Epilepsy medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
m (Bot: Removing from Primary care)
 
(37 intermediate revisions by one other user not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Epilepsy}}
{{Epilepsy}}
{{CMG}} {{AE}} {{VVS}}
{{CMG}} {{AE}} {{Fs}}
==Medical Therapy==
Epilepsy is usually treated with [[medication]] prescribed by a [[physician]]; [[primary care]]givers, [[neurologist]]s, and [[neurosurgeon]]s all frequently care for people with epilepsy. In some cases the implantation of a stimulator of the [[vagus nerve]], or a special diet can be helpful. Neurosurgical operations for epilepsy can be [[palliative]], reducing the frequency or severity of seizures; or, in some patients, an operation can be curative.


===Responding to a Seizure===
== overview ==
In most cases, the proper emergency response to a generalized [[tonic-clonic seizure|tonic-clonic epileptic seizure]] is simply to prevent the patient from self-injury by moving him or her away from sharp edges, placing something soft beneath the [[head (anatomy)|head]], and carefully rolling the person into the [[recovery position]] to avoid [[asphyxiation]]. In some cases the person may seem to start [[snoring]] loudly following a seizure, before coming to. This merely indicates that the person is beginning to breathe properly and does not mean he or she is suffocating. Should the person regurgitate, the material should be allowed to drip out the side of the person's mouth by itself. If a seizure lasts longer than 5 minutes, or if the seizures begin coming in 'waves' one after the other - then [[Emergency Medical Services]] should be contacted immediately. Prolonged seizures may develop into ''[[status epilepticus]]'', a dangerous condition requiring hospitalization and emergency treatment.


Objects should never be placed in a person's [[mouth]] by anybody - including paramedics - during a seizure as this could result in serious injury to either party. Despite common folklore, it is not possible for a person to swallow their own [[tongue]] during a seizure. However, it is possible that the person will bite their own tongue, especially if an object is placed in the mouth.
==Medical Therapy==
 
Pharmacologic medical therapies for epilepsy is anti-seizure drugs such as:
With other types of seizures such as simple partial seizures and [[complex partial seizures]] where the person is not convulsing but may be hallucinating, disoriented, distressed, or unconscious, the person should be reassured, gently guided away from danger, and sometimes it may be necessary to protect the person from self-injury, but physical force should be used only as a last resort as this could distress the person even more. In complex partial seizures where the person is unconscious, attempts to rouse the person should not be made as the seizure must take its full course. After a seizure, the person may pass into a deep sleep or otherwise they will be disoriented and often unaware that they have just had a seizure, as amnesia is common with complex partial seizures. The person should remain observed until they have completely recovered, as with a tonic-clonic seizure.
 
After a seizure, it is typical for a person to be exhausted and confused. Often the person is not immediately aware that they have just had a seizure. During this time one should stay with the person - reassuring and comforting them - until they appear to act as they normally would. Seldom during a seizure the person may have soiled themselves. In some instances the person may also [[vomit]] after coming to. People should not eat or drink until they have returned to their normal level of awareness, and they should not be allowed to wander about unsupervised. Many patients will sleep deeply for a few hours after a seizure - this is common for those having just experienced a more violent type of seizure such as a tonic-clonic. In about 50% of people with epilepsy, headaches may occur after a seizure. These headaches share many features with migraines, and respond to the same medications.
 
It is helpful if those present at the time of a seizure make note of how long and how severe the seizure was. It is also helpful to note any mannerisms displayed during the seizure. For example, the individual may twist the body to the right or left, may blink, might mumble nonsense words, or might pull at clothing. Any observed behaviors, when relayed to a neurologist, may be of help in diagnosing the type of seizure which occurred.
 
===Pharmacologic Treatment===
{{main|Anticonvulsant}}
Some medications can be taken daily in order to prevent seizures altogether or reduce the frequency of their occurrence.  These are termed "anticonvulsant" or "antiepileptic" drugs (sometimes AEDs). All such drugs have side effects that are idiosyncratic and others that are dosage-dependent. It is not possible to predict who will suffer from side effects or at what dose the side effects will appear.
 
Some people with epilepsy will experience a complete remission when treated with an anticonvulsant medication. If this does not occur, the dose of medication may be increased, or another medication may be added to the first. The general strategy is to increase the medication dose until either the seizures are controlled, or until dose-limiting side effects appear; at which point the medication dose is reduced to the highest amount that did not produce undesirable side effects.


