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Current Challenges and Advances in the Treatment of Epilepsy

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (25 February 2023) | Viewed by 27653

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Special Issue Editors

Prof. Dr. Sergiusz Jozwiak

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Guest Editor

Research Department, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland
Interests: early childhood epilepsy; tuberous sclerosis; neurocutaneous disorders
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Nicola Specchio

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Guest Editor

Rare and COmplex EPilepsy Unit, Department of Neuroscience, Bambino Gesu' Children's Hospital, IRCCS, Rome, Italy
Interests: epilepsy; developmental and epileptic encephalopathies; genetics; EEG; outcome; epileptic syndromes

Prof. Dr. Martha Feucht

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Guest Editor

Department of Pediatric and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
Interests: epilepsy; epileptic syndromes; developmental and epileptic encephalopathies

Special Issue Information

Dear Colleagues,

Epilepsy affects 1 to 2 percent of the global population and over 6 million people in Europe, being one of the most common causes of morbidity due to neurological conditions.

Despite the approval of over 20 antiseizure drugs, none of these drugs prevent epilepsy, and 30% of patients remain refractory to current available treatment. In addition, more than 30% of treated patients experience adverse events that compromise their quality of life. Epilepsy is particularly destructive in young children, in whom frequent seizures contribute to intellectual disability and autistic behavior.

Treatment of epilepsy is no longer exclusively pharmacologic. Identification of epilepsy biomarkers and understanding underlying mechanisms of epileptogenesis allow for the use of precision medicine, which is designed for specific conditions, specific groups of patients or individuals.

With this Special Issue, we hope to encourage submissions that address the current state of the art in epileptology and that indicate new areas for future research in the field.

Prof. Dr. Sergiusz Jozwiak
Prof. Dr. Nicola Specchio
Prof. Dr. Martha Feucht
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

precision medicine
biomarkers
children
adults
animal studies
tuberous sclerosis complex
neurocutaneous disorders
epileptic encephalopathies
drug-resistant epilepsy
ketogenic diet
nerve vagus stimulation
epilepsy surgery
epilepsy prevention
mTOR inhibitors
antiepileptic treatment

Published Papers (14 papers)

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Research

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7 pages, 228 KiB

Open AccessCommunication

Treatment with Cenobamate in Adult Patients with Lennox–Gastaut Syndrome: A Case Series

by Giovanni Falcicchio, Simona Lattanzi, Francesco Negri, Marina de Tommaso, Angela La Neve and Nicola Specchio

J. Clin. Med. 2023, 12(1), 129; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12010129 - 24 Dec 2022

Cited by 5 | Viewed by 1714

Abstract

Background. Lennox–Gastaut syndrome (LGS) is a developmental and epileptic encephalopathy (DEE) in which drug resistance to antiepileptic drugs (AEDs) is common. Focal-onset seizures (FOS) are among the seizure types characterizing LGS. Cenobamate (CNB) is a new AED indicated for the treatment of FOS and it has shown promising results in terms of seizure frequency reduction in both clinical trials and real-world experience. To date, the use of CNB in patients with DEEs is limited to Dravet syndrome. Methods: This was a retrospective study aimed to determine the 12-month effectiveness and tolerability of CNB in patients with LGS following real-world practice. Results: Four patients with LGS receiving CNB treatment were identified. At 12 months from starting CNB, the reduction in baseline seizure frequency ranged from 25 to 74%, with two patients achieving ≥50% seizure reduction. CNB was generally well tolerated and adjustments in doses of concomitant AEDs were required. Conclusions: CNB may represent a promising therapeutic option in patients with drug-resistant epilepsy associated with LGS. Further research is needed to confirm this preliminary evidence. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

13 pages, 1345 KiB

Open AccessArticle

Early Epilepsy Surgery in Benign Cerebral Tumors: Avoid Your ‘Low-Grade’ Becoming a ‘Long-Term’ Epilepsy-Associated Tumor

by Catrin Mann, Nadine Conradi, Elisabeth Neuhaus, Jürgen Konczalla, Thomas M. Freiman, Andrea Spyrantis, Katharina Weber, Patrick Harter, Felix Rosenow, Adam Strzelczyk and Susanne Schubert-Bast

