Preview

Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Rationale for mono- versus polytherapy with antiepileptic drugs for patients with epilepsy

https://doi.org/10.14412/2074-2711-2017-1S-84-88

Full Text:

Abstract

The article considers the arguments that can provide a rationale for treatment policy in patients with epilepsy after failure of monotherapy with a first antiepileptic drug (AED). When choosing alternative monotherapy or early polytherapy with AEDs, one should consider a diversity of criteria: the mechanism of action, pharmacokinetic and pharmacodynamic properties, efficacy, and safety profile of AEDs, disease features, individual patient characteristics, and social factors. The choice of the right AED treatment policy in the early stages of the disease is important for patients because the inadequate control of seizures can result in irreversible psychosocial consequences and reduce the chance to eliminate future disabling seizures.

About the Authors

L. V. Lipatova
V.M. Bekhterev Saint Petersburg Psychoneurology Research Institute, Ministry of Health of Russia
Russian Federation
3, Bekhterev St., Saint Petersburg 192019


T. V. Kapustina
V.M. Bekhterev Saint Petersburg Psychoneurology Research Institute, Ministry of Health of Russia
Russian Federation
3, Bekhterev St., Saint Petersburg 192019


References

1. Зенков ЛР. Эпилепсия: диагноз и лечение: Руководство для врачей. Москва: Медицинское информационное агентство; 2012. 176 c. [Zenkov LR. Epilepsiya: diagnoz i lechenie: Rukovodstvo dlya vrachei [Epilepsy: Diagnosis and Treatment: A Guide for Physicians]. Moscow: Meditsinskoe informatsionnoe agentstvo; 2012. 176 p.].

2. Deckers CL, Hekster YA, Keyser A, et al. Mono therapy versus polytherapy for epilepsy: a multicenter double-blind randomized study. Epilepsia. 2001 Nov;42(11):1387-94. doi: 10.1046/j.1528-1157.2001.30800.x

3. Власов ПН, Шахабасова ЗС, Филатова НВ. Эпилепсия, впервые выявленная у пожилых пациентов: диагностика, дифференциальная диагностика, терапия. Фарматека. 2010;(7):40-7 [Vlasov PN, Shakhabasova ZS, Filatova NV. Epilepsy, first detected in elderly patients: diagnosis, differential diagnosis, therapy. Farmateka. 2010;(7):40-7 (In Russ.)].

4. Карлов ВА. Эпилепсия у детей и взрослых женщин и мужчин: Руководство для врачей. Москва: Медицина; 2010. 720 с. [Karlov VA. Epilepsiya u detei i vzroslykh zhenshchin i muzhchin: Rukovodstvo dlya vrachei [Epilepsy in children and adults, men and women: A guide for physicians]. Moscow: Meditsina; 2010. 720 p.].

5. Baulac M. Rational conversion from antiepileptic polytherapy to monotherapy. Epileptic Disorders. 2003;5(3):125-32.

6. Perucca E, Tomson T. The pharmacological treatment of epilepsy in adults. Lancet Neurology. 2011;10:446-56. doi: 10.1016/S1474-4422(11) 70047-3

7. Glauser T, Ben-Menachem E, Bourgeois B, et al; for the ILAE Subcommission on AED Guidelines. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2013;54(3):551-63. doi: 10.1111/epi.12074

8. Bourgeois B. Reducing overtreatment. Epilepsy Res. 2002 Nov;52(1):53-60.

9. Kwan P, Brodie MJ. Epilepsy after the first drug fails substitution or add-on. Seizure. 2000;9:464-8. doi: 10.1053/seiz.2000.0442

10. Schmidt D, Haenel F. Therapeutic plasma levels of phenytoin, phenobarbital, and carbamazepine: individual variation in relation to seizure frequency and type. Neurology. 1984;34(9):1252. doi: 10.1212/WNL.34.9.1252

11. Schmidt D, Richter K. Alternative single anticonvulsant drug therapy for refractory epilepsy. Ann Neurol. 1986 Jan;19(1):85-7. doi: 10.1002/ana.410190118

12. Kwan P, Brodie MJ. Combination therapy in epilepsy. When and what to use. Drugs. 2006;66(14):1817-29. doi: 10.2165/00003495-200666140-00004

