Antiepileptic drug treatment in a community health care setting in northern Ecuador: a prospective 12-month assessment

Placencia, M.; Sander, Josemir W.; Shorvon, Simon; Román, Mario Pavel Díaz; Alarcón, Fiorella; Bimos, C.; S, Cascante

doi:10.1016/0920-1211(93)90048-c

Cited by 72 publications

(39 citation statements)

References 13 publications

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“…Latency to anticonvulsant treat ment aver aged 7.7 years (SD 1.7), and sus tained treat ment lasted 1.7 years (SD 1.2). In all 4 stud ies iden ti fied, there was no rela tion between treat ment latency and effec tive ness of anticonvulsant ther apy (39)(40)(41)(42).…”

Section: Discussionmentioning

confidence: 99%

Prophylaxis Latency and Outcome in Bipolar Disorders

et al. 2003

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Key Words: anticonvulsants, bi po lar dis or der, de layed pro phy laxis, kind ling, la tency, lith ium, ma jor af fec tive dis or der, out come, pro phy laxis, re sponse, treat ment P a tients di ag nosed with bi po lar dis or ders (BDs) of ten expe ri ence pro longed la tency from ill ness on set to the start of sus tained, long-term pro phy laxis (1-4). This may rep re sent a par tic u larly crit i cal pe riod in the nat u ral his tory of these disor ders (5-9). A widely con sid ered hy poth e sis is that kindling-like phe nom ena or be hav ioural sen si ti za tion oc curs in BD, as re flected in in creas ingly se vere or more rap idly recur ring ill ness ep i sodes over time (5,6). Of ten cited in sup port of this con cept is ev i dence that in ma jor af fec tive ill nesses the cy cle length (that is, the time from the start of an ep i sode to the start of the next) and the in ter vals of rel a tive wellness be tween acute ep i sodes may un dergo pro gres sive short en ing, par tic ularly with out treat ment (10-12).The kind ling hypoth e sis of pro gres sive wors en ing in major affec tive dis or ders arises from an ani mal model of sec ond arily gen er al ized epi lepsy fol low ing ini tially minor and local ized, exper i men tally induced sei zures (6,13). This phe nom e non is some times taken as a nonhomologous model for mood dis orders. The model sug gests that untreated affec tive ill ness may lead to pathophysiological changes in brain tis sue of untreated patients. Some neuroradiological and post mor tem neuropathological find ings have been inter preted as sup porting this hypoth e sis. They include struc tural changes in brain imag ing and post mor tem neuropathological changes in the brain tis sue of BD patients, as well as sug ges tions that mood sta bi liz ers may pre vent or reverse such changes (7,(14)(15)(16) Ob jec tive:To an a lyze new and re viewed find ings to eval u ate re la tions be tween treat ment response and la tency from on set of bi po lar dis or der (BD) to the start of mood-stabilizer pro phy laxis. Method:We an a lyzed our own new data and added find ings from re search re ports iden ti fied by com put er ized search ing.Re sults: We found 11 rel e vant stud ies, in volv ing 1485 adult pa tients di ag nosed pri mar ily with BD. Re ported la tency to pro phy laxis av er aged 9.6 years (SD 1.3), and fol low-up in treat ment av er aged 5.4 years (SD 3.1). Greater ill ness in ten sity and shorter treat ment la tency were closely as so ci ated, re sult ing in a greater ap par ent re duc tion in mor bid ity with ear lier treat ment. However, this find ing was not sus tained af ter cor rec tion for pre treat ment mor bid ity, and treatment la tency did not pre dict mor bid ity dur ing treat ment. There fore, as sess ments based on improve ment with treat ment, or with out cor rec tion for pre treat ment mor bid ity, can be mis lead ing. Con clu sions:Avail able ev i dence does not sup port the pro posal that de layed pro phy laxis may limit re sponse to pro phy lac tic treat ment i...

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Section: Discussionmentioning

confidence: 99%

Prophylaxis Latency and Outcome in Bipolar Disorders

et al. 2003

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“…Indeed, in human epilepsy it was thought that patients should be treated with AEDs immediately after a seizure to increase the likelihood of achieving remission. However, evidence that remission rates in countries with and without ready access to AEDs are similar [33] implies that AEDs may act to suppress seizures, but have no influence on achieving remission. In addition, there is increasing evidence from both canine, rodent and human studies, that other aspects of disease e.g.…”

Section: Introductionmentioning

confidence: 99%

Clinical Risk Factors Associated with Anti-Epileptic Drug Responsiveness in Canine Epilepsy

et al. 2014

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The nature and occurrence of remission, and conversely, pharmacoresistance following epilepsy treatment is still not fully understood in human or veterinary medicine. As such, predicting which patients will have good or poor treatment outcomes is imprecise, impeding patient management. In the present study, we use a naturally occurring animal model of pharmacoresistant epilepsy to investigate clinical risk factors associated with treatment outcome. Dogs with idiopathic epilepsy, for which no underlying cause was identified, were treated at a canine epilepsy clinic and monitored following discharge from a small animal referral hospital. Clinical data was gained via standardised owner questionnaires and longitudinal follow up data was gained via telephone interview with the dogs’ owners. At follow up, 14% of treated dogs were in seizure-free remission. Dogs that did not achieve remission were more likely to be male, and to have previously experienced cluster seizures. Seizure frequency or the total number of seizures prior to treatment were not significant predictors of pharmacoresistance, demonstrating that seizure density, that is, the temporal pattern of seizure activity, is a more influential predictor of pharmacoresistance. These results are in line with clinical studies of human epilepsy, and experimental rodent models of epilepsy, that patients experiencing episodes of high seizure density (cluster seizures), not just a high seizure frequency pre-treatment, are at an increased risk of drug-refractoriness. These data provide further evidence that the dog could be a useful naturally occurring epilepsy model in the study of pharmacoresistant epilepsy.

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“…Information on treatment failure time was available from 15 randomised trials [18][19][20][21][22][23][24][25][26][27][28][29][30][31] involving 3883 individuals, collected as part of a suite of individual patient data metaanalyses concerning six different AEDs [7][8][9][10][11][12][13][14].…”

Section: Individual Patient Data Meta-analysis Datasetmentioning

confidence: 99%