- Patient-specific treatment goals should be identified as early as possible.
- Accurate diagnosis and classification of seizure/syndrome type is critical to selection of appropriate pharmacotherapy.
- Patient characteristics such as age, comorbid conditions, ability to comply with the prescribed regimen, and presence or absence of insurance coverage can also influence the choice of antiepileptic drugs (AEDs).
- Pharmacotherapy of epilepsy is highly individualized and requires titration of the dose to optimize AED therapy (maximal seizure control with minimal or no side effects). Approximately 50% to 70% of patients can be maintained on one AED.
- If the therapeutic goal is not achieved with monotherapy, a second drug can be added or a switch to an alternative single AED can be made. If a second AED is added it should have a different mechanism of action from the first, although there is no clear evidence in humans to support this.
- Some patients eventually can discontinue AED therapy. Several factors predict successful withdrawal of AEDs.
- Surgery is the treatment of choice in selected patients with refractory focal epilepsy.
- The appropriate use of AEDs requires a thorough understanding of their clinical pharmacology, including mechanism of action, pharmacokinetics, adverse reactions, and drug interactions, as well as available dosage forms.
On completion of the chapter, the reader will be able to:
Describe the epidemiology of various seizure disorders.
Compare and contrast the clinical presentation of partial versus generalized seizures.
Discuss the pathophysiologic mechanisms underlying seizure disorders.
List the general treatment goals for a patient with a seizure disorder.
List the preferred first-line and alternative antiepileptic drugs for both partial and generalized seizures.
Describe the factors that would guide selection of a specific antiepileptic drug for an individual patient.
Select an appropriate antiepileptic drug for a patient based on patient-specific data.
Describe the cognitive adverse effects of the various antiepileptic drugs.
Discuss the hormonal/reproductive health considerations of antiepileptic drug treatment.
Discuss and compare the mechanisms of action of the antiepileptic drugs.
Compare and contrast the adverse-effect profile of individual antiepileptic drugs.
Compare and contrast the various antiepileptic drugs with respect to the pharmacokinetic, metabolic, and antiepileptic drug interactions.
Describe the role of therapeutic drug monitoring in the management of a patient with epilepsy.
Formulate a monitoring plan for a patient on a given antiepileptic drug based on patient-specific information and the prescribed regimen.
Discuss general considerations regarding duration of antiepileptic drug treatment and withdrawal of treatment.
Identify nonpharmacologic therapy for patients with refractory seizures.
Formulate appropriate counseling information to be provided a patient on antiepileptic drug therapy.
Epilepsy is a disorder that is best viewed as a symptom of disturbed electrical activity in the brain, which may have many etiologies. It is a collection of many different types of seizures that vary widely in severity, appearance, cause, consequence, and management. Seizures that are prolonged or repetitive can be life-threatening. Epilepsy is defined by the occurrence of at least two unprovoked seizures separated by 24 hours.1 The effect ...