Background:Besides seizures,a myriad of overlapping neuropsychiatric and cognitive comorbidities occur in patients with epilepsy,which further debilitates their quality of life.This study provides an in-depth characte...Background:Besides seizures,a myriad of overlapping neuropsychiatric and cognitive comorbidities occur in patients with epilepsy,which further debilitates their quality of life.This study provides an in-depth characterization of the impact of brivaracetam and rufinamide individually and in combination at 10 and 20 mg/kg doses,respec-tively,on corneal kindling-induced generalized seizures and behavioral alterations.Furthermore,observed convulsive frequency and behavioral changes were corre-lated to post-kindling-induced changes in the activity of markers of oxidative stress.Methods:Adult C57BL/6 mice were kindled via twice-daily transcorneal 50-Hz elec-trical stimulations(3 mA)for 3 s for 12 days until animals reached a fully kindled state.After the kindling procedure,animals were tested using a set of behavioral tests,and neurochemical alterations were assessed.Results:Corneal-kindled animals exhibited intense generalized convulsions,altered behavioral phenotypes typified by positive symptoms(hyperlocomotion),negative symptoms(anxiety and anhedonia),and deficits in semantic and working memory.BRV 10+RFM 20 dual regime increased convulsive threshold and propensity toward the start of stage 4–5 seizures and improved phenotypical deficits,that is,anxiety,depression,and memory impairments.Moreover,this combination therapy mitigated kindling-induced redox impairments as evidenced by reduced malondialdehyde and acetylcholinesterase levels and increased glutathione antioxidant activity in the brain of animals subjected to repetitive brain insult.Conclusion:Based on our outcomes,this dual therapy provides supporting evidence in alleviating epilepsy-induced neurobehavioral comorbidities and changes in redox homeostasis.展开更多
Epilepsy is a common neurological disorder that is primarily treated with antiseizure medications(ASMs).Although dozens of ASMs are available in the clinic,approximately 30%of epileptic patients have medically refract...Epilepsy is a common neurological disorder that is primarily treated with antiseizure medications(ASMs).Although dozens of ASMs are available in the clinic,approximately 30%of epileptic patients have medically refractory seizures;other limitations in most traditional ASMs include poor tolerability and drug-drug interactions.Therefore,there is an urgent need to develop alternative ASMs.Levetiracetam(LEV)is a first-line ASM that is well tolerated,has promising efficacy,and has little drug-drug interaction.Although it is widely accepted that LEV acts through a unique therapeutic target synaptic vesicle protein(SV)2A,the molecular basis of its action remains unknown.Even so,the next-generation SV2A ligands against epilepsy based on the structure of LEV have achieved clinical success.This review highlights the research and development(R&D)process of LEV and its analogs,brivaracetam and padsevonil,to provide ideas and experience for the R&D of novel ASMs.展开更多
Background There are increasing incidence of psychiatric side effects associated with the use of anti-epileptics.Prospective observational studies on the effectiveness and safety of levetiracetam(LEV)and brivaracetam(...Background There are increasing incidence of psychiatric side effects associated with the use of anti-epileptics.Prospective observational studies on the effectiveness and safety of levetiracetam(LEV)and brivaracetam(BRV),along with the haematological abnormalities of both treatments,in seizure patients in an Indian population are lacking.Therefore,we aimed to compare the effectiveness and safety of LEV and BRV in seizure patients and evalu-ated behavioural and non-behavioural side effects,as well as outcomes when switching between LEV and BRV.Methods A prospective observational study was conducted in newly diagnosed as well as previously diagnosed patients(n=115)with epilepsy aged≥5 years of age receiving LEV(n=66)or BRV(n=49).Baseline