ObjectiveTo observe the children with idiopathic epilepsy who received AED therapy and seizure-free, withdrawal at least 1 year, and analyze the risk factors of seizure recurrence. In order to give better instructions for AED withdrawal of children with idiopathic epilepsy in pediatric department. MethodsChildren with idiopathic epilepsy who were seizure-free and had stopped AED treatment at least 1 year before the deadline of observation were collected from pediatric outpatient and inpatient department of the First Affiliated Hospital of Guangxi Medical University from January 2011 to January 2014. The following variables, derived from the case records were analyzed: sex, age at seizure onset, type of seizure, time period between the onset of the first seizure and start of treatment, number of seizures in the time period between the start of AED therapy and the last seizure, number of AEDs before remission, time period between the start of AED therapy and the last seizure, time period between the last seizure and withdrawal of AED treatment (seizure-free period, timing of AED withdrawal), time period between the start of AED withdrawal and total discontinuation(speed of withdrawal), EEG registered at the time of diagnosis, before AED withdrawal, during and after AED withdrawal, and the condition of recurrence, data analysed by multi-variate step-wise Cox regression model analysis. ResultsA total of 16(12.8%) children relapsed in a total number of 125 children with idiopathic epilepsy we collected; date evaluated by multi-variable analysis showed that the children suffering from seizure type of focal seizure, starting withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording was associated with a higher risk of seizure recurrence. ConclusionsChildren with idiopathic epilepsy have a low risk of recurrence after AED withdrawal. Those who suffer from seizure type of focal seizure, start withdrawal after a seizure-free period of less than 3 years and with abnormal post-withdrawal EEG recording are associated with a higher risk of seizure recurrence.
ObjectiveThe aim of this study is to identify clinical and electroencephalographic features associated with refractoriness to the initial antiepileptic drug in typical benign childhood epilepsy with centrotemporal spikes (BECTS). MethodsA total of 87 children with typical BECTS were retrospectively reviewed in the analyses.The patients were subdivided into two groups:patients whose seizures were controlled with monotherapy, and those requiring two medications. 63 childrenachieved seizure-freedom with monotherapy, while 24 received two medications for seizure control. ResultsDiffusing foci at the follow-up EEG and delayed treatment (duration > 1 year) are two main risk factors associated with more refractory cases (P < 0.001). Delayed diagnosis (37.1%) and non-adherence to treatment (57.2%) contributed to delayed treatment. ConclusionsOur findings suggested that diffusing foci on EEG and delayed treatment are associated with more frequent seizures and refractoriness in BECTS. Diagnostic delays and non-adherence hindered timely care, which may represent opportunities for improved intervention.
ObjectiveUsing retrospective study to analyze the data of 112 patients with benign childhood epilepsy with centrotemporal spikes (BECTS) and investigate the clinical characteristics and provide some clinical experience in treatment. MethodsWe collected the medical records of 112 cases of BECTS children in the First Affiliated Hospital of Guangxi Medical University of children's clinics from January 2011 to December 2012. According to whether taking antiepileptic drugs (AEDs) treatment regularly, the 112 cases with BECTS was divided into the treated group and the non-treated group, then analyzed the clinical characteristics between the two groups retrospectively, including age of onset, single episode duration, frequency of seizure, pattern of seizure and EEG performances. ResultsThrough regular AEDs treatment, the duration of a single attack was shortened, generalized tonic-clonic seizure(GTCS) was decreased significantly in the treatment group (P < 0.05). For patients whose seizure frequency was≥3 times/3 months, AEDs could effectively control or reduce their seizure frequency (P < 0.05), while AEDs had no obvious effect on the seizure frequency of those whose seizure frequency was≤2 times/3 months (P > 0.05). In the treatment group, 29 cases whose age < 7 controlled their epilepsy attacks after taking AEDs for average of 13.76 months, while 35 cases whose age≥7 controlled their epilepsy attacks after taking AEDs for average of 6.36 months. Conclusion①BECTS patients with a long duration of a single attack and seizure frequency more than 3 times/3 months could be effectively controlled after receiving early AEDs treatment.②The younger age of onset (< 7 years old) required longer AEDs treatment to control seizures.
