Navegando por Palavras-chave "Refractory epilepsy"

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    Efficacy and safety of eslicarbazepine acetate as add-on treatment in patients with focal-onset seizures: Integrated analysis of pooled data from double-blind phase III clinical studies
    (Wiley-Blackwell, 2013-01-01) Gil-Nagel, Antonio; Elger, Christian; Ben-Menachem, Elinor; Halasz, Peter; Lopes-Lima, Jose; Gabbai, Alberto Alain [UNIFESP]; Nunes, Teresa; Falcao, Amilcar; Almeida, Luis; Soares-da-Silva, Patricio; Hospital Ruber Internacional; University of Bonn; Sahlgrenska University Hospital; Institute for Experimental Medical Research; Universidade do Porto; Universidade Federal de São Paulo (UNIFESP); BIAL Portela & Ca SA; 4Health; Universidade de Coimbra; Universidade de Aveiro
    Purpose: To evaluate the efficacy and safety profile of eslicarbazepine acetate (ESL) added to stable antiepileptic therapy in adults with partial-onset seizures. Methods: Data from 1,049 patients enrolled from 125 centers, in 23 countries, in three phase III double-blind, randomized, placebo-controlled studies were pooled and analyzed. Following a 2-week titration period, ESL was administered at 400 mg, 800 mg, and 1,200 mg once-daily doses for 12 weeks. Key Findings: Seizure frequency was significantly reduced with ESL 800 mg (p < 0.0001) and 1,200 mg (p < 0.0001) compared to placebo. Median relative reduction in seizure frequency was, respectively, 35% and 39% (placebo 15%) and responder rate was 36% and 44% (placebo 22%). ESL was more efficacious than placebo regardless of gender, geographic region, epilepsy duration, age at time of diagnosis, seizure type, and number and type of concomitant antiepileptic drugs (AEDs). Incidence of adverse events (AEs) and AEs leading to discontinuation were dose dependent. AEs occurred mainly during the first weeks of treatment, with no difference between groups after 6 weeks. Most common AEs (>10% patients) were dizziness, somnolence, and headache. the incidence of AEs in ESL groups compared to placebo was generally consistent among different subpopulations. Significance: Once-daily ESL 800 mg and 1,200 mg showed consistent results across all efficacy and safety end points. Results were independent of study population characteristics and type and number of concomitant AEDs.
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    Impacto nutricional da dieta cetogênica na epilepsia refratária infantil de difícil controle
    (Universidade Federal de São Paulo (UNIFESP), 2004) Ramos, Ana Maria Figueiredo [UNIFESP]; Gabbai, Alberto Alain [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introdução: A dieta cetogênica caracteriza-se por ser hiperlipídica, normoprotéica e hipoglicídica, levando ao estado de cetose. O mecanismo da dieta cetogênica ainda não está claro, porém, têm-se demonstrado uma forma terapêutica adequada nos casos de epilepsia refratária com crises do tipo Tônico-clônico, crises parciais, mioclônicas, e crises de ausência. A dieta produz um estado crônico cetose, com efeito, anticonvulsivante. Objetivos: Analisar a importância da dieta cetogênica utilizada em crianças e adolescentes com epilepsia de difícil controle e que não respondem a terapia medicamentosa. Metodologia: A dieta foi iniciada com a hospitalização de crianças em jejum durante 36 a 48 horas, até entrarem em cetose (4+); quatro importantes itens necessários para o cálculo da dieta foram acompanhados: peso ideal, calorias por Kg de peso, proporção da dieta cetogênica (gordura/proteínas/carboidratos) e ingestão hídrica. Resultados: 12 crianças entre 6 a 17 anos foram submetidas à dieta cetogênica, 4 delas, até o presente momento, apresentaram redução nas crises e melhora em aspectos psicológicos e motores e melhora entre 70 – 100% na qualidade de vida. Uma das crianças com a Síndrome de Lennox Gestaut após dez dias de dieta chegou ao ambulatório tendo um controle das crises e balbuciando as primeiras palavras. Um dos adolescentes, que usualmente passava a maior parte do dia dormindo por conta da medicação, atualmente apresenta vida regular normal, voltaram à escola e estão pintando. Não houve casos de má nutrição após a dieta cetogênica, colesterol sérico e triglicérides não sofreram aumento em seus níveis. Conclusão: Em relação ao custo, não foram encontrados obstáculos para introduzir a dieta cetogênica, já que partes não convencionais dos alimentos podem ser utilizadas, tornando as preparações mais acessíveis à família.
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    Suplementação com ácidos graxos poliinsaturados (ômega 3 - EPA e DHA) para o tratamento de pacientes com epilepsia refratária : revisão sistemática e metanálise
    (Universidade Federal de São Paulo (UNIFESP), 2017-06-29) Vasconcelos, Vivian Sarmento de [UNIFESP]; Torloni, Maria Regina [UNIFESP]; http://lattes.cnpq.br/5661395483781554; http://lattes.cnpq.br/6022583540773749; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To assess the effectiveness and safety of omega-3 polyunsaturated fatty acids (PUFA) in the control of seizures in patients with refractory epilepsy. Methods: Cochrane systematic review. We searched the following eletronic databases, without language restrictions: Cochrane Epilepsy Group Specialised Register, CENTRAL, MEDLINE, EMBASE, SCOPUS, LILACS and clinical trials registers. We included all randomised and quasi-randomised studies using PUFAs (in association with convential treatment) versus conventional treatment or other treatments for patients of any age with drug-resistant epilepsy. The following outcomes were assessed: seizure freedom, seizure reduction, improvement in quality of life, adverse effects and changes in plasma lipid profile. Two independent review authors were involved in study selection, data extraction and quality assessment of the included trials. Results: The search retrieved 71 citations, 8 studies were selected for full-text reading and 3 studies fulfilled the selection criteria and were included in the review. Two placebo controlled trials involving adults were conducted in developed countries, while one placebo controlled trial involving children was conducted in a developing country (Egypt). The three studies recruited a total of 155 subjects (85 adults and 70 children); 78 (43 adults and 35 children) were randomised to PUFAs and 77 (42 adults and 35 children) to placebo. All participants were followed for up to 12 weeks. Seizure freedom was reported by only one study, with a high risk of bias, involving exclusively children. The relative risk (RR) for this outcome was significantly higher in the children receiving PUFA compared to the control group: RR 20.00, 95% confidence interval (CI) 2.84 to 140.99, 1 study, 70 children. Similarly, PUFA supplementation was associated with a significant difference in the proportion of children with at least 50% reduction in seizure frequency: RR 33.00 95% CI 4.77 to 228.15, 1 study with a high risk of bias, 70 children. However, this effect was not observed when the data from two studies with adults were pooled: RR 0.57, 95% CI 0.19 to 1.75, I² 0%, 2 studies, 78 participants, low-quality evidence. None of the studies assessed bleeding as a potential adverse effect. There were no significant differences between the PUFA and control groups in relation to gastrointestinal effects: RR 0.78, 95% CI 0.32 to 1.89, 2 studies, 85 participants, low-quality evidence. Supplementation with PUFA did not produce significant differences in mean frequency of seizures, quality of life or other side effects. Conclusions: In view of the limited number of studies and small sample sizes, there is not enough evidence to support the use of PUFA supplementation in patients with refractory epilepsy. More trials are needed to assess the benefits of PUFA supplementation in the treatment of drug resistant epilepsy.