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Update on treatment of partial onset epilepsy: role of eslicarbazepine  [cached]
Markus Rauchenzauner,Gerhard Luef
Neuropsychiatric Disease and Treatment , 2010,
Abstract: Markus Rauchenzauner1,2, Gerhard Luef31Department of Pediatrics IV, Medical University Innsbruck, Austria; 2Neuropediatric Department, Sch n Klinik Vogtareuth, Vogtareuth, Germany; 3Department of Neurology, Medical University Innsbruck, AustriaAbstract: Partial epilepsy comprises simple partial seizures, complex partial seizures, and secondarily generalized seizures, and covers more than 60% of patients with epilepsy. Antiepileptic drugs are generally considered to be the major therapeutic intervention for epilepsy but, despite a broad range of commonly used antiepileptic drugs, approximately 30% of adult patients and approximately 25% of children with epilepsy have inadequate seizure control. Eslicarbazepine acetate (ESL) is a novel voltage-gated sodium channel-blocking agent with presumed good safety and efficacy for adjunctive treatment of patients with drug-resistant partial epilepsy. ESL is a prodrug of eslicarbazepine (the active entity responsible for pharmacologic effects), and is rapidly and extensively hydrolyzed during first pass by liver esterases after oral administration. The half-life of eslicarbazepine at steady-state plasma concentrations is 20–24 hours, compatible with once-daily administration. ESL 800 mg and 1200 mg significantly reduces seizure frequency and shows a favorable safety profile in adult patients with drug-resistant partial-onset seizures, as demonstrated in previous Phase II and III trials. In children, ESL showed a clear dose-dependent decrease in seizure frequency with good tolerability. The most commonly reported adverse events associated with ESL are dizziness, somnolence, nausea, diplopia, headache, vomiting, blurred vision, vertigo, and fatigue. In conclusion, these characteristics suggest that ESL might be a valid and well tolerated treatment option for patients with drug-resistant partial-onset epilepsy. The convenience of once-daily dosing and a short, simple titration regimen would be of special interest for children, although conclusive published data are lacking to date. Hence, there is an urgent need to establish the therapeutic value of ESL in this special population in the near future.Keywords: eslicarbazepine, partial epilepsy, drug-resistant, antiepileptic drugs
Adult-onset epilepsy and history of childhood febrile seizures: A retrospective study  [cached]
Mohebbi Mohammad,Navipour Reza,SeyedKazemi Mojdeh,Zamanian Hadi
Neurology India , 2004,
Abstract: BACKGROUND: Children with febrile seizures (FS) are at higher risk of developing epilepsy. There is robust literature on epilepsy with onset in childhood following FS but very little on the same issue in adults. AIMS: We intended to assess the association between adult-onset epilepsy and history of childhood FS. SETTINGS: The neurology clinic of a university hospital. DESIGN: A retrospective study. MATERIALS AND METHODS: Records of 101 consecutive adults (>14 years old) who were referred to our hospital with adult-onset seizures were reviewed and the patients and their families were interviewed to assess the medical history. STATISTICAL ANALYSIS: Chi-square test and Mantel-Haenszel method. RESULTS: Of the 101 patients, 9 were excluded for reasons of bacterial meningitis, recent head trauma, brain tumor, tricyclic antidepressants′ overdose and missing reliable data of the childhood FS event. Thirty-one (33.7%) of the remaining 92 patients had history of FS in the childhood (71% men). Localization-related epilepsies were significantly associated with history of FS [Odds ratio: 3.29; (95% CI, 1.30-8.06)] ( 2= 5.49, df = 1, P=0.012) when compared to other epilepsies and epilepsy syndromes. An initial unprovoked simple partial seizure was also significantly associated with a positive history of FS [Odds ratio: 8.05; (95% CI 2.88-22.45)] ( 2= 15.86, df = 1, P<0.001). CONCLUSIONS: Localization-related epilepsies and partial seizures seem to be associated with a history of FS in childhood. This warrants more investigation to understand the mechanism as well as a possible pathology common in both localization-related epilepsies and FS in the affected probands.
