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[PMID]:29285947
[Au] Autor:Willems LM; Zöllner JP; Paule E; Schubert-Bast S; Rosenow F; Strzelczyk A
[Ad] Endereço:a Epilepsy Center Frankfurt Rhine-Main and Department of Neurology , Goethe-University , Frankfurt am Main , Germany.
[Ti] Título:Eslicarbazepine acetate in epilepsies with focal and secondary generalised seizures: systematic review of current evidence.
[So] Source:Expert Rev Clin Pharmacol;11(3):309-324, 2018 Mar.
[Is] ISSN:1751-2441
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Eslicarbazepine acetate (ESL) is a third-generation antiepileptic drug (AED) approved for adjunctive treatment in adults, children, and adolescents with focal-onset seizures. Recently ESL was approved for initial monotherapy in adults. The intention of this article is to review current evidence for ESL and to summarise its pharmacological profile in comparison to other AEDs of the dibenzazepine group. Areas covered: We performed a systematic literature search in electronic databases (MEDLINE database, Cochrane Central Register of Controlled Trials, Excerpta Medica dataBASE) using a combined search strategy including the following keywords: eslicarbazepine, epilepsy and seizure. The search was performed from 2000 until December 2017. Using a standardised assessment form, information on the study design, methodological framework, data sources and efficacy and adverse events attributed to ESL were extracted from each publication and systematically reported. Expert commentary: ESL is an effective, safe and well tolerated third-generation AED for the treatment of focal epilepsies. During therapy, especially serum sodium levels and possible interactions with other substances have to be monitored. As of yet, long-term experience is still needed to make severe late-occurring adverse events unlikely and to obtain data regarding its use in pregnancy.
[Mh] Termos MeSH primário: Anticonvulsivantes/uso terapêutico
Dibenzazepinas/uso terapêutico
Epilepsias Parciais/tratamento farmacológico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Anticonvulsivantes/efeitos adversos
Criança
Dibenzazepinas/efeitos adversos
Interações Medicamentosas
Monitoramento de Medicamentos/métodos
Epilepsia Generalizada/tratamento farmacológico
Seres Humanos
Sódio/sangue
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anticonvulsants); 0 (Dibenzazepines); 9NEZ333N27 (Sodium); BEA68ZVB2K (eslicarbazepine acetate)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171230
[St] Status:MEDLINE
[do] DOI:10.1080/17512433.2018.1421066


  2 / 2716 MEDLINE  
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[PMID]:28464258
[Au] Autor:Vorderwülbecke BJ; Kowski AB; Kirschbaum A; Merkle H; Senf P; Janz D; Holtkamp M
[Ad] Endereço:Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité - University Medicine Berlin, Berlin, Germany.
[Ti] Título:Long-term outcome in adolescent-onset generalized genetic epilepsies.
[So] Source:Epilepsia;58(7):1244-1250, 2017 07.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Until now, it has been unclear if the three subsyndromes of adolescent-onset generalized genetic epilepsy (GGE) differ in long-term prognosis. Therefore, this study aimed to compare long-term seizure outcome in juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and epilepsy with generalized tonic-clonic seizures alone (EGTCS). METHODS: This retrospective study is based on the archive of an institutional tertiary care outpatient clinic for adult patients with epilepsy. Charts of 870 epilepsy outpatients were reviewed among whom 176 had adolescent-onset GGE (53 JAE, 66 JME, 57 EGTCS). Median patient age at investigation was 60 years; median follow-up time was 42.5 years. If possible, GGE patients were additionally interviewed on psychosocial and clinical variables. RESULTS: Age at first seizure was significantly higher in EGTCS patients (median 18 years) than in patients with JAE or JME (14 years each; p ≤ 0.001). Long-term seizure outcome hardly differed between the three subsyndromes. At the end of follow-up, 60% of all patients were in 5-year terminal seizure remission, and in 14%, epilepsy even had resolved (>10 years without seizures, >5 years without pharmacotherapy). Twenty percent of patients had persistent seizures during the last year of follow-up. Across all patients, 23% reported a psychiatric comorbidity, 87% had married, and 57% had achieved university entrance qualification. SIGNIFICANCE: Long-term outcome was shown to be highly similar across all subsyndromes of adolescent-onset GGE. Even in a selection of difficult-to-treat epilepsy patients still attending an adult epilepsy clinic, most become seizure-free. To confirm these findings, prospective studies are needed.
