Publications by authors named "José Ángel Mauri-Llerda"

11 Publications

  • Page 1 of 1

Effectiveness and safety of perampanel monotherapy for focal and generalized tonic-clonic seizures: Experience from a national multicenter registry.

Epilepsia 2020 06 8;61(6):1109-1119. Epub 2020 Jun 8.

Epilepsy Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain.

Objective: To assess the effectiveness and tolerability of perampanel (PER) monotherapy in routine clinical practice for the treatment of focal onset and generalized tonic-clonic seizures (GTCS).

Methods: This multicenter, retrospective, observational study was conducted in patients aged ≥12 years treated with PER as primary monotherapy or converted to PER monotherapy by progressive reduction of background antiepileptic drugs. Outcomes included retention, responder, and seizure-free rate after 3, 6, and 12 months and tolerability throughout the follow-up.

Results: A total of 98 patients (mean age = 49.6 ± 21.7 years, 51% female) with focal seizures and/or GTCS were treated with PER monotherapy for a median exposure of 14 months (range = 1-57) with a median dose of 4 mg (range = 2-10). The retention rates at 3, 6, and 12 months and last follow-up were 93.8%, 89.3%, 80.9%, and 71.4%, respectively. The retention rates according to the type of monotherapy (primary vs conversion) did not differ (log-rank P value = .57). Among the 98 patients, 61.2% patients had seizures throughout the baseline period, with a median seizure frequency of 0.6 seizures per month (range = 0.3-26). Responder rates at 3, 6, and 12 months were 79.6%, 70.1%, and 52.8%, respectively, and seizure freedom rates at the same points were 62.7%, 56.1%, and 41.5%. Regarding the 33 patients who had GTCS in the baseline period, 87.8% were seizure-free at 3 months, 78.1% at 6 months, and 55.1% at 12 months. Over the entire follow-up, PER monotherapy was generally well tolerated, and only 16% of patients discontinued PER due to adverse events (AEs). Female patients were found to be at a higher risk of psychiatric AEs (female vs male odds ratio = 2.85, 95% confidence interval = 1-8.33, P = .046).

Significance: PER demonstrated good effectiveness and a good safety profile when used as primary therapy or conversion to monotherapy at relatively low doses, in a clinical setting with patients with focal seizures and GTCS.
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June 2020

Familial association of genetic generalised epilepsy with limb-girdle muscular dystrophy through a mutation in .

Epilepsy Behav Case Rep 2019 21;11:122-124. Epub 2019 Mar 21.

Hospital Clínico Universitario Lozano Blesa, Avda. San Juan Bosco 15, 50009 Zaragoza, Spain.

•We present a family that includes members with phenotypes of generalized epilepsy and limb-girdle muscular dystrophy.•Subjects with heterozygous mutation developed epilepsy; a subject with homozygous mutation developed limb-girdle dystrophy.•Mutations in CAPN3 may play a role in the complex genetics of genetic generalized epilepsies.
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March 2019

Eslicarbazepine acetate and carotid intima-media thickness in epileptic patients.

Epilepsy Res 2017 12 29;138:81-87. Epub 2017 Oct 29.

Complejo Hospitalario Torrecárdenas, Fundación Investigación Biosanitaria Andalucía Oriental (FIBAO), Almería, Spain.

Objective: Evaluate if eslicarbazepine acetate (ESL) in combination with other non-inducer antiepileptic drugs (AEDs) in the treatment of epilepsy may represent a positive impact in the cardiovascular risk profile.

Methods: multicentre, retrospective, observational, non-interventional, real-life study comparing patients treated with cytochrome P450 (CYP) inducer vs. ESL plus non-inducer AEDs. Primary endpoint: Carotid intima-media thickness (CIMT) measured following the Manheim Consensus criteria.

Results: Patients included: 163. The main demographic, clinical and vascular risk parameters were comparable between the two groups except for duration of the disease, prevalence of dyslipidemia and use of lipid-lowering drugs (significantly higher in the inducers group) and number of previous antiepileptic drugs (significantly higher in the non-inducers group). Bivariate analysis of the main endpoint showed almost significant differences (p=0.05) in CIMT measures favourable to non-inducers (average 0.617mm+SD=0.148) vs. inducers (average 0.663mm+SD=0.147). Other variables reaching statistical significance were: age >50 years (p<0.001), high blood pressure (p<0.01) and dyslipidemia (p<0.05). A multivariate analysis including these variables and biochemical vascular risk factors showed a predictor model including two variables: inducers group (p=0.031; Coefficient β=0.234) and age >50 years (p=0.001; Coefficient β=0.387). Regarding gender, the mean CIMT in males was significantly higher in the inducers (0.693mm; SD=0.139) than in the non- inducers groups (0.628mm; SD=0.151; p<0.05). In females the differences were not significant.

