Posts Tagged Medication

[ARTICLE] SUPPORTIVE PRINCIPLES IN THE PHARMACOLOGICAL MANAGEMENT OF THE PATIENTS WITH EPILEPSY

Abstract

Background: Pharmacological management of patients with epilepsy is still a very challenging approach for the best outcome of these patients. When considering the appropriate treatment choice for patients it is necessary to take into account several factors that can influence the effectiveness and quality of life. Cancelling or changing treatment suddenly can lead to uncontrolled seizures. After a short period without seizures, many patients are tempted to abandon treatment. Cessation of treatment can be discussed after a seizure-free period for at least two years. Treatment should be discontinued gradually by reducing the dosage and constant supervision of the physician. This paper analyses briefly the general pharmacological and treatment methods in several forms of adult epilepsy.

Conclusions: Management of epilepsy means more than observing the medication prescribed by the specialist. It is also important for the patient to maintain his general health status, monitor the symptoms of epilepsy and response to treatment and take care of his safety. Involvement in the management of one’s own affection can help the patient to control his condition and to continue his routine in usual manner. The objective of antiepileptic treatment is to reduce epileptic seizures to zero without intolerable side effects. New treatments should focus not only on reducing the frequency and intensity of seizures but also improving the quality of life of patients. Key words: patient, epilepsy, therapy and dynamics.

Introduction

The analysis of the specialized literature reveals that many issues regarding differential treatment of epilepsy require subsequent clarification. As far as we are concerned, we have designed and developed therapeutic recommendations, in our opinion, effective, supporting the results of treating epilepsy in its various stages, from premonition to status variants. In this context, the main element in the choice of preparations, besides the trivial clinical signs, was the use of sub-curative monitoring data, including repeated EEG examinations, which fixed the subjective response of patients. Choosing the best possible medicine or an optimal combination of medicines is sometimes difficult. The perfect antiepileptic should be long, nonsedative, well tolerated, very active in various types of convulsive and with non-harmful effects on vital organs and functions. In addition, it must be effective in various forms of active epilepsy and in treating underlying epileptic seizures and capable of restoring the electroencephalogram between seizures to its normal form [5; 9; 10; 18; 23; 24; 27; 31; 38; 40; 41; 43].

It is still debatable whether such a drug will ever be discovered, and especially one that will control all types of epilepsy. The thorough study of pharmacological properties allows us to appreciate which of the existing antiepileptics will meet the current requirements of our patients under study. Due to the fact that patients differ considerably after clinical response to known anticonvulsants and the possibilities of treatment with associated drugs are insufficiently and superficially researched, testing of more efficient substances including new combinations continues. Due to the modern medication, which benefits from a wide and sufficiently efficient range of specific drugs, a large proportion of the recurrent and the disabling sequelae of the disease can be prevented. The adverse effects of drugs are low, so many of the past patients who have been labelled for life by this suffering can now live a productive life. The actual ability to control this disease effectively prevents more of its severe consequences [12; 13; 15; 22; 29; 46; 50].

General principles of pharmacotherapy of epilepsies

In the treatment of psychiatric disorders of our patients with epilepsy we have taken into account the following principles:

Appropriate selection of the remedy, its dosing, routes of administration and possible side effects. And we took into account the following:

  1. The syndrome of psychic state – the gradual expression of the disorders, the relationship between productive and negative alterations and the type of impairment of psychic processes.
  2. The dynamic characteristics of the psychic state – the duration of the disturbances, the changes in the presence of paroxysmal manifestations.
  3. The somatic and neurological condition of the patient with epilepsy. This parameter is important in the context

of the evidence of side effects of favorable and unfavorable preparations. Somatic mood dictates and the route of administration of drugs: parenteral in gastrointestinal disorders, endonasal or transorbital (by electrophoresis) when parenteral administration is not preferred.

Individual features of the patient with epilepsy (age, weight, response to anticonvulsant therapy and others) are also considered. It is often forgotten that lower doses are indicated for children and older people as the exchange of substances in them is slow and standard dose treatment leads to accumulation of preparations and adverse effects [6; 7; 14; 19].