[Mh] Termos MeSH primário: Epilepsia Tipo Ausência/diagnóstico
Epilepsia Tipo Ausência/genética
Epilepsia Generalizada/diagnóstico
Epilepsia Generalizada/genética
Epilepsia Tônico-Clônica/diagnóstico
Epilepsia Tônico-Clônica/genética
Epilepsia Mioclônica Juvenil/diagnóstico
Epilepsia Mioclônica Juvenil/genética
[Mh] Termos MeSH secundário: Adolescente
Adulto
Anticonvulsivantes/uso terapêutico
Epilepsia Tipo Ausência/tratamento farmacológico
Epilepsia Generalizada/tratamento farmacológico
Epilepsia Tônico-Clônica/tratamento farmacológico
Feminino
Seres Humanos
Masculino
Meia-Idade
Epilepsia Mioclônica Juvenil/tratamento farmacológico
Prognóstico
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticonvulsants)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180107
[Lr] Data última revisão:
180107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13761


  3 / 2716 MEDLINE  
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[PMID]:28745672
[Au] Autor:Grebenyuk OV; Kazennykh TV; Alifirova VM; Svetlik MV; Bokhan NA
[Ad] Endereço:Siberian State Medical University, Tomsk, Russia.
[Ti] Título:[Gender aspects of medico-social adaptation in adults with early onset of epilepsy].
[Ti] Título:Gendernye aspekty mediko-sotsial'noi adaptatsii u vzroslykh pri rannem debiute épilepsii..
[So] Source:Zh Nevrol Psikhiatr Im S S Korsakova;117(6):53-58, 2017.
[Is] ISSN:1997-7298
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:AIM: To study the relationship between indicators of clinical picture and social adaptation in idiopathic and symptomatic epilepsies with onset before adulthood depending on patient's gender. MATERIAL AND METHODS: The cross-sectional study was carried out. The study group included 212 women and 171 men, aged 24-60 years, with confirmed diagnosis of epilepsy with onset before 18 years. Seventy-three patients were diagnosed with symptomatic epilepsy, 310 with idiopathic epilepsy. In 120 patients, the frequency of seizures was rarer than once a year. All patients had secondary education and were on treatment with antiepileptic drugs. RESULTS AND CONCLUSION: In symptomatic epilepsy with early onset, gender differences in family and educational status were not identified. Regardless of gender, patients with myoclonus had higher education more frequently than patients with absence and tonic-clonic seizures. Patients with the combination of different types of seizures, irrespective from etiology and gender, had secondary education more frequently. Women with rare generalized seizures more frequently had higher education and were married. Unmarried men with rare generalized seizures lived separately from their relatives more frequently. To author's opinion, the contradiction in indicators of social adaptation in men with rare generalized seizures, to the great extent, is related to the phenomenon of self-stigmatization than to the influence of disease. The results can be used in rehabilitation of patients with idiopathic epilepsy syndromes.
[Mh] Termos MeSH primário: Epilepsias Mioclônicas/psicologia
Epilepsia Generalizada/psicologia
Ajustamento Social
[Mh] Termos MeSH secundário: Adulto
Idade de Início
Anticonvulsivantes/uso terapêutico
Estudos Transversais
Escolaridade
Epilepsias Mioclônicas/tratamento farmacológico
Epilepsia Generalizada/tratamento farmacológico
Feminino
Seres Humanos
Masculino
Meia-Idade
Fatores Sexuais
Síndrome
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticonvulsants)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.17116/jnevro20171176153-58


  4 / 2716 MEDLINE  
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[PMID]:28913875
[Au] Autor:Santolini I; Celli R; Cannella M; Imbriglio T; Guiducci M; Parisi P; Schubert J; Iacomino M; Zara F; Lerche H; Moyanova S; Ngomba RT; van Luijtelaar G; Battaglia G; Bruno V; Striano P; Nicoletti F; EuroEPINOMICS CoGIE Consortium; Genetic Commission of Italian League Against Epilepsy (LICE)
[Ad] Endereço:I.R.C.C.S. Neuromed, Pozzilli, Italy.
