- |||||||||| pregabalin / Generic mfg., carbamazepine / Generic mfg., Trileptal (oxcarbazepine) / Novartis
Levetiracetam Versus Sodium Channel Blockers as First Prescribed Antiepileptic Drug: Data from the Human Epilepsy Project (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_1095;
Results 157 (59.5%) initiated levetiracetam (LEV), 49 (18.6%) lamotrigine (LTG), 21 (8%) oxcarbazepine (OXC), 11 (4.2%) phenytoin, 5 (1.9%) topiramate, 12 (4.5%) carbamazepine, (CBZ) 2 (0.8%) lacosamide, 5 (1.9%) valproic acid, 1 (0.4%) pregabalin, and 1 (0.4%) zonisamide.Of the 157 started on LEV, 63 (31.6%) remained on the drug in monotherapy, 76 (48%) switched to another AED, 12 (7.6%) added an AED in conjunction, and 6 (3.8%) ceased AED usage...By the end of the study, pts were receiving the following AEDs alone or in combination: LEV 36.0%, LTG 37.5%, CBZ 6.8%, OXC 17.0%, PHT 0.8%, topiramate 2.3%, lacosamide 7.2%, valproic acid 1.9%, zonisamide 4.9%, lorazepam 0.8%, clobazam 0.4%, clonazepam 0.4%...The likelihood of remaining on initial monotherapy was twice as high for a sodium channel blocker as for LEV in the first 2 years of treatment. (P=.001)
- |||||||||| Trileptal (oxcarbazepine) / Novartis
New Pathogenic Variant in SCN8A Causing SCN8A-Epilepsy in Identical Twins (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_1075;
Future steps including genetic testing on parents and identical twin brother. We propose that our patient (Twin1) demonstrates a new pathogenic variant of SCN8A (c.796G>A (p.Ala266Thr) not previously described in the literature based on clinical phenotype and ancillary studies.
- |||||||||| levetiracetam / Generic mfg.
Neuropsychological Outcomes at Age 2 Years in the MONEAD Study (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_1003;
Children exposed to AED polytherapy did perform worse than those exposed to AED monotherapy. More detailed neuropsychological evaluations are planned for the children at later ages.
- |||||||||| lacosamide / Generic mfg., levetiracetam / Generic mfg., levetiracetam low dose (AGB101) / AgeneBio
Second-Line Anti-Seizure Medication Dosing in Pediatric Refractory Convulsive Status Epilepticus (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_959;
If a patient was > 50kg, we considered 1000mg as the minimum dose (for all ASM, except for lacosamide –LAC-)...Reasons of dividing doses may include medical concerns related to clinical presentation or potential side effects. At times, treatment times exceeded optimal medication application, and analysis of factors related to treatment timing is ongoing to tailor respective interventions.
- |||||||||| levetiracetam / Generic mfg.
Proteomic and Metabolomic Changes in a Model of Drug-Resistant Temporal Lobe Epilepsy Are Mitigated by Treatment with Sodium Selenate (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_950;
Conclustions This study provides evidence that sodium selenate treatment of chronic epileptic rats in the post-kainic acid SE model of TLE has an enduring disease modifying effect, with fewer spontaneous seizures and a modified proteomic expression profile in comparison to vehicle treated rats. Furthermore, the study highlights candidate prognostic biomarkers, which might inform the design of novel targeted molecular disease modifying-treatment approaches.
- |||||||||| carbamazepine / Generic mfg., Trileptal (oxcarbazepine) / Novartis
Effect of Antiepileptic Drug Monotherapy on the Risk of Death in Patients with Poststroke Epilepsy (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_941;
The opposite applies for patients treated with VPA, who seem to have a higher risk of both cardiovascular and all-cause death compared to CBZ and LTG. The analyses are adjusted for several confounders, but further studies are needed to establish a causal relationship.
- |||||||||| carbamazepine / Generic mfg.
Functional Consequences of a Novel De Novo SCN2A Variant of Unknown Significance Associated with an Early-Onset Epilepsy (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_926;
The child became seizure free after an intravenous loading dose of fosphenytoin...After discovery of the SCN2A variant, the patient’s treatment was modified to carbamazepine with a resulting decrease in seizure frequency...We interpret these data as indicating a gain of channel function which is consistent with the pathogenesis of epilepsy and the observed clinical efficacy of the sodium channel blocking anticonvulsant drugs. Our findings further demonstrate the value of conducting functional analyses of SCN2A variants of unknown significance to establish pathogenicity and genotype-phenotype correlations.
