PubMed · 14367947
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1955. EPILEPSY.. https://pubmed.ncbi.nlm.nih.gov/14367947/
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BACKGROUND: Everolimus, a mechanistic target of rapamycin (mTOR) inhibitor, is increasingly used in tuberous sclerosis complex (TSC)-associated epilepsy; however, long-term real-world outcomes and factors associated with favorable response remain unclear. This study aimed to evaluate the long-term seizure outcomes of adjunctive everolimus and explore clinical factors associated with treatment response. METHODS: We retrospectively recruited 21 patients with active TSC-associated epilepsy receiving adjunctive everolimus and assessed seizure outcomes during follow-up. Clinical characteristics were compared between responders and non-responders at 1 year after treatment initiation. RESULTS: Over a median treatment duration of 72 months, responder rates ranged from 53.8% to 64.7%, and seizure-free rates ranged from 33.3% to 41.2%. Responders had fewer involved organ systems at baseline (median 3 vs. 4, p = 0.020) and lower anti-seizure medication burden (median 2 vs. 4, p = 0.045). Younger age at treatment initiation showed a trend toward improved response. CONCLUSION: Adjunctive everolimus was associated with sustained long-term seizure reduction in this real-world cohort. In exploratory analyses, fewer involved organ systems and fewer baseline ASMs were associated with favorable treatment response. These findings require validation in larger prospective cohorts.
OBJECTIVE: Epilepsy is associated with an increased risk of mortality, which, however, is rarely due to the epilepsy itself; suicide, on the other hand, is a chief cause of death among persons with epilepsy. We conducted a meta-analysis to compare data reported in representative studies of suicide mortality in epilepsy with data on mortality from epilepsy in the general population. METHODS: We searched Index Medicus to 2006 through MedLine. We also searched the World Health Statistics Annual to ascertain rates of mortality from epilepsy in the age groups indicated in the studies on patients with epilepsy for specific years and countries. RESULTS: We selected 30 studies comprising 51,216 persons, 188 of whom committed suicide and died. Results obtained for each study were processed together to calculate, per 100,000 individuals in the general population per year, the mean number of suicide deaths expected in persons with epilepsy with respect to the current prevalence of epilepsy. We found that the number of suicide deaths among persons with epilepsy is the same as the number of deaths from epilepsy, suggesting that the former are not included in mortality rates for epilepsy. Also, we found that, according to data derived from cohorts we selected, 32.5% of all deaths of persons with epilepsy are due to suicide and at least 13.5% of all registered suicides are committed by these persons. Study findings may not generalize to other samples, settings, and treatments, thus perhaps tending to exaggerate the phenomenon actually attainable under broader clinical conditions. CONCLUSIONS: Our meta-analysis indicates that suicide deaths in persons with epilepsy are a disturbingly frequent phenomenon that should be addressed to reduce mortality among patients with epilepsy dramatically. In particular, mortality rates for persons with epilepsy do not include mortality from suicide, greatly underestimating death rates and the need for suicide prevention strategies for these patients.
BLOG (Web Log) is a new internet media system characterized by a frequent, chronological publication of personal thoughts with multiple Web links. The author investigated whether a 'fiction novel' on BLOG describing a girl undergoing epilepsy surgery can potentially facilitate familiarity to epilepsy surgery among the general internet users in Japan. The BLOG was initiated on July 13, 2005 and obtained daily public accesses ranging about 80-500 without any external funding support. The survey was conducted on the BLOG from November 28 until December 4, 2005. The mean of daily accesses during the survey period was 135, and a total of 27 users responded to a single questionnaire. Sixteen responders indicated that this novel facilitated awareness of epilepsy surgery, and eight indicated that they have been aware of epilepsy surgery even before reading the novel. The author found that advantages of BLOG as a tool for outreach and survey included a small cost and high speediness, whereas major limitations of BLOG-based surveys included limited coverage and severe non-response bias. A public outreach in epilepsy surgery might be possible using BLOG, but the magnitude of public outreach in this project has been quite small. A better outreach system may be required to increase the number of patients with uncontrolled seizures benefiting from epilepsy surgery.