Eslicarbazepine Acetate Modulates EEG Activity and Connectivity in Focal Epilepsy.

Introduction: Eslicarbazepine acetate (ESL) is an antiepileptic drug approved as monotherapy or add-on for the treatment of epilepsy with seizures of focal onset. ESL owns a good profile in terms of efficacy and tolerability, but its effects on EEG activity and connectivity are unknown. The purpose of this study was to investigate EEG activity and connectivity changes after ESL treatment in persons with focal epilepsy (PFE). Material and Methods: We performed a multicentre, longitudinal, retrospective, quantitative EEG study on a population of 22 PFE, and a group of 40 controls. We investigated the ESL-related changes of EEG power spectral activity and global connectivity [phase locking value (PLV), amplitude envelope correlation (AEC) and amplitude envelope correlation of orthogonalized signals (Ortho-AEC)] for standard frequency bands (delta to gamma). Seizure frequency was evaluated to assess ESL efficacy in our cohort. Results: ESL significantly enhanced both global power spectral density and connectivity for all frequency bands, similarly for all connectivity measures. When compared to the control group, Post-ESL power was significantly higher in theta and gamma band. Pre-ESL connectivity values were significantly lower than control for all frequency bands. Post-ESL connectivity increased and the gap between the two groups was no longer significant. ESL induced a 52.7 ± 41.1% reduction of seizure frequency, with 55% of clinical responders (reduction of seizures ≥50%). Discussion: ESL therapy induces significant enhancement of brain activity and connectivity. Post-ESL connectivity profile of epilepsy patients was similar to the one of healthy controls.

Effects of eslicarbazepine acetate on lipid profile and sodium levels in patients with epilepsy.

PURPOSE: Several studies have demonstrated that treatment with enzyme-inducing antiepileptic drugs is associated with increased serum lipid levels. Eslicarbazepine acetate (ESL) is a novel antiepileptic drug specifically designed with the objective to identify carbamazepine and oxcarbazepine analogues with favorable pharmacodynamic and pharmacokinetic profiles. The present study aimed to assess the changes in lipid profile and sodium levels in patients with epilepsy taking ESL as adjunctive therapy. METHOD: This report describes a retrospective cohort study of 36 adult patients with epilepsy, taking ESL as an add-on treatment. The laboratory values assessed prior and after (range 6-18 months) ESL treatment were sodium levels, total cholesterol (TC), low (LDL) and high (HDL) density lipoproteins and triglycerides. RESULTS: TC and LDL values were significantly decreased already after at least six months of therapy with ESL (191.3±29.6 vs 179.7±29.2mg/dl, p <0.0001 and 114.58±22.7 vs 103.11±19.46mg/dl, p <0.0001 respectively). HDL values before and during ESL treatment were significantly increased (57.5± 9.1 vs 63.9±8.3mg/dl; p<0.0001). No statistically significant changes have been found in triglycerides and sodium values. CONCLUSIONS: Add-on therapy with ESL, in contrast to the negative effects observed with traditional older carboxamides, positively affects lipid metabolism profile in patients with epilepsy over an average follow-up of 11 months. Further research is needed to confirm the obtained results with a focus on a comprehensive assessment of the biochemical and molecular mechanisms involved.

Effect of 24-h continuous rotigotine treatment on stationary and non-stationary locomotion in de novo patients with Parkinson disease in an open-label uncontrolled study.

The aim of this study was to investigate the effect of a rotigotine transdermal patch on stationary and non-stationary locomotion in de novo Parkinson disease (PD) patients in an open-label uncontrolled study. A 3-D gait analysis system was used to investigate four different locomotor tasks: steady-state linear walking, gait initiation, gait termination and 180°-turning. A series of gait variables were measured for each locomotor task. PD patients who received rotigotine treatment (4-8 mg) displayed: (1) increased step length, gait speed, cadence and arm oscillations, and reduced double support duration and step asymmetry during steady-state linear gait; (2) increased initial step length during gait initiation; (3) increased final step length and gait speed, and decreased stability index during gait termination; (4) decreased duration of turning and head-pelvis delays during 180°-turning. The main finding that emerges from the present study is that the dopamine agonist rotigotine can improve various aspects of gait in de novo PD patients.

Scuba diving is not associated with high prevalence of headache: a cross-sectional study in men.

OBJECTIVE: To study the prevalence of cephalalgia in male divers. BACKGROUND: Scuba divers work in stressing environments and have a high cerebrovascular risk, both conditions which are supposed to contribute to the genesis of cephalalgia. However, no study assessed expressly the prevalence of cephalalgia in divers, to date. METHODS: We enrolled 201 professional male scuba divers (41.0 ± 7.2 years) and controls (41.1 ± 7.2 years), and the risk ratio and its corresponding 95% confidence of suffering from cephalalgia was calculated. RESULTS: We found that 16% of divers and 22% of matched controls were affected by cephalalgia (P > .05), accounting for a risk ratio of 0.71 (95% CI 0.47-1.07). Divers reported fewer attacks per month (1.8 ± 0.7, n = 32) with regard to controls (2.5 ± 1.8, n = 45) (P = .02), but no differences concerning age at onset and severity were detected (P > .05). Divers suffered from migraine, migraine with aura and tension headache as much as controls. CONCLUSION: Scuba diving, an intense physical activity characterized by cerebral micro-vascular distress, is not associated with cephalalgia, as a whole, or migraine, tension headache or migraine with aura, more commonly than in a matched, non-diving, population. A longitudinal study may disclose if diving may act as a protective factor in the occurrence of crises of cephalalgia.

The contribution of trigemino-cervical reflexes in distinguishing progressive supranuclear palsy from multiple system atrophy.

OBJECTIVE: Trigemino-cervical reflexes (TCRs) are electromyographic responses induced by electrical stimulation of the trigeminal nerve and recorded in the neck muscles. Trigemino-cervical reflexes are detectable in Parkinson's disease, whereas they are absent in progressive supranuclear palsy (PSP), an atypical parkinsonism associated with brainstem degeneration. To date, no study has investigated TCRs in multiple system atrophy (MSA), another atypical parkinsonism associated with brainstem involvement, which resembles PSP. METHODS: To understand whether TCRs are helpful in differentiating PSP from MSA, we compared the TCRs recorded in 10 PSP patients with those obtained from 10 patients diagnosed as having probable MSA, parkinsonian type (MSA-P). RESULTS: Trigemino-cervical reflexes were not recorded in any of the PSP patients, while they were clearly detectable in all the MSA-P patients. CONCLUSIONS: Trigemino-cervical reflex recording is a rapid neurophysiological method, which could assist in the differential diagnosis between PSP and MSA-P. SIGNIFICANCE: This study further improves our understanding of the different neuronal functioning of extrapyramidal disorders. TCRs monitoring may be useful to support the diagnosis of atypical parkinsonisms especially when clinical evidence is uncertain.