Objective To assess the effectiveness and safety of flunarizine for refractory epilepsy. Methods Relevant randomized controlled trials (RCTs) were searched from the database of PubMed, EMbase, Cochrane Library, CNKI, CBM, and VIP, and the related references were traced to obtain the information. The methodological quality of included RCTs was assessed using Jadad scale and meta-analysis was performed using RevMan 5.0 software. Results A total of eight studies involving 545 patients were included. The results of meta-analyses showed that: based on the conventional therapy, compared with placebo and none-treatment, flunarizine was more effective on adults and children with refractory epilepsy (OR=2.98, 95%CI 1.88 to -4.73; OR=33.75, 95%CI 4.13 to -276.00). Major adverse events of flunarizine were fatigue, dizziness, headache, and weight gain etc. All those symptoms except for the weight gain were observed in the early stage of medication, which might get self-cured or could disappear by constant medication or reducing the dose or symptomatic treatment. Conclusion The present study shows that based on the conventional therapy, flunarizine is effective and safe for refractory epilepsy.
ObjectiveTo evaluate the effectiveness of levetiracetam (LEV) added on to usual care, in treating children refractory partial seizure epilepsy.MethodsWe searched the Cochrane library, EMBASE and PubMed between January 1998-January 2017, We systematically searched CNKI database and Wanfang data, Chinese biology medline and the manual retrieval related magazines.RevMan 5.3 statistical software for Meta analysis.ResultsAccording to the enrollment criteria, fourtrials were included involving 498 participants according to the intent-to-treat, 268 for LEV, and 230 for placebo groups.We assessed the following outcomes: 50% or greater seizure reduction, seizure freedom, adverse effects, proportion of dropouts and quality of life. There was no evidence of statistical heterogeneity between trials.We assessed outcomes by using a meta-analysis to calculate odds ratio (OR) with 95% confidence intervals (95% CI). For the 50% or greater reduction in focal seizure frequency outcome, the OR was significantly in favour of LEV [OR=2.94, 95% CI(1.99, 4.34)].Participants were significantly more likely in LEV groups than placebo groups to get seizure free[OR=5.31, 95% CI(2.49, 11.32)]. There was no significance between LEV groups and placebo groupsin the rate of Treatment withdrawal[OR=0.76, 95% CI(1.32, 1.82)]. Somnolence[OR=2.57, 95% CI(1.36, 4.86)]and changes in behaviour [OR=2.54, 95% CI(1.56, 4.14)] were significantly associated with LEV. Other adverse effects were not significantly associated with LEV in children.ConclusionThe existing evidence suggests that LEV add in treatment of children refractory epilepsy have definite curative effect, LEV long-term treatment effect is stable, good security, retention rate is higher, can be used in clinical further promotion.
Febrile seizures (FS) are one of the most common neurological disorders in pediatrics, commonly seen in children from three months to five years of age. Most children with FS have a good prognosis, but some febrile convulsions progress to refractory epilepsy (RE). Epilepsy is a common chronic neurological disorder , and refractory epilepsy accounts for approximately one-third of epilepsies. The etiology of refractory epilepsy is currently complex and diverse, and its mechanisms are not fully understood. There are many pathophysiological changes that occur after febrile convulsions, such as inflammatory responses, changes in the blood-brain barrier, and oxidative stress, which can subsequently potentially lead to refractory epilepsy, and inflammation is always in tandem with all physiological changes as the main response. This article focuses on the pathogenesis of refractory epilepsy resulting from post-febrile convulsions.
Objective To observe the efficacy and safety of subretinal injection of Aflibercept for the treatment of refractory or recurrent polypoidal choroidal vasculopathy (PCV). MethodsA prospective clinical research. From January to June 2022, 18 patients of 18 eyes with PCV diagnosed in The Affiliated Eye Hospital of Nanchang University were included in the study. All patients underwent best corrected visual acuity (BCVA), indocyanine green angiography and optical coherence tomography (OCT). The BCVA examination was performed using the international standard visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. The large choroidal vessel thickness (LVCT), central retinal thickness (CRT), sub-foveal choroidal thickness (SFCT) and retinal pigment epithelium detachment (PED) height were measured by enhanced depth imaging technique of OCT. The choroidal vascular index (CVI) was calculated. There were 18 patients of 18 eyes, 11 males of 11 eyes and 7 females of 7 eyes. The age was (64.22±3.86) years old. The disease duration was (5.22±1.80) years. The patient had received intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs for (7.72±1.36) times. The logMAR BCVA of the affected eyes was 1.28±0.25. The SFCT, CRT, LVCT, PED height were (436.56±9.80), (432.44±44.29), (283.78±27.10), (342.44±50.18) μm, respectively, and CVI was 0.65±0.01. All eyes were treated with a single subretinal injection of 40 mg/ml Aflibercept 0.05 ml (including Aflibercept 2.0 mg). According to the results of OCT and BCVA after treatment, the lesions were divided into active type and static type. The active lesions were treated with intravitreal injection of Aflibercept at the same dose as before. Quiescent lesions were followed up. Examinations were performed 1-3, 6, 9 and 12 months after treatment using the same equipment and methods before treatment. The BCVA, LVCT, CRT, SFCT, PED height, CVI, interretinal or subretinal fluid, lesion regression rate, injection times, and complications during and after treatment were observed. The BCVA, SFCT, CRT, LVCT, PED height and CVI before and after treatment were compared by repeated measures analysis of variance. ResultsEighteen eyes received subretinal and/or intravitreal injection of Aflibercept (1.61±0.85) times (1-4 times). At the last follow-up, the polypoid lesions regressed in 4 eyes and PED disappeared in 1 eye. Compared with before treatment, BCVA (F=50.298) gradually increased, CRT (F=25.220), PED height (F=144.16), SFCT (F=69.77), LVCT (F=136.69), CVI (F=72.70) gradually decreased after treatment. The differences were statistically significant (P＜0.001). Macular hole occurred in 1 eye after treatment, and the hole closed spontaneously 3 months after treatment. No serious complications such as retinal tear, retinal detachment, endophthalmitis and vitreous hemorrhage occurred during and after treatment. ConclusionSubretinal injection of Aflibercept is safe and effective in the treatment of refractory PCV.