Antiepileptic drug therapy

Determine when and how to discontinue antiepileptic drug therapy. 

Antiepileptic drug therapy should usually be initiated carefully using a titration schedule to minimize adverse events. 

Patient Encounter 3, Discontinuing Antiepileptic Drug Therapy ... 

Morsehi PL. Development of physiological variables important for drug kinetics. In Morsehi PL, Pippenger CE, Penry JK, editors. Antiepileptic drug therapy in pediatrics. New York Raven Press 1983. p. 1-12. 

Kaneko S. A rational antiepileptic drug therapy of epileptic women in child bearing age. Jpn J Psychiatry Neurol 1988 42 473-482. 

Perucca, E., Beghi, E., Dulac, O., Shorvon, S., Tomson, T. Assessing risk benefit ratio in antiepileptic drug therapy, Epilepsy Res 2000, 41, 107-139. 

Duncan S, Blacklaw J, Beastall GH, Brodie MJ. Antiepileptic drug therapy and sexual function in men with epilepsy. Epilepsia 1999 40(2) 197-204. 

L. Bossi, Fetal effects of anticonvulsants, in P.L. Morselli, C.E. Pippenger and J.K. Penry (Eds.), Antiepileptic Drug Therapy in Pediatrics, Raven Press, New York, 1983, pp. 37-64. 

Antiepileptic Drug Therapy in Pregnancy I Gestation-Induced Effects on AED Pharmacokinetics... 

Antiepileptic Drug Therapy in Pregnancy II Fetal and Neonatal Exposure... 

Nilsson L, Bergman U, Diwan V, Farahmand BY, Persson PG, Tomson T. Antiepileptic drug therapy and its management in sudden unexpected death in epilepsy a case-control study. Epilepsia 2001 42(5) 667-73. 

In an open study of the effects of topiramate 100-1600 mg/day in 292 adults (mean age 33 years) with partial and/or generalized seizures previously resistant to antiepileptic drug therapy over 50% of the patients achieved at least a 50% reduction in seizures (1). The most commonly reported adverse events were related to the central nervous system, including headache, difficulty in concentrating, somnolence, anorexia, fatigue, dizziness, nervousness, nausea, confusion, and paresthesia 32% discontinued because of adverse events. 

Cranial nerves Note facial tone and symmetry, gaze preference, and ptosis check for nystagmus by having patient follow object across visual field engage in conversation to assess for slurred speech. Myasthenia gravis (ptosis), Parkinson s disease (masked facies), stroke (palsy), antiepileptic drug therapy (nystagmus, slurred speech)... 

Pharmacotherapy of epilepsy is highly individualized and requires titration of dose to optimize antiepileptic drug therapy (maximal seizure control with minimal or no side effects). About 70% of patients can be maintained on one antiepileptic drug. 

Shinnar S, Gross-Tsur V. Discontinuing antiepileptic drug therapy. In Wyllie E, ed. The Treatment of Epilepsy, 3d ed. Philadelphia, Lippincott Williams Wilkins, 2001 811-819. 

Willmore, L. J., Antiepileptic drug therapy in the elderly, Pharmacol. Then, 78 9-16,... 

Cloyd, J. C. et al.. Pharmacokinetics of valproic acid in children I. Multiple antiepileptic drug therapy. Neurology, 33 185-191, 1983. 

Neuvonen PJ, Lehtovaara R, Barcfy A, Elomaa E. Antipyretic analgesics in j)atients on antiepileptic drug therapy. EtirJ Clin Pharmacol (1979) 15,263—8. 

Breast feeding The effects of breast feeding during antiepileptic drug therapy on subsequent cognitive ability have been investigated in 199 children who had also been exposed in utero [100 ]. Among the 42% of children who were breast fed IQ did not differ from non-breast-fed children. This topic has been reviewed [101, 102 ]. 

Levetiracetam and phenytoin have been retrospectively compared in the prophylaxis of early and late postoperative seizures in 315 patients [182 ]. Levetiracetam (n = 105) was at least as effective as phenytoin ( = 210) and significantly better tolerated. Adverse effects that prompted a change in antiepileptic drug therapy occurred in one patient taking levetiracetam, who had visual hallucinations, compared with 38 patients taking phenytoin (18%). In patients who were followed for at least 1 year and developed epilepsy, levetiracetam also had a higher retention rate. 

In 204 patients with epilepsy, grouped on the basis of antiepileptic drug therapy (current, previous, or no exposure to vigabatrin), there was bilateral visual field constriction in 59% of current users, 43% of prior users, and 24% of never users [426 ]. Assessment of retinal function showed abnormal responses in 48% of current users and 22% of prior users, but in none of the never users. 

Tan TY, Lu CH, Chuang HY, Lin TK, Liou CW, Chang WN, Chuang YC. Long-term antiepileptic drug therapy contributes to the acceleration of atherosclerosis. Epilepsia 2009 50(6) 1579-86. 

Nettekoven S, Strohle A, Trunz B, Wolters M, Hoffmann S, Horn R, Steinert M, Brabant G, Lichtinghagen R, Welkoborsky HJ, Tuxhorn I, Hahn A. Effects of antiepileptic drug therapy on vitamin D status and biochemical markers of bone turnover in children with epilepsy. Eur J Pediatr 2008 167(12) 1369-77. 

M. Podell, Antiepileptic drug therapy, Clin. Tech. Small Anim. Tract., 1998, 13, 185-192. 

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