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Key points from the Angelini Pharma Satellite Symposia at EEC 2024

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Pubblished: 2024-11-28

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Summary of Angelini Pharma Satellite Symposia at EEC 2024

This year, Angelini Pharma had the honor of supporting the 15th European Congress on Epilepsy as one of its major sponsors with two satellite symposia entitled:

“Seizure freedom: is the theory matching the practice?”
8th September 2024

“Seizures beget more than seizures: the impact of uncontrolled epilepsy.”
9th September 2024

Our symposia were held by two esteemed international faculties:
- Simona Lattanzi (Chair), Bernhard Steinhoff, Shanika Samarasekera and Vicente Villanueva
- Heinz Beck (Chair), Marian Galovic, Adam Strzelczyk and Matthew Walker.

Below are summaries of the key topics discussed in the symposium – have a good read!

SEIZURE FREEDOM:
IS THE THEORY MATCHING THE PRACTICE?

 

Simona Lattanzi

MD, PhD Department of Experimental and Clinical Medicine,
Marche Polytechnic University, Ancona, Italy

Simona Lattanzi
  • Almost one-third of people with epilepsy continue to have seizures despite appropriate anti-seizure drug treatment, placing them at considerable risk of cognitive and psychosocial dysfunction and death.¹
  • Patients who did not achieve 1 year of seizure freedom by taking the first ASM had a greater likelihood of uncontrolled epilepsy for each additional ASM tried.²
  • Barrier to achieving seizure freedom range from lack of access to care and delayed diagnosis, to delayed treatment and lack of treatment optimization.³

THE IMPACT OF OVERTREATMENT IN PATIENTS WITH EPILEPSY MANAGEMENT.

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Shanika Samarasekera

MD Queen Elizabeth Hospital Birmingham
University Hospitals Birmingham NHS Trust, United Kingdom

  • Many of the protocols and guidelines and screening programmes are driving so much overdiagnosis and overtreatment in contemporary medicine.4
  • When death or disease occurs prematurely and unpredictably, doctors may face “sense of fault” that invites them always to do more instead of less, however harmful the consequence.4
  • Overtreatment may have serious consequences in terms of adverse effects. These effects can range from subtle CNS impairment to overt toxic effects5, worsen QoL, reduce adherence, and potentially lead to treatment.6

HOW TO MAXIMIZE EFFICACY OUTCOMES IN PATIENTS WITH EPILEPSY MANAGEMENT: EARLY TREATMENT AND REGIMEN SIMPLIFICATION.

Vicente Villanueva

Head of Section. Refractory Epilepsy Unit. Neurology Service.
Hospital Universitario y Politécnico La Fe Valencia, Spain

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  • Of the many ASM options now available, several newer ASMs, such as cenobamate, have been approved for the adjunctive treatment of drug-resistant FOS in adult patients.⁷
  • Real-world outcomes with cenobamate in a large series of patients with highly DRE shows how 44.7% of them reduced their concomitantASMs, particularly sodium channel blockers.⁸
  • In early therapy lines, cenobamate had the highest retention rate compared with lacosamide, levetiracetam, valproate, and topiramate. Seizure freedom and response rate were also the highest on cenobamate.⁹

