Exploring postictal recovery with acetaminophen or nimodipine: A randomized-controlled crossover trial.

Autor: Pottkämper JCM; Clinical Neurophysiology group, University of Twente, Enschede, The Netherlands.; Department of Psychiatry, Rijnstate Hospital, P.O. Box 9555, Arnhem, 6800 TA, The Netherlands.; Department of Neurology, Rijnstate Hospital, P.O. Box 9555, Arnhem, 6800 TA, The Netherlands.; Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands., Verdijk JPAJ; Clinical Neurophysiology group, University of Twente, Enschede, The Netherlands.; Department of Psychiatry, Rijnstate Hospital, P.O. Box 9555, Arnhem, 6800 TA, The Netherlands., Stuiver S; Clinical Neurophysiology group, University of Twente, Enschede, The Netherlands.; Department of Psychiatry, Rijnstate Hospital, P.O. Box 9555, Arnhem, 6800 TA, The Netherlands., Aalbregt E; Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands., Ten Doesschate F; Department of Psychiatry, Rijnstate Hospital, P.O. Box 9555, Arnhem, 6800 TA, The Netherlands.; Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands., Verwijk E; Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands.; Department of Psychology, Amsterdam University, P.O. Box 19268, Amsterdam, 1000 GG, The Netherlands., Schmettow M; Department of Cognitive Psychology and Ergonomics, Faculty of Behavioural, Management and Social Sciences, University of Twente, P.O. Box 217, Enschede, 7500 AE, the Netherlands., van Wingen GA; Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands., van Putten MJAM; Clinical Neurophysiology group, University of Twente, Enschede, The Netherlands.; Department of Neurology and Clinical Neurophysiology, Medisch spectrum Twente, P.O. Box 50000, Enschede, 7500 KA, The Netherlands., Hofmeijer J; Clinical Neurophysiology group, University of Twente, Enschede, The Netherlands.; Department of Neurology, Rijnstate Hospital, P.O. Box 9555, Arnhem, 6800 TA, The Netherlands., van Waarde JA; Department of Psychiatry, Rijnstate Hospital, P.O. Box 9555, Arnhem, 6800 TA, The Netherlands.
Jazyk: angličtina
Zdroj: Annals of clinical and translational neurology [Ann Clin Transl Neurol] 2024 Aug 19. Date of Electronic Publication: 2024 Aug 19.
DOI: 10.1002/acn3.52143
Abstrakt: Objective: The postictal state is underrecognized in epilepsy. Animal models show improvement of postictal symptoms and cerebral perfusion with acetaminophen or nimodipine. We studied the effects of acetaminophen or nimodipine on postictal electroencephalographic (EEG) recovery, clinical reorientation, and hypoperfusion in patients with ECT-induced seizures.
Methods: In this prospective clinical trial with three-condition randomized crossover design, study interventions were administered orally 2 h before ECT sessions (1000 mg acetaminophen, 60 mg nimodipine, or a placebo condition). Primary outcome measure was the speed of postictal EEG recovery. Secondary outcomes were the extent of postictal EEG recovery, clinical reorientation time, and postictal cerebral blood flow as assessed by perfusion-weighted MRI. Bayesian generalized mixed-effects models were applied for analyses.
Results: We included 300 seizures, postictal EEGs, and reorientation time values, and 76 MRI perfusion measures from 33 patients (median age 53 years, 19 female). Pretreatment with acetaminophen or nimodipine was not associated with change in speed of EEG recovery compared to placebo (1.13 [95%CI 0.92, 1.40] and 1.07 [95%CI 0.87, 1.31], respectively), nor with the secondary outcomes. No patient reached full EEG recovery at 1 h post-seizure, despite clinical recovery in 89%. Longer seizures were associated with slower EEG recovery and lower postictal perfusion. Nimodipine altered regional perfusion in the posterior cortex.
Interpretation: Pretreatment with acetaminophen or nimodipine did not alleviate symptoms and signs of the postictal state. Systematic study of the postictal state after ECT-induced seizures is feasible.
(© 2024 The Author(s). Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)
Databáze: MEDLINE
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