rss_2.0Pharmacy FeedSciendo RSS Feed for Pharmacy Feed and experiences of satellite haemophilia clinic set-ups in Uganda – a short report<abstract> <title style='display:none'>Abstract</title> <p>Haemophilia knowledge and care are largely missing in much of sub-Saharan Africa and there is a need for concerted efforts to ensure access to care services by affected persons. Haemophilia Foundation Uganda, supported by the global haemophilia community and working with the Uganda Ministry of Health, has set up eight satellite haemophilia treatment centres (HTCs) as part of a wider initiative to raise awareness and improve haemophilia care. Setting up the HTCs has involved a six-step process involving stakeholders in government, healthcare and the community, and ranging from securing initial support to an ongoing follow-up programme of mentorship and training. Over 1,700 healthcare professionals have been trained and 186 patients have been registered at these peripheral facilities over the past five years. This is helping to improve access to care, but there are still shortcomings around diagnostic capacity, available healthcare personnel, and facilities to procure recombinant factor products. We will continue and further our advocacy for budgetary inclusion of haemophilia at political and facility levels. We also propose a continued strengthening of the haemophilia care teams through mentorship, networking, and mobilisation for diagnostic support at large public hospitals.</p> </abstract>ARTICLE2022-05-20T00:00:00.000+00:00Discrete choice experiments: An overview of experience to date in haemophilia<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title><p>The patient voice is an important consideration in the availability and choice of pharmaceuticals – however, how to capture this complex area and apply it formally within regulation, health technology assessment and reimbursement remains subject to ongoing debate. Patient preference studies such as discrete choice experiments (DCEs) are being utilised more frequently in healthcare and it is anticipated that patient preference data will be incorporated more frequently into regulatory submissions moving forward.</p></sec> <sec><title style='display:none'>Aim</title><p>The aim of this review is to provide an overview of DCEs conducted within haemophilia to date and to consider the key issues in response to a rapidly evolving therapeutic pathway.</p></sec> <sec><title style='display:none'>Methods</title><p>A systematic literature search was undertaken via Ovid MEDLINE and EMBASE CLASSIC + EMBASE. Abstracts were uploaded and analysed via Rayyan systematic review software. Results: Of 478 records identified from the database searches, 12 full text journal articles met the inclusion criteria with a date range from 2005–2021. There have been two published studies exploring haemophilia patient preferences in relation to gene therapy: one DCE and one utilising a threshold technique. Surveyed audiences included physicians, patients, pharmacists, healthcare professionals and caregivers. 50% of the included studies (n=6) were exclusively conducted in the US, whilst 3 recruited participants across multiple countries. The sample size varied considerably between studies with the total sample size ranging from 30 participants to 505 participants. For the studies involving patients and their caregivers, the mean patient age range was 8.2–41.4 years. There was diversity in (a) the scale of the qualitative work undertaken to support the DCEs, (b) the undertaking of pilots, and (c) how extensively these elements were reported in the included studies. There is a notable trend towards using an online web-based format, with 3 out of 4 DCEs since 2019 utilising this approach. The number of attributes observed per DCE ranged from 5–12 with a median of 6 attributes from the included studies. The number of levels per attribute was relatively consistent (range 2–5) with 2–3 (n=4) and 2–4 levels (n=4) being utilised most frequently.</p></sec> <sec><title style='display:none'>Conclusion</title><p>Patient preferences and the methods for capturing these are likely to be subject to ongoing debate as the haemophilia care pathway evolves to offer more therapeutic options with a range of risks and benefits. Whilst techniques such as DCE are effective at quantifying patient preferences, they tell us little about the reasons driving these decisions and the likelihood that they will change in response to temporal or external factors. DCEs could be particularly useful for estimating the uptake of new products and assessing potential budget impact. Accelerated and reformed regulatory processes are likely to increase demand for patient preference studies. There is therefore an increased requirement to ensure that patient advocacy groups (PAGs) are resourced and have the expertise to support these studies alongside other research commitments, and that manufacturers consider collaborative approaches when formally capturing patient preferences.