| 1. |
- Harden, C, et al.
(författare)
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Practice Guideline Summary: Sudden Unexpected Death in Epilepsy Incidence Rates and Risk Factors: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society
- 2017
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Ingår i: Epilepsy currents. - : SAGE Publications. - 1535-7597 .- 1535-7511. ; 17:3, s. 180-187
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine the incidence rates of sudden unexpected death in epilepsy (SUDEP) in different epilepsy populations and address the question of whether risk factors for SUDEP have been identified. Methods: Systematic review of evidence; modified Grading Recommendations Assessment, Development and Evaluation process for developing conclusions; recommendations developed by consensus. Results: Findings for incidence rates based on 12 Class I studies include the following: SUDEP risk in children with epilepsy (aged 0–17 years) is 0.22/1,000 patient-years (95% CI 0.16–0.31) (high confidence in evidence). SUDEP risk increases in adults to 1.2/1,000 patient-years (95% CI 0.64–2.32) (low confidence in evidence). The major risk factor for SUDEP is the occurrence of generalized tonic-clonic seizures (GTCS); the SUDEP risk increases in association with increasing frequency of GTCS occurrence (high confidence in evidence). Recommendations: Level B: Clinicians caring for young children with epilepsy should inform parents/guardians that in 1 year, SUDEP typically affects 1 in 4,500 children; therefore, 4,499 of 4,500 children will not be affected. Clinicians should inform adult patients with epilepsy that SUDEP typically affects 1 in 1,000 adults with epilepsy per year; therefore, annually 999 of 1,000 adults will not be affected. For persons with epilepsy who continue to experience GTCS, clinicians should continue to actively manage epilepsy therapies to reduce seizures and SUDEP risk while incorporating patient preferences and weighing the risks and benefits of any new approach. Clinicians should inform persons with epilepsy that seizure freedom, particularly freedom from GTCS, is strongly associated with decreased SUDEP risk.
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| 2. |
- Ben-Menachem, Elinor, 1945
(författare)
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AAN/AES guidelines on use of new AEDS.
- 2005
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Ingår i: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 5:1, s. 30-2
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Tidskriftsartikel (refereegranskat)
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| 3. |
- Ben-Menachem, Elinor, 1945
(författare)
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Is prolactin a clinically useful measure of epilepsy?
- 2006
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Ingår i: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 6:3, s. 78-9
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Tidskriftsartikel (refereegranskat)abstract
- Use of Serum Prolactin in Diagnosing Epileptic Seizures: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Chen DK, So YT, Fisher RS Neurology 2005;65(5):668–675 (Review) The purpose of this article is to review the use of serum prolactin assay in epileptic seizure diagnosis. Methods The authors identified relevant studies in multiple databases and reference lists. Studies that met inclusion criteria were summarized and rated for quality of evidence, and the results were analyzed and pooled where appropriate. Results Most studies used a serum prolactin of at least twice baseline value as abnormal. For the differentiation of epileptic seizures from psychogenic nonepileptic seizures, one Class I and seven Class II studies showed that elevated serum prolactin was highly predictive of either generalized tonic–clonic or complex partial seizures. Pooled sensitivity was higher for generalized tonic–clonic seizures (60.0%) than for complex partial seizures (46.1%), while the pooled specificity was similar for both (approximately 96%). Data were insufficient to establish validity for simple partial seizures. Two Class II studies were consistent in showing prolactin elevation after tilt-test–induced syncope. Inconclusive data exist regarding the value of serum prolactin following status epilepticus, repetitive seizures, and neonatal seizures. Recommendations Elevated serum prolactin assay, when measured in the appropriate clinical setting at 10 to 20 minutes after a suspected event, is a useful adjunct for the differentiation of generalized tonic–clonic or complex partial seizure from psychogenic nonepileptic seizure among adults and older children (Level B). Serum prolactin assay does not distinguish epileptic seizures from syncope (Level B). The use of serum PRL assay has not been established in the evaluation of status epilepticus, repetitive seizures, and neonatal seizures (Level U).