data were col-lected during the initiation of the study and were compared to the data obtained at the end of the study.A seizure severity questionnaire was used to assess the severity of seizures,and a brief psychiatric rating scale,Hamilton anxiety rating scale,and pediatric epilepsy side effects questionnaire were used to assess the behavioural and non-behav-ioural side effects.Results At baseline,adults taking LEV showed higher rates of behavioral adverse events(BAEs)compared to those on BRV.During follow-up,the most common behavioural adverse event reported in both treatment groups(LEV and BRV)was depression.The most frequently reported non-behavioural side effect in patients taking BRV was drows-iness.Patients who switched from LEV to BRV due to psychiatric side effects showed positive results with BRV(n=5).Conclusions In summary,the study found that BRV is a safe alternative,with fewer and less severe side effects compared to LEV.While LEV showed slightly higher efficacy and a lower probability of drowsiness,BRV proved more tolerable for patients experiencing LEV-induced side effects.Switching from LEV to BRV decreased the psychiatric side effects.展开更多
抗癫痫药物是癫痫患者的首选治疗癫痫手段。全球癫痫发病率的不断提高,给国家、个人和家庭生活等带来较大经济负担。随着越来越多的癫痫患者得到规范化治疗,使得抗癫痫药物临床需求越来越大。突触囊泡蛋白2A(synaptic vesicle protein 2...抗癫痫药物是癫痫患者的首选治疗癫痫手段。全球癫痫发病率的不断提高,给国家、个人和家庭生活等带来较大经济负担。随着越来越多的癫痫患者得到规范化治疗,使得抗癫痫药物临床需求越来越大。突触囊泡蛋白2A(synaptic vesicle protein 2A,SV2A)通过调节神经递质的释放,来维持脑内兴奋性神经递质和抑制性神经递质的平衡。随着SV2A确证为新的抗癫痫靶点,左乙拉西坦和布瓦西坦的上市,抗癫痫靶点和抗癫痫新药进一步丰富。本文围绕抗癫痫药物靶点SV2A以及以SV2A为靶点的上市及在研药物做概述,并对其构效关系进行总结。展开更多
基金The authors extend their appreciation to the Distinguished Scientist Fellowship program at King Saud University,Riyadh,Saudi Arabia,for funding this work through Research Supporting Project Number RSP2024R131.
文摘Background:Besides seizures,a myriad of overlapping neuropsychiatric and cognitive comorbidities occur in patients with epilepsy,which further debilitates their quality of life.This study provides an in-depth characterization of the impact of brivaracetam and rufinamide individually and in combination at 10 and 20 mg/kg doses,respec-tively,on corneal kindling-induced generalized seizures and behavioral alterations.Furthermore,observed convulsive frequency and behavioral changes were corre-lated to post-kindling-induced changes in the activity of markers of oxidative stress.Methods:Adult C57BL/6 mice were kindled via twice-daily transcorneal 50-Hz elec-trical stimulations(3 mA)for 3 s for 12 days until animals reached a fully kindled state.After the kindling procedure,animals were tested using a set of behavioral tests,and neurochemical alterations were assessed.Results:Corneal-kindled animals exhibited intense generalized convulsions,altered behavioral phenotypes typified by positive symptoms(hyperlocomotion),negative symptoms(anxiety and anhedonia),and deficits in semantic and working memory.BRV 10+RFM 20 dual regime increased convulsive threshold and propensity toward the start of stage 4–5 seizures and improved phenotypical deficits,that is,anxiety,depression,and memory impairments.Moreover,this combination therapy mitigated kindling-induced redox impairments as evidenced by reduced malondialdehyde and acetylcholinesterase levels and increased glutathione antioxidant activity in the brain of animals subjected to repetitive brain insult.Conclusion:Based on our outcomes,this dual therapy provides supporting evidence in alleviating epilepsy-induced neurobehavioral comorbidities and changes in redox homeostasis.
基金supported by funding from the High-level New R&D Institute(2019B090904008)the High-level Innovative Research Institute(2021B0909050003)of the Department of Science and Technology of Guangdong Province+4 种基金National Science and Technology Innovation 2030 Major Program(2021ZD0200900)Shanghai Municipal Science and Technology Major Project(2018SHZDZX05)Zhongshan Municipal Bureau of Science and Technology(CXTD2022013)the National Science Fund for Distinguished Young Scholars(81825021)the funding from Zhongshan Municipal Bureau of Science and Technology(210724194041939).
