Frequency of drug combinations between enzyme-inducing first-generation antiepileptic drugs and inducible drugs in patients with epilepsy

AbstractWe conducted this meta-analysis to evaluate effects of second-generation anti-epileptic drugs (AEDs; levetiracetam, lamotrigine) compared to first-generation AEDs (valproic acid, carbamazepine) on bone metabolism in epilepsy patients. PubMed, Web of Science, Clinical trials.gov, Wanfang, and China national knowledge infrastructure databases were searched. Ten trials were included. Results showed: (1) The overall SMD for changes of serum calcium, phosphorus, ALP, and PTH levels from baseline of LEV versus first-generation AEDs were 1.00 (95% CI=0.23–1.77, Z=2.56, p=0.01), 0.98 (95% CI=− 0.05 to 2.01, Z=1.86, p=0.06), − 1.17 (95% CI=− 2.08 to − 0.25, Z=2.50, p=0.01), 0.07 (95% CI=− 0.14 to 0.27, Z=0.63, p=0.53), respectively. (2) The overall SMD for changes of serum calcium, phosphorus, ALP, and PTH levels from baseline of LTG versus first-generation AEDs were −0.16 (95% CI=− 0.47 to 0.16, Z=0.99, p=0.32), −0.05 (95% CI=− 0.55 to 0.44, Z=0.22, p=0.83), 0.10 (95% CI=− 0.53 to 0.73, Z=0.31, p=0.75), −0.05 (95% CI=− 0.52 to 0.42, Z=0.22, p=0.83), respectively. Overall, our results indicate that compared to first-generation AEDs, LEV has less adverse effects on blood bone metabolism markers in epilepsy patients, while LTG does not. However, due to small number of included studies, our results warrant additional research.

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Phenobarbital and primidone

10.1093/med/9780198791577.003.0009 ◽

2018 ◽

Author(s):

Andrea E. Cavanna

Keyword(s):

Twentieth Century ◽

Antiepileptic Drug ◽

Psychiatric Disorders ◽

Antiepileptic Drugs ◽

First Generation ◽

Developing World ◽

Tolerability Profile ◽

Behavioural Symptoms ◽

Safety Issues ◽

Patients With Epilepsy

Phenobarbital and primidone are first-generation antiepileptic drugs currently associated with restricted ranges of antiepileptic indications, despite their acceptable interaction profiles in polytherapy. Although phenobarbital is still widely prescribed as antiepileptic drug in the developing world, safety issues (including risks of dependence and overdose), together with the development of other antiepileptic drugs throughout the second half of the twentieth century, left little room for the use of barbiturates in patients with epilepsy. Both phenobarbital and primidone are barbiturates with an acceptable behavioural tolerability profile, but there are no approved indications or clinical uses for the treatment of behavioural symptoms in patients with psychiatric disorders.

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Models for predicting treatment efficacy of antiepileptic drugs and prognosis of treatment withdrawal in epilepsy patients

Acta Epileptologica ◽

10.1186/s42494-020-00035-9 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Shijun Yang ◽

Bin Wang ◽

Xiong Han

Keyword(s):

Antiepileptic Drugs ◽

Statistical Models ◽

Prediction Models ◽

External Validation ◽

Machine Learning Algorithms ◽

Treatment Withdrawal ◽

Patient Treatment ◽

Recent Developments ◽

Progression Of Disease ◽

Patients With Epilepsy

AbstractAlthough antiepileptic drugs (AEDs) are the most effective treatment for epilepsy, 30–40% of patients with epilepsy would develop drug-refractory epilepsy. An accurate, preliminary prediction of the efficacy of AEDs has great clinical significance for patient treatment and prognosis. Some studies have developed statistical models and machine-learning algorithms (MLAs) to predict the efficacy of AEDs treatment and the progression of disease after treatment withdrawal, in order to provide assistance for making clinical decisions in the aim of precise, personalized treatment. The field of prediction models with statistical models and MLAs is attracting growing interest and is developing rapidly. What’s more, more and more studies focus on the external validation of the existing model. In this review, we will give a brief overview of recent developments in this discipline.

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Changes in autonomic cardiac control in patients with epilepsy after discontinuation of antiepileptic drugs: a randomized controlled withdrawal study

European Journal of Neurology ◽

10.1111/j.1468-1331.2007.01863.x ◽

2007 ◽

Vol 14 (9) ◽

pp. 1022-1028 ◽

Cited By ~ 22

Author(s):

M. I. Lossius ◽

J. E. Erikssen ◽

P. Mowinckel ◽

P. Gulbrandsen ◽

L. Gjerstad

Keyword(s):

Antiepileptic Drugs ◽

Randomized Controlled ◽

Cardiac Control ◽

Patients With Epilepsy

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Effect and Safety of Shihogyejitang for Drug Resistant Childhood Epilepsy

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/3410213 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Jinsoo Lee ◽

Kwanghyun Son ◽

Gwiseo Hwang ◽

Moonju Kim

Keyword(s):

Adverse Events ◽

Antiepileptic Drugs ◽

Retention Rate ◽

Seizure Type ◽

Drug Resistant ◽

Exact Test ◽

Alternative Treatment Option ◽

Drug Resistant Epilepsy ◽

Intent To Treat ◽

Patients With Epilepsy

Objective. Herbal medicine has been widely used to treat drug resistant epilepsy. Shihogyejitang (SGT) has been commonly used to treat epilepsy. We investigated the effect and safety of SGT in children with drug resistant epilepsy.Design. We reviewed medical records of 54 patients with epilepsy, who failed to respond to at least two antiepileptic drugs and have been treated with SGT between April 2006 and June 2014 at the Department of Pediatric Neurology, I-Tomato Hospital, Korea. Effect was measured by the response rate, seizure-free rate, and retention rate at six months. We also checked adverse events, change in antiepileptic drugs use, and the variables related to the outcome.Results. Intent-to-treat analysis showed that, after six months, 44.4% showed a >50% seizure reduction, 24.1% including seizure-free, respectively, and 53.7% remained on SGT. Two adverse events were reported, mild skin rash and fever. Focal seizure type presented significantly more positive responses when compared with other seizure types at six months (p=0.0284, Fisher’s exact test).Conclusion. SGT is an effective treatment with excellent tolerability for drug resistant epilepsy patients. Our data provide evidence that SGT may be used as alternative treatment option when antiepileptic drug does not work in epilepsy children.