J. Clin. Med. 2022, 11(19), 5892; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11195892 - 05 Oct 2022

Cited by 3 | Viewed by 1329

Abstract

Epilepsy surgery in low-grade epilepsy-associated neuroepithelial tumors (LEAT) is usually evaluated in drug-resistant cases, often meaning a time delay from diagnosis to surgery. To identify factors predicting good postoperative seizure control and neuropsychological outcome, the cohort of LEAT patients treated with resective epilepsy surgery at the Epilepsy Center Frankfurt Rhine-Main, Germany between 2015 and 2020 was analyzed. Thirty-five patients (19 males (54.3%) and 16 females, aged 4 to 40 years (M = 18.1), mean follow-up 33 months) were included. Following surgery, 77.1% of patients remained seizure-free (Engel IA/ILAE 1). Hippocampus and amygdala resection was predictive for seizure freedom in temporal lobe epilepsy. In total, 65.7% of all patients showed cognitive deficits during presurgical workup, decreasing to 51.4% after surgery, predominantly due to significantly less impaired memory functions (p = 0.011). Patients with presurgical cognitive deficits showed a tendency toward a longer duration of epilepsy (p = 0.050). Focal to bilateral tonic-clonic seizures (p = 0.019) and young age at onset (p = 0.018) were associated with a higher likelihood of cognitive deficits after surgery. Therefore, we advocate early epilepsy surgery without requiring proof of drug-resistance. This refers especially to lesions associated with the non-eloquent cortex. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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12 pages, 720 KiB

Open AccessArticle

The Rate of and Factors Associated with Delivery by Caesarean Section among Women with Epilepsy: Time Trend in a Single-Centre Cohort in Mazovia, Poland

by Beata Majkowska-Zwolińska and Joanna Jędrzejczak

J. Clin. Med. 2022, 11(9), 2622; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11092622 - 06 May 2022

Viewed by 1124

Abstract

Data from literature suggest that the rate of caesarean section (CS) in women with epilepsy (WWE) is higher than in the general population. In Poland, there is neither a national registry nor another data set to access the outcome of pregnancy in WWE. Therefore, we address this gap by prospectively studying CS rates among 1021 WWE pregnancies at a single centre, their trends over time, and factors increasing the likelihood of the CS. To determine whether the diagnosis of epilepsy itself increased this likelihood, mixed models were used to analyse the contributions of specific variables, including the presence of seizures at different pregnancy-related timepoints. Over 20 years, the mean rate of CS in WWE was progressively growing and was higher than in the general population in Mazovia (47% vs. 32%). Generalized seizures in the third trimester increased the likelihood of CS with the highest odds (OR 4.4). The most frequent indication for a CS was obstetric (58.1%), followed by epilepsy-related (25.2%). Almost half of women who indicated epilepsy as the sole reason for CS had no seizure during pregnancy, and nearly 70% did not have generalized seizures. This suggests the overuse of epilepsy as an indication of CS and encourages defining more strict criteria. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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9 pages, 533 KiB

Open AccessArticle

Antiepileptic Drugs and Their Dual Mechanism of Action on Carbonic Anhydrase

by Calin Magheru, Sorina Magheru, Marcela Coltau, Anica Hoza, Corina Moldovan, Liliana Sachelarie, Irina Gradinaru, Loredana Liliana Hurjui, Felicia Marc and Dorina Maria Farcas

J. Clin. Med. 2022, 11(9), 2614; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11092614 - 06 May 2022

Cited by 4 | Viewed by 1950

Abstract

(1) Background: The benefit of using inhibitors of carbonic anhydrase (CA), such as acetazolamide, in the treatment of epilepsy has previously been described. (2) Methods: In this paper, the effect on CA of the most well-known antiepileptic drugs was studied in vitro and in vivo. The effects, after chronic treatment, of carbamazepine, phenytoin, valproate, primidone, clonazepam, and ethosuximide were studied in vitro on purified CA, isozyme I (CA I) and CA, and isozyme II (CA II) activity and in vivo on epileptic erythrocyte CA I and CA II activity. (3) Results: In vitro results showed that all antiepileptic drugs reduced purified CA II activity according to dose–response relationships and slightly inhibited CA I activity. In vivo results showed that the chronic administration of antiseizure drugs induced a progressive reduction in erythrocyte CA II activity in all the groups studied. This study shows that CA II inhibition can be induced both in vitro and in vivo by major antiepileptic agents as it might be one of the effective mechanisms of these anticonvulsant drugs. (4) Conclusions: The decrease in CA II activity in epileptic patients after antiseizure treatment suggests the involvement of CA II in the pathogenesis of epilepsy. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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13 pages, 1414 KiB

