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Epilepsia - Editor's Choice

May 2014

Antiepileptic drug use in seven electronic health record databases in Europe: A methodological comparison Free Access

Mark C. H. de Groot, Markus Schuerch, Frank de Vries, Ulrik Hesse, Belén Oliva, et al.
Article first published 27 February 2014. DOI: 10.1111/epi.12557

Up to 1.1% of the European population is estimated to use antiepileptic drugs (AEDs). The annual prevalence of AED prescribing apparently differs among European countries probably from different type of data sources and time periods. This study measured prevalence of AED prescribing across health care data databases in Spain, Denmark, the Netherlands, the UK, and Germany between 2001 and 2009. Analyses were stratified by sex, age, and AED and standardized to the European 2008 reference population. Results showed that prevalence of any AED varied from 88 (Netherlands) to 144 per 10,000 (Spain and Denmark) in 2001. In all databases prevalence increased linearly from 6% in Denmark to 15% in Spain each year since 2001. The increase was attributed to an increase in new, recently marketed AEDs while prevalence of older AEDs hardly changed. AED use increased with age for both females and males up to ages of 80-89 years-old and tended to be higher in females than in males from age 40 to 70. Using a standardized methodology showed consistent trends across databases and countries over time. Differences in age and sex distribution explained only part of the variation between countries. Thus remaining variation in AED use was attributed to other differences in national health care systems.

Article (enhanced html)

Effects of an Inpatient Rehabilitation Program after Temporal Lobe Epilepsy Surgery and other Factors on Employment two Years after Epilepsy Surgery Free Access

Rupprecht Thorbecke, Theodor W. May, Steffi Koch-Stoecker, Alois Ebner, Christian G. Bien and Ulrich Specht
First published: 29 April 2014. DOI: 10.1111/epi.12573

Multiple studies reported on the positive effects of temporal lobe resection on seizure control and quality of life. The employment outcome, though, is more heterogeneous. The effects of postsurgical rehabilitation programs on employment status two years after temporal lobe epilepsy surgery were evaluated in 232 adult patients who had a three week inpatient rehabilitation program immediately after surgery (“Rehab group”) compared with 119 patients who had surgery before such a rehabilitation program existed. In the Rehab group, 139 (59.9%) subjects attended the rehabilitation program. Preoperatively, both groups did not differ in variables relevant for employment, including employment rate. Two years after surgery, the rate of unemployment had decreased in the Rehab group from 38.4% to 27.6% (p<0.001), and slightly increased in the control group (37.8% to 42.0%; n.s.), resulting in a difference of 14.4% in favor of the Rehab group (p=0.008). General unemployment rates during the two observation periods were similar. Besides the offer of rehabilitation support (“Rehab group”) and preoperative employment, seizure outcome, diagnosis of a personality disorder preoperatively, and age at surgery were shown as negative predictors for employment post-surgery in multivariate regression analysis. These data show that a three week inpatient rehabilitation program after temporal lobe epilepsy surgery seems to improve employment status two years after surgery.

Article (enhanced html)

February 2014

Evaluation of Kilifi Epilepsy Education Programme (KEEP): A randomised controlled trial Free Access

Fredrick Ibinda, Caroline K. Mbuba, Symon M. Kariuki, Eddie Chengo, Anthony K. Ngugi, Rachael Odhiambo, Brett Lowe, Greg Fegan, Julie A. Carter Charles R. Newton
Article first published online: 21 Jan 2014. DOI: 10.1111/epi.12498

Commentary by Editors-in-Chief Gary W. Mathern, MD and Astrid Nehlig, PhD:
The epilepsy treatment gap is largest in resource-poor countries. This randomized control trial evaluated the efficacy of a one-day health education program in a rural area in Kenya. The primary outcome was adherence to anti-epileptic drugs (AEDs) as measured by blood drug levels, and the secondary outcomes were seizure frequency and Kilifi Epilepsy Beliefs and Attitudes Scores (KEBAS). The study comprised 738 persons with epilepsy (PWE) that were randomized to the intervention (education) or non-intervention group. Data were collected at baseline and one year after the education intervention; 581 PWE were assessed at both time points. At the end of the study, 105 PWE from the intervention group and 86 from the non-intervention groups gave blood samples which were assayed for the most common AEDs (phenobarbital, phenytoin, carbamazepine). Both experimental groups adhered to AEDs based on detectable drug levels and self-report. The beliefs about traditional causes of epilepsy, cultural treatment and negative stereotypes were reduced in the intervention compared with the non-intervention group. There was no difference in seizure frequency between both groups. In both groups, improved therapeutic adherence was positively associated with positive change in beliefs about risks of epilepsy and the absence of non-traditional religious beliefs. Positive changes in KEBAS were associated with having tertiary education as compared with none. This study shows that health education improves knowledge about epilepsy but a single contact does not improve adherence which might need sustained education.

Abstract | Full Article | PDF

A potassium leak channel silences hyperactive neurons and ameliorates status epilepticus Free Access

Deblina Dey, Veit-Simon Eckle, Iuliia Vitko, Kyle A. Sullivan, Zofia M. Lasiecka, Bettina Winckler, Ruth L. Stornetta, John M. Williamson, Jaideep Kapur and Edward Perez-Reyes
Article first published online: 2 Dec 2013. DOI: 10.1111/epi.12472

Commentary by Editors-in-Chief Gary W. Mathern, MD and Astrid Nehlig, PhD:
TREK-1 (KCNK2) is a two-pore domain K+ channel highly expressed in the nervous system where it modulates neuronal excitability. The resting activity of TREK-1 channels drive the membrane potential closer to the K+ equilibrium potential (-80 mV), and hyperpolarize neurons. The authors developed a constitutively active K+mutant leak channel (TREK-M) to validate its ability to silence hyperactive neurons. They found that TREK-M inhibited neuronal firing by hyperpolarizing the resting membrane potential and decreasing input resistance in hippocampal neurons in culture. Adeno-associated virus (AAV) delivery of TREK-M to animals before lithium-pilocarpine SE initiation decreased the duration of SE by 50% and reduced neuronal death in areas targeted by the AAV injection (hippocampus and entorhinal cortex). These findings demonstrate that TREK-M can silence hyperexcitable neurons and opens the possibility for alternative gene therapy treatment of SE and for studies of AAV-TREK-M's effect on spontaneous seizures.

Abstract | Full Article | PDF

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