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]
    • Lamotrigine
      • It can be used for adjunctive treatment for primary generalized tonic-clonic seizures and focal seizures in adults and children under two y/o.[9]
      • The initial dosage is 25 mg/daily.
      • The maximum dosage is 225 to 375 mg/daily[10]
      • The most common side effects are rash and nausea.[11]
    • Oxcarbazepine
      • It can be used for treatment of focal and secondarily generalized tonic-clonic seizures.[12]
      • The initial dosage is 300 to 600 mg/day.
      • The maximum dosage is 900 to 3000 mg/day.[13]
      • The most common side effects are hyponatremia, sedation, headache, rash, dizziness, vertigo, ataxia, nausea, and diplopia.[14]
    • Phenytoin
      • It can be used for treatment of focal/generalized seizures and status epilepticus.[15]
      • The initial dosage is 15 mg/kg/day in three doses.[16]
      • The most common side effects are gingival hypertrophy, hirsutism, rash, folic acid depletion, and decreased bone density.[17]
    • Rufinamide
      • It can be used for adjunctive treatment of seizures associated with Lennos-gastaut syndrome (LGS).[18]
      • 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.[19]
      • The most common side effects are drowsiness and vomiting.[20]
  • Drugs that affect Ca currents
    • Ethosuximide
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
  • Drugs that affect GABA activity
    • Benzodiazepines
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
    • Phenobarbital
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
    • Tiagabine
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
    • Vigabatrin
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
  • Drugs that affect glutamate receptor
    • Perampanel
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
  • Drugs with multiple mechanisms of action
    • Felbamate
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
    • Topiramate
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
    • Valporate
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
  • Drugs with other mechanisms of action
    • Brivaracetam
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
    • Gabapentin
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
    • Levetiracetam
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are
    • Pregabalin
      • It can be used for treatment of
      • The initial dosage is
      • The most common side effects are

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.

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