Evolving Antiepileptic Drug Treatment in Juvenile Myoclonic Epilepsy

Prasad, Ashoka Jahnavi; Kuzniecky, Ruben; Knowlton, Robert C.; Welty, Tim E.; Martin, Roy C.; Mendez, M.; Faught, R. Edward

doi:10.1001/archneur.60.8.1100

Cited by 92 publications

(72 citation statements)

References 17 publications

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“…In patients with JME, it was initially shown that TPM was effective in cases refractory to other AED 10 , and later its efficacy was demonstrated in patients with recent onset epilepsy and intolerable side effects of other AED 4,5,8 .…”

Section: Discussionmentioning

confidence: 99%

“…TPM in an average dose of 663 mg/day improved s e i z u re f requency in 11 patients, maintained control in t w o and led to worsening in two. In the series of Prasad et al 5 , TPM used in a minimum effective dose of 230 mg in monotherapy and 250 mg in polytherapy was considered to be an alternative to VPA . Tolerability to TPM was lower than to VPA, which the authors attributed to excessively rapid titration of the drug; in this series, one of the 19 patients showed worsening of the seizures.…”

Section: Discussionmentioning

confidence: 99%

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Topiramate for the treatment of juvenile myoclonic epilepsy

Sousa

Filho

Garzón

et al. 2005

Arq. Neuro-Psiquiatr.

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-O b j e c t i v e:The aim of this study was to evaluate the efficacy and tolerability of topiramate ( T P M ) in juvenile myoclonic epilepsy (JME). M e t h o d: We assessed seizure control and adverse effects of TPM in 22 patients (18 females) aged 13 to 53 years. Ta rget TPM dosage was up to 200 mg/day. The patients were subdivided into 3 groups: those treated with seizure control plus side effects (n=4); treated with non-cont rolled seizures (n=15) and with JME newly diagnosed (n=3). Results: Sixteen patients completed the first year of the follow-up. Generalized tonic-clonic seizures were completely controlled in 10 (62.5%); more t h a n 50% of reduction in 4 (25.0%) and less than 50% in 2 (12.5%). Myoclonia were controlled in 11 (68.8%) a n d persisted in 5 (31.2%) patients. Absence seizures were present in 5 (22.7%) of whom 2 (9.0%) showed more than 50% of seizure reduction while 3 (13.6%) presented worsening. Discontinuations were due to inadequate seizure control and adverse events (N=4), low compliance and loss of follow-up (N=2) and subject choice (N=1). C o n c l u s i o n: TPM showed to be an effective and well-tolerated drug in the treatment of JME. Although frequently observed, TPM side effects were tolerable and the drug could be maintained in the majority of patients.KEY WORDS: topiramate, treatment, juvenile myoclonic epilepsy.Tratamento da epilepsia mioclônica juvenil com topiramato RESUMO -Objetivo: Avaliar a eficácia e tolerabilidade do topiramato (TPM) na epilepsia mioclônica juvenil (EMJ). Método: Avaliamos a resposta terapêutica e efeitos colaterais do TPM em 22 pacientes (18 mulh eres) com idades entre 13 e 53 anos. A dose alvo utilizada foi até 200 mg/dia. Os pacientes foram divididos em 3 grupos no início do tratamento: aqueles com controle das crises mas que apresentavam efeitos colaterais (n=4); com crises não controladas (n=15) e com EMJ recém diagnosticada (n=3). Resultados: D e z e s s e i s pacientes completaram o primeiro ano de acompanhamento. Crises tônico-clonicas generalizadas foram c o mpletamente controladas em 10 (62,5%), tiveram redução maior de 50% em 4 (25,0%) e menor de 50% em 2 (12,5%). Mioclonias foram controladas em 11 (68,8%) e persistiram em 5 (31.2%) pacientes. As crises de ausências, presentes em 5 (22,7%) pacientes, tiveram redução maior do que 50% em 2 (9,0%) e agravamento em 3 (13,6%). A retirada do estudo foi devida principalmente ao controle inadequado das crises e efeitos colaterais indesejáveis (n=4), pouca adesão e perda do seguimento (n=2) e escolha do paciente ( n = 1 ) . Conclusão: TPM foi considerada droga eficaz e bem tolerada no tratamento da EMJ. Apesar de fre q ü e ntemente observados, os efeitos colaterais do TPM foram toleráveis e a medicação pode ser mantida na maioria dos pacientes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Topiramate for the treatment of juvenile myoclonic epilepsy

Sousa

Filho

Garzón

et al. 2005

Arq. Neuro-Psiquiatr.

