Epilepsy: Difference between revisions
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==Treatment== | ==Treatment== | ||
Many [[medication]]s are available that vary in efficacy, [[drug toxicity]], and costs.<ref name="pmid18497720">{{cite journal |author= |title=Drugs for epilepsy |journal=Treat Guidel Med Lett |volume=6 |issue=70 |pages=37–46 |year=2008 |month=June |pmid=18497720 |doi= |url=http://www.medicalletter.org/scripts/articlefind.cgi?issue=70&page=37 |issn=}}</ref>Due to the narrow therapeutic window of these medications, generic substitution should be done carefully according to a [[clinical practice guideline]].<ref name="pmid17438213">{{cite journal |author=Liow K, Barkley GL, Pollard JR, Harden CL, Bazil CW |title=Position statement on the coverage of anticonvulsant drugs for the treatment of epilepsy |journal=Neurology |volume=68 |issue=16 |pages=1249–50 |year=2007 |month=April |pmid=17438213 |doi=10.1212/01.wnl.0000259400.30539.cc |url=http://www.neurology.org/cgi/pmidlookup?view=long&pmid=17438213 |issn=}}</ref> | |||
A [[randomized controlled trial]] concluded:<ref name="pmid17382828">{{cite journal |author=Marson AG, Al-Kharusi AM, Alwaidh M, ''et al'' |title=The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial |journal=Lancet |volume=369 |issue=9566 |pages=1016–26 |year=2007 |pmid=17382828 |doi=10.1016/S0140-6736(07)60461-9}} [http://www.acpjc.org/Content/147/3/issue/ACPJC-2007-147-3-075.htm ACP Journal Club summary]</ref><ref name="pmid17903391">{{cite journal |author=Marson AG, Appleton R, Baker GA, ''et al'' |title=A randomised controlled trial examining the longer-term outcomes of standard versus new antiepileptic drugs. The SANAD trial |journal=Health technology assessment (Winchester, England) |volume=11 |issue=37 |pages=1–154 |year=2007 |pmid=17903391 |doi=}}</ref> | A [[randomized controlled trial]] concluded:<ref name="pmid17382828">{{cite journal |author=Marson AG, Al-Kharusi AM, Alwaidh M, ''et al'' |title=The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial |journal=Lancet |volume=369 |issue=9566 |pages=1016–26 |year=2007 |pmid=17382828 |doi=10.1016/S0140-6736(07)60461-9}} [http://www.acpjc.org/Content/147/3/issue/ACPJC-2007-147-3-075.htm ACP Journal Club summary]</ref><ref name="pmid17903391">{{cite journal |author=Marson AG, Appleton R, Baker GA, ''et al'' |title=A randomised controlled trial examining the longer-term outcomes of standard versus new antiepileptic drugs. The SANAD trial |journal=Health technology assessment (Winchester, England) |volume=11 |issue=37 |pages=1–154 |year=2007 |pmid=17903391 |doi=}}</ref> | ||
* For idiopathic generalised epilepsy or difficult to classify epilepsy, "[[valproate]] | * For idiopathic generalised epilepsy or difficult to classify epilepsy, "[[valproate]] remains the clinically most effective drug, although [[topiramate]] may be a cost-effective alternative for some patients". | ||
* For partial seizures, "[[lamotrigine]] | * For partial seizures, "[[lamotrigine]] may be a clinical and cost-effective alternative to the existing standard drug treatment, [[carbamazepine]]" | ||
* Regarding [[drug toxicity]] | |||
** [[lamotrigine]] had more [[hypersensitivity]] (allergic) reactions | |||
** [[valproate]] had more weight gain | |||
** [[topiramate]] had more fatigue, behavioral changes, problems and weight loss | |||
==References== | ==References== | ||
Revision as of 08:40, 21 June 2008
People who have epilepsy suffer from a abnormality of their brain that causes them to have seizures — generalized convulsions of their body (muscle spasms) or more subtle mental or physical behavioral disturbances lasting from seconds to minutes and typically recurring at varying intervals.[1] Some types of seizures manifest as strange sensations or emotional states, and others, unconsciousness.
