scholarly journals Topiramate Effectiveness as Add-on Therapy in Bulgarian Patients with Drug-resistant Epilepsy

Folia Medica ◽  
2020 ◽  
Vol 62 (4) ◽  
pp. 712-722
Author(s):  
Ekaterina Viteva ◽  
Zahari Zahariev
Keyword(s):  
Adverse Events ◽  
Seizure Frequency ◽  
Dynamic Assessment ◽  
University Hospital ◽  
Drug Resistant ◽  
Seizure Severity ◽  
Impaired Awareness ◽  
Eeg Recordings ◽  
Drug Resistant Epilepsy ◽  
Stable Improvement

Introduction: There are no reliable prospective studies on the effectiveness of topiramate in Bulgarian adult patients with drug-resistant epilepsy. Aim: The aim of the study was to conduct an open, prospective study on various aspects of topiramate (TPM) effectiveness in Bulgarian patients with drug-resistant epilepsy.  Patients and methods: The study included patients with epilepsy who attended the Clinic of Neurology at the University Hospital in Plovdiv, Bulgaria. Patients completed diaries for seizure frequency, seizure severity, and adverse events. There were regular documented visits at 3 or 6 months during the first year of TPM treatment and at 6 months afterwards, with a dynamic assessment of seizure fre-quency, severity, adverse events, and EEG recordings.  Results: TPM was used as an add-on treatment in 120 patients (69 males, mean age 37 years). There was a relatively mild and stable dynamic improvement of seizure severity, a satisfactory seizure frequency reduction in 37% of participants, a stable mean seizure fre-quency reduction (47%) from month 6 to month 24 of treatment and a stable responder rate (48-51%) during the same period. New seizure types (focal with impaired awareness with/without evolution to bilateral tonic-clonic seizures) occurred in 5 patients. There were adverse events (dizziness/vertigo, irritability, speech disturbances, memory impairment, concentration problems, tremor, loss of appe-tite and weight, weakness, numbness, bradypsychia, confusion, visual hallucinations, sleepiness, insomnia, headache, itching, unstable gait, nausea, and vomiting) in 20% of patients.  Conclusions: TPM treatment is associated with low and stable improvement of seizure severity, good and stable improvement of sei-zure frequency, possible worsening of seizure control and appearance of new seizure types, good safety and tolerability.

scholarly journals Various Aspects of Tiagabine Effectiveness as Add-on Therapy in Patients with Refractory Epilepsy

Folia Medica ◽  
2020 ◽  
Vol 62 (1) ◽  
pp. 59-64
Author(s):  
Ekaterina Viteva ◽  
Zahari Zahariev
Keyword(s):  
Adverse Events ◽  
Seizure Frequency ◽  
Dynamic Assessment ◽  
University Hospital ◽  
Seizure Severity ◽  
Transient Improvement ◽  
Eeg Recordings ◽  
Drug Resistant Epilepsy ◽  
Loss Of Appetite ◽  
Patients With Epilepsy

The aim of the present study was to investigate various aspects of tiagabine (TGB) effectiveness in Bulgarian patients with drug-resistant epilepsy. This open, prospective study recruited the patients with epilepsy attending the Clinic of Neurology at the University Hospital of Plovdiv, Bulgaria. The patients completed diaries about the seizure frequency, severity, and adverse events. There were regular documented visits at 3 or 6 months during the first year of treatment with TGB and at 6 months or 1 year afterwards, with dynamic assessment of seizure frequency, severity, adverse events, and EEG recordings. TGB was applied as an add-on treatment in 43 patients (24 males, mean age 39 years). There was relatively mild and transient dynamic improvement of seizure severity, satisfactory seizure frequency reduction in 32.6% of participants, stable mean seizure frequency reduction (40-50%) from month 6 to month 24 and a stable response rate (52.3-50%) during the same period. New seizure types (myoclonic, myoclonic-atonic) occurred in 2 patients. The final clinical efficacy was higher in patients with initial monotherapy. There were adverse events (dizziness/vertigo, sedation, memory impairment, loss of appetite and weight, confusion, psychosis, insomnia, transient diplopia, lymphadenomegaly, rash, nausea, depression, anxiety, tremor of hands, unstable gait, legs edema, thrombocytopenia, cervical muscles tightening) in 26.19% of patients. In conclusion, TGB treatment is associated with low and transient improvement of seizure severity, good and stable improvement of seizure frequency, possible worsening of seizure control, possible appearance of new seizure types, and acceptable safety and tolerability.

scholarly journals Levetiracetam effectiveness as add-on therapy in Bulgarian patients with drug-resistant epilepsy

Folia Medica ◽  
2021 ◽  
Vol 63 (2) ◽  
pp. 234-241
Author(s):  
Ekaterina I. Viteva ◽  
Zahari I. Zahariev
Keyword(s):  
Adverse Events ◽  
Seizure Frequency ◽  
Sleep Disturbances ◽  
Dynamic Assessment ◽  
Epileptic Seizures ◽  
University Hospital ◽  
Drug Resistant ◽  
Seizure Severity ◽  
Drug Resistant Epilepsy ◽  
Loss Of Appetite