We recommend the gradual increase of the doses, with the preference of the minimal effective doses of the drugs. All the above-described drugs are initially indicated at minimal doses, then the dose gradually increases until the first positive effects are displayed, the subsequent increase of the doses is made after a certain period of time to stabilize the positive effect.

Complex treatment – it is necessary to prescribe unimoment of anticonvulsant remedies from different classes and groups in combination with non-medication methods. Polipharmacologic treatment has certain priorities in comparison with monotherapy because it addresses different links of the pathological process. It is important to avoid the multidimensional effects of many drugs, the doubling of the mechanisms of action and the predilection of some and the same psychological processes.

Continuous therapy. The treatment of productive disorders is done until their complete jugulation (sometimes with the purpose of preventing relapse and longer), of the deficient ones by alternating the cures, with gradual modifications [28; 30; 34; 39; 42].

Principles of medication of psychosomatic syndromes in epilepsy

Criteria for the effectiveness of psychotropic remedies administered in epilepsy are those of improving the knowledge and behavioral processes. More differentiated treatment is based on syndrome of mental disorders.

  1. Deficient disorder (transient dementia, mental-mental diminution, etc.) The treatment is continuously practiced, alternating the belts. It is rational to indicate the preparations of different subgroups. The following criteria are taken into consideration when drawing up the treatment scheme:

a) Main mechanism of action: nootrop, general metabolism, cerebrovascular or actoprotector;

b) Predominant action on mediating processes: GABA (piracetam, fenibut, gamma-aminobutyric acid); cholin-ergic (gliatiline); dopaminergic (nakom); and combined (meclofenoxate, glycine, glutamic acid);

c) With predominant action on the function of the encephalic structures: the cerebral and subcortical (nakom), on the left hemisphere (gliatilline); on the right hemisphere (cortexil);

d) With action on psychomotor activity: major stimulation (piracetam, nakom vinpocetine), mean enhancement (aminalone, gamma-aminobutyric acid, cerebrolizine, nicergoline, tanakan), diminishment (fenibut, glycine, ci-narizine);

e) Route of administration: parenteral, internal, endo-nasal, transorbital (by electrophoresis), mixed. Duration of treatment: from 7 days to 4 months (nakom, fenibut). On the basis of this therapy it is also possible to indicate prophylactic doses of anticonvulsants.

  1. For different types of excitation (chaotic, twilight, delusional, manic, psychopathic, etc.) the support treatment are the sedative neuroleptics. Major tranquilizers, barbiturates and other anticonvulsants, may also be indicated sedative antidepressants.
  • Hallucinatory delusions. More rational are antipsy-chotic neuroleptics. In the case of neuroleptic syndrome with caution are added corrective remedies. That adjuvant preparations use daytime tranquilizers, in depressive or anxious states are used antidepressants.
  • Emotional productive disruptions. In the states of excitation are indicated predominantly sedative neuroleptics and tranquilizers, antidepressants – in depression, tranquilizers and antiepileptics – in dysphoria, in anxiety states -neuroleptics and tranquilizers.

  • Productive districts nearby. Psychoparticular depressions are typically treated with “inor” euroleptics, preferably “behavioral correctors” or low doses of risperidone and tranquilizers; in neurotic manifestations (asthenia, obsessions, hysteria, hypocondria) are used tranquilizers and low doses of antidepressants [1; 2; 3; 4; 8; 11; 25; 26].
    КиберЛенинка: https://cyberleninka.ru/article/n/supportive-principles-in-the-pharmacological-management-of-the-patients-with-epilepsy

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    Continue —> SUPPORTIVE PRINCIPLES IN THE PHARMACOLOGICAL MANAGEMENT OF THE PATIENTS WITH EPILEPSY – тема научной статьи по медицине и здравоохранению читайте бесплатно текст научно-исследовательской работы в электронной библиотеке КиберЛенинка

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    [WEB SITE] List of Seizures (Convulsions) Medications (60 Compared) – Drugs.com

    Medications for Seizures (Convulsions)

    Other names: Absence Seizure; Complex Partial Seizure; Fits

    About Seizures:  A seizure or convulsion can be a sudden, violent, uncontrollable contraction of a group of muscles. A seizure can also be more subtle, consisting of only a brief “loss of contact” or a few moments of what appears to be daydreaming.

