Comparative Efficacy of Levetiracetam for Epilepsy in School-Aged Children with Intellectual Disability and Normal Intelligence

Choosing optimal anti-seizure medication (ASM) is very important in pediatric patients with epilepsy who attend school, especially children with an intellectual disability (ID). Levetiracetam (LEV) has proven to be an effective, safe, generally well-tolerated, broad-spectrum ASM in children. In the context of increasing use of LEV in school-aged children with epilepsy and ID, we evaluate relevant clinical data, including efficacy, safety, and tolerability in children with epilepsy and an intellectual disability (ID) or normal intelligence (NI). We performed a retrospective chart review of children and included 298 pediatric patients with epilepsy who were treated with LEV with NI (147) and ID (151). After 6 months, 96% of NI and 83% of ID subjects had a seizure reduction rate greater than 50% (p = 0.031). The tolerability of LEV was generally good, with 75% retention rates at 2 years in both groups and only minor side effects (under 15%). The retention rates of patients with NI and ID were 76% and 74%, respectively (p = 0.597). Thus, LEV showed considerable efficacy with minimal side effects and high retention rates and is an easily maintained and safe treatment option for pediatric epilepsy with ID. However, better-designed research studies are needed to clearly elucidate the efficacy and safety of LEV in children with epilepsy and ID.

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PROVE—Phase IV Study of Perampanel in Real-World Clinical Care of Patients with Epilepsy: Interim Analysis in Pediatric Patients

Journal of Child Neurology ◽

10.1177/08830738211047665 ◽

2022 ◽

pp. 088307382110476

Author(s):

Eric Segal ◽

Katherine Moretz ◽

James Wheless ◽

Patricia Penovich ◽

Marcelo Lancman ◽

...

Keyword(s):

Medical Records ◽

Interim Analysis ◽

Pediatric Patients ◽

Clinical Care ◽

Retention Rates ◽

Routine Clinical Care ◽

Adolescent Patients ◽

Patients With Epilepsy ◽

Oral Doses ◽

Phase Iv

PROVE is a retrospective, phase IV study assessing retention, dosing, efficacy, and safety of perampanel when administered to patients during routine clinical care. We report an interim analysis of preadolescent (1 to <12 years) and adolescent (12 to <18 years) patients. Data were obtained from medical records of patients with epilepsy initiating perampanel after January 1, 2014; cut-off date for this analysis was October 10, 2018. Overall, 151 preadolescent and 183 adolescent patients were included. Retention rates following 24 months on perampanel were 42.5% (preadolescent subgroup; n = 31/73) and 55.7% (adolescent subgroup; n = 54/97). Treatment-emergent adverse events occurred in 53 (35.1%) preadolescent (most common: aggression, irritability, and somnolence) and 78 (42.6%) adolescent patients (most common: somnolence, aggression, and dizziness). These data indicate that daily oral doses of perampanel are generally well tolerated during routine clinical care, with favorable retention rates for ≤2 years, in patients aged 1 to <18 years.

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Multimodality Language Mapping Using Cortical Stimulation in Paediatric Patients With Epilepsy

Neurosurgery ◽

10.1093/neuros/nyz310_652 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Sneha Sharma ◽

Carrie R Muh ◽

Sandra Serafini ◽

Naomi D Chou ◽

Tracy G Spears ◽

...

Keyword(s):

