Anti-Epileptic Drug Prescription in a Psychiatric Hospital Outpatient Clinic in Southeast Nigeria

The optimum control of seizures requires adequate dosing of appropriately selected anti-epileptic medications. The availability of AEDs in Nigeria is limited and this constrains the prescription latitude of clinicians. This study was conducted to describe the prescribing pattern of anti-epileptic drugs in the outpatient service of a psychiatric facility in southeast Nigeria. The case records of the epileptic patients attending the outpatient clinic of a psychiatric hospital were retrieved, reviewed and data abstracted with a prepared proforma. The information extracted include age, sex, marital status, residence, type of seizure and anti-seizure medications prescribed, frequency of administration and dosage among other variables. Of the 178 patients whose prescriptions and case records were assessed, males constituted 62.9% and females 37.1%. Most of the patients were single (78.1%) and the group had a mean age of 25.6 ± 10.9 years. Generalized tonic-clonic seizures predominated (61.2%) among the seizure types, whilst complex partial seizure type was identified in 35.4% of the patients. Patient diagnosis relied heavily on the use of clinical description alone. About 92.7% of the patients were treated with monotherapy, whereas 7.3% received two anti-epileptic drug combinations. Carbamazepine was the most frequently prescribed drug, and was utilized in the treatment of 87.9% of patients receiving monotherapy and 92.3% of individuals receiving two drug combinations. Adjunctive medications like benzodiazepines were rarely utilised to improve the effect of the AEDs. The patients that received polytherapy could only be distinguished from those that received monotherapy by higher frequency of epileptic auras and higher mean dose of AEDs per day. The predominant use of monotherapy is in accordance with the treatment recommendations and needs to be encouraged. The greater use of carbamazepine is probably related to its perceived benefits in the control of behavioural symptoms.

Discontinuation of AEDs: When and how?

Once a patient has initiated an antiepileptic drug (AED) and achieved a sustained period of seizure freedom, the decision to discontinue AED should be balanced against continuation of AED therapy indefinitely. Studies show that the rate of seizure recurrence after AED withdrawal is about two to three times the rate in patients who continue AEDs. However, there are many benefits to AED withdrawal that should be evaluated on an individualized basis. AED discontinuation may be considered in patients whose seizures have been completely controlled for a prolonged period. There are several factors that would increase risk of recurrences which will be reviewed and discussed. As a consequence, the decision to withdraw or withhold treatment must be still individualized. In any patient, the decision to discontinue treatment should also take into effect the social aspects like driving license, job and leisure activities as well as emotional and personal factors and patients with adverse effects or drug interactions. Patients will ultimately have to decide themselves whether they wish to discontinue drug treatment.

A follow-up study on newer anti-epileptic drugs as add-on and monotherapy for partial epilepsy in China

Background Recently,new anti-epileptic drugs （AEDs） have been more frequently selected to treat epilepsy.In the present study,we evaluated the dynamic changes of efficacy and safety of three newer AEDs for treating partial epilepsy in China.Methods Patients were collected sequentially and were divided into three groups which accepted oxcarbazepine （OXC）,lamotrigine （LTG） or topiramate （TPM） therapy.Each group included monotherapy and add-on therapy subgroups.We followed all patients for one year and recorded the indexes of efficacy and safety in detail.Results A total of 909 patients finished the follow-up observation.No significant difference was found in proportion of patients with 〉 or =50% reduction,〉 or =75% reduction and 100% seizure reduction in the LTG and OXC groups between the first and the second six months.In the TPM group there was a statistical difference between the first and the second six months in proportion of patients with 〉 or =50% reduction （P=-0.002）,〉 or =75% reduction （P 〈0.0001） and 100% seizure reduction （P=0.009） in the monotherapy subgroup,and about 〉 or =75% reduction and 100% seizure reduction in the add-on therapy subgroup （P 〈0.0001）.The efficacy between the add-on and monotherapy subgroups showed a statistical difference.The safety of the three newer AEDs was good.Conclusions The three newer AEDs all showed good efficacy and tolerability for partial epilepsy.And the efficacy can be maintained for at least one year.

