Recommendations for the treatment of epilepsy in adult and pediatric patients in Belgium: 2020 update

Abstract

To guide health care professionals in Belgium in selecting the appropriate antiepileptic drugs (AEDs) for their epilepsy patients, a group of Belgian epilepsy experts developed recommendations for AED treatment in adults and children (initial recommendations in 2008, updated in 2012). As new drugs have become available, others have been withdrawn, new indications have been approved and recommendations for pregnant women have changed, a new update was pertinent. A group of Belgian epilepsy experts (partly overlapping with the group in charge of the 2008/2012 recommendations) evaluated the most recent international guidelines and relevant literature for their applicability to the Belgian situation (registration status, reimbursement, clinical practice) and updated the recommendations for initial monotherapy in adults and children and add-on treatment in adults. Recommendations for add-on treatment in children were also included (not covered in the 2008/2012 publications). Like the 2008/2012 publications, the current update also covers other important aspects related to the management of epilepsy, including the importance of early referral in drug-resistant epilepsy, pharmacokinetic properties and tolerability of AEDs, comorbidities, specific considerations in elderly and pregnant patients, generic substitution and the rapidly evolving field of precision medicine.

The Pharmacology and Clinical Efficacy of Antiseizure Medications: From Bromide Salts to Cenobamate and Beyond

“…The number of available ASMs has increased rapidly in the past 30 years, giving more choice when initiating therapy but also making drug selection a much more complex process. Major evidence-based guidelines have been developed during this time, assisting clinicians and patients in making appropriate treatment choices in newly diagnosed epilepsy [63,64]. These include guidelines issued by the International League Against Epilepsy [65,66], the American Academy of Neurology/American Epilepsy Society [67,68], and others.…”

“…Monotherapy alternatives refer to ASMs chosen when certain patient-or ASM-related factors preclude the use of the first-choice ASM. Data from various sources [63,64,67,68] and guidelines discussed in these papers. Note that several additional childhood epilepsy syndromes are not illustrated in this figure.…”

Minimum standards for inpatient long‐term video‐electroencephalographic monitoring: A clinical practice guideline of the International League Against Epilepsy and International Federation of Clinical Neurophysiology

“…6,7 Practice guidelines and quality measures are available to provide national and international standards for diagnosis and treatment of patients. [8][9][10] Because the manifestations of epilepsy are brief and intermittent, a standard 20-30-min electroencephalogram (EEG) often fails to show epileptiform activity. Inpatient LTVEM is the reference standard to provide a definitive diagnosis when standard EEG in conjunction with a clinical approach to diagnosis and management is unrevealing 5,[11][12][13][14][15][16][17][18][19][20] Position papers and standards, 16 services, 21 and guidelines 11,14,[22][23][24][25] exist for specific indications and certain aspects of LTVEM, although an international guideline to identify minimum performance standards is needed.…”

Safety and Tolerability of Lacosamide in Patients With Epilepsy: A Systematic Review and Meta-Analysis

“…In 2018, it was approved as an add-on treatment for adults and adolescents (age ≥ 16 years) with focal epilepsy in China. The practice guidelines in Belgium ( Boon et al, 2021 ) to date recommend LCM as registered and reimbursed ASMs for add-on treatment for focal-onset seizures in adults and children. Among the newer ASMs, LCM has been increasingly used for acute seizures and status epilepticus in the intensive care unit ( Chimakurthy et al, 2020 ).…”