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Fenfluramine hydrochloride for the treatment of seizures in Dravet syndrome: a randomised, double-blind, placebo-controlled trial. Dravet syndrome is a rare, treatment-resistant developmental epileptic encephalopathy characterised by multiple types of frequent, disabling seizures. Fenfluramine has been reported to have antiseizure activity in observational studies of photosensitive epilepsy and Dravet syndrome. The aim of the present study was to assess the efficacy and safety of fenfluramine (...) in patients with Dravet syndrome.In this randomised, double-blind, placebo-controlled clinical trial, we enrolled children and young adults with Dravet syndrome. After a 6-week observation period to establish baseline monthly convulsiveseizure frequency (MCSF; convulsiveseizures were defined as hemiclonic, tonic, clonic, tonic-atonic, generalised tonic-clonic, and focal with clearly observable motor signs), patients were randomly assigned through an interactive web response system in a 1:1:1 ratio
estimated using a direct elicitation exercise, where 11 patients with epilepsy and 19 caregivers of patients with epilepsy were asked to value a series of vignettes through the perspective of a patient with Lennox-Gastaut Syndrome using a Visual Analogue Scale (VAS). Although not derived using a ‘choice-based’ approach, the company utilised mean estimates from this exercise in the base case (utilities ranged from 0.75 [‘seizure-free’] to 0.235 [= 3 seizure-free days with more than 110 seizures (...) providing tertiary epilepsy specialist care and when treatment with lamotrigine, rufinamide and topiramate has proved ineffective or not tolerated. 11 The Scottish Intercollegiate Guidelines Network (SIGN) issued publication number 148: diagnosis and management of epilepsy in adults in May 2015 and it was updated in 2018. This makes no specific recommendations on the treatment of Lennox-Gastaut syndrome, but notes that drop attacks in patients with Lennox-Gastaut syndrome may respond to rufinamide. 15
with Dravet syndrome (70% to 80%) have abnormalities in the sodium channel a1 subunit gene (SCN1A). 2 6 Stiripentol 6 is the only other medicine specifically licensed for Dravet syndrome, although sodium valproate and clobazam, licensed for use in epilepsy, 2,7,8 are widely used in Dravet syndrome. Sodium valproate is often used to prevent initial recurrence of convulsiveseizures, and benzodiazepines (for example, diazepam, midazolam, clonazepam, or clobazam) are frequently co- administered to limit (...) as follows: ADVICE: following a full submission considered under the orphan process cannabidiol (Epidyolex ® ) is accepted for use within NHSScotland. Indication under review: for use as adjunctive therapy of seizures associated with Dravet syndrome, in conjunction with clobazam, for patients 2 years of age and older. In two phase III, placebo-controlled studies cannabidiol reduced convulsiveseizure frequency in the clobazam-treated subgroup of children (aged 2 to 18 years) with Dravet syndrome
with antiepileptic treatment including at least clobazam. How do Prescrire's editors rate this treatment in this situation? Full text (3 pages) available for download by subscribers. Lennox-Gastaut syndrome and Dravet syndrome are severe forms of epilepsy that affect children and infants. Pharmacological treatment is based on combinations of antiepileptic drugs, sometimes including valproic acid and clobazam.These combinations frequently fail to fully prevent seizures. An oral solution of cannabidiol (...) , the subjects in Prescrire’s Spotlight. 100 most recent :  |   |   |   |   |   |   |   |   |  Spotlight Cannabidiol (Epidyolex°) in certain severe forms of childhood epilepsy: an option to consider, but liver function must be monitored FEATURED REVIEW Cannabidiol (Epidyolex°) has been granted marketing authorisation in the European Union for patients aged 2 years and older with Lennox-Gastaut syndrome or Dravet syndrome, in combination
. doi: 10.1001/jamapediatrics.2020.2282. Online ahead of print. Efficacy of Ketogenic Diet, Modified Atkins Diet, and Low Glycemic Index Therapy Diet Among Children With Drug-Resistant Epilepsy: A Randomized Clinical Trial , , , , , , , , , , Affiliations Expand Affiliations 1 Center of Excellence & Advanced Research on Childhood Neurodevelopmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India. 2 Department of Pediatrics, All (...) Among Children With Drug-Resistant Epilepsy: A Randomized Clinical Trial Vishal Sondhi et al. JAMA Pediatr . 2020 . Show details Display options Display options Format JAMA Pediatr Actions . 2020 Aug 3;e202282. doi: 10.1001/jamapediatrics.2020.2282. Online ahead of print. Authors , , , , , , , , , , Affiliations 1 Center of Excellence & Advanced Research on Childhood Neurodevelopmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