ObjectiveThe aim of this study was to investigate the pathogenesis of AED-induced SJS/TEN across the spectrum of HLA-A, -B and -DRB1 alleles, and to explore the different clinical characteristics of patients with and without the HLA-B*15:02 allele in the SJS/TEN group. MethodsA total of twenty-three patients exhibiting AED-induced SJS/TEN (16 CBZ-SJS/TEN, seven LTG-SJS/TEN) and fifty-two patients who exhibited tolerance to AEDs were recruited. High-resolution HLA genotyping was performed to estimate the prevalence of the HLA-A, -B and -DRB1 alleles for each subject. Patients in the SJS/TEN group were further divided to positive HLA-B*15:02 allele group and negative HLA-B*15:02 allele group depending on whether carrying the HLA-B*15:02 allele, and the clinical feathers were compared between the two groups. ResultsNine of twenty-three patients (39%) in the SJS/TEN group were male, and the mean age of this group was 32 (8-68) years old. Twenty-eight of fifty-four (54%) patients in the tolerant group were male, and the mean age of the tolerant group was 28 (9-64) years old.Fourteen subjects in the SJS/TEN group carried the HLA-B*15:02 allele, whereas only four subjects (7.7%) in the AED-tolerant group carried this allele; the carrier rate of HLA-B*15:02 was significantly different between the groups (P<0.001). Among the fourteen patients who carried the HLA-B*15:02 allele in the SJS/TEN group, composing the positive HLA-B*15:02 allele group, eight patients (57.1%) were female, whereas six of nine patients in the negative HLA-B*15:02 allele group were female. The difference of the gender didn't have statistical significance between the two groups, nor did the other clinical characteristics, including mean age, the dosage of the AEDs, the interval from the drug administration to the onset of the SJS/TEN, fever, allergic history, abnormal MRI and abnormal EEG results. ConclusionsThe pathogenesis of AED-induced SJS/TEN is a complex process, which may involve one or more alleles. The HLA-B*15:02 allele may be a genetic susceptibility factor of the AED-induced SJS/TEN. However, we didn't find significant difference of the clinical characteristics of SJS/TEN between the patients with and without the HLA-B*15:02 allele. Notably, further studies using larger samples are required to confirm these conclusions.
ObjectiveAnalysis prophylactic anti-epileptic drugs (AEDs) therapy in patients with brain tumor-related epilepsy (BTE) to observe whether seizures occurance, frequency will decrease, and the adverse reactions risk assessment of the patient's after using AEDs in 3 months and 12 month. MethodsRetrospective analysis of the cases and follow-up data of patients with the diagnosis of brain tumors in the Second Affiliated Hospital of Chongqing Medical University in June 2011 to February 2015. Through the strict inclusion criteria and exclusion criteria review, the sixty-eight standard patients were divided into two groups:treatment group (44 cases) and control group (24 cases), and compared in the incidence of epilepsy and seizure frequency two groups of patients, and observe the adverse reactions after using AEDs. And analyzed the outcome of patients with brain tumors at 3 months and 2 months. ResultsThrough at least 1 year follow up, compared the data of patients in the two groups with seizure incidence at 3 months and with seizures frequency≥3 times at 12 months, the difference was statistically significant (P < 0.05).In the treatment group, however, 7 patients experienced mild adverse reactions, such as dizziness, fatigue, nausea and vomiting, mild white blood cell reduction, mild liver damage, menstrual cycle changes, mental and behavioral abnormalities, etc.A patient discontinued due to mental disorder, and a patient change AEDs due to menstrual cycle change. All patients had no serious adverse reactions. Conclusions①prophylactic use of AEDs can significantly reduce the incidence of seizures at 3 months; ②Although prophylactic use of AEDs did not reduce the incidence of seizures at 12 months, but can reduce the frequency of seizures; ③The risk of adverse reactions of prophylactic use of AEDs in patients with BTE is relatively low.
ObjectiveThis study aimed to explore the timing of the long-term antiepileptic drugs (AEDs) therapy in patients with stroke related seizures. MethodsWe enrolled 90 Patients with post-stroke seizures who diagnosed in neurology and epilepsy specialist clinic of Tianjin Medical University General Hospital and followed up for at least 12 months from September 2014 to August 2016. The patients were divided into early-onset seizure group (occurring within 2 weeks of stroke) and late-onset seizure group (occurring after 2 weeks of stroke).The two groups were subdivided into treated and untreated group after the first seizure. ResultsThe patients were followed up for 12~96m (median 20m). 31 patients in ES group, 19 of which in treated group and 12 of which in untreated group. 59 patients in LS group, 36 of which in treated group and 23 of cases in untreated group. The recurrence rate of second seizures occurred in each group and the comparison between the subgroups in the 3rd, 6th, 9th and 12th mouth of follow-up as follows. 1 LS group compared with the group of ES, the recurrence rate of second seizures was high (25.81%~38.71% vs. 49.15%~69.49%), and there was statistical difference (P < 0.05). 2 The recurrence rate of ES in untreated group was lower than that in untreated LS group (16.77% 33.33% vs. 56.52% 73.91%), but only in 3m and 12m the difference was statistically significant (P < 0.05). 3 There was on statistically significant different in ES treated group compared to untreated group, LS treated group compared to untreated group, ES treated group compared to LS treated group (P > 0.05). Both in group of ES and LS, The ratio of seizure recurred patients at different time points during follow-up period was highest at the time of 3m, 3 6m followed, within six months respectively as high as 91.67% and 76.59%. ConclusionOnly one early-onset seizure after stroke can be suspended long-term AEDs treatment, once it recurred that indicates the need for treatment. However, the recurrence rate of late-onset seizure was higher than that of early-onset seizure and it should be given long term AEDs treatment after the first seizure.