Temporal Lobe ◽

Pediatric Patients ◽

Cortical Stimulation ◽

Epileptic Focus ◽

Pediatric Epilepsy ◽

Minimal Risk ◽

Language Mapping ◽

Anterior Temporal Lobe ◽

Exact Test ◽

Patients With Epilepsy

Abstract INTRODUCTION Pediatric patients with epilepsy often undergo language mapping using electrical cortical stimulation. Previous studies have shown general localization of auditory naming in the anterior temporal lobe and visual naming in the posterior parietal and temporal lobe. No probabilistic map exists, however, that quantifiably details the location of the different language modalities for pediatric patients with epilepsy. METHODS A series of 41 consecutive pediatric patients underwent cortical language mapping (24 female; range 5.2-18.5 yr; mean age 13.8 yr), either extraoperative (n = 34) or intraoperative (n = 7), prior to epileptic focus resection. The exact location of where an error occurred was recorded and transposed on a cortical parcellation system. Statistical analysis used a binomial one sided exact test with a cut off set at 60%. RESULTS Results show an increased range of sites for both visual and auditory naming as compared to adults. Cortical stimulation language testing was conducted 2102 times; 1201 visual and 901 auditory. Visual naming sites extended into the anterior temporal lobe. Auditory naming sites extended from the anterior temporal lobe to the middle temporal and posterior temporal gyrus. CONCLUSION The anterior temporal lobe is a commonly resected region, often felt to be of minimal risk. Knowledge of how these 2 language modalities extend into the temporal lobe in addition to how they differ from adults provides insight into which areas are safe to resect and which areas to spare during pediatric epilepsy surgery.

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Advances in the Treatment of Drug-Resistant Pediatric Epilepsy

Seminars in Neurology ◽

10.1055/s-0040-1702941 ◽

2020 ◽

Vol 40 (02) ◽

pp. 257-262

Author(s):

Ernesto Gonzalez-Giraldo ◽

Joseph E. Sullivan

Keyword(s):

Pediatric Patients ◽

Pediatric Epilepsy ◽

Drug Resistant ◽

Significant Morbidity ◽

Treatment Resistant ◽

Childhood Onset ◽

Number Of Patients ◽

Patients With Epilepsy ◽

The U.S ◽

Deep Brain

AbstractEpilepsy is a common disorder in children and adults that causes significant morbidity and affects many aspects of a patient's lives. Two-thirds of patients with epilepsy are controlled with established antiseizure medications, leaving a significant number of patients searching for other options. The purpose of this review is to provide an overview of recent advancements in the management of treatment-resistant epilepsy in pediatric patients. Recent publications have shown the efficacy of new pharmaceutical options such as fenfluramine and cannabidiol, some of which have been tested specifically in patients with childhood-onset epilepsy syndromes such as Dravet's syndrome and Lennox–Gastaut's syndrome. Furthermore, recent approval by the U.S. Food and Drug Administration of stiripentol has made available a previously difficult-to-obtain option for patients with Dravet's syndrome. Finally, implanted responsive neurostimulation devices for direct cortical stimulation and deep brain stimulation have shown efficacy in adult patients and may represent a thrilling new horizon for pediatric patients.

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Effectiveness of Levetiracetam Monotherapy in Pediatric Patients With Epilepsy

Journal of Child Neurology ◽

10.1177/0883073819846804 ◽

2019 ◽

Vol 34 (10) ◽

pp. 593-597 ◽

Cited By ~ 2

Author(s):

Rafal D. Mazur ◽

Qianyu Wang, BA ◽

Kenneth Kato, BS ◽

Richard Buchsbaum, BS ◽

Jennifer Bonito, BS ◽

...

Keyword(s):

Adverse Effects ◽

Adverse Events ◽

Prospective Studies ◽

Pediatric Patients ◽

Retention Rate ◽

Retention Rates ◽

Seizure Freedom ◽

Entire Cohort ◽

Number Of Patients ◽

Patients With Epilepsy

The main objective of this study was to assess the efficacy, safety, and retention rates of levetiracetam monotherapy in children with epilepsy. A retrospective review of pediatric patients receiving levetiracetam monotherapy at 2 large tertiary epilepsy centers over an 11-year period was conducted. One hundred two patients using levetiracetam monotherapy with a mean age of 13.1 years were identified. For the entire cohort, a 6-month retention rate was 61.1% and a 12-month retention rate 53.1%. With regard to seizure freedom, 46.8% of those patients that remained on monotherapy for at least 6 months became seizure free. Twelve-month seizure freedom was reached by 41.2%. About one-third (32.4%) of patients reported adverse effects, with irritability, moodiness, and depression being the most common. Despite a number of patients that reported adverse events, levetiracetam monotherapy was found to be potentially effective in this cohort of children with epilepsy and warrants further, prospective studies.

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Genetic Diagnoses in Pediatric Patients with Epilepsy and Comorbid Intellectual Disability

Epilepsy Research ◽

10.1016/j.eplepsyres.2021.106552 ◽

2021 ◽

pp. 106552

Author(s):

Mei Yang ◽

Bocheng Xu ◽

Jiamin Wang ◽

Zhu Zhang ◽

Hanbing Xie ◽

...