</p> <p><fig id="j_jhp-2022-0006_fig_007" position="float" fig-type="figure"><caption><p>As more therapeutic options become available in haemophilia care, discrete choice experiment may be a useful means of gauging patient preference</p><p>© Shutterstock</p></caption><graphic xmlns:xlink="" xlink:href="graphic/j_jhp-2022-0006_fig_007.jpg"/></fig></p></sec> </abstract>ARTICLE2022-05-20T00:00:00.000+00:00Point of care ultrasonography in patients with haemophilia and acute haemarthrosis: a physiotherapist and sonographer inter-professional agreement pilot study<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title><p>Haemophilia treatment centres (HTCs) around the world are increasingly adopting point-of-care ultrasonography (POCUS) for the assessment of acute haemarthrosis and to monitor joint health. POCUS is in large part administered by physiotherapists in most comprehensive care teams. Appropriate implementation of haemophilia-specific POCUS requires an educational foundation and training to ensure competency and optimal outcomes. Inter-professional agreement and evaluation of image quality are important measures of competency and acceptable use of POCUS.</p></sec> <sec><title style='display:none'>Aims</title><p>To determine the level of agreement between physiotherapist and sonographer-performed POCUS scans and to compare the quality of the ultrasound images obtained by physiotherapists to those obtained by the sonographer.</p></sec> <sec><title style='display:none'>Methods</title><p>This single blind, prospective, pilot study recruited patients with haemophilia A and B who presented to clinic with a suspected acute haemarthrosis of the elbow, knee, or ankle and consented to participate. POCUS scans were performed by one trained physiotherapist and one sonographer in the haemophilia ambulatory clinic at patient presentation, one-week follow-up, and two-week follow-up. The physiotherapist participated in formal training consisting of 12 hours of online didactic modules and a two-day, 12-hour practical module with instructor-led hands-on training. For the primary objective, the outcome of interest was the binary decision on the presence or absence of blood within the joint. For the secondary objective, image quality was evaluated by the radiologist post hoc and rated as optimal, acceptable, or sub-optimal.</p></sec> <sec><title style='display:none'>Results</title><p>Thirteen participants with haemophilia consented to the study. The results indicated an excellent level of agreement (k=0.80) with an observed agreement of 91.7%, a specific positive agreement of 94.1%, and a specific negative agreement of 85.7% for the detection of blood within the joint space. The quality of the ultrasound images obtained by the physiotherapist were rated by the radiologist as optimal (84.6%) and acceptable (15.4%). None of the images were rated as sub-optimal.</p></sec> <sec><title style='display:none'>Conclusion</title><p>Optimal image quality and a high level of agreement between the physiotherapist and sonographer-performed POCUS for the assessment of acute hemarthrosis in people with haemophilia A and B was observed. These results suggest that, with a short formal training programme, physiotherapists can be proficient in the performance, acquisition, and interpretation of POCUS scans in patients with haemophilia.</p></sec> </abstract>ARTICLE2022-05-20T00:00:00.000+00:00Treatment of a patient with severe haemophilia A presenting with left extra pleural haematoma and diagnosed with inhibitors – case report<abstract> <title style='display:none'>Abstract</title> <p>Haemophilia is an inherited X-linked bleeding disorder characterised by a deficiency or absence of clotting factor VIII (haemophilia A) or IX (haemophilia B), which can cause musculoskeletal bleeding. The standard treatment for haemophilia is with factor concentrates to replace the missing or deficient clotting factor. However, there is a risk that the immune system develops antibodies against the exogenous factor, known as inhibitors. Managing patients with haemophilia and inhibitors who develop bleeding in unusual sites can be challenging for the treating physician. Here, we present a rare case of patient with severe haemophilia A who was diagnosed with inhibitors after developing bleeding in the left posterior chest wall (extra pleural haematoma). The patient was successfully managed with activated prothrombin complex concentrate (aPCC) (FEIBA: FVIII inhibitor bypassing activity; Baxter AG), and the pain and swelling gradually resolved over three weeks. This case emphasises the importance of clinical suspicion of inhibitor formation in a patient already diagnosed with haemophilia A presenting with unusual bleeding that does not respond to standard treatment.</p> </abstract>ARTICLE2022-05-20T00:00:00.000+00:00The role of the hepatic metabolisation for the interaction between valproic acid and carbapenem antibiotics interrelationship between clinical and immunity variables in epilepsy<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0015_s_001"><title style='display:none'>Introduction</title><p>The role of cellular immunity in the pathogenesis of epilepsy, as an interaction between immunity and clinical and neurobiological variables is not properly understood.</p></sec><sec id="j_joepi-2016-0015_s_002"><title style='display:none'>Aim</title><p>The aim of the current study was to investigate the possible relationship between epilepsy forms, gender, focus localization, lateralization, handedness and cellular immunity with seizures frequency, their severity and length of therapeutic remission in partial forms of epilepsy.