Serum levels of AEDs can be checked to determine [[Compliance (medicine)|medication compliance]] and to assess the effects of drug-drug interactions; some physicians do not use serum levels to fine tune medication, but other physicians believe that serum levels provide excellent data for tailoring medications to suit an individual's specific and relatively variable body chemistry. For example, therapeutic doses (the dose at which seizures are controlled and side effects are minimal and tolerable) may vary widely from among patients. The therapeutic ranges provided by pharmaceutical companies are only ranges and by using blood serum levels and seizures diaries, better seizure control can sometimes be reached. In some cases (such as a seizure flurry) serum levels can be useful to know if the level is very high or very low.
=== Drugs that affect voltage-dependent Na+ channels ===
* [[Carbamazepine]]:
** It can be used in treatment of both [[Generalised epilepsy|generalized]] and [[Focal Epilepsy|focal epilepsy]].
** The initial dose is 2-3 mg/kg per day divided into at least two time.
** The maximum dosing is 10 mg/kg three-times-daily.
** The most common [[side effects]] of this drug are [[Gastrointestinal tract|GI]] disturbance, [[rash]], [[hyponatremia]] and [[fluid retention]].<ref name="pmid18981374">{{cite journal |vauthors=Hirsch LJ, Arif H, Nahm EA, Buchsbaum R, Resor SR, Bazil CW |title=Cross-sensitivity of skin rashes with antiepileptic drug use |journal=Neurology |volume=71 |issue=19 |pages=1527–34 |date=November 2008 |pmid=18981374 |doi=10.1212/01.wnl.0000334295.50403.4c |url=}}</ref> <ref name="pmid4207990">{{cite journal |vauthors=Cereghino JJ, Brock JT, Van Meter JC, Penry JK, Smith LD, White BG |title=Carbamazepine for epilepsy. A controlled prospective evaluation |journal=Neurology |volume=24 |issue=5 |pages=401–10 |date=May 1974 |pmid=4207990 |doi= |url=}}</ref>
* [[Eslicarbazepine|Eslicarbazepin]]
** It can be used for treatment of [[Focal seizures|focal-onset seizures]] in adult and children under 4 y/o.<ref name="pmid29067682">{{cite journal |vauthors=Chang XC, Yuan H, Wang Y, Xu HQ, Hong WK, Zheng RY |title=Eslicarbazepine acetate add-on for drug-resistant partial epilepsy |journal=Cochrane Database Syst Rev |volume=10 |issue= |pages=CD008907 |date=October 2017 |pmid=29067682 |doi=10.1002/14651858.CD008907.pub3 |url=}}</ref>
** The initial dosage is 400 mg/daily for adults.
** The maximum dosing is maintenance dose of 800 mg/daily.<ref name="pmid18508949">{{cite journal |vauthors=Almeida L, Minciu I, Nunes T, Butoianu N, Falcão A, Magureanu SA, Soares-da-Silva P |title=Pharmacokinetics, efficacy, and tolerability of eslicarbazepine acetate in children and adolescents with epilepsy |journal=J Clin Pharmacol |volume=48 |issue=8 |pages=966–77 |date=August 2008 |pmid=18508949 |doi=10.1177/0091270008319706 |url=}}</ref>
** The most common [[side effects]] of this drug are [[dizziness]], [[drowsiness]], [[nausea]], [[headache]], [[fatigue]], [[vertigo]], [[ataxia]], [[diplopia]], [[blurred vision]], and [[tremor]].<ref name="pmid25528898">{{cite journal |vauthors=Sperling MR, Abou-Khalil B, Harvey J, Rogin JB, Biraben A, Galimberti CA, Kowacs PA, Hong SB, Cheng H, Blum D, Nunes T, Soares-da-Silva P |title=Eslicarbazepine acetate as adjunctive therapy in patients with uncontrolled partial-onset seizures: Results of a phase III, double-blind, randomized, placebo-controlled trial |journal=Epilepsia |volume=56 |issue=2 |pages=244–53 |date=February 2015 |pmid=25528898 |pmc=4354260 |doi=10.1111/epi.12894 |url=}}</ref>
* [[Lacosamide]]
** It can be used for treatment of [[Focal seizures|focal-onset seizures]] in adult and children older than 4 y/o.<ref name="pmid19043448">{{cite journal |vauthors=Perucca E, Yasothan U, Clincke G, Kirkpatrick P |title=Lacosamide |journal=Nat Rev Drug Discov |volume=7 |issue=12 |pages=973–4 |date=December 2008 |pmid=19043448 |doi=10.1038/nrd2764 |url=}}</ref>
** The initial dosage is 50 mg twice/daily as adjunctive therapy in adults and 100 mg twice per day as monotherapy  .
** The maximum dosage is 200 to 400 mg per day. Children should be dosed according to body weight.<ref name="pmid17635557">{{cite journal |vauthors=Ben-Menachem E, Biton V, Jatuzis D, Abou-Khalil B, Doty P, Rudd GD, Halász P, Kälviäinen R, Mazurkiewicz-Beldzińska M, Rosenow F, Doty P, Hebert D, Sullivan T |title=Efficacy and safety of oral lacosamide as adjunctive therapy in adults with partial-onset seizures |journal=Epilepsia |volume=48 |issue=7 |pages=1308–17 |date=July 2007 |pmid=17635557 |doi=10.1111/j.1528-1167.2007.01188.x |url=}}</ref>
** The most common [[side effects]] are [[Dizziness]], [[nausea]], [[vertigo]], and [[ataxia]].<ref name="pmid190434482">{{cite journal |vauthors=Perucca E, Yasothan U, Clincke G, Kirkpatrick P |title=Lacosamide |journal=Nat Rev Drug Discov |volume=7 |issue=12 |pages=973–4 |date=December 2008 |pmid=19043448 |doi=10.1038/nrd2764 |url=}}</ref>
* [[Lamotrigine]]
** It can be used for adjunctive treatment for primary generalized [[Tonic-clonic seizure|tonic-clonic seizures]] and [[focal seizures]] in adults and children under two y/o.<ref name="pmid15111659">{{cite journal |vauthors=French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, Theodore WH, Bazil C, Stern J, Schachter SC, Bergen D, Hirtz D, Montouris GD, Nespeca M, Gidal B, Marks WJ, Turk WR, Fischer JH, Bourgeois B, Wilner A, Faught RE, Sachdeo RC, Beydoun A, Glauser TA |title=Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society |journal=Neurology |volume=62 |issue=8 |pages=1252–60 |date=April 2004 |pmid=15111659 |doi= |url=}}</ref>
** The initial dosage is 25 mg/daily.
** The maximum dosage is 225 to 375 mg/daily<ref name="pmid15452293">{{cite journal |vauthors=Hirsch LJ, Weintraub D, Du Y, Buchsbaum R, Spencer HT, Hager M, Straka T, Bazil CW, Adams DJ, Resor SR, Morrell MJ |title=Correlating lamotrigine serum concentrations with tolerability in patients with epilepsy |journal=Neurology |volume=63 |issue=6 |pages=1022–6 |date=September 2004 |pmid=15452293 |doi= |url=}}</ref>
** The most common [[side effects]] are [[rash]] and [[nausea]].<ref name="pmid189813742">{{cite journal |vauthors=Hirsch LJ, Arif H, Nahm EA, Buchsbaum R, Resor SR, Bazil CW |title=Cross-sensitivity of skin rashes with antiepileptic drug use |journal=Neurology |volume=71 |issue=19 |pages=1527–34 |date=November 2008 |pmid=18981374 |doi=10.1212/01.wnl.0000334295.50403.4c |url=}}</ref>
* [[Oxcarbazepine]]
** It can be used for treatment of focal and secondarily generalized [[tonic-clonic seizures]].<ref name="pmid19821367">{{cite journal |vauthors=Koch MW, Polman SK |title=Oxcarbazepine versus carbamazepine monotherapy for partial onset seizures |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD006453 |date=October 2009 |pmid=19821367 |doi=10.1002/14651858.CD006453.pub2 |url=}}</ref>
** The initial dosage is 300 to 600 mg/day.
** The maximum dosage is 900 to 3000 mg/day.<ref name="pmid22091603">{{cite journal |vauthors=Kim DW, Gu N, Jang IJ, Chu K, Yu KS, Cho JY, Yoon SH, Kim HS, Oh J, Lee SK |title=Efficacy, tolerability, and pharmacokinetics of oxcarbazepine oral loading in patients with epilepsy |journal=Epilepsia |volume=53 |issue=1 |pages=e9–12 |date=January 2012 |pmid=22091603 |doi=10.1111/j.1528-1167.2011.03318.x |url=}}</ref>
** The most common [[side effects]] are [[hyponatremia]], [[sedation]], [[headache]], [[rash]], [[dizziness]], [[vertigo]], [[ataxia]], [[nausea]], and [[diplopia]].<ref name="pmid20132298">{{cite journal |vauthors=Buggy Y, Layton D, Fogg C, Shakir SA |title=Safety profile of oxcarbazepine: results from a prescription-event monitoring study |journal=Epilepsia |volume=51 |issue=5 |pages=818–29 |date=May 2010 |pmid=20132298 |doi=10.1111/j.1528-1167.2009.02489.x |url=}}</ref>
* [[Phenytoin]]
** It can be used for treatment of [[Focal Epilepsy|focal]]/[[Generalised epilepsy|generalized seizures]] and [[status epilepticus]].<ref name="pmid2428283">{{cite journal |vauthors=Yaari Y, Selzer ME, Pincus JH |title=Phenytoin: mechanisms of its anticonvulsant action |journal=Ann. Neurol. |volume=20 |issue=2 |pages=171–84 |date=August 1986 |pmid=2428283 |doi=10.1002/ana.410200202 |url=}}</ref>
** The initial dosage is 15 mg/kg/day in three doses.<ref name="pmid25099164">{{cite journal |vauthors=Caudle KE, Rettie AE, Whirl-Carrillo M, Smith LH, Mintzer S, Lee MT, Klein TE, Callaghan JT |title=Clinical pharmacogenetics implementation consortium guidelines for CYP2C9 and HLA-B genotypes and phenytoin dosing |journal=Clin. Pharmacol. Ther. |volume=96 |issue=5 |pages=542–8 |date=November 2014 |pmid=25099164 |doi=10.1038/clpt.2014.159 |url=}}</ref>
** The most common [[side effects]] are gingival hypertrophy, [[hirsutism]], [[rash]], [[Folic Acid|folic acid]] depletion, and decreased [[bone density]].<ref name="pmid6424397">{{cite journal |vauthors=Iivanainen M, Savolainen H |title=Side effects of phenobarbital and phenytoin during long-term treatment of epilepsy |journal=Acta Neurol. Scand., Suppl. |volume=97 |issue= |pages=49–67 |date=1983 |pmid=6424397 |doi= |url=}}</ref>
* [[Rufinamide]]
** It can be used for adjunctive treatment of seizures associated with [[Lennox-Gastaut syndrome|Lennox-gastaut syndrome]] (LGS).<ref name="pmid18401024">{{cite journal |vauthors=Glauser T, Kluger G, Sachdeo R, Krauss G, Perdomo C, Arroyo S |title=Rufinamide for generalized seizures associated with Lennox-Gastaut syndrome |journal=Neurology |volume=70 |issue=21 |pages=1950–8 |date=May 2008 |pmid=18401024 |doi=10.1212/01.wnl.0000303813.95800.0d |url=}}</ref>
** The initial dosage In children is 10 mg/kg per day in two divided doses and in adults is 400 to 800 mg per day in two divided doses.
** The maximum dosage in children is 45 mg/kg per day or 3200 mg/day and in adults is 3200 mg/day.<ref name="pmid20084538">{{cite journal |vauthors=Marchand M, Fuseau E, Critchley DJ |title=Supporting the recommended paediatric dosing regimen for rufinamide in Lennox-Gastaut syndrome using clinical trial simulation |journal=J Pharmacokinet Pharmacodyn |volume=37 |issue=1 |pages=99–118 |date=February 2010 |pmid=20084538 |doi=10.1007/s10928-009-9146-4 |url=}}</ref>
** The most common [[side effects]] are [[drowsiness]] and [[vomiting]].<ref name="pmid20126329">{{cite journal |vauthors=Wheless JW, Vazquez B |title=Rufinamide: a novel broad-spectrum antiepileptic drug |journal=Epilepsy Curr |volume=10 |issue=1 |pages=1–6 |date=January 2010 |pmid=20126329 |pmc=2812713 |doi=10.1111/j.1535-7511.2009.01336.x |url=}}</ref>
* Zonisamide
** It can be used for treatment of [[Focal Epilepsy|focal]] and [[Generalised epilepsy|generalized seizures]] in both adults and children.<ref name="pmid23837461">{{cite journal |vauthors=Guerrini R, Rosati A, Segieth J, Pellacani S, Bradshaw K, Giorgi L |title=A randomized phase III trial of adjunctive zonisamide in pediatric patients with partial epilepsy |journal=Epilepsia |volume=54 |issue=8 |pages=1473–80 |date=August 2013 |pmid=23837461 |doi=10.1111/epi.12233 |url=}}</ref>
** The initial dosage is 100 to 200 mg/daily in two divided doses.
** The maximum dosage is 400 to 600 mg/daily.<ref name="pmid15511691">{{cite journal |vauthors=Leppik IE |title=Zonisamide: chemistry, mechanism of action, and pharmacokinetics |journal=Seizure |volume=13 Suppl 1 |issue= |pages=S5–9; discussion S10 |date=December 2004 |pmid=15511691 |doi=10.1016/j.seizure.2004.04.016 |url=}}</ref>
** The most common [[side effects]] are [[drowsiness]], [[anxiety]], [[ataxia]], [[anorexia]], [[confusion]], abnormal thinking, [[fatigue]], [[dizziness]] and decreased sweating and [[fever]] in children. <ref name="pmid17945539">{{cite journal |vauthors=Park SP, Hwang YH, Lee HW, Suh CK, Kwon SH, Lee BI |title=Long-term cognitive and mood effects of zonisamide monotherapy in epilepsy patients |journal=Epilepsy Behav |volume=12 |issue=1 |pages=102–8 |date=January 2008 |pmid=17945539 |doi=10.1016/j.yebeh.2007.08.002 |url=}}</ref>


