Therapeutic intensive seizure analysis (TISA) in presurgical evaluation of Losigamone

Stefan, Hermann; Wang, Y.; Kerling, Frank; Hopp, Peter; Zhou, Dong; Dienel, Angelika; Feichtinger, Michael; Kirchner, A.; Pauli, E.

doi:10.1034/j.1600-0404.2001.00371.x

Cited by 13 publications

(14 citation statements)

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“…The duration of these seizures varied in a way similar to the changes observed in human epilepsy over time. In the report from Theodore et al (50) and from our studies with video‐EEG monitoring (33–36), the generalized tonic–clonic seizures typically last for ∼1 min, and most partial seizures last <60 s; the secondarily generalized tonic–clonic phases last ∼20 s. Consistent with human studies, the mean duration of partial seizures recorded in this CL model was 32 s, and 57 s for secondarily generalized seizures, with a tonic–clonic phase lasting ∼20 s. All recorded spontaneous seizures were partial seizures. The higher rate of secondarily generalized seizures was due to the repeated injections of CL.…”

Section: Discussionsupporting

confidence: 83%

A Kindling Model of Pharmacoresistant Temporal Lobe Epilepsy in Sprague–Dawley Rats Induced by Coriaria Lactone and Its Possible Mechanism

et al. 2003

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Summary:Purpose: The aim of this study was to develop a new animal model of pharmacoresistant temporal lobe epilepsy (TLE) by repeated intramuscular injection of Coriaria lactone (CL) at subthreshold dosages and to explore the mechanisms that might be involved.Methods: Healthy male Sprague-Dawley rats (n ‫ס‬ 160) were randomized into four groups during the kindling process: three groups (n ‫ס‬ 50 for each group) received CL injection at subthreshold dosages (1.25, 1.5, and 1.75 mg/kg, respectively), and ten received normal saline (NS) injection as a control group. The maximal human adult dosage of carbamazepine (CBZ), valproate (VPA), and phenytoin (PHT) was administered as monotherapy to different groups of kindled rats for 1 month (n ‫ס‬ 20 for each group). Changes in EEG recording, seizure number, intensity (expressed as grade 1-5 according to Racine stage), and duration, including spontaneous seizures during different interventions, were compared. The expression of P-170, a multiple drug resistance gene (MDR1) encoding P-glycoprotein, was measured in brain samples from different groups of experimental rats by using an image analysis and measurement system (ImagePro-Plus 4.0).Results: A total of 70 (46.7%) rats were fully kindled with a median of 15 (seven to 20) CL injections. Electrocorticogram (ECoG) including hippocampal (EHG) monitoring revealed the temporal lobe origins of epileptiform potentials, which were consistent with the behavioral changes observed. Spontaneous seizures occurred with frequency and diurnal patterns similar to those of human TLE. The antiepileptic drugs (AEDs) tested lacked a satisfactory seizure control. The maximal P-170 expression was in the kindled rats with AED treatment; the next highest was in the kindled rats without AED intervention. Nonkindled SD rats with CL injection also had increased P-170 expression compared with control SD rats. Conclusions:The study provided a simple and stable animal TLE kindling model with pharmacoresistant properties. The pharmacoresistance observed in the kindled rats to CBZ, VPA, and PHT at maximal human adult dosages together with the increased P-170 expression was a distinct feature of this model. This model might be used in further investigations of the mechanisms involved in pharmacoresistant TLE and for developing new AEDs. Key Words: Epilepsy-Animal model-Coriaria lactone-Pharmacoresistant partial seizureMultidrug resistance gene 1 (MDR1).A major challenge in epilepsy treatment is the handling of pharmacoresistant seizures. Difficulties in obtaining human samples, especially the control group, hamper studies for further understanding pharmacoresistance. In this respect, animal models would be a valuable tool to study why and how seizures become intractable and to develop more effective therapeutic strategies. More than 100 seizure models are now available for epilepsy research (1,2). Among them, kindling models are widely used as the optimal type for drug-resistant seizures. An example is the phenytoin (PHT)-resistant amygdala-kindled Wi...

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Section: Discussionsupporting

confidence: 83%

A Kindling Model of Pharmacoresistant Temporal Lobe Epilepsy in Sprague–Dawley Rats Induced by Coriaria Lactone and Its Possible Mechanism

et al. 2003

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“…Therapeutic intensive seizure analysis is a new method for the detailed evaluation of changes in seizure activity including various ictal signs using quantitative data obtained via continuous video‐EEG‐monitoring during pre‐surgical evaluation (Stefan et al. , 2000, 2001; Wang et al.…”

Section: Seizure Analysis: Tisa Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…In the present study, the clinical influence of simultaneous withdrawal of LTG with CBZ in their combined therapy has been compared with that of either LTG or CBZ withdrawal from their monotherapy in patients with pharmacoresistant partial seizures. The new quantitative assessment method therapeutic intensive seizure analysis (TISA) (Stefan, 2001;Stefan et al, 2000Stefan et al, , 2001Wang et al, 2001Wang et al, , 2002Zhou et al, 2000Zhou et al, , 2002 was used for a better interpretation of the rapid withdrawal effects. Interests are addressed on the following issues: Does LTG withdrawal (1) alter the clinical seizure activity including frequency and duration of seizures and ictal signs like secondarily generalized tonic and clonic signs?…”

