Pharmacological Approaches to the Treatment of Epilepsy


Authors: J. Hovorka
Authors‘ workplace: Neurochirurgická klinika 1. LF UK a ÚVN Praha
Published in: Cesk Slov Neurol N 2010; 73/106(4): 351-373
Category: Minimonography

Overview

In this paper we provide an overview of the basic principles of the treatment of epilepsy. These include attention to certain key points: making a correct diagnosis; the risk of seizure recurrence; the decision to initiate drug therapy in newly-diagnosed epilepsy; drug choice in relation to seizure/syndrome type and individual patient characteristics; treatment strategy in terms of monotherapy or of combination therapy; the treatment of pharmaco-resistant epilepsy, and finally the decision to withdraw antiepileptic drug(s) from seizure-free patients.

Key words:
epilepsy – treatment of epilepsy – anti-epileptic drugs – treatment strategy – newly diagnosed epilep­­sy – monotherapy – rational polytherapy – pharmaco-resistant epilepsy – drug withdrawal


Sources

1. Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 1993; 34(3): 453–468.

2. EpiStop. Soubor minimálních diagnostických a terapeutických standardů u pacientů s epilepsií. Praha: Maxdorf 2007: 1–58. (Dostupné z URL: ­www.­epistop.­cz)

3. Dolanský J. Současná epileptologie. Praha: Triton 2000.

4. Komárek V. Epilepsie a epileptické syndromy. Praha: Galén 1997: 1–117.

5. Donáth V, Kuchar M, Sýkora P. Epilepsia. Bratislava: Slovenské pedagogické nakladatelstvo 2000: 1–340.

6. Hovorka J. Základní principy protizáchvatové léčby. Cesk Slov Neurol N 1998: 61/94(1): 1–16.

7. Hadač J. Epilepsie-základy diagnostických a léčebných postupů. In: Hadač J (ed). Klinické zkušenosti s přípravkem neurontin (gabapentin) v léčbě epilepsie. Praha: Maxdorf 2003: 7–23.

8. Leppik IE. Contemporary diagnosis and management of the patient with epilepsy. 5th ed. Pennsylvania: Newton 2001.

9. Panayotopoulos CP. A clinical guide to epileptic syndromes and their treatment. 2nd ed. London: Springer-Verlag 2007.

10. Hovorka J, Herman E, Nežádal T. Epilepsie a základy antiepileptické léčby – I. Neurol pro praxi 2004; 3: 45–49.

11. Shorvon S. Principles of treatment of epilepsy. In: Shorvon S (ed). Epilepsy. Oxford: Oxford Neurology ­Library 2009: 65–90.

12. Komárek V. Léčba věkově vázaných epileptických syndromů s příznivou prognózou. Neurol pro praxi 2007; 2: 87–90.

13. Komárek V. Léčba epileptických syndromů u dětí. Cesk Slov Neurol N 2007; 71/103(5): 473–487.

14. Ošlejšková H et al. Epileptické a neepileptické záchvaty v dětství a adolescenci. Plzeň: Adela 2009: 1–274.

15. Hovorka J, Herman E. Neuropsychiatrické aspekty u epilepsie. Cesk Slov Neurol N 2001; 70/103 (Suppl): 1–16.

16. Hovorka J, Herman E, Bajaček M, Doubek P, Praško J. Psychiatrické aspekty epilepsie. Neurol pro praxi 2005; 2: 89–94.

17. Hovorka J, Herman E, Nežádal T. Epilepsie a základy antiepileptické léčby – II, aspekty psychiatrické. Neurol pro praxi 2004; 4: 13–17.

18. Praško J, Pastucha P, Raszka M, Látalová E, Herman E, Hovorka J et al. Disociativní křeče. Cesk Slov Neurol N 2009; 72/105(4): 429–436.

19. Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electrographic classification of epileptic seizures. Epilepsia 1981; 22(4): 489–501.

20. Kalina M. Status epilepticus. Neurol pro praxi 2002; 2: 87–93.

21. Blume WT, Lüders HO, Mizrahi E, Tassinari C, van Emde Boas W, Engel J jr. Glossary of descriptive terminology for ital semiology: report of the ILAE task force on classification and terminology. Epilepsia 2001; 42(9): 1212–1218.

22. Commision on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiological studies on epilepsy. Epilepsia 1993; 34(4): 592–596.

