Purpose: Severe cytopenia and liver dysfunction are characterized as antiepileptic drug (AED) adverse effects dependent upon an idiosyncrasy. However, in clinical practice, we often find hemato-logical and biochemical changes during AED treatment with causes other than an idiosyncrasy. This study aims to investigate the effect of antiepileptic monotherapy on hematological and biochemical parameters.
Methods: We retrospectively recruited 480 patients untreated with AED at baseline. Changes in hematological and biochemical parameters before and after initiation of medication were investigated, and correlation with plasma concentrations of AED was analyzed.
Results: Sixty-six of 480 patients treated with carbamazepine (CBZ: n = 27), sodium valproate (VPA: n = 19) or levetiracetam (LEV: n = 20) monotherapy were eventually selected for analysis. After CBZ treatment, decreased white blood cell (WBC) count and increased gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) activities were recorded at high frequencies. Decreased WBC count tended to correlate with elevated serum CBZ level. Elevated GGT activity was observed in all patients treated with CBZ. In patients treated with VPA, platelet (PLT) counts decreased. In patients treated with LEV, there were no significant differences in the measured parameters before and after medication.
Discussion: We considered that the reduction in WBC count might be dose-dependently related to AEDs. Elevated GGT activity was observed in all patients treated with CBZ, but the average increase in GGT activity was 35.19 ± 33.08 U/L. In patients undergoing VPA treatment, decreased PLT counts were also observed at high frequency. Thus, hematological and biochemical parameters should be closely monitored in patients receiving AED, especially in patients treated with high doses of AEDs.
Musicogenic epilepsy is an extremely rare type of reflex epilepsy triggered by listening to music. A 27-year-old woman began to recognize auras of déjà-vu approximately once a month when listening to a ballad since she was 23 years of age. She experienced a total of 5 episodes of aura followed by tonic-clonic seizure, and was referred to our department. We strongly suspected the patient as having musicogenic epilepsy based on electroencephalography findings and symptomatological features, although there were no obviously abnormal findings on cephalic magnetic resonance imaging performed during the interval between seizures. The seizures were controlled by antiepileptic drug. Type 1 diabetes mellitus with a high level of anti-glutamic acid decarboxylase antibodies (GAD-ab) developed approximately 3 years after epilepsy onset, which resulted in triggering of the aura without listening to music.
To investigate the linearity and nonlinearity of EEGs before and after psychosis in patients with epilepsy, continuous EEGs before and after psychosis of five patients who developed epileptic psychosis were examined. The continuous EEGs of eight patients without psychosis were used as controls. EEGs were analyzed by Fourier transform for the frequency bands of delta, theta, alpha, and beta as linear indices and by Sample entropy (SampEn) as a nonlinear index. Significant changes were seen in SampEn before vs after psychosis at bilateral frontal and frontal-anterior temporal regions. Significant differences in SampEn between the before psychosis group and the control group were found at the right frontal and frontal-anterior temporal regions. In patients with epilepsy, SampEn may not only decrease in the right frontal and frontal-anterior temporal regions before psychosis, but it may also increase in the frontal and frontal-temporal regions during psychosis. EEG complexity may be useful to investigate the pathophysiological association between epilepsy and psychosis.
Purpose: To assess the efficacy, safety, and pharmacokinetics of oxcarbazepine (OXC) as an adjunctive therapy in Japanese pediatric patients with inadequately controlled partial seizures.
Methods: We conducted a double-blind, randomized, multi-center, placebo-controlled study (the core study) and its open-label extension study. In the core study, the primary efficacy end point was percent change from baseline in seizure frequency per 28 days at week 8.
Results: In the core study, a total of 99 patients were randomized. The median percent change in seizure frequency per 28 days from baseline was -15.30% in patients taking OXC and +2.44% in those taking placebo but the unadjusted difference was not significantly different between two groups (p = 0.0585). However, preplanned sensitive analysis that adjusted the primary efficacy end point by baseline seizure frequency per 28 days (p = 0.0492) and analyses of secondary efficacy end points (responder rate and Clinical Global Impression of Change, p = 0.0157 and 0.0007, respectively) demonstrated significant differences between OXC and placebo. In the extension study, the decrease of seizure frequency in OXC–OXC group (patients randomized to OXC in core study and continued taking OXC in extension study) was maintained, In the switching group (Placebo–OXC: patients randomized to placebo in core study and took OXC in extension study) seizure frequency decreased at a similar level as OXC–OXC group. Common drug-related adverse events observed in the studies were nervous system disorders (somnolence, dizziness), skin disorders (rash, drug eruption), and gastrointestinal disorders (vomiting, nausea). Two cases of hypersensitivity requiring hospitalization were reported, but no serious skin disorders such as Stevens-Johnson syndrome and toxic epidermal necrolysis.
Conclusion: The results showed that adjunctive OXC treatment was effective and well tolerated in Japanese pediatric patients with inadequately controlled partial seizures.
A girl born at 41 weeks of gestation experienced a seizure involving the extremities 12 hours after birth. Hypoglycemia was observed, although various tests failed to identify the cause of hypoglycemia. Thereafter, her development and weight gain were normal, and no hypoglycemia was observed. At five months of age, atypical spasms occurred concomitant with hypoglycemia. The patient was diagnosed with glycogen storage disease type 1b based on genetic testing. Hypsarrhythmia on electroencephalography (EEG) revealed West syndrome. The hypoglycemia were treated by continuous nasogastric tube feeding and neutropenia by injection of granulocyte-colony stimulating factor (G-CSF). The spasms and hypsarrhythmia did not improve by administration of oral antiepileptic drugs including vigabatrin. However, the symptoms improved with 0.011 mg/kg adrenocorticotropic hormone (ACTH) and G-CSF therapy, with no apparent adverse effects. ACTH was a safe treatment for an immunocompromised patient.