- Email: [email protected]
PO18-WE-45 Surveillance of Croatian pregnant women with epilepsy and effects of antiepileptic drugs exposure in their offspring
S256
19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339
Purpose: The aim of the study was to evaluate the efficacy of alternative drugs when first-line valproic acid (VPA) fails in juvenile myoclonic epilepsy (JME). Material: 23 patients with JME in whom seizure control was insufficient (13) or experienced side effects (10) on VPA, were started with different drugs according to patient-specific variables. In three patients with only persistent myoclonias, clonazepam was added. In patients with uncontrolled myoclonias and tonic-clonic seizures we introduced: lamotrigine (LTG) in 10, topiramate (TPM) in 3, levetiracetam (LEV) in 3 and phenobarbital (PB) in 4 of them. Observational period was 6 months. Results: CNZ was effective in all 3 patients in suppressing myoclonias. In LTG group one patient drop out because of rush and another because of worsening of tremor when LTG added to VPA. Of remaining 8 patients, 3 were seizure free and in 2 marked reductions occurred. Worsening was observed in 2 and 1 without effect. TPM was effective in 1, LEV in 2 and PB in 2 of patients. Conclusion: In JME patients, in whom VPA failed, LTG, LEV and TPM of newer AEDs, but not to forget CNZ and PB in selected patients, could be useful therapeutic agents. PO18-WE-45 Surveillance of Croatian pregnant women with epilepsy and effects of antiepileptic drugs exposure in their offspring S. Miskov1 , R. Gjergja Juraski2 , A. Fucic3 , T. Ivicevic Bakulic4 , I. Mikula1 , L.J. Cvitanovic-Sojat2 , J. Bosnjak1 , V. Demarin1 . 1 Neurology, University Hospital Sisters of Mercy, Zagreb, Croatia; 2 Neuropediatrics, University Hospital Sisters of Mercy, Zagreb, Croatia; 3 Institute for Medical Research/Occupational Health, Zagreb, Croatia; 4 Obstetrics and Gynecology, University Hospital Sisters of Mercy, Zagreb, Croatia Purpose: The aim was to follow up pregnancies exposed to AED and their offspring in order to assess teratogenic and neurodevelopmental effect of particular AED of newer generation. Methods: The study is prospective surveillance of pregnancies in Croatian women with epilepsy from May 2003 to May 2009. The data about pregnancy planning, folate supplementation, seizure frequency and AED therapy were obtained. The results were compared with healthy controls (mother/newborn pairs). Results: We have surveyed 68 pregnancies from 52 women: 91% (62/68) were exposed to monotherapy: 33 to lamotrigine (LTG): 19 live-births (LB), 2 premature deliveries (one with motor delay), 3 spontaneous abortions (SA), 1 artificial abortion, 1 intrauterine death and 7 ongoing pregnancies (OP). Eleven LB and 2 SA were exposed to carbamazepine (CBZ), 1 LB was under phenitoine (PHT) and 1 under phenobarbiton (PB) with EPH gestosis/peripartal asphyxia. One LB and 1 preterm LB with ASD, severe psychomotor delay and epilepsy was exposed to gabapentine (GBP), 5 LB and 1 OP were under valproic acid (VP). Two pregnancies were under meprobamate (MPB): 1 LB and 1 SA. Six pregnancies were exposed to polytherapy: 1 LB, 1 SA and 1 OP to topiramate (TPM) and VP, 1 still-birth to CBZ and PB, 1 LB with intrauterine growth retardation and dysmorphism to TPM, CBZ, PHT, and 1 OP to VP and clonazepam (CZP). Four pregnancies without AED resulted in healthy LB. About 35% of women have planned their pregnancy, but only 20% took folic acid periconceptionaly. Conclusion: We have surveyed pregnancies exposed to LTG, VP, PHT, PB, GBP, TMP, CBZ, MPB and CZP. AED polytherapy resulted in larger proportion of complications. Adequate preconceptional counseling in women with epilepsy resulted in higher proportion of pregnancy planning and folic acid intake. Further follow up of all live-births till school age will be provided.