     

    Drugs Used to Treat Seizures

    The following list of medications are in some way related to, or used in the treatment of this condition.[…]

    For the list of medications, Visit Site —> List of Seizures (Convulsions) Medications (60 Compared) – Drugs.com

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    [WEB SITE] Medication Adherence Key to Epilepsy Treatment

    Medication Adherence Key to Epilepsy Treatment

    In assessing the effectiveness of prescribed medication there is a strong emphasis on the ability of the patient to adhere to the regime recommended by the clinician. For individuals with epilepsy, adherence to medication is crucial in preventing or minimizing seizures and their cumulative impact on everyday life. Non-adherence to antiepileptic drugs (AEDs) can result in breakthrough seizures many months or years after a previous episode and can have serious repercussions on an individual’s perceived quality of life. Reasons for non-adherence are complex and multilayered. Patients can accidentally fail to adhere through forgetfulness, misunderstanding, or uncertainty about clinician’s recommendations, or intentionally due to their own expectations of treatment, side-effects, and lifestyle choice.

    Adherence in epilepsy

    Adherence is acting in accordance with advice, recommendations or instruction. Ways that adherence can be optimized;
    1.  Educating individuals and their families and caregivers in understanding of their condition and the rationale of treatment, reducing the stigma associated with the conditions.

    2.  Using simple medication regimes.

    3.  Positive relationships between healthcare professionals, the individual with epilepsy and their family and /or caregivers.

    4.  Other measures are; manual telephones follow up, home visits, special reminders, regular appointments/ refill reminders.

    While failing to adhere to treatment plans can adversely affect individuals with any general medical condition, Non- adherence to anti-epileptic drugs results to increased risk of status epilepticus (prolonged seizures) resulting into brain damage, SUDEP, risk of injuries, increase rates of admission to hospital due prolonged seizures. The consequences of not taking medication can be more immediate with epilepsy.

    Epilepsy as a chronic condition relies heavily on adherence to medical advice in order to maximize an individual’s quality of life by controlling seizures more effectively while avoiding unwanted side-effects. Treatment of those diagnosed with epilepsy the vast majorities are treated with AEDs and approximately 70% can become seizure-free once the most effective regime is followed.
    Monotherapy is viewed as the initial and preferential option for treating epilepsy, the choice of drug depending on seizure type and effectiveness of the drug balanced against possible side-effects. It is difficult to find estimates of how many people are on monotherapy or polytherapy at any one point in time.
    However, in one of the cases I encountered that of Sarafina Muthoni from Banana, Kiambu County, she was diagnosed with Epilepsy at a very young age in her primary school days. With no history of such a condition in her family, it got everybody thinking what could have gone wrong with their lovely daughter. After days of trying to figure out, the family had to adapt to reality of their daughter living with Epilepsy. She was lucky to have very supportive parents ready to see her through the long journey of treating the condition. The motivation and support from her loved ones to access medication improved her status by far as she continued to adhere to the prescribed treatment. Unfortunately, the support didn’t last long and the burden of continuing with treatment squarely relied on her. This adversely contributed to the beginning of non-adherence to medication for lack of funds to buy drugs. Not only were finances a challenge but also finding a good hospital to comply was a problem.
    Muthoni had to live with the sad reality of pain every time she experienced a seizure. Pain which she clearly knew with access to medication the situation could by far be controlled. At the very worse of her situation she found help. Cheshire Disability Services Kenya (CDSK) a Non-Governmental Organization in Kenya whose objective is to empower an inclusive society of persons with disability and develop their full potential to lead a quality life, in partnership with Kenya Association of People with Epilepsy (KAWE) came for Muthonis’ rescue.
    Under CDSK’s program to help Epilepsy patients’ access medication and ensure compliance, Muthoni benefited and today she leads a life full of potential and energy as she explores her skills as a beauty and hair stylist.
    As we celebrate International Epilepsy Day on Feb 12th 2018, themed on “Life is beautiful”, Muthoni’s story is a highlight of what beauty is all about. Hers’ is just but one of the many inspiring stories to celebrate during this season of Epilepsy Awareness.

