LETTER TO THE EDITOR
LETTER TO THE EDITOR
Why is mesial temporal lobe epilepsy with Ammon’s horn sclerosis becoming less common? T. A. Butler, P. Dugan and J. French NYU Comprehensive Epilepsy Center, New York, NY, USA
EUROPEAN JOURNAL OF NEUROLOGY
Correspondence: Tracy Butler, NYU Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, USA (tel.: +1-646-558-0800; fax: +1-646-3857164; e-mail: [email protected]).
Keywords: epileptogenesis, febrile seizures, ibuprofen, inflammation, mesial temporal sclerosis, NSAID, temporal lobe epilepsy doi:10.1111/ene.12570 Received: 14 July 2014 Accepted: 25 July 2014 We read the article ‘Temporal lobe surgery in Germany from 1988 to 2008: diverse trends in etiological subgroups’ [1] with great interest. The authors found that the age and duration of epilepsy of patients with mesial temporal lobe epilepsy with Ammon’s horn sclerosis (mTLE + AHS) undergoing epilepsy surgery increased over time, supporting a hypothesis of a decreasing incidence of mTLE + AHS. This confirms the impression of many epileptologists. To explain this apparent decrease in the ‘supply’ of patients with mTLE + AHS, the authors speculate that vaccinations, improved treatment of childhood infections and better seizure control with newer antiepileptic drugs may be modifying the epileptogenic disease process. We agree with this, and would like to suggest another potentially relevant factor: increased use
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of ibuprofen in children. Inflammation is now known to play a role in epilepsy and epileptogenesis [2,3] and ibuprofen is a potent non-steroidal anti-inflammatory agent (NSAID) that can reduce inflammation in the brain [4]. Ibuprofen became available in the UK in1969, and was made over-the-counter in the UK in 1983 and in the USA in 1984 [5]. Whilst ibuprofen and other NSAIDs have complex effects on epileptogenesis in animal models [6] and do not prevent febrile seizure recurrence in children in the short term [7], long-term studies have not to our knowledge been performed. Could increased use of ibuprofen to treat fever and febrile seizures in children starting in the 1980s account for the decreased incidence of current patients with pharmacoresistant mTLE + AHS? Testing this speculation epidemiologically and/or in animal models could have important public health implications since even a modest antiepileptogenic effect of ibuprofen could contribute significantly to decreasing the worldwide burden of epilepsy given the established safety and low cost of this widely available medication. Disclosure of conflicts of interest
Neither Dr Butler nor Dr Dugan have any conflicts of interest to disclose. Dr French has no conflict of interest related to this manuscript; however, she serves as the president of the Epilepsy Study Consortium, a non-profit organization dedicated to improving the lives of epilepsy patients. Dr Jacqueline French consults for a large number of pharmaceutical companies, in which all money is paid to the Epilepsy Study Consortium and not to Dr French personally. The money towards her salary is for work performed by Dr French on behalf of the
Epilepsy Study Consortium. Within the past year, the Epilepsy Study Consortium received payments from the 21 companies listed below. All payments are reported annually and reviewed by NYU’s Conflict of Interest Committee: Cyberonics; Cypress Bioscience Inc.; Eisai Medical Research; Entra Pharmaceuticals; GlaxoSmithKline; Icagen Inc.; Intranasal/Ikano; Johnson & Johnson; Marinus; Neurotherapeutics; NeuroVista Corporation; Ono Pharma USA Inc.; Ovation/Lundbeck; Pfizer; Sepracor; SK Life Science; Supernus Pharmaceuticals; Taro; UCB Inc./Schwarz Pharma; Upshire Smith; Valeant.
References 1. Helmstaedter C, May T, Lehe M, et al. Temporal lobe surgery in Germany from 1988 to 2008: diverse trends in etiological subgroups. Eur J Neurol 2014; 21: 827– 834. 2. Vezzani A, French J, Bartfai T, Baram TZ. The role of inflammation in epilepsy. Nat Rev Neurol 2011; 7: 31–40. 3. Butler T, Ichise M, Teich AF, et al. Imaging inflammation in a patient with epilepsy due to focal cortical dysplasia. J Neuroimaging 2013; 23: 129–131. 4. Lim G, Yang F, Chu T, et al. Ibuprofen suppresses plaque pathology and inflammation in a mouse model for Alzheimer’s disease. J Neurosci 2000; 20: 5709–5714. 5. Moore N. Ibuprofen: a journey from prescription to over-the-counter use. J R Soc Med (Supplement). 2007; 100: 2–6. 6. Wallenstein M. Attenuation of epileptogenesis by nonsteroidal anti-inflammatory drugs in the rat. Neuropharmacology 1991; 30: 657–663. 7. Strengell T, Uhari M, Tarkka R, et al. Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. Arch Pediatr Adolesc Med 2009; 163: 799–804.
