Posts Tagged antiepileptic drugs

[Abstract] Post-stroke epilepsy

Highlights

Post-stroke epilepsy (PSE) is a major complication after stroke.

It is unclear which treatments are most effective in the prevention of recurrence of symptoms, or whether such therapy is needed for primary prevention.

The current understanding of epidemiology, diagnoses, mechanisms, risk factors, and treatments of PSE are covered in this review.

Abstract

Post-stroke epilepsy (PSE) is a common complication after stroke, yet treatment options remain limited. While many physicians prescribe antiepileptic drugs (AED) for secondary prevention of PSE, it is unclear which treatments are most effective in the prevention of recurrence of symptoms, or whether such therapy is needed for primary prevention. This review discusses the current understanding of epidemiology, diagnoses, mechanisms, risk factors, and treatments of PSE.

Source: Post-stroke epilepsy

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[Abstract] The withdrawal of antiepileptic drugs in patients with low-grade and anaplastic glioma.

Abstract

Introduction: The withdrawal of antiepileptic drugs (AEDs) in World Health Organization (WHO) grade II-III glioma patients with epilepsy is controversial, as the presence of a symptomatic lesion is often related to an increased risk of seizure relapse. However, some glioma patients may achieve long-term seizure freedom after antitumor treatment, raising questions about the necessity to continue AEDs, particularly when patients experience serious drug side effects.
Areas covered: In this review, we show the evidence in the literature from 1990-2016 for AED withdrawal in glioma patients. We put this issue into the context of risk factors for developing seizures in glioma, adverse effects of AEDs, seizure outcome after antitumor treatment, and outcome after AED withdrawal in patients with non-brain tumor related epilepsy.
Expert commentary: There is currently scarce evidence of the feasibility of AED withdrawal in glioma patients. AED withdrawal could be considered in patients with grade II-III glioma with a favorable prognosis, who have achieved stable disease and long-term seizure freedom. The potential benefits of AED withdrawal need to be carefully weighed against the presumed risk of seizure recurrence in a shared decision-making process by both the clinical physician and the patient.

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Source: The withdrawal of antiepileptic drugs in patients with low-grade and anaplastic glioma – Expert Review of Neurotherapeutics –

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[WEB SITE] List of 31 Common Epilepsy and Seizure Medications – Healthy resources

LIST OF 31 COMMON EPILEPSY AND SEIZURE MEDICATIONS

Get a Complete Understanding

Epilepsy is a disorder in which the brain sends abnormal signals, which can lead to seizures. Although seizures can occur for a variety of reasons, such as injury or sickness, epilepsy causes recurrent seizures. There are many types of epileptic seizures. Many of them can be treated with anti-seizure medications.

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Anti-seizure medications are also known as antiepileptic drugs (AEDs). According to the National Institute of Neurological Disorders and Stroke (NINDS), there are more than 20 AEDs available through prescription. While there are many options in epilepsy treatment, your therapy choices will depend on your:

  • age
  • type of seizures
  • frequency of seizures
  • lifestyle
  • chances of pregnancy (in women)

Seizure medications are available in two types: narrow- and broad-spectrum AEDs. Some patients may need more than one medication to prevent epileptic seizures more effectively. It’s important to discuss the possibility of side effects, and even worsening seizures, with your doctor before starting any of these medications.

See average costs for the most common epilepsy medications »

Part 2 of 3: Narrow-Spectrum AEDs

Narrow-Spectrum AEDs

Narrow-spectrum AEDs are designed for specific types of seizures. These are the most appropriate medications if seizures occur in one specific part of the brain on a regular basis.

Carbamazepine (Carbatrol, Tegretol, Epitol, Equetro)

Carbamazepine is used to treat seizures that occur in the temporal lobe. It may also be helpful in treating secondary, partial, and refractory seizures. It is used for many other purposes, including pain and mood treatment. Carbamazepine interacts with many other drugs.

Clobazam (Frisium, Onfri)

Clobazam helps prevent absence, secondary, and partial seizures. It is a benzodiazepine, a drug class that is often used for sedation, sleep, and anxiety. According to the Epilepsy Foundation, this medication may be used in patients as young as 2 years old. It has recently been linked to a rare but potentially serious skin reaction.