PO18-WE-46 Step one: study on the treatment of elderly patients with older and newer anti-epileptic drugs, interim report on recruitment and drop-out rates 1 G. Kramer ¨ , K.J. Werhahn2 , E. Trinka3 . 1 Medical, Swiss Epilepsy Center, Z¨ urich, Switzerland; 2 Neurology, University Medicine, Mainz, Germany; 3 Neurology, Medical University Hospital, Innsbruck, Austria
Purpose: New onset focal epilepsy occurs frequently in the elderly, yet, randomised controlled studies on antiepileptic treatment are scarce. Lamotrigine (LTG) and gabapentin are of equal efficacy but better tolerability compared to CBZ standard release. Retention is not different to LTG when CBZ slow-release is used. In this trial Levetiracetam (LEV) is compared to CBZ-SR and LTG. Method: STEP-ONE is a randomized, double-blind, multicenter study. Patients aged 60 years or above with new onset focal epilepsy (either at least one seizure and spike discharges on EEG or a relevant lesion on CT/MRI or a total of 2 spontaneous seizures) are eligible and those with symptomatic epileptic seizures due to acute (<2 weeks) brain injuries are excluded. Patients receive CBZ-SR, LTG or LEV in a parallel group design over 58 weeks (6 weeks titration and 52 weeks maintenance, target 400, 100, 1000 mg, respectively). Results: N = 212 (of 360) patients have been included so far. The drop-out rate is 38%. Drop-out reasons include: 25% patients personal request, 19% side effects on lowest daily dose (CBZ-SR 200 mg, LTG 50 mg, and LEV 500 mg), 33% newly occurring medical conditions. There were no unexpected drug-related serious adverse events. Conclusion: Retention is comparable to previous trials. Antiepileptic treatment in the elderly requires slow titration on low target dosages. Data with standard CBZ and faster titration or high target dosages should be interpreted with caution. Special drug trial designs are needed for the elderly. Recruitment of elderly people is difficult but study adherence is good. PO18-WE-47 A case of toxic hepatitis developing during phenytoin treatment H.N. Gune ¨ s¸ 1 , G. Gune ¨ s¸ 2 , T.K. Yoldas¸ 1 . 1 Neurology, Dıskapı ¸ Y.B. Training and Research Hospital, Ankara, Turkey; 2 Internal Medicine, Ufuk University, Faculty of Medicine, Ankara, Turkey Purpose: Idiosyncratic reactions such as lymphadenopathy, liver toxicity and hematological and dermatological side effects may be encountered during treatment of epilepsy with the widely-used phenytoin. The hepatotoxicity usually appears following six weeks of drug use in a dose-dependent manner. Case: A 30-year-old man with no history of epilepsy or liver disease presented at the emergency neurology outpatients department following a generalized tonic clonic seizure. The first intervention included phenytoin loading followed by maintenance treatment (Phenytoin 17 mg/kg infusion and 300 mg/day in 3 doses po as maintenance). The patient started to have liver enzyme (AST, ALT) elevations on the second day of maintenance phenytoin treatment. Following other tests, the phenytoin treatment was stopped with a preliminary diagnosis of phenytoin-related liver toxicity. The liver enzyme levels gradually decreased during follow-up and approached normal limits. Conclusion: Some articles report that phenytoin-related liver toxicity starts at least one week after initial drug usage. The elevation of liver enzymes from the second day of phenytoin use in our case is interesting as it indicates that phenytoin-related liver toxicity can be seen with low doses and at an early stage.
19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339
Purpose: The aim of the study was to evaluate the efficacy of alternative drugs when first-line valproic acid (VPA) fails in juvenile myoclonic epilepsy (JME). Material: 23 patients with JME in whom seizure control was insufficient (13) or experienced side effects (10) on VPA, were started with different drugs according to patient-specific variables. In three patients with only persistent myoclonias, clonazepam was added. In patients with uncontrolled myoclonias and tonic-clonic seizures we introduced: lamotrigine (LTG) in 10, topiramate (TPM) in 3, levetiracetam (LEV) in 3 and phenobarbital (PB) in 4 of them. Observational period was 6 months. Results: CNZ was effective in all 3 patients in suppressing myoclonias. In LTG group one patient drop out because of rush and another because of worsening of tremor when LTG added to VPA. Of remaining 8 patients, 3 were seizure free and in 2 marked reductions occurred. Worsening was observed in 2 and 1 without effect. TPM was effective in 1, LEV in 2 and PB in 2 of patients. Conclusion: In JME patients, in whom VPA failed, LTG, LEV and TPM of newer AEDs, but not to forget CNZ and PB in selected patients, could be useful therapeutic agents. PO18-WE-45 Surveillance of Croatian pregnant women with epilepsy and effects of antiepileptic drugs exposure in their offspring S. Miskov1 , R. Gjergja Juraski2 , A. Fucic3 , T. Ivicevic Bakulic4 , I. Mikula1 , L.J. Cvitanovic-Sojat2 , J. Bosnjak1 , V. Demarin1 . 