Efficacy and tolerability of antiseizure drugs

Abstract

Drug-resistant epilepsy occurs in 25–30% of patients. Furthermore, treatment with a first-generation antiseizure drug (ASD) fails in 30–40% of individuals because of their intolerable adverse effects. Over the past three decades, 20 newer- (second- and third-)generation ASDs with unique mechanisms of action and pharmacokinetic profiles have been introduced into clinical practice. This advent has expanded the therapeutic armamentarium of epilepsy and broadens the choices of ASDs to match the individual patient’s characteristics. In recent years, research has been focused on defining the ASD of choice for different seizure types. In 2017, the International League Against Epilepsy published a new classification for seizure types and epilepsy syndrome. This classification has been of paramount importance to accurately classify the patient’s seizure type(s) and prescribe the ASD that is appropriate. A year later, the American Academy of Neurology published a new guideline for ASD selection in adult and pediatric patients with new-onset and treatment-resistant epilepsy. The guideline primarily relied on studies that compare the first-generation and second-generation ASDs, with limited data for the efficacy of third-generation drugs. While researchers have been called for investigating those drugs in future research, epilepsy specialists may wish to share their personal experiences to support the treatment guidelines. Given the rapid advances in the development of ASDs in recent years and the continuous updates in definitions, classifications, and treatment guidelines for seizure types and epilepsy syndromes, this review aims to present a complete overview of the current state of the literature about the efficacy and tolerability of ASDs and provide guidance to clinicians about selecting appropriate ASDs for initial treatment of epilepsy according to different seizure types and epilepsy syndromes based on the current literature and recent US and UK practical guidelines.

Diagnostic utility of pediatric epilepsy monitoring unit:Retrospective single center study

“… 1 , 5 , 7 The medical history about seizure origin, duration and type obtained from family members or patients can lead to misdiagnosis in this disorder, so it is very important to obtain and record the EEG to capture the epileptic discharge and provide best option for treatment regimn. 7 , 8 , 9 …”

“…1,5,7 The medical history about seizure origin, duration and type obtained from family members or patients can lead to misdiagnosis in this disorder, so it is very important to obtain and record the EEG to capture the epileptic discharge and provide best option for treatment regimn. 7,8,9 Around 5.7% of patients had normal EEG and did not show abnormal epileptic activity 10 and 19.4% showed focal and generalized seizure activity on video EEG in EMU. This is similar to previous studies.…”

Recent Developments in Autism Genetic Research: A Scientometric Review from 2018 to 2022

“…The smallest cluster—namely, Cluster #14 “Antiseizure Drug”—has the paper authored by Hakami [ 208 ] as major citing document, with a coverage of 4 and a GCS of 2. The naming of this cluster is based on a series of two papers written by Hakami [ 208 , 209 ] on antiseizure drugs, and may be related to ASD due to the higher prevalence of seizure and epilepsy diagnoses among these individuals [ 210 ]. Similarly, other contributing papers focused on understanding the genetic bases of epilepsy [ 211 , 212 , 213 ] and epilepsy treatment [ 214 , 215 ].…”

Aquatic Freshwater Vertebrate Models of Epilepsy Pathology: Past Discoveries and Future Directions for Therapeutic Discovery

“…Despite the large number of anti-seizure compounds on the market, drug-resistant epilepsy occurs in up to 30% of patients, refs. [ 2 , 3 , 4 , 5 , 6 , 7 ] and initial treatment fails in an additional 30% of patients due to intolerable side effects [ 12 ]. Discovery of therapeutic compounds that could affect disease progression is a required new direction for anti-seizure therapeutic discovery [ 13 ].…”