Diazepam (Valium, Diastat)

Used to treat cluster seizures, diazepam can also be used to treat prolonged seizures. Diazepam is a benzodiazepine. It’s also used to treat anxiety, alcohol withdrawal, and more. The product Diastat is used rectally for life threatening seizures.

Divalproex (Depakote)

This medication is approved to help treat complex partial, absence, partial, and multiple seizure types. Divalproex increases availability of gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter. It may also be helpful for bipolar mania and migraines.

Eslicarbazepine Acetate (Aptiom)

This seizure drug is approved as additional (adjunctive) treatment for partial-onset seizures. Its action is thought to involve blockade of sodium channels.

Ethosuximide (Zarontin)

This AED is used to treat all forms of absence seizures. These also include atypical, childhood, and juvenile absence seizures. Ethosuxemide reduces the likelihood of seizures.

Gabapentin (Neurontin, Gralise, Gabarone)

Glabapentin is used to treat partial seizures. It may be preferable over other AEDs because the potential side effects are mild. The most common are dizziness and fatigue. Gabapentin is also widely used for several pain syndromes.

Lacosamide (Vimpat)

This medication is used for partial seizures. According to the Epilepsy Foundation, it is approved for patients ages 17 and older. Lacosamide may be prescribed orally or intravenously.

Perampanel (Fycompa)

Perampanel is used to treat complex, simple, and refractory seizures. The way it works is not fully understood. The medication is thought to affect glutamate receptors in the brain. Perampanel can cause serious of life-threatening psychiatric or behavioral adverse reactions.

Phenobarbital

This is one of the first and oldest seizure medications still used in the treatment of epilepsy. It can treat generalized seizures, partial seizures, and tonic-clonic seizures. Phenobarbital is a long-acting sedative drug with anticonvulsant action.

Phenytoin (Dilantin, Phenytek, and others)

Phenytoin is another old and prominent anti-epileptic drug on the market. It stabilizes neuronal membranes. It’s used in the treatment of complex, simple, and refractory seizures. Phenytoin is available in both capsule and liquid form.

Pregabalin (Lyrica)

This medication is used as additional (adjunctive) treatment for partial-onset seizures. Pregabalin is used more often to treat diabetic neuropathy or fibromyalgia.

Rufinamide (Banzel)

This medication is used as additional (adjunctive) treatment of seizures associated with Lennox-Gastaut syndrome. It can cause adverse effects like high rate of heart rhythm changes and drug interactions. These effects limit the use of this drug.

Tiagabine Hydrochloride (Gabitril)

This medication is used as additional (adjunctive) treatment for complex and simple partial seizures.

Oxcarbazepine (Trileptal)

Oxcarbasepine is used to treat call types of focal seizures. According to Panayiotopoulos, it can be used in adults and children as young as 2 years old.

Vigabatrin (Sabril)

This medication is used as additional (adjunctive) treatment for complex partial seizures. This medication is restricted in use. It must be prescribed and dispensed by prescribers and pharmacies registered with the program. It comes with possible serious adverse effects, including permanent vision loss.

Part 3 of 3: Broad-Spectrum AEDs

Broad-Spectrum AEDs

If you have more than one type of seizure, a broad-spectrum AED may be your best choice of treatment. These medications are designed to prevent seizures in more than one part of the brain, as opposed to the focalized effects of narrow-spectrum AEDs.

Clonazepam (Epitril, Klonopin, Rivotril)

Clonazepam is a long-acting benzodiazepine. It’s used to treat multiple types of seizures. This includes myoclonic, akinetic, and absence seizures. Klonopin is the most common brand name. Clonazepam is also used to treat several other non-epileptic disorders.

Ezogabine (Potiga)

This AED is used as an additional (adjunctive) treatment. It’s used for generalized seizures, refractory, and complex partial seizures. Ezogabine can cause vision abnormalities that can become vision loss over time. It’s reserved for patients who do not respond to other drugs.

Felbamate (Felbatol)

Felbamate is used to treat nearly all types of seizures in people who don’t respond to other therapy. It can be used as single therapy or in combination with other drugs. It is used when other therapies have failed.