- |||||||||| methylprednisolone / Generic mfg., Rituxan (rituximab) / Roche, Biogen
Improvement of Cognition, Parkinsonism and Faciobrachial Dystonic Seizures with Immunosuppression in LGI1 Encephalitis (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_899;
A 5 day course of IV methylprednisolone resulted in a marked seizure improvement and cognitive/mobility gains...The patient continued on prednisone infusions weekly as bridge to rituximab for long term therapy...Early initiation of immunotherapy may prevent development of cognitive decline and improve long-term outcomes. Parkinsonian features of this patient may further implicate basal ganglia dysfunction in this autoimmune disorder, though future studies will be needed.
- |||||||||| lacosamide / Generic mfg., levetiracetam / Generic mfg., acyclovir / Generic mfg.
Cotard’s Syndrome: An Uncommon Presentation of Postictal Psychosis (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_860;
High serum concentrations of CMMG (carboxymethoxymethylguanine), the principal metabolite of acyclovir, have been associated with Cotard’s delusions, nevertheless, this often seen in patients with renal disease. There is no specific treatment for Cotard’s syndrome; the general approach for treatment involves treating the underlying medical or neuropsychiatric illness in all cases.
- |||||||||| Epilepsy and Multiple Sclerosis: A Single Institutional Experience (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_821;
It seems that an increased degree of surveillance and awareness of seizure risk will benefit the standard of care as patients develop more active, advanced, or longstanding MS disease. In our patient cohort, less than half of the patients were seizure free, and most were taking second generation AED rather than first generation AED.
- |||||||||| lacosamide / Generic mfg., lorazepam / Generic mfg., levetiracetam / Generic mfg.
An Unusual Case of Subacute Encephalopathy with Seizures in Alcoholics (SESA) Syndrome (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_815;
He was given intravenous (IV) lorazepam and levetiracetam which resulted in cessation of clinical seizure activity, however he remained poorly responsive and unable to follow commands...He was continued on levetiracetam, lacosamide and valproic acid and was discharged to a rehabilitation facility...The evolution into super-refractory NCSE makes this case particularly unusual and highlights the importance of continuous EEG monitoring in this condition. Unlike alcohol withdrawal seizures, SESA syndrome typically requires chronic treatment with AEDs as recurrence is common.
- |||||||||| carbamazepine / Generic mfg.
Paradoxical Worsening of Frontal Lobe Seizures with Benzodiazepines (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_752;
Patient’s seizure medications were held, and on the third night, he was noted to have a cluster of seven nocturnal seizures prompting IV diazepam use for a total of 15mg.The patient continued to have seizures requiring additional BZDs, total of 12mg of IV lorazepam and 4mg of IV midazolam over the course of 7 – 8 hours...His ASDs were continued at home doses (brivaracetam 100mg TID, carbamazepine 600-400-400, and perampanel 18mg QHS)...At that point his clobazam was stopped and switched to zonisamide and his seizure frequency decreased to 0-1 per night...Conclustions Paradoxical worsening of frontal lobe seizures with benzodiazepine usage can occur. BZDs still remain the first line for acute seizure treatment, however additional precautions should be taken when used for sleep activated frontal lobe seizures.
- |||||||||| levetiracetam / Generic mfg.
Nonketotic Hyperglycemia-Induced Occipital Lobe Seizures (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_751;
We report a case of occipital lobe seizures secondary to hyperglycemia that did not meet the criteria for NKHH. Recognition of the role of hyperglycemia in seizures is vital because such seizures tend to be focal, refractory to AEDs, and respond mainly to insulin therapy and hydration [2, 3].
- |||||||||| levetiracetam / Generic mfg.
Visual Todd's Paralysis (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_750;
The abrupt onset and quality of ictal hallucinations is also noticeably different from visual aura commonly encountered in patients with migraine, which could have been considered given his concurrent headache. Thus, although occipital epilepsy with visual hallucinations is rare, it is important to be aware of this condition and consider it as a differential diagnosis for new onset hemianopsia with hallucinations.
- |||||||||| dexamethasone / Generic mfg., Actemra IV (tocilizumab) / Roche, JW Pharma
Seizure Prophylaxis in CART Patients: An Institutional Experience (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_747;
Three patients developed CRS and required IV Tocilizumab...Limitations of our study include small sample size and retrospective data. Further studies will be valuable to elucidate the efficacy and cost-benefit analysis of routine seizure prophylaxis in this patient population.