Introduction: There are no reliable prospective studies on the effectiveness of LEV in Bulgarian adult patients with drug-resistant epilepsy. Aim: The study aimed at conducting an open, prospective study on various aspects of levetiracetam (LEV) effectiveness in Bulgarian patients with drug-resistant epilepsy.  Materials and methods: The study was performed with patients with epilepsy recruited from those attending the Department of Neurology at the University Hospital in Plovdiv, Bulgaria. The patients completed diaries about seizure frequency, severity, and adverse events. There were regular documented visits at 3 or 6 months during the first year of treatment with LEV and at 6 months afterwards, with dynamic assessment of seizure frequency, severity, adverse events, and EEG recordings.  Results: LEV was applied as an add-on therapy in 135 patients (86 males, mean age 35 years). There was a relatively mild and persisting dynamic improvement of seizure severity, a satisfactory seizure frequency reduction in 49.6% of participants, a persisting mean seizure frequency reduction (48-58%) from 6 to 36 months of treatment and a high responder rate (53-60%) during the same period. New seizure types (focal with impaired awareness with /without evolution to bilateral tonic-clonic seizures) occurred in 4 patients. There were adverse events (dizziness, memory impairment, aggressiveness, numbness, non-epileptic seizures, depression, anxiety, speech disturbances, visual hallucinations, sleepiness, pelvic muscles weakness, confusion, sleep disturbances, loss of appetite, unstable gait, hair loss, acne, generalized rash) in 13.33% of patients. Conclusions: LEV treatment is associated with: low and persisting improvement of seizure severity, a good and persisting improvement of seizure frequency, a possible worsening of seizure control, a possible appearance of new seizure types, a good safety and tolerability.

Vagus nerve stimulation for drug-resistant epilepsy

2019 ◽  
Vol 20 (3) ◽  
pp. 189-198 ◽  
Author(s):  
Laura Pérez-Carbonell ◽  
Howard Faulkner ◽  
Sean Higgins ◽  
Michalis Koutroumanidis ◽  
Guy Leschziner
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Therapeutic Option ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
Randomised Controlled

Vagus nerve stimulation (VNS) is a neuromodulatory therapeutic option for drug-resistant epilepsy. In randomised controlled trials, VNS implantation has resulted in over 50% reduction in seizure frequency in 26%–40% of patients within 1 year. Long-term uncontrolled studies suggest better responses to VNS over time; however, the assessment of other potential predictive factors has led to contradictory results. Although initially designed for managing focal seizures, its use has been extended to other forms of drug-resistant epilepsy. In this review, we discuss the evidence supporting the use of VNS, its impact on seizure frequency and quality of life, and common adverse effects of this therapy. We also include practical guidance for the approach to and the management of patients with VNS in situ.

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 Seizure frequency and social outcome in drug resistant epilepsy patients who do not undergo epilepsy surgery

Seizure ◽  
2011 ◽  
Vol 20 (7) ◽  
pp. 580-582 ◽  
Author(s):  
Mar Carreño ◽  
Juan Luis Becerra ◽  
Joaquín Castillo ◽  
Iratxe Maestro ◽  
Antonio Donaire ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Epilepsy Surgery ◽  
Drug Resistant ◽  
Social Outcome ◽  
Drug Resistant Epilepsy

Efficacy and tolerability of clobazam in adults with drug-refractory epilepsy

2020 ◽  
pp. 10.1212/CPJ.0000000000000992
Author(s):  
Alisha Jamil ◽  
Noah Levinson ◽  
Michael Gelfand ◽  
Chloe E. Hill ◽  
Pouya Khankhanian ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Seizure Frequency ◽  
Retrospective Chart Review ◽  
Adjunctive Treatment ◽  
Drug Resistant ◽  
Before And After ◽  
Initial Cohort ◽  
Epilepsy Classification ◽  
Drug Resistant Epilepsy

ObjectivesTo evaluate the effectiveness and tolerability of clobazam as an adjunctive treatment for adults with drug-resistant epilepsy.MethodsWe performed a single-center, retrospective chart review of patients ≥18 years of age with drug-resistant epilepsy who started clobazam between 2010 and 2018. Included patients had outpatient visits both before and ≥1 month after clobazam initiation. Epilepsy classification, seizure frequency before and after clobazam, duration of clobazam treatment, and adverse effects were analyzed.ResultsA total of 417 patients met inclusion criteria. Mean age was 37.5 years, and 54% of patients were female. Patients were on a mean of 2.4 antiepileptic drugs at time of initiation of clobazam. Epilepsy types were focal (56.8%), Lennox-Gastaut syndrome (LGS) (21.1%), generalized (15.1%), and unclassified (7.0%). At the first follow-up visit ≥1 month after clobazam initiation, 50.3% of patients had >50% reduction in seizure frequency, and 20.5% were seizure-free. Of the initial cohort, 17.1% were followed >1 year and were seizure-free at last follow-up. Response rates did not differ between different epilepsy classifications. Fifty-one percent of patients experienced ≥1 side effect, most commonly lethargy/fatigue (30.7%) or mood changes (10.8%). A total of 178 (42.6%) patients discontinued clobazam, most commonly due to adverse effects (55%).ConclusionsClobazam is effective and safe as a long-term adjunctive therapy for adults with drug-resistant epilepsy; efficacy in off-label use is similar to that in LGS.Classification of evidenceThis study provides Class IV evidence that clobazam is an effective treatment for adults with drug-resistant epilepsy, independent of epilepsy classification.