of Biomedical and Neuromotor Sciences, University of Bologna, Italy. PMID: 32601123 DOI: Item in Clipboard Full-text links Cite Abstract Objective: To determine whether systematic screening for adverse effects of antiepileptic drugs (AEDs) reduces toxicity burden and improves health-related quality of life in patients with epilepsy. Methods: Consecutive patients with uncontrolled seizures aged ≥16 years and a high Adverse Event Profile (AEP) score were randomized to 2 groups and followed up for 18 months (...) MP, De Sarro G, Fattore C, Galimberti CA, Gatti G, La Neve A, Muscas G, Specchio LM, Striano S, Perucca E; SOPHIE Study Group. Luoni C, et al. Epilepsia. 2011 Dec;52(12):2181-91. doi: 10.1111/j.1528-1167.2011.03325.x. Epilepsia. 2011. PMID: 22136077 Clinical Trial. Micoulaud-Franchi JA, Bartolomei F, Duncan R, McGonigal A. Micoulaud-Franchi JA, et al. Epilepsy Behav. 2017 Oct;75:18-24. doi: 10.1016/j.yebeh.2017.07.016. Epub 2017 Aug 15. Epilepsy Behav. 2017. PMID: 28818810 LeBlanc EL, Patnode CD
, impaired immune function due to underlying conditions or drug treatment, and older age, particularly when associated with frailty. People with epilepsy may also have any of these conditions. Because autoimmune disorders are associated with an increased risk of epilepsy and are often treated with immunosuppressive therapies, this is a concern for some people with epilepsy. Individuals with tuberous sclerosis complex, which is often accompanied by epilepticseizures, may have reduced lung function (...) and may also be treated with immune therapy. For certain epilepsysyndromes such as Dravet syndrome, as well as for other epilepsies where seizures are triggered by fever or illness, there may be a risk of worsening in a person with fever due to COVID-19. To date, case reports of worsening have not come forward, which is reassuring. Children are less likely to have severe respiratory illnesses (0.9% 0–14 years in China, 1.5% affected were younger than 20 years in Italy ). c. Are there medications
with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, in patients 2 years of age and older . General Contraceptive Considerations Adolescents with seizuredisorders require ongoing education about potential adverse pregnancy outcomes and the most effective contraceptive options. Ideally, education should begin in early adolescence and continue throughout a patient’s reproductive lifespan because antiepileptic drugs, contraceptive needs, and desire for pregnancy may (...) 2011;52:199–211. Article Locations: Cummings LN, Giudice L, Morrell MJ. Ovulatory function in epilepsy. Epilepsia 1995;36:355–9. Article Locations: Tauboll E, Sveberg L, Svalheim S. Interactions between hormones and epilepsy. Seizure 2015;28:3–11. Article Locations: Morrell MJ, Hayes FJ, Sluss PM, Adams JM, Bhatt M, Ozkara C, et al. Hyperandrogenism, ovulatory dysfunction, and polycystic ovary syndrome with valproate versus lamotrigine. Ann Neurol 2008;64:200–11. Article Locations: Joffe H, Cohen LS
are challenged by the new SARS-CoV-2 virus causing corona virus disease 2019 (COVID-19). The virus is causing mainly viral pneumonia and respiratory tract infection. In this statement, we will focus on the impact of COVID-19 on epilepsy. To our knowledge, no publication covering epilepsy, seizures or paroxysmal events has so far been published in relation to COVID-19. However, there are several general aspects to address: During the previous SARS epidemic, some people with epilepsy (PwE) stopped taking (...) their medicine due to isolation, or fear of contracting infection from hospitals, doctors’ offices, pharmacies or surgical procedures. This obviously leads to an increased risk for seizures and status epilepticus with all related complications including injuries, hospital admissions, and potentially sudden unexpected death in people with epilepsy (SUDEP). Hence, patient information is very important and should stress the importance of maintaining concordance with and supply of prescribed medication. COVID-19
will wane over a few days. Nasal decongestant products should be avoided. In some places, herbal products that contain various constituents, such as Ma Huang (ephedra), have been used in treating COVID-19. These products should be avoided in patients with epilepsy as they may interact with ASM and could exacerbate seizures. Patients should always be asked about nonprescription medication and natural product use when taking a medication history. Possible Drugs for Treating COVID-19 Several different (...) Managing Patients with Epilepsy during COVID-19 - Pharmacotherapy-related Recommendations COVID-19 | Pharmacotherapy and Epilepsy | American Epilepsy Society Google Tag Manager | | | You are here » COVID-19 | Pharmacotherapy and Epilepsy COVID-19 | Pharmacotherapy and Epilepsy T his page was last updated April 17, 2020 Managing Patients with Epilepsy during COVID-19 Pharmacotherapy-related Recommendations Prepared by a Task Force of the AES Council on Clinical Activities: Timothy Welty, PharmD
of classifications of seizures: a preliminary study with 28 participants and 48 seizures. Epilepsy Behav. 2005;6(4):607-612. 5. Pellock JM. The classification of childhood seizures and epilepsysyndromes. Neurol Clin. 1990;8(3):619- 632. 6. Scheuer ML, Pedley TA. The evaluation and treatment of seizures. N Engl J Med. 1990;323(21):1468-1474. 7. Engel J, Jr. Report of the ILAE classification core group. Epilepsia. 2006;47(9):1558-1568. 8. Panayiotopoulos CP. Neonatal EpilepticSeizures and Syndromes. Available (...) Boas W, Blume W, et al. Epilepticseizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005;46(4):470-472. 3. Weitemeyer L, Kellinghaus C, Weckesser M, et al. The prognostic value of [F]FDG-PET in nonrefractory partial epilepsy. Epilepsia. 2005;46(10):1654-1660. ACR Appropriateness Criteria ® 9 Seizures — Child 4. Baykan B, Ertas NK, Ertas M, Aktekin B, Saygi S, Gokyigit A. Comparison