回、汉族癫痫患者ABCB1基因C3435T多态性与癫痫耐药的相关性研究

目的研究ABCB1基因C3435T的单核苷酸多态性在回、汉族癫痫人群中的分布特点;探讨回、汉族癫痫患者人群中ABCB1基因型对癫痫耐药的影响,进一步阐明癫痫耐药机制。方法收集宁夏地区回族癫痫耐药患者33例,回族药物敏感癫痫患者29例,汉族癫痫耐药患者62例,汉族药物敏感癫痫患者61例,采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法对入选患者的ABCB1基因C3435T位点进行基因分型,并随机抽取11%的基因分型样本进行直接测序证实。统计4组癫痫患者中C3435T的基因型、等位基因频率,分别用2χ等检验进行统计分析。结果回、汉族对照比较,回族癫痫患者中外显子26 C3435T位点基因型及等位基因频率与汉族癫痫患者均没有差异,(均P>0.05)。与药物敏感组比较,耐药组外显子26C3435T-CC基因型明显多于药物敏感组(P<0.001),而TT基因型则少于药物敏感组(P<0.001)。与药物敏感组比较,耐药组C等位基因频率高于药物敏感组,而T等位基因频率低于药物敏感组(P<0.001)。结论在中国回、汉族人群中均存在的ABCB1-C3435T位点基因多态性与癫痫耐药有关联,这一位点的基因多态性可以影响癫痫患者对抗癫痫药物(AEDs)的反应性。

Clinical Characteristics and Current Medical Practice in a Group of Sudanese Patients with Epilepsy: A Cross Sectional Hospital Based-Study

Introduction: The epilepsy classification in under developed countries faces many difficulties in reporting, work-up and management strategies. Exploring local practice in general hospitals will positively add to the welfare of patients with epilepsy. The objectives of this study were to assess the current medical practice in epilepsy work up and to study the selection of AEDs as per ILAE guidelines. Methods: This was a cross sectional-retrospective hospital based study, conducted between April and September 2016 in Omdurman Teaching Hospital, Khartoum, Sudan. Patients aged 18 years old and above were enrolled. Epilepsy was defined as having at least two non-provoked seizures in the least 6 months in a patient who was assessed by clinical review and electroencephalogram (EEG). Epilepsy was classified as generalized, focal or unclassified. Medications refer to all internationally licensed antiepileptic medications (AEDs) in 2016. Results: One hundred adult Sudanese patients were enrolled for this study. The most common event described during the ictal phase was tongue biting in 50% of participants followed by body stiffness in 46%. Epilepsy was classified as generalized in 84%, focal in 11% and unclassified in 5% patients. In generalized epilepsy, the MRI detected 23.3% abnormal findings higher than the CT which detected 14.8% (4/27), p value = 0.032. In focal epilepsy, the CT detected 75% abnormal findings higher than the MRI which detected 33.3%, p value = 0.02. The AEDs used were as follows: Carbamazepine (CBZ) 48%, Na valproate (VP) 33%, Lamotrigine (LMT) 2%, Levetricetan (LVT) 1%, CBZ + VP 14% and CBZ + Oxcarbazepine (OXC) 2%. Conclusion: The current medical practice in Omdurman teaching hospital should be modified to match the international league against epilepsy (ILAE) guidelines in workup, management, AEDs selection and classification of epilepsy.