Open AccessArticle

Analysis of Factors That May Affect the Effectiveness of Ketogenic Diet Treatment in Pediatric and Adolescent Patients

by Anna Winczewska-Wiktor, Adam Sebastian Hirschfeld, Magdalena Badura-Stronka, Paulina Komasińska-Piotrowska and Barbara Steinborn

J. Clin. Med. 2022, 11(3), 606; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11030606 - 25 Jan 2022

Cited by 1 | Viewed by 2431

Abstract

Purpose. The aim was to find predictors for ketogenic diet (KD) treatment effectiveness. In addition, recognized factors influencing the efficacy of KD were analyzed based on the ILAE (International League Against Epilepsy) proposed Classification and Definition of the Epilepsy Syndromes. Methods. A sample of 42 patients treated with KD were analyzed. The effectiveness of KD was assessed according to the type of diet, the type of seizures, and the known (KE) or undetermined genetic etiology (UNKE). The group of KE consisted of patients with CACNA1S, CHD2, DEPDC5, KIF1A, PIGN, SCN1A, SCN8A, SLC2A1, SYNGAP1 pathogenic variants. The usefulness of the new Classification and Definition of Epilepsy Syndromes proposed by the ILAE was evaluated. Results. KD therapy was effective in 69.05% of cases. No significant correlation was observed with the type of diet used. KE was related to greater effectiveness after KD treatment. KD treatment was most effective in the reduction of non-focal seizures. Considering the ILAE proposed classification, it was found that KD efficacy was higher in patients with simultaneous focal and tonic-clonic seizures compared to patients with only tonic-clonic or focal seizures. Conclusion. The occurrence of focal seizures does not determine the potential ineffectiveness of treatment with a ketogenic diet. A significant efficacy of ketogenic diet treatment was observed in the group of patients with focal and generalized seizures, as well as epileptic and developmental encephalopathies. The etiology of epileptic seizures plays a more significant role. The new classification will make it easier to select patients who can benefit from this form of treatment. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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9 pages, 723 KiB

Open AccessArticle

Involvement of Peripheral Monocytes with IL-1β in the Pathogenesis of West Syndrome

by Tomoko Takamatsu, Gaku Yamanaka, Koko Ohno, Kanako Hayashi, Yusuke Watanabe, Mika Takeshita, Shinji Suzuki, Shinichiro Morichi, Soken Go, Yu Ishida, Shingo Oana, Yasuyo Kashiwagi and Hisashi Kawashima

J. Clin. Med. 2022, 11(2), 447; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11020447 - 16 Jan 2022

Cited by 4 | Viewed by 1587

Abstract

Neuroinflammation has been implicated in the pathogenesis of West syndrome (WS). Inflammatory cytokines, including interleukin-1β(IL-1β), have been reported to be associated with epilepsy. However, the assessment of cytokine changes in humans is not always simple or deterministic. This study aimed to elucidate the immunological mechanism of WS. We examined the intracellular cytokine profiles of peripheral blood cells collected from 13 patients with WS, using flow cytometry, and measured their serum cytokine levels. These were compared with those of 10 age-matched controls. We found that the WS group had significantly higher percentages of inter IL-1β, interleukin-1 receptor antagonist (IL-1RA)-positive monocytes, and interferon gamma (IFN-γ) in their CD8+ T cells than the control group. Interestingly, the group with sequelae revealed significantly lower levels of intracellular IFN-γ and IL-6 in their CD8+ T and CD4+ T cells, respectively, than the group without sequelae. There was no correlation between the ratios of positive cells and the serum levels of a particular cytokine in the WS patients. These cytokines in the peripheral immune cells might be involved in the neuroinflammation of WS, even in the absence of infectious or immune disease. Overall, an immunological approach using flow cytometry analysis might be useful for immunological studies of epilepsy. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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10 pages, 332 KiB

Open AccessArticle

Prevalence of Neural Autoantibodies in Paired Serum and Cerebrospinal Fluid in Adult Patients with Drug-Resistant Temporal Lobe Epilepsy of Unknown Etiology

by Pablo Cabezudo-García, Nicolás L. Ciano-Petersen, Natalia Mena-Vázquez, Jesús Ortega-Pinazo, María J. Postigo-Pozo, Guillermina García-Martín, Helena Antolí-Martínez, Violeta Sánchez-Sánchez, Pablo Quiroga-Subirana, Pedro J. Serrano-Castro and Guillermo Estivill-Torrús

