Epilepsy & behavior : E&B
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Epilepsy & behavior : E&B · Mar 2012
Multicenter StudyRational polytherapy with lacosamide in clinical practice: results of a Spanish cohort analysis RELACOVA.
There has been little long-term success with polytherapy for patients with refractory partial-onset epilepsy. The rational combination of antiepileptic drugs based on their mechanism of action may help improve treatment efficacy and tolerability. Lacosamide, a novel sodium channel blocker (SCB), was investigated in 158 patients with partial-onset epilepsy in the prospective, multicenter, observational, RELACOVA cohort study conducted in Spain. ⋯ Lacosamide was well tolerated; dizziness was the most frequent adverse event. Efficacy was better (responder rate, 65% vs 38%; seizure free rate, 35% vs 17%) and there was a lower adverse event rate (33% vs 58%) in patients receiving non-SCBs (n=49) versus those receiving SCBs (n=104) as concomitant therapy at baseline. Further investigation of lacosamide combination therapy is warranted.
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Epilepsy & behavior : E&B · May 2011
Review Multicenter StudyShould "migralepsy" be considered an obsolete concept? A multicenter retrospective clinical/EEG study and review of the literature.
The few reports that have been published on the current International Classification of Headache Disorders, Second Edition (ICHD-II), criteria for migralepsy and hemicrania epileptica have highlighted the considerable confusion regarding this "hot topic" within both headache and epilepsy classifications (ICHD-II and International League Against Epilepsy [ILAE]). Indeed, the ICHD-II describes a migraine-triggered seizure as a rare event in which a seizure occurs during migraine aura; on the other hand, hemicrania epileptica is described as an "ictal headache" that occurs "synchronously" with a partial seizure. To confuse matters even further, neither the term migralepsy nor the term hemicrania epileptica is included in the currently used ILAE classification. On the basis of both a review of "migralepsy" cases in the literature and 16 additional retrospective multicenter cases, we suggest that the term migraine-triggered seizure or migralepsy be deleted from the ICHD-II classification until unequivocal evidence is provided of its existence, and that the term ictal epileptic headache be introduced into the ILAE classification.
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Epilepsy & behavior : E&B · May 2006
Multicenter StudyDeterminants of success in the use of oral levetiracetam in status epilepticus.
The use of new antiepileptic drugs for treatment of status epilepticus (SE) has not been studied systematically, particularly with respect to response predictors, the possibility of a dose-response relationship, and the efficacy of administration through a nasogastric tube. We analyzed 23 patients with SE treated with levetiracetam (LEV). The median daily dose of LEV was 2000 mg (range: 750-9000 mg). ⋯ No demographic or etiological variable was predictive. Among 16 patients given LEV through a nasogastric tube, administration was successful in 5; blood levels in 2 nonresponders were within or above the range 5-30 microg/mL. These data suggest that LEV may be a useful alternative in SE if administered early, even in intubated patients, and that escalating the dosage beyond 3000 mg/day will unlikely provide additional benefit.
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Epilepsy & behavior : E&B · Aug 2005
Multicenter Study Comparative Study Clinical TrialPatient and physician reactions to generic antiepileptic substitution in the treatment of epilepsy.
The clinical and economic consequences of generic antiepileptic drug (AED) substitution are not yet fully understood. This article provides a broad perspective of generic AED substitution in five countries. ⋯ There is an opposition to generic substitution by both patients and physicians, especially with concern over increased breakthrough seizure risk. Further evidence is required to understand how costs and effects of generic AED substitution affect patient welfare.