</p></sec><sec id="j_joepi-2016-0015_s_003"><title style='display:none'>Material and methods</title><p>Ninety two patients (38 men and 54 women) were included in the study. Symptomatic epilepsy was diagnosed in 40 patients and the cryptogenic form was diagnosed in 52 patients. The amount of different lymphocyte clusters were evaluated and they were transformed into nominal variables for MANOVA analysis. MANOVA was used for the analysis of the interrelationship between nominal fixed factors (epilepsy forms, gender, handedness, and focus laterality, and immunity variables) and dependent variables (remission and seizure frequency and their severity).</p></sec><sec id="j_joepi-2016-0015_s_004"><title style='display:none'>Results</title><p>Simple partial seizure (SPS) and complex partial seizure (CPS) frequencies were under the influence of interaction between immune and neurobiological variables. SPS, and in particular sensory SPS, were associated with CD4/CD8 ratio, gender, left temporal focus and handedness. The highest frequencies of SPS were revealed in cases of low CD4/CD8 ratio combined with left temporal focus, female gender and left-handedness. The maximal CPS frequency was observed in patients with a left frontal focus combined with a high B-lymphocyte level. The more severe seizures were revealed in left-handers with low CD8 and high CD4/CD8 ratio and in frontal left focus and a high T-lymphocyte level. There was a correlation between CD4 cell level and length of remission.</p></sec><sec id="j_joepi-2016-0015_s_005"><title style='display:none'>Conclusion</title><p>The complex multifarious connections between neurobiological, immune and clinical variables in patients with partial forms of epilepsy really exist.</p></sec></abstract>ARTICLE2016-12-22T00:00:00.000+00:00The epileptic multifactorial patient’s burden. Review of the topic<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0009_s_001"><title style='display:none'>Background</title><p>Approximately 26% of the burden of neurologic diseases is due to epilepsy. Its negative impact reflects mainly on people with epilepsy (PWE) themselves.</p></sec><sec id="j_joepi-2016-0009_s_002"><title style='display:none'>Aims</title><p>To highlight the negative impacts of epilepsy on the lives of PEW’s so as to identify a realistic approach to their individual needs.</p></sec><sec id="j_joepi-2016-0009_s_003"><title style='display:none'>Methods</title><p>For recently published papers PubMed and MEDLINE databases were used. In addition relevant references mentioned in the searched articles were also considered.</p></sec><sec id="j_joepi-2016-0009_s_004"><title style='display:none'>Review and discussion</title><p>Generalized tonic-clonic seizures and refractory epilepsy are the most important factors burdening PWE’s, resulting in increased injuries and mortality, including Sudden Unexpected Death in Epilepsy (SUDEP). The need of chronic intake of antiepileptic drugs (AEDs) and of epilepsy surgery are also important with regards to potential for side effects, drug interactions, and different surgery risks. PWE harbour more medical and psychiatric comorbidities than the general population and results in a decreased quality of life. Decreased self-esteem and major stigma are also frequent, linked to social, economic and personal negative consequences.</p><p>Age also plays a role, younger people being more stigmatized given the interdiction to drive or difficulty in getting a job. In the elderly, seizures may have an impact on mental status, mood and sleep. Gender may also contribute, particularly involving women in childbearing age, linked to the fear or depression due to the possibility of AED-induced fertility disturbances, foetal malformations, or breast feeding side-effects.</p></sec><sec><title style='display:none'>Conclusions</title><p>The burden that PWE face must be considered by all people involved in the management of their epilepsy. The causes may be multifactorial, all interconnected and each one influencing the others.</p></sec></abstract>ARTICLE2016-09-30T00:00:00.000+00:00Biofeedback as complementary treatment in patients with epilepsy – an underestimated therapeutic option? Review, results, discussion<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0013_s_001"><title style='display:none'>Background</title><p>Biofeedback methods represent side effect free complementary options in the treatment of epilepsy. In this paper we review the current status of these methods in terms of clinical study results and their evaluation by systematic review papers. Possible mechanisms of action in biofeedback methods are discussed.</p></sec><sec id="j_joepi-2016-0013_s_002"><title style='display:none'>Aim</title><p>To present the current status of biofeedback methods applied to patients with epilepsy.</p></sec><sec id="j_joepi-2016-0013_s_003"><title style='display:none'>Material and Methods</title><p>With a literature search up to 10/2016 we screened publications containing the search terms “biofeedback”, “neurofeedback” or “neurotherapy” and “epilepsy” or “seizure” for intervention and population search terms respectively.</p></sec><sec id="j_joepi-2016-0013_s_004"><title style='display:none'>Results</title><p>Four different techniques of biofeedback were used to improve seizure frequency in patients with epilepsy. Three of these techniques, measuring EEG (slow cortical potentials and sensory motor rhythm) or electrodermal activity (galvanic skin response, GSR) seem to be promising methods for successful seizure control. Nevertheless, methodological standards in the conducted trials were too low for assured empirical evidence in their efficacy.