ObjectiveTo evaluate the effectiveness of levetiracetam (LEV) added on to usual care, in treating children refractory partial seizure epilepsy.MethodsWe searched the Cochrane library, EMBASE and PubMed between January 1998-January 2017, We systematically searched CNKI database and Wanfang data, Chinese biology medline and the manual retrieval related magazines.RevMan 5.3 statistical software for Meta analysis.ResultsAccording to the enrollment criteria, fourtrials were included involving 498 participants according to the intent-to-treat, 268 for LEV, and 230 for placebo groups.We assessed the following outcomes: 50% or greater seizure reduction, seizure freedom, adverse effects, proportion of dropouts and quality of life. There was no evidence of statistical heterogeneity between trials.We assessed outcomes by using a meta-analysis to calculate odds ratio (OR) with 95% confidence intervals (95% CI). For the 50% or greater reduction in focal seizure frequency outcome, the OR was significantly in favour of LEV [OR=2.94, 95% CI(1.99, 4.34)].Participants were significantly more likely in LEV groups than placebo groups to get seizure free[OR=5.31, 95% CI(2.49, 11.32)]. There was no significance between LEV groups and placebo groupsin the rate of Treatment withdrawal[OR=0.76, 95% CI(1.32, 1.82)]. Somnolence[OR=2.57, 95% CI(1.36, 4.86)]and changes in behaviour [OR=2.54, 95% CI(1.56, 4.14)] were significantly associated with LEV. Other adverse effects were not significantly associated with LEV in children.ConclusionThe existing evidence suggests that LEV add in treatment of children refractory epilepsy have definite curative effect, LEV long-term treatment effect is stable, good security, retention rate is higher, can be used in clinical further promotion.
Objective To investigate the changes of cognitive function of epileptic patients after antiepileptic drugs (AEDs) therapy. Methods Twenty eight cases of epileptic patients with new diagnosis and untreatment from March 2015 to February 2016 were collected. According to the seizure type, degree of attack and drug efficacy, patients were divided into three groups and treated with one of three AEDs, including Lamotrigine (LTG), Oxcarbazepine (OXC), and Sodium valproate (VPA). Among them, 11 were LTG group, 12 were OXC group and 5 were VPA group.Then the patients were followed up for 1 year. The clinical memory scale was used to analyze cognitive function of epileptic patients before and after therapy. Results Compared to 30 cases of healthy volunteers, the scores of memory quotient (P<0.01), directed memory (P<0.05), associative learning (P<0.05) and image free recall (P<0.01) of epileptic patients were obviously decreased before AEDs therapy.AEDs therapy reduced or controlled seizures in new diagnostic epileptic patients, and the total effective rate was 85.7%. In the clinical memory scale tests, the scores of memory quotient (P<0.01), directed memory (P<0.05), associative learning (P<0.05), portrait characteristics contact memory (P<0.05) were improved after therapy. The scores of image free recall and meaningless graphics recognition were also improved, but there was no statistical significance. Besides, there was a statistically significant improvement in the score of portrait characteristics contact memory after LTG treatment (P<0.05), and directed memory after VPA treatment (P<0.05). Conclusions Epileptic patients accompanied with cognitive deficits before drug intervention. Through standard AEDs treatment, seizures could be better controlled. The cognitive function of epileptic patients was not declined after short-term（within 1 year） intervention of LTG, OCX or VPA. Moreover some parts of the cognitive domain could be improved.
Objectives To investigate the effects of new antiepileptic drugs [oxcarbazepine (OXC), levetiracetam (LEV), lamotrigine (LTG)] on thyroid hormones in male adults with epilepsy. Methods Thirty-eight newly diagnosed male adult patients with epilepsy were enrolled in the Epilepsy Center of Sichuan Province People's Hospital from April 2015 to November 2016. The diagnosis was in line with the classification of epilepsy defined by the International League Against Epilepsy (ILAE, 1981). Only patients with generalized or secondary generalized epilepsy were recruited into the present study. Individual treatment with OXC, LEV, or LTG was randomly assigned to the 38 patients. Thyroid hormones was measured before treatment and 6 months after taking the medicine. Followed by an analysis of the comparison between the treated patients and healthy volunteers (healthy controls) as well as the changes and differences between the patients themselves before and after treatment. Results There was no significant difference in the thyroid hormone levels between male patients with epilepsy before taking the medicine and healthy controls (P>0.05). After 6 months, total thyroxine (TT4) and free thyroxine (FT4) in OXC group was significantly lower than the baseline (P<0.05). However, the thyroid hormone levels in the LEV group and LTG group showed no statistical difference before and after treatment (P>0.05). Conclusions OXC can reduce serum total thyroxine (TT4) and free thyroxine (FT4), which might be harmful to thyroid hormone of patients.
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.