© 2014 EAN
LETTER TO THE EDITOR
Why is mesial temporal lobe epilepsy with Ammon’s horn sclerosis becoming less common? T. A. Butler, P. Dugan and J. French NYU Comprehensive Epilepsy Center, New York, NY, USA
EUROPEAN JOURNAL OF NEUROLOGY
Correspondence: Tracy Butler, NYU Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, USA (tel.: +1-646-558-0800; fax: +1-646-3857164; e-mail: [email protected]).
Keywords: epileptogenesis, febrile seizures, ibuprofen, inflammation, mesial temporal sclerosis, NSAID, temporal lobe epilepsy doi:10.1111/ene.12570 Received: 14 July 2014 Accepted: 25 July 2014 We read the article ‘Temporal lobe surgery in Germany from 1988 to 2008: diverse trends in etiological subgroups’ [1] with great interest. The authors found that the age and duration of epilepsy of patients with mesial temporal lobe epilepsy with Ammon’s horn sclerosis (mTLE + AHS) undergoing epilepsy surgery increased over time, supporting a hypothesis of a decreasing incidence of mTLE + AHS. This confirms the impression of many epileptologists. To explain this apparent decrease in the ‘supply’ of patients with mTLE + AHS, the authors speculate that vaccinations, improved treatment of childhood infections and better seizure control with newer antiepileptic drugs may be modifying the epileptogenic disease process. We agree with this, and would like to suggest another potentially relevant factor: increased use
e12
of ibuprofen in children. Inflammation is now known to play a role in epilepsy and epileptogenesis [2,3] and ibuprofen is a potent non-steroidal anti-inflammatory agent (NSAID) that can reduce inflammation in the brain [4]. Ibuprofen became available in the UK in1969, and was made over-the-counter in the UK in 1983 and in the USA in 1984 [5]. Whilst ibuprofen and other NSAIDs have complex effects on epileptogenesis in animal models [6] and do not prevent febrile seizure recurrence in children in the short term [7], long-term studies have not to our knowledge been performed. Could increased use of ibuprofen to treat fever and febrile seizures in children starting in the 1980s account for the decreased incidence of current patients with pharmacoresistant mTLE + AHS? Testing this speculation epidemiologically and/or in animal models could have important public health implications since even a modest antiepileptogenic effect of ibuprofen could contribute significantly to decreasing the worldwide burden of epilepsy given the established safety and low cost of this widely available medication. Disclosure of conflicts of interest
Neither Dr Butler nor Dr Dugan have any conflicts of interest to disclose. Dr French has no conflict of interest related to this manuscript; however, she serves as the president of the Epilepsy Study Consortium, a non-profit organization dedicated to improving the lives of epilepsy patients. Dr Jacqueline French consults for a large number of pharmaceutical companies, in which all money is paid to the Epilepsy Study Consortium and not to Dr French personally. The money towards her salary is for work performed by Dr French on behalf of the
Epilepsy Study Consortium. Within the past year, the Epilepsy Study Consortium received payments from the 21 companies listed below. All payments are reported annually and reviewed by NYU’s Conflict of Interest Committee: Cyberonics; Cypress Bioscience Inc.; Eisai Medical Research; Entra Pharmaceuticals; GlaxoSmithKline; Icagen Inc.; Intranasal/Ikano; Johnson & Johnson; Marinus; Neurotherapeutics; NeuroVista Corporation; Ono Pharma USA Inc.; Ovation/Lundbeck; Pfizer; Sepracor; SK Life Science; Supernus Pharmaceuticals; Taro; UCB Inc./Schwarz Pharma; Upshire Smith; Valeant.
References 1. Helmstaedter C, May T, Lehe M, et al. Temporal lobe surgery in Germany from 1988 to 2008: diverse trends in etiological subgroups. Eur J Neurol 2014; 21: 827– 834. 2. Vezzani A, French J, Bartfai T, Baram TZ. The role of inflammation in epilepsy. Nat Rev Neurol 2011; 7: 31–40. 3. Butler T, Ichise M, Teich AF, et al. Imaging inflammation in a patient with epilepsy due to focal cortical dysplasia. J Neuroimaging 2013; 23: 129–131. 4. Lim G, Yang F, Chu T, et al. Ibuprofen suppresses plaque pathology and inflammation in a mouse model for Alzheimer’s disease. J Neurosci 2000; 20: 5709–5714. 5. Moore N. Ibuprofen: a journey from prescription to over-the-counter use. J R Soc Med (Supplement). 2007; 100: 2–6. 6. Wallenstein M. Attenuation of epileptogenesis by nonsteroidal anti-inflammatory drugs in the rat. Neuropharmacology 1991; 30: 657–663. 7. Strengell T, Uhari M, Tarkka R, et al. Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. Arch Pediatr Adolesc Med 2009; 163: 799–804.
© 2014 EAN
