Evidence-Based Pharmacotherapy of Epilepsy

Abstract

Background: Due to the narrow therapeutic window of the AEDs prescription, their side effects and efficacy are the most important items that should be considered in epileptic patients. Objectives: This study aimed to investigate evidence-based pharmacotherapy in epileptic patients. Patients and Methods: Data were collected Cross-sectionally from patients (n = 24) registered at Kashani Epilepsy Ward in Isfahan. Demographic, clinical, hematology and biochemical data were recorded in d-base and analyzed using SPSS application for windows. Results: The frequency of polypharmacy was 79% in which 50% of epileptic patients received 3 to 4 AEDs. The onset of seizure was under 16 years old in 70% of patients. Fourteen varieties of AEDs were used, among them valproic acid (Depakote) was the most administered drugs. Prescriptions of two patients consisted of 4 and 6 AEDs: patient with code No. 575 (carbamazepine, topiramate, clobasam, lamotrigine) and another one with code No. 587 (oxcarbamazepine, phenytoin, gabapentin, valproic acid, clonazepam, lamotrigine). Red blood cell counts, hemoglobin and hematocrit in patients under more than one drug treatment were significantly lower than patients with AED monotherapy. Conclusions: AEDs are well-recognized to control seizure attacks. In clinical practice, the older generation of AEDs such as carbamazepine (CBZ), valporic acid (VPA), phenytoin (PHT), topiramate (TOP) and lamotrigine (LAMO) might need monitoring serum levels. Nonrational polypharmacy in terms of simultaneous using of both AEDs inducer and inhibitor could cause sedation, dizziness, and cognitive adverse effects. Further studies are needed to confirm these associations. Finally, to avoid polypharmacy that could arise side effects, a sufficient intervention for each AED to decide on its continuation, interruption or the number of drugs should be attempted. Combinations based on CBZ + VP, VP + TOP, CBZ + TOP, VP + LAMO, and TOP + LAMO could cause pharmacokinetic interactions.

Spirituality Believing in End Stage Diseases Such as; Genito-Urinary Cancers, Multiple Sclerosis, Recipients of Liver, Kidney or Heart Transplantations

“…Regarding to organ transplantation, the legendary and symbolic uses of the different parts of body in texts and paintings continue a fairly unknown topic. Previous publications reported that organ donation could be described as the manifestation of the love of our neighbor [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. A recent study performed in 5360 deceased confirmed that in order to prevent worse outcome in critically ill patients admitted to hospitals, quality of care need to be upgrading [20].…”

“…Within this population spiritual believing could improve heart rate and the ability of immune system to fight against the attack in such conditions. Indeed, God is with the patient with those who have believed, seek help through patience and entreaty [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Spirituality believing by patients could lead to better care.…”

Review of Warfarin; A Cytochrome P450 Metabolizing Drug, in Clinical Practice

“…In conclusion, experienced pharmacotherapy in relation to drugs with narrow therapeutic windows and in terms of recommendations based on detailed benefitrisk assessment requires thorough understanding and the establishment of well-balanced pharmacokinetic parameters in the Iranian population (31)(32)(33)(34)(35)(36). Finally, the cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase complex 1 (VKORC1) genotypes have been confirmed to be associated with warfarin dose requirements.…”

Review of Sodium Valproate Clinical and Biochemical Properties

“…Sodium valproate possibly could affect sodium channels and potentiate GABA receptors. It also increases the formation of GABA [5]. It is well known that VPA belongs to group of drugs with narrow therapeutic window and as prescription of VPA in Iranian epileptic patients continues to increase [4][5][6], an approach adjoining clinical pharmacotherapy guideline to control seizure attack was of interest that reviewed.…”