If a person's epilepsy cannot be brought under control after adequate trials of two or three (experts vary here) different drugs, that person's epilepsy is generally said to be medically refractory. or Drug-Resistant Epilepsy. [[Ketogenic diet]] (a high-fat, low-protein, low-carbohydrate diet) is used in children with drug-resistant epilepsy. A randomized, controlled trial showed that the number of seizures fell by more than 50% in approximately half of children after 1 year on the diet.  
=== Drugs that affect Ca currents ===
* [[Ethosuximide]]
** It can be used for treatment of [[Absence seizure|absence seizures]].
** The initial dosage is 20 to 40 mg/kg/day.  
** The maximum serum level is 40 to 100 mcg/mL (280 to 700 micromol/L).
** The most common [[side effects]] are [[nausea]] and [[vomiting]], sleep disorders and [[somnolence]].<ref name="pmid20200383">{{cite journal |vauthors=Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Capparelli EV, Adamson PC |title=Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy |journal=N. Engl. J. Med. |volume=362 |issue=9 |pages=790–9 |date=March 2010 |pmid=20200383 |pmc=2924476 |doi=10.1056/NEJMoa0902014 |url=}}</ref>


Various drugs may prevent seizures or reduce seizure frequency: these include [[carbamazepine]] (common brand name Tegretol), [[clobazam]] (Frisium), [[clonazepam]] (Klonopin), [[ethosuximide]] (Zarontin), [[felbamate]] (Felbatol), [[fosphenytoin]] (Cerebyx), [[flurazepam]] (Dalmane), [[gabapentin]] (Neurontin), [[lamotrigine]] (Lamictal), [[levetiracetam]] (Keppra), [[oxcarbazepine]] (Trileptal), [[mephenytoin]] (Mesantoin), [[phenobarbital]] (Luminal), [[phenytoin]] (Dilantin), [[pregabalin]] (Lyrica), [[primidone]] (Mysoline), [[sodium valproate]] (Epilim), [[tiagabine]] (Gabitril), [[topiramate]] (Topamax), [[valproate semisodium]] (Depakote, Epival), [[valproic acid]] (Depakene, Convulex), [[vigabatrin]] (Sabril), and [[zonisamide]] (Zonegran).
=== Drugs that affect [[GABA]] activity ===
* [[Benzodiazepine|Benzodiazepines]]
** It can be used for adjunctive therapy for [[Myoclonic seizure|myoclonic]]/[[Atonic seizure|atonic seizures]] and [[Focal Epilepsy|focal]]/[[Generalised epilepsy|generalized tonic-clonic seizures]].
** The most common [[side effects]] are [[anterograde amnesia]], [[drowsiness]] and increased risk of falling in elderly persons.<ref name="pmid20305598">{{cite journal |vauthors=Uzun S, Kozumplik O, Jakovljević M, Sedić B |title=Side effects of treatment with benzodiazepines |journal=Psychiatr Danub |volume=22 |issue=1 |pages=90–3 |date=March 2010 |pmid=20305598 |doi= |url=}}</ref>
* [[Phenobarbital]]
** It can be used for treatment of generalized and [[focal seizures]].
** The initial dosage is 1 to 5 mg/kg per day.
** The goal therapeutic level is 10 to 40 mcg/mL (43 to 172 micromol/L).<ref name="urlapps.who.int">{{cite web |url=http://apps.who.int/iris/bitstream/handle/10665/61822/WHO_MNH_MND_90.3.pdf?sequence=1&isAllowed=y |title=apps.who.int |format= |work= |accessdate=}}</ref>
** The most common [[side effects]] are sleep disturbance and daytime irritability.<ref name="pmid381616">{{cite journal |vauthors=Camfield CS, Chaplin S, Doyle AB, Shapiro SH, Cummings C, Camfield PR |title=Side effects of phenobarbital in toddlers; behavioral and cognitive aspects |journal=J. Pediatr. |volume=95 |issue=3 |pages=361–5 |date=September 1979 |pmid=381616 |doi= |url=}}</ref>
* [[Tiagabine]]
** It can be used for adjunctive treatment for [[focal seizures]].<ref name="pmid151116592">{{cite journal |vauthors=French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, Theodore WH, Bazil C, Stern J, Schachter SC, Bergen D, Hirtz D, Montouris GD, Nespeca M, Gidal B, Marks WJ, Turk WR, Fischer JH, Bourgeois B, Wilner A, Faught RE, Sachdeo RC, Beydoun A, Glauser TA |title=Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society |journal=Neurology |volume=62 |issue=8 |pages=1252–60 |date=April 2004 |pmid=15111659 |doi= |url=}}</ref>
** The initial dosage is 4 to 8 mg/day.
** The most common [[side effects]] are [[dizziness]], [[somnolence]], [[anxiety]], [[tremor]], difficulty concentrating, [[nausea]] and abdominal pain.<ref name="pmid22592677">{{cite journal |vauthors=Pulman J, Marson AG, Hutton JL, French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, Theodore WH, Bazil C, Stern J, Schachter SC, Bergen D, Hirtz D, Montouris GD, Nespeca M, Gidal B, Marks WJ, Turk WR, Fischer JH, Bourgeois B, Wilner A, Faught RE, Sachdeo RC, Beydoun A, Glauser TA |title=Tiagabine add-on for drug-resistant partial epilepsy |journal=Cochrane Database Syst Rev |volume=62 |issue=5 |pages=CD001908 |date=May 2012 |pmid=22592677 |pmc=4058679 |doi=10.1002/14651858.CD001908.pub2 |url=}}</ref>
* [[Vigabatrin]]
** It can be used for add-on treatment for refractory [[focal seizures]].<ref name="pmid23440814">{{cite journal |vauthors=Hemming K, Maguire MJ, Hutton JL, Marson AG |title=Vigabatrin for refractory partial epilepsy |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD007302 |date=January 2013 |pmid=23440814 |doi=10.1002/14651858.CD007302.pub2 |url=}}</ref>
** The initial dosage is 500 mg/day.
** The maximum dosage is 3 gr/day.<ref name="pmid20208475">{{cite journal |vauthors= |title=Vigabatrin (Sabril) for epilepsy |journal=Med Lett Drugs Ther |volume=52 |issue=1332 |pages=14–6; quiz 17 |date=February 2010 |pmid=20208475 |doi= |url=}}</ref>
** The most common [[side effects]] are  [[visual loss]], [[drowsiness]], [[fatigue]], [[headache]], and [[dizziness]].<ref name="pmid10406359">{{cite journal |vauthors=Chadwick D |title=Safety and efficacy of vigabatrin and carbamazepine in newly diagnosed epilepsy: a multicentre randomised double-blind study. Vigabatrin European Monotherapy Study Group |journal=Lancet |volume=354 |issue=9172 |pages=13–9 |date=July 1999 |pmid=10406359 |doi= |url=}}</ref>


