Evidence-based guidelines for the management of epilepsy

Singh, Sanjay; Sankaraneni, Ram; Antony, Arun

doi:10.4103/neuroindia.ni_1027_16

Cited by 13 publications

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“…Antiseizure medications are the mainstay of therapy in the management of epilepsy and are indicated for patients who have experienced two or more unprovoked seizures, or a single unprovoked seizure accompanied by additional factors that increase the risk of seizure recurrence [ 1 , 2 ]. The ultimate goal in managing epilepsy is to achieve complete seizure control without inducing adverse effects [ 3 ].Therefore, treatment should be individualized and optimized to achieve better control of seizures while preventing or minimizing adverse drug- related harms and complications [ 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Drug therapy problems and contributing factors among patients with epilepsy

Niriayo,

Gebregziabher,

Demoz

et al. 2024

PLoS ONE

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Background Although antiseizure medications play a crucial role in the management of epilepsy, their benefit can be compromised due to drug-related problems. Drug therapy problems can lead to poor seizure control, reduced quality of life, and increased morbidity and mortality in patients with epilepsy. However, in our setting, there is limited knowledge about drug therapy problems and the factors that contribute to them. Objective The aim of this study was to investigate the prevalence and contributing factors of drug-therapy problems among patients with epilepsy. Methodology A hospital-based prospective observational study was conducted at the neurologic clinic of Ayder Comprehensive Specialized Hospital, located in the Tigray region of Northern Ethiopia. The study included adult patients diagnosed with epilepsy who had been taking at least one antiseizure medication for a minimum of six months. Data were collected by conducting patient interviews and expert reviews of medical and medication records. Prior to data review and interviews, each patient provided written informed consent. Drug therapy problems were identified and classified using Cipolle’s method, followed by a consensus review conducted with a panel of experts. Statistical analysis was performed using a statistical software package; SPSS version 22. Binary logistic regression analysis was conducted to determine the contributing factors of drug therapy problems. Statistical significance was determined at p<0.05. Results A study conducted on 250 participants revealed that 55.2% of the patients experienced one or more drug therapy problems. Our analysis identified a total of 282 drug therapy problems, with a mean of 2±0.52 drug therapy problems per patient. The most commonly observed drug therapy problems were dosage too low (30.0%), noncompliance (22%), adverse drug reaction (18%), and unnecessary drug therapy (16.4%). The commonly involved antiseizure medications in these drug therapy problems were phenytoin (22.8%), Valproic acid (20.8%), and Phenobarbital (18.4%). Furthermore, our findings revealed that combination therapy (AOR: 3.92, 95%CI: 1.19–12.97) and uncontrolled seizure (AOR: 108.37, 95%CI: 38.7–303.6) exhibited significant associations with drug therapy problems. Conclusion Drug therapy problems were prevalent among patients with epilepsy. The use of combination therapy and the presence of uncontrolled seizures were identified as significant indicators of drug therapy problems. Therefore, more emphasis should be given to patients with multiple medications and uncontrolled seizures.

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Section: Introductionmentioning

confidence: 99%

Drug therapy problems and contributing factors among patients with epilepsy

Niriayo,

Gebregziabher,

Demoz

et al. 2024

PLoS ONE

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Design, synthesis, and evaluation of anticonvulsant activities of benzoxazole derivatives containing the 1,2,4‐triazolone moiety

Song

Huang

Wang

et al. 2019

Archiv der Pharmazie

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A novel series of benzoxazole derivatives containing 1,2,4‐triazolone (5a‐m) was designed. These compounds were synthesized in order to screen their anticonvulsant activities by the maximal electroshock seizure (MES) model and the subcutaneous pentylenetetrazole (sc‐PTZ) seizure model in mice. The rotarod test was used to evaluate their neurotoxicities. Most of the compounds showed anti‐MES activities at 100 and 300 mg/kg. Compound 5f, which showed potential anticonvulsant activity in the MES model with ED50 values of 22.0 mg/kg, was considered as the most promising one in this study. It exhibited greater safety than that of carbamazepine and valproate regarding neurotoxicity. The efficacy of compound 5f in inhibiting the tonic seizures and death induced by the convulsants 3‐mercaptopropionic acid and BIC was also verified. In an enzyme‐linked immunosorbent assay, compound 5f and the positive drug phenytoin significantly increased the γ‐aminobutyric acid (GABA) level in the mouse brain. Further, pretreatment with an inhibitor of the GABA synthesizing enzyme dramatically raised the ED50 value of 5f in the MES model. These results confirmed that the compound 5f plays its anticonvulsive action via regulating the GABA function in the brain. Also, a docking study of the compound 5f in the benzodiazepine (BZD) binding site of the GABAA receptor confirmed possible binding of the compound 5f with BZD receptors.

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Synthesis and antiseizure effect evaluation of nonimidazole histamine H₃receptor antagonists containing the oxazole moiety

Xiao

Yan

Zhang

et al. 2020

Archiv der Pharmazie

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The use of histamine H3 receptor (H3R) antagonists is becoming a promising therapeutic approach for epilepsy. In this paper, a series of novel nonimidazole H3R antagonists was synthesized and screened as antiepileptic drugs. All of these prepared antagonists displayed micromolar or submicromolar H3R antagonistic activities in the cAMP response element luciferase screening assay. Compounds 5a (IC50 = 0.11 μM), 5b (IC50 = 0.56 μM), and 5f (IC50 = 0.78 μM) displayed the most potent H3R antagonistic activities, with considerable potency when compared with pitolisant (IC50 = 0.51 μM). In the maximal electroshock (MES)‐induced seizure model, compounds 5c, 5e, and 5g showed obvious protection for the electrostimulated mice, and the protection of 5g against the MES‐induced seizures was fully abrogated when mice were cotreated with R‐(α)‐methyl‐histamine, a central nervous system‐penetrant H3R agonist, suggesting that the potential therapeutic effect of 5g was observed to work through H3R. These results indicate that the attempt to find a new antiepileptic drug among H3R antagonists is practicable, but it is necessary to consider the log P of the molecules to ensure penetration of the blood–brain barrier.

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Evidence-based guidelines for the management of epilepsy

Cited by 13 publications

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Drug therapy problems and contributing factors among patients with epilepsy

Drug therapy problems and contributing factors among patients with epilepsy

Design, synthesis, and evaluation of anticonvulsant activities of benzoxazole derivatives containing the 1,2,4‐triazolone moiety

Synthesis and antiseizure effect evaluation of nonimidazole histamine H₃receptor antagonists containing the oxazole moiety

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Evidence-based guidelines for the management of epilepsy

Cited by 13 publications

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Drug therapy problems and contributing factors among patients with epilepsy

Drug therapy problems and contributing factors among patients with epilepsy

Design, synthesis, and evaluation of anticonvulsant activities of benzoxazole derivatives containing the 1,2,4‐triazolone moiety

Synthesis and antiseizure effect evaluation of nonimidazole histamine H3receptor antagonists containing the oxazole moiety

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Synthesis and antiseizure effect evaluation of nonimidazole histamine H₃receptor antagonists containing the oxazole moiety