13. Hirsch LJ, Arif H, Nahm EA, et al. Crosssensitivity of skin rashes with antiepileptic drug use. Neurology. 2008;71;1527-34. doi: 10.1212/01.wnl.0000334295.50403.4c

14. Guberman AH, Besag FM, Brodie MJ, et al. Lamotrigine-associated rash: risk/benefit considerations in adults and children. Epilepsia. 1999;40:985-91. doi: 10.1111/j.1528-1157.1999.tb00807.x

15. Messenheimer J, Mullens EL, Giorgi L, Young F. Safety review of adult clinical trial experience with lamotrigine. Drug Safety. 1998;18:281-96. doi: 10.2165/00002018-199818040-00004

16. Bourgeois BFD, Dodson WE. Antiepileptic and neurotoxic interaction between antiepileptic drugs. In: Pitlick WH, editor. Antiepileptic drug interactions. New York: Demos Publications; 1989. P. 209-19.

17. Ramsay RE, Rowan AJ, Slater JD, et al. Effect of age on epilepsy and its treatment: results from the VA Cooperative Study. Epilepsia. 1994;35(Suppl 8): 1-173.

18. Ben-Menachem E. Medical management of refractory epilepsy: practical treatment with novel antiepileptic drugs. Epilepsia. 2014;55 (Suppl 1):3-8. doi: 10.1111/epi.12494

19. Липатова ЛВ. Нерешенные вопросы инициальной терапии парциальной эпилепсии. Эпилепсия и пароксизмальные состояния. 2014;6(4):55-61 [Lipatova LV. Unresolved issues of initial therapy of partial epilepsy. Epilepsiya i Paroksizmal'nye Sostoyaniya. 2014;6(4):55-61 (In Russ.)].

20. Липатова ЛВ. Принципы лечения эпилепсии у пожилых пациентов. Журнал неврологии и психиатрии им. С.С. Корсакова. 2013;113(4-2):52-8 [Lipatova LV. Principles of treatment of epilepsy in elderly patients. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova = SS Korsakov Journal of Neurology and Psychiatry. 2013;113(4-2):52-8 (In Russ.)].

21. Одинак ММ, Прокудин МЮ, Скиба ЯБ. Фармакорезистентность при фокальных эпилепсиях у взрослых. В кн.: Гусев ЕИ, Гехт АБ, редакторы. Эпилепсия: фундаментальные, клинические и социальные аспекты. Москва: АПКИППРО; 2013. С. 691-701 [Odinak MM, Prokudin MYu, Skiba YaB. Farmakorezistentnost' pri fokal'nykh epilepsiyakh u vzroslykh. In: Gusev EI, Gekht AB, editors. Epilepsiya: fundamental'nye, klinicheskie i sotsial'nye aspekty [Epilepsy: the fundamental, clinical and social aspects]. Moscow: APKIPPRO; 2013. P. 691-701].

22. Одинак ММ. Эпилепсия: этиопатогенез, клиника, дифференциальная диагностика, медикаментозное лечение. Санкт-Петербург: Политехника; 1997. 233 с. [Odinak MM. Epilepsiya: etiopatogenez, klinika, differentsial'naya diagnostika, medikamentoznoe lechenie [Epilepsy: etiopathogenesis, clinic, differential diagnosis, drug treatment]. St. Petersburg: Politekhnika; 1997. 233 p.].

23. Gillham R, Baker G, Thompson P. Standardization of a self-report questionnaire for use in evaluating cognitive, effective and behavioral side effects of antiepileptic drugs. Epilepsy Res. 1996;24:47-55. doi: 10.1016/0920-1211(95)00102-6

24. Helal SI, Megahed HS, Salem SM, Youness ER. Monotherapy versus polytherapy in epileptic adolescents. Maced J Med Sci. 2013 June 15;6(2):174-7. doi: 10.3889/MJMS.1857-5773.2013.0298

25. Perucca E. Pharmacoresistance in epilepsy. How should it be defined? CNS Drugs. 1998;10:171-9. doi: 10.2165/00023210-199810030-00002

26. Kwan P, Sills GJ, Brodie MJ. The mechanisms of action of commonly used antiepileptic drugs. Pharmacol Ther. 2001;90:21-34. doi: 10.1016/S0163-7258(01)00122-X

