Early identification of refractory epilepsy

Article Abstract:

People who have had many seizures before treatment or who do not respond to the initial treatment are likely to have epilepsy that will be difficult to treat. This was the conclusion of researchers who followed 525 patients who were diagnosed with epilepsy. Only 63% were seizure-free when on medication or after the medication was stopped. Those who had had more than 20 seizures before beginning treatment were most likely to have persistent seizures when taking the medication. Those whose seizures were not controlled by the first drug used were less likely to respond to another drug.

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Antiepileptic drugs

Article Abstract:

Various medications can be used to treat epilepsy. The benefits and risks of drug treatment and no treatment should be discussed with patients. The choice of medication requires careful diagnosis and classification of the type of seizure. The dosage should start low and be increased gradually with an effort to minimize side effects. Carbamazepine, phenytoin, and phenobarbital are effective in treating tonic-clonic seizures, while valproic acid is effective on a variety of seizures. These drugs may cause side effects such as rashes, excessive hair growth or hair loss, drowsiness, tremor, or poor muscle coordination. Most of the drugs operate by blocking membrane channels which effect the repetitive firing of nerve cells. Approximately 30% of people with epilepsy will not respond to drug treatment. Combination drug treatment should be tried only after different individual drugs have been tried. Multiple drug treatment appears to increase the risk of birth defects when given during pregnancy. Approximately 60% of people who are successfully treated can eventually be completely weaned off of medication.

Health aspects

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New antiepileptic drugs

Article Abstract:

Several drugs have been approved for the treatment of epilepsy and many more are being tested. Since 1993, three anti-epileptic drugs have been approved by the FDA: gabapentin, lamotrigine, and felbamate. All were approved as add-on drugs in patients with partial seizures alone or secondarily generalized seizures. Most work in the same way as phenytoin and carbamazepine and have been shown to be extremely effective in many epileptic patients. Most have side effects and felbamate in particular should only be used in patients who are not helped by other anticonvulsants. Gabapentin may be widely used because of its mild side effects and the fact that it does not interact with most other drugs. Other anticonvulsants under development include clobazam, vigabatrin, oxcarbazepine, zonisamide, tiagabine, topiramate, losigamone, remacemide, levetiracetam, fosphenytoin, and tegretol-oros.

Evaluation

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