Antiepileptic drug treatment in the nineties in The Netherlands.

In this review the state of the art of treating patients with epilepsy in the nineties in the Netherlands is presented. It describes general strategies for treatment with antiepileptic drugs and the history of development of the classical anticonvulsant drugs. Eight new drugs, including vigabatrin, lamotrigine, felbamate, oxcarbazepine, gabapentin, tiagabine, levetiracetam and topiramate are discussed. A review of their pharmacological and clinical properties is presented. Dutch experience with these drugs is included.     

Effect of carbamazepine, oxcarbazepine and lamotrigine on the increase in extracellular glutamate elicited by veratridine in rat cortex and striatum

Lamotrigine, carbamazepine and oxcarbazepine inhibit veratrine-induced neurotransmitter release from rat brain slices in concentrations corresponding to those reached in plasma or brain in experimental animals or humans after anticonvulsant doses, presumably due to their sodium channel blocking properties. Microdialysis measurements of extracellular glutamate and aspartate were carried out in conscious rats in order to investigate whether corresponding effects occur in vivo. Veratridine (10 M) was applied via the perfusion medium to the cortex and the corpus striatum in the presence of the glutamate uptake inhibitor L-trans-pyrrolidine-2,4-dicarboxylic acid (1 mM in perfusion medium). Maximally effective anticonvulsant doses of carbamazepine (30 mg/kg), oxycarbazepine ( 60 mg/kg) and lamotrigine (15 mg/kg) were given orally.The uptake inhibitor increased extracellular glutamate and aspartate about 2-fold in striatum and about 7-fold and 3-fold, respectively, in cortex. Veratridine caused a further 2–3-fold increase in extracellular glutamate in striatum and cortex, respectively, but its effect on extracellular aspartate was less marked in both areas. None of the anticonvulsant compounds affected the veratridine-induced increases in extracellular glutamate or aspartate in the striatum which were, however, markedly inhibited by tetrodotoxin (1 M) and thus are sensitive to sodium channel blockade. In the cortex, the same drugs at the same doses did cause about 50% inhibition of the veratridine-induced increase in extracellular glutamate. Carbamazepine and to a lesser extent lamotrigine, but not oxcarbazepine, also inhibited the veratridine-induced increase in extracellular aspartate in the cortex.Although our results might seem to support the view that inhibition of glutamate and aspartate release is responsible for the anticonvulsant effects of lamotrigine, carbamazepine and oxcarbazepine, two complementary findings argue against this interpretation. First, as previously shown, inhibition of electrically induced release of glutamate requires 5 to 7 times higher concentrations of these compounds than release elicited by veratrine. Second, the present study indicates that doses totally suppressing convulsions caused no inhibition in the striatum and at best a 50% inhibition in the brain cortex. From this we conclude that the doses used here, although to some extent effective against veratridine, did not suppress the release of GLU and ASP elicited by the normal ongoing electrical activity of the glutamatergic and aspartatergic neurons and that the mechanism of the suppression of convulsions must be sought elsewhere.     

Effectiveness and Tolerability of Carbamazepine vs. Oxcarbazepine as Mood Stabilizers

Abstract

Background.?Patients with bipolar illness or maniac-type schizoaffective disorder often present a variety of symptoms and mixed responses to treatment. Several anticonvulsants have been found effective in the treatment of mood disorders. In the early 70's, the clinical efficacy of carbamazepine in the treatment of acute mania was reported. Oxcarbazepine has been available in the United States since 2000. Both drugs display a different spectrum of properties and side effect profiles. Objective.?To compare the effectiveness and tolerability of carbamazepine and oxcarbazepine in a naturalistic setting. Methods.?A retrospective and concurrent chart review of all patients treated with carbamazepine or oxcarbazepine (n = 33) as mood stabilizers between 01 and 12 2002. The effectiveness was evaluated using the Positive And Negative Syndrome Scale (PANSS). Tolerability was assessed according to side effects recorded on charts. Patients with charts that were not complete were excluded from this study. Results.?There were no significant differences in efficacy between groups on positive (F = 3.575, P = 0.075), negative (F = 2.641, P = 0.121), or the general subscales (F = 1.111, P = 0.306) of the PANSS. Patients in both groups developed gastrointestinal upset and headache, but no significant differences in tolerability between the two therapies were found (χ² = 0.466, df = 1, P = 0.659) and (χ² = 0.195, df = 1, P = 0.367 respectively). Conclusion.?In summary, the patient charts reviewed demonstrated that carbamazepine, as well as, oxcarbazepine are equally effective and tolerable as mood stabilizers.     