Lamotrigine (Lamictal)

This medication may treat a wide range of epileptic seizures. It’s also sometimes used in the treatment of Lennox-Gastaut Syndrome. When you start lamotrigine, your dose is gradually increased. People on this drug must watch for rare skin reactions, which can be serious.

Lorazepam (Ativan)

Lorazepam is approved for use in status epilepticus (prolonged, critical seizure). Lorazepam is a benzodiazepine. It’s often used for anxiety and mild sedation, with a rapid onset of action. It’s available in oral tablets, liquid, and injectable forms.

Primidone (Mysoline)

Primidone is used to treat myoclonic, tonic-clonic, and focal seizures. This medication is also approved for the use in juvenile myoclonic epilepsy.

Topiramate (Topamax)

Used as single or in combination treatment for a variety of seizures, topiramate is only available in its brand-name form Topamax. It has several actions. Topiramate is also used to treat migraine. It may also cause headache in some patients.

Levetiracetam (Keppra)

Levetiracetam is considered first line therapy for generalized and partial seizures, atypical, absence and other types of seizures. According to Panayiotopoulos, this promising drug can be used to treat all focal or generalized, idiopathic, or symptomatic epilepsy in people of all ages. It is also considered one of the drugs most free from adverse reactions.

Zonisamide (Zonegran)

Zonisamide is used as additional (adjuctive) treatment in partial seizures and other types of epilepsy. This drug has been shown to be effective in treating a range of epilepsy and seizure types. However, it comes with many potentially serious adverse reactions.

Valproic Acid

Valproic acid is a common AED. It’s approved to treat most seizures on its own or in combination treatment. Valproic acid increases the availability of gamma-aminobutryic acid (GABA). GABA is an inhibitory neurotransmitter to brain neurons. Valproic acid is also used to treat mood disorders or migraine. It is available in the following brands:

  • Depacon
  • Depakene
  • Depakine
  • Depakote
  • Depakote Sprinkles
  • Stavzor

Source: List of 31 Common Epilepsy and Seizure Medications – Healthy resources

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[WEB SITE] Seizure Decisions: After an unprovoked seizure, patients are often left wondering what’s next. A new guideline from a panel of epilepsy experts tries to answer that question.

Dolan, Darrach

Last September, Anthony Bonadio, 26, flew from New York to San Diego for a friend’s wedding. The morning after the wedding, he turned on the water for a shower—and the next thing he remembers is waking up in an ambulance. His friend, who was sharing the hotel room, says he heard a heavy thump followed by several more. He rushed to the bathroom and found Bonadio convulsing on the floor.

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In October, after a long, stressful day playing piano in auditions for a Broadway musical, Nick Day, 23, went to bed and fell asleep. When he woke up, his girlfriend told him he’d had a seizure and an ambulance was on the way.Both young men were examined by emergency department doctors, observed for a few hours, and sent home with orders to take it easy. Both were told that unprovoked seizures were quite common and that theirs may have been brought on by exhaustion.

AN UNCERTAIN FUTURE

Each year, an estimated 150,000 Americans experience unprovoked seizures—seizures without an obvious trigger like a blow to the head, a high fever, low blood sugar, or alcohol withdrawal. More than 50 percent of the time, patients will never have a second seizure, even though the cause of the first remains a mystery.Neither Bonadio nor Day knew whether the seizure was an isolated incident or signaled the onset of epilepsy. Should they take antiepileptic drugs (AEDs) to reduce the risk of having a second seizure, or do nothing and hope they were among the percentage of patients who never have another seizure?With such uncertainty common in medical practice, the American Academy of Neurology (AAN) and the American Epilepsy Society convened a panel of experts to review the available evidence and draft a guideline, published in the journal Neurology, to help patients and doctors decide what to do in the case of a first unprovoked seizure. The experts set out to answer three questions: If you have an unprovoked seizure, what is your risk of a second one? If you take an AED immediately after your first seizure, will this help you remain free of seizures in the long term? And are there any adverse side effects of AEDs that patients need to know about?

Continue —> Seizure Decisions: After an unprovoked seizure, patients are… : Neurology Now.