</p></sec><sec id="j_joepi-2016-0013_s_005"><title style='display:none'>Conclusions</title><p>Biofeedback methods could be applied to patients to a greater extent. Probably due to the missing empirical evidence of efficacy and the high demand on patients’ and therapists’ time and commitment and therefore low cost effectiveness, these methods are hardly offered. Especially the relatively new approach of GSR biofeedback represents a promising option here.</p></sec></abstract>ARTICLE2016-12-17T00:00:00.000+00:00The quality of life of children with epilepsy in Poland – the opinion of children and their parents<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0012_s_001"><title style='display:none'>Background</title><p>Every chronic illness, including epilepsy, has a negative effect on both the quality of life of the sufferer as well as on their relationship with their surroundings.</p></sec><sec id="j_joepi-2016-0012_s_002"><title style='display:none'>Aims</title><p>To investigate the quality of life of children suffering from epilepsy and analyse how they assessed and scored their experiences compared to their parents.</p></sec><sec id="j_joepi-2016-0012_s_003"><title style='display:none'>Materials and methods</title><p>The study included 209 children with epilepsy and their parents. The research tool was a questionnaire for gathering demographic and clinical data as well as the Pediatric Quality of Life Inventory™ 4.0 Generic Core Scales (PedsQL™ 4.0) questionnaire in two versions, one for 8–12 year olds and one for 13–18 year olds and their parents.</p></sec><sec id="j_joepi-2016-0012_s_004"><title style='display:none'>Results</title><p>Cronbach’s alpha coefficient for the entire PedsQL™ 4.0 questionnaire was 0.91 and 0.93 for children with epilepsy and their parents respectively. Children rated their Total Scale Score higher (67.5 points) than their parents (62.5 points). Whilst analyzing children’s functioning in different areas it was observed that girls’ assessments were higher than boys’, except for Emotional Functioning. Both parents and children scored School Functioning the lowest. The greatest agreement of responses was observed in the domain of Physical Functioning, the smallest in the domain of Emotional Functioning.</p></sec><sec id="j_joepi-2016-0012_s_005"><title style='display:none'>Conclusions</title><p>Quality of life was rated higher by both age groups of children suffering from epilepsy than by their parents. A statistically significant difference was found when comparing the assessment scores of children and parents in light of the following variables; child age, gender, illness duration, seizure frequency and treatment effectiveness.</p></sec></abstract>ARTICLE2016-12-19T00:00:00.000+00:00The relationship of medial temporal lobe epilepsy with the declarative memory system<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0011_s_001"><title style='display:none'>Introduction</title><p>Medial temporal lobe of epilepsy (MTLE) is considered as local/regional epilepsy. However, as was discussed in Part I of this review (Halász, 2016a) there is more evidence regarding the involvement of both temporal lobes so as to consider MTLE as one of the typical bilateral system epilepsies.</p></sec><sec id="j_joepi-2016-0011_s_002"><title style='display:none'>Aim</title><p>To provide contemporary review of MTLE in relation to the declarative memory system and the newly recognized hippocampo-frontal memory consolidation during slow wave sleep.</p></sec><sec id="j_joepi-2016-0011_s_003"><title style='display:none'>Methods</title><p>A review of the available literature on experimental and clinical data and also the authors own studies in MTLE patients.</p></sec><sec id="j_joepi-2016-0011_s_004"><title style='display:none'>Review, discussion and results</title><p>New experimental and clinical neurophysiological data have shown that MTLE is closely linked to the hippocampal memory system. It is likely that hippocampal spiking is the epileptic variations of the normal sharp wave ripple events mediating the encoding and consolidation of memory engrams by a hippocampo-frontal dialogue during slow wave sleep.</p></sec><sec id="j_joepi-2016-0011_s_005"><title style='display:none'>Conclusions</title><p>The source of memory impairment in MTLE patients is not merely the cell loss and synaptic transformation of the hippocampal structure, but the every night interference with memory consolidation due to interictal spiking.</p></sec></abstract>ARTICLE2016-11-22T00:00:00.000+00:00Additive interactions between retigabine and oxcarbazepine in the chimney test and the model of generalized tonic-clonic seizures in mice<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0016_s_001"><title style='display:none'>Introduction</title><p>Patients with pharmacoresistant epilepsy are usually treated with two or more antiepileptic drugs (AEDs). The search for therapeutically efficacious AED combinations is still a challenging issue for clinicians and epileptologists throughout the world.</p></sec><sec id="j_joepi-2016-0016_s_002"><title style='display:none'>Aim</title><p>To determine the interaction profile for the combination of retigabine (RTG) and oxcarbazepine (OXC) in both, the model of tonic-clonic seizures, the maximal electroshock (MES)-induced seizure model and chimney test (motor performance) in adult male albino Swiss mice.