PH2113 - Neurodegenerative Disease and Epilepsy 10 Flashcards
What percentage of people with epilepsy who respond to medication can withdraw from medication and remain seizure free?
50%
How long does treatment for epilepsy last?
At least three years, up to life
What are the aims of treating epilepsy?
Minimise polypharmacy
- use 1 drug to limit side effects
- use adequate drugs for each type of epilepsy
- fewer adverse effects
- less adverse drug reactions
- better compliance
- lower cost
What percentage of people with epilepsy can be treated with monotherapy?
Almost 80%
How is multi-drug therapy started to treat epilepsy when monotherapy has failed?
Start with 2 drug regimen
- almost half of the monotherapy failures will improve
- 20% will become seizure free
The need to use more than 3 AEDs is exceptional
What should be considered if multi-therapy fails to treat epilepsy?
Surgery
What is first line therapy to treat epilepsy?
Carbamazepine
Sodium valproate
Lamotrigine
What is second line therapy to treat epilepsy?
Levetiracetam
Topiramate
Pregabalin
Give examples of new Anti-epileptic drugs that are reserved for use when first and second line treatments have failed?
Zonisamide
Eslicarbazepine
Retigabine
Which anti-epilepsy medicine must be prescribed with consistent manufacturer’s medication?
Phenytoin
Carbamazepine
Phenobarbital
Primidone
Advised to ensure maintenance on a specific manufacturer’s product
Which anti-epilepsy medicine manufacturers must only be changed based on clinical judgement and consultant with patient and/or carers?
Valproate
Lamotrigine
Perampanel
Rufinamide
Clobazam
Clonazepam
Oxcarbazepine
Eslicarbazepine acetate
Zonisamide
Topiramate
Which anti-epilepsy medicines can be easily switched between manufacturers if there are no specific concerns?
Levetiracetam
Lacosamide
Tiagabine
Gabapentin
Pregabalin
Ethosuximide
Vigabatrin
Why is combination therapy of treating epilepsy complicated?
Must exhaust one drug at a time first
Enhances toxicity
May not enhance anti-epileptic effect
Interactions
- complex
- variable
- unpredictable
What are the issues with anti-convulsants?
Cognitive effects
- dampen down brain activity
Weight gain
Teratogenicity
Bone metabolism
Lipid metabolism
- might be diagnosed in childhood and have to stay on for life
Altered hormone secretion
Most new anti-epileptic drugs have milder/fewer adverse events
What considerations need to be taken into account with female patients with epilepsy?
Induction of CYP3A4 enzymes by some anti-epileptic drugs may increase oral contraceptive metabolism
- makes them less effective