Clinical response and tolerability of eslicarbazepine in treatment of partial onset seizures: impact of a novel metabolic pathway
Serrano E, Harden C
Journal of Receptor, Ligand and Channel Research , 2011, DOI: http://dx.doi.org/10.2147/JRLCR.S16729
Abstract: ical response and tolerability of eslicarbazepine in treatment of partial onset seizures: impact of a novel metabolic pathway Review (2374) Total Article Views Authors: Serrano E, Harden C Published Date April 2011 Volume 2011:4 Pages 23 - 28 DOI: http://dx.doi.org/10.2147/JRLCR.S16729 Enrique Serrano1, Cynthia L Harden2 1Comprehensive Epilepsy Center, Department of Neurology, University of Miami, Miami, FL, USA; 2Comprehensive Epilepsy Care Institute, Long Island Jewish School of Medicine, Hofstra North Shore, New Hyde Park, NY, USA Abstract: Epilepsy is a common chronic neurological condition affecting 50 million people worldwide. Because at least 30% of patients with partial seizures do not achieve seizure control with the current antiepileptic drugs, there remains an urgent need for novel antiepileptic drugs with more favorable safety profiles. Eslicarbazepine acetate (formerly known as BIA 2-093) is a novel voltage-gated sodium channel blocker used as adjunctive therapy in the treatment of refractory partial-onset seizures. Eslicarbazepine acetate is a dibenzazepine that is chemically related to carbamazepine and oxcarbazepine, designed to avoid production of active metabolites, as occurs with both carbamazepine and oxcarbazepine. Carbamazepine is metabolized by the liver to the active metabolite, carbamazepine-10, 11-epoxide, which contributes to clinical toxicity. Eslicarbazepine acetate is reduced by esterases in the liver to the active metabolite eslicarbazepine, the S (+) enantiomer of licarbazepine,27 without production of the 10,11-epoxide, resulting in a lower drug interaction potential and fewer adverse neurological effects. Further, while oxcarbazepine is a prodrug that is metabolized into both the S- and R- enantiomers of licarbazepine, eslicarbazepine acetate is metabolized to solely the S- enantiomer of licarbazepine. Eslicarbazepine acetate stabilizes the inactivated state of the voltage-gated sodium channels, preventing their return to an activated state and sustaining repetitive neuronal firing. Eslicarbazepine acetate also has a higher affinity for the inactivated state of the sodium channel compared with the resting state, suggesting enhanced selective inhibition of rapidly firing neurons associated with epileptic discharges. Consequently, eslicarbazepine acetate is less likely to bind to normally active neurons, and, therefore, less likely to cause adverse neurological effects. In clinical trials, eslicarbazepine acetate shows significant efficacy in reducing seizure frequency, and a favorable adverse effect profile at once per day doses of 800 mg or 1200 mg. This novel antiepileptic drug is a promising addition to the treatments for people with partial epilepsy.
Clinical response and tolerability of eslicarbazepine in treatment of partial onset seizures: impact of a novel metabolic pathway  [cached]
Serrano E,Harden C
Journal of Receptor, Ligand and Channel Research , 2011,
Abstract: Enrique Serrano1, Cynthia L Harden21Comprehensive Epilepsy Center, Department of Neurology, University of Miami, Miami, FL, USA; 2Comprehensive Epilepsy Care Institute, Long Island Jewish School of Medicine, Hofstra North Shore, New Hyde Park, NY, USAAbstract: Epilepsy is a common chronic neurological condition affecting 50 million people worldwide. Because at least 30% of patients with partial seizures do not achieve seizure control with the current antiepileptic drugs, there remains an urgent need for novel antiepileptic drugs with more favorable safety profiles. Eslicarbazepine acetate (formerly known as BIA 2-093) is a novel voltage-gated sodium channel blocker used as adjunctive therapy in the treatment of refractory partial-onset seizures. Eslicarbazepine acetate is a dibenzazepine that is chemically related to carbamazepine and oxcarbazepine, designed to avoid production of active metabolites, as occurs with both carbamazepine and oxcarbazepine. Carbamazepine is metabolized by the liver to the active metabolite, carbamazepine-10, 11-epoxide, which