[Ti] Título:Alterations in the α δ ligand, thrombospondin-1, in a rat model of spontaneous absence epilepsy and in patients with idiopathic/genetic generalized epilepsies.
[So] Source:Epilepsia;58(11):1993-2001, 2017 Nov.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Thrombospondins, which are known to interact with the α δ subunit of voltage-sensitive calcium channels to stimulate the formation of excitatory synapses, have recently been implicated in the process of epileptogenesis. No studies have been so far performed on thrombospondins in models of absence epilepsy. We examined whether expression of the gene encoding for thrombospondin-1 was altered in the brain of WAG/Rij rats, which model absence epilepsy in humans. In addition, we examined the frequency of genetic variants of THBS1 in a large cohort of children affected by idiopathic/genetic generalized epilepsies (IGE/GGEs). METHODS: We measured the transcripts of thrombospondin-1 and α δ subunit, and protein levels of α δ, Rab3A, and the vesicular glutamate transporter, VGLUT1, in the somatosensory cortex and ventrobasal thalamus of presymptomatic and symptomatic WAG/Rij rats and in two control strains by real-time polymerase chain reaction (PCR) and immunoblotting. We examined the genetic variants of THBS1 and CACNA2D1 in two independent cohorts of patients affected by IGE/GGE recruited through the Genetic Commission of the Italian League Against Epilepsy (LICE) and the EuroEPINOMICS-CoGIE Consortium. RESULTS: Thrombospondin-1 messenger RNA (mRNA) levels were largely reduced in the ventrobasal thalamus of both presymptomatic and symptomatic WAG/Rij rats, whereas levels in the somatosensory cortex were unchanged. VGLUT1 protein levels were also reduced in the ventrobasal thalamus of WAG/Rij rats. Genetic variants of THBS1 were significantly more frequent in patients affected by IGE/GGE than in nonepileptic controls, whereas the frequency of CACNA2D1 was unchanged. SIGNIFICANCE: These findings suggest that thrombospondin-1 may have a role in the pathogenesis of IGE/GGEs.
[Mh] Termos MeSH primário: Canais de Cálcio/genética
Modelos Animais de Doenças
Epilepsia Tipo Ausência/genética
Epilepsia Generalizada/genética
Trombospondina 1/genética
[Mh] Termos MeSH secundário: Animais
Canais de Cálcio/biossíntese
Estudos de Coortes
Epilepsia Tipo Ausência/metabolismo
Epilepsia Generalizada/metabolismo
Seres Humanos
Masculino
Ratos
Ratos Wistar
Trombospondina 1/biossíntese
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (CACNA2D1 protein, human); 0 (Calcium Channels); 0 (Thrombospondin 1); 0 (thrombospondin-1, human)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13898


  5 / 2716 MEDLINE  
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[PMID]:28899008
[Au] Autor:Epi4K Consortium
[Ti] Título:Phenotypic analysis of 303 multiplex families with common epilepsies.
[So] Source:Brain;140(8):2144-2156, 2017 Aug 01.
