scholarly journals Atrophy in the Left Amygdala Predicted Drug Responses in Idiopathic Generalized Epilepsy Patients With Tonic–Clonic Seizures

2021 ◽  
Vol 15 ◽  
Author(s):  
Xin Li ◽  
Zhongyuan Wang ◽  
Qian Chen ◽  
Xiaoyun Wang ◽  
Zhao Qing ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Shape Analysis ◽  
Imaging Biomarkers ◽  
Support Vector ◽  
Subcortical Structures ◽  
Idiopathic Generalized Epilepsy ◽  
Drug Responses ◽  
Clonic Seizures ◽  
Generalized Epilepsy

We aimed to determine the alterations in the subcortical structures of patients with idiopathic generalized epilepsy with tonic–clonic seizures (IGE-GTCS) via MRI volumetry and vertex-based shape analysis and to evaluate the relationships between MRI measures and drug responses. In a follow-up sample of 48 patients with IGE-GTCS and 48 matched normal controls (NCs), high-resolution 3D T1WI was performed at baseline. After 1 year of follow-up, 31 patients were classified as seizure free (SF) and 17 as drug resistant (DR). The volumes of subcortical structures were extracted, and vertex-based shape analysis was performed using FSL-Integrated Registration and Segmentation Toolbox (FSL-FIRST). Comparisons among groups were calculated adjusting for covariates [age, sex, and intracranial volume (ICV)]. Analysis of the relationships among imaging biomarkers along with frequency and duration was assessed using partial correlations. The differential imaging indicators were used as features in a linear support vector machine (LSVM). The DR group displayed significant regional atrophy in the volume of the left amygdala compared with NCs (p = 0.004, false discovery rate corrected) and SF patients (p = 0.029, uncorrected). Meanwhile, vertex-based shape analysis showed focal inward deformation in the basolateral subregion of the left amygdala in DR compared with the results for SF and NC (p < 0.05, FWE corrected). There were significant correlations between the volume changes and seizure frequency (r = −0.324, p = 0.030) and between shape (r = −0.438, p = 0.003) changes and seizure frequency. Moreover, the volume of the left thalamus in the DR group was significantly correlated with seizure frequency (r = −0.689, p = 0.006). The SVM results revealed areas under the receiver operating characteristic curve of 0.82, 0.68, and 0.88 for the classification between SF and DR, between SF and NC, and between DR and NC, respectively. This study indicates the presence of focal atrophy in the basolateral region of the left amygdala in patients with IGE drug resistance; this finding may help predict drug responses and suggests a potential therapeutic target.

scholarly journals Children with idiopathic generalized epilepsy those underwent at least two years seizure remission: a retrospective analysis

2021 ◽  
Vol 8 (9) ◽  
pp. 1508
Author(s):  
Chandan Raybarman
Keyword(s):  
Antiepileptic Drugs ◽  
Idiopathic Generalized Epilepsy ◽  
Care Clinic ◽  
Female Ratio ◽  
Titration Phase ◽  
Male Female Ratio ◽  
Clonic Seizures ◽  
Generalized Epilepsy ◽  
Initial Target

Background: The aim of the retrospective study was to evaluate the effectiveness of the index antiepileptic drugs in children with idiopathic generalized epilepsy who underwent at least 2 years remission.Methods: A total of 52 children with idiopathic generalized epilepsy who underwent at least 2 years remission were identified retrospectively from the records of the paediatric and neurology care clinic from April 2017 to December 2020.Results: The seizure patterns of 52 cases were tonic-clonic seizures alone (73%), a combination of tonic-clonic seizures and absences (13.5%), and combined tonic-clonic seizures and myoclonus (13.5%).  The total number of seizures at enrolment in all (age at seizure onset 7.44±5.12 years, male-female ratio (31:21) was 651 (mean 12.52±26.60). The total number of follow-up visits in all was 6.62±14.44 consisting of 1177.5±772.86 days of follow-up periods. All patients continued index antiepileptic drugs with initial target doses varies from low to moderate ranges. Add-on therapy was initiated in 43% of cases around the titration phase of index antiepileptic drugs (i.e. very early add-on). Treatment trends reveal increased use of 1st generation antiepileptic drugs than 2nd and 3rd generation. 2 years seizure remission rates were 55.77% by index antiepileptic drugs only therapy and 44.23% by very early add-on therapy.  The seizure remission period was mean±SD 858.71±209.08 days.Conclusions: Index antiepileptic drugs with low to moderate initial target doses lead to achieving 2 years or more seizure remission. Very early add-on therapy is the novelty and leads to achieving the goal.

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.

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.

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.

scholarly journals Efficacy of Vagal Nerve Stimulation for Drug-Resistant Epilepsy: Is it the Stimulation or Medication?

2017 ◽  
Vol 44 (5) ◽  
pp. 532-537 ◽  
Author(s):  
Jaylynn Arcand ◽  
Karen Waterhouse ◽  
Lizbeth Hernandez-Ronquillo ◽  
Aleksander Vitali ◽  
Jose F. Tellez-Zenteno
Keyword(s):  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Drug Resistant ◽  
Idiopathic Generalized Epilepsy ◽  
Drug Resistant Epilepsy ◽  
Generalized Epilepsy ◽  
Patients With Epilepsy ◽  
Seizure Classification

AbstractBackground: Vagus nerve stimulation (VNS) therapy has been widely recognized as an alternative for the treatment of drug-resistant epilepsy, although modification of antiepileptic drugs (AEDs) during VNS treatment could explain the improvement in patients. Methods: We retrospectively assessed the efficacy of VNS in 30 adult patients with epilepsy treated with >6 months of follow-up. The criteria for implantation were the following: (1) not a candidate for resective epilepsy surgery, (2) drug-resistant epilepsy, (3) impairment of quality of life, (4) no other option of treatment, and (5) patients with idiopathic generalized epilepsy who fail to be controlled with appropriate AEDs. We assessed sociodemographics, seizure etiology, seizure classification, and AEDs used during treatment with VNS. We assessed adverse effects and efficacy. Responder rate was defined as >50% seizure improvement from baseline. Results: Thirty patients (females, 18; males, 12; age, 35.1±13.3 years) were included. After 6, 12, 24, and 36 months of follow-up, the response rates were: 13/30 (43%), 13/27 (48%), 9/22 (41%), and 8/16 (50%), respectively; none was seizure free. Fifty-seven percent, 33%, 59%, and 81% of patients had changes of medication type or dose at 6, 12, 24, and 36 months respectively. In the majority of patients, the change of medication consisted of an increase in the dose of AEDs. Conclusions: Our study shows that VNS is an effective therapy, although significant changes in medications were done along with the therapy; therefore, the real effect of VNS could be controversial.

Lack of Evidence for Association Between D2S124 and D2S111 Polymorphisms of the SCN2A Gene and Idiopathic Generalized Epilepsy With Generalized Tonic—Clonic Seizures

2007 ◽  
Vol 22 (7) ◽  
pp. 907-910 ◽  
Author(s):  
Anna Volzone ◽  
Renata Rizzo ◽  
Antonella Gagliano ◽  
Mariella Palmarino ◽  
Paola Lucarelli ◽  
...  
Keyword(s):  
Idiopathic Generalized Epilepsy ◽  
Clonic Seizures ◽  
Generalized Epilepsy
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