Letter to the Editor
Reduction of photoparoxysmal response from patients with drug-resistant photosensitive epilepsy by using Z1 filters
Reducción de la respuesta fotoparoxística en pacientes con epilepsia fotosensible farmacorresistente mediante el uso de filtros Z1
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"apellidos" => "Rocamora" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821001929?idApp=UINPBA00004N" "url" => "/21735808/0000003700000001/v1_202201220534/S2173580821001929/v1_202201220534/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173580822000037" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2021.02.007" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "1568" "copyright" => "Sociedad Española de Neurología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Neurologia. 2022;37:77-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Recurrent intracranial hemorrhage in a patient with relapsing multiple sclerosis under interferon-β therapy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "77" "paginaFinal" => "79" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemorragia intracraneal recurrente en una paciente con Esclerosis Múltiple y tratamiento con Interferon-β" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 419 "Ancho" => 1405 "Tamanyo" => 100768 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) CT brain (2014) showing right frontal hemorrhage and subarachnoid hemorrhage around temporal lobe. (b) Gradient Echo T2 sequence one month later showing hypointense signal around temporal lobe due to subarachnoid hemorrhage and around right frontal hemorrhage. No hypointense signals suggestive of microbleeds are showed. (c) High signal lesions on axial FLAIR-T2 sequence one month later showing juxtacortical and periventricular lesions suggestive of MS diagnosis. (d) CT brain (2019) showing left frontal hemorrhage, subarachnoid hemorrhage around frontal and temporal lobe, and mass effect.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Sánchez-Soblechero, J.P. Cuello, M.L. Martínez Ginés, A. Lozano Ros, F. Romero Delgado, C. De Andrés, H. Goicochea Briceño, J.M. García Domínguez" "autores" => array:8 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Sánchez-Soblechero" ] 1 => array:2 [ "nombre" => "J.P." "apellidos" => "Cuello" ] 2 => array:2 [ "nombre" => "M.L." "apellidos" => "Martínez Ginés" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Lozano Ros" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Romero Delgado" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "De Andrés" ] 6 => array:2 [ "nombre" => "H." "apellidos" => "Goicochea Briceño" ] 7 => array:2 [ "nombre" => "J.M." "apellidos" => "García Domínguez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580822000037?idApp=UINPBA00004N" "url" => "/21735808/0000003700000001/v1_202201220534/S2173580822000037/v1_202201220534/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Reduction of photoparoxysmal response from patients with drug-resistant photosensitive epilepsy by using Z1 filters" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "79" "paginaFinal" => "81" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "O.A. Martinez, L. Lagos, G. Ernst, R. Ebner" "autores" => array:4 [ 0 => array:4 [ "nombre" => "O.A." "apellidos" => "Martinez" "email" => array:1 [ 0 => "omartinez@hbritanico.com.ar" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Lagos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Ernst" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Ebner" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Neurology Department. Hospital Británico de Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Ophthalmology Department, Hospital Británico de Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Scientific Advisory Committee, Hospital Británico de Buenos Aires, Argentina" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reducción de la respuesta fotoparoxística en pacientes con epilepsia fotosensible farmacorresistente mediante el uso de filtros Z1" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2843 "Ancho" => 1579 "Tamanyo" => 272511 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) PPR response using Waltz types grouped by filter use (percentage of patients), PPR distribution: (B) Mean and SD, (C) change of the PPR response before and after filter use.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Reflex epilepsy is characterized by seizures triggered by a specific stimulus. Photosensitive epilepsy (PSE) has seizures provoked by photic stimuli. PSE is the most common form of reflex epilepsy and affects 2–5% of patients with epilepsy. The main feature is photosensitivity, which is an abnormal paroxysmal electrical reaction in the brain induced by strobe lights. The photoparoxysmal response (PPR) is the appearance of epileptiform activity induced by intermittent photic stimulation (IPS).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Capovilla G et al, have demonstrated that Z1-filter, was more effective than four other colored types of lenses in reducing the response to IPS in PSE patients.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> These results were confirmed in a multicenter study, the use of Z1 filters abolished PPR in 75.9% and a 17.9% of PPR attenuation, evaluated by increased latency between the stimulus and the appearance of PPR, reduced duration of PPR, disappearance of clinical manifestations, or change to a less severe type according to Waltz's classification in17.9% from patients.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It has been previously described that 30% of patients with epilepsy have no control of their seizures, despite the use of 2 or more correctly used AEDs, considering this condition as Drug Resistant Epilepsy (DRE). Valproic acid can control photosensitivity in about 40% of cases. There are no studies focusing on patients with PSE who are refractory to Valproic Acid. We selected from our database, those patients who had PSE, and continued with seizures despite the use of Valproic Acid in doses of at least 1500<span class="elsevierStyleHsp" style=""></span>mg/day or higher and a new AED.