Cenobamate as an Early Adjunctive Treatment in Drug-Resistant Focal-Onset Seizures: An Observational Cohort Study

CNS Drugs, Journal Year: 2024, Volume and Issue: 38(9), P. 733 - 742

Published: Aug. 3, 2024

Cenobamate (CNB) is a new antiseizure medication (ASM) to treat drug-resistant, focal-onset seizures. Data on its use in early therapy lines are not yet available, and clinicians frequently consider CNB be later ASM drug choice. We investigated the efficacy safety of as an adjunctive treatment The study population were patients with seizures who initiated after they did respond two or three lifetime ASMs, including all prior concomitant ASMs. These matched (1:2) by sex, age, seizure frequency controls any other than CNB. All participants participated Mainz Epilepsy Registry. evaluated retention rate 12 months each control group. In addition, freedom response (reduction ≥ 50% from baseline) estimated. included 231 aged 44.4 ± 15.8 years. Of these, 33.3% (n = 77) CNB, 19.0% 44) valproate (VPA), 17.3% 40) lacosamide (LCS), 16.4% 38) levetiracetam (LEV), 13.9% 32) topiramate (TPM). highest since beginning was observed (92.0%), compared LCS (80.0%), LEV (73.3%), VPA (68.2%), TPM (62.5%) (p < 0.05). Seizure also best (19.5% 71.4%, respectively) ASMs (8.3% 52.5%, respectively; p No significant differences adverse events between observed. Our provides evidence that effective good profile This data should support medical decision making management refractory epilepsy. NCT05267405.

Language: Английский

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Differences in patterns of outpatient epilepsy‐specific medication initiation after acute ischemic stroke in the Medicare population

Epilepsia, Journal Year: 2025, Volume and Issue: unknown

Published: April 4, 2025

Acute ischemic stroke (AIS) is a leading hospitalization cause and significantly contributes to seizures among older adults. We examined outpatient epilepsy-specific medication (ESM) initiation patterns after AIS discharge in adults 65 years older, trends over time (by stratifying the analysis from 2013 2021), racial/ethnic differences. analyzed nationwide administrative claims data for 20% sample of US Medicare beneficiaries (enrolled Traditional Parts A, B, D at least 12 months before admission) aged ≥65 hospitalized between 2021. estimated cumulative incidence ESM within 90 days discharge, with mortality as competing risk censoring person if individuals experienced an inpatient readmission. described drug type stratified our by race, ethnicity, geographic region, hospital year discharge. Of 128 174 community-dwelling 2435 (1.9%, 95% confidence interval [CI] = 1.8%-2.0%) initiated 90-day follow-up period levetiracetam was most common across all (81%). Mean age 79 (range 65-110), 56% were female, 81% non-Hispanic White, 10% Black/African American, 5% Hispanic, 3% Asian. The overall 1.4% (95% CI 1.3%-1.4%); it 1.8% 1.6%-2.1%) 1.9% 1.6%-2.3%) 1.2% 1.2%-1.3%) White beneficiaries. also varied Census division, 1.0% .8-1.3; West North Central) 1.5% 1.3%-1.8%; East South Central). observed increase time, 1.0%-1.5%) 1.7% 1.5%-1.9%) 1.6% 1.4%-1.8%) 65-70-year group decreased groups. American Hispanic had higher post-AIS than Whites.

Language: Английский

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Levetiracetam, from broad-spectrum use to precision prescription: A narrative review and expert opinion

Seizure, Journal Year: 2023, Volume and Issue: 107, P. 121 - 131

Published: March 24, 2023

Language: Английский

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Bidirectional two-sample Mendelian randomization analysis identifies causal associations between cardiovascular diseases and frozen shoulder

Journal of Orthopaedic Surgery and Research, Journal Year: 2024, Volume and Issue: 19(1)

Published: Feb. 3, 2024

Abstract Background Although prior observational studies indicate an association between cardiovascular diseases (CVDs) and frozen shoulder (FS), the potential causal relationship them remains uncertain. This study aims to explore genetic CVDs FS using Mendelian randomization (MR). Methods Genetic variations closely associated with were obtained from FinnGen Consortium. Summary data for CVD, including atrial fibrillation (AF), coronary artery disease (CAD), heart failure (HF), myocardial infarction (MI), stroke, ischemic stroke (IS), sourced several large-scale genome-wide (GWAS). MR analysis was performed inverse variance weighting (IVW), Egger, weighted median methods. IVW, as primary method, complemented by other sensitivity analyses, utilized validate robustness of results. Further reverse conducted presence relationships. Results In forward analysis, genetically determined risk IS positively (OR [95% CI] = 1.58 (1.23–2.03), P < 0.01; OR 1.46 (1.16–1.85), 0.01, respectively). There no strong evidence effect predicted on risk. Sensitivity analyses confirmed relationships observed various CVDs. Conclusion The suggests that increases developing FS. However, further basic clinical research is needed substantiate our findings.

Language: Английский

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Antiseizure medication use in acute symptomatic seizures: A narrative review

Epilepsia, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 22, 2025

Abstract Acute symptomatic seizures, occurring shortly after a central nervous system insult, constitute nearly half of all seizure cases. However, there is conspicuous absence clear, comprehensive, and cohesive guidelines for the management these seizures with antiseizure medications, especially their duration use. This lack consensus on optimal therapy leads to prolonged treatments that may carry adverse consequences. The primary objective this narrative review present existing evidence‐based literature acute within context underlying pathologies trigger them. We explore risk developing epilepsy each specific etiology identify factors influence risk. Finally, facilitate decision‐making regarding treatment duration, we categorize based temporal characteristics hyperexcitability as acute, subacute, prolonged. Such rubric offer clarity in an area where are lacking.

