Eslicarbazepine acetate in post‐stroke epilepsy: Clinical practice evidence from Euro‐Esli

Sales, Francisco; Chaves, João; McMurray, Rob; Loureiro, Rui; Fernandes, Helder Miguel; Villanueva, Vicente

doi:10.1111/ane.13323

Cited by 16 publications

(15 citation statements)

References 31 publications

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“…A more recent analysis of the etiology‐specific treatment response was done in a post hoc analysis of the Euro‐Esli study on patients all of whom were treated with eslicarbazepine acetate in mono‐ or polytherapy. In that study, patients with epilepsy due to stroke compared to all other causes of focal epilepsy had a significantly higher 50% responder rate; that is, >50% fewer seizures with eslicarbazepine acetate than before 13 . However, there is no reason to assume that specific ASMs are more or less efficacious in focal epilepsy of different etiologies.…”

Section: Discussionmentioning

confidence: 93%

“…In that study, patients with epilepsy due to stroke compared to all other causes of focal epilepsy had a significantly higher 50% responder rate; that is, >50% fewer seizures with eslicarbazepine acetate than before. 13 However, there is no reason to assume that specific ASMs are more or less efficacious in focal epilepsy of different etiologies.…”

Section: Discussionmentioning

confidence: 99%

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Etiology‐specific response to antiseizure medication in focal epilepsy

2021

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Objective In focal epilepsy, data on the etiology‐specific response to antiseizure medication (ASM) are surprisingly sparse. In this study, we sought to reappraise whether seizure outcome of pharmacological treatment is linked to the underlying etiology. Furthermore, we assessed ASM load with respect to the cause of epilepsy. Methods Data were retrospectively obtained from the electronic database of the three sites of an academic adult epilepsy outpatient clinic. For each patient, presumed cause of epilepsy was categorized into one of nine etiological groups. Individual drug loads were calculated according to the 2020 World Health Organization Center for Drug Statistics Methodology ATC/DDD Index. Univariate and multivariate analyses were conducted to explore the association between different etiologies and outcome regarding 12‐month seizure freedom as well as ASM load. Results A total of 591 patients with focal epilepsy were included in the final analysis. Ischemic stroke was the etiology with the highest rate of 12‐month terminal seizure freedom (71.2%, 95% confidence interval [CI] = 57.9–82.2) and, considering all etiological groups, was an independent predictor of seizure freedom (odds ratio = 2.093, 95% CI = 1.039–4.216). The lowest rates of seizure freedom were observed in patients with hippocampal sclerosis (28.2%, 95% CI = 15.0–44.9) and malformation of cortical development (16.7%, 95% CI = 2.1–48.4). In patients with ischemic stroke, median ASM load (1.0, interquartile range [IQR] = .5–1.8) was significantly lower compared to that in patients with hippocampal sclerosis (median = 1.8, IQR = 1.2–3.0, p = .008) and brain tumors (median = 1.7, IQR = .7–3.2, p = .049). Significance Response to treatment with ASM is highly etiology‐specific and best in patients with epilepsy due to ischemic stroke. Interestingly, this most favorable treatment outcome can be achieved by the lowest ASM load considering all etiological groups. In focal epilepsy, etiology should be taken into account when counseling patients about their expected seizure outcome with pharmacological treatment and when tailoring initial ASM doses.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Etiology‐specific response to antiseizure medication in focal epilepsy

2021

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“…Uncontrolled trials showing the efficacy and tolerability of individual drugs such as eslicarbazepine acetate [ 87 ], gabapentin [ 88 ], levetiracetam [ 89 , 90 ], valproic acid, and other newer ASMs [ 91 ] are also sparse. However, the validity of these studies is limited by bias, placebo effect, regression to the mean, and other confounding factors.…”

