Rectal carbamazepine as effective long-acting treatment after cluster seizures and status epilepticus

Cordato, Dennis; Malkan, Ashish; Beran, Roy G.

doi:10.1016/j.yebeh.2013.10.027

Cited by 12 publications

(5 citation statements)

References 11 publications

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“…Carbamazepine (CBZ) is an established treatment for focal epilepsy in adults, but no parenteral formulation is available [150]. In one small series, rectal CBZ syrup appeared to help prevent relapse in patients whose cluster of seizures in GCSE had been halted earlier [151].…”

Section: Non-sedating Drugs In the Treatment Of Rsementioning

confidence: 99%

Treatment of Refractory and Super-refractory Status Epilepticus

Rai

Drislane

2018

Neurotherapeutics

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Refractory and super-refractory status epilepticus (SE) are serious illnesses with a high risk of morbidity and even fatality. In the setting of refractory generalized convulsive SE (GCSE), there is ample justification to use continuous infusions of highly sedating medications-usually midazolam, pentobarbital, or propofol. Each of these medications has advantages and disadvantages, and the particulars of their use remain controversial. Continuous EEG monitoring is crucial in guiding the management of these critically ill patients: in diagnosis, in detecting relapse, and in adjusting medications. Forms of SE other than GCSE (and its continuation in a "subtle" or nonconvulsive form) should usually be treated far less aggressively, often with nonsedating anti-seizure drugs (ASDs). Management of "non-classic" NCSE in ICUs is very complicated and controversial, and some cases may require aggressive treatment. One of the largest problems in refractory SE (RSE) treatment is withdrawing coma-inducing drugs, as the prolonged ICU courses they prompt often lead to additional complications. In drug withdrawal after control of convulsive SE, nonsedating ASDs can assist; medical management is crucial; and some brief seizures may have to be tolerated. For the most refractory of cases, immunotherapy, ketamine, ketogenic diet, and focal surgery are among several newer or less standard treatments that can be considered. The morbidity and mortality of RSE is substantial, but many patients survive and even return to normal function, so RSE should be treated promptly and as aggressively as the individual patient and type of SE indicate.

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Section: Non-sedating Drugs In the Treatment Of Rsementioning

confidence: 99%

Treatment of Refractory and Super-refractory Status Epilepticus

Rai

Drislane

2018

Neurotherapeutics

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“…Enhanced technical experience and global recognition help retain talented researchers . Clinical research contributes to medical knowledge and allows clinicians to offer their patients the latest cutting‐edge therapies . Research may protect against physician burn out, stimulate intellectual curiosity and advance professional development .…”

Section: Resultsmentioning

confidence: 99%

Justification for conducting neurological clinical trials as part of patient care within private practice

Beran

Stepanova²,

Beran³

2016

Int J Clin Pract

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Summary The aim of this review was to assess the benefits and drawbacks of conducting neurological clinical trials and research in private practice for the patients, clinician, Practice Manager, sponsors/Clinical Research Organisations (CROs) and Clinical Trial Coordinator (CTC) to determine if this is justified for all involved. A combination of literature reviews, original research articles and books were selected from 2005 to 2015. Provided that the practice has sufficient number of active trials to prevent financial loss, support staff, adequate facilities and equipment and time, the benefits outweigh the drawbacks. Clinical trials provide patients with more thorough monitoring, re‐imbursement of trial‐related expenses and the opportunity to try an innovative treatment at no charge when other options have failed. For the clinician, clinical trials provide more information to ensure better care for their patients and improved treatment methods, technical experience and global recognition. Trials collect detailed and up‐to‐date information on the benefits and risks of drugs, improving society's confidence in clinical research and pharmaceuticals, allow trial sponsors to explore new scientific questions and accelerate innovation. For the CTC, industry‐sponsored clinical trials allow potential entry for a career in clinical research giving CTCs the opportunity to become Clinical Research Associates (CRAs), Study Start‐Up Managers or Drug Safety Associates.

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“…Extended‐release tablets or capsules cannot be used for rectal administration. Dilution of the suspension may be needed to avoid a cathartic effect [40, 41]. At least one study has shown that rectal carbamazepine can be used as alternative long‐acting treatment to parenteral ASMs following the termination of cluster seizures or status epilepticus with acute intravenous therapies [40].…”

Section: Rectal Administration Of Asms In Emergency Situationsmentioning

confidence: 99%

Recommendations for treatment strategies in people with epilepsy during times of shortage of antiseizure medications

Asadi‐Pooya¹,

Patel²,

Trinka³

et al. 2022

Epileptic Disorders

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In times of severe antiseizure medication (ASM) shortage due to emergency situations (e.g., disasters, conflicts, sudden disruption to international supply chains) management of people with epilepsy (PWE) with available ASMs can be difficult. A group of experts, brought together by the International League Against Epilepsy (ILAE), to formulate recommendations for such circumstances. Every effort was made to base these recommendations on direct published literature or extrapolations from basic information available about ASMs. Actual published literature in this area is however limited and at times, assumptions were made by the experts to generate these recommendations. During times of shortage of ASMs, switching between different ASMs (e.g., oxcarbazepine and carbamazepine) can occasionally be considered as a mitigation procedure. However, for many ASMs, the option of an overnight switch to another drug does not exist. Switching from brand to generic or between generic products has often been shown to be safe, if required. Finally, when supplies of benzodiazepines or equipment to administer medications intravenously are not available, rectal administration of some ASMs may be an emergency alternative route for treating serial seizures and status epilepticus. Decisionmaking with regard to treatment and possible options should be driven by what is best for the patient.

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Rectal carbamazepine as effective long-acting treatment after cluster seizures and status epilepticus

Cited by 12 publications

References 11 publications

Treatment of Refractory and Super-refractory Status Epilepticus

Treatment of Refractory and Super-refractory Status Epilepticus

Justification for conducting neurological clinical trials as part of patient care within private practice

Recommendations for treatment strategies in people with epilepsy during times of shortage of antiseizure medications

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