No abstract

In patients with epilepsy, previously not satisfactorily treated with CBZ or OXC, conversion to TPM may result in an improvement in seizure control as well as in quality of life.

Oxcarbazepine (OXC) has been licensed for monotherapy and add-on therapy of focal epilepsy in Germany since February 2000. It is chemically related to carbamazepine, and its anticonvulsant effect has been proven in placebo-controlled double blind studies to be comparable to standard antiepileptic drugs such as carbamazepine, valproate, and phenytoin. Patients whose epilepsy is not well controlled with carbamazepine or in whom side effects occur with carbamazepine can be switched to oxcarbazepine overnight, i.e., without a titration phase. In a retrospective analysis on 51 patients with focal epilepsy, the exchange of carbamazepine with oxcarbazepine was investigated. An exchange in a dosage ratio of 1:1-1:1.5 led to a reduction in seizure frequency by more than 50% in 51% of patients. Oxcarbazepine was better tolerated than carbamazepine. During exchange, CNS toxicity occurred more often with high initial dosages and with an exchange ratio of 1:1.5. In patients pretreated with high dosages of carbamazepine, an exchange ratio of 1:1 and rapid subsequent titration to the maximally tolerated dosage may thus be preferable. In 35% (18/51) of patients treated with oxcarbazepine, hyponatremia developed, which was symptomatic in three patients. Sodium levels should be controlled after exchange and if side effects occur. In conclusion, the overnight switch to oxcarbazepine is an attractive option in patients insufficiently controlled by carbamazepine.

The purpose of this study was to assess the prevalence of injection site reactions (ISR) and flu-like symptoms (FLS) during treatment with subcutaneous (SC) interferon (IFN) beta therapies and to document measures to mitigate and prevent ISR and FLS. Patients and Methods: The cross-sectional post-authorization safety study PERFECT was conducted from 11/2017 to 7/2019 in neurology practices in Germany. Adult patients with relapsing-remitting multiple sclerosis (MS) receiving SC IFN beta for ≥3 months were eligible. The primary endpoints were patient-reported prevalence of ISR and FLS. Additional endpoints reported by patients, MS nurses, and neurologists included type, frequency, duration, time of occurrence, and management of ISR and FLS. Results: In total, 603 patients (median age 45 years [range 36-53], 74% female) were included in the analysis. Time since MS diagnosis was >5 years in most patients. The majority had received none (64%) or 1 (22%) prior therapy. Current MS therapy in 36%, 32%, and 30% of patients was IFN beta-1b, IFN beta-1a, and peginterferon beta-1a, respectively. ISR and FLS under current therapy were reported by 84% and 68% of patients, respectively. ISR developed within 5 days after injection (84%) and lasted for 2-14 days (53%) in most patients. The most frequent patient-reported symptom was erythema (39%). ISR resolved or abated with systemic treatments or topical ointments. Most frequent preventive measures included alternating injection sites (58%). Occurrence of ISR rarely resulted in treatment interruption (5%). FLS occurred predominantly up to 6 h after injection (40%) and lasted <12 h (26%). The most frequent patient-reported symptoms were fatigue (15%) and aching limbs (15%). Assessments by physicians and MS nurses differed from patientreported results. Conclusion:Although ISR were experienced by the majority of patients, they rarely resulted in treatment interruption. In this real-world setting, ISR and FLS management was in line with published expert recommendations.

No abstract

Topiramate is an effective and well tolerated long-term treatment option for adolescents and adults with epilepsy.

In diesem Artikel wird die gegenwärtige Rolle von Topiramat (TPM) bei der Behandlung ver− schiedener Anfallsarten und Epilepsiesyndrome diskutiert. Dabei werden Daten zu TPM aus ran− domisierten, doppelblinden klinischen Prüfun− gen wie auch offenen, nichtinterventionellen Studien im Hinblick auf die Leitlinien der Deut− schen Gesellschaft für Neurologie analysiert, die TPM als ein Mittel der ersten Wahl für die Be− handlung fokaler wie auch idiopathisch generali− sierter Epilepsien empfehlen. In randomisierten Monotherapiestudien wurden Wirksamkeit und Verträglichkeit einer niedrig dosierten TPM−Mo− notherapie in der Behandlung sowohl fokaler als auch generalisierter Epilepsien und verschiede− ner Anfallstypen des Lennox−Gastaut−Syndroms belegt. Diese breite Wirksamkeit wurde als wich− tig gerade bei der Behandlung von Patienten an− gesehen, bei denen Anfallstyp oder Epilepsiesyn− drom noch nicht klar definiert sind. Es zeigte sich, dass eine initiale Zieldosierung von 100 mg effektiv und verträglich ist. Studien, die ältere Pa− tienten eingeschlossen haben, weisen darauf hin, dass auch niedrigere Dosen ab 50 ± 75 mg/Tag für eine initiale Therapie ausreichen können. TPM ist eine gute Option auch für ältere Patienten. Die Verträglichkeit war bei Kombinationstherapie mit hohen TPM−Dosen problematisch, unter niedrigen Dosierungen hat sich die Nebenwir− kungsrate deutlich reduziert. Abstract !