Medical management of epileptic seizures: challenges and solutions

Abstract

Epilepsy is one of the most common neurologic illnesses. This condition afflicts 2.9 million adults and children in the US, leading to an economic impact amounting to $15.5 billion. Despite the significant burden epilepsy places on the population, it is not very well understood. As this understanding continues to evolve, it is important for clinicians to stay up to date with the latest advances to provide the best care for patients. In the last 20 years, the US Food and Drug Administration has approved 15 new antiepileptic drugs (AEDs), with many more currently in development. Other advances have been achieved in terms of diagnostic modalities like electroencephalography technology, treatment devices like vagal nerve and deep-brain stimulators, novel alternate routes of drug administration, and improvement in surgical techniques. Specific patient populations, such as the pregnant, elderly, those with HIV/AIDS, and those with psychiatric illness, present their own unique challenges, with AED side effects, drug interactions, and medical–psychiatric comorbidities adding to the conundrum. The purpose of this article is to review the latest literature guiding the management of acute epileptic seizures, focusing on the current challenges across different practice settings, and it discusses studies in various patient populations, including the pregnant, geriatric, those with HIV/AIDS, comatose, psychiatric, and “pseudoseizure” patients, and offers possible evidence-based solutions or the expert opinion of the authors. Also included is information on newer AEDs, routes of administration, and significant AED-related drug-interaction tables. This review has tried to address only some of these issues that any practitioner who deals with the acute management of seizures may encounter. The document also highlights the numerous avenues for new research that would help practitioners optimize epilepsy management.

Ferroptosis Induction in Pentylenetetrazole Kindling and Pilocarpine-Induced Epileptic Seizures in Mice

“…Nevertheless, nearly 30% of patients fail to achieve seizure control (Kwan et al, 2011; Fiest et al, 2017). Additionally, the traditional ASDs show various and serious adverse reactions as a result of their action on ubiquitously distributed targets that are involved in physical processes (Sarma et al, 2016). This has spurred the identification of alternative targets to develop satisfactory anti-seizure therapies.…”

Seizures in HIV: The case for special consideration

“…However, LEV had the highest incidence of side effects reported by patients (4/7) and had to be discontinued in two cases due to mood/personality disturbance. Levetiracetam has the least ASD–ART interactions reported in the literature but its propensity to cause intolerable neuropsychiatric side effects has been documented [10] , [25] . Therefore, careful consideration needs to be given to LEV prescription in patients as HIV-infected individuals may develop depression as part of their primary diagnosis.…”

Current epidemiological and etiological characteristics and treatment of seizures or epilepsy in patients with HIV infection

“…Though having no significant drug interactions with ARVs [ 57 , 58 ], they still face restrictions in application. Levetiracetam, which is reported to have the least AED-ARV interactions, often causes intolerable neuropsychiatric side effects [ 59 , 60 ]. And deliberate assessment of the tolerance of patients with impaired renal function should be performed when gabapentin or pregabalin is administered.…”