The importance of drug titration in the management of patients with epilepsy

Seiden, Lawrence; Connor, Gregory S.

doi:10.1016/j.yebeh.2021.108517

Cited by 16 publications

(11 citation statements)

References 68 publications

(93 reference statements)

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“…This survey reports data on caregivers’ experience of shared decision-making and the caregivers’ preference for starting new medication with a low dose. This “low and slow” approach with ASM is one that is widely accepted by clinicians and is recommended clinically in most situations [ 11 ]. This approach may help mitigate the risk of experiencing adverse events, thus supporting measures to aid adherence [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Shared decision-making and the caregiver experience in tuberous sclerosis complex: results from a UK survey

Skrobanski

Vyas²,

Bowditch³

et al. 2023

Orphanet J Rare Dis

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Background Tuberous sclerosis complex (TSC) is a rare genetic condition commonly accompanied by neurological and neuropsychological disorders, resulting in a high burden of illness for individuals and a substantial impact on their caregivers. Due to the diversity and complexity of clinical manifestations, patients with TSC need aligned multidisciplinary healthcare services starting in childhood through to adulthood. However, patients and caregivers are sometimes dissatisfied with the care provided, for which one of the most common reasons is a lack of involvement in clinical decision-making. Shared decision-making, whereby clinicians make clinical management decisions together with patients and their caregivers, is advocated for in the management of epilepsy, but evidence of its benefit in managing TSC is currently lacking. In this cross-sectional, UK-based analysis we used an online survey to capture the experiences of primary caregivers for individuals with TSC, including the impact on work productivity, clinical shared decision-making, satisfaction with care, and the impact of the coronavirus disease 2019 (COVID-19) pandemic. Results In total, 73 eligible caregivers provided consent (analysis set), with 14 completing the survey partially and 59 completing the full survey. Many caregivers (72%) reported receiving recommendations about new treatments from their doctor and discussing the treatment together, with a high proportion (89%) preferring that treatment was initiated at a low dose. Most caregivers (69%) were satisfied or extremely satisfied with pediatric TSC healthcare services, but only 25% were satisfied or extremely satisfied with the transition to adult TSC healthcare services. Several (n = 30) caregivers specified the impact of caring on their work productivity and career in optional open-ended survey responses. Finally, 80% of caregivers indicated that the COVID-19 pandemic had a “large” or “very large” impact on their caring activities, negatively affecting the emotional wellbeing and behavior of individuals with TSC, and caregivers’ ability to work and arrange medical appointments. Conclusions Caregivers largely feel involved in treatment decisions, and the majority were satisfied with healthcare services for children with TSC. However, many highlighted the need for an improved transition from pediatric to adult healthcare services. The survey also showed that COVID-19 has considerably affected caregivers and individuals with TSC.

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Section: Discussionmentioning

confidence: 99%

“…This “low and slow” approach with ASM is one that is widely accepted by clinicians and is recommended clinically in most situations [ 11 ]. This approach may help mitigate the risk of experiencing adverse events, thus supporting measures to aid adherence [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Shared decision-making and the caregiver experience in tuberous sclerosis complex: results from a UK survey

Skrobanski

Vyas²,

Bowditch³

et al. 2023

Orphanet J Rare Dis

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“…The emerging development of minimally invasive devices with more recording channels and a suite of on-board algorithms could leverage seizure severity recordings to self-optimize parameters without manual clinical input [41][42][43] . Administration of ASMs are also iterative, as dosage and new medications are altered based on patient reports of seizure frequency 44 . Changes in seizure severity could objectively measure the effects of medication administration and decrease the time to finding effective medication plans for patients.…”

Section: Discussionmentioning

confidence: 99%

A quantitative tool for seizure severity: diagnostic and therapeutic applications

Pattnaik

Ghosn

Ong

et al. 2022

Preprint

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Objective: More than one-third of the people with focal epilepsy do not achieve seizure freedom with medication, neuromodulation, or neurosurgery therapies. Palliative care with the goal of reducing epilepsy burden is an alternative for these patients. Minimizing severe seizures is essential for reducing morbidity. Existing seizure severity scales are qualitative and rely on patient reports, limiting our ability to rigorously track and intervene to curb severe seizures. The goal of this study is to develop and validate a quantitative metric for seizure severity. Methods: We retrospectively analyzed preictal and ictal intracranial-EEG (iEEG) recordings from 54 people with drug-resistant epilepsy undergoing pre-surgical evaluation. We developed a new metric that objectively combines seizure duration, spread, and semiology to quantify seizure severity. We calculated preictal iEEG network features and fit a linear mixed-effects model to quantify patient-specific associations between preictal networks and seizure severity. Results: We evaluated 256 seizures from 54 patients using the quantitative seizure severity score. Seizure severity was consistent with clinical seizure type. Medication taper strategy was associated with seizure severity (p = 0.018, 97.5% confidence interval = [-1.242, -0.116]) and lower pre-surgical seizure severity was associated with better post-surgical seizure outcome (U = 465, p = 0.042). A linear mixed-effects model with preictal network features as regressors and seizure severity as response revealed a group-level positive trend. In 12 out of 14 patients with multiple types of seizures, more severe seizures were preceded by more abnormal preictal networks. Significance: We present a quantitative metric for seizure severity that correlates with clinical and electrographic features. We found that the seizure severity score was associated with abnormal preictal networks. We propose this measure to holistically capture patient condition and guide incremental changes in therapy to improve patient outcome over time.

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“…LTG has a dose-dependent effect and a slow onset of action. Its full therapeutic effect may only be seen in a few weeks or months [ 78 , 79 ]. Overall, the pharmacodynamics of lamotrigine are complex and varied, with potential effects on folate metabolism, kidney function, melanin-containing tissues, and the cardiovascular system, according to the FDA label [ 24 ].…”

Section: Overview Of Antiepileptic Drugsmentioning

confidence: 99%

Understanding Lamotrigine’s Role in the CNS and Possible Future Evolution

Costa

Vale

2023

IJMS

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The anti-epileptic drug lamotrigine (LTG) has been widely used to treat various neurological disorders, including epilepsy and bipolar disorder. However, its precise mechanism of action in the central nervous system (CNS) still needs to be determined. Recent studies have highlighted the involvement of LTG in modulating the activity of voltage-gated ion channels, particularly those related to the inhibition of neuronal excitability. Additionally, LTG has been found to have neuroprotective effects, potentially through the inhibition of glutamate release and the enhancement of GABAergic neurotransmission. LTG’s unique mechanism of action compared to other anti-epileptic drugs has led to the investigation of its use in treating other CNS disorders, such as neuropathic pain, PTSD, and major depressive disorder. Furthermore, the drug has been combined with other anti-epileptic drugs and mood stabilizers, which may enhance its therapeutic effects. In conclusion, LTG’s potential to modulate multiple neurotransmitters and ion channels in the CNS makes it a promising drug for treating various neurological disorders. As our understanding of its mechanism of action in the CNS continues to evolve, the potential for the drug to be used in new indications will also be explored.

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The importance of drug titration in the management of patients with epilepsy

Cited by 16 publications

References 68 publications

Shared decision-making and the caregiver experience in tuberous sclerosis complex: results from a UK survey

Shared decision-making and the caregiver experience in tuberous sclerosis complex: results from a UK survey

A quantitative tool for seizure severity: diagnostic and therapeutic applications

Understanding Lamotrigine’s Role in the CNS and Possible Future Evolution

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