contributes to clinical toxicity. Eslicarbazepine acetate is reduced by esterases in the liver to the active metabolite eslicarbazepine, the S (+) enantiomer of licarbazepine,27 without production of the 10,11-epoxide, resulting in a lower drug interaction potential and fewer adverse neurological effects. Further, while oxcarbazepine is a prodrug that is metabolized into both the S- and R- enantiomers of licarbazepine, eslicarbazepine acetate is metabolized to solely the S- enantiomer of licarbazepine. Eslicarbazepine acetate stabilizes the inactivated state of the voltage-gated sodium channels, preventing their return to an activated state and sustaining repetitive neuronal firing. Eslicarbazepine acetate also has a higher affinity for the inactivated state of the sodium channel compared with the resting state, suggesting enhanced selective inhibition of rapidly firing neurons associated with epileptic discharges. Consequently, eslicarbazepine acetate is less likely to bind to normally active neurons, and, therefore, less likely to cause adverse neurological effects. In clinical trials, eslicarbazepine acetate shows significant efficacy in reducing seizure frequency, and a favorable adverse effect profile at once per day doses of 800 mg or 1200 mg. This novel antiepileptic drug is a promising addition to the treatments for people with partial epilepsy.Keywords: antiepileptic drugs, neurotransmission, seizures
A Review of Eslicarbazepine Acetate for the Adjunctive Treatment of Partial-Onset Epilepsy
Rajinder P. Singh and Jorge J. Asconapé
Journal of Central Nervous System Disease , 2012, DOI: 10.4137/JCNSD.S4888
Abstract: Eslicarbazepine acetate (ESL) is a novel antiepileptic drug indicated for the treatment of partial-onset seizures. Structurally, it belongs to the dibenzazepine family and is closely related to carbamazepine and oxcarbazepine. Its main mechanism of action is by blocking the voltage-gated sodium channel. ESL is a pro-drug that is rapidly metabolized almost exclusively into S-licarbazepine, the biologically active drug. It has a favorable pharmacokinetic and drug-drug interaction profile. However, it may induce the metabolism of oral contraceptives and should be used with caution in females of child-bearing age. In the pre-marketing placebo-controlled clinical trials ESL has proven effective as adjunctive therapy in adult patients with refractory of partial-onset seizures. Best results were observed on a single daily dose between 800 and 1200 mg. In general, ESL was well tolerated, with most common dose-related side effects including dizziness, somnolence, headache, nausea and vomiting. Hyponatremia has been observed (0.6%–1.3%), but the incidence appears to be lower than with the use of oxcarbazepine. There is very limited information on the use of ESL in children or as monotherapy.
Autonomic seizures and autonomic status epilepticus in early onset benign childhood occipital epilepsy (Panayiotopoulos syndrome)
Tedrus, Gloria Maria Almeida Souza;Fonseca, Lineu Corrêa;
Arquivos de Neuro-Psiquiatria , 2006, DOI: 10.1590/S0004-282X2006000500004
Abstract: to study clinical and eeg features of children with ictal vomiting and no underlying brain lesions (panayiotopoulos syndrome). the subjects were 36 children aged 2-13 years. the onset of seizures occurred between 1 and 5 years of age. fourteen children (38.8%) had a single seizure. fourteen children (38.8%) had autonomic status epilepticus. impairment of consciousness was reported in 30 (83.3%) children, eye deviation in 10 (27.7%) other autonomic symptoms and head deviation in 9, generalization in 8, visual symptoms in one child, and, speech arrest or hemifacial motor symptoms in 8 cases. the eeg showed occipital spikes or spike-wave complexes in 27 (75.0%) children, blocked by opening of the eyes in 8 (22.2%) cases. nine patients (25%) also had rolandic spikes and 3 had extraoccipital spikes. six (16.6%) patients had normal eeg. no clinical differences were observed between patients having occipital or extraoccipital spikes. in children only with autonomic seizures, the spikes are predominantly occipital but blockage by opening of the eyes is a less frequent feature. in some children there is an overlapping of different focal childhood idiopathic syndromes.