[Is] ISSN:1460-2156
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Gene identification in epilepsy has mainly been limited to large families segregating genes of major effect and de novo mutations in epileptic encephalopathies. Many families that present with common non-acquired focal epilepsies and genetic generalized epilepsies remain unexplained. We assembled a cohort of 'genetically enriched' common epilepsies by collecting and phenotyping families containing multiple individuals with unprovoked seizures. We aimed to determine if specific clinical epilepsy features aggregate within families, and whether this segregation of phenotypes may constitute distinct 'familial syndromes' that could inform genomic analyses. Families with three or more individuals with unprovoked seizures were studied across multiple international centres. Affected individuals were phenotyped and classified according to specific electroclinical syndromes. Families were categorized based on syndromic groupings of affected family members, examined for pedigree structure and phenotypic patterns and, where possible, assigned specific familial epilepsy syndromes. A total of 303 families were assembled and analysed, comprising 1120 affected phenotyped individuals. Of the 303 families, 117 exclusively segregated generalized epilepsy, 62 focal epilepsy, and 22 were classified as genetic epilepsy with febrile seizures plus. Over one-third (102 families) were observed to have mixed epilepsy phenotypes: 78 had both generalized and focal epilepsy features within the same individual (n = 39), or within first or second degree relatives (n = 39). Among the genetic generalized epilepsy families, absence epilepsies were found to cluster within families independently of juvenile myoclonic epilepsy, and significantly more females were affected than males. Of the 62 familial focal epilepsy families, two previously undescribed familial focal syndrome patterns were evident: 15 families had posterior quadrant epilepsies, including seven with occipito-temporal localization and seven with temporo-parietal foci, and four families displayed familial focal epilepsy of childhood with multiple affected siblings that was suggestive of recessive inheritance. The findings suggest (i) specific patterns of syndromic familial aggregation occur, including newly recognized forms of familial focal epilepsy; (ii) although syndrome-specificity usually occurs in multiplex families, the one-third of families with features of both focal and generalized epilepsy is suggestive of shared genetic determinants; and (iii) patterns of features observed across families including pedigree structure, sex, and age of onset may hold clues for future gene identification. Such detailed phenotypic information will be invaluable in the conditioning and interpretation of forthcoming sequencing data to understand the genetic architecture and inter-relationships of the common epilepsy syndromes.
[Mh] Termos MeSH primário: Epilepsia Generalizada/classificação
Saúde da Família
Fenótipo
[Mh] Termos MeSH secundário: Adolescente
Idade de Início
Criança
Pré-Escolar
Feminino
Seres Humanos
Masculino
Linhagem
Fatores Sexuais
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170914
[St] Status:MEDLINE
[do] DOI:10.1093/brain/awx129


  6 / 2716 MEDLINE  
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[PMID]:28842445
[Au] Autor:Zhang YH; Burgess R; Malone JP; Glubb GC; Helbig KL; Vadlamudi L; Kivity S; Afawi Z; Bleasel A; Grattan-Smith P; Grinton BE; Bellows ST; Vears DF; Damiano JA; Goldberg-Stern H; Korczyn AD; Dibbens LM; Ruzzo EK; Hildebrand MS; Berkovic SF; Scheffer IE
[Ad] Endereço:From the Epilepsy Research Centre, Department of Medicine (Y.-H.Z., R.B., J.P.M., G.C.G., K.L.H., L.V., B.E.G., S.T.B., D.F.V., J.A.D., M.S.H., S.F.B., I.E.S.), The University of Melbourne, Austin Health, Australia; Department of Pediatrics (Y.-H.Z.), Peking University First Hospital, Beijing, China
[Ti] Título:Genetic epilepsy with febrile seizures plus: Refining the spectrum.
[So] Source:Neurology;89(12):1210-1219, 2017 Sep 19.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Following our original description of generalized epilepsy with febrile seizures plus (GEFS+) in 1997, we analyze the phenotypic spectrum in 409 affected individuals in 60 families (31 new families) and expand the GEFS+ spectrum. METHODS: We performed detailed electroclinical phenotyping on all available affected family members. Genetic analysis of known GEFS+ genes was carried out where possible. We compared our phenotypic and genetic data to those published in the literature over the last 19 years. RESULTS: We identified new phenotypes within the GEFS+ spectrum: focal seizures without preceding febrile seizures (16/409 [4%]), classic genetic generalized epilepsies (22/409 [5%]), and afebrile generalized tonic-clonic seizures (9/409 [2%]). Febrile seizures remains the most frequent phenotype in GEFS+ (178/409 [44%]), followed by febrile seizures plus (111/409 [27%]). One third (50/163 [31%]) of GEFS+ families tested have a pathogenic variant in a known GEFS+ gene. CONCLUSION: As 37/409 (9%) affected individuals have focal epilepsies, we suggest that GEFS+ be renamed genetic epilepsy with febrile seizures plus rather than generalized epilepsy with febrile seizures plus. The phenotypic overlap between GEFS+ and the classic generalized epilepsies is considerably greater than first thought. The clinical and molecular data suggest that the 2 major groups of generalized epilepsies share genetic determinants.