文摘Epilepsy is a common neurological disorder that is primarily treated with antiseizure medications(ASMs).Although dozens of ASMs are available in the clinic,approximately 30%of epileptic patients have medically refractory seizures;other limitations in most traditional ASMs include poor tolerability and drug-drug interactions.Therefore,there is an urgent need to develop alternative ASMs.Levetiracetam(LEV)is a first-line ASM that is well tolerated,has promising efficacy,and has little drug-drug interaction.Although it is widely accepted that LEV acts through a unique therapeutic target synaptic vesicle protein(SV)2A,the molecular basis of its action remains unknown.Even so,the next-generation SV2A ligands against epilepsy based on the structure of LEV have achieved clinical success.This review highlights the research and development(R&D)process of LEV and its analogs,brivaracetam and padsevonil,to provide ideas and experience for the R&D of novel ASMs.
文摘Background There are increasing incidence of psychiatric side effects associated with the use of anti-epileptics.Prospective observational studies on the effectiveness and safety of levetiracetam(LEV)and brivaracetam(BRV),along with the haematological abnormalities of both treatments,in seizure patients in an Indian population are lacking.Therefore,we aimed to compare the effectiveness and safety of LEV and BRV in seizure patients and evalu-ated behavioural and non-behavioural side effects,as well as outcomes when switching between LEV and BRV.Methods A prospective observational study was conducted in newly diagnosed as well as previously diagnosed patients(n=115)with epilepsy aged≥5 years of age receiving LEV(n=66)or BRV(n=49).Baseline data were col-lected during the initiation of the study and were compared to the data obtained at the end of the study.A seizure severity questionnaire was used to assess the severity of seizures,and a brief psychiatric rating scale,Hamilton anxiety rating scale,and pediatric epilepsy side effects questionnaire were used to assess the behavioural and non-behav-ioural side effects.Results At baseline,adults taking LEV showed higher rates of behavioral adverse events(BAEs)compared to those on BRV.During follow-up,the most common behavioural adverse event reported in both treatment groups(LEV and BRV)was depression.The most frequently reported non-behavioural side effect in patients taking BRV was drows-iness.Patients who switched from LEV to BRV due to psychiatric side effects showed positive results with BRV(n=5).Conclusions In summary,the study found that BRV is a safe alternative,with fewer and less severe side effects compared to LEV.While LEV showed slightly higher efficacy and a lower probability of drowsiness,BRV proved more tolerable for patients experiencing LEV-induced side effects.Switching from LEV to BRV decreased the psychiatric side effects.
文摘癫痫是以脑神经元异常放电引起反复痫性发作为特征。癫痫是神经系统常见疾病之一,患病率仅次于脑卒中。布立西坦(Brivaracetam,BRV)被认为是左乙拉西坦(Levetiracetam,LEV)的衍生物,是一种新型的抗癫痫药物(antiseizure medications,ASMs)。这种药物对脑内中枢突触囊泡蛋白(synaptic vesicle protein 2A,SV2A)表现出非凡的亲和力,布立西坦可被迅速吸收并广泛生物转化。近年来,布立西坦在癫痫治疗中应用引起学者的广泛关注。本文将从影响癫痫的作用机制以及布立西坦对癫痫患者的临床试验进行阐述与总结,为癫痫治疗提供更好的药物选择。
文摘抗癫痫药物是癫痫患者的首选治疗癫痫手段。全球癫痫发病率的不断提高,给国家、个人和家庭生活等带来较大经济负担。随着越来越多的癫痫患者得到规范化治疗,使得抗癫痫药物临床需求越来越大。突触囊泡蛋白2A(synaptic vesicle protein 2A,SV2A)通过调节神经递质的释放,来维持脑内兴奋性神经递质和抑制性神经递质的平衡。随着SV2A确证为新的抗癫痫靶点,左乙拉西坦和布瓦西坦的上市,抗癫痫靶点和抗癫痫新药进一步丰富。本文围绕抗癫痫药物靶点SV2A以及以SV2A为靶点的上市及在研药物做概述,并对其构效关系进行总结。