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| 4. |
- Ben-Menachem, Elinor, 1945
(författare)
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Is topiramate tops?
- 2008
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Ingår i: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 8:3, s. 60-1
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Tidskriftsartikel (refereegranskat)abstract
- TOPIRAMATE MONOTHERAPY IN NEWLY DIAGNOSED EPILEPSY IN CHILDREN AND ADOLESCENTS: Glauser TA, Dlugos DJ, Dodson WE, Grinspan A, Wang S, Wu SC EPMN-106/INT-28 Investigators. J Child Neurol2007226:693-69917641254 A double-blind, dose-controlled study evaluated topiramate as monotherapy in 470 patients with newly diagnosed (3 months) epilepsy or epilepsy relapse in the absence of therapy. In addition to having at least 2 lifetime-unprovoked seizures, patients had 1 or 2 partial-onset seizures or generalized-onset tonic-clonic seizures during a 3-month retrospective baseline. The trial included a large cohort (N = 151, 32%) of children and adolescents 6 to 15 years of age. Eligible patients were randomized to treatment groups in which topiramate was titrated to target maintenance dosages of either 400 mg/day (n = 77) or 50 mg/day (n = 74). Patients were followed for at least 6 months. Based on Kaplan-Meier analyses, the primary efficacy endpoint of time to first seizure favored the higher topiramate dose in both the overall population and the cohort of children/adolescents. The probability that children/adolescents remaining in the study were seizure free at 6 months was 78% in the 50-mg target dose group and 90% with the higher dose. At 12 months, the probability of being seizure free was 62% and 85%, respectively. The incidence of treatment-limiting adverse events was 4% in the 50-mg target dose group and 14% in the group assigned to 400 mg as a target dose. The most common adverse events, excluding typical childhood illnesses, were headache, appetite decrease, weight loss, somnolence, dizziness, concentration/attention difficulty, and paresthesia. As shown in this subset analysis, topiramate is effective and well tolerated as monotherapy in children and adolescents.
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| 5. |
- Ben-Menachem, Elinor, 1945
(författare)
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Retigabine: has the orphan found a home?
- 2007
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Ingår i: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 7:6, s. 153-4
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Tidskriftsartikel (refereegranskat)abstract
- Randomized, Multicenter, Dose-Ranging Trial of Retigabine for Partial-Onset Seizures. Porter RJ, Partiot A, Sachdeo R, Nohria V, Alves WM; 205 Study Group. Neurology 2007;68(15):1197–1204. OBJECTIVE: To evaluate the efficacy and safety of retigabine 600, 900, and 1,200 mg/day administered three times daily as adjunctive therapy in patients with partial-onset seizures. METHODS: A multicenter, randomized, double-blind, placebo-controlled trial was performed. After an 8-week baseline phase, patients were randomized to a 16-week double-blind treatment period (8-week forced titration and 8-week maintenance) followed by either tapering or entry into an open-label extension study. Primary efficacy was the percentage change from baseline in monthly seizure frequency and compared across treatment arms. Secondary efficacy comparisons included the proportion of patients experiencing 50% reduction in seizure frequency (responder rate), emergence of new seizure types, and physician assessment of global clinical improvement. Safety/tolerability assessments included adverse events (AEs), physical and neurologic examinations, and clinical laboratory evaluations. Efficacy analyses were performed on the intent-to-treat population. RESULTS: Of the 399 randomized patients, 279 (69.9%) completed the double-blind treatment period. The median percent change in monthly total partial seizure frequency from baseline was −23% for 600 mg/day, −29% for 900 mg/day, and −35% for 1,200 mg/day vs −13% for placebo ( p < 0.001 for overall difference across all treatment arms). Responder rates for retigabine were 23% for 600 mg/day, 32% for 900 mg/day ( p = 0.021), and 33% for 1,200 mg/day ( p = 0.016), vs 16% for placebo. The most common treatment-emergent AEs were somnolence, dizziness, confusion, speech disorder, vertigo, tremor, amnesia, abnormal thinking, abnormal gait, paresthesia, and diplopia. CONCLUSION: Adjunctive therapy with retigabine is well tolerated and reduces the frequency of partial-onset seizures in a dose-dependent manner.
