Some practical aspects of first monotherapy prescribing to adult patients with epilepsy | Ukrainian Medical Journal

Maryenko L.B.

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Some practical aspects of first monotherapy prescribing to adult patients with epilepsy

Some practical aspects of first monotherapy prescribing to adult patients with epilepsy

June 25, 2021

1061

Neurology and Psychiatry

Keywords :

Specialities :

Neurology and Psychiatry

Resume

Due to the high prevalence of epilepsy in the world, patients with this pathology need more and more attention from neurologists, epileptologists, psychiatrists and family physicians. The aim of the work is to acquaint physicians who care for such patients with the main provisions of the modern scientific literature, author’s own experience in prescribing the first antiepileptic drug in the established diagnosis of epilepsy. The algorithm of the physician’s actions in the course of consultation of the patient is presented, the basic questions to which it is necessary to pay special attention are underlined; how to establish the diagnosis correctly, to appoint diagnostic procedures, to choose antiepileptic drug depending on the type of a seizure and etiology of epilepsy. The basic principles of drug administration in structural (post-stroke, post-traumatic, mesial temporal), genetic, cryptogenic and undifferentiated epilepsy are given. Third-generation drugs, having similar efficacy with classic, traditional second-generation drugs, show advantages in less teratogenicity, better tolerability, less interaction with other drugs prescribed to patients with comorbid pathology. Each patient needs a holistic assessment of their condition and an individualized approach to prescribing treatment.

References:

1. Ngugi A.K., Bottomley C., Kleinschmidt I. et al. (2010) Estimation of the burden of active and life-time epilepsy: a meta-analytic approach. Epilepsia, 51(5): 883–890. doi: 10.1111/j.1528-1167.2009.02481.x.
2. GBD 2016 Neurology Collaborators (2019) Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol., 18(5): 459-480. doi: 10.1016/S1474-4422(18)30499-X.
3. Chen Z., Brodie M.J., Liew D., Kwan P. (2018) Treatment Outcomes in Patients With Newly Diagnosed Epilepsy Treated With Established and New Antiepileptic Drugs: A 30-Year Longitudinal Cohort Study. JAMA Neurol., 75(3): 279–286. doi: 10.1001/jamaneurol.2017.3949.
4. Fisher R.S., Cross J.H., French J.A. et al. (2017) Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58(4): 522–530. doi: 10.1111/epi.13670.
5. Pellinen J., Tafuro E., Yang A. et al.; Human Epilepsy Project Co-Investigators (2020) Focal nonmotor versus motor seizures: The impact on diagnostic delay in focal epilepsy. Epilepsia, 61(12): 2643–2652. doi: 10.1111/epi.16707.
6. Fisher R.S., Acevedo C., Arzimanoglou A. et al. (2014) ILAE official report: a practical clinical definition of epilepsy. Epilepsia, 55(4): 475–482. doi: 10.1111/epi.12550.
7. Krumholz A., Wiebе S., Gronseth G.S. et al. (2015) 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. Neurology, 84(16): 1705–1713. doi:10.1212/WNL.0000000000001487.
8. Herman S.Т. (2004) Single Unprovoked Seizures. Curr. Treat. Options Neurol., 6(3): 243–255. doi: 10.1007/s11940-004-0016-5.
9. Geerts A., Arts W.F., Stroink H. et al. (2010) Course and outcome of childhood epilepsy: a 15-year follow-up of the Dutch Study of Epilepsy in Childhood. Epilepsia, 51(7): 1189–1197. doi: 10.1111/j.1528-1167.2010.02546.x.
10. zakononline.com.ua/documents/show/72894___72894
11. Scheffer I.E., Berkovic S., Capovilla G. et al. (2017) ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58(4): 512–521. doi: 10.1111/epi.13709.
12. Holtkamp M., Beghi E., Benninger F. et al.; Christensen H. European Stroke Organisation (2017) European Stroke Organisation guidelines for the management of post-stroke seizures and epilepsy. Eur Stroke J., 2(2): 103–115. doi: 10.1177/2396987317705536.
13. Harris L., Hateley S., Tsang K.T. et al. (2020) Impact of anti-epileptic drug choice on discharge in acute traumatic brain injury patients. J. Neurol., 267(6): 1774–1779. doi: 10.1007/s00415-020-09769-5.
14. Pittau F., Bisulli F., Mai R. et al. (2009) Prognostic factors in patients with mesial temporal lobe epilepsy. Epilepsia, 50 (Suppl. 1): 41–44. doi: 10.1111/j.1528-1167.2008.01969.x.
15. Nevitt S.J., Sudell M., Weston J. et al. (2017) Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data. Cochrane Database Syst. Rev., 29: 6, CD011412.
16. Chen Z., Brodie M.J., Kwan P. (2020) What has been the impact of new drug treatments on epilepsy? Curr. Opin. Neurol., 33(2): 185–190. doi: 10.1097/WCO.0000000000000803.