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“…A case series also found TPM to be effective when used as combination therapy in JME [21,Class III]. A pilot study comparing VPA and TMP in patients with newly diagnosed JME (or patients who never received VPA or TPM for JME) found the medications to be similarly effective, but with different adverse event profiles [27,Class II].…”

Section: Topiramatementioning

confidence: 99%

Idiopathic generalized epilepsy

Sullivan¹,

Dlugos

2004

Curr Treat Options Neurol

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Successful treatment of idiopathic generalized epilepsy begins with accurate seizure classification. Seizure types, such as absence, myoclonic, and primary generalized tonic-clonic seizures (PGTCS), often can be classified based on a detailed history and inter-ictal electroencephalogram (EEG). Ideally, patients can be classified into specific epilepsy syndromes, such as childhood absence epilepsy, juvenile myoclonic epilepsy (JME), or generalized tonic-clonic seizures on awakening. Idiopathic generalized epilepsy should be distinguished from focal epilepsy with rapid secondary generalization. If this distinction is not clear after history, physical examination, and routine inter-ictal EEG, then ambulatory EEG, video EEG monitoring, or neuroimaging studies may be needed. Ethosuximide, valproate, or lamotrigine are all appropriate first-line choices in the treatment of childhood absence epilepsy. The specific medication should be chosen based on the side effect profiles, dosing formulations, and titration schedules of the medications. The available evidence best supports valproate as the first-line choice in the treatment of JME, although lamotrigine and topiramate may be appropriate choices in this setting. More data specific to JME are needed to clarify the role of medications such as levetiracetam and zonisamide in the treatment of JME. The available evidence to guide the treatment of PGTCS is limited, because most trials did not rigorously exclude patients with focal epilepsy with rapid secondary generalization. Available evidence suggests that valproate is an appropriate first-line choice for PGTCE. Lamotrigine or topiramate also may be appropriate choices. More data are needed to clarify the role of levetiracetam and zonisamide in the treatment of PGCTS. If it is unclear whether a patient has idiopathic generalized epilepsy or focal epilepsy with secondary generalization, then a broad-spectrum anticonvulsant, including valproate, lamotrigine, or topiramate, should be considered. More data are needed to support the broad-spectrum efficacy of levetiracetam and zonisamide.

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“…The efficacy of LTG in IGE is unquestionable (Morris et al, 2004;Prasad et al, 2004). Nevertheless, there may be cases in which LTG is not effective.…”

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confidence: 99%

How to Replace Lamotrigine with Valproate

Steinhoff

2006

Epilepsia

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Summary:If lamotrigine (LTG) has to be replaced with valproate (VPA), this exchange may be complicated by adverse events that result from the complex interaction of both drugs. We report on two cases in which such problems occurred in spite of a cautious switch considering the VPA induced LTG serum increase. The satisfying outcome after a sudden and complete withdrawal of LTG in both cases encouraged us to perform the switch from LTG to VPA systematically by discontinuing LTG abruptly and building up the VPA maintenance dosage very rapidly in the following five consecutive patients who required this exchange. We recommend our abrupt dosage changeover strategy as an easy, safe and cost-effective option.

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Evolving Antiepileptic Drug Treatment in Juvenile Myoclonic Epilepsy

Cited by 92 publications

References 17 publications

Topiramate for the treatment of juvenile myoclonic epilepsy

Topiramate for the treatment of juvenile myoclonic epilepsy

Idiopathic generalized epilepsy

How to Replace Lamotrigine with Valproate

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