Retrospective evaluation of low long-term efficacy of antiepileptic drugs and ketogenic diet in 39 patients with CDKL5-related epilepsy

A. Müller, I. Helbig, C. Jansen, T. Bast, R. Guerrini, J. Jähn, H. Muhle, S. Auvin, G. C. Korenke, S. Philip, R. Keimer, P. Striano, N. I. Wolf, B. Püst, Ch Thiels, A. Fogarasi, S. Waltz, G. Kurlemann, T. Kovacevic-Preradovic, B. CeulemansB. Schmitt, H. Philippi, D. Tarquinio, S. Buerki, C. Von Stülpnagel, G. Kluger

Research output: Article

13 Citations (Scopus)

Abstract

Objective Mutations in the CDKL5 gene cause an early-onset epileptic encephalopathy. To date, little is known about effective antiepileptic treatment in this disorder. Method Accordingly, the aim of this retrospective study was to explore the role of different antiepileptic drugs (AEDs) and the ketogenic diet (KD) in the treatment of this rare genetic disorder. We evaluated the efficacy in 39 patients with CDKL5 mutations at 3, 6 and 12 months after the introduction of each treatment. One patient was lost to follow-up after 6 and 12 months. Results The responder rate (>50% reduction in seizure frequency) to at least one AED or KD was 69% (27/39) after 3 months, 45% (17/38) after 6 months and 24% (9/38) after 12 months. The highest rate of seizure reduction after 3 months was reported for FBM (3/3), VGB (8/25), CLB (4/17), VPA (7/34), steroids (5/26), LTG (5/23) and ZNS (2/11). Twelve patients (31%) experienced a seizure aggravation to at least one AED. Most patients showed some but only initial response to various AEDs with different modes of actions. Significance Considering both age-related and spontaneous fluctuation in seizure frequency and the unknown impact of many AEDs or KD on cognition, our data may help defining realistic treatment goals and avoiding overtreatment in patients with CDKL5 mutations. There is a strong need to develop new treatment strategies for patients with this rare mutation.

Original languageEnglish
Pages (from-to)147-151
Number of pages5
JournalEuropean Journal of Paediatric Neurology
Volume20
Issue number1
DOIs
Publication statusPublished - jan. 1 2016

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Ketogenic Diet
Anticonvulsants
Epilepsy
Seizures
Mutation
Therapeutics
Inborn Genetic Diseases
Lost to Follow-Up
Brain Diseases
Cognition
Retrospective Studies
Steroids
Genes

ASJC Scopus subject areas

  • Clinical Neurology
  • Pediatrics, Perinatology, and Child Health

Cite this

Retrospective evaluation of low long-term efficacy of antiepileptic drugs and ketogenic diet in 39 patients with CDKL5-related epilepsy. / Müller, A.; Helbig, I.; Jansen, C.; Bast, T.; Guerrini, R.; Jähn, J.; Muhle, H.; Auvin, S.; Korenke, G. C.; Philip, S.; Keimer, R.; Striano, P.; Wolf, N. I.; Püst, B.; Thiels, Ch; Fogarasi, A.; Waltz, S.; Kurlemann, G.; Kovacevic-Preradovic, T.; Ceulemans, B.; Schmitt, B.; Philippi, H.; Tarquinio, D.; Buerki, S.; Von Stülpnagel, C.; Kluger, G.

In: European Journal of Paediatric Neurology, Vol. 20, No. 1, 01.01.2016, p. 147-151.

