Epilepsia
-
To explore the effect of anterior temporal lobectomy on employment and define demographic and clinical predictors of postoperative employment in a large cohort with a prolonged observational period. ⋯ Anterior temporal lobectomy is followed by reduced unemployment and underemployment, with elimination of seizures, relative youth, and operating a motor vehicle serving as the main driving forces for improvement. This is important information for patients and physicians who contemplate surgery as it helps define reasonable expectations, and provides further objective evidence for benefits beyond purely medical outcomes after epilepsy surgery.
-
Comparative Study
Profiling the evolution of depression after epilepsy surgery.
Both neurobiologic and psychosocial factors have been proposed to account for the high prevalence of depression surrounding epilepsy surgery. Using a prospective longitudinal approach, this study aimed to profile the evolution of depression after epilepsy surgery at multiple time points, including early and longer-term follow-up. We also sought to identify neurobiologic and psychosocial predictors of depression before and after surgery, including whether patients undergoing mesial temporal lobe resection (MTR) were at greater risk of depression than patients undergoing nonmesial temporal lobe resection (NMTR). ⋯ The findings of this study confirm high rates of major depression before and after epilepsy surgery, the etiology of which is multifactorial. They highlight the need for thorough assessment and diagnosis before surgery, as well as the provision of routine follow-up and psychological support, particularly early after surgery. When estimating level of risk for depression, patients should be counseled about the role of both neurobiologic and psychosocial factors. Before surgery, these include a family history of psychiatric illness and financial dependence, whereas poor family adjustment to life after surgery and a patient preoperative history of depression were risk factors for postoperative depression. Finally, disruption to mesial temporal structures known to play a role in mood via MTR may place patients at increased risk of new-onset depression after surgery.
-
Review Meta Analysis
The adverse event profile of pregabalin: a systematic review and meta-analysis of randomized controlled trials.
Despite the widespread use of antiepileptic drugs (AEDs) across different neurologic and psychiatric disorders, no study has systematically reviewed all available randomized controlled trials (RCTs) of a given AED to fully uncover its tolerability profile. We aimed at identifying treatment emergent adverse events (AEs) associated with pregabalin through a systematic review and meta-analysis of all available RCTs. We also assessed the association between serious AEs and pregabalin, and investigated whether pregabalin AEs display a dose-response relationship. ⋯ Individuals starting treatment with pregabalin are at increased risk for several AEs, particularly those affecting cognition/coordination. Pregabalin AEs appear according to a selective dose-response pattern, possibly reflecting the severity of dysfunction of distinct anatomic structures. These findings may aid clinicians in providing better patient management, and support the value of including in meta-analyses of AED tolerability profiles RCTs performed in different conditions.
-
Multicenter Study Clinical Trial
Phenobarbital for neonatal seizures in hypoxic ischemic encephalopathy: a pharmacokinetic study during whole body hypothermia.
Therapeutic hypothermia has recently been introduced to treat term newborns with hypoxic-ischemic encephalopathy, of whom more than half have seizures. Phenobarbital is widely used to treat neonatal seizures, but it is unknown whether its pharmacokinetics is affected by hypothermia. We evaluated the influence of hypothermia on phenobarbital pharmacokinetics in asphyxiated newborns. ⋯ Phenobarbital administered to newborns under whole body hypothermia results in higher plasma concentrations and longer half-lives than expected in normothermic newborns.
-
Editorial Review
Modern antiepileptic drug development has failed to deliver: ways out of the current dilemma.
Despite the development of various new antiepileptic drugs (AEDs) since the early 1990s, the available evidence indicates that the efficacy and tolerability of drug treatment of epilepsy has not substantially improved. What are the reasons for this apparent failure of modern AED development to discover drugs with higher efficacy? One reason is certainly the fact that, with few exceptions, all AEDs have been discovered by the same conventional animal models, particularly the maximal electroshock seizure test (MES) in rodents, which served as a critical gatekeeper. These tests have led to useful new AEDs, but obviously did not help developing AEDs with higher efficacy in as yet AED-resistant patients. ⋯ The failure of AED development has led to increasing disappointment among clinicians, basic scientists, and industry and may halt any further improvement in the treatment of epilepsy unless we find ways out of this dilemma. Therefore, we need new concepts and fresh thinking about how to radically change and improve AED discovery and development. In this respect, the authors of this critical review will discuss several new ideas that may hopefully lead to more efficacious drug treatment of epilepsy in the future.