Initial monotherapy of patients with epilepsy is the key to further therapeutic success

August 18, 2022
1008
Specialities :
Resume

The conditions for the success of the first monotherapy of epilepsy are primarily compliance antiepileptic drugs (AEDs) of the seizure type and form of epilepsy, in adult patients, the seizure type is the majority of cases is a determining indicator, but the form of epilepsy should also be taken into account. Undoubtedly, these parameters are closely related to each other, but for the clinician it is adequate the choice should take into account all the clinical features of the patient. The choice of AEDs should be made not only according to the type of attack and the form of epilepsy. It is also necessary to understand that appropriate first- and second-line drugs and what is especially important understand that there are drugs that should not be prescribed in certain clinical situations. At when prescribing the first monotherapy, preference should be given to new AEDs that have a much better range of safety and portability. A very important factor in the success of initial monotherapy is the appointment of AEDs in adequate doses. The problems of choosing the first monotherapy are extremely relevant in clinical practice. The effectiveness of adequate first monotherapy is about 45–60%. It is efficiency and the tolerability of the first monotherapy determines the patient’s compliance in the future. Patients first of all pay attention to the absence of side effects of treatment at the beginning of taking drugs. As they do not yet have a large effect experience of the negative impact of attacks on their quality of life, precisely adequate choices the first monotherapy helps to reduce the number of patients with secondary pharmacoresistance to АEDs and as a result — a decrease in the number of patients with disability.

References

  • 1. Fisher R.S., Acevedo C., Arzimanoglou A. et al. (2014) A practical clinical definition of epilepsy. Epilepsia, 55(4): 475–482. doi: 10.1111/epi.12550.
  • 2. Fisher R.S., van Emde Boas W., Blume W. et al. (2005) Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia, 46: 470–472.
  • 3. Berg A.T., Shinnar S. (1991) The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology, 41: 965–972.
  • 4. Hauser W.A., Rich S.S., Lee J.R. et al. (1998) Risk of recurrent seizures after two unprovoked seizures. N. Engl. J. Med., 338: 429–434.
  • 5. Beghi E., Carpio A., Forsgren L. et al. (2010) Recommendation for a definition of acute symptomatic seizure. Epilepsia, 51: 671–675.
  • 6. Harding G. (2004) The reflex epilepsies with emphasis on photosensitive epilepsy. Suppl. Clin. Neurophysiol., 57: 433–438.
  • 7. Wilden J.A., Cohen-Gadol A.A. (2012) Evaluation of first nonfebrile seizures. Am. Fam. Physician, 86: 334–340.
  • 8. Berg A.T., Berkovic S.F., Brodie M.J. et al. (2010) Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia, 51: 676–685.
  • 9. dec.gov.ua/wp-content/uploads/images/dodatki/2014_276_Epilepsii/2014_276_YKPMD_epilepsiya_dorosli.pdf.
  • 10. Glauser T., Ben-Menachem E., Bourgeois B. et al. (2006) ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia, 47: 1094–1120.
  • 11. Faught E., Helmers S., Thurman D. et al. (2018) Patient characteristics and treatment patterns in patients with newly diagnosed epilepsy: a US database analysis. Epilepsy Behav., 85: 37–44.
  • 12. Australian Bureau of Statistics. 2033.0.55.001 — Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, Canberra, Australia, 2013. http://www.abs.gov.au/ausstats/[email protected]/mf/2033.0.55.001.
  • 13. 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.
  • 14. Sharma S., Chen Z., Rychkova M. et al. (2020) Treatment initiation decisions in newly diagnosed epilepsy — A longitudinal cohort study. Epilepsia, 61(3): 445–454. doi: 10.1111/epi.16439
  • 15. Мар’єнко Л.Б. (2021) Деякі практичні аспекти призначення першої монотерапії дорослим пацієнтам із епілепсією. Укр. мед. часопис, 3(143): https://www.umj.com.ua/article/209123.
  • 16. World Health Organization (2003) Adherence to long-term therapies: Evidence for action. Geneva, 212 p.
  • 17. Faught E. (2012) Adherence to antiepilepsy drug therapy. Epilepsy & Behavior, 25(3): 297–302. DOI:10.1016/j.yebeh.2012.08.027.
  • 18. Rho J.M., White H.S. (2018) Brief history of anti‐seizure drug development. Epilepsia Open, 3(2): 114–119.
  • 19. Perucca E., Gram L., Avanzini G., Dulac O. (1998) Antiepileptic drugs as a cause of worsening seizures. Epilepsia, 39(1): 5–17. doi: 10.1111/j.1528-1157.1998.tb01268.x.
  • 20. Dubenko A., Sazonov S., Моstоvа O. et al. (2020) Using of antiepileptic drugs for epilepsy treatment adult patients in Ukraine according to electronic register’s data. African and Middle East Epilepsy J., 9(3): 4–8.
  • 21. Дубенко А.Є., Сазонов С.О., Бабкіна Ю.А. та ін. (2018) Застосування протиепілептичних препаратів для лікування епілепсії в Україні за даними електронного регістру. НейроNEWS, 1: 10–14.
  • 22. Villanueva V., Sánchez-Álvarez J.C., Peña P. et al. (2010) Treatment initiation in epilepsy: An expert consensus in Spain. Epilepsy & Behavior, 19332–19342.
  • 23. Löscher W., Potschka H., Sisodiya S.M., Vezzani A. (2020) Drug Resistance in Epilepsy: Clinical Impact, Potential Mechanisms, and New Innovative Treatment Options. Pharmacological Reviews, 72(3): 606–638; DOI: doi.org/10.1124/pr.120.019539.
  • 24. Дубенко А.Є. (2020) Формулювання діагнозу «епілепсія». Початок лікування. Перша монотерапія. Междунар. неврол. журн., 5(93): 106–113.