Treatment of idiopathic generalized epilepsy – a review of the evidence

Beydoun, Ahmad; D’Souza, Joseph

doi:10.1517/14656566.2012.685162

Cited by 25 publications

(18 citation statements)

References 68 publications

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“…Carbamazepine, lamotrigine and topiramate dominated in the prescription pattern for partial epilepsies, which is consistent with evidence that these agents are particularly useful in the treatment of partial seizures [8,9,10]. Among patients with generalized and in mixed and/or undetermined seizures, the ranking of the most frequently prescribed AEDs was comparable with current recommendations, except for a lower utilization of levetiracetam [12,13,14] Valproate dominated, which could be expected in view of its broad spectrum of activity against all seizure types [15] and references it that should remain the drug of first choice for many patients with generalized and unclassified epilepsies [16]. Overall, second generation AEDs were quite widely prescribed, lamotrigine and topiramate were extensively used; lower exploitation of levetiracetam is due to its special prescription (fully reimbursed only for refractory epilepsy).…”

Section: Discussionsupporting

confidence: 75%

Brief Communication of Assessment of Clinical Practice Regarding Pharmacological Treatment of Epilepsy: A Survey of Neurologists in Republic of Macedonia

Cvetkovska

Kuzmanovski²,

Boshkovski³

2014

Prilozi

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A questionnaire of 15 items was developed in order to evaluate clinical practice regarding pharmacological treatment of epilepsy among adult neurologists in R. Macedonia. It was mailed to 30 practising neurologists, 24 answered (80%). Half of them administer AED after a first unprovoked seizure considering EEG and MRI, while others usually wait for a second one before introducing treatment. Discontinuation of treatment should be individualized. Carbamazepine and lamotrigine are the most frequently prescribed first-line drugs for partial seizures; second choices include a number of older and new generation AEDs. For generalized tonic-clonic seizures, absences, myoclonic, mixed or undetermined seizures, valproate is by far the most commonly used AED. The survey showed that prescription patterns are in accordance with current evidence about the spectrum of efficacy of individual AEDs in different types of seizures. Yet some results are a cause of concern and continuous education of the neurological community on AED treatment of epilepsy is needed.

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Section: Discussionsupporting

confidence: 75%

Brief Communication of Assessment of Clinical Practice Regarding Pharmacological Treatment of Epilepsy: A Survey of Neurologists in Republic of Macedonia

Cvetkovska

Kuzmanovski²,

Boshkovski³

2014

Prilozi

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“…Levetiracetam (LEV), one of the new generation antiepileptic drugs (AEDs), is considered to be a broad spectrum anticonvulsant with favorable safety and pharmacokinetic profiles [1]. It is currently licensed in the USA as adjunctive therapy for the treatment of partial onset seizures in patients one month of age and older, myoclonic seizures in patients 12 years and older diagnosed with juvenile myoclonic epilepsy [2] and primarily generalized tonic-clonic seizures in patients 6 years and older diagnosed with an idiopathic generalized epilepsy [3].…”

Section: Introductionmentioning

confidence: 99%

Paradoxical exacerbation of myoclonic-astatic seizures by levetiracetam in myoclonic astatic epilepsy

et al. 2015

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BackgroundLevetiracetam is a broad spectrum antiepileptic drug (AED) with proven efficacy when used as adjunctive therapy against myoclonic seizures. We report two patients suffering from epilepsy with myoclonic-astatic epilepsy (MAE) who experienced a paradoxical worsening of seizures after initiation of treatment with LEV, a finding not previously described.Case presentationPatients included were enrolled in an ongoing large prospective study evaluating children and adults with new onset epilepsy in Lebanon conducted at the American University of Beirut Medical Center in association with the Lebanese Chapter of the International League against Epilepsy. Based on an extensive evaluation, these patients were stratified into idiopathic partial, idiopathic generalized, symptomatic partial or symptomatic generalized epilepsies. Whenever possible the electroclinical syndrome was identified according to the ILAE classification of epilepsy syndromes. Patients were subsequently followed up on regular intervals and were assessed for adverse events, and seizure recurrence.MAE was diagnosed in five (1.6%) out of 307 consecutive children enrolled in this study. LEV was used as adjunctive therapy in four of those children with two experiencing a substantial and dose related worsening in the frequency of their myoclonic and atonic seizures.ConclusionLEV should be used with caution in children with MAE and an exacerbation of seizure frequency temporally related to the introduction of LEV should alert the clinician to the possibility of a paradoxical seizure exacerbation.

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“…A primary generalized seizure, for example, can be classified as a macroelectrical disturbance (Level 2) that has significant downstream effects on motor circuitry (Level 3). Seizures are typically associated with a GABA-glutamate imbalance (Level 4) that can manifest as resultant motoric dysfunction and/or altered consciousness (Level 5) 34 . The triggers for such seizures have been identified at various model levels, from emotional stress (Level 5) to missed medications (Level 4 and 3) and sleep deprivation (Level 2) 35 .…”

Section: Nested Hierarchiesmentioning

confidence: 99%

Beyond Neural Cubism

2015

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Cubism was an influential early 20th century art movement characterized by angular, disjointed imagery. The two-dimensional appearance of Cubist figures and objects is created through juxtaposition of angles. The authors posit that the constrained perspectives found in Cubism may also be found in the clinical classification of brain disorders. Neurological disorders are often separated from psychiatric disorders as if they stem from different organ systems. Maintaining two isolated clinical disciplines fractionalizes the brain in the same way that Pablo Picasso fractionalized figures and objects in his Cubist art. This Neural Cubism perpetuates a clinical divide that does not reflect the scope and depth of neuroscience. All brain disorders are complex and multidimensional, with aberrant circuitry and resultant psychopharmacology manifesting as altered behavior, affect, mood or cognition. Trainees should receive a multidimensional education based on modern neuroscience, not a partial education based on clinical precedent. The authors briefly outline the rationale for increasing the integration of neurology and psychiatry and discuss a nested model with which clinical neuroscientists (neurologists and psychiatrists) can approach and treat brain disorders.

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Treatment of idiopathic generalized epilepsy – a review of the evidence

Cited by 25 publications

References 68 publications

Brief Communication of Assessment of Clinical Practice Regarding Pharmacological Treatment of Epilepsy: A Survey of Neurologists in Republic of Macedonia

Brief Communication of Assessment of Clinical Practice Regarding Pharmacological Treatment of Epilepsy: A Survey of Neurologists in Republic of Macedonia

Paradoxical exacerbation of myoclonic-astatic seizures by levetiracetam in myoclonic astatic epilepsy

Beyond Neural Cubism

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