Other drugs are commonly used to abort an active seizure or interrupt a seizure flurry; these include [[diazepam]] (Valium) and [[lorazepam]] (Ativan). Drugs used only in the treatment of refractory [[status epilepticus]] include [[paraldehyde]] (Paral) and [[pentobarbital]] (Nembutal).
=== Drugs that affect glutamate receptor ===
* [[Perampanel]]
** It can be used for treatment of [[Focal Epilepsy|focal-onset seizures]] in patients older than 12 y/o and as adjunctive treatment for primary [[Tonic-clonic seizures|generalized tonic-clonic seizures]].<ref name="urlDrugs@FDA: FDA Approved Drug Products">{{cite web |url=http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm |title=Drugs@FDA: FDA Approved Drug Products |format= |work= |accessdate=}}</ref>
** The initial dosage is 2 mg/day.
** The maximum dose is 12 mg/day.<ref name="pmid25461214">{{cite journal |vauthors=Coyle H, Clough P, Cooper P, Mohanraj R |title=Clinical experience with perampanel: focus on psychiatric adverse effects |journal=Epilepsy Behav |volume=41 |issue= |pages=193–6 |date=December 2014 |pmid=25461214 |doi=10.1016/j.yebeh.2014.09.072 |url=}}</ref>
** The most common [[side effects]] are [[dizziness]], [[drowsiness]], [[headache]], [[fatigue]], [[irritability]], [[ataxia]], [[nausea]], and weight gain.<ref name="pmid22843280">{{cite journal |vauthors=French JA, Krauss GL, Biton V, Squillacote D, Yang H, Laurenza A, Kumar D, Rogawski MA |title=Adjunctive perampanel for refractory partial-onset seizures: randomized phase III study 304 |journal=Neurology |volume=79 |issue=6 |pages=589–96 |date=August 2012 |pmid=22843280 |pmc=3413761 |doi=10.1212/WNL.0b013e3182635735 |url=}}</ref>


[[Potassium bromide|Bromides]] were the first of the effective anticonvulsant pure compounds, but are no longer used in humans<ref name="BromideDogs">{{cite web
=== Drugs with multiple mechanisms of action ===
| last = Clemmons DVM, PhD
* [[Felbamate]]
| first = R.M.
** It can be used for treatment of [[focal seizures]] and [[Lennox-Gastaut syndrome]] (LGS).<ref name="pmid8039474">{{cite journal |vauthors=Bourgeois BF |title=Felbamate in the treatment of partial-onset seizures |journal=Epilepsia |volume=35 Suppl 5 |issue= |pages=S58–61 |date=1994 |pmid=8039474 |doi= |url=}}</ref>
| year = 1997
** This drug can cause fatal [[aplastic anemia]] and [[hepatic failure]].<ref name="pmid8628501">{{cite journal |vauthors=O'Neil MG, Perdun CS, Wilson MB, McGown ST, Patel S |title=Felbamate-associated fatal acute hepatic necrosis |journal=Neurology |volume=46 |issue=5 |pages=1457–9 |date=May 1996 |pmid=8628501 |doi= |url=}}</ref>
| url = http://neuro.vetmed.ufl.edu/neuro/seizures/seizures.htm
* [[Topiramate]]
| title = Seizure Disorders in Dogs and Cats
** It can be used for treatment of [[focal seizures]] in adults and children older than two y/o.<ref name="pmid24570033">{{cite journal |vauthors=Pulman J, Jette N, Dykeman J, Hemming K, Hutton JL, Marson AG |title=Topiramate add-on for drug-resistant partial epilepsy |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD001417 |date=February 2014 |pmid=24570033 |doi=10.1002/14651858.CD001417.pub3 |url=}}</ref>
| work = The Neurology Service at the VMTH
** The initial dosage is 50 mg/day.<ref name="pmid20633037">{{cite journal |vauthors=Ramsay E, Faught E, Krumholz A, Naritoku D, Privitera M, Schwarzman L, Mao L, Wiegand F, Hulihan J |title=Efficacy, tolerability, and safety of rapid initiation of topiramate versus phenytoin in patients with new-onset epilepsy: a randomized double-blind clinical trial |journal=Epilepsia |volume=51 |issue=10 |pages=1970–7 |date=October 2010 |pmid=20633037 |doi=10.1111/j.1528-1167.2010.02670.x |url=}}</ref>
| publisher = University of Florida’s Veterinary Medical Teaching Hospital
** The most common [[side effects]] are Weight loss, [[Paresthesia|paresthesias]], [[drowsiness]], [[dizziness]], [[depression]], [[headache]], [[cognition]] and language impairment.<ref name="pmid15857429">{{cite journal |vauthors=Majkowski J, Neto W, Wapenaar R, Van Oene J |title=Time course of adverse events in patients with localization-related epilepsy receiving topiramate added to carbamazepine |journal=Epilepsia |volume=46 |issue=5 |pages=648–53 |date=May 2005 |pmid=15857429 |doi=10.1111/j.1528-1167.2005.35904.x |url=}}</ref>
| accessdate = 2006-03-29
* Valporate
}}</ref> due to their [[toxicity]] and low [[efficacy]].
** It can be used for treatment of [[Generalised epilepsy|generalized]] and [[focal seizures]].
 
** The initial dosage is 10 to 15 mg/kg per day.<ref name="pmid6425050">{{cite journal |vauthors=Loiseau P |title=Rational use of valproate: indications and drug regimen in epilepsy |journal=Epilepsia |volume=25 Suppl 1 |issue= |pages=S65–72 |date=1984 |pmid=6425050 |doi= |url=}}</ref>
It has been found that taking [[valproic acid|valproates]] while pregnant can have high chances of reduced IQ towards children.<ref>{{cite web | url = http://www.medscape.com/viewarticle/549073 | title = NEAD: In Utero Exposure To Valproate Linked to Poor Cognitive Outcomes in Kids | last = Cassels | first = Caroline | date = [[December 8]] [[2006]] | publisher = Medscape | accessdate = 2007-05-23}}</ref><ref>{{cite journal |author=Meador KJ, Baker GA, Finnell RH, ''et al'' |title=In utero antiepileptic drug exposure: fetal death and malformations |journal=Neurology |volume=67 |issue=3 |pages=407-12 |year=2006 |pmid=16894099 |doi=10.1212/01.wnl.0000227919.81208.b2}}</ref>
** The most common [[side effects]] are [[nausea]], [[vomiting]], hair loss, [[easy bruising]], [[tremor]], weight gain, [[obesity]], [[insulin resistance]], [[metabolic syndrome]], [[thrombocytopenia]] and other [[coagulation]] disturbances, subclinical [[hypothyroidism]], [[Polycystic ovary syndrome|polycystic ovarian syndrome]], [[fanconi syndrome]].<ref name="pmid11160951">{{cite journal |vauthors=Biton V, Mirza W, Montouris G, Vuong A, Hammer AE, Barrett PS |title=Weight change associated with valproate and lamotrigine monotherapy in patients with epilepsy |journal=Neurology |volume=56 |issue=2 |pages=172–7 |date=January 2001 |pmid=11160951 |doi= |url=}}</ref><ref name="pmid20304335">{{cite journal |vauthors=Endo A, Fujita Y, Fuchigami T, Takahashi S, Mugishima H |title=Fanconi syndrome caused by valproic acid |journal=Pediatr. Neurol. |volume=42 |issue=4 |pages=287–90 |date=April 2010 |pmid=20304335 |doi=10.1016/j.pediatrneurol.2009.12.003 |url=}}</ref><ref name="pmid16886976">{{cite journal |vauthors=Gerstner T, Teich M, Bell N, Longin E, Dempfle CE, Brand J, König S |title=Valproate-associated coagulopathies are frequent and variable in children |journal=Epilepsia |volume=47 |issue=7 |pages=1136–43 |date=July 2006 |pmid=16886976 |doi=10.1111/j.1528-1167.2006.00587.x |url=}}</ref><ref name="pmid18503558">{{cite journal |vauthors=Sahota P, Prabhakar S, Kharbanda PS, Bhansali A, Jain V, Das CP, Modi M |title=Seizure type, antiepileptic drugs, and reproductive endocrine dysfunction in Indian women with epilepsy: a cross-sectional study |journal=Epilepsia |volume=49 |issue=12 |pages=2069–77 |date=December 2008 |pmid=18503558 |doi=10.1111/j.1528-1167.2008.01676.x |url=}}</ref><ref name="pmid21824562">{{cite journal |vauthors=Aggarwal A, Rastogi N, Mittal H, Chillar N, Patil R |title=Thyroid hormone levels in children receiving carbamazepine or valproate |journal=Pediatr. Neurol. |volume=45 |issue=3 |pages=159–62 |date=September 2011 |pmid=21824562 |doi=10.1016/j.pediatrneurol.2011.04.005 |url=}}</ref>
 
