Practices in the prescription of antiseizure medications: is it time to change?

Abstract

The treatment of epilepsy has advanced over the past 30 years through the development of new antiseizure medications (ASMs). Unfortunately, not all of them have been approved yet in Brazil, and many are still underused. When comparing new ASMs to older ones, they are generally not more effective in treating epilepsy. However, they offer better tolerability, with fewer interactions and long-term side effects, especially for patients with comorbidities or those requiring polytherapy. Enzyme induction caused by older ASMs is associated with increased cholesterol levels, drug interactions with decreased effects of statins and other cardiovascular medications, anticoagulants, chemotherapy, immunosuppressors, anti-infective agents (including HIV treatment), antidepressants, and contraceptives. Additionally, they can reduce levels of vitamin D and sex hormones, as well as decrease bone density. The increasing concern about these effects during life, especially after prolonged exposure, has led most developed countries to change prescription patterns in favor of new ASMs, particularly levetiracetam and lamotrigine. Both are also considered the safest options for women of childbearing age. Regrettably, the prescription trends in Brazil have remained largely unchanged over time. This can be partially attributed to the slower approval process of ASM and the reluctance of general physicians and neurologists to embrace these new concepts. In this concise review, we highlight the various advantages linked to the new ASM, aiming to promote a shift in the prescription pattern for ASM. The selection of ASM should be customized according to individual characteristics, and practical suggestions for choosing ASMs are provided in this paper.

Update on the diagnosis and treatment of neurological diseases

“…4 In the area of epilepsy, Pinto and colleagues present the article entitled "Practices in the prescription of antiseizure medications: is it time to change?". 5 The authors review the various advantages of prescribing the new antiseizure medications (ASM), emphasizing that the selection of these ASMs should be made according to the individual characteristics of each patient, and provide practical suggestions for choosing the new ASMs. 5 In the area of sleep, Santos Coelho presents a structured review entitled "Narcolepsy: an interface among neurology, immunology, sleep, and genetics".…”

“…5 The authors review the various advantages of prescribing the new antiseizure medications (ASM), emphasizing that the selection of these ASMs should be made according to the individual characteristics of each patient, and provide practical suggestions for choosing the new ASMs. 5 In the area of sleep, Santos Coelho presents a structured review entitled "Narcolepsy: an interface among neurology, immunology, sleep, and genetics". 6 The author reviews valuable information about this rare clinical entity, highlighting the clinical picture with excessive daytime sleepiness plus cataplexy, hallucinations, sleep paralysis, and sleep fragmentation, as well as the pathophysiological mechanism, with the consequent hypocretin-1 deficiency.…”