Research output: Article

Müller, A, Helbig, I, Jansen, C, Bast, T, Guerrini, R, Jähn, J, Muhle, H, Auvin, S, Korenke, GC, Philip, S, Keimer, R, Striano, P, Wolf, NI, Püst, B, Thiels, C, Fogarasi, A, Waltz, S, Kurlemann, G, Kovacevic-Preradovic, T, Ceulemans, B, Schmitt, B, Philippi, H, Tarquinio, D, Buerki, S, Von Stülpnagel, C & Kluger, G 2016, 'Retrospective evaluation of low long-term efficacy of antiepileptic drugs and ketogenic diet in 39 patients with CDKL5-related epilepsy', European Journal of Paediatric Neurology, vol. 20, no. 1, pp. 147-151. https://doi.org/10.1016/j.ejpn.2015.09.001
Müller, A. ; Helbig, I. ; Jansen, C. ; Bast, T. ; Guerrini, R. ; Jähn, J. ; Muhle, H. ; Auvin, S. ; Korenke, G. C. ; Philip, S. ; Keimer, R. ; Striano, P. ; Wolf, N. I. ; Püst, B. ; Thiels, Ch ; Fogarasi, A. ; Waltz, S. ; Kurlemann, G. ; Kovacevic-Preradovic, T. ; Ceulemans, B. ; Schmitt, B. ; Philippi, H. ; Tarquinio, D. ; Buerki, S. ; Von Stülpnagel, C. ; Kluger, G. / Retrospective evaluation of low long-term efficacy of antiepileptic drugs and ketogenic diet in 39 patients with CDKL5-related epilepsy. In: European Journal of Paediatric Neurology. 2016 ; Vol. 20, No. 1. pp. 147-151.
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T1 - Retrospective evaluation of low long-term efficacy of antiepileptic drugs and ketogenic diet in 39 patients with CDKL5-related epilepsy

AU - Müller, A.

AU - Helbig, I.

AU - Jansen, C.

AU - Bast, T.

AU - Guerrini, R.

AU - Jähn, J.

AU - Muhle, H.

AU - Auvin, S.

AU - Korenke, G. C.

AU - Philip, S.

AU - Keimer, R.

AU - Striano, P.

AU - Wolf, N. I.

AU - Püst, B.

AU - Thiels, Ch

AU - Fogarasi, A.

AU - Waltz, S.

AU - Kurlemann, G.

AU - Kovacevic-Preradovic, T.

AU - Ceulemans, B.

AU - Schmitt, B.

AU - Philippi, H.

AU - Tarquinio, D.

AU - Buerki, S.

AU - Von Stülpnagel, C.

AU - Kluger, G.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Objective Mutations in the CDKL5 gene cause an early-onset epileptic encephalopathy. To date, little is known about effective antiepileptic treatment in this disorder. Method Accordingly, the aim of this retrospective study was to explore the role of different antiepileptic drugs (AEDs) and the ketogenic diet (KD) in the treatment of this rare genetic disorder. We evaluated the efficacy in 39 patients with CDKL5 mutations at 3, 6 and 12 months after the introduction of each treatment. One patient was lost to follow-up after 6 and 12 months. Results The responder rate (>50% reduction in seizure frequency) to at least one AED or KD was 69% (27/39) after 3 months, 45% (17/38) after 6 months and 24% (9/38) after 12 months. The highest rate of seizure reduction after 3 months was reported for FBM (3/3), VGB (8/25), CLB (4/17), VPA (7/34), steroids (5/26), LTG (5/23) and ZNS (2/11). Twelve patients (31%) experienced a seizure aggravation to at least one AED. Most patients showed some but only initial response to various AEDs with different modes of actions. Significance Considering both age-related and spontaneous fluctuation in seizure frequency and the unknown impact of many AEDs or KD on cognition, our data may help defining realistic treatment goals and avoiding overtreatment in patients with CDKL5 mutations. There is a strong need to develop new treatment strategies for patients with this rare mutation.

AB - Objective Mutations in the CDKL5 gene cause an early-onset epileptic encephalopathy. To date, little is known about effective antiepileptic treatment in this disorder. Method Accordingly, the aim of this retrospective study was to explore the role of different antiepileptic drugs (AEDs) and the ketogenic diet (KD) in the treatment of this rare genetic disorder. We evaluated the efficacy in 39 patients with CDKL5 mutations at 3, 6 and 12 months after the introduction of each treatment. One patient was lost to follow-up after 6 and 12 months. Results The responder rate (>50% reduction in seizure frequency) to at least one AED or KD was 69% (27/39) after 3 months, 45% (17/38) after 6 months and 24% (9/38) after 12 months. The highest rate of seizure reduction after 3 months was reported for FBM (3/3), VGB (8/25), CLB (4/17), VPA (7/34), steroids (5/26), LTG (5/23) and ZNS (2/11). Twelve patients (31%) experienced a seizure aggravation to at least one AED. Most patients showed some but only initial response to various AEDs with different modes of actions. Significance Considering both age-related and spontaneous fluctuation in seizure frequency and the unknown impact of many AEDs or KD on cognition, our data may help defining realistic treatment goals and avoiding overtreatment in patients with CDKL5 mutations. There is a strong need to develop new treatment strategies for patients with this rare mutation.

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