ObjectivesTo evaluate the efficacy and safety of newer-generation antidepressants for patients with myocardial infarction (MI) and depression.MethodsPubMed, The Cochrane Library, EMbase, Web of Science, CBM, CNKI, WanFang Data, and VIP databases were searched from inception to December 2017 to collect randomized controlled trials (RCT) on newer-generation antidepressants for patients with MI and depression. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsTen RCTs involving 552 participants were included. The results showed that the antidepressant group was superior to the placebo or treatment group in terms of the improvement of depressive symptoms (SMD=–1.38, 95%CI –1.93 to –0.82, P<0.000 01), and incidence of angina (RR=0.42, 95%CI 0.25 to 0.71,P=0.001), recurrent MI (RR=0.43, 95%CI 0.22 to 0.83, P=0.01), and re-hospitalization for cardiac reasons (RR=0.51, 95%CI 0.28 to 0.92, P=0.03). However, there were no significant differences between two groups on all-cause mortality (RR=0.45, 95%CI 0.18 to 1.11, P=0.08), cardiovascular mortality (RR=0.53, 95%CI 0.16 to 1.73, P=0.29) and incidence of heart failure (RR=0.75, 95%CI 0.39 to 1.43, P=0.38). Subgroup analysis revealed that the type of antidepressants could affect the improvement of depression outcome. Citalopram and fluoxetine might be the most effective drugs for patients with MI and depression.ConclusionsNewer-generation antidepressants are effective for treatment of depressive symptoms in patients with MI and depression, with no significant impact on all-cause mortality and cardiovascular mortality. Moreover, antidepressants can reduce the incidence of angina, recurrent MI, and re-hospitalization for cardiac reasons in patients suffering from MI and depression. Due to limited quantity and quality of included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo analyze and evaluate the clinical characteristics, efficacy, and tolerability of lacosamide monotherapy in the treatment of primary paroxysmal kinesigenic dyskinesia (PKD). Methods The Clinical data of children with primary PKD who received lacosamide monotherapy between July 2021 and June 2025 in the Children's Hospital of Soochow University were analyzed, and their efficacy and tolerability were followed up. Results During the study period, a total of 7 children with primary PKD received lacosamide monotherapy. Among them, 4 had simple-type PKD and 3 had complex-type PKD; 2 had familial PKD and 5 had sporadic PKD; 4 were male and 3 were female. The age of onset was 11.0 (0.5 ~ 12.0) years. All 7 cases presented with dystonia as the form of onset, with 1 case also exhibiting athetosis. The attack frequency ranged from once every few days or weeks to 20 times per day, with a duration of 3 ~ 60 seconds. Bilateral limb involvement was most common, and 2 cases also had facial involvement. In auxiliary examinations, 3 cases showed abnormal EEG results, and 4 cases had abnormal genetic test results. Among genetic test results, 2 cases had PRRT2 gene mutations, 1 had a TMEM151A gene mutation, and 1 had a CLCN1 gene mutation. During lacosamide treatment, the initial and long-term maintenance doses were similar, at 2.87 (0.50 ~ 4.44) mg/(kg·d) and 2.67 (0.50 ~ 4.00) mg/(kg·d), respectively. At both the 4-week and long-term follow-ups, all 7 children showed good efficacy and tolerability.ConclusionLacosamide is effective and well-tolerated in children with both familial and sporadic, simple-type and complex-type primary PKD. A low dose of 2.67 (0.50 ~ 4.00) mg/(kg·d) is sufficient to control attacks, which is lower than the minimum maintenance dose of 4 ~ 6 mg/(kg·d) used in the treatment of epilepsy with lacosamide.