Epilepsy medical therapy

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

overview

Medical Therapy

Pharmacologic medical therapies for epilepsy is antiseizure drugs such as:

  • Drugs that affect voltage-dependent Na+ channels
    • Carbamazepin:
      • It can be used in treatment of both generalized and 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 GI disturbance, rash, hyponatremia and fluid retention.[1] [2]
    • Eslicarbazepin
      • It can be used for treatment of focal-onset seizures in adult and children under 4 y/o.[3]
      • The initial dosage is 400 mg/daily for adults. The maximum dosing is maintenance dose of 800 mg/daily.[4]
      • The most common side effects of this drug are dizziness, drowsiness, nausea, headache, fatigue, vertigo, ataxia, diplopia, blurred vision, and tremor.[5]
    • Lacosamide
      • It can be used for treatment of focal-onset seizures in adult and children older than 4 y/o.[6]
      • 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.[7]
      • The most common side effects are Dizziness, nausea, vertigo, and ataxia.[8]
    • Oxcarbazepine
    • Phenytoin
    • Rufinamide
  • Drugs that affect Ca currents
    • Ethosuximide
  • Drugs that affect GABA activity
    • Benzodiazepines
    • Phenobarbital
    • Tiagabine
    • Vigabatrin
  • Drugs that affect glutamate receptor
    • Perampanel
  • Drugs with multiple mechanisms of action
    • Felbamate
    • Topiramate
    • Valporate
  • Drugs with other mechanisms of action
    • Brivaracetam
    • Gabapentin
    • Levetiracetam
    • Pregabalin

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.

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