Risks of suicidality in adult patients with epilepsy

AIM: To determine the prevalence and risks of suicidality in a group of patients with epilepsy. METHODS: Included were 200 adult patients and 100 matched healthy subjects. The clinical interview using The Diagnostic and Statistical Manual of Mental Disorders(4th edition), Beck Depression Inventory(2nd edition)(BDI-Ⅱ), Hamilton Anxiety Rating Scale(HAM-A), Yale-Brown Obsessive Compulsive Scale(Y-BOCS) and Eysenck Personality Questionnaire-Revised Rating Scale testings were used for diagnosis and assessment of severity of psychiatric symptoms. Blood concentrations of serotonin, catecholamines and dopamine were also measured.RESULTS: Suicidality was reported in 35%(compared to 9% for controls), of them 80%, 72.86%, 55.71% and 52.9% had depression, anxiety, obsession and aggression respectively. Patients with suicidality had higher scores of BDI-Ⅱ(P = 0.0001), HAM-A(P = 0.0001), and Y-BOCS(P = 0.037) and lower scores of psychotic(P = 0.0001) and extroversion(P = 0.025) personality traits. Regardless the presence or absence of suicidality, patients with epilepsy had low serotonin(P = 0.006), noradrenaline(P = 0.019) and adrenaline(P = 0.0001) levels. With suicidality, significant correlations were identified between:(1) age and scores of BDI-Ⅱ(r = 0.235, P = 0.0001) and HAM-A(r = 0.241, P = 0.046);(2) age at onset and concentrations of noradrenaline(r =-0.502, P = 0.024);(3) duration of illness and scores of BDI-Ⅱ(r = 0.247, P = 0.041), Y-BOCS(r = 0.270, P = 0.025) and neurotic personality trait(r =-0.284, P = 0.018); and(4) doses of antiepileptic drugs and scores of psychotic personality traits(r =-0.495, P = 0.006 for carbamazepine; r =-0.508, P = 0.0001 for valproate).CONCLUSION: This is the first study which systematically estimated the prevalence and risks of suicidality in a homogenous group of patients with epilepsy. This study emphasizes the importance of epilepsy itself as a risk for suicidality and not its treatment.

Epilepsy Properties and Seizure Suppression in a Severe Motor and Intellectual Disabilities

Purpose: In hospitalized patients with severe motor and intellectual disabilities (SMID), we analyzed the association of the SMID class to factors such as the prevalence of epilepsy, frequency of seizures and number of concomitantly used anti-epileptic drugs (AEDs), and evaluated the usefulness of addition of the new AEDs (gabapentin, topiramate, lamotrigine and levetiracetam) to the treatment regimen. Results: The prevalence of epilepsy in the study population was about 60%. There were 39.5% who were free of epileptic seizures during the 6-year survey period and remained well-controlled with medication. As the SMID increased in severity, the frequency of seizures increased, the number of concomitantly used AEDs increased, and the tendency towards addition of new AEDs became more marked. About the use situation of new AED and old AED, this comparison revealed a tendency towards addition of a new AED when the seizures were poorly controlled in response to concomitant use of multiple old AEDs. The frequency of seizures and the number of concomitantly used AEDs were higher in patients with SMID of high severity than in those with SMID of low severity. Analysis of the time-course of the frequency of seizures before and after the addition of new AEDs revealed a significant reduction in the frequency of seizures following the addition of the new AEDs (P > 0.001). Conclusions: These results suggest that the new AEDs are useful in the management of SMID-associated epilepsy, because of their effect of reducing the frequency of SMID-associated seizures and their high tolerability.

Electroencephalographic Findings after Eslicarbazepine Therapy in Focal Epileptic Syndrome Patients

The efficacy and the tolerance of the AEDs have been extensibly studied in the past, however the effects of them on the EEG activity of epileptic patients have been scarcely studied. Eslicarbazepine is a third generation blocker-sodium channels AED associated with a high reduction in the rate of partial seizures in epileptic patients. We designed an open label, non control study to determine the effects of Eslicarbazepine on the EEG activity of EP with focal seizures in a 12-week follow up. The EP with focal paroxystical activity enrolled in this study showed a statistical significant reduction in the rate of monthly seizures when Eslicarbazepine 800 mgs was added to a previous AED compared to those patients who only received an increase of the AED in monotherapy, concomitantly, EP treated with ESL added to a previous AED showed a statistically significant reduction in the mean occipital frequency and voltage amplitude in the central and parietal regions in the twelfth-week EEG compared to the control group.

发作间期癫痫样放电(IED)对癫痫患者减停抗癫痫药物(AED)后复发的影响探究

目的评价发作间期癫痫样放电(IED)对癫痫患者减停抗癫痫药物(AED)后复发的影响。方法选择2016年6月到2019年6月我院的癫痫患者36例,按照具体的癫痫发作分类将其分成IED组与非IED组,每个小组有18例,分析减停抗癫痫药物(AED)后复发率、复发患者的年龄和性别、病程指标。结果 IED组的复发率为11.1%,非IED组的复发率为55.5%。分析具体的复发患者临床指标特点,IED组的男性为20.0%,女性为80.0%,非IED组的男性为0.0%,女性为100.0%,可见女性的复发率要高于男性。IED组的年龄为(67.7±1.3)岁,非IED组的年龄为(67.8±2.2)岁。IED组病程为(4.5±0.6)年,非IED组的病程为(4.6±0.8)年。在相互对比之后发现IED组的复发率高于非IED组,相互的比较存在差异,P<0.05。复发患者的年龄偏高,性别多为女性,且病程一般较长。结论在癫痫患者实际治疗期间,减停抗癫痫药物后的复发,很容易受到发作间期癫痫放电因素的影响,应合理的进行分析和研究,正确的探索实际情况。