Significance: The use of CYP inducer AEDs is associated with a significant increase in CIMT as compared with ESL and other non-inducer AEDs. The study shows a decrease in the vascular risk measured by ultrasound criteria in male patients treated with ESL compared with patients treated with inducer AEDs.
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December 2017

[Propriospinal myoclonus causing severe insomnia].

Med Clin (Barc) 2016 09 23;147(6):e31-2. Epub 2016 Jun 23.

Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.

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September 2016

One-year clinical experience of perampanel in Spain: a multicentre study of efficacy and tolerability.

Epileptic Disord 2016 Jun;18(2):173-80

Hospital Universitario Cruces, Baracaldo.

Perampanel, a non-competitive antagonist of the α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptors, is the most recent antiepileptic drug available in Spain, marketed in January 2014. It was initially approved by the European Medicines Agency as adjunctive treatment for partial-onset seizures in patients 12 years and older, but recently also for primary generalized tonic-clonic seizures. Although clinical trials provide essential information about the drug, they do not reflect daily clinical practice. This retrospective study shows the initial experience with perampanel in 11 Spanish hospitals during its first year post-commercialisation. All patients who started perampanel treatment were included, but efficacy and tolerability were only assessed in those patients with a minimum follow-up period of six months. In total, 256 patients were treated with perampanel before September 2014, and 253 had an observational period of one year. After six months, 216/256 patients (84%) continued on perampanel and 180/253 (71.1%) completed one year of treatment. The mean number of previous antiepileptic drugs used was 6.83 and the median number of concomitant antiepileptic drugs was 2. The mean perampanel dose was 7.06 mg and 8.26 mg at six and 12 months, respectively. The responder rate was 39.5% and 35.9% at both follow-up points, respectively. Adverse events were experienced by 91/253 (35.5%) and resulted in withdrawal in 37 (14.6%). The most common adverse events were somnolence, dizziness, and irritability. We found no significant differences between concomitant use of enzyme-inducing and non-inducing antiepileptic drugs, regarding efficacy, adverse effects, or withdrawals. Irritability was not influenced by concomitant use of levetiracetam, relative to other drugs, but was more frequently observed in patients with a history of psychiatric problems or learning disabilities.
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June 2016

Adult Prevalence of Epilepsy in Spain: EPIBERIA, a Population-Based Study.

ScientificWorldJournal 2015 10;2015:602710. Epub 2015 Dec 10.

Servicio de Neurologia, Hospital Clínico San Carlos, Calle del Profesor Martín Lagos S/N, 28040 Madrid, Spain.

Background: This study assesses the lifetime and active prevalence of epilepsy in Spain in people older than 18 years.

Methods: EPIBERIA is a population-based epidemiological study of epilepsy prevalence using data from three representative Spanish regions (health districts in Zaragoza, Almería, and Seville) between 2012 and 2013. The study consisted of two phases: screening and confirmation. Participants completed a previously validated questionnaire (EPIBERIA questionnaire) over the telephone.

Results: A total of 1741 valid questionnaires were obtained, including 261 (14.99%) raising a suspicion of epilepsy. Of these suspected cases, 216 (82.75%) agreed to participate in phase 2. Of the phase 2 participants, 22 met the International League Against Epilepsy's diagnostic criteria for epilepsy. The estimated lifetime prevalence, adjusted by age and sex per 1,000 people, was 14.87 (95% CI: 9.8-21.9). Active prevalence was 5.79 (95% CI: 2.8-10.6). No significant age, sex, or regional differences in prevalence were detected.

Conclusions: EPIBERIA provides the most accurate estimate of epilepsy prevalence in the Mediterranean region based on its original methodology and its adherence to ILAE recommendations. We highlight that the lifetime prevalence and inactive epilepsy prevalence figures observed here were compared to other epidemiological studies.
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August 2016

Analysis of factors influencing telephone call response rate in an epidemiological study.

ScientificWorldJournal 2014 21;2014:179375. Epub 2014 Oct 21.

Research Operations Office, IT Department, Spanish Society of Neurology, San Sebastian de los Reyes, 28701 Madrid, Spain.

Descriptive epidemiology research involves collecting data from large numbers of subjects. Obtaining these data requires approaches designed to achieve maximum participation or response rates among respondents possessing the desired information. We analyze participation and response rates in a population-based epidemiological study though a telephone survey and identify factors implicated in consenting to participate. Rates found exceeded those reported in the literature and they were higher for afternoon calls than for morning calls. Women and subjects older than 40 years were the most likely to answer the telephone. The study identified geographical differences, with higher RRs in districts in southern Spain that are not considered urbanized. This information may be helpful for designing more efficient community epidemiology projects.
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November 2015

[A comparative study of the effectiveness of topiramate and flunarizine in independent series of chronic migraine patients without medication abuse].

Rev Neurol 2013 Oct;57(8):347-53

HUMS. Hospital Universitario Miguel Servet, 50009 Zaragoza, Espana.