</p></sec><sec id="j_joepi-2016-0016_s_003"><title style='display:none'>Methods</title><p>Isobolographic analysis (type I) was applied to characterize interactions for the combination of RTG with OXC with respect to its anticonvulsant and acute side (neurotoxic) effects, as determined in the MES and chimney tests, respectively.</p></sec><sec id="j_joepi-2016-0016_s_004"><title style='display:none'>Results</title><p>The combination of RTG with OXC at the fixed-ratios of 1:3, 1:1 and 3:1 produced additive interactions in the MES test in mice. Similarly, the combination of RTG with OXC at the fixed-ratio of 1:1 produced additive interaction with a tendency towards sub-additivity in the chimney test in mice. Measurement of total brain concentrations of both AEDs revealed that RTG did not affect total brain concentrations of OXC and inversely, OXC had no impact on RTG’s total brain concentrations, confirming pharmacodynamic interaction between the drugs.</p></sec><sec id="j_joepi-2016-0016_s_005"><title style='display:none'>Conclusions</title><p>The additive pharmacodynamic interactions in both the MES and chimney tests in mice were observed for the combination of RTG with OXC.</p></sec></abstract>ARTICLE2016-12-22T00:00:00.000+00:00Presurgical diagnosis of epilepsies – concepts and diagnostic tools<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0014_s_001"><title style='display:none'>Introduction</title><p>Numerous reviews of the currently established concepts, strategies and diagnostic tools used in epilepsy surgery have been published. The focus concept which was initially developed by Forster, Penfield and Jasper and popularised and enriched by Lüders, is still fundamental for epilepsy surgery.</p></sec><sec id="j_joepi-2016-0014_s_002"><title style='display:none'>Aim</title><p>To present different conceptual views of the focus concept and to discuss more recent network hypothesis, emphasizing so-called “critical modes of an epileptogenic circuit”.</p></sec><sec id="j_joepi-2016-0014_s_003"><title style='display:none'>Method</title><p>A literature search was conducted using keywords: presurgical evaluation, epileptic focus concepts, cortical zones, diagnostic tools.</p></sec><sec id="j_joepi-2016-0014_s_004"><title style='display:none'>Review and remarks</title><p>The theoretical concepts of the epileptic focus are opposed to the network hypothesis. The definitions of the various cortical zones have been conceptualized in the presurgical evaluation of candidates for epilepsy surgery: the seizure onset zone versus the epileptogenic zone, the symptomatogenic zone, the irritative and functional deficit zones are characterized. The epileptogenic lesion, the “eloquent cortex” and secondary epileptogenesis (mirror focus) are dealt with. The current diagnostic techniques used in the definition of these cortical zones, such as video-EEG monitoring, non-invasive and invasive EEG recording techniques, magnetic resonance imaging, ictal single photon emission computed tomography, and positron emission tomography, are discussed and illustrated. Potential modern surrogate markers of epileptogenicity, such as <italic>High frequency oscillations, Ictal slow waves/DC shifts, Magnetic resonance spectroscopy, Functional MRI,</italic> the use of <italic>Magnetized nanoparticles</italic> in MRI, <italic>Transcranial magnetic stimulation, Optical intrinsic signal</italic> imaging, and <italic>Seizure prediction</italic> are discussed. Particular emphasis is put on the EEG: Scalp EEG, semi-invasive and invasive EEG (Stereoelectroencephalography) and intraoperative electrocorticography are illustrated. Ictal SPECT and <sup>18</sup>F-FDG PET are very helpful and several other procedures, such as dipole source localization and spike-triggered functional MRI are already widely used. The most important lateralizing and localizing ictal signs and symptoms are summarized. It is anticipated that the other clinically valid surrogate markers of epileptogenesis and epileptogenicity will be further developed in the near future. Until then the concordance of the results of seizure semiology, localization of epileptogenicity by EEG and MRI remains the most important prerequisite for successful epilepsy surgery.</p></sec><sec id="j_joepi-2016-0014_s_005"><title style='display:none'>Conclusions and future perspectives</title><p>Resective epilepsy surgery is a widely accepted and successful therapeutic approach, rendering up to 80% of selected patients seizure free. Although other therapies, such as radiosurgery, and responsive neurostimulation will increasingly play a role in patients with an unresectable lesion, it is unlikely that they will replace selective resective surgery. The hope is that new diagnostic techniques will be developed that permit more direct definition and measurement of the epileptogenic zone.</p></sec></abstract>ARTICLE2016-12-22T00:00:00.000+00:00The medial temporal lobe epilepsy is a bilateral disease – novel aspects<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0010_s_001"><title style='display:none'>Introduction</title><p>Medial temporal lobe epilepsy (MTLE) is the most frequent form of epilepsy in adulthood. It is classified as local/regional epilepsy. However, there is increasing evidence of the involvement of both temporal lobes and this provides abundant arguments to question this view, and consider MTLE as one of the typical bilateral system epilepsies.