The Epilepsy Foundation's 4th Biennial Epilepsy Pipeline Update Conference

French, Jacqueline A.; Schachter, Steven C.; Sirven, Joseph; Porter, Roger J.

doi:10.1016/j.yebeh.2015.02.033

Cited by 4 publications

(1 citation statement)

References 84 publications

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“…The introduction of new AEDs starting with vigabatrin (VGB) in the UK and zonisamide (ZNS) in Japan in 1989 has yielded 16 new drugs already3 with significant impact on clinical practice for following reasons. First, the new drugs underwent rigorous randomized controlled clinical trials (RCTs) for add-on therapy in patients with DRE and showed significantly higher efficacy in comparison with placebo, because of which they were used primarily in combination therapy for DRE.…”

Section: Introductionmentioning

confidence: 99%

Antiepileptic Drug Therapy in Patients with Drug-Resistant Epilepsy

Park¹,

Kim²,

Lee³

2019

J Epilepsy Res

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Antiepileptic drug (AED) therapy starts with an accurate diagnosis of epilepsy and is followed by sequential drug trials. Seizure freedom is largely achieved by the first two drug trials; thus, epilepsy that cannot be controlled after appropriately conducted trials of the first two drugs is defined as drug-resistant epilepsy (DRE). It is still unclear which mode of pharmacotherapy, among monotherapy and polytherapy, shows better outcomes in cases of DRE. However, in a recent large hospital cohort study over past two decades, combination therapy was associated with a progressive increase in seizure-free rate than monotherapy in DRE. The benefits of polytherapy in the management of DRE might be related to the recent introduction of many new AEDs with different and novel mechanisms of action and better pharmacokinetic and tolerability profiles. These new AEDs were introduced to the market after they have proven their superiority over placebos in randomized controlled trials (RCTs) on add-on therapy in patients with DRE. Therefore, polytherapy including these new AEDs in the regimen is the approved mode of treatment for cases of DRE; this has prompted physicians to try various combinations of polytherapy to optimize the clinical outcomes. In addition, the significant discrepancies in AED responder rates between RCTs and real-world practice may support the importance of judicious use of new drugs in polytherapy by experienced epileptologists. Most experts now agree to the concept of "rational polytherapy" consisting of mechanistic combinations of AEDs exerting synergistic interactions and to the importance of continuing trials of different rational polytherapy regimens to improve the outcome of the core population of epilepsy patients in the long term. (2019;9:14-26

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Section: Introductionmentioning

confidence: 99%

Antiepileptic Drug Therapy in Patients with Drug-Resistant Epilepsy

Park¹,

Kim²,

Lee³

2019

J Epilepsy Res

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New technologies and future trends

Schachter

2020

Neurocognitive Development: Disorders and Disabilities

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Ambulatory EEG Usefulness in Epilepsy Management

Hasan

Tatum

2021

Journal of Clinical Neurophysiology

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Summary: Long-term video-EEG monitoring has been the gold standard for diagnosis of epileptic and nonepileptic events. Medication changes, safety, and a lack of recording EEG in one's habitual environment may interfere with diagnostic representation and subsequently affect management. Some spells defy standard EEG because of ultradian and circadian times of occurrence, manifest nocturnal expression of epileptiform activity, and require classification for clarifying diagnostic input to identify optimal treatment. Some patients may be unaware of seizures, have frequent events, or subclinical seizures that require quantification before optimal management. The influence on antiseizure drug management and clinical drug research can be enlightened by long-term outpatient ambulatory EEG monitoring. With recent governmental shifts to focus on mobile health, ambulatory EEG monitoring has grown beyond diagnostic capabilities to target the dynamic effects of medical and nonmedical treatment for patients with epilepsy in their natural environment. Furthermore, newer applications in ambulatory monitoring include additional physiologic parameters (e.g., sleep, detection of myogenic signals, etc.) and extend treatment relevance to patients beyond seizure reduction alone addressing comorbid conditions. It is with this focus in mind that we direct our discussion on the present and future aspects of using ambulatory EEG monitoring in the treatment of patients with epilepsy.

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The Epilepsy Foundation's 4th Biennial Epilepsy Pipeline Update Conference

Cited by 4 publications

References 84 publications

Antiepileptic Drug Therapy in Patients with Drug-Resistant Epilepsy

Antiepileptic Drug Therapy in Patients with Drug-Resistant Epilepsy

New technologies and future trends

Ambulatory EEG Usefulness in Epilepsy Management

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