Epilepsy drug treatment

In addition to epilepsy, neuronal death due to the toxic effects of glutamate has also been implicated in cerebral ischaemia associated with multi-infarct dementia and possibly Alzheimer s disease. With the plethora of selective excitatory amino acid receptor antagonists currently undergoing development, some of which are already in clinical trials, one may expect definite advances in the drug treatment of neurodegenerative disorders in the near future. 

Faught E. Epidemiology and drug treatment of epilepsy in elderly people. Drugs Aging 1999 15 255-269. 

Drugs that may cause cognitive disorders in the elderly. Med Let 2000 42 111-112. Faught E. Epidemiolgy and drug treatment of epilepsy in elderly people. Drugs Aging 1999 15 255-269. 

For the purpose of drug treatment, the epilepsies are classified according to the seizure type. The classification generally used is based on that proposed by the Commission on Classification and Terminology of the International League against Epilepsy. The main groups are ... 

Membrane-bound enzymes, particularly the ATPases involved in the ionic pumps for calcium, sodium and potassium, have been found to function abnormally in the brains of epileptic patients and animals. A reduction in Na+K+-ATPase activity has been reported in human focal epileptogenic tissue, but it is uncertain whether such changes are due to the disease itself or a reflection of drug treatment. Similar changes have, however, been reported in experimental animals following the localized application of alumina cream and in DBA/2 mice that exhibit sound-induced seizures a reduction in calcium-dependent ATPase has also been found in the brain of DBA/2 mice. Such findings are consistent with the hypothesis that a defect in ion channels may occur in epilepsy. 

Chronic stimulation of vagus as a non-drug treatment for epilepsy and depression. 

Shorvan, S. D. Handbook of Epilepsy Treatment. Oxford Blackwell Science, 2000. Vermeulen, J. and Aldenkamp, A. P. Cognitive side effects of chronic antiepileptic drug treatment a review of 25 years research. Epilepsy Res. 22 (1995) 65-80. 

Seizures have been classified into two broad groups, partial (or focal), and generalized. Choice of drug treatment is based on the classification of the epilepsy being treated (Figure 15.2). 

Therapeutic drug monitoring is as essential as clinical and biochemical monitoring in the drug treatment of epilepsy. 

In cases where fits are liable to occur at a particular time, e.g. the menstrual period, dosage should be adjusted to achieve maximal drug effect at that time or drug treatment can be confined to this time. For example, in catamenial epilepsy, clobazam can be useful given only at period time. 

Marson, A. et al. (2005) Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures a randomised controlled trial. Lancet, 365 (9476), 2007-2013. 

The direct costs of epilepsy include the cost of the drug, treatment of adverse events, emergency room visits, drug levels, laboratory tests, physician visits, rehabilitation, and transportation. Indirect costs include the costs associated with time lost from work, the inability to get a job, decreased productivity, and mortality. 

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