23. Fischer RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Burelu for Epilepsy (IBE). Epilepsia 2005; 46(4): 470–472.

24. Hauser WA, Rich SS, Annegers JF, Anderson VE. Seizure recurrence after a 1st unprovoked seizure: an extended follow-up. Neurology 1990; 40(8): ­1163–1170.

25. Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology 1991; 41(7): 965–972.

26. Berg AT. Risk of recurrence after a first unprovoked seizure. Epilepsia 2008; 49 (Suppl 1): 13–18.

27. Hauser WA, Rich SS, Lee JR, Annegers JF, Anderson VE. Risk of recurrent seizures after two unprovoked seizures. N Engl J Med 1998; 338(7): ­429–434.

28. Leach JP, Mohanraj R. Treatment of adults with newly diagnose epilepsy. In: French JA, Delanty N (eds). Therapeutic strategies in epilepsy. Oxford: Clinical Publishing 2009: 119–133.

29. Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and Management of Epilepsy in Adults. Edinburg 2003: 1–49. (Dostupné z URL: www.sign.ac.uk)

30. Shinnar S, Berg AT, O´Dell C, Newstein D, Moshe SL, Hauser WA. Predictors of multiple seizures in a cohort of children prospectively followed from the time of their first unprovoked seizure. Ann Neurol 2000; 48: 140–147.

31. Haut SR, O´Dell C, Shinnar S. Risk factors for deve­loping epilepsy after first unprovoked seizure. In: Ryvlin P, Beghi E, Camfield P et al (eds). From first unprovoked seizure to newly diagnosed epilepsy. Progress in epileptic disorders, vol. 3. Mesher: John Libbey Eurotext 2007: 37–57.

32. Sýkora P. Liečba epileptických syndrómov v dětskom veku s nepriaznivou prognózou. Neurol pro praxi 2007; 2: 91–93.

33. Hovorka J. Přínos EEG vyšetření pro klinickou epileptologii – možnosti „využití“ a „zneužití“. In: Hovorka J (ed). Klinická elektroencefalografe, základy klasifikace a interpretace. Praha: Maxdorf 2003: ­105–165.

34. First Seizure Trial Group. Randomized clinical trial on efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. Neurology 1993; 43 (3 Pt 1): ­478–483.

35. Marson A, Jacoby A, Johnson A, Kim L, Gamble C, Chadwick D. Medical Research Council MESS Study Group. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet 2005; 365(9476): 2007–2013.

36. Shellhaas RA, Dlugos DJ. Treatment of the child or adolescent with newly diagnose epilepsy. In: French JA, Delanty N (eds). Therapeutic strategies in epilepsy. Oxford: Clinical Publishing 2009: 85–102.

37. Zárubová J. Zásady farmakoterapie epilepsie u dospělých. Postgrad Med 2005; 6(7): 654–662.

38. Mohanraj R, Brodie MJ. Diagnosis refractory epilepsy: response to sequential treatment scheadules. Eur J Neurol 2006; 13(3): 277–282.

40. Hovorka J.Volba optimální antiepileptické léčby na dvou osách: osa I – podle typu epileptických ­záchvatů­/­syndromu, osa II – podle typu, individuality pacienta. Postgrad Med 2009; 8: 898–905.

41. Commission on Classification and Terminology of the International League Against Epilepsy (1989). Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989; 30(4): 389–399.

42. Commission on Classification and Terminology of the International League Against Epilepsy. Revised terminology and concepts for organization of the epi­lepsies: Report of the Commission on Classification and Terminology. ILAE 28 July 2009: 1–16.

43. Hovorka J. Farmakologická léčba epilepsie podle „guidelines“? Neurol pro praxi 2009; 4: 171–176.

44. Glauser T, Ben-Menachem E, Bourgeois E, Cnaan A, Chadwick D, Guerreiro C et al. ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2006; 47(7): 1094–1120.

45. French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL et al. 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 2004; 62(8): 1252–1260. (Dostupné z URL: www.aan.com/professionals/index/cfm)

46. French JA, Kanner AM, Bautista J, Abou-Khalil B, Browne T, Harden CL et al. 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 2004; 62(8): 1261–1273. (Dostupné z URL: ­www­.­aan.com/professionals/index/cfm)

47. National Institute for Clinical Excellence (NICE). The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care. London: Clinical guideline 2004: 1–73. (Dostupné z URL: www.nice.org.uk)

48. Brodie MJ, Perucca E, Ryvlin P, Ben-Menachem E, Meencke HJ. Comparison of levetiracetam and controlled-release carbamazepin in newly diagnosed epilepsy. Neurology 2007; 68(6): 402–408.