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[WEB SITE] Management of Epilepsy During Pregnancy – Medscape

Abstract

Child-bearing years are often the most precarious management period in the life of a woman with epilepsy. This article reviews the results of many different studies with findings that enable the healthcare team to make confident decisions and recommendations during these critical periods. Preconceptional planning, effective contraception and folic acid supplementation are important fundamentals in preparation for pregnancy. There is growing evidence to avoid valproic acid use during the child-bearing years. Emerging data on congenital malformations and neurocognitive outcomes are available for some of the second-generation antiepileptic drugs and appear reassuring for lamotrigine and levetiracetam. Also reviewed are the benefits of postpartum drug tapers and favorable breastfeeding facts. Counseling the mother and her family on medication choices enables the healthcare team to implement informed decisions that are beneficial for the mother and child.

Introduction

The management of epilepsy during pregnancy is challenging and complicated. Epilepsy is the fourth most common neurologic disorder, but one of the most common chronic medical disorders of any kind that requires daily treatment with known teratogens during pregnancy. Over 1 million women with epilepsy in the USA are of reproductive age, and these women give birth to approximately 20,000 infants every year.[1] The majority of patients with epilepsy maintain seizure control during pregnancy, with actual seizure freedom reported in 66% of pregnant women in one large, international pregnancy registry.[2] But while some studies report that 63% of women experience no change in seizure activity, 17% experience an increase, and 16% a decrease in seizure frequency.[3] Seizures pose a risk to the developing fetus, especially if generalized tonic clonic convulsions. They can cause direct injuries from a fall, compromise the blood supply to the fetus, cause postictal hypoxia and lactic acidosis. This argues for stricter vigilance about seizure control during pregnancy than in any other period of a woman’s life. However, the treatment of epilepsy during pregnancy is a double-edged sword, because many of the antiepileptic drugs (AEDs) that most effectively control seizures are also teratogenic to various degrees, posing another obvious risk to the developing fetus. This makes the management of the pregnant patient with epilepsy a unique challenge (Figure 1). With the increasing use of AEDs for various nonepileptic disorders like chronic or neuralgic forms of pain, migraines and mood disorders, it is necessary to understand the best evidence based strategies for using AEDs in pregnant women. This review presents numerous prospective studies, registry data and updated results describing treatment strategies and outcomes for treating epileptologists, general neurologists, internists, family practitioners, obstetricians and pediatricians.

Continue —> Management of Epilepsy During Pregnancy.

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[REPORT] Progress report on new antiepileptic drugs: A summary of the Eleventh Eilat Conference (EILAT XI) – Full Text HTML

Summary

The Eleventh Eilat Conference on New Antiepileptic Drugs (AEDs)-EILAT XI, took place in Eilat, Israel from the 6th to 10th of May 2012.

About 100 basic scientists, clinical pharmacologists and neurologists from 20 countries attended the conference, whose main themes included “Indications overlapping with epilepsy” and “Securing the successful development of an investigational antiepileptic drug in the current environment”.

Consistent with previous formats of this conference, a large part of the program was devoted to a review of AEDs in development, as well as updates on AEDs introduced since 1994. Like the EILAT X report, the current manuscript focuses only on the preclinical and clinical pharmacology of AEDs that are currently in development. These include brivaracetam, 2-deoxy-glucose, ganaxolone, ICA-105665, imepitoin, NAX 801-2, perampanel and other AMPA receptor antagonists, tonabersat, valnoctamide and its homologue sec-propylbutylacetamide (SPD), VX-765 and YK3089.

Since the previous Eilat conference, retigabine (ezogabine) has been marketed and four newer AEDs in development (NAX 810-2, SPD, tonabersat and VX-765) are included in this manuscript.

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Full Text HTML –> Progress report on new antiepileptic drugs: A summary of the Eleventh Eilat Conference (EILAT XI).

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[WEB SITE] Risk for Seizures After a Traumatic Brain Injury

A brain injury can cause many long-term problems in patients, resulting in frustrating and sometimes debilitating issues that have to be dealt with by medical professionals, family members and the patients themselves. One of those problems is seizures. While some people who have a TBI may never experience a seizure, it is a good idea to be on the lookout for risk factors and what a seizure looks like in order to understand how to best deal with the issue, and when and how to seek treatment.