27. Panayiotopoulos CP, editor. Atlas of Epilepsies. London: Springer-Verlag; 2010.

28. Kanner AM, Balabanov AJ. Pharmacotherapy of mood disorders in epilepsy: The role of newer psychotropic drugs. Curr Treat Options Neurol. 2005;7:281-90. doi: 10.1007/s11940-005-0038-7

29. Lazarowski A, Czornyj L, Lubienieki F, et al. ABC transporters during epilepsy and mechanisms underlying multidrug resistance in refractory epilepsy. Epilepsia. 2007 Sept;48(5): 140-9. doi: 10.1111/j.1528-1167.2007.01302.x

30. Sisodiya SM, Lin WR, Harding BN, et al. Drug resistance in epilepsy: expression of drug resistance proteins in common causes of refractory epilepsy. Brain. 2002 Jan ;125 (Pt1):22-31. doi: 10.1093/brain/awf002

31. Patsalos PN, Berry DJ, Bourgeois BF, et al. Antiepileptic drugs-best practice guideline for therapeutic drug monitoring: a position paper by the subcommissionon therapeutic drug monitoring, ILAE commission on Therapeutic Strategies. Epilepsia. 2008 Jul;49(7):1239-76. doi: 10.1111/j.1528-1167.2008.01561.x

32. Perucca E. Pharmacological principles as a basis for polytherapy. Acta Neurol Scand Suppl. 1995;162:31-4. doi: 10.1111/j.1600-0404.1995.tb00497.x

33. Panayiotopoulos CP. Clinical guide to epileptic syndromes and their treatment. London: Springer; 2010. 578 p.

34. Schmidt D, Lö scher W. Drug resistance in epilepsy: putative neurobiologic and clinical mechanisms. Epilepsia. 2005;46:858-77. doi: 10.1111/j.1528-1167.2005.54904.x

35. Tatum IV WO. Antiepileptic drugs adverse effects and drug-drug interactions, continuum lifelong learning. Continuum (Minneap Minn). 2010 Jun;16(3 Epilepsy):136-58. doi: 10.1212/01.CON.0000368236.41986.24.

36. Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol. 2006;61(3):246-55. doi: 10.1111/j.1365-2125.2005.02529.x

37. Ibrahim GM, Rutka JT, Snead III OC. Network analysis reveals patterns of antiepileptic drug use in children with medically intractable epilepsy. Epilepsy Behav. 2013;28: 22-5. doi: 10.1016/j.yebeh.2013.03.030

38. Wilmshurst JM, Burman R, Gaillard WD, Cross JH. Treatment of infants with epilepsy: Common practices around the world. Epilepsia. 2015;56(7):1033-46. doi: 10.1111/epi.13003

39. Canevini MP, de Sarro G, Galimberti CA, et al; and on behalf of the SOPHIE Study Group (2010). Relationship between adverse effects of antiepileptic drugs, number of coprescribed drugs, and drug load in a large cohort of consecutive patients with drug-refractory epilepsy. Epilepsia. 2010; 51(5):797-804. doi: 10.1111/j.1528-1167.2010.02520.x

40. Gomez-Arias B, Crail-Melendez D, Lopez-Zapata R, Martinez-Juarez IE. Severity of anxiety and depression are related to a higher perception of adverse effects of antiepileptic drugs. Seizure. 2012 Oct;21(8):588-94. doi: 10.1016/j.seizure.2012.06.003

41. French J, Arrigo C. Rapid onset of action of levetiracetam in refractory epilepsy patients. Epilepsia. 2005 Feb;46(2):324-6. doi: 10.1111/j.0013-9580.2005.31504.x

42. Mula M, Trimble MR. Antiepileptic druginduced cognitive adverse effects: potential mechanisms and contributing factors. CNS Drugs. 2009;23(2):121-37. doi: 10.2165/00023210-200923020-00003


Review

For citations:


Lipatova L.V., Kapustina T.V. Rationale for mono- versus polytherapy with antiepileptic drugs for patients with epilepsy. Neurology, Neuropsychiatry, Psychosomatics. 2017;9(1S):84-88. (In Russ.) https://doi.org/10.14412/2074-2711-2017-1S-84-88

Views: 603


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)