Ontozry® (cenobamat) 12,5 mg odragerad tablett samt 25 mg, 50 mg, 100 mg, 150 mg och 200 mg filmdragerade tabletter. Rx F. ATC-kod: N03AX25 - antiepileptika, övriga antiepileptika. Indikation: Ontozry är indicerat som tilläggsbehandling av fokala anfall, med eller utan sekundär generalisering hos vuxna patienter med epilepsi, som inte kontrollerats tillräckligt trots tidigare behandling med minst två antiepileptika. Kontraindikationer: Överkänslighet mot den aktiva substansen eller mot något hjälpämne, ärftligt kort QT-syndrom. Varningar: Patienter ska uppsöka läkare om tecken på självmordstankar/självmordsbeteende uppstår, samt om tecken och symptom på läkemedelsreaktion med eosinofili och systemiska symtom (DRESS) inträffar. Innehåller laktos. Cenobamat kan minska exponeringen av substanser som metaboliseras via CYP3A4, CYP2B6 samt öka exponeringen av substanser som metaboliseras via CYP2C19. Cenobamat rekommenderas inte till fertila kvinnor som inte använder preventivmedel eller vid amning. MAH: Angelini Pharma S.p.A. Lokal kontakt: Angelini Pharma Nordics, nordic.medinfo@angelinipharma.com. Datum för senaste översyn av SPC: 11/2023. För AUP och ytterligare information, se www.fass.se. ▼Detta läkemedel är föremål för utökad övervakning.

OVERTREATMENT VERSUS THERAPEUTIC NIHILISM

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Bernhard Steinhoff

Prof. Dr. Medical Director, Erwachsenenklinik Ambulanz Epilepsiezentrum Kork, Kehl-Kork, Germany

  • Doctors are at risk of falling into the twin traps of overtreatment and therapeutic nihilism, even when they arrived at the correct diagnosis.10
  • Sense of nihilism, leading patients and clinicians to abandon further medication trials. This denies the opportunity for PWE to sustained seizure freedom, and the resulting benefits to survival and QoL.11
  • On the other hand, even though the importance of complete seizure control cannot be overemphasised, no patient should be made to suffer more from the AEs of treatment than from the manifestations of the seizure disorder.12

ASM, anti-seizure medication; DRE, drug-resistant epilepsy; AE, adverse event

References

  1. Pati S, Alexopoulus AV. Pharmacoresistant epilepsy: From pathogenesis to current and emerging therapies. Cleve Clin J Med. 2010 Jul 1;77(7):457-567.
  2. Chen Z, Brodie MJ, Liew D et al. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: A 30-year longitudinal cohort study. JAMA Neurol. 2018;75(3):279-286.
  3. Pellinen J. Treatment gaps in epilepsy. Front Epidemiol. 2022;2:976039. DOI: 10.3389
  4. Heath I. Role of fear in overdiagnosis and overtreatment—an essay by Iona Heath. BMJ. 2014 Oct 24;349.g6123. DOI: 10.1136
  5. Perucca E, Kwan P. Overtreatment in Epilepsy: How It Occurs and How It Can Be Avoided. CNS Drugs. 2005;19(11):897-908.
  6. Orozco-Hernández JP, Marín-Medina DS, Valencia-Vásquz A et al. Predictors of adverse effects to antiseizure drugs in adult patients with epilepsy from Colombia: A case–control study. Epilepsy Behav. 2023 Sep;146:109383.
  7. Mulheron S, Leahy TP, McStravick M et al. A comparison of cenobamate with other newer antiseizure medications for adjunctive treatment of focal-onset seizures: A systematic review and network meta-analysis. Seizure: European Journal of Epilepsy. 2024 Apr 5.
  8. Villanueva V, Santos-Carrasco D, Cabezudo-García P et al. Real-world safety and effectiveness of cenobamate in patients with focal onset seizures: Outcomes from an Expanded Access Program. Epilepsia Open. 2023;8(3):918-929.
  1. Mamede S, Schmidt HG. The twin traps of overtreatment and therapeutic nihilism in clinical practice. Med Educ. 2014 Jan;48(1):34-43.
  2. Blond BN, Hirsch LJ, Mattsson RH. Misperceptions on the chance of seizure freedom with antiseizure medications after two failed trials. Epilepsia. 2020;61(8):1789-1790.