J. Clin. Med. 2021, 10(21), 4843; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10214843 - 21 Oct 2021

Cited by 2 | Viewed by 2090

Abstract

In order to determine the prevalence of neural autoantibodies in adult patients with drug-resistant temporal lobe epilepsy (DRTLE) of unknown etiology, we compared the characteristics of patients with and without autoantibodies and applied antibody predictive scores to the patients. Patients aged ≥18 years with DRTLE of unknown etiology and ≥12 months of evolution were prospectively recruited. Neural autoantibodies in serum and CSF were systematically determined in all patients. We created the ARTE (antibody in drug-resistant temporal lobe epilepsy) score based on the variables associated with the presence of neural autoantibodies. Twenty-seven patients were included. The mean (SD) age in years at the index date was 52 (±14.2) and at epilepsy onset was 32 (±17.1). The mean epilepsy duration was 19 (±12.5) years. Neural autoantibodies were detected in 51.85% (14/27) of patients. The presence of bitemporal, independent, interictal epileptiform discharges (BIIED) had a higher frequency in patients with neural autoantibodies (57.1% vs. 15.4%; p = 0.025) as well as those patients with a previous history of status epilepticus (49.2% vs. 0.0%; p = 0.007). The ARTE score showed an area under the curve (AUC) of 0.854. Using a cut-off point of ≥1, the sensitivity was 100% and the specificity was 46.1%, whereas when using a cut-off point of ≥3, the results were 35.7% and 100%, respectively. We found a high prevalence of neural autoantibodies in patients with DRTLE of unknown etiology, indicating an autoimmune mechanism. The presence of BIIED and a history of SE in DRTLE of unknown etiology are possible markers for autoimmune-associated epilepsy. The proposed ARTE score requires future validation in larger independent cohorts. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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10 pages, 960 KiB

Open AccessCommunication

Multiple Comorbidity Profile of Psychiatric Disorders in Epilepsy

by Agata M. Grzegorzewska, Mariusz S. Wiglusz, Jerzy Landowski, Katarzyna Jakuszkowiak-Wojten, Wiesław J. Cubała, Adam Włodarczyk and Joanna Szarmach

J. Clin. Med. 2021, 10(18), 4104; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10184104 - 11 Sep 2021

Cited by 6 | Viewed by 1992

Abstract

The co-occurrence of psychiatric disorders in people with epilepsy (PWE) is not well documented or studied. Anxiety and depressive disorders are the most frequent comorbid disorders in PWE. In this paper, we characterized the rates of multiple psychiatric disorder comorbidity by reanalyzing data from a study sample of PWE. A total of 96 outpatient PWE completed the self-report symptom scale, and were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) Axis I disorders (SCID-I). For analyses, patients were assigned to a comprehensive diagnostic group of anxiety and depressive disorders. In order to determine comorbidity across psychiatric diagnoses for the DSM-IV categories, Pearson’s chi-squared test (χ²) was used. In the study sample, eight patients (8.3% of the study sample, n = 96) had comorbid major depressive disorder and anxiety disorder. When looking at comorbidity of each diagnosis separately, it was determined that 50% of individuals with an anxiety disorder had comorbid Major Depressive Disorder (MDD) and 38% patients with MDD had comorbid anxiety disorder. This finding encourages a more systematic reporting of psychiatric prevalence data in epilepsy, especially taking into account the high ratio of multiple comorbid anxiety and depressive disorders in PWE. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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12 pages, 1988 KiB

Open AccessArticle

Long-Term V-EEG in Epilepsy: Chronological Distribution of Recorded Events Focused on the Differential Diagnosis of Epileptic Seizures and Psychogenic Non-Epileptic Seizures

by Fernando Vázquez-Sánchez, Beatriz García-López, Ana Isabel Gómez-Menéndez, Asunción Martín-Santidrián, Jesús Macarrón Vicente, Alicia Hernando-Asensio, Pedro Gámez-Beltrán, Jerónimo J. González-Bernal, Raúl Soto-Cámara, María Jiménez-Barrios and Josefa González-Santos

