Practice Update: Review of Anticonvulsant Therapy

  title={Practice Update: Review of Anticonvulsant Therapy},
  author={Derek J. Chong and Andrew M Lerman},
  journal={Current Neurology and Neuroscience Reports},
  • D. ChongA. Lerman
  • Published 16 March 2016
  • Medicine, Psychology
  • Current Neurology and Neuroscience Reports
Since 2010, the Food and Drug Administration has approved the use of four new anti-epilepsy drugs (AEDs) for the treatment of epilepsy in the USA: clobazam (Onfi), ezogabine (Potiga), perampanel (Fycompa), and eslicarbazepine (Aptiom) as well as two extended release formulations, topiramate ER (Qudexy XR and Trokendi) and oxcarbazepine ER (Oxtellar). This not only provides practitioners ample choice to match medication profiles to their patients’ preferences and co-morbidities better, but also… 

Pharmacokinetics and Drug Interaction of Antiepileptic Drugs in Children and Adolescents

The mechanism of action, pharmacokinetics, drug–drug interactions, and safety/tolerability profiles of the main AEDs currently used in children and adolescents are reviewed, paying particular regard to issues of relevance when treating this patient population.


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In general, AED therapy following a first unprovoked seizure in children is not recommended, however, treatment should be considered after a second seizure, and guidelines for monitoring adverse effects are outlined.

The pharmacological management of Lennox-Gastaut syndrome and critical literature review

Miscellaneous Therapeutic Drugs

The final group of drugs discussed in this chapter are the non-narcotic analgesics and include aspirin, nonsteroidal anti-inflammatory agents, and acetaminophen.

Perampanel: Does it have broad‐spectrum potential?

Perampanel is a potentially broad‐spectrum antiepileptic drug with a novel mechanism of action that may be a useful addition for patients with epilepsy with various seizure types.

Identification of Guaifenesin-Andrographolide as a Novel Combinatorial Drug Therapy for Epilepsy Using Network Virtual Screening and Experimental Validation.

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Experience in the use of clobazam in the treatment of Lennox–Gastaut syndrome

Clobazam appears to have a safe profile and sustained effectiveness over the first 3 years of use in LGS and other epilepsy syndromes with intractable seizures, which makes it a viable long-term treatment option.

Comprehensive overview: efficacy, tolerability, and cost-effectiveness of clobazam in Lennox–Gastaut syndrome

  • M. Faulkner
  • Medicine, Psychology
    Therapeutics and clinical risk management
  • 2015
Data from an open-label extension trial have confirmed that clobazam is efficacious for the treatment of seizures associated with LGS, particularly atonic seizures (drop seizures), over the long term.

Clobazam in the Treatment of Epilepsy: A Review of the Literature

  • C. Remy
  • Medicine, Psychology
  • 1994
Clobazam appears to be a useful treatment for epilepsy as intermittent or short‐term add‐on therapy; but it should also be tried as long‐term therapy in some situations, especially as add-on therapy for patients with refractory epilepsy, as add‐ on or monotherapy for Patients with anxiety, or in some women in association with oral contraceptives.

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

The results of this evidence-based assessment provide guidelines for the prescription of AEDs for patients with newly diagnosed epilepsy and identify those seizure types and syndromes where more evidence is necessary.

The use of monotherapy in patients with epilepsy: An appraisal of the new antiepileptic drugs

The advantages of using AEDs in monotherapy in patients with newly diagnosed and refractory epilepsies are reviewed, focusing on the individual properties of the drugs that may make them more appropriate in various patient groups.

Drug Interactions with the Newer Antiepileptic Drugs (AEDs)—Part 1: Pharmacokinetic and Pharmacodynamic Interactions Between AEDs

  • P. Patsalos
  • Biology, Medicine
    Clinical Pharmacokinetics
  • 2013
Overall, the new AEDs are less interacting primarily because many are renally excreted or not hepatically metabolised and most do not (or minimally) induce or inhibit hepatic metabolism.

Levetiracetam and pregabalin for antiepileptic monotherapy in patients with primary brain tumors. A phase II randomized study.

This study shows that LEV and PGB represent valuable monotherapy options in this setting, with very good antiepileptic efficacy and an acceptable tolerability profile, and provides important data for the design of a phase III trial.

Position statement on the coverage of anticonvulsant drugs for the treatment of epilepsy

The American Academy of Neurology has developed evidence-based guidelines that strongly support complete physician autonomy in determining the appropriate use of anticonvulsant drugs for the patients with epilepsy.

Epilepsy after the first drug fails: substitution or add-on?

Preliminary observations have generated verifiable hypotheses regarding the early management of epilepsy and a randomized study comparing substitution and combination after the failure of the first AED is underway.

The clinical pharmacology profile of the new antiepileptic drug perampanel: A novel noncompetitive AMPA receptor antagonist

Overall, perampanel has a favorable clinical pharmacology profile, which should aid its clinical use and can be used to advantage because dose titration can be faster and thus optimum therapeutic outcome can be achieved sooner.