Dose supplementation at the time of dialysis may be needed for these drugs.
Many antibiotics, antifungals, and antiparasitics can lower seizure threshold so this should be considered as well. In these situations, selecting an AED with minimal drug-drug interactions Table 1 is beneficial. Certain chemotherapeutic drugs may lower seizure threshold eg, L-asparaginase, busulfan, carmustine, cisplatin, cyclosporine, etoposide, and methotrexate. Selecting AEDs with minimal interactions is beneficial eg, levetiracetam, lacosamide, briviact, lamotrigine, topiramate, zonisamide, pregablin, gabapentin see Table 1. Refractory epilepsy is defined as the presence of seizures despite trials of at least 2 appropriately selected AEDs at tolerated therapeutic doses.
There is growing awareness of cannabis-based therapies from physicians and patients alike that are a subject of significant investigation 24,25 ; these are addressed in the article Cannabis, Cannabinoids, and Epilepsy in this issue. Along with appropriate choice of AED, it important to keep in mind several nonpharmacologic adjunctive strategies that are useful in managing epilepsy. Patients should be counseled regarding seizures triggers, including sleep deprivation, stress, and mood disorders. This may be especially important for patients who have comorbid psychogenic nonepileptic spells that can benefit from cognitive behavioral therapy CBT.
Although data on the effect of alcohol on seizures is limited, patients with epilepsy commonly report alcohol as a trigger, and this should be discussed as well. Several studies suggest that treatment of obstructive sleep apnea in patients with epilepsy can lead to improved seizure control, specifically with the use of positive airway pressure therapy. There is no proven algorithm for selecting an AED for patients with epilepsy, and multiple factors must be considered during the selection process, including the type of epilepsy being treated ie, focal vs generalized, specific syndrome, or if a clear first-line treatment exists , patient factors that narrow possible treatment options ie, comorbid medical problems, concurrent medications, pregnancy, financial constraints , medication factors ie, tolerability and rational polypharmacy , and nonpharmacological adjuncts.
For those with refractory epilepsy, early referral to an epilepsy specialist and ideally a National Association of Epilepsy Centers NAEC Level 4 center, where alternative therapies such as advanced surgical treatments, neurostimulation, and research trials can be considered is prudent. N Engl J Med. Association of non-adherence to antiepileptic drugs and seizures, quality of life, and productivity: survey of patients with epilepsy and physicians.
Epilepsy Behav ;13 2 Managing epilepsy in women. Husain A Ed. Practical Epilepsy. Navis A, Harden C. A Treatment approach to catamenial epilepsy.
Pharmacological management of epilepsy. Adult status epilepticus: a review of the prehospital and emergency department management. During epilepsy reviews advice on diet and weight-bearing exercise should be given for prevention of vitamin D deficiency, along with advice about over-the-counter vitamin D supplements. A person who has suffered an epileptic attack whilst asleep must also refrain from driving from 1 year from the date of the attack, unless they have had an attack whilst asleep more than 3 years ago and have not had any awake attacks since that sleep attack. I prepared or cooperated in the preparation of the Work as part of my duties as an employee, and the Work is, therefore, a "work made for hire", as defined by the United States Copyright Act of , as amended. Seizure ;22 3 —6.
Curr Treat Options Neurol ;18 7 Herzog AG Progesterone vs placebo therapy for women with epilepsy. A randomized clinical trial. Evidence-based guideline: management of an unprovoked first seizure in adults: report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society.
Zangaladze A, Skidmore C. Lacosamide use in refractory idiopathic primary generalized epilepsy. Epilepsy Behav. Afra P, Adamolekun B.
Lacosamide treatment of juvenile myoclonic epilepsy. Patient-reported cognitive side effects of antiepileptic drugs: predictors and comparison of all commonly used antiepileptic drugs. Epilepsy Behav ;14 1 Abou-Khalil BW. Antiepileptic drugs. Combining antiepileptic drugs--rational polytherapy? Bourgeois BF. Antiepileptic drug combinations and experimental background: the case of phenobarbital and phenytoin. Naunyn Schmiedebergs Arch Pharmacol.
Phenytoin and carbamazepine, alone and in combination: anticonvulsant and neurotoxic effects. Carbamazepine toxicity with lamotrigine: pharmacokinetic or pharmacodynamic interaction? Lamotrigine substitution study: evidence for synergism with sodium valproate?
source url Epilepsy Res. Special considerations in treating the elderly patient with epilepsy. Carlson C, Anderson CT.
Special issues in epilepsy: the elderly, the immunocompromised, and bone health. Biller J, Ferro JM. Krikorian S, Rudorf, DC. Drug-drug interactions and HIV therapy: what should pharmacists know? J Pharm Pract. Neurologic complications of chemotherapy and radiation therapy. Epilepsia ;51 6 Risk of sudden unexpected death in epilepsy in patients given adjunctive antiepileptic treatment for refractory seizures: a meta-analysis of placebo-controlled randomised trials.
Lancet Neurol. FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy [press release]. Accessed August 18, Cannabinoids in treatment-resistant epilepsy: A review. Effect of positive airway pressure therapy on seizure control in patients with epilepsy and obstructive sleep apnea. SA received honoraria for serving on a medical advisory board of Greenwich Biosciences and receives research support from Sunovion.
October Choosing Antiepileptic Drugs As the number of available antiepileptic drugs increases, so does the challenge of choosing the most appropriate drug for a given patient. The Faculty of Sexual and Reproductive Healthcare agrees that enzyme-inducing drugs may decrease efficacy and recommend considering IUDs and injectable contraceptive methods.
SSRIs decrease platelet serotonin levels resulting in defective platelet aggregation and impaired hemostasis. Studies have also shown that SSRIs increase gastric acidity, which leads to increased risk of peptic ulcer disease and GI bleeding. The evidence. Another meta-analysis found that the OR for bleeding risk increased to 6.
Skip to main content. Applied Evidence. J Fam Pract. Winslow, MD. B Strength of recommendation SOR A Good-quality patient-oriented evidence B Inconsistent or limited-quality patient-oriented evidence C Consensus, usual practice, opinion, disease-oriented evidence, case series. Next Article: Addressing sexual health with adolescents must be a priority. Women's Health Musculoskeletal Disorders Neurology. Menu Menu Presented by Register or Login. Menu Close.