Efficacy and Tolerability of the New Antiepileptic Drugs, II: Treatment of Refractory Epilepsy: Report of the TTA and QSS Subcommittees of the American Academy of Neurology and the American Epilepsy Society

French, Jacqueline A.; Kanner, Andrés M.; Bautista, Jocelyn F.; Abou‐Khalil, Bassel; Browne, Thomas R.; Harden, Cynthia L.; Theodore, William H.; Bazil, Carl W.; Stern, John M.; Schachter, Steven C.; Bergen, Donna; Hirtz, Deborah; Montouris, Georgia; Nespeca, Mark; Gidal, Barry E.; Marks, William J.; Turk, William R.; Fischer, James H.; Bourgeois, Blaise; Wilner, Andrew N.; Faught, R. Edward; Sachdeo, Rǎjesh C.; Beydoun, Ahmad; Glauser, Tracy A.

doi:10.1111/j.0013-9580.2004.06304.x

Cited by 140 publications

(45 citation statements)

References 85 publications

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“…In a decreasing order, CBZ, CLB, LTG, and TPM were the most commonly prescribed AED found in the present study, which reasonably agrees with important international gui delines that highlight the efficacy and effectiveness of all available 13 or only new AED 14 for treating partial onset seizures, the most prevalent seizure type in adults 15 . Carbamazepine and PHT are considered by ILAE to have the highest evidence level for use in treating refractory epilepsy as initial monotherapy.…”

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confidence: 90%

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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: 90%

“…French and colleagues 14 concluded that all new AED are adequate for use as adjunctive therapy in adults with refractory partial epilepsy. Indeed, there is an international tendency toward increasing prescription of new AED 22 , sometimes even overcoming the number of prescriptions of old AED…”

mentioning

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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“…The responder rates by seizure type were 22 % in SPS, 28% in CPS, 44% in 2 nd GS, and 25% in generalized seizures. Similar to previous reports [8,12], therapeutic effects were seen not only in patients with partial epilepsies and partial seizures, but also in those with generalized epilepsies, generalized seizures, and SMEI. The frequency of adverse events was 54% in our study, which was lower than that of a previous study in Japan (81%) that used an initial dose of 100 mg/day and rapid dose escalation (weekly increment of 100 mg/day) [18,22].…”

Section: Discussionsupporting

confidence: 90%

“…TPM has been proven to be effective as an adjunctive AED for partial epilepsy [5], generalized epilepsy [6], and Lennox-Gastaut syndrome [7]. Its efficacy and safety have been shown by several clinical studies in adult patients, not only in the United States and European countries [8,9], but also in Asian countries including Taiwan [10], Republic of China [11], and Korea [12]. We conducted this investigation to assess the clinical effectiveness and adverse reactions of TPM in Japanese adult patients with refractory epilepsy.…”

Section: Introductionmentioning

confidence: 99%

Topiramate Add-on Therapy for Adult Patients with Refractory Epilepsy in Japan

Araki

Minakawa

Ono

et al. 2013

E&S

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“…Unfortunately, the remaining 20 -30% of patients will continue to experience intractable seizures or have significant adverse reactions to AEDs. 1,126 In patients with refractory CPS, the overall risk of death (whether due to accident, suicide, or SUDEP) is very high, compared with age-matched, healthy people. 127 Heart rate abnormalities have been found to accompany CPS in drug-resistant children and adolescents, which may contribute to the occurrence of SUDEP.…”

Section: Consequences Of Uncontrolled Seizuresmentioning

confidence: 99%

Vigabatrin

2007

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Summary: Refractory epilepsies such as infantile spasms (IS) and complex partial seizures (CPS) can have a severe negative impact on the neurological integrity and quality of life of affected patients, in addition to drastically increasing their risk of premature mortality. Early identification of potentially effective pharmacotherapy agents is important. Vigabatrin has been shown to be a generally well tolerated and effective antiepileptic drug (AED) in a wide variety of seizure types affecting both children and adults, particularly those with IS and CPS. A bilateral, concentric constriction of the peripheral visual field characterizes the visual field defect (VFD) associated with vigabatrin, well characterized by numerous studies. This peripheral VFD presents in 30 -50% of patients with exposure of several years; however, most of these patients are asymptomatic. In well-controlled studies, the earliest onset in patients with CPS is 11 months and at 5 months in infants, with average onsets being more than 5 years and 1 year, respectively. Patients with a peripheral VFD retain an average 65°of lateral vision (normal, 90°). The fact that many patients never develop the vigabatrin-related peripheral VFD, despite long-term exposure at high doses, may support the hypothesis that the injury is an idiosyncratic adverse drug reaction (as opposed to a strict dose-or duration-dependent toxicity). Effective testing methods are available to aid in the early detection and management of the peripheral VFD. This article discusses issues of importance to clinical decision-making in the use of vigabatrin to assist the physician and patient in assessing the benefits of vigabatrin therapy and understanding the potential risks of the VFD and uncontrolled seizures.

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Efficacy and Tolerability of the New Antiepileptic Drugs, II: Treatment of Refractory Epilepsy: Report of the TTA and QSS Subcommittees of the American Academy of Neurology and the American Epilepsy Society

Cited by 140 publications

References 85 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

Topiramate Add-on Therapy for Adult Patients with Refractory Epilepsy in Japan

Vigabatrin

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