抗癫痫药物与骨代谢异常的相关性分析

抗癫痫药物(antiepileptic drugs,AEDs)是癫痫最主要的治疗手段,与此同时与AEDs相关的不良反应也受到广泛关注。对骨代谢的影响主要表现为骨代谢指标异常、骨密度(bone mineral density,BMD)降低,进而引起骨质疏松、骨折等。据统计,癫痫患者的骨折率是普通人群的2~6倍[1],且超过50%服用抗癫痫药物的癫痫患者报告有骨骼异常[2]。由于早期骨代谢异常往往没有明确的症状,常被人们忽视。

卡马西平、丙戊酸钠和托吡酯单药对新诊断部分癫痫患者额叶相关认知功能的影响

目的 研究卡马西平 (CBZ)、丙戊酸钠 (VAP)、托吡酯 (TPM)对新诊断成人部分发作癫痫患者额叶相关认知功能的影响。方法 采用前瞻和随机对照研究 ,对 4 8例新诊断为部分发作伴或不伴全面发作的癫痫患者进行 6项神经心理学测验后 ,随机给予CBZ、VAP、TPM单药治疗 ,1月后复查神经心理学检查。结果 与治疗前比较CBZ组B型连线测验错误数增加 (P <0 .0 5 ) ,汉罗塔 (TowerofHanoi)平均计划时间缩短 (P <0 .0 5 ) ;VAP组Stroop读字正确数增加 (P <0 .0 1) ,威斯康星卡片分类测验(WSCT)错误数下降 (P <0 .0 5 )、非持续错误数下降 (P <0 .0 1) ;TPM组倒背数下降 (P <0 .0 1)。治疗后组间比较 ,有 6项神经心理学指标差异有显著性 ,分别是顺背数 (P <0 .0 5 )、词汇总数 (P <0 .0 1)、Stroop读字时间 (P <0 .0 1)、Stroop读字错误数 (P <0 .0 1)、Stroop读色纠正数 (P <0 .0 5 )以及汉罗塔平均计划时间 (P <0 .0 1)。结论 抗癫痫药物的化学结构和作用机制不同 ,所以 ,对认知功能的影响也不同 ;TPM低剂量起始 ,缓慢加量 。

拉莫三嗪对难治性癫痫的临床观察

应用 LTG 添加,开放性自身对照法,观察难治性癫痫30例,观察时间12～24周。结果:12周末,显效9例(30%),有效4例,总有效率43.3%。16～24周获类似的结果。LTG 对各型癫痫发作均有一定效果,似对 GTCS 和 Abs 疗效更佳,EEG 有改善的趋向。副反应轻,主要为皮疹(18.8%)、头晕、头痛、困倦、复视及恶心,除2例因副作用停药(皮疹1例,原精神兴奋复发1例),余多自行消退,治疗前后各项实验室检查均未见有临床意义的异常变化。

抗癫痫药物对患者记忆功能的影响

目的探讨不同抗癫痫药对治疗癫痫患者记忆功能的影响。方法癫痫患者280例随机分4组,分别以卡马西平(CBZ)、丙戊酸钠(VAP)、托吡酯(TPM)、托吡酯联用丙戊酸钠(TPM+VAP)治疗。并设正常健康对照组32例。采用修订韦氏记忆量表(Wechsler Memory Scale,WMS甲式)对患者治疗前后记忆功能做出评价,并与正常健康组对比。结果CBZ组和VAP组治疗后记忆功能与正常健康组对比无显著性差异;TPM组治疗后记忆功能低于正常健康组,TPM+VAP联合用药组记忆功能与正常健康组比较下降更为显著。结论CBZ和VAP对治疗患者记忆功能未有明显影响,而TPM和TPM+VAP可使治疗患者记忆功能明显降低。

传统抗癫痫药物对认知功能影响的研究进展

药物是癫痫治疗的主要手段,抗癫痫药物对认知（conition）功能的损害愈来愈受到临床的重视.目前约75%的癫痫患者需要抗癫痫药（antiepileptic drugs, EDs）来控制痫性发作,而AEDs对认知功能的损害不同程度地影响了患者的生存质量及其对药物的依从性.

