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.
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.
ObjectiveTo systematically evaluate the efficacy of steroids combined with antiepileptic drugs compared with alone antiepileptic drugs in the treatment of children with epileptic electrical status during sleep to provide evidence-based medical basis for its treatment.MethodsElectronic searches were maded in PubMed, Embase database, Cochrane Library, CNKI, Wanfang and the Chinese biomedical literature database for the literature about steroids combined with antiepileptic drugs compared with alone antiepileptic drugs in the treatment, and retrieval time is from January 1990 to October 2020. Two evaluators independently screened literature, extracted data, evaluated literature quality and risk of bias and checked each other. Meta analysis was performed by stata16.0 software.ResultsA total of 679 children with ESES were included in 10 studies, including 9 randomized controlled trials and 1 retrospective cohort study. Meta analysis results showed that there were statistically significant differences in clinical improvement rate [RR=1.31, 95%CI (1.21, 1.42), P<0.01], electroencephalogram discharge improvement rate [RR=1.35, 95%CI (1.25, 1.46), P<0.01] and cognitive intelligence score [SMD=1.19, 95%CI (0.80, 1.57), P<0.01] between steroids combined with antiepileptic drugs group and alone antiepileptic drugs group after 6 months follow-up. The incidence of adverse reactions in steroids combined with antiepileptic drugs group was higher than that in alone antiepileptic drugs group, and the difference was statistically significant [RR=4.13, 95%CI (1.06, 16.13), P<0.01]. All adverse reactions improved or disappeared after drug withdrawal.ConclusionCompared with alone antiepileptic drugs, steroids combined with antiepileptic drugs group has advantages in controlling epileptic seizures, improving electroencephalogram abnormalities and improving cognitive ability, and it is relatively safe.
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.
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.
PurposeTo analyze the effect of medication withdraw (MW) on long-term electroencephalogram (EEG) monitoring in children who need preoperative assessment for refractory epilepsy.MethodsRetrospective analysis was performed on the data of preoperative long-term EEG monitoring of children with refractory epilepsy who needed preoperative evaluation in the Pediatric Epilepsy Center of Peking University First Hospital from August 2018 to December 2019. Monitoring duration: at least three habitual seizures were detected, or the monitoring duration were as long as 10 days. MW protocol was according to the established plan.ResultsA total of 576 children (median age 4.4 years) required presurgical ictal EEGs, and 75 (75/576, 13.0%) needed MW for ictal EEGs. Among the 75 cases, 38 were male and 37 were female. The age range was from 15 months to 17 years (median age: 7.0 years). EEG and clinical data of with 65 children who strictly obey the MW protocol were analyzed. The total monitoring duration range was from 44.1 h (about 2 days) to 241.8 h (about 10 days)(median: 118.9 h (about 5 days)). Interictal EEG features before MW were including focal interictal epileptiform discharge (IED) in 39 cases (39/65, 60%), focal and generalized IED in 2 cases (2/65, 3.1%), multifocal IED in 20 cases (20/65, 30.7%), multifocal and generalized IED in 2 cases (2/65, 3.1%), and no IED in 2 cases (2/65, 3.1%). After MW, 18 cases (18/65, 27.7%) had no change in IED and the other 47 cases had changes of IED after MW. And IEDs in 46 cases (46/65, 70.8%) were aggravated, and IED was decreased in 1 case. The pattern of aggravated IED was original IED increasement, in 41 cases (41/46, 89.1%), and 5 cases (5 /46, 10.9%) had generalized IED which was not detected before MW. Of the 46 patients with IED exacerbations, 87.3% appeared within 3 days after MW. Habitual seizures were detected in 56 cases (86.2%, 56/65) after MW, and within 3 days of MW in 80.4% cases. Eight patients (14.3%) had secondary bilateral-tonic seizure (BTCS), of which only 1 patient had no BTCS in his habitual seizures. In 56 cases, 94.6% (53/56) had seizures after MW of two kinds of AEDs.Conclusions① In this group, thirteen percent children with intractable epilepsy needed MW to obtain ictal EEG; ② Most of them (86.2%) could obtain ictal EEG by MW. The IED and ictal EEG after MW were still helpful for localization of epileptogenic zone; ③ Most of the patients can obtain ictal EEG within 3 days after MW or after MW of two kinds of AEDs;4. The new secondary generalization was extremely rare.
ObjectiveTo investigate the anxious level of people with epilepsy (PWE) during the outbreak of 2019 Novel Coronavirus Diseases (COVID-19) and explore the reasons of anxiety.MethodsAn internet questionnaire survey were conducted on the anxiety state of PWE and health controls (HC) aged 18 to 45 years old between Feb 9, 2020 and Feb 17, 2020. The questionnaire included demographic information, general status and the State-Trait Anxiety Inventory (STAI).ResultsIn all, 148 PWE and 300 HC were included in this study. The total SAI score (46.72±9.98 vs. 41.77±10.20, P<0.001) and the total TAI score (44.18±8.88 vs. 31.27±17.44, P<0.001) were significantly higher in PWE than in HC. PWE concerned most (69.9%) about the difficulty of obtaining antiepileptic drugs (AEDs) while HC concerned most about the lack of face masks (73.3%).ConclusionHigh anxious level in PWE during the outbreak of COVID is probably due to the difficulty of obtaining AEDs. Thus, the society should strengthen the solution of the problem of purchasing AEDs and conduct timely psychological counseling.
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 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.