J. Clin. Med. 2021, 10(10), 2080; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10102080 - 12 May 2021

Cited by 3 | Viewed by 2043

Abstract

Differential diagnosis in epilepsy is sometimes challenging. Video-electroencephalography (V-EEG) is an essential tool in the diagnosis and management of epilepsy. The prolonged duration of V-EEG recording increases the diagnostic yield of a conventional V-EEG. The right length of monitoring for different indications is still to be established. We present a retrospective descriptive study with a sample of 50 patients with long-term V-EEG monitoring, with a mean age of 36.1 years, monitored from 2013 to 2019 at the Burgos University Hospital. The mean monitoring time was 3.6 days. Events were obtained in 76% of the patients, corresponding to epileptic seizures (ES) in 57.9% of them, with psychogenic non-epileptic seizures (PNES) in 39.5%, and with episodes of both pathologies in 2.6% of the patients. We found that the first event was highly representative, and it correlated with the rest of the events that would be recorded. Moreover, 92% of the first PNES had been captured at the end of the second day, and 89% of the first ES by the end of the third day. V-EEG for differential diagnosis between ES and PNES can be performed in hospitals without specialized epilepsy surgery units. For this indication, the duration of long-term V-EEG can be adjusted individually depending on the nature of the first event. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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Review

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12 pages, 855 KiB

Open AccessReview

Photo-Dependent Reflex Seizures—A Scoping Review with Proposal of Classification

by Jolanta Strzelecka, Dariusz Wojciech Mazurkiewicz, Tymon Skadorwa, Jakub S. Gąsior and Sergiusz Jóźwiak

J. Clin. Med. 2022, 11(13), 3766; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133766 - 29 Jun 2022

Cited by 3 | Viewed by 1886

Abstract

Children and adolescents are the largest at-risk group for the appearance of reflex seizures or epilepsy syndromes with a photoparoxysmal response. The aim of this study was to present an overview of the literature regarding photo-dependent reflex seizures. Epilepsy with seizures provoked by intermittent light stimulation is a distinct group of epilepsies; therefore, we focused on reflex seizures provoked by different factors whose common feature is the patient’s response to intermittent photic stimulation. A qualitative search of PubMed/MEDLINE, Scopus, EBSCO, and Cochrane Library electronic databases for selected terms was carried out for scientific articles published up to May 2020 outlining the outcomes of control, observational, and case studies. This scoping review was developed and followed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The review of the qualitative evidence for the synthesis of photosensitive epilepsy allowed us to distinguish the following categories: light-induced seizures and light-deprived seizures. Differentiating between intermittent photic stimulation-related epilepsy syndromes and seizures is essential in order to determine the length of appropriate treatment. Photo-dependent reflex seizures make up the majority of this type of disorder among reflex seizures. Since there are many seizures provoking factors in the world around us, it is important to distinguish amongst them in order to be able to protect the patient exposed to this factor. It is recommended that the photostimulation procedure be performed during a routine electroencephalogram study. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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18 pages, 461 KiB

Open AccessReview

Risk Factors Associated with Refractory Epilepsy in Patients with Tuberous Sclerosis Complex: A Systematic Review

by Dominika Miszewska, Monika Sugalska and Sergiusz Jóźwiak

J. Clin. Med. 2021, 10(23), 5495; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10235495 - 24 Nov 2021

Cited by 10 | Viewed by 1986

Abstract

Background: Epilepsy affects 70–90% of patients with tuberous sclerosis complex (TSC). In one-third of them, the seizures become refractory to treatment. Drug-resistant epilepsy (DRE) carries a significant educational, social, cognitive, and economic burden. Therefore, determining risk factors that increase the odds of refractory seizures is needed. We reviewed current data on risk factors associated with DRE in patients with tuberous sclerosis. Methods: The review was performed according to the PRISMA guidelines. Embase, Cochrane Library, MEDLINE, and ClinicalTrial.gov databases were searched. Only full-text journal articles on patients with TSC which defined risk factors related to DRE were included. Results: Twenty articles were identified, with a cohort size between 6 and 1546. Seven studies were prospective. Three factors appear to significantly increase DRE risk: TSC2 mutation, infantile spasms, and a high number of cortical tubers. Conclusions: A proper MRI and EEG monitoring, along with genetic testing, and close observation of individuals with early onset of seizures, allow identification of the patients at risk of DRE. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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11 pages, 530 KiB

Open AccessReview

Dysphoria and Irritability—Diagnostic Pitfalls in the Assessment of Interictal Dysphoric Disorder in Epilepsy

by Agata M. Grzegorzewska, Mariusz S. Wiglusz, Wiesław J. Cubała, Katarzyna Jakuszkowiak-Wojten, Adam Włodarczyk and Joanna Szarmach