Summary of topics discussed in our second symposium

SEIZURE BEGET MORE THAN SEIZURES: THE IMPACT OF UNCONTROLLED EPILEPSY

The Impact of seizures at
cellular/network level

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Matthew Walker

Dept. of Clinical Experimental Epilepsy, UCL Queen Square
Institute of Neurology, University College London

  • Perpetual interactions among neuronal populations through the scaffold of axonal pathways promote interregional communication and shape the brain’s structural and functional network organization.1
  • Prior to the occurrence of the epileptic seizure, the gradual changes of epileptogenesis occurs in neuronal excitability led to changes in interconnectionsand structure, including neurodegeneration, neurogenesis, gliosis, axonal damage or sprouting, dendritic plasticity and breakdown of the Brain Blood Barrier.2
  • It is possible that recurrent seizures in patients with poorly controlled epilepsy may produce neuronal damage and contribute to progressive functional and cognitive declines observed in some patients.3

The impact of epilepsy on human brain structure and function.

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Marian Galovic

MD University Hospital Zurich, Zurich, Switzerland

  • There is evidence that some types of epilepsy progress over time, and an important part of this knowledge has derived from neuroimaging studies.4
  • People with focal epilepsy may develop progressive cortical atrophy that can affect widespread cortical areas.5
  • Widespread progressive cortical thinning exceeding that seen with normal aging may occur in patients with focal epilepsy.5
  • Future longitudinal studies should determine whether medical treatment, either with certain ASMs or alternative approaches, or successful epilepsy surgery prevent or slow accelerated cortical thinning.5

The impact of epilepsy on human brain structure and function.

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Adam Strzelczyk

Prof. Dr. Med. Senior Consultant, Deputy Head of the Frankfurt Rhine-Main Epilepsy Centre,
Goethe University-Frankfurt University Hospital Frankfurt Clinic for Neurology

  • The impact of epilepsy is multifaceted and extensive on its effects. The occurrence of seizures is unpredictable and often dangerous, increasing the risk of injury, hospitalization and mortality, and adversely affecting a patient's mental health, often resulting in anxiety, depression or cognitive impairment.6
  • Lack of seizure freedom associated with recurrent seizures, hospitalization, and seizure-related unemployment and productivity losses are the main cost-driving factors underlying epilepsy-related Cost Of Illness (COI).7
  • Although complete seizure control is the primary treatment consideration for most patients with epilepsy, depression and the adverse effects of anti-seizure medication appear to be important considerations for the optimal outcome for many patients.8

References

  1. Larivière S, Rodriguez-Cruces R, Royer J et al. Network-based atrophy modeling in the common epilepsies: A worldwide ENIGMA study. Sci Adv. 2020 Nov 18;6(47):eabc6457.
  2. Sumadewi KT, Harkitasari S, Tjandra DC. Biomolecular mechanisms of epileptic seizures and epilepsy: a review. Acta Epileptologica. 2023 Nov 15;5(1):28.
  3. Sutula TP, Hagen J, Pitkänen A. Do epileptic seizures damage the brain? Curr Opin Neurol. 2003 Apr;16(2):189-95.
  4. Coan AC, Cendes F. Epilepsy as progressive disorders: What is the evidence that can guide our clinical decisions and how can neuroimaging help? Epilepsy Behav. 2013 Mar;26(3):313-21.
  5. Galovic M, van Dooren VQH, Postma TS et al. Progressive Cortical Thinning in Patients With Focal Epilepsy. JAMA Neurol. 2019 Oct 1;76(10):1230-1239.
  6. Kerr MP. The impact of epilepsy on patients’ lives. Acta Neurol Scand Suppl. 2012;(194):1-9.
  7. Willems LM, Hochbaum M, Frey K et al. Multicenter, cross-sectional study of the costs of illness and cost-driving factors in adult patients with epilepsy. Epilepsia. 2022 Apr;63(4):904-918.
  8. Gilliam FG, Santos J, Vahle V et al. Depression in Epilepsy: Ignoring Clinical Expression of Neuronal Network Dysfunction? Epilepsia. 2004;45 (Suppl 2):28-33.

SW26301P Dec 2024

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