- |||||||||| Trileptal (oxcarbazepine) / Novartis
Investigating Predictors for Developing Refractory Epilepsy in Patients with Tumor-Related Epilepsy (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_708;
Conclustions The only significant factor predicting the development of refractory epilepsy in this study was the length of seizure freedom period after initiation of first line AED, with seizure free intervals less than 1 month having a much higher risk for refractory epilepsy. Additionally, there was also no statistical difference in efficacy between the 1st and 2nd line anti-epileptic medications in tumor-related epilepsy.
- |||||||||| carbamazepine / Generic mfg.
Antiseizure Drug Response of Outbred Versus Inbred Mice in Pharmacoresistant Acute and Chronic Seizure Models (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_678;
Conclustions This work highlights strain-related differences in the potency of acutely administered ASDs in common mouse seizure models; both inbred (C57Bl/6) and outbred (CF-1) mouse strains are frequently used in the development of novel ASDs. It also highlights the dose-dependent impacts that pharmacologically-equivalent doses of ASDs can have upon quantifiable locomotor behavior beyond the TD50 alone.
- |||||||||| Briviact (brivaracetam) / UCB, carbamazepine / Generic mfg., Trileptal (oxcarbazepine) / Novartis
Real-World Study of Brivaracetam in the US: An Interim Analysis (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_653;
Three patients died during the study, but none were judged to be drug-related. Conclustions This interim analysis indicates that retention on BRV (a measure of effectiveness) at 3 and 6 months is similar between patients that had previously failed LEV, LTG, OXC, and CBZ.
- |||||||||| Fycompa (perampanel) / Eisai, carbamazepine / Generic mfg.
Effect of Concomitant Anti-Seizure Drugs During Adjunctive Perampanel Treatment in Pediatric Patients (Aged 4 to <12 Years): Post Hoc Analysis of Study 311 (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_647;
P3
For the most common concomitant ASDs these were: levetiracetam: 48.9% (22/45) and 55.6% (5/9); valproic acid: 39.6% (19/48) and 75.0% (3/4); clobazam: 52.5% (21/40) and 66.7% (4/6); lamotrigine: 42.9% (15/35) and 77.8% (7/9); topiramate: 54.5% (12/22) and 40.0% (2/5); and carbamazepine: 42.3% (11/26) and 0.0% (0/0), respectively. Conclustions These data suggest adjunctive perampanel is generally well tolerated and efficacious in pediatric patients (aged 4 to ˂12 years) with POS (with/without SGS) or PGTCS, irrespective of baseline ASD use.
- |||||||||| pregabalin / Generic mfg.
A Case of Pregabalin-Induced Myoclonic Status Epilepticus (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_609;
Patient should be counseled accordingly and PGB withdrawn if MSE should occur. Additional research is needed to determine how PGB can evoke MSE.
- |||||||||| lamotrigine liquid oral suspension / OWP Pharma
Behavioral Complications from Levetiracetam in the Epilepsy Monitoring Unit (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_608;
We recommend at minimum discussion with patients regarding risk of behavioral side effects when initiating LEV and follow up specifically regarding side effects after the patient has been on maintenance LEV. When necessary, transition to an AED with a lower incidence of adverse mood effects should be considered.
- |||||||||| levetiracetam / Generic mfg.
Levetiracetam Hepatotoxicity in Treatment of Status Epilepticus (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_606;
The findings of this study are subject to bias due to the retrospective nature and the population of critically ill where many confounders exist that may contribute to liver injury. More rigorous and prospective research is needed to clarify levetiracetam’s potential for hepatotoxicity in the critically ill.
- |||||||||| levetiracetam / Generic mfg.
Treatment of Electrographic Seizures in Critically Ill Children (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_593;
Second, the approach to treating subclinical seizures differs in comparison to treatment of clinical seizures. Further study is needed to assess the impact of early aggressive treatment, seizure burden, and developmental outcome.
- |||||||||| Use of Perampanel in Two Patients with Epilepsy and Severe Mental Health or Behavioral Disorders (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_567;
She was unable to work or maintain custody of her child due to bipolar disorder (treated with 1 mg risperidone twice daily)...He was transitioned to 1600 mg/day eslicarbazepine acetate (replacing oxcarbazepine) and 200 mg lacosamide twice daily; phenobarbital was slowly tapered off over 6 months...The patient has continued to receive quetiapine 200 mg twice daily...During titration and at higher doses of perampanel, patients must be monitored for atypical behavior. Further research is required.