J. Clin. Med. 2021, 10(19), 4624; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10194624 - 08 Oct 2021

Cited by 4 | Viewed by 1840

Abstract

This article aims to review the concept of epilepsy-specific psychiatric disturbance, Interictal Dysphoric Disorder (IDD), focusing on issues related to its core symptoms and methodological pitfalls. In the psychiatric literature, an epilepsy-specific pleomorphic mood disorder has been long recognized and described as IDD, a condition characterized by eight symptoms, which are grouped into four labile depressive symptoms, two labile affective symptoms, and two specific symptoms. The existence of IDD is still a matter of debate because of several methodological issues. The main features of IDD, such as dysphoria and irritability, lack precise and clear definition. This review article explores the different definitions and approaches towards both terms described in the psychiatric literature and the rationale for modifying the diagnostic process of IDD. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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Other

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10 pages, 816 KiB

Open AccessBrief Report

Replacement of Valproic Acid with New Anti-Seizure Medications in Idiopathic Generalized Epilepsy

by Ayataka Fujimoto, Hideo Enoki, Keisuke Hatano, Keishiro Sato and Tohru Okanishi

J. Clin. Med. 2022, 11(15), 4582; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11154582 - 05 Aug 2022

Cited by 2 | Viewed by 1890

Abstract

Background: Little is known regarding the non-inferiority of new anti-seizure medications (ASMs) in terms of replacing valproic acid (VPA) in patients with idiopathic generalized epilepsy (IGE). We hypothesized that replacement of VPA with new ASMs would offer non-inferior or better control of seizure frequency. The purpose of this study was to compare epileptic seizure frequency between the subset of patients with IGE who were on VPA and the subset of patients with IGE who replaced VPA with new ASMs. Methods: Patients with IGE who were on or had been on VPA between January 2016 and March 2022 were divided into a group that replaced VPA with new ASMs (VPA-replace group) and a group that remained on VPA (VPA-continue group). We then compared the groups in terms of seizure frequency and myoclonus. Results: Of the 606 patients on VPA between January 2016 and March 2022, 156 patients with IGE were enrolled to this study (VPA-replace group, n = 68; VPA-continue group, n = 88). The VPA-replace group included significantly more females than the VPA-continue group (p < 0.001). The VPA-replace group also showed significantly higher seizure frequency before replacement (p < 0.001), but not after replacement (p = 0.074). Patients on monotherapy displayed improved seizure frequency with new ASMs (p < 0.001). Among the new ASMs, perampanel (PER) significantly improved seizure frequency (p = 0.002). Forty-two patients in the VPA-replace group who had myoclonus achieved significant improvements (p < 0.001). Among these, patients on PER monotherapy (p < 0.001) or PER + lamotrigine (0.016) showed significantly improved myoclonus scale scores. Conclusions: This study shows the non-inferiority of new ASMs compared to VPA, with better seizure control using new ASMs in subsets of patients with IGE on monotherapy. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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6 pages, 221 KiB

Open AccessBrief Report

Comparison of Acute Withdrawal and Slow Taper of Antiseizure Medications during Video Electroencephalographic Monitoring: Efficacy for Shortening of Hospital Stay

by Ayako Motoki, Naoki Akamatsu, Tomoyuki Fumuro, Ayako Miyoshi, Hideaki Tanaka, Koichi Hagiwara, Shinji Ohara, Takashi Kamada, Hiroshi Shigeto and Hiroyuki Murai

J. Clin. Med. 2021, 10(24), 5972; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10245972 - 20 Dec 2021

Cited by 2 | Viewed by 1430

Abstract

Antiepileptic medications (ASMs) are withdrawn at the epilepsy monitoring unit to facilitate seizure recordings. The effect of rapid tapering of ASMs on the length of hospital stay has not been well documented. We compared the mean length of hospital stay between patients who underwent acute ASM withdrawal and slow dose tapering during long-term video electroencephalography (EEG) monitoring. We retrospectively investigated 57 consecutive patients admitted to the epilepsy monitoring unit regarding the mean length of hospital stay in the acute ASM withdrawal group (n = 30) and slow-taper group (n = 27). In the acute-withdrawal group, all ASMs were discontinued once the patients were admitted. In the slow-taper group, the doses of ASMs were gradually reduced by 15–30% daily. We also evaluated the safety of the acute-withdrawal and slow-taper protocols. The mean lengths of hospital stay were 3.8 ± 1.92 and 5.2 ± 0.69 days in the acute-withdrawal and slow-taper groups, respectively (p < 0.005). No severe adverse events, including status epilepticus, were observed. Acute ASM withdrawal has the advantage of significantly reducing the length of hospital stay over slow tapering, without any severe adverse effects. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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