JZP-258 Effective to Treat Narcolepsy, Pavel Klein Discusses Telemedicine Limitations, Earlier Focal Epilepsy Diagnosis Shows Benefit

October 24, 2020
NeurologyLive Staff

Neurology News Network for the week ending October 24, 2020.

This week Neurology News Network covered the 12-week open-label trial of JZP-258 in patients with narcolepsy, a discussion with Pavel Klein on the limitations with telemedicine, and new study results on overcoming the challenges obstructing earlier diagnosis of focal epilepsy.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus.

Results from a 12-week, open-label trial confirmed the efficacy of calcium, magnesium, potassium, and sodium oxybates oral solution to treat cataplexy and excessive daytime sleepiness, while also showing a safety profile consistent to what has been observed. Otherwise known as JZP-258, the treatment showed no median change in weekly number of cataplexy attacks from the 2-week stable-dose period (SDP) to the double-blind, randomized withdrawal period (DBRWP). In comparison, those on placebo showed statistically significant worsening of symptoms, with a median of 2.35 change in weekly number of cataplexy attacks from SDP to DBRWP. Median change in Epworth Sleepiness Scale score, defined as a key secondary end point, was 2.0 in the placebo group, compared to 0.0 in the JZP-258 group. JZP-258 got its FDA approval in July 2020 for the treatment of cataplexy or EDS in patients 7 years of age or older with narcolepsy, making it the first treatment indicated for both cataplexy and EDS in 15 years.

Throughout the COVID-19 pandemic, clinicians have been forced to adapt to technological strategies of seeing and treating patients from their homes. This lack of in-person visits has its pros and cons. On one hand, it further accelerated the clinical care use of telemedicine for treating patients, something that has been continually building for years, while also appealing to those who may be a long distance from their clinician. On the other hand, there are limitations that come with it. Pavel Klein, MD, director, Mid-Atlantic Epilepsy and Sleep Center, in Bethesda, Maryland, feels that the in-person patient-clinician dynamic is not the same with these technology-based visits, and takes away from the personal relationship that comes with treating patients. He was quoted saying “You cannot compensate Zoom over that face-to-face interaction. You don’t get to know the person as well when you’re not in the room with them. This may not be such an issue for someone you’ve cared for over 20 years… But it certainly impacts getting to know someone for the first time.” Head over to NeurologyLive.com to watch Klein discuss the increased role of telemedicine since the beginning of the pandemic and how it has affected the patient-clinician relationship.

New study results suggest that overcoming the challenges obstructing earlier diagnosis of focal epilepsy can prevent the morbidity-related consequences of the delays in identifying new-onset disease, such as motor vehicle accidents. Ultimately, the findings of the prospective, observational, multicenter study, dubbed the Human Epilepsy Project, point to a gap in treatment, specifically for those individuals who experience nonmotor seizures at epilepsy onset. Between the 246 participants with nonmotor seizures and the 201 participants with motor seizures at onset, those with nonmotor seizures experienced a delay in median time to diagnosis from first seizure tenfold that of those with motor seizures. Notably, more patients with new-onset focal disease presented with initial nonmotor seizures than motor seizures. As well, the majority of injuries reported by patients prior to diagnosis for those who presented initially with nonmotor seizures occurred in those who ultimately developed motor seizures.

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