Caregiver Perspective of Benefits and Side Effects of Anti-Seizure Medications in CDKL5 Deficiency Disorder from an International Database.

Journal

CNS drugs
ISSN: 1179-1934
Titre abrégé: CNS Drugs
Pays: New Zealand
ID NLM: 9431220

Informations de publication

Date de publication:
26 Jul 2024
Historique:
accepted: 19 06 2024
medline: 27 7 2024
pubmed: 27 7 2024
entrez: 26 7 2024
Statut: aheadofprint

Résumé

CDKL5 deficiency disorder presents as a challenging condition with early-onset refractory seizures, severe developmental delays, and a range of other neurological symptoms. Our study aimed to explore the benefits and side effects of anti-seizure medications (ASMs) in managing seizures among individuals with CDKL5 deficiency disorder, drawing on data from the International CDKL5 Disorder Database. Data for this retrospective cohort study were obtained from the International CDKL5 Disorder Database, which contains responses from a baseline questionnaire administered between 2012 and 2022 and a follow-up questionnaire administered between 2018 and 2019. Families of eligible individuals were asked to provide information on ASMs that were previously and currently taken, the dose prescribed, the age at starting the medications, and the age at discontinuation for past medications. The outcome variables of interest were perceived seizure-related benefits for the current and past use of ASMs and caregiver-reported side effects. Rescue medications and infrequently used ASMs were excluded from the analysis. Descriptive statistics were used to summarise the characteristics of the study population. The study included 399 children and adults with CDKL5 deficiency disorder, descriptively analysing the perceived benefits and side effects of 23 unique ASMs based on caregiver reports. The study identified levetiracetam, topiramate, sodium valproate, vigabatrin, phenobarbital and clobazam as the most used ASMs. Notably, cannabidiol showed highly beneficial outcomes with few side effects, whereas levetiracetam and phenobarbital exhibited less favourable benefit-to-side-effect ratios. Dual therapy involving sodium valproate and levetiracetam was only used a small number (n = 5) of times but appeared effective in reducing seizure activity with relatively few side effects. Compared with monotherapy, polytherapy had a relatively higher likelihood of reported side effects than benefits. The study, leveraging a large sample size that exceeds that of previous research, emphasises the complex nature of seizure management in CDKL5 deficiency disorder. Our findings underscore the necessity of ongoing research to optimise treatment strategies, considering both the efficacy of seizure control and the potential for adverse effects. The study also points to the need for future investigations into the therapeutic potential of emerging treatments such as ganaxolone and the unresolved efficacy of cannabis products in seizure management.

Sections du résumé

BACKGROUND AND OBJECTIVE OBJECTIVE
CDKL5 deficiency disorder presents as a challenging condition with early-onset refractory seizures, severe developmental delays, and a range of other neurological symptoms. Our study aimed to explore the benefits and side effects of anti-seizure medications (ASMs) in managing seizures among individuals with CDKL5 deficiency disorder, drawing on data from the International CDKL5 Disorder Database.
METHODS METHODS
Data for this retrospective cohort study were obtained from the International CDKL5 Disorder Database, which contains responses from a baseline questionnaire administered between 2012 and 2022 and a follow-up questionnaire administered between 2018 and 2019. Families of eligible individuals were asked to provide information on ASMs that were previously and currently taken, the dose prescribed, the age at starting the medications, and the age at discontinuation for past medications. The outcome variables of interest were perceived seizure-related benefits for the current and past use of ASMs and caregiver-reported side effects. Rescue medications and infrequently used ASMs were excluded from the analysis. Descriptive statistics were used to summarise the characteristics of the study population.
RESULTS RESULTS
The study included 399 children and adults with CDKL5 deficiency disorder, descriptively analysing the perceived benefits and side effects of 23 unique ASMs based on caregiver reports. The study identified levetiracetam, topiramate, sodium valproate, vigabatrin, phenobarbital and clobazam as the most used ASMs. Notably, cannabidiol showed highly beneficial outcomes with few side effects, whereas levetiracetam and phenobarbital exhibited less favourable benefit-to-side-effect ratios. Dual therapy involving sodium valproate and levetiracetam was only used a small number (n = 5) of times but appeared effective in reducing seizure activity with relatively few side effects. Compared with monotherapy, polytherapy had a relatively higher likelihood of reported side effects than benefits.
CONCLUSIONS CONCLUSIONS
The study, leveraging a large sample size that exceeds that of previous research, emphasises the complex nature of seizure management in CDKL5 deficiency disorder. Our findings underscore the necessity of ongoing research to optimise treatment strategies, considering both the efficacy of seizure control and the potential for adverse effects. The study also points to the need for future investigations into the therapeutic potential of emerging treatments such as ganaxolone and the unresolved efficacy of cannabis products in seizure management.

Identifiants

DOI: 10.1007/s40263-024-01105-z PMID: 39060900
pubmed: 39060900
doi: 10.1007/s40263-024-01105-z
pii: 10.1007/s40263-024-01105-z
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Orphan Disease Center, Perelman School of Medicine, University of Pennsylvania
ID : CDKL5-19-D-101-3

Informations de copyright

© 2024. The Author(s).

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Auteurs

Kingsley Wong (K)

Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, 15 Hospital Avenue, Nedlands, Perth, WA, 6009, Australia.

Mohammed Junaid (M)

Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, 15 Hospital Avenue, Nedlands, Perth, WA, 6009, Australia.

Solomon Alexander (S)

Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, 15 Hospital Avenue, Nedlands, Perth, WA, 6009, Australia.

Heather E Olson (HE)

Division of Epilepsy and Clinical Neurophysiology and Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA.

Elia M Pestana-Knight (EM)

Cleveland Clinic, Neurological Institute, Cleveland, OH, USA.

Rajsekar R Rajaraman (RR)

UCLA Mattel Children's Hospital, Los Angeles, CA, USA.

Jenny Downs (J)

Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, 15 Hospital Avenue, Nedlands, Perth, WA, 6009, Australia.

Helen Leonard (H)

Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, 15 Hospital Avenue, Nedlands, Perth, WA, 6009, Australia. Helen.Leonard@telethonkids.org.au.
ORCID: 0000-0001-6405-5834

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