Background Vagus nerve stimulation system (VNS) has been employed worldwide as adjunctive therapy in drug-resistant epileptic patients. Only nine previous pregnancies with six-positive outcomes have been reported in women with epilepsy treated with VNS since 1998. Aims of the study To communicate the experience of pregnancies in women treated with VNS in our country. Methods Clinical data of four female patients treated with VNS during pregnancy and delivery in five gestations is described. Results Four pregnancy outcomes were positive and one ended in spontaneous abortion, probably more related to the use antiepileptic drugs than VNS itself. Two births were vaginal and the other two with cesarean section. None of the complications during delivery were attributed to VNS. No teratogenicity was documented. Conclusions Based on our experience VNS constitutes a safe therapy for the treatment of drug-resistant epilepsy in women of childbearing potential and during pregnancy and delivery. Larger series will be useful to confirm this finding.

Vagus Nerve Stimulation

Therapeutic abortion

Cesarean delivery

10.1111/ane.12780

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Relationship between sleep and dysautonomic symptoms assessed by self‐report scales

Movement Disorders (2011)

Beatriz Tijero Johanne Somme Juan Carlos Gómez‐Esteban Koldo Berganzo Ishan Adhikari

Movement Disorders

10.1002/mds.23761

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Patología cerebrovascular en un hospital terciario. Situación actual y puntos de mejora

Revista de Neurología (2005)

Juan Carlos Gómez‐Esteban Tomás Pérez Concha Juan José Zarranz Imirizaldu Jesús M. Garibi Undabarrena Gabriel Gutiérrez

Caring for patients suffering from a cerebrovascular diseases requires a large quantity of resources which must be optimised. The aim of this study is to analyse the management of stroke in a tertiary care hospital.All admissions with a diagnosis of stroke were analysed retrospectively for the year 2003. Length of stay, computed tomography in the Emergency Room, origin, previous admissions during the last year, presence of vascular risk factors, stroke subtype, complications and mortality during admission and destination when discharged from hospital, were all recorded.936 patients were admitted to hospital with a diagnosis of stroke. 80.22% corresponded to acute ischaemic strokes (27.14% lacunar, 18.57% transient ischaemic attacks, 10.25% cardioembolic, 15.44% aterothrombotic, 8.44% infarct of undetermined cause, 0.24% unusual aetiology) and 19.78% corresponded to haemorrhagic strokes (13.99% intraparenchymatous hemorrhage, 5.79% subarachnoid hemorrhage). Intra-hospital mortality was 5.3%. 11% suffered from complications while in hospital, and average length of stay was 10.4 days, being much longer for those patients discharged to a medium-long stay centre (17.5 days). Compared to other series, the incidence of cardioembolic and aterothrombotic subtypes of stroke is low. However, because of the inclusion of neurosurgical patients, an increase of cerebral haemorrhages is observed.Intra-hospital morbidity and mortality and average length of stay in our series are consistent with those from other centres of similar characteristics. A better coordination with medium-long stay centres along with the presence of neurologists on call, would certainly improve these variables.

Etiology

Stroke

Ischaemic stroke

10.33588/rn.4012.2004505

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Perampanel in routine clinical use in idiopathic generalized epilepsy: The 12-month GENERAL study

Epilepsia (2018)

Vicente Villanueva Javier Montoya Ascensión Castillo J A Mauri-Llerda P. Giner

Summary Objective To analyze the effectiveness and tolerability of perampanel across different seizure types in routine clinical care of patients with idiopathic generalized epilepsy ( IGE ). Methods This multicenter, retrospective, 1‐year observational study collected data from patient records at 21 specialist epilepsy units in Spain. All patients who were aged ≥12 years, prescribed perampanel before December 2016, and had a confirmed diagnosis of IGE were included. Results The population comprised 149 patients with IGE (60 with juvenile myoclonic epilepsy, 51 generalized tonic–clonic seizures [ GTCS ] only, 21 juvenile absence epilepsy, 10 childhood absence epilepsy, 6 adulthood absence epilepsy, and one Jeavons syndrome). Mean age was 36 years. The retention rate at 12 months was 83% (124/149), and 4 mg was the most common dose. At 12 months, the seizure‐free rate was 59% for all seizures (88/149); 63% for GTCS (72/115), 65% for myoclonic seizures (31/48), and 51% for absence seizures (24/47). Seizure frequency was reduced significantly at 12 months relative to baseline for GTCS (78%), myoclonic (65%), and absence seizures (48%). Increase from baseline seizure frequency was seen in 5.2% of patients with GTCS seizures, 6.3% with myoclonic, and 4.3% with absence seizures. Perampanel was effective regardless of epilepsy syndrome, concomitant antiepileptic drugs ( AEDs ), and prior AED s, but retention and seizure freedom were significantly higher when used as early add‐on (after ≤2 prior AED s) than late (≥3 prior AED s). Adverse events were reported in 50% of patients over 12 months, mostly mild or moderate, and irritability (23%), somnolence (15%), and dizziness (14%) were most frequent. Significance In routine clinical care of patients with IGE , perampanel improved seizure outcomes for GTCS , myoclonic seizures, and absence seizures, with few discontinuations due to adverse events. This is the first real‐world evidence with perampanel across different seizure types in IGE .

Perampanel

Idiopathic generalized epilepsy

Juvenile myoclonic epilepsy

Tolerability

Epilepsy syndromes

Generalized epilepsy

Concomitant

10.1111/epi.14522

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Perampanel in routine clinical use across Europe: Pooled, multicenter, observational data

Epilepsia (2018)

Alexandra Rohracher Georg Zimmermann Vicente Villanueva Íñigo Garamendi Josemir W. Sander

Summary Objective To pool observational data on the routine use of perampanel to obtain information on real‐world outcomes and data in populations typically underrepresented in clinical trials. Methods Individual‐level data of people with epilepsy treated with perampanel at 45 European centers were merged into a single dataset. Prespecified outcomes were: 1‐year retention rate, 1‐year seizure freedom rate (duration ≥6 months), and incidence of treatment‐emergent adverse events ( TEAE s). In addition, relationships were explored with logistic regression analyses. Results The full analysis set comprised 2396 people: 95% had focal seizures; median epilepsy duration was 27 years; median number of concomitant antiepileptic drugs ( AED s) was 2; and median prior AED s was 6. One‐year retention rate was 48% (1117/2332; 95% confidence interval [ CI ] 46‐50%), and 1‐year seizure‐free rate (≥6‐month duration) was 9.2% (74/803; 95% CI 7‐11%). Median treatment duration was 11.3 months (1832 patient‐years); median dose was 8 mg. In 388 individuals with available data at 3, 6, and 12 months, responder rates were 42%, 46%, and 39%, respectively. During the first year, TEAE s were reported in 68% of participants (1317/1497; 95% CI 66‐70%). Logistic regression found higher age at perampanel initiation was associated with higher seizure‐free rate, and higher number of prior AED s with lower seizure‐free rate and lower rates of somatic TEAE s. In 135 individuals aged ≥65 years, 1‐year retention rate was 48% and seizure‐free rate was 28%. Significance Across a large, treatment‐resistant population, add‐on perampanel was retained for ≥1 year by 48% of individuals, and 9% were seizure‐free for ≥6 months. TEAE s were in line with previous reports in routine clinical use, and less frequent than in the clinical trial setting. No new or unexpected TEAE s were seen. Despite the limitations of observational studies, our data indicate that some individuals may derive a marked benefit from the use of perampanel.

Perampanel

Retention rate

Concomitant

Rate ratio

10.1111/epi.14520

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Citations (75)