拉莫三嗪与奥卡西平单药治疗成人新诊断局灶性癫痫的长期疗效及安全性比较

目的 比较拉莫三嗪(LTG)和奥卡西平(OXC)单药治疗成人新诊断局灶性癫痫的长期疗效、耐受性和安全性。方法 收集本院癫痫专病门诊新诊断的局灶性癫痫,随机分成OXC组和LTG组,根据临床情况调整剂量,OXC最大剂量1200 mg/d,LTG最大剂量300 mg/d,至少随访3年,评估二种药物单药治疗成人新诊断局灶性癫痫无发作率、保留率及不良反应。结果 2009年6月-2016年6月符合入组标准146例,其中OXC组74例,LTG组72例,2组1年无发作率分别为35.1%和51.3%(χ2=3.9,P=0.047),3年无发作率分别为21.6%和40.2%(χ2=5.96,P=0.015),LTG组总体无发作率高于OXC组(P<0.05); OXC组和LTG组1年保留率分别为59.5%和69.4%(χ2=1.59,P=0.208),3年保留率分别为44.6%和51.4%(χ2=0.68,P=0.411),LTG组总体保留率亦高于OXC组,但无明显差异(P>0.05)。OXC组和LTG组最常见的不良反应均为皮疹(6.8% vs. 8.3%)。结论 LTG单药治疗新诊断成人局灶性癫痫的长期无发作率高于OXC,两者不良反应较轻,有较好的安全性。     

奥卡西平和左乙拉西坦治疗新诊断部分性发作癫疒间患儿的疗效分析

目的观察奥卡西平与左乙拉西坦对新诊断部分性发作癫疒间患儿的疗效和安全性。方法选择2011年1月至2013年12月新诊断部分性发作癫疒间患儿75例,随机分为2组。A组38例,给予奥卡西平治疗,剂量由10 mg/(kg·d)逐渐调整至最低有效量,最高为60 mg/(kg·d);B组37例,给予左乙拉西坦,剂量从5 mg/(kg·d)逐渐调整至最低有效量,最高为60 mg/(kg·d)。治疗12个月后,比较两组临床疗效、脑电图变化及不良反应。结果治疗后,A组的症状完全控制率(63.16%)、好转率(89.47%)与B组(安全控制率70.27%、好转率94.59%)比较差异无统计学意义(P>0.05);A组癫疒间样放电正常率(31.58%)、好转率(71.05%)与B组(37.84%、89.19%)比较差异无统计学意义(P>0.05);A组脑电背景α节律(9.67±1.36)与B组(9.84±1.31)比较差异无统计学意义(P>0.05);A组脑电图θ频段功率(30.64±7.66)比治疗前(20.67±6.36)明显增加(P<0.05),且高于B组(22.03±6.43),差异有统计学意义(P<0.05);A组不良反应发生率(20.05%)明显高于B组(2.70%),差异有统计学意义(P<0.05)。结论奥卡西平与左乙拉西坦治疗新诊断部分性发作癫疒间患儿均有效,但左乙拉西坦安全性更高。     

奥卡西平治疗精神分裂症兴奋激越患者的临床效果及对血清同型半胱氨酸水平的影响

目的探析奥卡西平治疗精神分裂症兴奋激越患者的临床疗效,并分析对患者血清同型半胱氨酸(Hcy)水平的影响。方法前瞻性选取2018年1月至2019年1月海南省安宁医院收治的48例精神分裂症兴奋激越患者为研究对象,采用随机数字表法分为2组,其中对照组(n=24)予以氟哌啶醇治疗,治疗组(n=24)予以奥卡西平治疗。比较2组患者治疗前、治疗2个月以及3个月后的阳性和阴性症状量表兴奋因子(PANSS-EC)减分值评分变化,并同时比较临床治疗总有效率,观察血清治疗前、治疗3个月后的血清Hcy水平,记录不良反应发生情况。结果治疗前与治疗2个月后,2组患者的PANSS-EC减分值组间比较[(1.68±0.83)分vs.(1.43±0.57)分、(5.48±3.10)分vs.(5.12±3.03)分],差异无统计学意义(P>0.05);治疗3个月后,治疗组的PANSS-EC减分值显著高于对照组[(13.03±4.23)分vs.(8.38±4.15)分],差异有统计学意义(P<0.05)。治疗组临床总有效率(83.33%)明显高于对照组(50.00%),差异有统计学意义(P<0.05)。治疗前,2组患者的血清Hcy水平比较[(26.68±4.83)μmol/L vs.(27.24±4.57)μmol/L],差异无统计学意义(P>0.05);治疗3个月后,治疗组患者的Hcy水平显著低于对照组[(7.03±1.23)μmol/L vs.(13.38±2.15)μmol/L],差异有统计学意义(P<0.05)。治疗组总不良反应发病率(4.17%)明显低于对照组(25.00%),差异有统计学意义(P<0.05)。结论相对氟哌啶醇,奥卡西平在治疗精神分裂症兴奋激越患者方面具有优势,临床疗效较高,能有效调节血清Hcy水平,不良反应相对少,安全性较高,值得临床推广应用。     