===Other Treatment===
[[Ketogenic diet]]s may occasionally be effective in controlling some types of epilepsy; although the mechanism behind the effect is not fully understood, shifting of [[pH]] towards a [[metabolic acidosis]] and alteration of brain [[metabolism]] may be involved. Ketogenic diets are high in [[fat]] and extremely low in [[carbohydrate]]s, with intake of fluids often limited. This treatment, originated as early as the 1920s at [[Johns Hopkins Hospital|Johns Hopkins Medical Center]], was largely abandoned with the discovery of modern anti-epileptic drugs, but recently has returned to the anti-epileptic treatment arsenal. Ketogenic diets are sometimes prescribed in severe cases where drugs have proven ineffective.  
 
A [http://www.hopkinsmedicine.org/press/1998/DECEMBER/981207.HTM study conducted by Johns Hopkins] reported that 50% of those patients starting the Ketogenic diet reported a decrease in seizures of 50% or more, with 29% of patients reporting a 90% reduction in symptoms; these patients had previously tried an average of six anticonvulsant drugs.  
 
[[Vagus nerve stimulation]] (VNS) is a recently developed form of seizure control which uses an implanted electrical device, similar in size, shape and implant location to a [[heart pacemaker]], which connects to the [[vagus nerve]] in the [[neck]]. Once in place the device can be set to emit electronic pulses, stimulating the vagus nerve at pre-set intervals and milliamp levels. Treatment studies have shown that approximately 50% of those treated in this fashion will show significant seizure reduction.
 
The Responsive Neurostimulator System (RNS) is currently undergoing clinical study prior to FDA approval. This system relies upon a device implanted just under the scalp. The leads attached to the device are implanted either on the brain surface or in the brain area itself and are located close to the area where the seizures are believed to start. When a seizure begins, an electrical shock is delivered to suppress it. This system is different from the VNS system in that the RNS relies on direct brain stimulation and the RNS is a responsive system. The VNS pulses at predetermined intervals previously set by medical personnel. The RNS system  responds to detected signs that a seizure is about to begin and can record events and allow customized response patterns which may provide a greater degree of seizure control.
 
A [[seizure response dog]] is a form of service dog that is trained to summon help or ensure personal safety when a seizure occurs. These are not suitable for everybody and not all dogs can be so trained. Rarely, a dog may develop the ability to sense a seizure before it occurs.<ref>{{cite news
| first = Marianne
| last = Barriaux
| title = Dogs trained to warn of an imminent epileptic fit
| url = http://business.guardian.co.uk/story/0,,1923146,00.html
| publisher = The Guardian
| date = [[2006-10-16]]
| accessdate = 2006-11-24
}}</ref>
 
A number of [[systematic review]]s by the [[Cochrane Collaboration]] into treatments for epilepsy looked at [[acupuncture]],<ref name="Cheuk2006">{{cite journal
| author=Cheuk D, Wong V
| title=Acupuncture for epilepsy
| journal=Cochrane Database Syst Rev
| year=2006
| pages=CD005062
| issue=2
| id=PMID 16625622}}
</ref> [[psychological]] interventions,<ref name="Ramaratnam2005">{{cite journal
| author=Ramaratnam S, Baker GA, Goldstein LH
| title=Psychological treatments for epilepsy
| journal=Cochrane Database Syst Rev
| year=2005
| pages=CD002029
| issue=4
| id=PMID 16235293}}
</ref> [[vitamins]]<ref name="Ranganathan2005">{{cite journal
| author=Ranganathan LN, Ramaratnam S
| title=Vitamins for epilepsy
| journal=Cochrane Database Syst Rev
| year=2005
| pages=CD004304
| issue=2
| id=PMID 15846704}}
</ref> and [[yoga]]<ref name="Ramaratnam2000">{{cite journal
| author=Ramaratnam S, Sridharan K
| title=Yoga for epilepsy
| journal=Cochrane Database Syst Rev
| year=2000
| pages=CD001524
| issue=3
| id=PMID 10908505}}
</ref> and found there is no reliable [[Evidence-based medicine|evidence]] to support the use of these as treatments for epilepsy. Further studies are needed on the subject.