    Managing Adherence

    Adherence to medication regardless of medical condition remains an important problem in treatment. Factors that have been discussed here – side-effects, drug regime, family support, impact on everyday life, relationship with the clinician – are unlikely to be the only predictors of adherence. While adherence to treatment within the context of epilepsy has been the focus of this review, these factors can equally be applied to various chronic conditions.
    Assessment of adherence should be a routine part of management of epilepsy. Further recognition and support should be given to patients who have poor seizure control since they are more likely to be more anxious and have unhelpful illness and treatment beliefs.
    Finally, patients may be fully aware of the importance of taking AED medication and the benefits gained by altering their lifestyle choices in order to prevent seizures, but will make a decision about the degree to which they follow advice. Patients only have a small amount of time in contact with the clinician in their “patient role”, after which they return to the practicalities of their everyday routine where their adherence fluctuates based on how they feel their medication affects their quality of life.
    Strategies to manage adherence originate from different perspectives. While the medical model may advocate less complex drug regimes, the use of measured pill containers, and minimization of side-effects, the psychosocial model analyzes non-adherence in terms of patient attitudes to medication, stigma, family and peer influences, and ability to manage self care. Neither model can adequately improve adherence independently. Perhaps the best approach is to offer a “menu” of adherence-enhancing strategies. However, what is increasingly clear from both models is that total adherence is an unrealistic goal. The emphasis has shifted away from total adherence towards a compromise with both patient and clinician involved in a joint process of treatment negotiation and decision-making in order to achieve the best outcome for the individual.

    Source: Evewoman

    via Medication Adherence Key to Epilepsy Treatment – EpilepsyU

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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.

    https://tbirehabilitation.files.wordpress.com/2016/01/man-woman-upset_3106.jpg

    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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    [ARTICLE] Pharmacotherapy in rehabilitation of post-acute traumatic brain injury

    Available online 20 January 2016

    Highlights

    • Post-acute TBI has numerous symptoms that require pharmacological management.
    • Beta-blockers work well in reducing hyper-arousal in TBI.
    • Donepezil can be used to improve cognition and memory after a TBI.
    • Melatonin and trazodone can be used to improve sleep after a TBI.
    • Sertraline and citalopram can be used to treat depression after a TBI.

    Abstract

    There are nearly 1.8 million annual emergency room visits and over 289,000 annual hospitalizations related to traumatic brain injury (TBI).

    The goal of this review article is to highlight pharmacotherapies that we often use in the clinic that have been shown to benefit various sequelae of TBI.

    We have decided to focus on sequelae that we commonly encounter in our practice in the post-acute phase after a TBI. These symptoms are hyper-arousal, agitation, hypo-arousal, inattention, slow processing speed, memory impairment, sleep disturbance, depression, headaches, spasticity, and paroxysmal sympathetic hyperactivity.

    In this review article, the current literature for the pharmacological management of these symptoms are mentioned, including medications that have not had success and some ongoing trials. It is clear that the pharmacological management specific to those with TBI is often based on small studies and that often treatment is based on assumptions of how similar conditions are managed when not relating to TBI. As the body of the literature expands and targeted treatments start to emerge for TBI, the function of pharmacological management will need to be further defined.

    This article is part of a Special Issue entitled SI:Brain injury and recovery.

    Abbreviations

    • TBI, traumatic brain injury;
    • CDC, Centers for Disease Control and Prevention;
    • ED,emergency department;
    • AHRQ, US Agency for Healthcare Research and Quality;
    • NMDA, N-methyl-D-aspartate;
    • DRS, disability rating scale;
    • CSM, cerebral state monitoring;
    • PTSD, post-traumatic stress disorder;
    • GABA, gamma aminobutyric acid;
    • CCI, controlled cortical impact;
    • TCA, tricyclic antidepressant;
    • MAS, Modified Ashworth Score;
    • SCI, spinal cord injury;
    • MS, multiple sclerosis;
    • BoNT, Botulinum toxin;
    • ITB,intrathecal baclofen

    Source: Pharmacotherapy in rehabilitation of post-acute traumatic brain injury

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