Cessation of еpileptic seizures series using peroral valproate in an adult patient with partial epilepsy  [PDF]
Spasi? Mirjana,Luki? Stevo
Vojnosanitetski Pregled , 2007, DOI: 10.2298/vsp0706425s
Abstract: Introduction. Golden rule for the initiation of antiepileptic therapy in the majority of epileptic syndromes is "start low and go slow", a principle after the second unprovoked seizure. There are certain clinical situations however when fast titration of antiepileptic medication is needed. Case report. We present a case of the 48-year-old man referred for further management of uncontrolled partial seizures. At the age of 37 years, he had subarachnoid haemorrhage, due to aneurysm rupture of the left internal carotid artery, with consecutive vasospasm and right haemiparesis. Since that time he had received phenobarbital 100 mg nocte. On examination he had a right sided upper motor neuron weakness affecting the arm more than the leg, and mild dysarthria, EEG investigation showed frequent transitory spikewaves discharges above the left hemisphere with the fast contralateral propagation with generalised discharges and CT showed old infarction in distribution of left medial cerebral artery. Valproate therapy was initiated with the retard form in the loading dose of 2000 mg. Seizures stopped in 7th hours after the treatment initiation. Laboratory parameters (liver function tests, blood count, level of antiepileptic drugs) were monitored every day. No further seizures were recorded. The patient was discharged from the hospital after 15 days in excellent condition. Conclusion. In selected clinical conditions it is possible to apply the protocol for valproate loading and switch-off from the previous antiepileptic drugs to valproate monotherapy. Adverse effects are rare and mild but potentially serious, and close monitoring of clinical and laboratory parameters is necessary. Hence, a rapid switch to valproate monotherapy can be done safely only in an inpatient setting. .
COMMON ETIOLOGIES OF ADULT ONSET EPILEPSIES IN NORTHWEST OF IRAN
M. Nikanfar,M. A. Arami,L. Mansourpoor S. Najmi
Acta Medica Iranica , 2005,
Abstract: Frequency of common etiologies of adult onset epilepsy is different in various studies. The aim of this study is to evaluate the frequency of common etiologies of late adult onset epilepsies. All patients referred to Razi and Imam Khomeini Hospitals in the year 2003 with at least two seizure attacks beginning after age of 50 were evaluated. In the majority of cases neuroimaging, electroencephalography and echocardiography were done and risk factors for atherosclerosis and cerebrovascular diseases were investigated. All medical records and previous medical histories were reviewed. A total of 97 patients were included. We found hemorrhagic stroke in 10 (10.3%), ischemic stroke in 43 (44.3%) and space-occupying lesion (all of them were tumors) in 19 patients (19.6%). In 24 (24.7%) cases we could not find a clear cause for seizure attacks. In conclusion, since seizures were associated with a central nervous system disease in about 75% of the patients, careful investigation is necessary. We also recommend better control of risk factors for cerebrovascular diseases in our country.
Temporal Epilepsy Causing Recurrent Abdominal Pain in Adults  [PDF]
Hassan Al-Hail, Stacy Schantz Wilkins, Boulenouar Mesroua, Gayane Melikyan, Nabil Azar, Naim Haddad, Basim Uthman, Maria Siddiqi, Ameer Jan, Rana Babur, Abdulraheem Alrabi, Dirk Deleu, Gonzalo Alarcón
World Journal of Neuroscience (WJNS) , 2018, DOI: 10.4236/wjns.2018.82021
Abstract: Abdominal epilepsy is often unrecognised as an epilepsy condition, particularly in adults. We present a rare adult patient who suffers daily episodes of abdominal pinching pain described lasting for 30 seconds, often evolving to loss of consciousness. Scalp EEG-video monitoring showed interictal left temporal slowing and frequent left temporal epileptiform discharges. Three stereotypical complex partial seizures consistent with her habitual attacks were recorded. Two seizures showed a left temporal onset and whereas the third one appeared to start on the right temporal lobe. In patients with paroxysms of abdominal pain, nausea or vomiting, abdominal epilepsy should be considered after exclusion of the most common aetiologies for gastrointestinal conditions.
Onset of Epilepsy In Menopause: Presentation of 5 Cases  [PDF]
Yüksel KAPLAN
Journal of Neurological Sciences , 2007,
Abstract: The distribution of epilepsy frequency is equal among women and men. However, menarche, pregnancy, menopause, hormone replacement therapy and use of oral contraceptives may affect the course of epilepsy in women. Few studies in literature have reported that the onset of epilepsy may first occur in menopause in women who have no previous history of epilepsy.In this presentation, we will discuss 5 cases who experienced their first seizures in posmenopausal period.
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