</p></sec><sec id="j_joepi-2016-0010_s_002"><title style='display:none'>Aim</title><p>To provide a contemporary review of medial temporal lobe epilepsy, discussing the bilateral aspects, with reference to epilepsy surgery.</p></sec><sec id="j_joepi-2016-0010_s_003"><title style='display:none'>Methods</title><p>A literature review and a resume of the author’s own experiences with MTLE patients.</p></sec><sec id="j_joepi-2016-0010_s_004"><title style='display:none'>Results</title><p>Recent electrophysiological and neuroimaging data provide convincing data supporting that MTLE is a bilateral disease. The uni-and bilateral features form a continuum and the participation rate of the two temporal lobes determine course and surgical perspective of the individual patient.</p></sec><sec id="j_joepi-2016-0010_s_005"><title style='display:none'>Conclusions</title><p>The contradictory data of invasive presurgical evaluations of MTLE patients suggest that there need to identify further indicatory markers of bilaterality and thus change the presurgical evaluation from the non-invasive towards the invasive ways. The mechanisms of the interrelationship between the two temporal lobes in MTLE warrants further research.</p></sec></abstract>ARTICLE2016-11-22T00:00:00.000+00:00Depression and anxiety in people with epilepsy: Why should we identify?<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0005_s_001"><title style='display:none'>Introduction</title><p>People with epilepsy (PWE) have a higher risk of developing depression and anxiety than people without epilepsy. However, understanding and management of that issue remain under-recognized.</p></sec><sec id="j_joepi-2016-0005_s_002"><title style='display:none'>Aim</title><p>To emphesize: a) the relationship between depression, anxiety, and epilepsy, and b) to suggest practical strategies for their identification by clinicians.</p></sec><sec id="j_joepi-2016-0005_s_003"><title style='display:none'>Methods</title><p>The current literatures was reviewed investigating the impact of depression and anxiety in PWE and those examining the validity of simple screening tools for the detection of depression and anxiety.</p></sec><sec id="j_joepi-2016-0005_s_004"><title style='display:none'>Review</title><p>Approximately one quarter of PWE have been known to be suffered from depression. The frequency of depression and anxiety was closely related to poor seizure control. Depression and anxiety have been reported to have a bidirectional relationship with epilepsy. The higher degree of depression and anxiety was more likely to elicit the suicidal ideation and attempt, adverse events and poor compliance of antiepileptic drugs, poor surgical outcome, and eventually, poor quality of life. Furthermore, depression and anxiety were closely associated with perceived stigma, obsessive-compulsive symptom, aggression, fatigue, and perceived stress.</p></sec><sec id="j_joepi-2016-0005_s_005"><title style='display:none'>Conclusions</title><p>Clinicians who take care of PWE in a busy clinical setting should identify their psychiatric problems by brief screening tools and treat them instantly to minimize their negative impacts.</p></sec></abstract>ARTICLE2016-06-07T00:00:00.000+00:00Natural course of treated epilepsy and medico-social outcomes. Turku studies. Part II<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0001_s_001"><title style='display:none'>Introduction</title><p>Population-based data on the prognosis of childhood-onset epilepsy were almost nonexistent in the 1960s. This prompted me to start an epidemiological prospective study on children with epilepsy.</p></sec><sec id="j_joepi-2016-0001_s_002"><title style='display:none'>Aim</title><p>To study the medical and social outcome of children with epilepsy.</p></sec><sec id="j_joepi-2016-0001_s_003"><title style='display:none'>Methods</title><p>The most important personal data on the natural course and outcome were reviewed and compared with the relevant data of other investigators.</p></sec><sec id="j_joepi-2016-0001_s_004"><title style='display:none'>Results and discussion</title><p>The natural course of treated epilepsy is remitting, uninterrupted by relapse (in 48%); a remitting-relapsing course (interrupted by relapses, in terminal remission) (19%); worsening course (early or late remission followed by drug-resistant epilepsy) (14%); and never in ?5-year remission (drug resistance) (19%) The medical and social outcomes based on my unique, five decades followed cohort show that most subjects are in 10-year remission without medications, which is the definition of resolved epilepsy. Normal or subnormal IQ, non-symptomatic etiology, and low seizure frequency both in the first year of AED treatment and prior to medication appear to be clinical predictors of cure in childhood-onset epilepsy. Subjects with 1-year remission during the first five years form onset of treatment have more than 10-fold chance for entering 5-year terminal remission vs those who have no 1-year remission during the first five years. Even about one fourth of difficult-to-treat subjects become seizure free on medication and more than half of them enter one or more 5-year remissions. Epilepsy has a substantial impact on quality of life even in those who are seizure free off medication for many years and particularly those not in remission or in remission but still on medication.