Practice Update: Review of Anticonvulsant Therapy

@article{Chong2016PracticeUR,
  title={Practice Update: Review of Anticonvulsant Therapy},
  author={Derek J. Chong and Andrew M Lerman},
  journal={Current Neurology and Neuroscience Reports},
  year={2016},
  volume={16},
  pages={1-14}
}
  • 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… 
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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.

EFFICACY AND SAFETY OF ANTIEPILEPTIC DRUGS DURING PREGNANCY: PHARMACOGENETIC ASPECTS

It was demonstrated that polymorphism of the ABCB1 gene and genes of other transport proteins can modify the effect of antiepileptic drugs on the foetus, thus increasing the teratogenic risk.

Antiepileptic Drugs in Children : Current Concept

  • Jeehun Lee
  • Medicine, Psychology
    Journal of Korean Neurosurgical Society
  • 2019
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.

Epilepsy treatment in adults and adolescents: Expert opinion, 2016

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.

It is reported that the combination of guaifenesin-andrographolide exerts effects against epilepsy through a novel synergistic mechanism and is thus a potential treatment for epilepsy, providing a promising mechanism for the design of novel combinatorial drug treatments against epilepsy.

Comparison of brand versus generic antiepileptic drug adverse event reporting rates in the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS)

Diagnostic implications of review-of-systems questionnaires to differentiate epileptic seizures from psychogenic seizures

References

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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

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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

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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.

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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.

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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.

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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.

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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.
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