[Mh] Termos MeSH primário: Epilepsias Parciais/fisiopatologia
Epilepsia Generalizada/fisiopatologia
Convulsões Febris/fisiopatologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idade de Início
Criança
Pré-Escolar
Epilepsias Parciais/genética
Epilepsia Generalizada/genética
Feminino
Seres Humanos
Lactente
Masculino
Meia-Idade
Linhagem
Fenótipo
Convulsões Febris/genética
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170827
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000004384


  7 / 2716 MEDLINE  
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[PMID]:28738275
[Au] Autor:Yang Z; Xue J; Li H; Qian P; Liu X; Jiang Y; Zhang Y
[Ad] Endereço:Department of Pediatrics, Peking University First Hospital, Beijing, China. Electronic address: zhixian.yang@163.com.
[Ti] Título:Early childhood myoclonic epilepsy: An independent genetic generalized epilepsy with myoclonic seizures as the main seizure type.
[So] Source:Clin Neurophysiol;128(9):1656-1663, 2017 Sep.
[Is] ISSN:1872-8952
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To elucidate the characteristics of the myoclonic seizures alone, or predominant myoclonus combined with generalized tonic-clonic seizures (GTCS) and/or absences, in early childhood, and discuss its classification. METHODS: Forty-two children were retrospectively recruited between January 2006 and June 2015. RESULTS: The mean age of seizure onset was 40.5months. They were divided into 4 groups: myoclonic seizures alone; predominant myoclonus combined with GTCS; predominant myoclonus combined with absences; predominant myoclonus combined with both GTCS and absences. Interictal EEG showed generalized spike- or polyspike-wave discharges at 2-4Hz. Seizures were controlled in 22 patients at a mean age of 60.5months. The psychomotor development was normal (30/37) or mildly delayed (7/37). CONCLUSIONS: We reported a cohort of patients with early childhood myoclonic epilepsy (ECME), with the following characteristics: Seizures started below 5years old in otherwise normal children; Seizure types included myoclonic seizures alone or combined with GTCS and/or absences; Febrile or afebrile GTCS might appear firstly; Interictal EEG showed generalized spike- or polyspike-wave; Seizures usually were in remission before adolescence with normal development or mild cognitive or behavioral deficits in most. SIGNIFICANCE: ECME might be an independent epileptic syndrome not established by International League Against Epilepsy (ILAE) previously.
[Mh] Termos MeSH primário: Eletroencefalografia
Epilepsias Mioclônicas/diagnóstico
Epilepsias Mioclônicas/fisiopatologia
Epilepsia Generalizada/diagnóstico
Epilepsia Generalizada/fisiopatologia
[Mh] Termos MeSH secundário: Pré-Escolar
Estudos de Coortes
Eletroencefalografia/métodos
Epilepsias Mioclônicas/genética
Epilepsia Generalizada/genética
Feminino
Seres Humanos
Lactente
Masculino
Mioclonia/diagnóstico
Mioclonia/fisiopatologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170725
[St] Status:MEDLINE


  8 / 2716 MEDLINE  
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[PMID]:28661008
[Au] Autor:Nevitt SJ; Sudell M; Weston J; Tudur Smith C; Marson AG
[Ad] Endereço:Department of Biostatistics, University of Liverpool, Block F, Waterhouse Building, 1-5 Brownlow Hill, Liverpool, UK, L69 3GL.
[Ti] Título:Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data.