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| 6. |
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| 7. |
- Ben-Menachem, Elinor, 1945
(författare)
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Neurostimulation - Past, Present, and Beyond
- 2012
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Ingår i: Epilepsy Currents. - : SAGE Publications. - 1535-7597 .- 1535-7511. ; 12:5, s. 188-191
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Tidskriftsartikel (refereegranskat)abstract
- Neurostimulation as a treatment for epilepsy has been around for almost 20 years in the form of vagus nerve stimulation. Newer types of neurostimulation are being developed and stand on the brink of approval for use. The two newest therapies, not yet approved in the United States, are deep brain stimulation and the Responsive Neurostimulator System . In fact, in Europe, approval has already been given for deep brain stimulation and newer forms of vagus nerve stimulation. Efficacy is similar between these therapies, and side effects are moderate, so what will be the future? The challenge will be to learn how to use these therapies correctly and offer the right treatment for the right patient.
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| 8. |
- Ben-Menachem, Elinor, 1945
(författare)
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Vaccination and the onset of dravet syndrome.
- 2011
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Ingår i: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7511. ; 11:4, s. 120-2
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Tidskriftsartikel (refereegranskat)
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| 9. |
- Ben-Menachem, Elinor, 1945
(författare)
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Epilepsy as a warning sign for stroke.
- 2005
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Ingår i: Epilepsy currents / American Epilepsy Society. - : SAGE Publications. - 1535-7597. ; 5:1, s. 42-3
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Tidskriftsartikel (refereegranskat)
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| 10. |
- Ben-Menachem, Elinor, 1945
(författare)
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Eslicarbazepine acetate: a well-kept secret?
- 2010
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Ingår i: Epilepsy currents. - : SAGE Publications. - 1535-7511 .- 1535-7597. ; 10:1, s. 7-8
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To study the efficacy and safety of eslicarbazepine acetate (ESL) as adjunctive therapy for refractory partial seizures in adults with ≥4 partial-onset seizures (simple or complex, with or without secondary generalization) per 4 weeks despite treatment with 1–2 antiepileptic drugs (AEDs). METHODS: This multicenter, parallel-group study had an 8-week, single-blind, placebo baseline phase, after which patients were randomized to placebo (n= 102) or once-daily ESL 400 mg (n= 100), 800 mg (n= 98), or 1,200 mg (n= 102) in the double-blind treatment phase. ESL starting dose was 400 mg; thereafter, ESL was titrated at weekly 400-mg steps to the full maintenance dose (12 weeks). RESULTS: Seizure frequency adjusted per 4 weeks over the maintenance period (primary endpoint) was significantly lower than placebo in the ESL 1,200-mg (p= 0.0003) and 800-mg (p= 0.0028) groups [analysis of covariance (ANCOVA) of log-transformed seizure frequency]. Responder rate was 20% (placebo), 23% (400 mg), 34% (800 mg), and 43% (1,200 mg). Median relative reduction in seizure frequency was 16% (placebo), 26% (400 mg), 36% (800 mg), and 45% (1,200 mg). The most frequent concomitant AEDs were carbamazepine (56–62% of patients), lamotrigine (25–27%), and valproic acid (22–28%). Similar efficacy results were obtained in patients administered ESL with or without carbamazepine as concomitant AED. Discontinuation rates caused by adverse events (AEs) were 3.9% (placebo), 4% (400 mg), 8.2% (800 mg), and 19.6% (1,200 mg). AEs in >10% of any group were dizziness, headache, and diplopia. Most AEs were mild or moderate. DISCUSSION: ESL, 800 and 1,200 mg once-daily, was well tolerated and more effective than placebo in patients who were refractory to treatment with one or two concomitant AEDs.
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