Section: Management Of Post-stroke Epilepsymentioning

confidence: 99%

Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management

et al. 2021

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Stroke is the leading cause of seizures and epilepsy in older adults. Patients who have larger and more severe strokes involving the cortex, are younger, and have acute symptomatic seizures and intracerebral haemorrhage are at highest risk of developing post-stroke epilepsy. Prognostic models, including the SeLECT and CAVE scores, help gauge the risk of epileptogenesis. Early electroencephalogram and blood-based biomarkers can provide information additional to the clinical risk factors of post-stroke epilepsy. The management of acute versus remote symptomatic seizures after stroke is markedly different. The choice of an ideal antiseizure medication should not only rely on efficacy but also consider adverse effects, altered pharmacodynamics in older adults, and the influence on the underlying vascular co-morbidity. Drug–drug interactions, particularly those between antiseizure medications and anticoagulants or antiplatelets, also influence treatment decisions. In this review, we describe the epidemiology, risk factors, biomarkers, and management of seizures after an ischaemic or haemorrhagic stroke. We discuss the special considerations required for the treatment of post-stroke epilepsy due to the age, co-morbidities, co-medication, and vulnerability of stroke survivors.

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“…Eslicarbazepine (ESL), LCM, oxcarbazepine (OXC), perampanel (PER), and zonisamide are currently underinvestigated in PSE [38][39][40]. An exploratory pilot study showed that LCM was relatively effective in patients with epilepsy with cerebrovascular aetiologies, with high tolerability, assuming that appropriate care is taken regarding contraindications (most importantly, certain cardiac conduction disorders).…”

Section: Choice Of Antiseizure Medication In the Treatment Of Post-stroke Seizuresmentioning

confidence: 99%

Seizures and epilepsy in patients with ischaemic stroke

Zöllner

Schmitt

Rosenow

et al. 2021

Neurol. Res. Pract.

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Background With the increased efficacy of stroke treatments, diagnosis and specific treatment needs of patients with post-stroke seizures (PSS) and post-stroke epilepsy have become increasingly important. PSS can complicate the diagnosis of a stroke and the treatment of stroke patients, and can worsen post-stroke morbidity. This narrative review considers current treatment guidelines, the specifics of antiseizure treatment in stroke patients as well as the state-of-the-art in clinical and imaging research of post-stroke epilepsy. Treatment of PSS needs to consider indications for antiseizure medication treatment as well as individual clinical and social factors. Furthermore, potential interactions between stroke and antiseizure treatments must be carefully considered. The relationship between acute recanalizing stroke therapy (intravenous thrombolysis and mechanical thrombectomy) and the emergence of PSS is currently the subject of an intensive discussion. In the subacute and chronic post-stroke phases, important specific interactions between necessary antiseizure and stroke treatments (anticoagulation, cardiac medication) need to be considered. Among all forms of prevention, primary prevention is currently the most intensively researched. This includes specifically the repurposing of drugs that were not originally developed for antiseizure properties, such as statins. PSS are presently the subject of extensive basic clinical research. Of specific interest are the role of post-stroke excitotoxicity and blood–brain barrier disruption for the emergence of PSS in the acute symptomatic as well as late (> 1 week after the stroke) periods. Current magnetic resonance imaging research focussing on glutamate excitotoxicity as well as diffusion-based estimation of blood–brain barrier integrity aim to elucidate the pathophysiology of seizures after stroke and the principles of epileptogenesis in structural epilepsy in general. These approaches may also reveal new imaging-based biomarkers for prediction of PSS and post-stroke epilepsy. Conclusion PSS require the performance of individual risk assessments, accounting for the potential effectiveness and side effects of antiseizure therapy. The use of intravenous thrombolysis and mechanical thrombectomy is not associated with an increased risk of PSS. Advances in stroke imaging may reveal biomarkers for PSS.

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Eslicarbazepine acetate in post‐stroke epilepsy: Clinical practice evidence from Euro‐Esli

Cited by 16 publications

References 31 publications

Etiology‐specific response to antiseizure medication in focal epilepsy

Etiology‐specific response to antiseizure medication in focal epilepsy

Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management

Seizures and epilepsy in patients with ischaemic stroke

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