Comparative evidence and clinical scenarios

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Patient Population ◽  
Psychiatric Symptoms ◽  
Rapid Expansion ◽  
Cognitive Effects ◽  
Behavioural Symptoms ◽  
Clinical Scenarios ◽  
Available Information ◽  
Patients With Epilepsy

By bringing together the available information from the use of individual antiepileptic drugs in patients with epilepsy, it is possible to derive some preliminary comparative evidence about their positive and negative psychotropic properties, as well as their implications for the management of behavioural symptoms in this patient population. These findings often match the available evidence supporting the use of antiepileptic drugs for the treatment of patients with primary psychiatric symptoms. Expertise on the relative advantages/disadvantages of each antiepileptic drug in different clinical situations requires up-to-date knowledge about the behavioural and cognitive effects of these medications (a task made increasingly more difficult by the rapid expansion of the field) .

Phenobarbital and primidone

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.

Other antiepileptic drugs: rufinamide, lacosamide, perampanel

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Psychiatric Disorders ◽  
Antiepileptic Drugs ◽  
Clinical Experience ◽  
Psychotic Symptoms ◽  
Third Generation ◽  
Behavioural Symptoms ◽  
Patients With Epilepsy ◽  
Anxiety Depression

Rufinamide, lacosamide, and perampanel are third-generation agents licensed for use as antiepileptic drugs in recent years. Clinical experience is still limited, and little is known about their positive and negative psychotropic properties or their implications for the management of behavioural symptoms in patients with epilepsy. There are initial reports of anxiety, depression, irritability, and agitation in patients with epilepsy treated with rufinamide, whereas depression, irritability, agitation, and psychotic symptoms have been reported during lacosamide treatment. There are initial reports of behavioural disturbances (especially depression, anxiety, irritability, and psychosis) in patients with epilepsy treated with perampanel. These effects seem to be dose-related and tend to appear within the first weeks of treatment. Overall, these antiepileptic drugs have no indications for the treatment of psychiatric disorders and there is insufficient experience to draw any conclusion regarding their psychotropic profiles.

scholarly journals Adverse effects of topiramate in patients with epilepsy in a tertiary care hospital: observational study

2019 ◽  
Vol 8 (4) ◽  
pp. 720
Author(s):  
Subahan S. P. ◽  
Kulandaiammal M. ◽  
Arunan S.
Keyword(s):  
Adverse Effects ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Medication Compliance ◽  
Tertiary Care ◽  
Pharmacokinetic Profile ◽  
Therapeutic Effects ◽  
Care Hospital ◽  
Patients With Epilepsy ◽  
Favourable Pharmacokinetic Profile

Background: Epilepsy is a common chronic neurological disorder characterized by paroxysmal cerebral dysrhythmia. Conventional antiepileptic drugs such as Phenytoin, carbamazepine, phenobarbitone and sodium valproate, have been proven to have good therapeutic effects. There are currently more than 10 different adjuvants which are approved for use in epileptics. Topiramate, a second-generation antiepileptic drug, is being used for several types of partial-onset and generalized-onset seizures. Effective treatment of epilepsy depends on medication compliance. The incidence of adverse effects is an important issue when antiepileptic drugs are prescribed to treat epilepsy. This study was done in Department of Neurology to observe the adverse effects of Topiramate in patients with epilepsy in a Tertiary care hospital.Methods: For this study 100 patients receiving topiramate as an adjuvant drug along with regular anti epileptic drugs were enrolled in the study for prescheduled three months. Data of the patients were collected.Results: In this study we observed that paresthesia (31%) was the commonly noted adverse effect followed by cognitive impairment (24%), sleepiness (19%), nausea (13%), anorexia (9%) and weight loss (4%).Conclusions: Topiramate is a potent antiepileptic drug effective against most seizure types and has relatively favourable pharmacokinetic profile. It is appropriate for initial monotherapy as well as for adjuvant therapy in refractory patients. The major problem limiting its use is the frequent occurrence of cognitive adverse effects, especially expressive language dysfunction, which are reversible upon discontinuation of the medication.

