Background Eslicarbazepine acetate (ESL), a novel sodium channel blocker, is approved for mono and adjunctive treatment of partial epileptic seizures with or without secondary generalization. Its efficacy in primary generalized seizures has not yet been evaluated. Objective To evaluate the efficacy and safety of ESL in primary generalized tonic-clonic seizures (PGTCS) in an observational study. Methods The data were collected from a prospective population-based register. Effectiveness was measured as relative reduction in standardized seizure frequency (SSF), responder rate (≥ 50% reduction in SSF), and seizure freedom rate at 6 and 12 months after initiation of ESL. Safety and tolerability were evaluated using patients’ diaries. Results Fifty-six adult patients with PGTCS were treated with ESL as adjunctive therapy. Of these, 30.4% ( n = 17) had myoclonic seizures in addition to PGTCS. The retention rate after 12 months was 80.4% ( n = 45). After initiating ESL therapy, reduction in SSF for PGTCS on ESL was 56.0% after 6 months and 56.9% after 12 months ( p < 0.01), whereas myoclonic seizures did not show any significant improvement in frequency. The responder rate for PGTCS was 64.3% after 6 months and 66.1% after 12 months, and seizure freedom was achieved in 32.1% and 35.7%, respectively. Forty-three patients (73.2%) reported no side effects. Among the reported side effects of ESL therapy, headache (7.1%), dizziness (8.9%), tiredness (7.1%), nausea (5.4%), and hyponatremia (5.4%) were the most prevalent. Conclusions Our data suggest that ESL may provide additional benefits in the treatment of patients with PGTCS and motivate randomized controlled trials in this indication.
Zusammenfassung Ziel der Studie Die vorliegende Untersuchung stellt die Chancen und Herausforderungen des Einsatzes von Video Online Seminaren (VOS) im klinischen Bereich des Humanmedizinstudiums aus der Sicht der Lehrenden und Studierenden dar. Methodik Lehrende und Medizinstudierende des 5. bis 10. Semesters wurden anhand von Fragebögen zu ihren Einstellungen und Erfahrungen mit VOS befragt. Aus den Ergebnissen wurden Empfehlungen zum Einsatz von VOS abgeleitet. Ergebnisse 19 Lehrende und 108 Studierende nahmen teil. VOS helfen 67% der Studierenden beim Lernen im klinischen Abschnitt des Medizinstudiums. Kognitive Lernziele (91% Zustimmung) sollen laut Studierenden häufiger in VOS vermittelt werden als affektive Lernziele (71% Zustimmung). 83% geben allerdings an, durch VOS allein nicht auf spätere praktische Tätigkeiten vorbereitet zu sein. Lehrende berichten, dass kognitive Lernziele (77% Zustimmung) deutlich besser vermittelt werden können als affektive (nur 27% Zustimmung). Für 2/3 der Lehrenden sind Unterstützungen bzw. Schulungen im Umgang mit VOS wichtig. Gute technische Voraussetzungen sind für beide Gruppen wichtig. Diskussion/Schlussfolgerung Als Vorteil der VOS unterstreicht die Studie die Option des ortsunabhängigen individuellen Lernens. Das Lehrformat wird als besonders hilfreich angesehen, wenn eine Interaktion zwischen Lehrenden und Studierenden gelingt. Im Rahmen von Blended Learning Konzepten mit vorausgehenden Vorlesungen und nachfolgenden praktischen Übungen ist der Lernerfolg durch VOS am größten. Kognitive und teilweise auch affektive Lernziele können gut durch diese Methode abgebildet werden. VOS können auf praktische Übungseinheiten vorbereiten, allerdings sind sie in der medizinischen Lehre nicht ausreichend, um praktische Lernziele umfassend zu lehren.
Objective: Due to the high mortality of patients with refractory status epilepticus (SE), new antiseizure medications (ASMs) are needed to improve long-term outcomes. In this study, we evaluated the efficacy and safety of eslicarbazepine acetate (ESL), a new sodium channel blocker, based on the data from a large epilepsy register.Methods: Data on the efficacy and safety of ESL for the treatment of refractory SE were gathered from the Mainz Epilepsy Registry (MAINZ-EPIREG). Logistic regression was applied to identify predictors of status interruption.Results: In total, 64 patients with remote symptomatic refractory SE were treated with ESL. No cases of idiopathic generalized epilepsy were included. The average age was 61.4 ± 11.0 years. The median number of administered ASMs before the start of ESL was three. On average, 2 days had elapsed since the onset of SE before the administration of ESL. The initial dose of 800 mg/day was increased up to a maximum daily dose of 1600 mg in case of nonresponse. In 29 of 64 patients (45.3%), the SE could be interrupted within 48 h of ESL therapy. In patients with poststroke epilepsy, the control of SE was achieved in 62% of patients (15/23). The earlier initiation of ESL therapy was an independent predictor of control of SE. Hyponatraemia occurred in five patients (7.8%). Other side effects were not observed.Significance: Based on these data, ESL may be used as an adjunct therapy for the treatment of refractory SE. The best response was found in patients with poststroke epilepsy. In addition, early initiation of ESL therapy appears to result in better control of SE. Besides a few cases of hyponatraemia, no other adverse events were detected. K E Y W O R D Sefficacy, eslicarbazepine acetate, hyponatraemia, poststroke epilepsy, safety, status epilepticus | INTRODUCTIONStatus epilepticus (SE) is a neurological emergency causing both high morbidity and mortality unless prompt and effective treatment is administered. 1 Excessive neuronal discharges lead to epileptiform potentials inducing brain damage and secondary systemic complications. Alterations at the molecular, cellular, synaptic, andThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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