[So] Source:Cochrane Database Syst Rev;6:CD011412, 2017 06 29.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Epilepsy is a common neurological condition with a worldwide prevalence of around 1%. Approximately 60% to 70% of people with epilepsy will achieve a longer-term remission from seizures, and most achieve that remission shortly after starting antiepileptic drug treatment. Most people with epilepsy are treated with a single antiepileptic drug (monotherapy) and current guidelines from the National Institute for Health and Care Excellence (NICE) in the United Kingdom for adults and children recommend carbamazepine or lamotrigine as first-line treatment for partial onset seizures and sodium valproate for generalised onset seizures; however a range of other antiepileptic drug (AED) treatments are available, and evidence is needed regarding their comparative effectiveness in order to inform treatment choices. OBJECTIVES: To compare the time to withdrawal of allocated treatment, remission and first seizure of 10 AEDs (carbamazepine, phenytoin, sodium valproate, phenobarbitone, oxcarbazepine, lamotrigine, gabapentin, topiramate, levetiracetam, zonisamide) currently used as monotherapy in children and adults with partial onset seizures (simple partial, complex partial or secondary generalised) or generalised tonic-clonic seizures with or without other generalised seizure types (absence, myoclonus). SEARCH METHODS: We searched the following databases: Cochrane Epilepsy's Specialised Register, CENTRAL, MEDLINE and SCOPUS, and two clinical trials registers. We handsearched relevant journals and contacted pharmaceutical companies, original trial investigators, and experts in the field. The date of the most recent search was 27 July 2016. SELECTION CRITERIA: We included randomised controlled trials of a monotherapy design in adults or children with partial onset seizures or generalised onset tonic-clonic seizures (with or without other generalised seizure types). DATA COLLECTION AND ANALYSIS: This was an individual participant data (IPD) review and network meta-analysis. Our primary outcome was 'time to withdrawal of allocated treatment', and our secondary outcomes were 'time to achieve 12-month remission', 'time to achieve six-month remission', 'time to first seizure post-randomisation', and 'occurrence of adverse events'. We presented all time-to-event outcomes as Cox proportional hazard ratios (HRs) with 95% confidence intervals (CIs). We performed pairwise meta-analysis of head-to-head comparisons between drugs within trials to obtain 'direct' treatment effect estimates and we performed frequentist network meta-analysis to combine direct evidence with indirect evidence across the treatment network of 10 drugs. We investigated inconsistency between direct estimates and network meta-analysis via node splitting. Due to variability in methods and detail of reporting adverse events, we have not performed an analysis. We have provided a narrative summary of the most commonly reported adverse events. MAIN RESULTS: IPD was provided for at least one outcome of this review for 12,391 out of a total of 17,961 eligible participants (69% of total data) from 36 out of the 77 eligible trials (47% of total trials). We could not include IPD from the remaining 41 trials in analysis for a variety of reasons, such as being unable to contact an author or sponsor to request data, data being lost or no longer available, cost and resources required to prepare data being prohibitive, or local authority or country-specific restrictions.We were able to calculate direct treatment effect estimates for between half and two thirds of comparisons across the outcomes of the review, however for many of the comparisons, data were contributed by only a single trial or by a small number of participants, so confidence intervals of estimates were wide.Network meta-analysis showed that for the primary outcome 'Time to withdrawal of allocated treatment,' for individuals with partial seizures; levetiracetam performed (statistically) significantly better than both current first-line treatments carbamazepine and lamotrigine; lamotrigine performed better than all other treatments (aside from levetiracetam), and carbamazepine performed significantly better than gabapentin and phenobarbitone (high-quality evidence). For individuals with generalised onset seizures, first-line treatment sodium valproate performed significantly better than carbamazepine, topiramate and phenobarbitone (moderate- to high-quality evidence). Furthermore, for both partial and generalised onset seizures, the earliest licenced treatment, phenobarbitone seems to perform worse than all other treatments (moderate- to high-quality evidence).Network meta-analysis also showed that for secondary outcomes 'Time to 12-month remission of seizures' and 'Time to six-month remission of seizures,' few notable differences were shown for either partial or generalised seizure types (moderate- to high-quality evidence). For secondary outcome 'Time to first seizure,' for individuals with partial seizures; phenobarbitone performed significantly better than both current first-line treatments carbamazepine and lamotrigine; carbamazepine performed significantly better than sodium valproate, gabapentin and lamotrigine. Phenytoin also performed significantly better than lamotrigine (high-quality evidence). In general, the earliest licenced treatments (phenytoin and phenobarbitone) performed better than the other treatments for both seizure types (moderate- to high-quality evidence).Generally, direct evidence and network meta-analysis estimates (direct plus indirect evidence) were numerically similar and consistent with confidence intervals of effect sizes overlapping.The most commonly reported adverse events across all drugs were drowsiness/fatigue, headache or migraine, gastrointestinal disturbances, dizziness/faintness and rash or skin disorders. AUTHORS' CONCLUSIONS: Overall, the high-quality evidence provided by this review supports current guidance (e.g. NICE) that carbamazepine and lamotrigine are suitable first-line treatments for individuals with partial onset seizures and also demonstrates that levetiracetam may be a suitable alternative. High-quality evidence from this review also supports the use of sodium valproate as the first-line treatment for individuals with generalised tonic-clonic seizures (with or without other generalised seizure types) and also demonstrates that lamotrigine and levetiracetam would be suitable alternatives to either of these first-line treatments, particularly for those of childbearing potential, for whom sodium valproate may not be an appropriate treatment option due to teratogenicity.