Carbamazepine, oxcarbazepine, and eslicarbazepine

2018 ◽  
Author(s):  
Andrea E. Cavanna
Keyword(s):  
Bipolar Disorder ◽  
Antiepileptic Drug ◽  
Clinical Experience ◽  
First Generation ◽  
Tolerability Profile ◽  
Third Generation ◽  
Acceptable Risk ◽  
Behavioural Symptoms ◽  
Patients With Epilepsy ◽  
Good Range

Carbamazepine is a first-generation antiepileptic drug characterized by a good range of antiepileptic indications, with acceptable risk of interactions in polytherapy. Carbamazepine has a very good behavioural tolerability profile and is in widespread psychiatric use (indication for bipolar disorder—acute mania). Oxcarbazepine and eslicarbazepine are carbamazepine derivatives. Oxcarbazepine is a second-generation antiepileptic drug characterized by a good range of antiepileptic indications, with acceptable risk of interactions in polytherapy. Like carbamazepine, oxcarbazepine has a very good behavioural tolerability profile and potential for widespread psychiatric use. Eslicarbazepine is a third-generation antiepileptic drug for which clinical experience is still limited. Little is known about its positive and negative psychotropic properties and their implications for the management of behavioural symptoms in patients with epilepsy.

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

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.

scholarly journals Antiepileptic Drug Management in Hospitalized Epilepsy Patients With Nil Per Os Diets: A Retrospective Review

2018 ◽  
Vol 9 (2) ◽  
pp. 65-70
Author(s):  
Anna M. Bank ◽  
Jong Woo Lee ◽  
Alexa N. Ehlert ◽  
Aaron L. Berkowitz
Keyword(s):  
Antiepileptic Drug ◽  
Medical Center ◽  
Academic Medical Center ◽  
Management Strategies ◽  
Hospital Setting ◽  
Drug Selection ◽  
Drug Management ◽  
Oral Medications ◽  
Academic Medical ◽  
Patients With Epilepsy

Background and Purpose: Antiepileptic drug (AED) management in patients with epilepsy who cannot take their usual oral medications is a common neurologic dilemma in the hospital setting. Strategies to maintain seizure control in patients with nil per os (NPO, nothing by mouth) diet orders include continuation of oral AEDs despite NPO nutrition orders, administration of intravenous AED(s), or temporary administration of benzodiazepines. The frequency with which these strategies are used and their effectiveness in preventing in-hospital seizures is unknown. Methods: We conducted a retrospective cohort study to determine AED management strategies and seizure frequency in hospitalized epilepsy patients with NPO diet status admitted to an academic medical center between 2001 and 2016. Clinical documentation was reviewed. Antiepileptic drug selection (medication and route of administration) and presence or absence of seizures were recorded. Results: We identified 199 admissions during which epilepsy patients had NPO diet orders. Antiepileptic drug management strategies included continuation of oral medications (50.3% of admissions), intravenous AED monotherapy (22.1%), intravenous AED polytherapy (12.6%), benzodiazepines (1.0%), holding AEDs (4.5%), or a combination (9.5%). Seizures occurred during 14 admissions. Treatment with AED polytherapy prior to admission and changing the patient’s AED regimen during admission were associated with increased odds of seizures during admission ( P = .0028; P = .0114). Conclusions: These results suggest that patients’ home oral AED regimens should be continued when possible in order to minimize the frequency of seizures during hospitalizations.

scholarly journals Effect and Safety of Shihogyejitang for Drug Resistant Childhood Epilepsy

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
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.

scholarly journals First, do no harm: the risks of overtreating children with epilepsy

2007 ◽  
Vol 65 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Eunice Chuang ◽  
Marilisa M. Guerreiro ◽  
Sara Y. Tsuchie ◽  
Angelica Santucci ◽  
Carlos A. M. Guerreiro ◽  
...  
Keyword(s):  
Adverse Events ◽  
Prospective Study ◽  
Antiepileptic Drug ◽  
Antiepileptic Drugs ◽  
Seizure Frequency ◽  
Seizure Control ◽  
Control Method ◽  
Refractory Epilepsy ◽  
Do No Harm ◽  
A Prospective Study

BACKGROUND: Although overtreatment with antiepileptic drugs contributes to the morbidity associated with epilepsy, many children still are overtreated. OBJECTIVE: To evaluate if the withdrawal of at least one antiepileptic drug (AED) in children with refractory epilepsy using polytherapy enable a better seizure control. METHOD: This was a prospective study. Children with refractory epilepsy using at least two AEDs were included. Once the patient, or guardian, agreed to participate in the study, one or more AED were slowly tapered off. The remaining AEDs dosages could be adjusted as needed, but a new AED could not be introduced. RESULTS: Fifteen patients were evaluated, three girls; ages ranging from 3 to 18 (mean=8.7 years). After at least one AED withdrawal, two (13.5%) patients became seizure free, seizures improved >50% in 5 (33.5%) patients, did not change in 5 (33.5%), and seizure frequency became worse in 3 (20%). Adverse events improved in 12 patients (80%). CONCLUSION: The withdrawal of at least one AED is a valuable option in the treatment of selected children with refractory epilepsy.

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