Epilepsy is one of the most common neurological diseases, and symptomatic epilepsy patients are the main group of epilepsy patients, and their etiologies mainly include structural, infectious, metabolic and autoimmune, and the seizures caused by each etiology may have different degrees of impact on the quality of life of patients. The purpose of this article is to review the research on the quality of life of patients with symptomatic epilepsy caused by structural and infectious etiologies, including cerebrovascular diseases, neurodegenerative diseases, brain tumors, traumatic brain injuries and neurocysticercosis, in order to help clinicians understand the quality of life of patients with symptomatic epilepsy and benefit patients in clinical practice.
ObjectivesTo systematically review the influence of antiepileptic drugs on bone mineral density and bone metabolism in adults.MethodsPubMed, EMbase, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect studies on the influence on antiepileptic drugs on the bone mineral density and bone metabolism in adults from inception to April 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 14 studies were included. The results of meta-analysis showed that: VPA could decline the bone mineral density of lumbar spine (SMD=–0.39, 95%CI –0.65 to –0.13, P=0.003); CBZ (SMD=–0.71, 95%CI –1.08 to –0.33, P=0.000 2) and VPA (SMD=–0.3, 95%CI –0.58 to –0.02, P=0.03) could decline the bone mineral density of femoral neck; CBZ could decline the bone mineral density of total hip (SMD=–0.47, 95%CI –0.84 to –0.10, P=0.01). Serum 25-hydroxy vitamin D3 was decreased in OXC group (SMD=–0.67, 95%CI –1.28 to –0.05, P=0.03); serum calcium was decreased in CBZ (SMD=–0.49, 95%CI –0.78 to –0.20, P=0.000 8), LEV (SMD=–0.83, 95%CI –1.15 to –0.51, P<0.000 01) and OXC (SMD=–0.48, 95%CI –0.90 to –0.05, P=0.03) group; serum phosphorus was decreased in LEV group (SMD=–11.36, 95%CI –12.97 to –9.76, P<0.000 01). Serum alkaline phosphatase was increased significantly in LEV (SMD=6.79, 95%CI 5.78 to 7.80, P<0.000 01) and CBZ (SMD=1.90, 95%CI 1.35 to 2.44, P<0.000 01) group.ConclusionsCurrent evidence shows that treatment with antiepileptic drugs may be associated with an decreasing bone mineral density and influence bone metabolism in epileptic adults. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
Objective To investigate the clinical effect and safety study of agomelatine combined with eszopiclone in the treatment of epilepsy complicated by insomnia. Methods 69 epilepsy complicated by insomnia patients were collected in the outpatient of the Department of Neurology, the First Affiliated Hospital of Shanxi Medical University from December 2021 to October 2022. Patients were randomly divided into control group (34 cases) and observation group (35 cases) Patients in control group were given eszopiclone, 1.5 ~ 3 mg (3 ~ 5 times/week). Patients in observation group were given agomelatine 25 mg (1 time/day) and eszopiclone 1.5 ~ 3 mg (3 ~ 5 times/week). Patients in both groups maintained their original anti-seizure medications treatment regimen for 12 weeks during the study. Pittsburgh sleep quality index (PSQI), Insomnia severity scale (ISI), Patient health questionnaire-9 (PHQ-9) and Generalized anxiety disorder-7 (GAD-7) were used to compare differences in subjective sleep quality, insomnia severity, depression and anxiety symptoms before treatment and at the end of 4 and 12 weeks of treatment. The change of seizure frequency before and after treatment was statistically evaluated to assess epilepsy control. The adverse effects after medication were recorded in both groups. Results After 4 weeks and 12 weeks of treatment, the scores of PSQI, ISI, PHQ-9 and GAD-7 of both groups were significantly lower than those before treatment, and the scores of PSQI, ISI, PHQ-9 and GAD-7 in the combined group at the 4th week and 12 weeks after treatment were significantly lower than those in the single-drug group (P<0.05). The incidence of adverse reactions was 13.33% in the single-agent group and 15.63% in the combined group. Conclusions Agomelatine combined with eszopiclone improve subjective sleep quality, insomnia severity, depression and anxiety symptoms of patients more significantly.
Ketogenic diet (KD) is one of the effective treatments for refractory epilepsy (RE) and is recommended when anti-seizure medications (ASMs) are ineffective or less effective, inoperable or ineffective. The efficacy of the medium-chain triglyceride (MCT) ketogenic diet is as good as the classical KD (CKD), which has been demonstrated in several retrospective, prospective, and randomized studies, and MCT is more ketogenic than long-chain triglycerides, so MCTD allows more carbohydrate and protein foods, which makes MCTD more palatable than CKD more palatable. Research advances in the mechanisms and clinical efficacy associated with MCTD in the treatment of refractory epilepsy are reviewed.
Objective To investigate the effect of anti-seizure medications (ASMs) pregabalin (PGB) monotherapy on sleep structure and quality of patients with focal epilepsy. MethodsAdult patients whom newly diagnosed focal epilepsy were collected and treated with PGB monotherapy. The main outcome measures were the changes of polysomnography and video-electroencephalography (PSG-VEEG), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) in epilepsy patients with PGB and baseline. Results PGB improved significantly sleep structural parameters, including increased total sleep time (P<0.001), decreased sleep latency (P<0.001), improved sleep efficiency (P<0.001), reduced wake time after sleep onset (P<0.001), increased sleep maintenance efficiency (P<0.001) and proportion of N3 sleep stage (P<0.001). In the group with poor sleep efficiency, 86.7% of patients achieved sleep efficiency>85% after PGB treatment. The difference was statistically significant (P<0.01). PGB reduced significantly PSQI score (P<0.001) and ISI score (P<0.001). No significant change in ESS score was observed (P>0.05). ConclusionsPGB could enhance slow-wave sleep (SWS), increase sleep quality and improve insomnia in patients with epilepsy without causing daytime sleepiness.