奥卡西平单药治疗2岁以下部分性发作癫痫患儿的临床观察

目的：探讨奥卡西平口服混悬液单药治疗2岁以下婴幼儿部分性发作癫痫的临床疗效和安全性。方法：收集2岁以下婴幼儿部分性发作癫痫患儿52例,给予奥卡西平口服混悬液单药治疗,起始量为8—10mg／（kg·d）,渐加量至20～40mg／（kg·d）,随访6～18个月,进行自身对照开放性研究,观察其疗效及安全性。结果：应用奥卡西平口服混悬液治疗后,有效率及控制率分别为94．2％、84．6％,8例（15．4％）患儿发生腹泻、呕吐、纳差、皮疹等不良反应。结论：奥卡西平口服混悬液治疗婴幼儿部分性发作癫痫疗效显著,临床应用方便,安全性好,不良反应较少,值得临床推广应用。     

左乙拉西坦和奥卡西平单药治疗新诊断儿童部分性癫痫的疗效及安全性分析

目的：观察左乙拉西坦（Levetiracetam,LEV）与奥卡西平（Oxcarbazepine,OXC）单药治疗新诊断部分性发作癫痫患儿的疗效和安全性。方法将68例新诊断部分性发作癫痫患儿随机分为两组,OXC组和LEV组各34例。观察两组的临床疗效、脑电图改变及不良反应。结果OXC组完成治疗32例,LEV组完成治疗34例。临床疗效比较OXC组总有效率为87．5％,LEV组总有效率为85．3％。两组总有效率比较差异无统计学意义（ P＞0．05）。脑电图改善情况比较OXC组有效率为50．0％,LEV组有效率为76．5％,LEV组有效率高于 OXC组,差异有统计学意义（P＜0．05）。 LEV组不良反应发生率低于OXC组,差异有统计学意义（P＜0．05）。结论奥卡西平与左乙拉西坦治疗儿童部分性发作癫痫临床疗效相当,但左乙拉西坦对脑电图改善优于奥卡西平,且不良反应少,安全性更高。     

Sustained efficacy and long-term safety of oxcarbazepine: one-year open-label extension of a study in refractory partial epilepsy

PURPOSE: To evaluate the long-term efficacy, tolerability, and safety of oxcarbazepine (OXC) in medically refractory partial epilepsy. METHODS: This study is the open-label extension phase that followed a multicenter, randomized, double-blind, dose-response clinical study of OXC monotherapy in patients with medically refractory partial epilepsy. We analyzed the efficacy, tolerability, and safety of OXC during the first 48 weeks of open-label therapy. To evaluate efficacy, we compared the change in seizure frequency throughout the 48 weeks of treatment with OXC with the baseline seizure frequency that preceded the double-blind phase of the core study by an intent-to-treat and completer analysis. Safety and tolerability were evaluated by using an intent-to-treat analysis. RESULTS: Of the 87 patients enrolled in the double-blind study, 76 patients participated in the open-label extension phase. Fifty-five (72%) patients completed 48 weeks of open-label treatment on a median OXC dose of 2,400 mg/day. Based on an intent-to-treat analysis, the median reduction in seizure frequency was 47%(p = 0.0054); the 50 and 75% responder rates were 46.1 and 25.0%, respectively, with 6.6% of patients remaining seizure free. The completer analysis yielded comparable efficacy results. OXC was well tolerated, with 13% of patients exiting because of adverse events. The six most common adverse events, irrespective of their causal relation to OXC, were dizziness, headache, fatigue, diplopia, nausea, and rash. For the most part, these adverse events tended to be transient. CONCLUSIONS: The efficacy of OXC is sustained with good safety and tolerability profiles during long-term treatment of patients with medically refractory partial epilepsy.