Section: Introductionmentioning

confidence: 99%

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Changes of seizures activity during rapid withdrawal of lamotrigine

Wang-Tilz

Tilz

Wang

et al. 2005

Euro J of Neurology

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Quantitatively evaluating the rapid withdrawal effects of lamotrigine (LTG) and carbamazepine (CBZ) on seizure activity during pre-surgical evaluation in patients with pharmacoresistant complex partial epilepsy. The duration and frequency of seizure activities and electrographic seizure onset of 41 patients totally withdrawing from CBZ monotherapy (n = 20), LTG monotherapy (n = 10) and CBZ + LTG combined therapy (n = 11) were intensively studied by therapeutic intensive seizure analysis (TISA) method. Study phases ran from the baseline phase to the antiepileptic drug (AED) withdrawal phase until the AED free phase, 3 days for each phase. Seizure duration and frequency obviously increased during the withdrawal process in each group (P < 0.05). The duration of secondarily generalized clonic signs markedly increased with the tapering of each drug; tonic signs, however, only in the AED free phase (P < 0.05). The frequency of secondary tonic and clonic signs only increased in the CBZ and CBZ + LTG group. Intergroup comparisons of all variables were insignificant (P > 0.05). There was no change of ictal EEG localization during all withdrawal protocols. All patients experienced more severe seizures during the withdrawal processes. An earlier aggravation of the clonic signs than the tonic signs was observed in each group. Difference between the withdrawal effects of LTG and CBZ monotherapy and LTG + CBZ polytherapy was mainly in the frequency change of ictal signs. The withdrawal process did not influence the ictal EEG localization. This study justified the withdrawal in pre-surgical localization, rationalized precautions for possible accompanying risks, and also aroused attentions in clinical anticonvulsant trials and substitutions involving withdrawal process.

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“…The setting of video‐EEG monitoring can provide a precise evaluation of the efficacy and safety of AEDs (Stefan et al., 2001), and proof‐of‐principle studies have been performed in this setting, for example, for felbamate (Bourgeois et al., 1993; Devinsky et al., 1995), losigamone (Stefan et al., 2001), topiramate (Wang et al., 2002), and levetiracetam (Stefan et al., 2006). However, AED trials in the setting of video‐EEG monitoring incorporate several problems: during a predefined study design the ethical dilemma could arise that continuation of video‐EEG monitoring remains necessary due to the protocol, even though sufficient electroclinical data for diagnostic purposes had already been collected (Schmidt, 2006).…”

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Rapid loading of intravenous lacosamide: Efficacy and practicability during presurgical video‐EEG monitoring

Stefan

Matzen

et al. 2012

Epilepsia

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SUMMARYPurpose: This study investigates immediate efficacy and safety of intravenous application of de novo lacosamide (LCM) as add-on therapy in patients with pharmacoresistant focal epilepsy. Methods: During presurgical video-electroencephalography (EEG) monitoring, 17 adult inpatients received LCM infusion (200 mg every 12 h for 2-3 days) followed by oral formulation with the same regimen. Before and after intravenous application of LCM, seizures and interictal epileptiform discharges (IEDs) recorded with continuous video-EEG monitoring were analyzed, and an assessment of adverse events (AEs) was performed daily. To evaluate the midterm tolerability and efficacy, follow-up visits were conducted 1 and 3 months after discharge from hospital.Key Findings: In the acute phase, intravenous initiation of LCM was well tolerated with few mild or moderate AEs (3 of 17, 17.6%). A significant reduction of seizure frequency in the treatment phase as compared to mean seizure frequency in the 2-day baseline phase was achieved (p < 0.05 for the first treatment day, and p < 0.005 for the second treatment day). On the first treatment day, 61.5% of the patients were seizure free, and 84.6% on the second treatment day. IED reduction after intravenous application of LCM was not significant. After 1 month, the 50% responder rate was 46.6% and after the 3-month period, 42.8%. Significance: Our data suggest that rapid intravenous initiation of de novo LCM is safe and may protect against seizures in a rapid and midterm time window.

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Therapeutic intensive seizure analysis (TISA) in presurgical evaluation of Losigamone

Abstract: Losigamone has a preferred inhibitory effect on propagated epileptic activity. TISA is a sensitive method for evaluation of the selective effects of AEDs.

Cited by 13 publications

References 12 publications

A Kindling Model of Pharmacoresistant Temporal Lobe Epilepsy in Sprague–Dawley Rats Induced by Coriaria Lactone and Its Possible Mechanism

A Kindling Model of Pharmacoresistant Temporal Lobe Epilepsy in Sprague–Dawley Rats Induced by Coriaria Lactone and Its Possible Mechanism

Changes of seizures activity during rapid withdrawal of lamotrigine

Rapid loading of intravenous lacosamide: Efficacy and practicability during presurgical video‐EEG monitoring

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