</p></sec><sec id="j_joepi-2016-0001_s_005"><title style='display:none'>Conclusions</title><p>The prognosis is excellent for medical and social outcome. The successful outcome is confirmed by several longitudinal studies from recent decades. Good response to early drug therapy does not necessarily guarantee a favorable seizure outcome, and even a late good response may still predict a successful prognosis. Our life-cycle study is being continued and targets to answer the question whether or not childhood-onset epilepsy is a risk factor for premature and/or increased incidence of mental impairment and dementia.</p></sec></abstract>ARTICLE2016-01-25T00:00:00.000+00:00Successful treatment of epilepsia partialis continua due to Rassmussen encephalitis with perampanel<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0003_s_001"><title style='display:none'>Background</title><p>Epilepsia partialis continua (EPC) is a difficult to treat condition, which tends to be refractory to antiepileptic drugs (AEDs). We previously published two other treatment episodes of EPC due to stroke and vascular dementia with a possible effect of perampanel (PER).</p></sec><sec id="j_joepi-2016-0003_s_002"><title style='display:none'>Aim</title><p>With the publication of a third treatment episode of EPC terminated by the administration of PER we would like to suggest that PER may be an effective treatment option in this condition.</p></sec><sec id="j_joepi-2016-0003_s_003"><title style='display:none'>Material and Methods</title><p>We present a case where PER was the last AED introduced in the treatment of a patient with EPC and individual seizures due to Rasmussen encephalitis before his seizure frequency could be reduced significantly.</p></sec><sec id="j_joepi-2016-0003_s_004"><title style='display:none'>Results</title><p>A 44 years old male patient, who had been on a combination therapy of at least 4 AEDs since the age of 24, was admitted to our hospital presenting with an EPC. After the introduction of PER in the therapy EPC stopped and he remained seizure free for more than a year. Two of his other AEDs could be tapered of.</p></sec><sec id="j_joepi-2016-0003_s_005"><title style='display:none'>Conclusion</title><p>PER might be especially effective in EPC.</p></sec></abstract>ARTICLE2016-03-31T00:00:00.000+00:00Lateralized periodic discharges associated with status epilepticus in the first year after stroke<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0001_s_001"><title style='display:none'>Backgrand</title><p>Lateralized periodic discharges (LPDs) are infrequent electroencephalograph (EEG) findings, and may present in ictal or interictal form. They are regarded as potential electrophysiologic signs of convulsive or nonconvulsive status epilepticus (NCSE). We report four patients who presented with NCSE and one who presented with convulsive status epilepticus in the postictal period, characterized by LPDs in EEG recordings in the first year after stroke.</p></sec><sec id="j_joepi-2016-0001_s_002"><title style='display:none'>Material and methods</title><p>We prospectively evaluated patients who clinically presented with status epilepticus associated LPDs between March 2014 and March 2015. We investigated patients that presented with a new stroke occurrence. We excluded the other LPD etiologies.</p><p>EEG studies of five patients (two men) who were admitted to our emergency unit with confusion, three of whom had visual symptoms; four were treated for NCSE as diagnosed with LPDs. The fifth patient had convulsive status epilepticus with LPD in the postictal period.</p></sec><sec id="j_joepi-2016-0001_s_003"><title style='display:none'>Results and Discussion</title><p>None of the five patients, who were aged between 68 and 92 years, showed any etiologic factor other than a history of cerebrovascular disease (CVD). Magnetic resonance imaging studies of the patients revealed old infarcts and transitional diffusion restrictions. The clinical and EEG findings decreased substantially upon antiepileptic drug treatment. Herein, we illustrate the first patient who had confusion, visual hallucinations, and ictal and interictal LPD in her consecutive EEGs.</p></sec><sec id="j_joepi-2016-0001_s_004"><title style='display:none'>Conclusions</title><p>CVDs may pave the way for LPDs in patients with a history of stroke because CVDs cause structural brain damage. Patients who present with a similar clinical profile and imaging signs of stroke should be checked for NCSE, particularly in the presence of LPDs in EEGs.</p></sec></abstract>ARTICLE2016-03-17T00:00:00.000+00:00Anticonvulsant therapy in brain-tumor related epilepsy<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0004_s_001"><title style='display:none'>Background</title><p>The lifetime risk of patients with brain tumors to have focal epileptic seizures is 10–100%; the risk depends on different histology. Specific guidelines for drug treatment of brain tumor-related seizures have not yet been established.</p></sec><sec id="j_joepi-2016-0004_s_002"><title style='display:none'>Aim</title><p>This review addresses the special aspects of antiepileptic drug (AED) therapy in brain tumor-related epilepsy.</p></sec><sec id="j_joepi-2016-0004_s_003"><title style='display:none'>Methods</title><p>We analyzed the literature up to December 2015.