scholarly journals Serum level of C-reactive protein and interleukin-6 in children with drug-resistant epilepsy

2018 ◽  
Vol 16 ◽  
pp. 205873921880816 ◽  
Author(s):  
Mohamed M Elwan ◽  
Nirmeen A Kishk ◽  
Rasha A El-Kapany ◽  
Ibrahim E Al-Ahmer ◽  
Ahmed Elkady
Keyword(s):  
Seizure Frequency ◽  
Interleukin 6 ◽  
Age Of Onset ◽  
Serum Levels ◽  
Control Group ◽  
Drug Resistant ◽  
C Reactive Protein ◽  
Mri Findings ◽  
Reactive Protein ◽  
Drug Resistant Epilepsy

There is increasing evidence that chronic inflammation affects the pathophysiology of epilepsy, especially the drug-resistant type. Drug-resistant epilepsy is a challenging condition, because of the difficulties in its management, and its unclear epileptogenesis. This study is looking at C-reactive protein (CRP) and interleukin-6 (IL-6) levels in those with drug-resistant epilepsy and the correlation of these levels with seizure frequency. Hence, 40 children with drug-resistant epilepsy were included in this study and compared with 20 healthy volunteers (as a control group). Participants were aged between 5 and 15 years. Patients were divided into two subgroups, those with daily seizures (Group A1) and those with monthly seizures (Group A2). Serum levels of CRP and IL-6 were measured in all participants. The clinical characteristics, electroencephalography, and magnetic resonance imaging (MRI) findings were then compared. CRP levels were significantly higher in Group A1, at 21.88–93.29 mg/L than both Group A2 and the control group, at 3.02–40.37 mg/L and 2.23–13.18 mg/L, P < 0.01 and P < 0.001, respectively. The IL-6 levels were also significantly higher in Group A1, at 153.60–597.80 ng/L than in both Group A2 and the control group, at 97.40–232.50 ng/L and 12.00–96.30 ng/L, P < 0.01 and P < 0.001, respectively. Significantly higher levels of CRP and IL-6 were associated with earlier age of onset ( P < 0.01), seizure frequency ( P < 0.05), and the frequency of status epilepticus ( P < 0.01). Moreover, frequent-generalized motor seizures are correlated with elevated CRP and IL-6 levels. As a result, this systemic inflammatory reaction in children may contribute to drug-resistant seizure and potentially could be used as biomarkers to be correlated with disease severity and prognosis.

scholarly journals Seizure frequency reduction after posteromedial hypothalamus deep brain stimulation in drug-resistant epilepsy associated with intractable aggressive behavior

Epilepsia ◽  
2015 ◽  
Vol 56 (7) ◽  
pp. 1152-1161 ◽  
Author(s):  
Juan C. Benedetti-Isaac ◽  
Martin Torres-Zambrano ◽  
Andres Vargas-Toscano ◽  
Esther Perea-Castro ◽  
Gabriel Alcalá-Cerra ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Aggressive Behavior ◽  
Seizure Frequency ◽  
Brain Stimulation ◽  
Drug Resistant ◽  
Drug Resistant Epilepsy ◽  
Deep Brain

scholarly journals Pilot Safety and Feasibility Study of Non-invasive Limb Proprioceptive Cerebellar Stimulation for Epilepsy

2021 ◽  
Vol 12 ◽  
Author(s):  
Ronald M. Harper ◽  
Dieter Hertling ◽  
Ashley Curtis ◽  
Eberhardt K. Sauerland ◽  
Christopher M. De Giorgio
Keyword(s):  
Feasibility Study ◽  
Seizure Frequency ◽  
Control Period ◽  
Drug Resistant ◽  
Vibratory Stimulation ◽  
Treatment Control ◽  
Non Invasive ◽  
Pre Treatment ◽  
Drug Resistant Epilepsy ◽  
Cerebellar Stimulation

Cerebellar stimulation reduces seizures in animals and in humans with drug-resistant epilepsy. In a pilot safety and feasibility study, we applied continuous cutaneous vibratory stimulation (limb proprioceptive cerebellar stimulation) to foot limb proprioceptive receptors to activate cerebellar, pontine, and thalamic structures in drug-resistant epilepsy patients for 8-h nocturnally up to 6-months after a 4-week pre-treatment control baseline. Seizure frequency was evaluated during the baseline control period, and at 6, 12, and 24 weeks after the control recordings. Five-subjects completed at least the first 6-week treatment. At 12-weeks, the median reduction in seizure frequency was −27.8% (mean reduction = −22.3%). Two subjects continued for 24 weeks, with a decline of −44.1 and −45.4%. This pilot study provides support for further clinical studies into the safety and efficacy of limb proprioceptive cerebellar stimulation for epilepsy.

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