ObjectiveTo investigate the clinical characteristics of epileptics with pregnancy and then provide reference for standardized management of epileptics with pregnancy. MethodsFrom June 2012 to June 2021, epileptics with pregnancy who delivered in Jinan Central Hospital were selected as the research subjects. The clinical data such as the application of Antiseizure medications (ASMs) during pregnancy, seizure frequency, pregnancy outcomes, delivery ways, offspring feeding ways and the incidence of complications were investigated and analyzed. ResultsAmong 36 epileptics with pregnancy, 20 cases (55.56%) were treated with ASMs alone, 5 cases (13.88%) were treated with combined medication, and 11 cases (30.56%) were treated without ASMs during pregnancy. 15 cases (41.67%) adhered to systematic application of ASMs, 17 cases (47.22%) did not adhere to systematic application of ASMs, and 4 cases (11.11%) had unknown medication history. The frequency of seizures increased in 5 cases, decreased in 7 cases and unchanged in 24 cases during pregnancy. Pregnancy outcomes: full-term delivery in 33 cases (91.67%), preterm delivery in 1 case (2.78%) and abortion in 2 cases (5.56%). Delivery mode: cesarean section in 31 cases (91.18%), vaginal delivery in 3 cases (8.82%). After delivery, 4 cases (11.76%) were fed with milk powder and 30 cases (88.24%) were breast-fed. Complications: There were 6 cases complicated with anemia (16.67%), 5 cases complicated with gestational hypertension (13.89%), 3 cases complicated with gestational diabetes (8.33%), 4 cases complicated with premature rupture of membranes (11.11%), 2 cases complicated with fetal growth restriction (5.56%), 2 cases complicated with oligohydramnios (5.56%), 3 cases complicated with fetal distress (8.33%) and 3 cases complicated with neonatal asphyxia (8.33%). ConclusionsThe proportion of epileptics with pregnancy who were systematically treated with ASMs was low and the seizures were poorly controlled. There is a lack of standardized management for such patients in clinical practice.
ObjectiveTo systematically review the efficacy and safety of new anti-epileptic drugs in the treatment of epilepsy. MethodsPubMed, EMbase, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of new anti-epileptic drugs rufinamide, zonisamide, and perampanel in the treatment of epilepsy from January 2006 to May 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 and Stata 16.0 software. ResultsA total of 16 RCTs involving 4 382 patients were included. The results of meta-analysis showed that the effective rate (RR=1.66, 95%CI 1.45 to 1.89, P<0.000 01) and seizure-free rate (RR=2.82, 95%CI 2.01 to 3.96, P<0.000 01) in new anti-epileptic drugs group were higher than those in the control group, while it did not increase the serious adverse events (RR=0.95, 95%CI 0.72 to 1.27, P=0.75). ConclusionCurrent evidence shows that new anti-epileptic drugs have trends of better effectiveness, and their safety is satisfactory. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.
ObjectiveTo investigate the anxious level of people with epilepsy (PWE) during the outbreak of 2019 Novel Coronavirus Diseases (COVID-19) and explore the reasons of anxiety.MethodsAn internet questionnaire survey were conducted on the anxiety state of PWE and health controls (HC) aged 18 to 45 years old between Feb 9, 2020 and Feb 17, 2020. The questionnaire included demographic information, general status and the State-Trait Anxiety Inventory (STAI).ResultsIn all, 148 PWE and 300 HC were included in this study. The total SAI score (46.72±9.98 vs. 41.77±10.20, P<0.001) and the total TAI score (44.18±8.88 vs. 31.27±17.44, P<0.001) were significantly higher in PWE than in HC. PWE concerned most (69.9%) about the difficulty of obtaining antiepileptic drugs (AEDs) while HC concerned most about the lack of face masks (73.3%).ConclusionHigh anxious level in PWE during the outbreak of COVID is probably due to the difficulty of obtaining AEDs. Thus, the society should strengthen the solution of the problem of purchasing AEDs and conduct timely psychological counseling.
Epilepsy is a common chronic disease of the nervous system, which has certain adverse effects on the cognitive, psychological and social functions of the patients. To date, anti-seizure medications (ASMs) remain the first-line treatment option for epilepsy, but many patients with epilepsy still do not have effective seizure control when multiple ASMs are used in combination. Therefore, there is an urgent need for a new target and mechanism ASMs to bring about new treatment options and hope for patients with intractable epilepsy. Perampanel, a new third-generation ASMs, whereas second-generation ASMs tend to exert anti-seizure effects mainly by regulating ion channels or enhancing related mechanisms such as gamma-aminobutyric acid (GABA) effects, perampanel exerts its effects mainly by targeting the excitatory neurotransmitter glutamate. Perampanel is the first selective α-amino-3-hydroxy-5-methyl-4-isoxazole-propionate (AMPA) receptor antagonist and the first selective inhibitory ASMs for excitatory postsynaptic function. Because of its unique target and mechanism, it has been approved by many countries in the world for adjuvant additive therapy and monotherapy for patients with focal and general epilepsy. In addition, with the discovery of the neuroprotective, antioxidant, neurotransmitter regulation effects of perampanel, it also provides a new potential choice for the treatment of other diseases. This article mainly reviews the mechanism of action, pharmacokinetics, clinical trials and treatment of other diseases other than epilepsy of perampanel.