[Mh] Termos MeSH primário: Anticonvulsivantes/uso terapêutico
Epilepsia/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Aminas/uso terapêutico
Carbamazepina/análogos & derivados
Carbamazepina/uso terapêutico
Criança
Ácidos Cicloexanocarboxílicos/uso terapêutico
Epilepsias Parciais/tratamento farmacológico
Epilepsia Generalizada/tratamento farmacológico
Frutose/análogos & derivados
Seres Humanos
Isoxazóis/uso terapêutico
Metanálise em Rede
Fenobarbital/uso terapêutico
Fenitoína/uso terapêutico
Piracetam/análogos & derivados
Piracetam/uso terapêutico
Indução de Remissão
Triazinas
Ácido Valproico/uso terapêutico
Ácido gama-Aminobutírico/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Amines); 0 (Anticonvulsants); 0 (Cyclohexanecarboxylic Acids); 0 (Isoxazoles); 0 (Triazines); 0H73WJJ391 (topiramate); 230447L0GL (etiracetam); 30237-26-4 (Fructose); 33CM23913M (Carbamazepine); 459384H98V (zonisamide); 56-12-2 (gamma-Aminobutyric Acid); 614OI1Z5WI (Valproic Acid); 6158TKW0C5 (Phenytoin); 6CW7F3G59X (gabapentin); U3H27498KS (lamotrigine); VZI5B1W380 (oxcarbazepine); YQE403BP4D (Phenobarbital); ZH516LNZ10 (Piracetam)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170824
[Lr] Data última revisão:
170824
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170630
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD011412.pub2


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[PMID]:28658141
[Au] Autor:Qu J; Lu SH; Lu ZL; Xu P; Xiang DX; Qu Q
[Ad] Endereço:aDepartment of Pharmacy, the Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy bDepartment of Neurosurgery, the Third Xiangya Hospital cDepartment of Pathology, the Affiliated Cancer Hospital of Xiangya School of Medicine dDepartment of Pharmacy, Xiangya Hospital, Central South University, Changsha, P. R. China.
[Ti] Título:Pharmacogenetic and case-control study on potassium channel related gene variants and genetic generalized epilepsy.
[So] Source:Medicine (Baltimore);96(26):e7321, 2017 Jun.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Potassium channels are the targets of antiepileptic drugs (AEDs), which play important roles in the etiology of epilepsy. KCNA1 and KCNA2 encode mammalian Kv1.1 and Kv1.2 channels, which are essential roles in the initiation and shaping of action potentials. KCNV2 encodes Kv8.2, which is a regional overlap with Kv2 subunits as functional heterotetramers. In our study, we aim to investigate whether variants of KCNA1, KCNA2, and KCNV2 genes influence susceptibility to genetic generalized epilepsies (GGEs) and the efficacy of AEDs. Seven hundred sixty-seven subjects (284 healthy controls, 279 drug-responsive, and 204 drug-resistant GGE patients) were enrolled in our study. Eight variants of KCNA1, KCNA2, and KCNV2 were assessed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry method. Results showed that there were no statistically significant correlations between the 8 variants of KCNA1, KCNA2, and KCNV2 and the risk/drug resistance of GGEs. In conclusion, our study suggests that KCNA1, KCNA2, and KCNV2 variants may not be involved in the risk/drug resistance of GGEs. Further multicenter, multiethnic, and large sample size pharmacogenetic and case-control studies are warranted to confirm our negative results.