49. Rektor I, Kuba R. Nová antiepileptika u dospělých – nové informace. Neurol pro praxi 2007; 2: 70–74.

50. Zárubová J. Novinky ve farmakoterapii epilepsie. Farmakoterapie 2008; 1: 13–18.

51. Brázdil M. Moderní racionální terapie epilepsie.Neurol pro praxi 2009; 10(2): 94–100.

52. Hovorka J. Novinky v léčbě epilepsie. Remedia 2009; 4: 23–27.

53. Ošlejšková H. Zhoršování epileptických záchvatů a epilepsií antiepileptiky – je to možné? Cesk Slov Neurol N 2007; 70/103(2): 137–142.

54. Bajaček M, Hovorka J, Nežádal T, Němcová I, Herman E. Is pseudo-intractibility in population of patient with epilepsy still alive in 21 century? Audit of 100 seizure free patients, referred with diagnosis of pharmacoresistant epilepsy. Neuroendocrinol Lett. In press 2010.

55. Mohanraj R, Brodie MJ. Pharmacological outcomes in newly diagnose epilepsy. Epilepsy Behav 2005; 6(3): 382–387.

56. Marson AG, Al-Kharusi AM, Alwaidh M, Appleton R, Baker GA, Chadwick DW et al. SANAD study group. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbamapezine, or topiramate for generalised epilepsy: an unblinded randomised controlled trial. Lancet 2007; 369(9566): 1000–1015.

57. Marson AG, Al-Kharusi AM, Alwaidh M, Appleton R, Baker GA, Chadwick DW et al. SANAD study group. The SANAD study of effectiveness of vaproate, lamotrigine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial. ­Lancet 2007; 369(9566): 1016–1026.

58. Deckers CL, Czuczwar SJ, Hekster YA, Keyser A, Kubova H, Meinardi H et al. Selection of antiepileptic drug polytherapy based on mechanism of action: the evidence reviewed. Epilepsia 2000; 41(11): ­1364–1374.

59. Kwan P, Brodie MJ. Combination therapy in epi­lepsy: when and what to use. Drugs 2006; 66(14): 1817–1829.

60. Hovorka J, Nežádal T. Kombinovaná léčba antiepileptiky u epilepsie: taktika, volba léků, interakce. Neurol pro praxi 2007; 2: 80–85.

61. Zárubová J. Epilepsie a mateřství. Neurol pro praxi 2004; 6: 331–336.

62. Zárubová J et al. Žena a epilepsie. Praha: Maxdorf 2004: 1–109.

63. Tomson T, Battino D. Teratogenic effects of antiepileptic medications. Neurol Clin 2009; 27(4): ­993–1002.

64. Topinková E et al. Geriatrie pro praxi. Praha: Galén 2005: 1–270.

65. Nežádal T, Hovorka J, Bajaček M, Janicadisová M. Léčba epilepsie ve vyšším věku – farmakokinetické interakce. Čes Ger Rev 2007; 5(3): 156–163.

66. Hovorka J, Nežádal T, Bajaček M. Epilepsie a epileptické záchvaty ve stáří. Postgrad Med 2008; 10(7): 763–771.

67. Svačina Š, Owen K, Bretšnajderová A. Syndrom inzulinové rezistence. Praha: Triton 2003: 1–182.

68. Hovorka J, Herman E, Bajaček M, Doubek P, Praško J. Psychiatrické aspekty epilepsie. Neurol pro praxi 2005; 2: 89–94.

69. Komárek V, Hovorka J. Pseudofarmakorezistence a zásady racionální polyterapie. In: Brázdil M, Hadač J, Marusič P et al (eds). Farmakorezistentní epilepsie. Praha: Triton 2004: 171–175.

70. Sillanpää M, Schmidt D. Natural history of treated childhood-onset epilepsy: prospective, long-term population-based study. Brain 2006; 129 (Pt 3): ­617–624.

71. Schmidt D, Löscher W. Drug resistance in epilepsy: putative neurobiological and clinical mechanism. Epilepsia 2005; 46(6): 858–877.