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Therapeutic Drug Monitoring of Second- and Third-Generation Antiepileptic Drugs: Insights From a College of American Pathologists Proficiency Testing Survey

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2020-0562-cp ◽

2021 ◽

Author(s):

Matthew D. Krasowski ◽

Thomas A. Long ◽

Christine L. H. Snozek ◽

Annabel Dizon ◽

Barbarajean Magnani ◽

...

Keyword(s):

Therapeutic Drug Monitoring ◽

Antiepileptic Drugs ◽

Proficiency Testing ◽

Drug Monitoring ◽

First Generation ◽

Therapeutic Drug ◽

Third Generation ◽

Enzyme Immunoassays ◽

Steady Growth ◽

Survey Results

Context.— Therapeutic drug monitoring has traditionally been widely used for first-generation antiepileptic drugs (AEDs) such as carbamazepine and phenytoin. The last 2 decades have seen the introduction of second- and third-generation AEDs (eg, lamotrigine, levetiracetam, and topiramate) into clinical practice. Objective.— To use data from the College of American Pathologists Therapeutic Drug Monitoring, Extended proficiency testing survey to determine the performance of assays used for therapeutic drug monitoring of newer AEDs, including comparison of enzyme immunoassay and chromatographic techniques. Design.— Six years of proficiency testing surveys were reviewed (2013–2018). Results.— Steady growth was seen in participant volumes for newer AEDs. The analytical performance of automated enzyme immunoassays for lamotrigine, levetiracetam, and topiramate was similar to that of chromatographic methods, consistent with published literature using patient samples for comparisons. The majority of participating laboratories now use enzyme immunoassays to measure levetiracetam. Conclusions.— Survey results reflect steadily growing interest in therapeutic drug monitoring of newer AEDs. The increasing availability of robust immunoassays for new AEDs should facilitate their clinical utility, especially for clinical laboratories that do not perform chromatographic assays for therapeutic drug monitoring.

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Long-term effectiveness and safety of antiepileptic drugs in children and adults

Reviews on Clinical Pharmacology and Drug Therapy ◽

10.17816/rcf192221-228 ◽

2021 ◽

Vol 19 (2) ◽

pp. 221-228

Author(s):

Roza M. Shaimardanova ◽

Rimma G. Gamirova

Keyword(s):

Valproic Acid ◽

Antiepileptic Drugs ◽

Focal Epilepsy ◽

City Hospital ◽

Long Term Follow Up ◽

Short And Long Term ◽

Long Term Observation ◽

Patients With Epilepsy

AIM: To conduct a retrospective comparative analysis of the efficacy and safety of epilepsy therapy with antiepileptic drugs. MATERIALS AND METHODS: The analysis of the treatment of 428 patients with epilepsy at the Childrens City Hospital No. 8 in Kazan, receiving antiepileptic drugs. RESULTS: It was found that valproic acid is more effective in the treatment of idiopathic generalized epilepsies compared to focal epilepsies (p = 0.0006). Valproate and carbamazepine were the most effective in the treatment of focal epilepsy with short- and long-term follow-up. Valproic acid is more effective than topiramate (p = 0.02), oxcarbazepine (p = 0.003), and levetiracetam (p = 0.003) in the treatment of focal epilepsy in short- and long-term follow-up. Carbamazepine is more effective than topiramate (p = 0.01), oxcarbazepine (p = 0.02), and levetiracetam (p = 0.001) in the treatment of focal epilepsy in long-term follow-up. It was revealed that more often they complained about side effects when using carbamazepine (63.2%). Levetiracetam was found to be better tolerated compared to valproate (p = 0.0006) and carbamazepine (p = 0.0006). Topiramate is better tolerated than carbamazepine (p = 0.02) and valproate (p = 0.03). Oxcarbazepine is better tolerated than carbamazepine in women (p = 0.04). CONCLUSIONS: When choosing an antiepileptic drug, it is necessary to be guided by the principle: first the basic, and then the drugs of the next generations, in the future, rely on information about the tolerability of the drug. It is necessary to evaluate the therapeutic effect of antiepileptic drugs with long-term observation, and use the criterion of complete absence of seizures as an indicator of the effectiveness of drugs.

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Withdrawing antiepileptic drugs

Drug and Therapeutics Bulletin ◽

10.1136/dtb.27.8.29 ◽

1989 ◽

Vol 27 (8) ◽

pp. 29-31

Keyword(s):

Antiepileptic Drugs ◽

Drug Withdrawal ◽

Toxic Effects ◽

Patients With Epilepsy

All antiepileptic drugs can cause toxic effects, especially when taken for long periods, and should therefore be discontinued when no longer needed. About 70% of patients with epilepsy eventually enter a prolonged remission and do not then require drugs. We here discuss when and how to attempt drug withdrawal, and what problems may occur.

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