Language: Английский

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Antiseizure Medications in Poststroke Seizures

Neurology, Journal Year: 2025, Volume and Issue: 104(3)

Published: Jan. 14, 2025

The most effective antiseizure medications (ASMs) for poststroke seizures (PSSs) remain unclear. We aimed to determine outcomes associated with ASMs in people PSS. systematically searched electronic databases studies on patients PSS ASMs. Our were seizure recurrence, adverse events, drug discontinuation rate, and mortality. assessed the risk of bias using Cochrane Risk Bias tool randomized controlled trials Of In Non-randomized Studies Interventions tools. Using levetiracetam as reference treatment, we conducted a frequentist network meta-analysis determined certainty evidence Grading Recommendations Assessment, Development, Evaluation methodology. search yielded 15 (3 randomized, 12 nonrandomized, N = 18,676 (121 early 18,547 late seizures), 60% male, mean age 69 years) comparing 13 Three had moderate high bias. Seizure recurrence was 24.8%. Compared levetiracetam, very low-certainty suggested that phenytoin higher recurrences (odds ratio [OR] 7.3, 95% CI 3.7-14.5) more events (OR 5.2, 1.2-22.9). Low-certainty carbamazepine 1.8, 1.5-2.2) 1.9, 1.4-2.8) rates. Moderate high-certainty valproic acid 4.7, 3.6-6.3) 8.3, 5.7-11.9) mortality Considering all treatments GRADE approach treatment ranking, eslicarbazepine, lacosamide, fewest recurrences. Low lamotrigine discontinuations, whereas exhibited low rates moderate-certainty evidence. found may be safe tolerable Despite ASM use, rate remains population. Owing confounding risks, these findings should interpreted cautiously. PROSPERO: CRD42022363844.

Language: Английский

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Comparative risk of major health events among individuals prescribed different antiseizure medications following ischemic stroke

Epilepsia, Journal Year: 2025, Volume and Issue: unknown

Published: March 11, 2025

Abstract Objective The aim of this study was to compare the risk seizure, recurrent stroke, fall or fracture, and mortality in individuals prescribed different antiseizure medications (ASMs) following an ischemic stroke. Methods We identified all patients admitted a Victorian public private hospital with principal diagnosis incident stroke between 2013 2017 dispensed ASM within 12 months discharge. Cox proportional hazards regression used estimate cause‐specific rehospitalization emergency department visits (seizure, stroke) all‐cause over 2‐year period. Inverse probability treatment weighting applied each model adjust for baseline covariates. Results Of 19 601 hospitalized 897 initiated months. More than three quarters were on non‐enzyme‐inducing (78.0%). Levetiracetam (41.9%), valproate (28.4%), carbamazepine (11.4%) commonly initial ASMs. Non‐enzyme‐inducing ASMs demonstrated similar seizure (hazard ratio [HR] = .93, 95% confidence interval [CI] .63–1.37), fracture (HR 1.47, CI .92–2.34), .83; .52–1.33), .96; .69–1.32) compared enzyme‐inducing However, when grouped as separate class, 1.67, 1.04–2.71) showed higher Significance At population level, types no significant differences hospitalization presentation 2 years presentation, suggesting short‐term health outcomes real‐world setting. Future research should investigate decision‐making around choice survivors examine impact long‐term exposure outcomes.

Language: Английский

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Choice of Epilepsy Anti-Seizure Medications and Associated Outcomes in Medicare Beneficiaries

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2025, Volume and Issue: unknown

Published: March 20, 2025

The lack of specific guidelines for seizure treatment after acute ischemic stroke (AIS), makes the choice an appropriate anti-seizure medication a challenge providers because each drug may have different adverse effects and outcomes. In this retrospective matched cohort study, we analyzed 20% sample U.S. Medicare beneficiaries aged 65 over hospitalized first (AIS) between 2009-2021 who were discharged home. We included individuals enrolled in hospital, medical prescription insurance 12 months prior to hospitalization not taking epilepsy-specific (ESM) hospitalization. on days from discharge ESM initiation. Individuals initiated ESMs other than Levetiracetam, i.e. Lamotrigine, Carbamazepine, Oxcarbazepine within 30 (N = 229) Levetiracetam initiators =687). investigated time seizure-like events, emergency department (ED) visits, re-hospitalizations with follow-up 180 initiation using semi-competing risk framework. estimated average effect among treated those received ESMs. 916 had median age 74 (IQR 69, 82) was 57% female 71% Non-Hispanic White. Using framework, 37% lower hazard events compared receiving LEV, given that death occurred, ratio 0.63 (95% CI: 0.43, 0.91). Among ED visits hospitalizations, did significantly initiating Levetiracetam; ratios 1.00 0.80, 1.25) 0.98 0.75, 1.28), respectively. home, outpatient setting associated higher However, no significant differences observed incidence or suggesting comparable safety profiles these broader clinical

Language: Английский

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Perampanel in post-stroke epilepsy: Clinical practice data from the PERampanel as Only Concomitant antiseizure medication (PEROC) study

Journal of the Neurological Sciences, Journal Year: 2024, Volume and Issue: 462, P. 123106 - 123106

Published: June 21, 2024

Language: Английский

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Post-Stroke Epilepsy: from clinical predictors to possible mechanisms

Epilepsy Research, Journal Year: 2023, Volume and Issue: 199, P. 107282 - 107282

Published: Dec. 14, 2023

Language: Английский

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