女性癫癎患者生殖内分泌功能紊乱

癫痫和抗癫痫药（antiepileptic drugs，AEDs）对生殖系统有复杂的交互作用。癫痫患者生殖内分泌功能紊乱的发生率普遍高于正常人群，这与疾病本身和AEDs均有关。本篇总结了癫痫和AEDs对女性癫痫患者生殖内分泌功能的影响。

抗癫痫药物血药浓度监测的作用及价值

目的:通过血药浓度监测了解常用抗癫痫药在儿科临床应用中血药浓度与药物疗效及不良反应的关系,以防止或减少药物不良反应的发生。方法:采用FPIA法测定228例癫痫患儿单一使用抗癫痫药物(AED)的血药浓度,并对药物剂量、疗效和药物不良反应的关系进行分析,所有患儿经过一年以上随访。结果:228例中192例(84.2%)在有效血药浓度范围内,癫痫发作控制有效183例(80.3%),发生不良反应55例(24.1%)。结论:剂量过大和特异体质是抗癫痫药发生不良反应的主要原因;不同类型的AED所导致的不良反应有明显差异;选择抗癫痫药物类型不当和药物剂量过低是造成治疗效果不满意的重要因素。

抗癫痫药物引起重型药疹33例临床分析

目的探讨抗癫痫药物（AEDs）引起重型药疹（SDE）的发病机制、临床表现、治疗和防预措施。方法回顾性研究了四川大学华西医院在1999年12月～2005年11月收治住院的药疹患者1265例,筛选出由抗癫痫药物（AEDs）引起重型药疹（SDE）患者33例临床资料。结果33例重型药疹（SDE）患者致敏药物为卡马西平（CBZ）占63.64%;重症多形性红斑（SEM）发生率为69.7%;并发药物性肝损害为63.64%。结论引起重型药疹的抗癫痫药物（AEDs）以卡马西平（CBZ）最常见,且以重症多形性红斑（SEM）发生率最高;并发药物性肝损害最常见。及时停用致敏药物,尽早使用糖皮质激素,大剂量免疫球蛋白冲击治疗能迅速控制病情,且无明显不良反应。

从不规范联合用药转变为单药治疗过程分析抗癫痫药物的选择策略

单药治疗或合理的联合用药是癫痫治疗的重要原则,本文运用抗癫痫药物的药代动力学知识,分析了1例复杂不规范的联合用药导致治疗失败的原因,系统讲解了将其转变为有效的传统或新型抗癫痫药物单药治疗的理论和实践过程,并以此展示抗癫痫药物的选择策略。

抗癫痫药物或非药物治疗反射性癫痫伴异常脑电图的临床观察

目的i比较抗癫痫药物或非药物治疗反射性癫痫的临床疗效和脑电图改变。方法i将27例患者分为3组：第1组为反射性癫痫伴脑电图异常（痫样放电1～4次／24h），未用抗癫痫药者；第2组：反射性癫痫伴脑电图异常（痫样放电1～4次／24h），使用抗癫痫药者；第3组为反射性癫痫伴脑电图异常（痫样放电≥5次／24h），使用抗癫痫药者。各组均需避开诱因。根据患者既往最长癫痫发作间期的3倍时间随访其癫痫发作次数和视频脑电图表现。结果：各组无1例临床加重患者，临床总有效率为63％～100％，各组之间比较差异无统计学意义。脑电图改善总有效率3个组之间有明显差异（P〈0．05）。脑电图异常（痫样放电1～4次／24h）病人用药与否脑电图改善总有效率比较差异有显著意义（P〈0．01）。结论：各组反射性癫痫预后良好，伴脑电图异常的反射性癫痫建议给予抗癫痫药治疗。