The Effect of Antiepileptic Drug Therapy on Cognition in Drug-Responsive Mesial Temporal Lobe Epilepsy

Objectives:The aim of this study was to examine the effect of antiepileptic drugs on memory and executive functions in drug-responsive mesial temporal lobe epilepsy with unilateral hippocampal sclerosis (MTLE-HS).Methods:The patients were classified according to the 2017 International League Against Epilepsy classification of seizures. Thirty-four patients with the diagnosis of MTLE-HS and 30 matched controls were enrolled. Patients treated with a maximum 2 anti-epileptic drugs and experiencing no more than 2 instances of focal impaired awareness per month or 2 focal to bilateral tonic-clonic seizures in a year were accepted as drug-responsive. Patients receiving monotherapy (PRM) and polytherapy (PRP) were compared in terms of memory and executive functions.Results:There were 19 (55.8%) monotherapy patients in the group and 15 (44.2%) polytherapy patients. The maximum number of learned words recorded in a verbal memory test, the immediate and delayed recall score, and the logical memory score were all statistically significantly lower in the PRP group compared with the PRM group (p<0.05). The results of the verbal attention test and verbal fluency test were also significantly lower in the PRP group (p<0.01).Conclusion:Significantly greater impairment was observed in several aspects of cognitive function in the PRP group. These results indicate that antiepileptic drugs may have a negative impact on cognition

Retrospective analysis of effectiveness of fingolimod in real life setting in Turkey (REFINE)

Background/aim: During multiple sclerosis (MS) treatment different modes of action such as lateral (interferon beta to glatiramer acetate or glatiramer acetate to interferon beta) or vertical (interferon beta/glatiramer acetate to fingolimod) drug switch can be performed. This study aims to investigate the clinical effectiveness of switching from the first-line injectable disease modifying treatments (iDMTs) to fingolimod (FNG) compared to switching between first-line iDMTs. Materials and methods: This is a multicenter, observational and retrospective study of patients with relapsing-remitting MS who had lateral and vertical switch. The observation period included three key assessment time points (before the switch, at switch, and after the switch). Data were collected from the MS patients’ database by neurologists between January 2018 and June 2019. The longest follow-up period of the patients was determined as 24 months after the switch. Results: In 462 MS patients that were included in the study, both treatments significantly decreased the number of relapses during the postswitch 12 months versus preswitch one year while patients in the FNG group experienced significantly fewer relapses compared to iDMT cohort in the postswitch 12 months period. FNG cohort experienced fewer relapses than in the iDMT cohort within the postswitch 2 year. The mean time to first relapse after the switch was significantly longer in the FNG group. Conclusion: The present study revealed superior effectiveness of vertical switch over lateral switch regarding the improvement in relapse outcomes. Patients in the FNG cohort experienced sustainably fewer relapses during the follow-up period after the switch compared the iDMT cohort. Importantly, switching to FNG was more effective in delaying time to first relapse when compared with iDMTs