Antiepileptic treatment in patients with epilepsy and other comorbidities

Ruiz-Giménez, Jesús; Sánchez-Álvarez, J C; Cañadillas-Hidalgo, F. M.; Serrano-Castro, Pedro J.

doi:10.1016/j.seizure.2010.05.008

Cited by 59 publications

(37 citation statements)

References 73 publications

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“…This scenario usually requires special medical care, since most of the AED can influence the occurrence/aggravation of psychiatric symptoms; in addition, some psychotropic drugs can potentially deteriorate seizure control due to interactions with AED and/or due to their potential epileptogenic effect 29 .…”

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confidence: 99%

Drug utilization profile in adult patients with refractory epilepsy at a tertiary referral center

Freitas‐Lima

Baldoni

Alexandre

et al. 2013

Arq. Neuro-Psiquiatr.

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Objective: To evaluate the utilization profile of antiepileptic drugs in a population of adult patients with refractory epilepsy attending a tertiary center. Method: Descriptive analyses of data were obtained from the medical records of 112 patients. Other clinical and demographic characteristics were also registered. Results: Polytherapies with ≥3 antiepileptic drugs were prescribed to 60.7% of patients. Of the old agents, carbamazepine and clobazam were the most commonly prescribed (72.3% and 58.9% of the patients, respectively). Among the new agents, lamotrigine was the most commonly prescribed (36.6% of the patients). At least one old agent was identified in 103 out of the 104 polytherapies, while at least one new agent was prescribed to 70.5% of the population. The most prevalent combination was carbamazepine + clobazam + lamotrigine. The mean AED load found was 3.3 (range 0.4-7.7). Conclusion: The pattern of use of individual drugs, although consistent with current treatment guidelines, is strongly influenced by the public health system. Keywords: epilepsy, refractory epilepsy, antiepileptic drugs, polytherapy, drug utilization. RESUMOObjetivo: Avaliar o perfil de utilização de fármacos antiepilépticos em uma população de pacientes adultos com epilepsia refratária atendidos em um centro terciário. Método: Análises descritivas dos dados obtidos dos registros médicos de 112 pacientes. Também foram consideradas as características clínicas e demográficas. Resultados: Foram prescritas politerapias com ≥3 antiepilépticos a 60,7% dos pacientes. Em relação aos fármacos de primeira geração, carbamazepina e clobazam foram os mais frequentemente prescritos (a 72,3% e 58,9% dos pacientes, respectivamente). Dentre os novos antiepilépticos, a lamotrigina foi o mais prescrito (36,6% dos pacientes). Ao menos um antiepiléptico de primeira geração foi encontrado em 103 das 104 politerapias; ao menos um novo antiepiléptico foi prescrito a 70,5% da população. A combinação mais prevalente foi carbamazepina+clobazan+lamotrigina. A carga média de antiepilépticos foi 3.3 (0.4 a 7.7). Conclusão: O padrão de utilização de antiepilépticos, embora concordante com guias atuais, é fortemente influenciado pelo sistema público de saúde.Palavras-chave: epilepsia, epilepsia refratária, fármacos antiepilépticos, politerapia, utilização de fármacos.Approximately one-third of the patients with epilepsy have recurrent seizures in spite of adequate pharmacological treatment and good compliance, characterizing what is known as refractory epilepsy 1 . The lack of control over seizure recurrence has a major impact not only on the patients' clinical and psychosocial status but also on economic consequences that could potentially overload the health care system due to avoidable expenses with regard to medications, hospitalizations, and examinations 2 .An important portion of the high costs related to the treatment of refractory epilepsy is devoted to the purchase of second-generation antiepileptic drugs (AED), which are more expensive than f...

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confidence: 99%

Drug utilization profile in adult patients with refractory epilepsy at a tertiary referral center

Freitas‐Lima

Baldoni

Alexandre

et al. 2013

Arq. Neuro-Psiquiatr.

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“…1). In Tang et al, 16 adherence in the first intervention group rose from 7% (95% CI, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] to 60% (95% CI, 47-72); and in the second intervention group, adherence rose from 9% (95% CI, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] to 66% (95% CI, 52-77). In Tang et al, 16 adherence in the first intervention group rose from 7% (95% CI, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]…”

Section: Resultsmentioning

confidence: 99%

Increasing adherence to treatment in epilepsy: what do the strongest trials show?

et al. 2016

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Patient non-adherence to prescribed anti-epileptic drugs (AEDs) remains a challenge to successful treatment of patients with epilepsy. However, the literature on epilepsy does not document a comprehensive review of interventions to improve adherence as a means to improve clinical outcomes. This study systematically reviews existing literature on interventions to enhance AED adherence and clinical outcomes, and the measures of adherence included in these studies. We selected randomized controlled trials (RCTs) of interventions to enhance adherence with AEDs, which also measured clinical outcomes, with at least 80% follow-up of participants for at least 6 months, from a comprehensive Cochrane review of adherence interventions for medications, complete to January 2013, and updated searches for additional AED studies in multiple bibliographic databases to January 2016. Two review authors independently extracted all data and a third author resolved disagreements. The present update included one trial from the Cochrane review and three RCTs published since, bringing the total number of RCTs on this topic to four. Two types of intervention were tested: educational (e.g., providing information to the patient or carer about treatment characteristics, duration, dosage regime, and how to use the AED) and behavioral (activity in order to remind the patient to take a medicine). Methods of measuring adherence included a combination of direct (plasma AED levels) and indirect measures (prescription refill frequency and appointment keeping) or use alone of self-report adherence on standardized scales. Despite the importance of the problem, evidence is limited concerning enhancement of adherence among people with epilepsy. However, the trials available to date show that medication adherence in epilepsy can be improved, leading to better seizure control.

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“…Currently the most favored AEDs are (1) levetiracetam and (2) valproic acid, and less recommended AEDs include (1) carbamazepine, (2) lamotrigine, and (3) topiramate. 10 Levetiracetam is at present the most favorable due to its efficacy, good safety profile, twice daily dosing schedule, ease of titration, few drug interactions, few side-effects, and no requirement for drug level monitoring. [10][11][12][13] Our study has also shown a high percentage of potential drug interactions.…”

Section: Discussionmentioning

confidence: 99%

A Review of the Use of Antiepileptic Drugs in High-Grade Central Nervous System Tumors

Wallace

O’Reilly

Twomey

2012

Am J Hosp Palliat Care

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Antiepileptic treatment in patients with epilepsy and other comorbidities

Cited by 59 publications

References 73 publications

Drug utilization profile in adult patients with refractory epilepsy at a tertiary referral center

Drug utilization profile in adult patients with refractory epilepsy at a tertiary referral center

Increasing adherence to treatment in epilepsy: what do the strongest trials show?

A Review of the Use of Antiepileptic Drugs in High-Grade Central Nervous System Tumors

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