Valproic acid can reduce the frequency of seizures through various mechanisms and is widely used in clinical practice as a monotherapy or adjunctive treatment for various types of epilepsy and epileptic syndromes. In addition, valproic acid has significant therapeutic effects on comorbidities associated with epilepsy, such as migraines and psychiatric disorders. It can also be effective in terminating status epilepticus and is commonly used as a broad-spectrum antieseizure medication in clinical settings. However, valproic acid has side effects such as teratogenicity, infertility, and menstrual disorders. Additionally, when used in combination with other drugs, the interactions between medications should be carefully considered. Therefore, in clinical practice, it is necessary to strictly adhere to the indications and dosage regimens for the use of valproic acid. This article provides a comprehensive review of the use of valproic acid in different types of seizures, epileptic syndromes, comorbidities associated with epilepsy, post-craniotomy cases, status epilepticus, and special populations. It also summarizes the combination therapy of valproic acid with other drugs, providing a basis for the rational use of valproic acid and individualized drug treatment selection for epilepsy patients.
ObjectiveTo summarize the clinical characteristics of epilepsy comorbid with tic disorders in children, and discuss its diagnosis, treatment and management. MethodsThe clinical data of 12 epileptic children comorbid with tic disorders treated in Wuhan children's Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from December, 2018 to June, 2021 was collected retrospectively. The clinical characteristics, EEG, MRI, treatment, prognosis of epileptic children comorbid with tic disorders were analyzed and summarized. ResultsThere were 12 epileptic children comorbid with tic disorders in total, 11 males, 1 female, average (10.0±2.9) years old. The onset age of epilepsy was ranged from 0.6 to 11 years old, average (6.5±3.3) years old. The onset age of tic disorders ranged from 3.5 to 11 years old, average (7.2±2.0) years old. The epileptic seizure types included focal seisures (Focal, 8 cases), atypical absence seizures(AAS, 2 cases), myoclonic seizure (MS, 1 case), generalized tonic-clonic seisures (GTCS, 3 cases). The epileptic syndromes included benign epilepsy with centrotemporal spikes (BECT, 2 cases), Dravet syndrome (1 case), juvenile myoclonic epilepsy(JME, 1 case), temporal lobe epilepsy (TLE, 1 case).The average oral antiepileptic seizure drug was 1, including lamotrigine(LTG), valproic acid(VPA), oxcarbazepine(OXC), levetiracetam(LEV), topiramate(TPM) and Perampanel. The clinical course of tic disorders ranged from 0.5 to 3.0 years, average (1.5±0.9) years. The clinical types included provisional tic disorder (PTD, 4 cases), chronic tic disorder (CTD, 5 cases, all of which were motor tics) and Tourette syndrome (TS, 3 cases). The severity of tic disorders was mild up to the last follow-up. In addition to tic disorders, other comorbidities included attention deficit and hyperactivity disorder (ADHD, 2 cases), 1 children was mixed type, 1 children was hyperactive impulse dominated type, psychomotor development disorder(3 cases), enuresis (1 case) and emotional disorder (1 case). There were interictal epileptiform discharges in 12 children with EEG, including focal discharges(7 cases, 1 EEG showed that focal discharges originated from the right temporal region), multiple discharges (5 cases, 1 EEG showed that multiple discharges originated from the right centro-temporal region), and clinical seizures were monitored in 6 cases (3 cases of focal seizures, 2 cases of atypical absence seizures, and 1 case of myoclonic seizure). Magnetic resonance imaging (MRI) of head showed no obvious abnormalities. The follow-up time was ranged from 0.5 to 3.0 years. Up to the last follow-up (2022.01.01), 8 cases of epilepsy had been controlled and 4 cases of tic disorders were cured. The prognosis of epilepsy comorbid with tic disorders in most children was good. ConclusionsThe prognosis of epilepsy comorbid with tic disorders in most children is good, the types of epileptic seizures and epileptic syndromes are various. Prognosis of these chidren mainly depends on the control of epileptic seizures, the severity of tics and existence of other neuropsychiatric comorbidities. Therefore, drug treatment mainly focuses on controlling the epileptic seizures, and the impact of comorbidities on children can not be ignored. The clinical management needs regular follow-up, timely evaluation and corresponding interventions.
Xenotansplantation has become a global focus because it may solve the formidable problems in allotransplantation, that is, the donor source. Hitherto clinical xenotransplantion has been in the stage of research with limited cases and unsatisfactory results. The difficulties which hinder the progress of xenotransplantation include: the ideal animal donor has not been found, it is rather difficult to control the rejections (hyperacute rejection, acute vascular rejection, perhaps acute cellular rejection and chronic rejection) after xenotransplantation compared with those after allotransplantation, some animal diseases might be transmitted to and do harm to human recipients, even the community. It is still unknown whether the functions of animal organs can substitute those of human organs permanently. Transgenic pigs on research and various measurements to suppress humoral and cellular immunity may be helpful in overcoming the problems of xenogeneic rejections. Animal diseases should be prevented, screened and treated, and animal models should be established to study the possibility of satisfactory working of animal organs in human body before clinical xenotransplantation is widely practised.
People with epilepsy often have other comorbidities (such as depression, stroke, obesity, migraine, autism spectrum disorder, anxiety, bipolar disorder, attention deficit hyperactivity disorder, etc.). Approximately 50% of adults with active epilepsy have at least one Comorbidities of epilepsy. Epilepsy comorbidities are often associated with worse quality of life and prognosis. Vagus nerve stimulation (VNS) is a neuromodulation technique that relies on electrical stimulation and was approved by the Food and Drug Administration (FDA) in 1997 for the treatment of epilepsy. In the process of exploring the efficacy and mechanism of VNS in the treatment of epilepsy, an additional benefit was unexpectedly found, that is, VNS can meliorate symptoms of a variety of comorbidities. Since the FDA approved VNS for the treatment of depression in 2005, VNS has shown increasingly bright prospects in the treatment of comorbidities. In addition to the approved indications, including depression, stroke, obesity and migraine, VNS in other neuropsychiatric comorbidities have shown great potential. From invasive implantable VNS (iVNS) to non-invasive transcutaneous VNS (tVNS), studies on the benefits of VNS in the treatment of epilepsy and its Comorbidities are also evolving. This article reviews the progress of clinical treatment and mechanism of VNS in the treatment of epilepsy comorbidities in recent years, with the aim to provide the best treatment strategy for epilepsy patients and research basis for scientific researchers. At the same time, the parameter Settings of previous and latest clinical trials of VNS for the treatment of epilepsy comorbidity were summarized and analyzed to provide more references for the clinical application of VNS.
Homocysteine is an intermediate product of methionine and cysteine metabolism, and plays a key role in methylation. Epilepsy is one of the common diseases of the nervous system, long-term repeated seizures will not only cause damage to the brain tissue, but also cause cognitive impairment. At present, the clinical treatment for epilepsy is still mainly to control symptoms, the fundamental etiology of epilepsy still needs to be improved, to explore the etiology of seizures, fundamentally control seizures, is still our long-term struggle direction. High homocysteine is associated with many diseases. Epidemiological studies have shown that the serum homocysteine level of 10% ~ 40% of epilepsy patients is higher than that of the normal population. By exploring the relationship between serum Hcy and epilepsy,We expect to provide help for the diagnosis and treatment of clinical epilepsy.