72. French J, Faught E. Rational polytherapy. Epilepsia 2009; 50 (Suppl 8): 63–68.

73. Kwan P, Brodie MJ. Combination therapy in epilepsy: when and what to use. Drugs 2006; 66(14): 1817–1829.

74. Bourgeois BF. Treatment of the child or adolescent with treatment-resistant epilepsy. In: French JA, Delanty N (eds). Therapeutic strategies in epilepsy. Oxford: Clinical Publishing 2009: 103–116.

75. Kwan P, Leung H. Treatment of adults with treatment-resistant epilepsy. In: French JA, Delanty N (eds). Therapeutic strategies in epilepsy. Oxford: Clinical Publishing 2009: 135–151.

76. Bourgeois BF. Anticonvulsant potency and neurotoxicity of valproate alone and in combination with carbamazepine or phenobarbital. Clin Neuropharmacol 1988; 11(4): 348–359.

77. Bourgeois BF. Combination of valproate and ethosuximide: antiepileptic and neurotoxic interaction. J Pharmacol Exp Ther 1988; 247(3): ­1128–1132.

78. Brodie MJ, Yuen AW. Lamotrigine substitution study: evidence for synergism with sodium vaplroate? 105 Study group. Epilepsy Res 1997; 26(3): 423–432.

79. Schmidt D. Strategies to present overtreatment with antiepileptic drugs in patients with epilepsy. ­Epilepsy Res 2002; 52(1): 61–69.

80. Brázdil M, Hadač J. Definice pseudofarmakorezistence, příčiny intraktibility. In: Brázdil M, Hadač J, Marusič P et al (eds). Farmakorezistentní epilepsie. Praha: Triton 2004: 13–21.

81. Wiebe S, Blume WT, Girvin JP, Eliazsiw M. A randomized trial of surgerical versus medical therapy of temporal lobe epilepsy. N Engl Med 2001; 345: ­311–318.

82. Brázdil M, Hadač J, Komárek V, Kuba R, Marusič P. Epileptochirurgické zákroky.

In: Brázdil M, Hadač J, Marusič P (eds). Farmakorezistentní epilepsie. Praha: Triton 2004: 182–203.

83. Régis J, Rey M, Bartolomei F, Vladyka V, Liscak R, Schröttner O et al. Gamma knife surgery in mesial temporal epilepsy: a prospective multicenter study. Epilepsia 2004; 45(5): 504–515.

84. Urgošík D. Funkční neurochirurgie. In: Liščák R. Radiochirurgie gama nožem. Praha: Grada Publishing 2009: 215–217.

85. Malíková H, Vojtěch Z, Liščák R, Procházka T, Vymazal J, Vladyka V et al. Stereotactic radiofrequency amygdalohippocampectomy for treatment of mesial temporal lobe epilepsy: correlation of MRI with clinical seizure outcome. Epilepsy Res 2009; 83(2–3): ­235–242.

86. Hovorka J, Nežádal T, Herman E, Němcová I, Bajaček M. Psychogenic non-epileptic seizures, prospective clinical experience: diagnosis, clinical features, risk factors, psychiatric comorbidity, treatment outcome. Epileptic Disord 2007; 9 (Suppl 1): 52–59.

87. Specchio LM, Beghi E. Should antiepileptic drugs be withdrawn in seizure-free patients? CNS Drugs 2004; 18(4): 201–212.

88. Medical Research Council Antiepileptic Drug Withdrawal Study Group. Prognostic index for recurrence of seizure after remission of epilepsy. BMJ 1993; 306(6889): 1374–1378.

89. Medical Research Council Antiepileptic Drug With­drawal Study Group. Randomised study of antiepileptic drug withdrawal in patients in remission. Lancet 1991; 337(8751): 1175–1180.

90. Temkin NR. Antiepileptogenesis and seizure prevention trial with antiepileptic drugs: meta- analysis of controled trials. Epilepsia 2001; 42: 515–524.

91. Watts AE. The natural history of untreated epilepsy in rural community in Africa. Epilepsia 1992; 33(3): 464–468.

92. Tennison M, Greenwood R, Lewis D, Thorn M. Discontinuing antiepileptic drugs in children with epilepsy: a comparison of a six-week and nine-month taper period. N Engl J Med 1994; 330(20): 1407–1410.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 4

2010 Issue 4

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account