</p></sec><sec id="j_joepi-2016-0004_s_004"><title style='display:none'>Results</title><p>Based on current evidence the management of tumor-related seizures does not differ substantially from that applied to epilepsies from other etiologies. Therefore, the choice of an AED is based, above all, on tolerability and pharmacokinetic interactions with chemotherapeutic drugs. Levetiracetam is recommended by many authors as first-line therapy in brain tumor-related epilepsy. Due to the possibility of interactions, the combination of enzyme-inducing AEDs and chemotherapeutic drugs, is usually not recommended as a first choice. Currently there is no evidence that prophylactic prescription of long-term AEDs in brain tumor-patients who did not present with seizures is justified. Because of the high risk of recurrence, however, AED treatment should be strongly considered after a single brain tumor-related seizure. The decision to withdraw AEDs must carefully consider the risk of seizure recurrence.</p></sec><sec id="j_joepi-2016-0004_s_005"><title style='display:none'>Conclusion</title><p>At present levetiracetam is the preferred drug in brain tumor-related epilepsy, especially when drug interactions need to be avoided. In the future we hope to acquire more targeted drugs against this disorder by uncovering its pathogenesis.</p></sec></abstract>ARTICLE2016-04-06T00:00:00.000+00:00Concomitant treatment with imipenem causes a rapid and extensive decrease in the plasma concentrations of valproic acid<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0006_s_001"><title style='display:none'>Background</title><p>Valproic acid (VPA) is a wide-spectrum antiepileptic drug used both in children and in adults. We describe a clinically important interaction between VPA and imipenem, a carbapenem antimicrobial.</p></sec><sec id="j_joepi-2016-0006_s_002"><title style='display:none'>Case presentation</title><p>Our patient was a 19-year-old man with childhood onset of mental retardation and severe epilepsy. He was hospitalized due to pneumonia. His antiepileptic drugs, including VPA, were administered intravenously. Due to pneumonia, intravenously administered imipenem was started. After the start of imipenem treatment, a dramatic decrease in the plasma concentrations of VPA occurred within 24 hours. After the discontinuation of imipenem treatment, the concentration of VPA recovered within a few hours. The decrease in VPA levels was associated with increased seizure frequency.</p></sec><sec id="j_joepi-2016-0006_s_003"><title style='display:none'>Conclusions</title><p>The time course of the VPA–imipenem interaction suggests that mechanisms other than a change in the enzymatic elimination of VPA is the cause for this pharmacokinetic interaction. Concomitant use of VPA and imipenem should be avoided.</p></sec></abstract>ARTICLE2016-06-15T00:00:00.000+00:00Russian experience of using perampanel in daily clinical practice. Preliminary report<abstract><title style='display:none'>Summary</title><sec id="j_joepi-2016-0007_s_001"><title style='display:none'>Introduction</title><p><bold>Perampanel (PER) (Fycompa) <italic>5’-(2-cyanophenyl)-1’-phenyl-2,3’-bipyridinyl-6’(1’H)-on</italic></bold> is the newest antiepileptic drug and is the first-in-class selective non-competitive antagonist of ionotropic AMPA glutamate receptors of the postsynaptic neuronal membrane.</p><p><bold>The aim</bold> was to summarize Russian experience in using PER in daily clinical practice, and for this purpose the results of its use as an add-on treatment for focal epilepsy were assessed retrospectively</p></sec><sec id="j_joepi-2016-0007_s_002"><title style='display:none'>Material and Method</title><p>The results of the study of PER efficacy and safety in 52 patients with refractory focal epilepsy are presented. Mean age was 28.9 ± 14.0 years; proportion of male patients was 56%, duration of the disease over 10 years - 69.2%, symptomatic epilepsy - 76.9%, with frontal - 46.2% and temporal - 44.2% localization of epileptic lesion. Majority of patients - 71.2% started PER treatment after 3 preceding lines of therapy</p></sec><sec id="j_joepi-2016-0007_s_003"><title style='display:none'>Results</title><p>The baseline seizure frequency of all types was 127.3 ± 82.3 per month; secondary generalized seizures - 6.7 ± 1.9 per month. After PER was added, a significant decrease in seizure frequency was observedalready during the first month, to 52.1 ± 29.3 seizures per month (Sign test, p = 0.00001) for seizures of all types and to 3.7 ± 1.7 (Sign test, p = 0.00001) for secondary generalized seizures. In an overwhelming majority of cases, duration of PER treatment was more than 6 months. In 58% of patients, seizure frequency decreased by more than 50% (responders). Seizure-free status for all seizure types was observed in 9% of cases at 12 month, and absence of secondary generalized seizures only was achieved in 31% of patients. Adverse events were observed in 30.1% of patients: aggression – 11.5% and drowsiness – 9.6%, with all other AEs observed more rarely. PER dose was reduced due to side effects in 7 patients (13.5%), and in 4 patients (7.7%) PER was discontinued. Average PER dose in adult patients was as low as 6 mg.</p></sec><sec id="j_joepi-2016-0007_s_004"><title style='display:none'>Conclusions</title><p>PER was effective in the treatment of refractory forms of focal epilepsy, reducing seizure frequency on average by 76% by the second month of treatment. In addition to a good clinical effect, PER demonstrated a rather acceptable and predictable safety profile.</p></sec></abstract>ARTICLE2016-01-25T00:00:00.000+00:00en-us-1