In technical terms, the U.S. National Library of Medicine, citing Adams et al.,[2] defines epilepsy as "a disorder characterized by recurrent episodes of paroxysmal brain dysfunction due to a sudden, disorderly, and excessive neuronal discharge. Epilepsy classification systems are generally based upon: (1) clinical features of the seizure episodes (e.g., motor seizure), (2) etiology (e.g., post-traumatic), (3) anatomic site of seizure origin (e.g., frontal lobe seizure), (4) tendency to spread to other structures in the brain, and (5) temporal patterns."[3]
The ancient Greeks recognized epilepsy, calling it the Sacred Disease, as they regarded it as inflicted by the gods. But Hippocrates of Cos (460 BCE - ?360 BCE), who discovered that diseases had natural causes, recognized it as a natural disorder of the brain:[4]
It is thus with regard to the disease called Sacred: it appears to me to be nowise more divine nor more sacred than other diseases, but has a natural cause from the originates like other affections....this disease seems to me to be no more divine than others; but it has its nature such as other diseases have, and a cause whence it originates, and its nature and cause are divine only just as much as all others are, and it is curable no less than the others, unless when, the from [the length] of time, it is confirmed, and has became stronger than the remedies applied....the brain is the cause of this affection, as it is of other very great diseases, and in what manner and from what cause it is formed, I will now plainly declare….
Classification
Benign neonatal epilepsy
Partial epilepsy
Febrile seizures
Generalized epilepsy
Landau-Kleffner syndrome
Myoclonic epilepsy
Post-traumatic epilepsy
Reflex epilepsy
Status epilepticus
Treatment
Many medications are available that vary in efficacy, drug toxicity, and costs.[5]Due to the narrow therapeutic window of these medications, generic substitution should be done carefully according to a clinical practice guideline.[6]
A randomized controlled trial concluded:[7][8]
- For idiopathic generalised epilepsy or difficult to classify epilepsy, "valproate remains the clinically most effective drug, although topiramate may be a cost-effective alternative for some patients".
- For partial seizures, "lamotrigine may be a clinical and cost-effective alternative to the existing standard drug treatment, carbamazepine"
- Regarding drug toxicity
- lamotrigine had more hypersensitivity (allergic) reactions
- valproate had more weight gain
- topiramate had more fatigue, behavioral changes, problems and weight loss
References
- ↑ Epilepsy. MedlinePlus, U.S. National Library of Medicine and National Institutes of Health.
- ↑ Adams RD, Victor M, Ropper AH. (1998). Principles of neurology. 6th ed. New York: McGraw-Hill, Health Professions Division. ISBN 0070005141.
- ↑ National Library of Medicine. Epilepsy. Retrieved on 2008-05-23.
- ↑ Hippocrates. (400 BCE). On the Sacred Disease. Translated by Francis Adams.
- ↑ (June 2008) "Drugs for epilepsy". Treat Guidel Med Lett 6 (70): 37–46. PMID 18497720. [e]
- ↑ Liow K, Barkley GL, Pollard JR, Harden CL, Bazil CW (April 2007). "Position statement on the coverage of anticonvulsant drugs for the treatment of epilepsy". Neurology 68 (16): 1249–50. DOI:10.1212/01.wnl.0000259400.30539.cc. PMID 17438213. Research Blogging.
- ↑ Marson AG, Al-Kharusi AM, Alwaidh M, et al (2007). "The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial". Lancet 369 (9566): 1016–26. DOI:10.1016/S0140-6736(07)60461-9. PMID 17382828. Research Blogging. ACP Journal Club summary
- ↑ Marson AG, Appleton R, Baker GA, et al (2007). "A randomised controlled trial examining the longer-term outcomes of standard versus new antiepileptic drugs. The SANAD trial". Health technology assessment (Winchester, England) 11 (37): 1–154. PMID 17903391. [e]