=== Drugs with other mechanisms of action ===
* Brivaracetam
** It can be used for treatment of focal-onset seizures and generalized epilepsy.<ref name="pmid26471380">{{cite journal |vauthors=Klein P, Schiemann J, Sperling MR, Whitesides J, Liang W, Stalvey T, Brandt C, Kwan P |title=A randomized, double-blind, placebo-controlled, multicenter, parallel-group study to evaluate the efficacy and safety of adjunctive brivaracetam in adult patients with uncontrolled partial-onset seizures |journal=Epilepsia |volume=56 |issue=12 |pages=1890–8 |date=December 2015 |pmid=26471380 |doi=10.1111/epi.13212 |url=}}</ref><ref name="pmid264713803">{{cite journal |vauthors=Klein P, Schiemann J, Sperling MR, Whitesides J, Liang W, Stalvey T, Brandt C, Kwan P |title=A randomized, double-blind, placebo-controlled, multicenter, parallel-group study to evaluate the efficacy and safety of adjunctive brivaracetam in adult patients with uncontrolled partial-onset seizures |journal=Epilepsia |volume=56 |issue=12 |pages=1890–8 |date=December 2015 |pmid=26471380 |doi=10.1111/epi.13212 |url=}}</ref>
** The initial dosage is 50 mg twice daily.<ref name="urlDrugs@FDA: FDA Approved Drug Products2">{{cite web |url=http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Overview&DrugName=BRIVIACT |title=Drugs@FDA: FDA Approved Drug Products |format= |work= |accessdate=}}</ref>
** The most common side effects are irritability, anxiety, insomnia and depression.<ref name="pmid264713802">{{cite journal |vauthors=Klein P, Schiemann J, Sperling MR, Whitesides J, Liang W, Stalvey T, Brandt C, Kwan P |title=A randomized, double-blind, placebo-controlled, multicenter, parallel-group study to evaluate the efficacy and safety of adjunctive brivaracetam in adult patients with uncontrolled partial-onset seizures |journal=Epilepsia |volume=56 |issue=12 |pages=1890–8 |date=December 2015 |pmid=26471380 |doi=10.1111/epi.13212 |url=}}</ref>
* Gabapentin
** It can be used for treatment of refractory focal seizures.<ref name="pmid15111660">{{cite journal |vauthors=French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, Theodore WH, Bazil C, Stern J, Schachter SC, Bergen D, Hirtz D, Montouris GD, Nespeca M, Gidal B, Marks WJ, Turk WR, Fischer JH, Bourgeois B, Wilner A, Faught RE, Sachdeo RC, Beydoun A, Glauser TA |title=Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society |journal=Neurology |volume=62 |issue=8 |pages=1261–73 |date=April 2004 |pmid=15111660 |doi= |url=}}</ref>
** The initial dosage is 300 mg three times daily.
** The maximum dosage is 2400 mg/day.<ref name="pmid23888424">{{cite journal |vauthors=Al-Bachari S, Pulman J, Hutton JL, Marson AG |title=Gabapentin add-on for drug-resistant partial epilepsy |journal=Cochrane Database Syst Rev |volume= |issue=7 |pages=CD001415 |date=July 2013 |pmid=23888424 |doi=10.1002/14651858.CD001415.pub2 |url=}}</ref>
** The most common side effects are sedation, dizziness, ataxia and weight gain.<ref name="pmid27265421">{{cite journal |vauthors=Smith RV, Havens JR, Walsh SL |title=Gabapentin misuse, abuse and diversion: a systematic review |journal=Addiction |volume=111 |issue=7 |pages=1160–74 |date=July 2016 |pmid=27265421 |pmc=5573873 |doi=10.1111/add.13324 |url=}}</ref>
* Levetiracetam
** It can be used for adjunctive  treatment of focal-onset seizures, myoclonic seizures in patients older than 12 y/o with juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures in patients older than six y/o with idiopathic generalized epilepsy.<ref name="pmid17625106">{{cite journal |vauthors=Berkovic SF, Knowlton RC, Leroy RF, Schiemann J, Falter U |title=Placebo-controlled study of levetiracetam in idiopathic generalized epilepsy |journal=Neurology |volume=69 |issue=18 |pages=1751–60 |date=October 2007 |pmid=17625106 |doi=10.1212/01.wnl.0000268699.34614.d3 |url=}}</ref><ref name="pmid22972056">{{cite journal |vauthors=Mbizvo GK, Dixon P, Hutton JL, Marson AG |title=Levetiracetam add-on for drug-resistant focal epilepsy: an updated Cochrane Review |journal=Cochrane Database Syst Rev |volume= |issue=9 |pages=CD001901 |date=September 2012 |pmid=22972056 |doi=10.1002/14651858.CD001901.pub2 |url=}}</ref><ref name="pmid22050371">{{cite journal |vauthors=Delanty N, Jones J, Tonner F |title=Adjunctive levetiracetam in children, adolescents, and adults with primary generalized seizures: open-label, noncomparative, multicenter, long-term follow-up study |journal=Epilepsia |volume=53 |issue=1 |pages=111–9 |date=January 2012 |pmid=22050371 |doi=10.1111/j.1528-1167.2011.03300.x |url=}}</ref>
** The initial dosage is 500 mg twice daily.
** The maximum dosage is 4000 mg daily.<ref name="pmid10845730">{{cite journal |vauthors=Betts T, Waegemans T, Crawford P |title=A multicentre, double-blind, randomized, parallel group study to evaluate the tolerability and efficacy of two oral doses of levetiracetam, 2000 mg daily and 4000 mg daily, without titration in patients with refractory epilepsy |journal=Seizure |volume=9 |issue=2 |pages=80–7 |date=March 2000 |pmid=10845730 |doi=10.1053/seiz.2000.0380 |url=}}</ref>
** The most common side effects are fatigue, drowsiness, dizziness, and upper respiratory tract infection.<ref name="pmid220503712">{{cite journal |vauthors=Delanty N, Jones J, Tonner F |title=Adjunctive levetiracetam in children, adolescents, and adults with primary generalized seizures: open-label, noncomparative, multicenter, long-term follow-up study |journal=Epilepsia |volume=53 |issue=1 |pages=111–9 |date=January 2012 |pmid=22050371 |doi=10.1111/j.1528-1167.2011.03300.x |url=}}</ref>
* Pregabalin
** It can be used for adjunctive therapy for focal seizures.<ref name="pmid14692903">{{cite journal |vauthors=Arroyo S, Anhut H, Kugler AR, Lee CM, Knapp LE, Garofalo EA, Messmer S |title=Pregabalin add-on treatment: a randomized, double-blind, placebo-controlled, dose-response study in adults with partial seizures |journal=Epilepsia |volume=45 |issue=1 |pages=20–7 |date=January 2004 |pmid=14692903 |doi= |url=}}</ref>
** The initial dosage is 150 mg daily in either two or three divided doses.<ref name="pmid15740180">{{cite journal |vauthors=Warner G, Figgitt DP |title=Pregabalin: as adjunctive treatment of partial seizures |journal=CNS Drugs |volume=19 |issue=3 |pages=265–72; discussion 273–4 |date=2005 |pmid=15740180 |doi=10.2165/00023210-200519030-00007 |url=}}</ref>
** The most common side effects are dizziness, gait abnormalities and drowsiness.<ref name="pmid21320112">{{cite journal |vauthors=Zaccara G, Gangemi P, Perucca P, Specchio L |title=The adverse event profile of pregabalin: a systematic review and meta-analysis of randomized controlled trials |journal=Epilepsia |volume=52 |issue=4 |pages=826–36 |date=April 2011 |pmid=21320112 |doi=10.1111/j.1528-1167.2010.02966.x |url=}}</ref>
==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[Category:Needs overview]]
[[Category:Needs overview]]
[[Category:Neurological disorders]]
[[Category:Neurological disorders]]
Line 106: Line 125:
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Primary care]]

Latest revision as of 21:37, 29 July 2020

Epilepsy Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Epilepsy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

EEG

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Epilepsy medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Epilepsy medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Epilepsy medical therapy

CDC on Epilepsy medical therapy

Epilepsy medical therapy in the news

Blogs on Epilepsy medical therapy

Directions to Hospitals Treating Epilepsy

Risk calculators and risk factors for Epilepsy medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

overview

Medical Therapy

Pharmacologic medical therapies for epilepsy is anti-seizure drugs such as:

Drugs that affect voltage-dependent Na+ channels

Drugs that affect Ca currents

Drugs that affect GABA activity

Drugs that affect glutamate receptor

Drugs with multiple mechanisms of action

Drugs with other mechanisms of action

  • Brivaracetam
    • It can be used for treatment of focal-onset seizures and generalized epilepsy.[47][48]
    • The initial dosage is 50 mg twice daily.[49]
    • The most common side effects are irritability, anxiety, insomnia and depression.[50]
  • Gabapentin
    • It can be used for treatment of refractory focal seizures.[51]
    • The initial dosage is 300 mg three times daily.
    • The maximum dosage is 2400 mg/day.[52]
    • The most common side effects are sedation, dizziness, ataxia and weight gain.[53]
  • Levetiracetam
    • It can be used for adjunctive treatment of focal-onset seizures, myoclonic seizures in patients older than 12 y/o with juvenile myoclonic epilepsy, and primary generalized tonic-clonic seizures in patients older than six y/o with idiopathic generalized epilepsy.[54][55][56]
    • The initial dosage is 500 mg twice daily.
    • The maximum dosage is 4000 mg daily.[57]
    • The most common side effects are fatigue, drowsiness, dizziness, and upper respiratory tract infection.[58]
  • Pregabalin
    • It can be used for adjunctive therapy for focal seizures.[59]
    • The initial dosage is 150 mg daily in either two or three divided doses.[60]
    • The most common side effects are dizziness, gait abnormalities and drowsiness.[61]