Introduction: Topiramate and onabotulinumtoxin A have proven to be effective in chronic migraine with or without medication abuse according to recent criteria of the International Headache Society's Headache Classification.

Aims: To show that flunarizine is as effective as topiramate in cases of chronic migraine without medication abuse.

Patients And Methods: We conducted a prospective, non-randomised, comparative study of two groups of patients paired by age and sex, with chronic migraine without abuse, who had been treated preventively for the first time with topiramate or flunarizine.

Results: Forty patients treated with flunarizine were assigned a patient of their same sex and age who was being treated with topiramate. The mean rate of reduction in intense migraines in the topiramate group was 59% and in the flunarizine group, 58.5% (p = 0.9444); the responder rate at four months of treatment did not show any significant differences either, the figures being 75% for topiramate and 70% for flunarizine (p = 0.6236). The mean reduction of other headaches in the topiramate group was 57% and in the flunarizine group, 64% (p = 0.4261); the responder rate at four months of treatment was similar in the two groups: 76%. The percentage of dropouts from treatment was higher with topiramate (19.5%) than with flunarizine (10%) (p = 0.3493). No serious side effects occurred in either of the groups. In all, 78.9% of the patients who took topiramate said they were satisfied with the drug versus 75% of those in the flunarizine group (p = 0.7903).

Conclusions: Flunarizine proved to be as effective as topiramate in the treatment of chronic migraine without medication abuse.
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October 2013

Management of Patients With Unclassified Epileptic Seizures in Outpatient Clinics in Spain. Results of the RETO Study.

Int J Neurosci 2010 Nov;120(11):711-6

Neurology Service, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.

Purpose: The objective of this study was to determine the approach and management of specialists in patients with unclassified epileptic seizures in outpatient clinics in Spain.

Methods: Observational, multicenter, and cross-sectional study. Ninety-three neurologists or neuropediatricians documented consecutive patients with a history of at least two difficult to classify or unclassified epileptic seizures. Patient demographics, quality of life (QOLIE-10-P), disease characteristics, and anticonvulsant treatment were captured. Physicians were asked about their therapeutic approach for the selection of an antiepileptic drug and underlying reasons.

Results: A total of 725 patients were included. At the time of the survey, 81% were treated (69% with monotherapy). Most frequently given reasons for starting antiepileptic therapy were ([mean] on a scale of 1–5) efficacy, (3.9), safety (3.61), and broad-spectrum effectiveness (3.5). Reasons given for switching therapy (226/725) included need for broader spectrum of action: 70 (31.0%); simpler dosing regimen: 25 (11.1%); quality of life considerations: 24 (10.6%); lack of adherence to therapy: 24 (10.6%); comorbidities: 13 (5.8%); drug interactions: 12 (5.3%); and possibility of pregnancy 6 (2.7%).

Conclusions: When deciding on starting or switching therapy for patients with difficult to classify or unclassified epilepsy, the most important consideration for the specialists included efficacy, safety, and broad-spectrum efficacy.
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November 2010

[Comparative study of the effectiveness of topiramate and nadolol in the preventive treatment of episodic migraine in independent series of patients].

Rev Neurol 2010 May;50(9):513-9

Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España.

Introduction: Topiramate and nadolol with levels A and C of scientific evidence, respectively, would be indicated as preventive treatments of migraine. To date only one study of satisfaction has been carried out to compare the two pharmaceuticals.

Aim: To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study.

Patients And Methods: From a database of 700 patients with migraine, those with episodic migraine and who had followed a course of preventive treatment, for the first time, with topiramate or nadolol were selected for the study. The effectiveness variables (reduction in the number of crises at four months of preventive treatment and responder rates) were analysed.

Results: Altogether 208 patients with were included for treatment: 140 with topiramate (77.8% females; mean age, 37.9) and 68 with nadolol (69% females; mean age, 36.9). The mean number of crises in the month prior to treatment was: topiramate group, 6.3 +/- 2.6; nadolol group 5.3 +/- 2.0 (p = 0.0066). At four months after starting treatment: topiramate group, 2.69 +/- 2.6; nadolol group 2.6 +/- 2.2 (NS). The percentage of reduction in the number of migraines was 56.6% with topiramate and 51.6% with nadolol (NS). The responder rate (reduction in the frequency of crises by at least 50%) was 71.3% with topiramate versus 69% with nadolol (NS). The excellent response rate (reduction in crises by at least 75%) was 53.3% with topiramate versus 32.2% with nadolol (p = 0.0077). Adverse side effects were reported by 54% of patients treated with topiramate versus 30.8% of those treated with nadolol (p = 0.0015). The rate of satisfaction was 61% for the topiramate group and 71% for the group with nadolol (NS).

Conclusions: Both topiramate and nadolol proved to be effective in the preventive treatment of episodic migraine. Topiramate was found to be more effective than nadolol, although it was used in patients with a higher frequency of crises, and was not tolerated so well.
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May 2010