[Mh] Termos MeSH primário: Epilepsia Resistente a Medicamentos/genética
Epilepsia Generalizada/genética
Canal de Potássio Kv1.1/genética
Canal de Potássio Kv1.2/genética
Canais de Potássio de Abertura Dependente da Tensão da Membrana/genética
[Mh] Termos MeSH secundário: Adolescente
Anticonvulsivantes/uso terapêutico
Estudos de Casos e Controles
Resistência a Medicamentos/genética
Epilepsia Resistente a Medicamentos/tratamento farmacológico
Epilepsia Generalizada/tratamento farmacológico
Feminino
Predisposição Genética para Doença
Técnicas de Genotipagem
Seres Humanos
Desequilíbrio de Ligação
Masculino
Variantes Farmacogenômicos
Polimorfismo de Nucleotídeo Único
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anticonvulsants); 0 (KCNA1 protein, human); 0 (KCNA2 protein, human); 0 (KCNV2 protein, human); 0 (Kv1.2 Potassium Channel); 0 (Potassium Channels, Voltage-Gated); 147173-20-4 (Kv1.1 Potassium Channel)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007321


  10 / 2716 MEDLINE  
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[PMID]:28591476
[Au] Autor:Striano S; Striano P
[Ad] Endereço:Department of Neurosciences, Reproductive and Odontostomatological Sciences, Epilepsy Center, School of Medicine, Federico II University, Napoli, Italy.
[Ti] Título:Clinical features and evolution of the gelastic seizures-hypothalamic hamartoma syndrome.
[So] Source:Epilepsia;58 Suppl 2:12-15, 2017 Jun.
[Is] ISSN:1528-1167
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Gelastic seizures, usually with onset in early infancy, are the hallmark manifestation of hypothalamic hamartoma. This seizure type is directly generated by hamartoma itself, intrinsically epileptogenic because of its anatomofunctional organization. Other types of seizures, focal or generalized, may appear during the evolution, probably resulting from mechanisms of secondary epileptogenesis. Nevertheless, the clinical expression and the severity of the syndrome, ranging from a focal drug-resistant epilepsy to a catastrophic generalized encephalopathy with severe cognitive and behavioral impairments, depends on the size and the site of attachment of the hamartoma. Early suspicion, timely diagnosis, and appropriate treatment are mandatory to reverse a potential catastrophic evolution of this condition.
[Mh] Termos MeSH primário: Epilepsias Parciais/diagnóstico
Hamartoma/diagnóstico
Doenças Hipotalâmicas/diagnóstico
[Mh] Termos MeSH secundário: Criança
Transtornos do Comportamento Infantil/diagnóstico
Transtornos do Comportamento Infantil/fisiopatologia
Transtornos do Comportamento Infantil/cirurgia
Pré-Escolar
Transtornos Cognitivos/diagnóstico
Transtornos Cognitivos/fisiopatologia
Transtornos Cognitivos/cirurgia
Progressão da Doença
Epilepsia Resistente a Medicamentos/diagnóstico
Epilepsia Resistente a Medicamentos/fisiopatologia
Epilepsia Resistente a Medicamentos/cirurgia
Diagnóstico Precoce
Intervenção Médica Precoce
Eletroencefalografia
Epilepsias Parciais/fisiopatologia
Epilepsias Parciais/cirurgia
Epilepsia Generalizada/diagnóstico
Epilepsia Generalizada/fisiopatologia
Epilepsia Generalizada/cirurgia
Hamartoma/fisiopatologia
Hamartoma/cirurgia
Seres Humanos
Doenças Hipotalâmicas/fisiopatologia
Doenças Hipotalâmicas/cirurgia
Hipotálamo/fisiopatologia
Hipotálamo/cirurgia
Lactente
Excitação Neurológica/fisiologia
Tomografia por Emissão de Pósitrons
Prognóstico
Radiocirurgia
Processamento de Sinais Assistido por Computador
Síndrome
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE
[do] DOI:10.1111/epi.13753



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