References

  1. ↑ Hirsch LJ, Arif H, Nahm EA, Buchsbaum R, Resor SR, Bazil CW (November 2008). "Cross-sensitivity of skin rashes with antiepileptic drug use". Neurology. 71 (19): 1527–34. doi:10.1212/01.wnl.0000334295.50403.4c. PMID 18981374.
  2. ↑ Cereghino JJ, Brock JT, Van Meter JC, Penry JK, Smith LD, White BG (May 1974). "Carbamazepine for epilepsy. A controlled prospective evaluation". Neurology. 24 (5): 401–10. PMID 4207990.
  3. ↑ Chang XC, Yuan H, Wang Y, Xu HQ, Hong WK, Zheng RY (October 2017). "Eslicarbazepine acetate add-on for drug-resistant partial epilepsy". Cochrane Database Syst Rev. 10: CD008907. doi:10.1002/14651858.CD008907.pub3. PMID 29067682.
  4. ↑ Almeida L, Minciu I, Nunes T, Butoianu N, Falcão A, Magureanu SA, Soares-da-Silva P (August 2008). "Pharmacokinetics, efficacy, and tolerability of eslicarbazepine acetate in children and adolescents with epilepsy". J Clin Pharmacol. 48 (8): 966–77. doi:10.1177/0091270008319706. PMID 18508949.
  5. ↑ Sperling MR, Abou-Khalil B, Harvey J, Rogin JB, Biraben A, Galimberti CA, Kowacs PA, Hong SB, Cheng H, Blum D, Nunes T, Soares-da-Silva P (February 2015). "Eslicarbazepine acetate as adjunctive therapy in patients with uncontrolled partial-onset seizures: Results of a phase III, double-blind, randomized, placebo-controlled trial". Epilepsia. 56 (2): 244–53. doi:10.1111/epi.12894. PMC 4354260. PMID 25528898.
  6. ↑ Perucca E, Yasothan U, Clincke G, Kirkpatrick P (December 2008). "Lacosamide". Nat Rev Drug Discov. 7 (12): 973–4. doi:10.1038/nrd2764. PMID 19043448.
  7. ↑ Ben-Menachem E, Biton V, Jatuzis D, Abou-Khalil B, Doty P, Rudd GD, Halász P, Kälviäinen R, Mazurkiewicz-Beldzińska M, Rosenow F, Doty P, Hebert D, Sullivan T (July 2007). "Efficacy and safety of oral lacosamide as adjunctive therapy in adults with partial-onset seizures". Epilepsia. 48 (7): 1308–17. doi:10.1111/j.1528-1167.2007.01188.x. PMID 17635557.
  8. ↑ Perucca E, Yasothan U, Clincke G, Kirkpatrick P (December 2008). "Lacosamide". Nat Rev Drug Discov. 7 (12): 973–4. doi:10.1038/nrd2764. PMID 19043448.
  9. ↑ French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, Theodore WH, Bazil C, Stern J, Schachter SC, Bergen D, Hirtz D, Montouris GD, Nespeca M, Gidal B, Marks WJ, Turk WR, Fischer JH, Bourgeois B, Wilner A, Faught RE, Sachdeo RC, Beydoun A, Glauser TA (April 2004). "Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society". Neurology. 62 (8): 1252–60. PMID 15111659.
  10. ↑ Hirsch LJ, Weintraub D, Du Y, Buchsbaum R, Spencer HT, Hager M, Straka T, Bazil CW, Adams DJ, Resor SR, Morrell MJ (September 2004). "Correlating lamotrigine serum concentrations with tolerability in patients with epilepsy". Neurology. 63 (6): 1022–6. PMID 15452293.
  11. ↑ Hirsch LJ, Arif H, Nahm EA, Buchsbaum R, Resor SR, Bazil CW (November 2008). "Cross-sensitivity of skin rashes with antiepileptic drug use". Neurology. 71 (19): 1527–34. doi:10.1212/01.wnl.0000334295.50403.4c. PMID 18981374.
  12. ↑ Koch MW, Polman SK (October 2009). "Oxcarbazepine versus carbamazepine monotherapy for partial onset seizures". Cochrane Database Syst Rev (4): CD006453. doi:10.1002/14651858.CD006453.pub2. PMID 19821367.
  13. ↑ Kim DW, Gu N, Jang IJ, Chu K, Yu KS, Cho JY, Yoon SH, Kim HS, Oh J, Lee SK (January 2012). "Efficacy, tolerability, and pharmacokinetics of oxcarbazepine oral loading in patients with epilepsy". Epilepsia. 53 (1): e9–12. doi:10.1111/j.1528-1167.2011.03318.x. PMID 22091603.
  14. ↑ Buggy Y, Layton D, Fogg C, Shakir SA (May 2010). "Safety profile of oxcarbazepine: results from a prescription-event monitoring study". Epilepsia. 51 (5): 818–29. doi:10.1111/j.1528-1167.2009.02489.x. PMID 20132298.
  15. ↑ Yaari Y, Selzer ME, Pincus JH (August 1986). "Phenytoin: mechanisms of its anticonvulsant action". Ann. Neurol. 20 (2): 171–84. doi:10.1002/ana.410200202. PMID 2428283.
  16. ↑ Caudle KE, Rettie AE, Whirl-Carrillo M, Smith LH, Mintzer S, Lee MT, Klein TE, Callaghan JT (November 2014). "Clinical pharmacogenetics implementation consortium guidelines for CYP2C9 and HLA-B genotypes and phenytoin dosing". Clin. Pharmacol. Ther. 96 (5): 542–8. doi:10.1038/clpt.2014.159. PMID 25099164.
  17. ↑ Iivanainen M, Savolainen H (1983). "Side effects of phenobarbital and phenytoin during long-term treatment of epilepsy". Acta Neurol. Scand., Suppl. 97: 49–67. PMID 6424397.
  18. ↑ Glauser T, Kluger G, Sachdeo R, Krauss G, Perdomo C, Arroyo S (May 2008). "Rufinamide for generalized seizures associated with Lennox-Gastaut syndrome". Neurology. 70 (21): 1950–8. doi:10.1212/01.wnl.0000303813.95800.0d. PMID 18401024.
  19. ↑ Marchand M, Fuseau E, Critchley DJ (February 2010). "Supporting the recommended paediatric dosing regimen for rufinamide in Lennox-Gastaut syndrome using clinical trial simulation". J Pharmacokinet Pharmacodyn. 37 (1): 99–118. doi:10.1007/s10928-009-9146-4. PMID 20084538.
  20. ↑ Wheless JW, Vazquez B (January 2010). "Rufinamide: a novel broad-spectrum antiepileptic drug". Epilepsy Curr. 10 (1): 1–6. doi:10.1111/j.1535-7511.2009.01336.x. PMC 2812713. PMID 20126329.
  21. ↑ Guerrini R, Rosati A, Segieth J, Pellacani S, Bradshaw K, Giorgi L (August 2013). "A randomized phase III trial of adjunctive zonisamide in pediatric patients with partial epilepsy". Epilepsia. 54 (8): 1473–80. doi:10.1111/epi.12233. PMID 23837461.
  22. ↑ Leppik IE (December 2004). "Zonisamide: chemistry, mechanism of action, and pharmacokinetics". Seizure. 13 Suppl 1: S5–9, discussion S10. doi:10.1016/j.seizure.2004.04.016. PMID 15511691.
  23. ↑ Park SP, Hwang YH, Lee HW, Suh CK, Kwon SH, Lee BI (January 2008). "Long-term cognitive and mood effects of zonisamide monotherapy in epilepsy patients". Epilepsy Behav. 12 (1): 102–8. doi:10.1016/j.yebeh.2007.08.002. PMID 17945539.
  24. ↑ Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Capparelli EV, Adamson PC (March 2010). "Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy". N. Engl. J. Med. 362 (9): 790–9. doi:10.1056/NEJMoa0902014. PMC 2924476. PMID 20200383.
  25. ↑ Uzun S, Kozumplik O, Jakovljević M, Sedić B (March 2010). "Side effects of treatment with benzodiazepines". Psychiatr Danub. 22 (1): 90–3. PMID 20305598.
  26. ↑ "apps.who.int" (PDF).
  27. ↑ Camfield CS, Chaplin S, Doyle AB, Shapiro SH, Cummings C, Camfield PR (September 1979). "Side effects of phenobarbital in toddlers; behavioral and cognitive aspects". J. Pediatr. 95 (3): 361–5. PMID 381616.
  28. ↑ French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, Theodore WH, Bazil C, Stern J, Schachter SC, Bergen D, Hirtz D, Montouris GD, Nespeca M, Gidal B, Marks WJ, Turk WR, Fischer JH, Bourgeois B, Wilner A, Faught RE, Sachdeo RC, Beydoun A, Glauser TA (April 2004). "Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society". Neurology. 62 (8): 1252–60. PMID 15111659.
  29. ↑ Pulman J, Marson AG, Hutton JL, French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, Theodore WH, Bazil C, Stern J, Schachter SC, Bergen D, Hirtz D, Montouris GD, Nespeca M, Gidal B, Marks WJ, Turk WR, Fischer JH, Bourgeois B, Wilner A, Faught RE, Sachdeo RC, Beydoun A, Glauser TA (May 2012). "Tiagabine add-on for drug-resistant partial epilepsy". Cochrane Database Syst Rev. 62 (5): CD001908. doi:10.1002/14651858.CD001908.pub2. PMC 4058679. PMID 22592677.
  30. ↑ Hemming K, Maguire MJ, Hutton JL, Marson AG (January 2013). "Vigabatrin for refractory partial epilepsy". Cochrane Database Syst Rev (1): CD007302. doi:10.1002/14651858.CD007302.pub2. PMID 23440814.
  31. ↑ "Vigabatrin (Sabril) for epilepsy". Med Lett Drugs Ther. 52 (1332): 14–6, quiz 17. February 2010. PMID 20208475.
