Recent advances in pharmacotherapy for epilepsy

Abstract

Purpose of reviewEpilepsy affects 70 million people worldwide and is a significant cause of morbidity and early mortality. The mainstay of therapy is oral medications. Epilepsy drug development is escalating, driven by continued drug resistance in up to a third of epilepsy patients. Treatment development now focuses on discovery of novel mechanisms of action and syndrome-specific therapiesRecent findingsDifficult-to-treat epilepsy related to conditions including tuberous sclerosis complex (TSC), Lennox Gastaut syndrome (LGS) and Dravet syndrome (DS) have been the target of recent developments. Disease-modifying therapy for epilepsy related to TSC with vigabatrin at onset of first electroencephalographic epileptiform changes, rather than after first clinical seizure, has demonstrated strongly positive seizure and developmental outcomes. Fenfluramine, approved for DS and, more recently, LGS, has robust data supporting efficacy, safety/tolerability, as well as mortality, quality of life and cognitive function. Rescue therapy has expanded to include better tolerated benzodiazepines in the form of nasal midazolam and valium. Cenobamate, a first-in-class inactivator of the persistent voltage-gated sodium channel and approved for adult partial onset epilepsy, has exceptional efficacy and tolerability and will be expanded to children and to generalized onset epilepsy in adults.SummaryThe repertoire of available and developmental therapies for epilepsy is rapidly expanding, and now includes disease-modifying vigabatrin in TSC and agents with extraordinary efficacy, fenfluramine and cenobamate.

The efficacy and safety of third-generation antiseizure medications and non-invasive brain stimulation to treat refractory epilepsy: a systematic review and network meta-analysis study

“…The etiology of intractable epilepsy is multifaceted, encompassing diverse factors associated with the environment, genetics, and medication ( 7 , 26 , 27 ). Pharmacotherapy plays a crucial role in mitigating the severity of epilepsy and enhancing the quality of life for patients ( 28 ).…”

Cenobamate (YKP3089) and Drug-Resistant Epilepsy: A Review of the Literature

“…DEA scheduling has significant drawbacks, such as apprehension by patients in using a medication related to addiction, low storage of the medication by pharmacies, and patients with epilepsy being unable to refill prescriptions until they have used up their existing pills. These factors probably affected access to CNB and led some individuals to discontinue or even avoid this medication [ 127 ]. Noteworthily, the discontinuation of CNB should be performed gradually to reduce the risk of withdrawal syndrome and increased seizure frequency.…”

Unveiling the Multifaceted Problems Associated with Dysrhythmia

“…In the case of the third generation of drugs, TDM is not necessary in most cases, although it should be considered in patients with side effects or ineffective therapy [97]. Table 1 shows AEDs classified according to their generation [98,99]. Some AEDs are classified as broad-spectrum because they treat a wide range of seizure types.…”