1 Neurology, University Hospital Sisters of Mercy, Zagreb, Croatia; 2 Neuropediatrics, University Hospital Sisters of Mercy, Zagreb, Croatia; 3 Institute for Medical Research/Occupational Health, Zagreb, Croatia; 4 Obstetrics and Gynecology, University Hospital Sisters of Mercy, Zagreb, Croatia Purpose: The aim was to follow up pregnancies exposed to AED and their offspring in order to assess teratogenic and neurodevelopmental effect of particular AED of newer generation. Methods: The study is prospective surveillance of pregnancies in Croatian women with epilepsy from May 2003 to May 2009. The data about pregnancy planning, folate supplementation, seizure frequency and AED therapy were obtained. The results were compared with healthy controls (mother/newborn pairs). Results: We have surveyed 68 pregnancies from 52 women: 91% (62/68) were exposed to monotherapy: 33 to lamotrigine (LTG): 19 live-births (LB), 2 premature deliveries (one with motor delay), 3 spontaneous abortions (SA), 1 artificial abortion, 1 intrauterine death and 7 ongoing pregnancies (OP). Eleven LB and 2 SA were exposed to carbamazepine (CBZ), 1 LB was under phenitoine (PHT) and 1 under phenobarbiton (PB) with EPH gestosis/peripartal asphyxia. One LB and 1 preterm LB with ASD, severe psychomotor delay and epilepsy was exposed to gabapentine (GBP), 5 LB and 1 OP were under valproic acid (VP). Two pregnancies were under meprobamate (MPB): 1 LB and 1 SA. Six pregnancies were exposed to polytherapy: 1 LB, 1 SA and 1 OP to topiramate (TPM) and VP, 1 still-birth to CBZ and PB, 1 LB with intrauterine growth retardation and dysmorphism to TPM, CBZ, PHT, and 1 OP to VP and clonazepam (CZP). Four pregnancies without AED resulted in healthy LB. About 35% of women have planned their pregnancy, but only 20% took folic acid periconceptionaly. Conclusion: We have surveyed pregnancies exposed to LTG, VP, PHT, PB, GBP, TMP, CBZ, MPB and CZP. AED polytherapy resulted in larger proportion of complications. Adequate preconceptional counseling in women with epilepsy resulted in higher proportion of pregnancy planning and folic acid intake. Further follow up of all live-births till school age will be provided.
PO18-WE-46 Step one: study on the treatment of elderly patients with older and newer anti-epileptic drugs, interim report on recruitment and drop-out rates 1 G. Kramer ¨ , K.J. Werhahn2 , E. Trinka3 . 1 Medical, Swiss Epilepsy Center, Z¨ urich, Switzerland; 2 Neurology, University Medicine, Mainz, Germany; 3 Neurology, Medical University Hospital, Innsbruck, Austria
Purpose: New onset focal epilepsy occurs frequently in the elderly, yet, randomised controlled studies on antiepileptic treatment are scarce. Lamotrigine (LTG) and gabapentin are of equal efficacy but better tolerability compared to CBZ standard release. Retention is not different to LTG when CBZ slow-release is used. In this trial Levetiracetam (LEV) is compared to CBZ-SR and LTG. Method: STEP-ONE is a randomized, double-blind, multicenter study. Patients aged 60 years or above with new onset focal epilepsy (either at least one seizure and spike discharges on EEG or a relevant lesion on CT/MRI or a total of 2 spontaneous seizures) are eligible and those with symptomatic epileptic seizures due to acute (<2 weeks) brain injuries are excluded. Patients receive CBZ-SR, LTG or LEV in a parallel group design over 58 weeks (6 weeks titration and 52 weeks maintenance, target 400, 100, 1000 mg, respectively). Results: N = 212 (of 360) patients have been included so far. The drop-out rate is 38%. Drop-out reasons include: 25% patients personal request, 19% side effects on lowest daily dose (CBZ-SR 200 mg, LTG 50 mg, and LEV 500 mg), 33% newly occurring medical conditions. There were no unexpected drug-related serious adverse events. Conclusion: Retention is comparable to previous trials. Antiepileptic treatment in the elderly requires slow titration on low target dosages. Data with standard CBZ and faster titration or high target dosages should be interpreted with caution. Special drug trial designs are needed for the elderly. Recruitment of elderly people is difficult but study adherence is good. PO18-WE-47 A case of toxic hepatitis developing during phenytoin treatment H.N. Gune ¨ s¸ 1 , G. Gune ¨ s¸ 2 , T.K. Yoldas¸ 1 . 1 Neurology, Dıskapı ¸ Y.B. Training and Research Hospital, Ankara, Turkey; 2 Internal Medicine, Ufuk University, Faculty of Medicine, Ankara, Turkey Purpose: Idiosyncratic reactions such as lymphadenopathy, liver toxicity and hematological and dermatological side effects may be encountered during treatment of epilepsy with the widely-used phenytoin. The hepatotoxicity usually appears following six weeks of drug use in a dose-dependent manner. Case: A 30-year-old man with no history of epilepsy or liver disease presented at the emergency neurology outpatients department following a generalized tonic clonic seizure. The first intervention included phenytoin loading followed by maintenance treatment (Phenytoin 17 mg/kg infusion and 300 mg/day in 3 doses po as maintenance). The patient started to have liver enzyme (AST, ALT) elevations on the second day of maintenance phenytoin treatment. Following other tests, the phenytoin treatment was stopped with a preliminary diagnosis of phenytoin-related liver toxicity. The liver enzyme levels gradually decreased during follow-up and approached normal limits. Conclusion: Some articles report that phenytoin-related liver toxicity starts at least one week after initial drug usage. The elevation of liver enzymes from the second day of phenytoin use in our case is interesting as it indicates that phenytoin-related liver toxicity can be seen with low doses and at an early stage.