Seizure Basics

Experts have found that about 5 percent of seizures occur in people with a TBI. Typically, the seizure occurs in the area where the brain was damaged in the injury, often where there is a scar. A seizure caused by a TBI may happen shortly after the injury, or may occur years later. A sudden electrical disturbance in the brain is what causes a seizure, which can result in some of the following symptoms:

  • Stiffening or shaking of the head, body or limbs
  • Staring and general unresponsiveness
  • Abnormal smell, sound, feeling or visual images
  • Fumbling movements, chewing or lip smacking
  • Inability to speak or understand other people
  • Sudden dizziness or tiredness

The symptoms of a seizure come on quickly and are uncontrollable for the patient. Some seizures may last only a few seconds, but may last for five to 10 minutes in some cases. During a seizure, a sufferer may be at risk for biting his or her tongue or the inside of the mouth. Afterwards, it may be difficult to stand, walk or communicate.

Conditions That Increase Seizure Risk

There are certain things that can cause the risk for seizures to increase, especially in TBI patients. Some of those conditions include the following:

  • Extreme fatigue
  • Drug and alcohol use
  • High fever
  • Low sodium, high calcium or other chemical changes

Avoiding these situations can be helpful for those who experience seizures after a traumatic brain injury.

Treating Seizures

About 70 to 80 percent of people who have seizures resulting from a TBI can be treated using medications. A doctor prescribes the medication based on the type of seizures, as well as other factors such as age, health and side effects. Antiepileptic drugs, also called AEDs, can help control seizures, but can also cause common side effects such as fatigue, confusion and double vision. For most people, the side effects are better than having frequent seizures.

Having a seizure can be a scary experience, but when you are aware of the signs and symptoms, you and your caretakers can keep you as safe as possible during one.

via Risk for Seizures After a Traumatic Brain Injury | The Smart Living Network.

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[ARTICLE] Post-traumatic epilepsy: current and emerging treatment options – Full Text

Abstract

Traumatic brain injury (TBI) leads to many undesired problems and complications, including immediate and long-term seizures/epilepsy, changes in mood, behavioral, and personality problems, cognitive and motor deficits, movement disorders, and sleep problems.

Clinicians involved in the treatment of patients with acute TBI need to be aware of a number of issues, including the incidence and prevalence of early seizures and post-traumatic epilepsy (PTE), comorbidities associated with seizures and anticonvulsant therapies, and factors that can contribute to their emergence.

While strong scientific evidence for early seizure prevention in TBI is available for phenytoin (PHT), other antiepileptic medications, eg, levetiracetam (LEV), are also being utilized in clinical settings. The use of PHT has its drawbacks, including cognitive side effects and effects on function recovery. Rates of recovery after TBI are expected to plateau after a certain period of time. Nevertheless, some patients continue to improve while others deteriorate without any clear contributing factors.

Thus, one must ask, ‘Are there any actions that can be taken to decrease the chance of post-traumatic seizures and epilepsy while minimizing potential short- and long-term effects of anticonvulsants?’ While the answer is ‘probably,’ more evidence is needed to replace PHT with LEV on a permanent basis. Some have proposed studies to address this issue, while others look toward different options, including other anticonvulsants (eg, perampanel or other AMPA antagonists), or less established treatments (eg, ketamine). In this review, we focus on a comparison of the use of PHT versus LEV in the acute TBI setting and summarize the clinical aspects of seizure prevention in humans with appropriate, but general, references to the animal literature.

Full Text–> Post-traumatic epilepsy: current and emerging treatment options.

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WEB SITE: More Fetal Risks Linked to Epilepsy Drugs

More Fetal Risks Linked to Epilepsy Drugs.

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Epilepsy Center at UC San Diego Health System

The Epilepsy Center at UC San Diego Neurological Institute is the only nationally designated epilepsy center in the region. We handle the most complex epilepsy cases in Southern California.

UC San Diego offers the latest technological advances in diagnostics, medical therapies, surgical procedures and clinical trials. Our epilepsy team includes EEG technologists, clinical nurse specialists, clinical trial specialists, neurologists, epileptologists, neuropathologists, neuropsychologists, neuroradiologists, neurosurgeons and psychiatrists.

μέσω Epilepsy Center at UC San Diego Health System.

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