Lacosamide in monotherapy in BTRE (brain tumor-related epilepsy): results from an Italian multicenter retrospective study.

PURPOSE: Lacosamide (LCM) is a third-generation anti-seizure medication (ASM) approved for focal onset epilepsy in patients aged ≥ 4.378 Previous studies have reported an efficacy of LCM as add-on treatment in brain tumor-related epilepsy (BTRE). To date, there are no studies in the literature focusing on lacosamide used in monotherapy to treat BTRE. In our retrospective study we investigated efficacy and tolerability of LCM in monotherapy in a multicenter national cohort of primary brain tumor patients. METHODS: We collected from 12 Italian Centers 132 patients with primary brain tumors who were treated with LCM in monotherapy. For each patient we evaluated seizure freedom at 3 and 6 months (primary endpoints), side effects and drop-out rate (secondary endpoints). RESULTS: Overall, LCM led to seizure freedom in 64.4% of patients at 3 months and 55% at 6 months. Patients who used two or more ASMs before LCM had a worse seizure control than patients in monotherapy with LCM as first choice. In 14 patients, we observed seizure control despite tumor progression on magnetic resonance (MRI). Multivariate analysis showed that gross-total resection at diagnosis was significantly associated with higher seizure freedom rate at 6 months. Side effects were mainly mild (grade 1-2 according to CTCAE classification) and drop-out rate was low (1.5%). Main side effects were dizziness and somnolence. CONCLUSIONS: This is the first study showing a good efficacy and tolerability of LCM when used in monotherapy in BTRE. Further prospective studies are needed to confirm these preliminary data, investigating also quality of life and neurocognitive functions.

Periodontitis and preterm delivery. A review of the literature.

The aim of this paper was to review the relationship between periodontitis and preterm delivery (PTD). Original papers on this subject, published in English until the first quarter of 2004, were located in the MEDLINE/PubMed database. Additional papers were obtained by searching reference lists of previously published review papers. Case control studies pointed to an association between periodontitis and increased rates of PTD of low birth-weight (LBW) infants. Longitudinal studies showed that the incidence or progression of periodontitis during pregnancy may be an independent risk factor for PTD and LBW. Microbiological, immunological and animal model studies suggested that periodontal pathogens and their products may translocate to the fetal-placental unit resulting in PTD or fetal growth restriction. Maternal periodontal infection may also provide a chronic reservoir of inflammatory mediators and cytokines (TNF-alpha, IL-1, IL-6, PGE2) that could adversely affect pregnancy outcome. Randomized controlled studies published indicated that periodontal treatment significantly reduces the risk of PTD and LBW infants. If these results are confirmed in further intervention studies, then prevention and treatment of periodontitis should be considered as a necessary part of prenatal care.