Initiating antiepilepsy treatment: An update of expert consensus in Spain

Villanueva, Vicente; Sánchez-Álvarez, J C; Carreño, Mar; Salas-Puig, Javier; Caballero-Martínez, Fernando; Gil‐Nagel, Antonio

doi:10.1016/j.yebeh.2020.107540

Cited by 6 publications

(6 citation statements)

References 59 publications

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“…About 50 million individuals have epilepsy worldwide, and 90% of them come from developing nations. It is a widespread progressive neurological condition in which unregulated excitability and recurring unprovoked seizures define the equilibrium between cortical excitability and inhibition (3)(4)(5)(6). There is no conclusive indication that the pathophysiology and effects of seizures have distinct distinctions between immature and adult brains.…”

Section: Introductionmentioning

confidence: 99%

Adverse Drug Reactions of Antiepileptic Drugs in the Neurology Department of a Tertiary Care Hospital, Srinagar, Jammu & Kashmir, India

2021

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Background: Epilepsy is a disorder that affects 1% of the global population. It is the second most common serious neurologic disorder after stroke, affecting humans. Since antiepileptic drugs have a narrow therapeutic index and their adverse effects can affect any organ, their widespread use has significant safety implications. Objectives: The study assessed adverse drug reactions (ADRs) using antiepileptic drugs in the Department of Neurology at a Tertiary Care Hospital, Srinagar, Jammu & Kashmir, India. Methods: This prospective observational study was conducted in the Department of Neurology of a Tertiary Care Hospital, Srinagar, Jammu & Kashmir, India, for eight months. It was a spontaneous reporting of ADRs by practicing physicians in the outpatient and inpatient settings that were included in the study. Results: Of the 3,300 patients who were on the anti-epileptic drug (AED), 92 (3.07%) had AED-related ADRs. A total of 18 cases were reported in the inpatient department and 74 cases in the outpatient setting. The most common ADRs were loss of appetite (34.78%), skin rashes (17.39%), and gum hypertrophy (9.78%). Of 80 ADRs, 42.5% were related to valproate, followed by phenytoin, carbamazepine, and levetiracetam. The suspected drug was changed in 22 patients with ADRs. Conclusions: For the early diagnosis and avoidance of ADRs, the frequent follow-up of patients on AEDs is needed to improve patient compliance with drug therapy and provide better drug therapy for avoiding associated morbidity and mortality.

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Section: Introductionmentioning

confidence: 99%

Adverse Drug Reactions of Antiepileptic Drugs in the Neurology Department of a Tertiary Care Hospital, Srinagar, Jammu & Kashmir, India

2021

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“…On the other hand, mitochondrial carbonic topiramate and zonisamide have been reported to be effective against antipsychotic-induced weight gain 74 . Unfortunately, these two antiepileptic drugs are inappropriate for patients with epilepsy and comorbid psychotic symptoms and mood disorders 75 . Based on the results of this study, both hypothalamic changing L-BAIBA levels by chronic administrations of clozapine and brexpiprazole are probably not modulated by ABAT activity.…”

Section: Discussionmentioning

confidence: 99%

Opposing effects of clozapine and brexpiprazole on β-aminoisobutyric acid: Pathophysiology of antipsychotics-induced weight gain

2023

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Clozapine is one of the most effective antipsychotics and has the highest risk of weight gain and metabolic complications; however, the detailed pathophysiology of its clinical action and adverse reactions remains to be clarified. Therefore, the present study determined the chronic effects of clozapine (high risk of weight gain) and brexpiprazole (relatively low risk of weight gain) on intracellular and extracellular levels of β-aminoisobutyric acid (BAIBA) enantiomers, which are endogenous activators of AMP-activated protein kinase (AMPK). L-BAIBA is the dominant BAIBA enantiomer in the rat hypothalamus and cultured astrocytes, whereas L-BAIBA accounts for only approximately 5% of the total plasma BAIBA enantiomers. L-BAIBA displayed GABAB receptor agonistic action in the extracellular space and was released through activated astroglial hemichannels, whereas in the intracellular space, L-BAIBA activated AMPK signalling. Chronic administration of the effective doses of clozapine increased intracellular and extracellular levels of L-BAIBA in the hypothalamus and cultured astrocytes, whereas that of brexpiprazole decreased them. These results suggest that enhancing hypothalamic AMPK signalling by increasing intracellular L-BAIBA levels is, at least partially, involved in the pathophysiology of clozapine-induced weight gain and metabolic complications.

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“…However, we think that there are some other ASMs that have shown some mood-stabilizing properties or have less impact on the occurrence of depression as a side effect (see above); these ASMs may be more desirable than others. Some authors recommend sodium channel blockers for PWE with a psychiatric comorbidity [ 38 ]. However, it is obvious that a recommendation for selecting the most appropriate ASM cannot be made on the basis of a single clinical characteristic.…”

Section: Discussionmentioning

confidence: 99%

Proposed Recommendations for the Management of Depression in Adults with Epilepsy: An Expert Consensus

et al. 2023

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Introduction: Experts agree that there is a need for protocols to guide health professionals on how to best manage psychiatric comorbidities in patients with epilepsy (PWE). We aimed to develop practical recommendations for key issues in the management of depression in PWE. Methods: This was a qualitative study conducted in four steps: (1) development of a questionnaire on the management of depression in PWE to be answered; (2) literature review and, if evidence from guidelines/consensus or systematic reviews was available, drafting initial recommendations; (3) a nominal group methodology for reviewing initial recommendations and formulating new recommendations

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Initiating antiepilepsy treatment: An update of expert consensus in Spain

Cited by 6 publications

References 59 publications

Adverse Drug Reactions of Antiepileptic Drugs in the Neurology Department of a Tertiary Care Hospital, Srinagar, Jammu & Kashmir, India

Adverse Drug Reactions of Antiepileptic Drugs in the Neurology Department of a Tertiary Care Hospital, Srinagar, Jammu & Kashmir, India

Opposing effects of clozapine and brexpiprazole on β-aminoisobutyric acid: Pathophysiology of antipsychotics-induced weight gain

Proposed Recommendations for the Management of Depression in Adults with Epilepsy: An Expert Consensus

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