantly affects the quality of life of patients, their ability to work and socialization. The conducted research showed that compared to the control group of healthy persons, patients with epilepsy showed improvement in their cognitive decline, anxiety and depressive disorders. Cognitive online training appeared to be effective for the patients with epilepsy.

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.

Withdrawing antiepileptic drugs

1989 ◽  
Vol 27 (8) ◽  
pp. 29-31
Keyword(s):  
Antiepileptic Drugs ◽  
Drug Withdrawal ◽  
Toxic Effects ◽  
Patients With Epilepsy

All antiepileptic drugs can cause toxic effects, especially when taken for long periods, and should therefore be discontinued when no longer needed. About 70% of patients with epilepsy eventually enter a prolonged remission and do not then require drugs. We here discuss when and how to attempt drug withdrawal, and what problems may occur.

KCNQ3 is the principal target of retigabine in CA1 and subicular excitatory neurons

2021 ◽  
Author(s):  
Nissi Varghese ◽  
Anna Lauritano ◽  
Maurizio Taglialatela ◽  
Anastasios Tzingounis
Keyword(s):  
Nervous System ◽  
Potassium Channel ◽  
Neuronal Excitability ◽  
Neuron Activity ◽  
Kcnq Channels ◽  
Beneficial Effects ◽  
Excitatory Neurons ◽  
The Central Nervous System ◽  
Ca1 Pyramidal Neuron ◽  
Patients With Epilepsy

Retigabine is a first-in-class potassium channel opener approved for patients with epilepsy. Unfortunately, several side effects have limited its use in clinical practice, overshadowing its beneficial effects. Multiple studies have shown that retigabine acts by enhancing the activity of members of the voltage-gated KCNQ (Kv7) potassium channel family, particularly the neuronal KCNQ channels KCNQ2-KCNQ5. However, it is currently unknown whether retigabine's action in neurons is mediated by all KCNQ neuronal channels or by only a subset. This knowledge is necessary to elucidate retigabine's mechanism of action in the central nervous system and its adverse effects and to design more effective and selective retigabine analogs. Here, we show that the action of retigabine in excitatory neurons strongly depends on the presence of KCNQ3 channels. Deletion of Kcnq3 severely limited the ability of retigabine to reduce neuronal excitability in mouse CA1 and subiculum excitatory neurons. Additionally, we report that in the absence of KCNQ3 channels, retigabine can enhance CA1 pyramidal neuron activity, leading to a greater number of action potentials and reduced spike frequency adaptation; this finding further supports a key role of KCNQ3 channels in mediating the action of retigabine. Our work provides new insight into the action of retigabine in forebrain neurons, clarifying retigabine's action in the nervous system.

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