Keyword(s):

Intellectual Disability ◽

Pediatric Patients ◽

Patients With Epilepsy

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Sleep and epilepsy—chicken or egg?

10.1093/oso/9780198778240.003.0011 ◽

2018 ◽

Author(s):

Dora A. Lozsadi

Keyword(s):

Side Effects ◽

Sleep Disorders ◽

Learning Disability ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Seizure Control ◽

Subjective Sleep ◽

Neurological Conditions ◽

The Uk ◽

Patients With Epilepsy

Epilepsy is the commonest serious chronic neurological condition, affecting 0.5% of the population in the UK. Subjective sleep disturbance and excessive daytime sleepiness are reported to be 50% more frequent in those with epilepsy than in controls. Causes are multiple. Both poor seizure control and nocturnal attacks are known to contribute to such sleep disorders. Epilepsy also increases the risk of associated sleep disorders, and additional neurological conditions, such as dementia, learning disability, and depression. These all affect sleep hygiene. Prescribed anti-epileptic drugs will further aggravate the problem. Side-effects will include drowsiness. Sedating benzodiazepines and barbiturates are considered worst offenders. Others affect sleep architecture to varying degrees and/or cause insomnia. While hyper-somnolence in patients with epilepsy will raise the possibility of any of the above issues, sleep deprivation is one of the commonest seizure triggers. This chapter will shed more light on the intricate relationship between sleep and epilepsy.

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Mutations in the Na+/Citrate Cotransporter NaCT (SLC13A5) in Pediatric Patients with Epilepsy and Developmental Delay

Molecular Medicine ◽

10.2119/molmed.2016.00077 ◽

2016 ◽

Vol 22 (1) ◽

pp. 310-321 ◽

Cited By ~ 21

Author(s):

Jenna Klotz ◽

Brenda E Porter ◽

Claire Colas ◽

Avner Schlessinger ◽

Ana M Pajor

Keyword(s):

Developmental Delay ◽

Pediatric Patients ◽

Patients With Epilepsy

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0897 Sleep Disordered Breathing In Pediatric Patients With Turner Syndrome

SLEEP ◽

10.1093/sleep/zsaa056.893 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A341-A342

Author(s):

Y A Yu ◽

B V Vaughn

Keyword(s):

Sleep Apnea ◽

Turner Syndrome ◽

Sleep Disordered Breathing ◽

Pediatric Patients ◽

Genetic Disorder ◽

Case Series ◽

Growth Failure ◽

Retrospective Chart Review ◽

Upper Airway Resistance Syndrome ◽

Disordered Breathing

Abstract Introduction Turner syndrome (TS) is a common genetic disorder that affects phenotypic females with partial or complete absence of one X chromosome. It typically presents with characteristic facial appearance, neck webbing, lymphedema, linear growth failure, and ovarian insufficiency. TS is also associated with other disorders, though sleep related disorders are not commonly reported. We present a case series of pediatric patients diagnosed with TS and assess their risk for sleep disordered breathing. Methods This study utilized retrospective chart review of the electronic medical record at the University of North Carolina at Chapel Hill from April 2014 to January 2019. Only pediatric patients under the age of 18 years who had previously undergone polysomnography and carrying the diagnosis of Turner syndrome were included in this study. Polysomnography results were reviewed. Results Retrospective chart analysis yielded ten (10) patients who qualified for inclusion. The mean age was 8.3 years (age range 1-15 years). Nine (9) patients were found to have sleep disordered breathing ranging from upper airway resistance syndrome to moderate sleep apnea (AHI range 1.2 to 6.2). Six (6) patients were found to have elevated periodic limb movement indices (PLM index range 5.1 to 30). Parasomnias and hypoventilation were not seen. Conclusion Our case series illustrates that sleep disordered breathing may be more common in TS than previously realized. Eklund et al. found that females with TS had more retrognathic mandibles and maxillas, shorter mandibles, and larger cranial base angles. These findings may indicate elevated risk of sleep apnea. Further studies are needed to define the overall risk of sleep disordered breathing in TS. Support None.

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