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">6–9</span></a> Most of patients (<span class="elsevierStyleItalic">n</span>:9), have shown plasma levels of Valproic Acid were within the therapeutic range. Nevertheless, in the rest of patients (<span class="elsevierStyleItalic">n</span>:6) these levels could not be obtained. In all of studied population, Valproic Acid dosis was tolerated without toxic effects. The correlation between plasma levels of Valproic Acid and PPR wasn’t studied. None of the patients received AEDs or other drugs that were hepatic inducers.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to assess whether the use of Z1 filters can reduce PPR in patients with drug-resistant PSE.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Prospective study to analyze the role of Z1 filters in the PPR from patients with drug-resistant PSE was performed. It was approved by the Ethics Committee of the Hospital Britanico. All patients signed an informed consent form. Patients with PSE, who had seizures despite being medicated with valproic acid at a minimum dose of 1500<span class="elsevierStyleHsp" style=""></span>mg and at least one of the following AEDs (levetiracetam: 1000–3000<span class="elsevierStyleHsp" style=""></span>mg/day, lacosamide 200–400<span class="elsevierStyleHsp" style=""></span>mg/day and topiramate 200–400<span class="elsevierStyleHsp" style=""></span>mg/day). For each patient, the maximum tolerated dose without adverse effects was used.were included.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Before performing the EEG, a complete ophthalmological examination was performed on all patients. An EEG was performed in a twilight room with 32-channel equipment (Neurovirtual®). Longitudinal, transversal and reference assemblies were used, according to the International 10/20 System. After 20<span class="elsevierStyleHsp" style=""></span>min of recording, the IPS was performed with a photo-stimulator placed 30<span class="elsevierStyleHsp" style=""></span>cm from the patient's face. Each stimulation lasted 1<span class="elsevierStyleHsp" style=""></span>ms for 5<span class="elsevierStyleHsp" style=""></span>s at 30-s intervals. Frequencies between 3 and 50<span class="elsevierStyleHsp" style=""></span>Hz were used.3 EEG recording with Intermittent Photic Stimulation.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Identical IPS protocol was implemented after the application of the Z.1 filter (Zeiss™) in front of the patient's eyes. PPR was evaluated using the Scale described by Waltz patients,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> which gives a score from 1 to 4 according to the severity of the response to IPS.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We included 15 patients with PSE. Mean age was 30.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.8 years. 53.4% were female. PPR without the use of Z.1 filter showed that the population in this study presented PPR in the following distribution: Type 4: 20% (<span class="elsevierStyleItalic">n</span>: 3); Type 3: 46.6% (<span class="elsevierStyleItalic">n</span>: 7); Type 2: 20% (<span class="elsevierStyleItalic">n</span>: 3); Type 1: 13.4% (<span class="elsevierStyleItalic">n</span>: 2); Type 1 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Our findings showed a significant decrease in PPR severity after the use of Filters Zeiss F.1 filters (0.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2 vs. 2.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). With the use of Zeiss F.1 filters, in more than half of the patients (60%) PPR was abolished (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Type 1 were 6 patients and with PPR Abolition, 9 patients.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In our study the Z1 Filters were effective in reducing photosensitivity in PSE patients treated with valproic acid and second or third generation AED.</p><p id="par0050" class="elsevierStylePara elsevierViewall">To our knowledge, there are no studies on the reduction of PPR with the use of Z1 filters only in patients with valproic acid associated with a third generation AED.</p><p id="par0055" class="elsevierStylePara elsevierViewall">To avoid photosensitivity, different strategies can be adopted.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> For example, avoiding places where this type of light stimuli are more frequent, treatment with AEDs or the use of special filters.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> We agree that the Z1 filters are effective, even in patients receiving pharmacological treatment with 2 AEDs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2843 "Ancho" => 1579 "Tamanyo" => 272511 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) PPR response using Waltz types grouped by filter use (percentage of patients), PPR distribution: (B) Mean and SD, (C) change of the PPR response before and after filter use.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reflex seizures, traits, and epilepsies: from physiology to pathology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 0 | 3 |
| 2024 October | 16 | 4 | 20 |
| 2024 September | 37 | 5 | 42 |
| 2024 August | 29 | 7 | 36 |
| 2024 July | 19 | 4 | 23 |
| 2024 June | 21 | 7 | 28 |
| 2024 May | 19 | 4 | 23 |
| 2024 April | 23 | 2 | 25 |
| 2024 March | 27 | 3 | 30 |
| 2024 February | 32 | 2 | 34 |
| 2024 January | 29 | 4 | 33 |
| 2023 December | 33 | 8 | 41 |
| 2023 November | 37 | 16 | 53 |
| 2023 October | 48 | 9 | 57 |
| 2023 September | 25 | 2 | 27 |
| 2023 August | 23 | 4 | 27 |
| 2023 July | 147 | 10 | 157 |
| 2023 June | 51 | 2 | 53 |
| 2023 May | 89 | 13 | 102 |
| 2023 April | 59 | 3 | 62 |
| 2023 March | 44 | 11 | 55 |
| 2023 February | 53 | 12 | 65 |
| 2023 January | 34 | 13 | 47 |
| 2022 December | 42 | 4 | 46 |
| 2022 November | 54 | 6 | 60 |
| 2022 October | 19 | 7 | 26 |
| 2022 September | 17 | 6 | 23 |
| 2022 August | 13 | 5 | 18 |
| 2022 July | 7 | 10 | 17 |
| 2022 June | 10 | 5 | 15 |
| 2022 May | 6 | 5 | 11 |
| 2022 April | 11 | 11 | 22 |
| 2022 March | 17 | 15 | 32 |
| 2022 February | 15 | 11 | 26 |
| 2022 January | 13 | 6 | 19 |
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