- |||||||||| Trileptal (oxcarbazepine) / Novartis
Mortality in Children with Sturge Weber Syndrome (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_558;
Seizures were not controlled despite adding levetiracetam and lorazepam, and she underwent right functional hemispherectomy at 6 months; however, resection was limited by blood loss...At 4 months, he developed left-sided focal seizures treated with phenobarbital, levetiracetam, and phenytoin, later responding to oxcarbazepine...No death directly related to prolonged seizures or SUDEP was seen in this cohort. Further studies will be necessary to identify the risk factors for mortality in children with SWS.
- |||||||||| How are Newly FDA Approved Anti-Epileptic Drugs (AEDs) Being Utilized? (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_550;
Esclicarbazepine was had the lowest average of concurrent AEDs (1.4), followed by clobazam (1.9), brivaracetam (1.9) and perampanel (2.2)...The most commonly concurrent AEDs are medications which longstanding proven efficacy and low side effect and efficacy profiles (levetiracetam, lamotrigine, and lacosamide)...As more AEDs become FDA approved for epilepsy, it will be valuable to see if prescribing trends of the AEDs approved between 2010 and 2016 are altered. It would be valuable in future studies to see if these prescribing trends can be reaffirmed in larger patient cohorts.
- |||||||||| First Clinical Experience with Ketocal in Mexican Pediatric Patients: Report of Two Cases. (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_540;
Results The response of both patients to the ketogenic diet was satisfactory, until now the same treatment is continued in ketosis surveillance as well as the registry of crisis number, lipid profile, and liver enzymes as well as electroencephalogram, during the use of the diet was decided to reduce topiramate to the risk of nephrocalcinosis without evidence of adverse effects related to diet. Conclustions The use of ketogenic diet has been well described for many years, however in Mexico the protocols for the administration of the diet are not well designed.The need for a multidisciplinary team of specialists is necessary as well as the monitoring of adverse effects related to diet in addition to the adjustment of antiepileptic drugs in each patient.The advantages of using Ketocal in these cases have been the absence of hypoglycemia, increased blood lipids in addition to not requiring nutrients such as calcium or magnesium in the treated patients.
- |||||||||| Fycompa (perampanel) / Eisai, levetiracetam / Generic mfg.
The Efficacy and Tolerability of Add-On Multivitamin Therapy in Patients with Intractable Focal Epilepsy (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_460;
Three patients reported seizure worsening and they were all taking levetiracetam in common (one with concurrent perampanel, one with lamotrigine and one without any other drug). Conclustions Our study demonstrated the therapeutic potential and relatively good tolerability of add-on multivitamin therapy in patients with refractory focal epilepsy.
- |||||||||| lacosamide / Generic mfg., levetiracetam / Generic mfg.
Two Cases with Post-Cardiac Arrest and Re-Emergence of EEG Reactivity (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_406;
Results These 2 patients had re-emergence of EEG reactivity and a good clinical outcome despite early seizures and lack of EEG reactivity until 3 days post cardiac arrest. Conclustions Although lack of EEG reactivity in the context of anoxic brain injury has been associated with poor prognosis, this finding cannot be consistently relied upon to guide decisions about prognostication and withdrawal of care, EEG reactivity may reemerge later on and patients may improve clinically.
- |||||||||| Epidiolex (cannabidiol) / GW Pharma
The Effect of Epidiolex on Felbamate Levels in Children with Treatment Resistant Epilepsy (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_397;
Another recent case series described a potential interaction between CBD and Brivaracetam2...Other concomitant AEDs included Valproic acid (N=8), Clobazam (N=11), Topiramate (N=3), Levetiracetam (N=2), Zonisamide (N=1), and Vigabatrin (N=1)...Additionally, of the six subjects who were only taking Epidiolex and Felbamate, five (83%) exhibited decreased Felbamate levels. While the mechanism for the interaction is unknown, these findings suggest that close laboratory monitoring and potential dose adjustments may be required when patients taking felbamate are started on Epidiolex.
- |||||||||| levetiracetam / Generic mfg., clobazam / Generic mfg., levetiracetam low dose (AGB101) / AgeneBio
Adult-Onset Visually Provoked Myoclonic Epilepsy (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_395;
Video EEG monitoring was necessary for correct diagnosis. Our patient had no response to Levetiracetam and complete response to low-dose Clobazam, suggesting a benzodiazepine responsive syndrome.
- |||||||||| levetiracetam / Generic mfg.
Stereotypes and Seizures in Patients with SLC6A1 Related Encephalopathy (Hall E) - Nov 28, 2019 - Abstract #AES2019AES_369;
Conclustions SLC6A1 mutations are relatively newly described and have a broad clinical phenotype. In a group of three patients seen in our practice, specific stereotypies such as hand to chin tapping and blinking with forceful eye closure were common findings which have not previously been described in the literature.
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