that exacerbation of seizures, especially from systemic effects of severe COVID-19 infections, will be a major concern. Given this likelihood, all caregivers of patients with epilepsy should take extra care to assist their patients in preventing potential COVID-19 infection. References Theodore WH, Porter RJ. Precipitation of epilepticseizures is influenced by the type of epilepticsyndrome, patient variability, and environmental factors. Epilepsy: 100 Elementary Principles . London: W.B. Saunders Co. Ltd (...) stages of evolution. Realizing both the need for and limitation of current information, this summary provides a focused summary of pertinent clinical diagnostic information about neurological involvement of SARS-CoV-2 virus and COVID-19, especially in relationship to patients with seizures and epilepsy. General issues There are multiple factors which influence frequency of epilepticseizures, including systemic and environmental factors. 1 COVID-19 therefore may exacerbate epilepticseizures from
Vagal nerve stimulation for epilepsy and depression Vagal nerve stimulation for epilepsy and depression | Washington State Health Care Authority Toggle search Toggle navigation Announcement Menu Apple Health Eligibility Manual Search Close menu Search form Search all of HCA Search Health care services and supports Search Billers, providers, & partners Search Employee & retiree benefits Search About HCA Search Vagal nerve stimulation for epilepsy and depression Vagal nerve stimulation (...) for epilepsy and depression Public comment period extended. Public comment on the vagal nerve stimulation draft report has been extended until close of business, March 30, 2020. Submit all comments to: Vagal nerve stimulation (VNS) for epilepsy and depression was first reviewed by the HTA in 2009. In 2013, a review of VNS medical literature was conducted to determine if newly available evidence published since 2008 was likely to change the original coverage determination. The technology was not selected
is a neurological condition characterised by episodes of abnormal electrical activity in the brain (recurrent seizures). The seizures can be focal or generalised. Current treatments Current treatments 2.2 The main treatment for epilepsy is antiepileptic drugs taken to prevent or reduce the occurrence of seizures. However, many people with epilepsy have drug-resistant epilepsy, which is refractory to drug treatment (estimates vary between 20% and 40% of people with epilepsy). They have frequent seizures (...) or neurological deficit, gait disturbance, visual field deficits, cognitive deficit or psychiatric disturbance, and amnestic disorder. 3.4 Patient commentary was sought but none was received. Committee comments Committee comments 3.5 The committee noted that, in adults, the procedure has primarily been used to treat temporal lobe epilepsy. In children it has primarily been used for hypothalamic hamartomas. 3.6 The committee was informed that the procedure is much less invasive than open surgery. MRI-guided
Epilepsy in older people. Globally, as populations age there will be challenges and opportunities to deliver optimal health care to senior citizens. Epilepsy, a condition characterised by spontaneous recurrent seizures, is common in older adults (aged >65 years) and yet has received comparatively little attention in this age group. In this Review, we evaluate the underlying causes of epilepsy in older people, explore difficulties in establishing a diagnosis of epilepsy in this population (...) , discuss appropriate antiseizure medications, and evaluate potential surgical treatment options. We consider cognitive, psychological, and psychosocial comorbidities and the effect that epilepsy might have on an older person's broader social or care network in high-income versus middle-income and low-income countries. We emphasise the need for clinical trials to be more inclusive of older people with epilepsy to help inform therapeutic decision making and discuss whether measures to improve vascular
: The 24 reports identified comprise mostly care programs addressing active convulsiveepilepsy. Phenobarbital has been used most frequently, although other conventional antiseizure medications (ASMs) have also been used, but none of the newer. Tolerability rates in these studies are high, but overall attrition is considerable. Other approaches include updating primary health care providers, reinforcing treatment adherence in clinics, and raising community awareness. In these programs, the coverage (...) of existing treatment gap in the community, epilepsy-related mortality, and comorbidity burden are only fleetingly addressed. None, however, explicitly describe sustainability plans. Conclusions: Cost-free provision, mostly of phenobarbital, has resulted in short-term seizure freedom in roughly half of the people with epilepsy in low- and middle-income countries. Future programs should include a range of ASMs. These should cover apart from seizure control and treatment adherence, primary health care