Monotherapy with Valproate in Primary Generalized Epilepsies

Bourgeois, Blaise F. D.; Beaumanoir, A; Blajev, B; Cruz, Norberto Sotelo; Despland, P. A.; Egli, M; Geudelin, Bernard; Kaspar, U.; Ketz, E; Kronauer, Ch.; Meyer, C; Scollo-Lavizzari, G; Tosi, C.; Vassella, F; Zagury, S.

doi:10.1111/j.1528-1157.1987.tb05769.x

Cited by 97 publications

(50 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Like VPA, ESM suppresses absence seizures in >80% of patients [11,Class II]. ESM may be a useful adjunct in the treatment of myoclonic seizures in PGE [12,Class III].…”

Section: Drugs With Proven Efficacy In Pge Treatment Ethosuximidementioning

confidence: 99%

Primary generalized epilepsies

Murphy

Delanty

2000

Curr Treat Options Neurol

View full text Add to dashboard Cite

For pure childhood absence epilepsy (CAE), ethosuximide (ESM) remains the drug of first choice. Although valproic acid (VPA) is of equal efficacy, it is more toxic, and is reserved for those patients with accompanying convulsions. Lamotrigine (LTG) is effective as both add-on and monotherapy for CAE. If any of these three drugs fails, one of the other two can be used as monotherapy. Rarely, when ESM, VPA, or LTG does not effectively control CAE, phenytoin (PHT), primidone (PRM), and phenobarbital (PB) may be partially effective, although carbamazepine (CBZ) may worsen absence seizures. Experience is limited with the newer AEDs. Tiagabine (TGB) may induce absence status epilepticus in PGE. Oxcarbazepine (OXC) and vigabatrin (VGB) may worsen absence seizures. Felbamate (FBM) is probably effective, but is potentially fatal. Lifelong therapy is not anticipated. For juvenile absence epilepsy (JAE), VPA is the drug of first choice. LTG is also of proven efficacy. The risks of VPA-induced teratogenicity (possibly lessened by the concurrent use of folic acid) and weight gain are potentially unacceptable in young women of childbearing age. Not enough data exists on the safety of LTG in pregnancy. A combination of VPA and LTG can be used if either drug alone is unsuccessful. For juvenile myoclonic epilepsy (JME), VPA is the traditional drug of first choice in most patients. As in JAE, side effects may make VPA an unacceptable choice in many patients, especially young women. In clinical practice, TPM is being increasingly used as monotherapy for JME. Many patients appreciate the accompanying weight loss seen with TPM, but it has potentially troubling side effects, has not been well studied as monotherapy for JME, and its safety in pregnancy has yet to be confirmed. PHT and CBZ may worsen myoclonus when used alone, but they may have a role as add-on treatment to VPA, LTG, or TPM, especially when generalized tonic-clonic seizures (GTCSs) are not controlled. PB and PRM may also be useful as add-on treatment, but often have unacceptable side effects. Clonazepam may be useful as adjunctive treatment for resistant myoclonic jerks. OXC and VGB both worsen myoclonic seizures. GBP is not useful in JME and can make seizures worse. The efficacy of FBM and TGB in JME is largely unknown. Lifelong AED therapy is necessary. In epilepsy with generalized tonic-clonic seizure (GTCS) on awakening (EGA), VPA is the drug of choice, especially if other seizure types (absence and myoclonic) are present. If only GTCSs are present, then PB, PHT, and CBZ may be as effective as VPA; however, the use of PHT and CBZ may "unearth" other seizure types (absence and myoclonic) in those patients with EGA, although PB is poorly tolerated. As for JME, LTG, and TPM may both be effective monotherapy for EGA, although the use of other AEDs in EGA has not been well studied. Lifelong AED treatment is necessary.

show abstract

“…Like VPA, ESM suppresses absence seizures in >80% of patients [11,Class II]. ESM may be a useful adjunct in the treatment of myoclonic seizures in PGE [12,Class III].…”

Section: Drugs With Proven Efficacy In Pge Treatment Ethosuximidementioning

confidence: 99%

Primary generalized epilepsies

Murphy

Delanty

2000

Curr Treat Options Neurol

View full text Add to dashboard Cite

show abstract

“…AED monitoring could thus confirm the presence of "false" intractable epilepsies. Many studies showed that, in about 80% of cases, it was possible to achieve good control of seizures in patients after a first seizure by prescribing only one AED (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Such monotherapy permitted comparison of the efficacy and toxicity of drugs used for initial treatment: VPA, CBZ, PHT, PB, and primidone…”

Section: Dogmatic Monotherapymentioning

confidence: 99%

The Problem of Intractability: The Continuing Need for New Medical Therapies in Epilepsy

Jallon

1997

Epilepsia

View full text Add to dashboard Cite

Summary: Treatment of epilepsy, one of the most common neurologic disorders, has evolved from "institutional" polytherapy to "dogmatic" monotherapy, and, most recently, to "rational" polypharmacy. The introduction of bromides for the treatment of epilepsy was followed first by phenobarbital and then by phenytoin as therapeutic options. Although attempts to combine medications were legion, none was supported by studies that demonstrated the benefit of such combinations. The issue of adverse effects became a principal argument in favor of monotherapy. Monotherapy, using newly developed drugs, avoided problems due to drug interactions but was ineffective in 20-30% of patients. A greater understanding of basic disease mechanisms and developments in molecular biology have led to an increased number of effective drugs for the estimated 6 1 2 % of patients with epilepsy whose condition is intractable. Clinical research continues to build on the work of basic scientists in attempting to develop treatments based on a desire to move beyond the palliative and to affect the causative mechanisms of the disease. Novel medical approaches now under exploration include the use of drugs with complementary mechanisms of action, stimulation of various components of the nervous system, biochemical manipulations, focal intracerebral drug perfusion, and gene therapy.

show abstract

“…However, there is little general consensus on the qualitative and quantitative characteristics of these effects. Clinical data suggest that VPA has both immediate and longer-lasting effects: although it effectively treats status epilepticus (Sirven and Waterhouse, 2003), there is poor correlation between plasma levels and clinical efficacy (Burr et al, 1984;Chadwick, 1985;Sundqvist et al, 1998), effective seizure control may only be achieved after days or weeks of treatment (Henriksen and Johannessen, 1982;Bourgeois et al, 1987), and effects may persist after cessation of treatment (Rowan et al, 1979).…”

Section: Introductionmentioning

confidence: 99%