  32. ↑ Chadwick D (July 1999). "Safety and efficacy of vigabatrin and carbamazepine in newly diagnosed epilepsy: a multicentre randomised double-blind study. Vigabatrin European Monotherapy Study Group". Lancet. 354 (9172): 13–9. PMID 10406359.
  33. ↑ "Drugs@FDA: FDA Approved Drug Products".
  34. ↑ Coyle H, Clough P, Cooper P, Mohanraj R (December 2014). "Clinical experience with perampanel: focus on psychiatric adverse effects". Epilepsy Behav. 41: 193–6. doi:10.1016/j.yebeh.2014.09.072. PMID 25461214.
  35. ↑ French JA, Krauss GL, Biton V, Squillacote D, Yang H, Laurenza A, Kumar D, Rogawski MA (August 2012). "Adjunctive perampanel for refractory partial-onset seizures: randomized phase III study 304". Neurology. 79 (6): 589–96. doi:10.1212/WNL.0b013e3182635735. PMC 3413761. PMID 22843280.
  36. ↑ Bourgeois BF (1994). "Felbamate in the treatment of partial-onset seizures". Epilepsia. 35 Suppl 5: S58–61. PMID 8039474.
  37. ↑ O'Neil MG, Perdun CS, Wilson MB, McGown ST, Patel S (May 1996). "Felbamate-associated fatal acute hepatic necrosis". Neurology. 46 (5): 1457–9. PMID 8628501.
  38. ↑ Pulman J, Jette N, Dykeman J, Hemming K, Hutton JL, Marson AG (February 2014). "Topiramate add-on for drug-resistant partial epilepsy". Cochrane Database Syst Rev (2): CD001417. doi:10.1002/14651858.CD001417.pub3. PMID 24570033.
  39. ↑ Ramsay E, Faught E, Krumholz A, Naritoku D, Privitera M, Schwarzman L, Mao L, Wiegand F, Hulihan J (October 2010). "Efficacy, tolerability, and safety of rapid initiation of topiramate versus phenytoin in patients with new-onset epilepsy: a randomized double-blind clinical trial". Epilepsia. 51 (10): 1970–7. doi:10.1111/j.1528-1167.2010.02670.x. PMID 20633037.
  40. ↑ Majkowski J, Neto W, Wapenaar R, Van Oene J (May 2005). "Time course of adverse events in patients with localization-related epilepsy receiving topiramate added to carbamazepine". Epilepsia. 46 (5): 648–53. doi:10.1111/j.1528-1167.2005.35904.x. PMID 15857429.
  41. ↑ Loiseau P (1984). "Rational use of valproate: indications and drug regimen in epilepsy". Epilepsia. 25 Suppl 1: S65–72. PMID 6425050.
  42. ↑ Biton V, Mirza W, Montouris G, Vuong A, Hammer AE, Barrett PS (January 2001). "Weight change associated with valproate and lamotrigine monotherapy in patients with epilepsy". Neurology. 56 (2): 172–7. PMID 11160951.
  43. ↑ Endo A, Fujita Y, Fuchigami T, Takahashi S, Mugishima H (April 2010). "Fanconi syndrome caused by valproic acid". Pediatr. Neurol. 42 (4): 287–90. doi:10.1016/j.pediatrneurol.2009.12.003. PMID 20304335.
  44. ↑ Gerstner T, Teich M, Bell N, Longin E, Dempfle CE, Brand J, König S (July 2006). "Valproate-associated coagulopathies are frequent and variable in children". Epilepsia. 47 (7): 1136–43. doi:10.1111/j.1528-1167.2006.00587.x. PMID 16886976.
  45. ↑ Sahota P, Prabhakar S, Kharbanda PS, Bhansali A, Jain V, Das CP, Modi M (December 2008). "Seizure type, antiepileptic drugs, and reproductive endocrine dysfunction in Indian women with epilepsy: a cross-sectional study". Epilepsia. 49 (12): 2069–77. doi:10.1111/j.1528-1167.2008.01676.x. PMID 18503558.
  46. ↑ Aggarwal A, Rastogi N, Mittal H, Chillar N, Patil R (September 2011). "Thyroid hormone levels in children receiving carbamazepine or valproate". Pediatr. Neurol. 45 (3): 159–62. doi:10.1016/j.pediatrneurol.2011.04.005. PMID 21824562.
  47. ↑ Klein P, Schiemann J, Sperling MR, Whitesides J, Liang W, Stalvey T, Brandt C, Kwan P (December 2015). "A randomized, double-blind, placebo-controlled, multicenter, parallel-group study to evaluate the efficacy and safety of adjunctive brivaracetam in adult patients with uncontrolled partial-onset seizures". Epilepsia. 56 (12): 1890–8. doi:10.1111/epi.13212. PMID 26471380.
  48. ↑ Klein P, Schiemann J, Sperling MR, Whitesides J, Liang W, Stalvey T, Brandt C, Kwan P (December 2015). "A randomized, double-blind, placebo-controlled, multicenter, parallel-group study to evaluate the efficacy and safety of adjunctive brivaracetam in adult patients with uncontrolled partial-onset seizures". Epilepsia. 56 (12): 1890–8. doi:10.1111/epi.13212. PMID 26471380.
  49. ↑ "Drugs@FDA: FDA Approved Drug Products".
  50. ↑ Klein P, Schiemann J, Sperling MR, Whitesides J, Liang W, Stalvey T, Brandt C, Kwan P (December 2015). "A randomized, double-blind, placebo-controlled, multicenter, parallel-group study to evaluate the efficacy and safety of adjunctive brivaracetam in adult patients with uncontrolled partial-onset seizures". Epilepsia. 56 (12): 1890–8. doi:10.1111/epi.13212. PMID 26471380.
  51. ↑ French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL, Theodore WH, Bazil C, Stern J, Schachter SC, Bergen D, Hirtz D, Montouris GD, Nespeca M, Gidal B, Marks WJ, Turk WR, Fischer JH, Bourgeois B, Wilner A, Faught RE, Sachdeo RC, Beydoun A, Glauser TA (April 2004). "Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society". Neurology. 62 (8): 1261–73. PMID 15111660.
  52. ↑ Al-Bachari S, Pulman J, Hutton JL, Marson AG (July 2013). "Gabapentin add-on for drug-resistant partial epilepsy". Cochrane Database Syst Rev (7): CD001415. doi:10.1002/14651858.CD001415.pub2. PMID 23888424.
  53. ↑ Smith RV, Havens JR, Walsh SL (July 2016). "Gabapentin misuse, abuse and diversion: a systematic review". Addiction. 111 (7): 1160–74. doi:10.1111/add.13324. PMC 5573873. PMID 27265421.
  54. ↑ Berkovic SF, Knowlton RC, Leroy RF, Schiemann J, Falter U (October 2007). "Placebo-controlled study of levetiracetam in idiopathic generalized epilepsy". Neurology. 69 (18): 1751–60. doi:10.1212/01.wnl.0000268699.34614.d3. PMID 17625106.
  55. ↑ Mbizvo GK, Dixon P, Hutton JL, Marson AG (September 2012). "Levetiracetam add-on for drug-resistant focal epilepsy: an updated Cochrane Review". Cochrane Database Syst Rev (9): CD001901. doi:10.1002/14651858.CD001901.pub2. PMID 22972056.
  56. ↑ Delanty N, Jones J, Tonner F (January 2012). "Adjunctive levetiracetam in children, adolescents, and adults with primary generalized seizures: open-label, noncomparative, multicenter, long-term follow-up study". Epilepsia. 53 (1): 111–9. doi:10.1111/j.1528-1167.2011.03300.x. PMID 22050371.
  57. ↑ Betts T, Waegemans T, Crawford P (March 2000). "A multicentre, double-blind, randomized, parallel group study to evaluate the tolerability and efficacy of two oral doses of levetiracetam, 2000 mg daily and 4000 mg daily, without titration in patients with refractory epilepsy". Seizure. 9 (2): 80–7. doi:10.1053/seiz.2000.0380. PMID 10845730.
  58. ↑ Delanty N, Jones J, Tonner F (January 2012). "Adjunctive levetiracetam in children, adolescents, and adults with primary generalized seizures: open-label, noncomparative, multicenter, long-term follow-up study". Epilepsia. 53 (1): 111–9. doi:10.1111/j.1528-1167.2011.03300.x. PMID 22050371.
  59. ↑ Arroyo S, Anhut H, Kugler AR, Lee CM, Knapp LE, Garofalo EA, Messmer S (January 2004). "Pregabalin add-on treatment: a randomized, double-blind, placebo-controlled, dose-response study in adults with partial seizures". Epilepsia. 45 (1): 20–7. PMID 14692903.
  60. ↑ Warner G, Figgitt DP (2005). "Pregabalin: as adjunctive treatment of partial seizures". CNS Drugs. 19 (3): 265–72, discussion 273–4. doi:10.2165/00023210-200519030-00007. PMID 15740180.
  61. ↑ Zaccara G, Gangemi P, Perucca P, Specchio L (April 2011). "The adverse event profile of pregabalin: a systematic review and meta-analysis of randomized controlled trials". Epilepsia. 52 (4): 826–36. doi:10.1111/j.1528-1167.2010.02966.x. PMID 21320112.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Epilepsy_medical_therapy&oldid=1637869"