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  • Print publication year: 2019
  • Online publication date: October 2019

Chapter 19 - Principles of Antiseizure Drug Management

Summary

Seizures are categorized as unprovoked or provoked, and the former may lead to the diagnosis of epilepsy. The term unprovoked seizure refers to a seizure of unknown etiology or that occurs in relation to a presenting brain lesion or progressive nervous system disorder. Provoked seizures are due to an acute condition such as toxic or metabolic disturbance, head trauma, or acute stroke. About 30% of patients with unprovoked seizures, which are nearly always generalized tonic–clonic convulsions, are seen by physicians after only a single attack. Studies have now established high-risk groups for recurrence after a single unprovoked seizure. The risk for epilepsy is greatly increased in the presence of an abnormal electroencephalogram (EEG), history of brain injury, and family history of epilepsy.1 Age of onset may impact the choice of antiseizure drug (ASD). Etiologies often vary with age of onset. Prognosis, consequences of etiology, and response to treatment may vary depending on age and comorbid conditions.

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1.Freeman, JM, Pedley, TA. Indications for treatment. In: Engel, J Jr., Pedley, TA, eds., Epilepsy: A Comprehensive Textbook. 2nd edn. Philadelphia: Lippincott Williams & Wilkins; 2008:11191123.
2.Rust, RS, Volpe, JJ. Neonatal seizures. In: Dodson, WE, Pellock, JM, eds., Pediatric Epilepsy: Diagnosis and Therapy. New York: Demos Publications; 1993:107128.
3.Volpe, JJ. Neonatal seizures. In: Volpe, JJ, ed., Neurology of the Newborn. Philadelphia: Saunders; 1987:129158.
4.Aicardi, J. Neonatal and infantile seizures. In: Morselli, PL, Pippenger, CE, Penry, JK, eds., Antiepileptic Drug Therapy in Pediatrics. New York: Raven Press; 1983:103113.
5.Lockman, LA, Kriel, R, Zaske, D, Thompson, T, Virnig, N. Phenobarbital dosage for control of neonatal seizures. Neurology. 1979;29(11):14451449.
6.Rust, RS, Dodson, WE. Phenobarbital: absorption, distribution and excretion. In: Levy, RH, Dreifuss, FE, Mattson, RH, Meldrum, BS, Penry, JK, eds., Antiepileptic Drugs. 3rd edn. New York: Raven Press; 1989.
7.Fischer, JH, Lockman, LA, Zaske, D, Kriel, R. Phenobarbital maintenance dose requirements in treating neonatal seizures. Neurology. 1981;31(8):10421044.
8.Painter, MJ, Pippenger, C, Wasterlain, C, et al. Phenobarbital and phenytoin in neonatal seizures: metabolism and tissue distribution. Neurology. 1981;31(9):11071112.
9.Gilman, JT, Gal, P, Duchowny, MS, Weaver, RL, Ransom, JL. Rapid sequential phenobarbital treatment of neonatal seizures. Pediatrics. 1989;83(5):674678.
10.Gal, P, Toback, J, Boer, HR, Erkan, NV, Wells, TJ. Efficacy of phenobarbital monotherapy in treatment of neonatal seizures – relationship to blood levels. Neurology. 1982;32(12):14011404.
11.Thong, YH, Abramson, DC. Continuous infusion of diazepam in infants with severe recurrent convulsions. Med Ann Dist Columbia. 1974;43(2):6365.
12.Dodson, WE. Antiepileptic drug use in newborns and infants. In: Pedley, TA, Meldrum, BS, eds., Recent Advances in Epilepsy. Edinburgh: Churchill Livingstone; 1983:231249.
13.Morselli, PL. Development of physiological variables important for drug kinetics. In: Morselli, PL, Pippenger, CE, Penry, JK, eds., Antiepileptic Drug Therapy in Pediatrics. New York: Raven Press; 1983:112.
14.Bourgeois, BF, Dodson, WE. Phenytoin elimination in newborns. Neurology. 1983;33(2):173178.
15.Morselli, PL, Baruzzi, A. Serum Levels and Pharmokinetics of Anticonvulsants in the Management of Seizure Disorders. Chicago: Year Book Medical Publishers; 1978.
16.Dodson, WE. Phenytoin elimination in childhood: effect of concentration-dependent kinetics. Neurology. 1980;30(2):196199.
17.Dodson, WE. Nonlinear kinetics of phenytoin in children. Neurology. 1982;32(1):4248.
18.Watanabe, K, Kuroyanagi, M, Hara, K, Miyazaki, S. Neonatal seizures and subsequent epilepsy. Brain Dev. 1982;4(5):341346.
19.Holden, KR, Mellits, ED, Freeman, JM. Neonatal seizures. I. Correlation of prenatal and perinatal events with outcomes. Pediatrics. 1982;70(2):165176.
20.Bergman, I, Painter, MJ, Crumrine, PK. Neonatal seizures. Semin Perinatol. 1982;6(1):5467.
21.Mizrahi, EM, Kellaway, P. Characterization and classification of neonatal seizures. Neurology. 1987;37(12):18371844.
22.Cloyd, J. Commonly Used Antiepileptic Drugs: Age-Related Pharmacokinetics. Woburn, MA: Butterworth-Heinemann; 1997.
23.Willmore, J. Commonly used antiepileptic drugs: age related efficacy. In: Rowan, AJ, Ramsay, E, eds., Seizures and Epilepsy in the Elderly. Woburn, MA: Butterworth-Heinemann; 1997:229238.
24.Krumholz, A, Wiebe, S, Gronseth, GS, et al. Evidence-based guideline: Management of an unprovoked first seizure in adults. Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;84(16):17051713.
25.Fields, MC, Labovitz, DL, French, JA. Hospital-onset seizures: an inpatient study. JAMA Neurol. 2013;70(3):360364.
26.Gidal, BE, French, JA, Grossman, P, Le Teuff, G. Assessment of potential drug interactions in patients with epilepsy: impact of age and sex. Neurology. 2009;72(5):419425.
27.Hessen, E, Lossius, MI, Gjerstad, L. Antiepileptic monotherapy significantly impairs normative scores on common tests of executive functions. Acta Neurol Scand. 2009;119(3):194198.
28.Motamedi, G, Meador, K. Epilepsy and cognition. Epilepsy Behav. 2003;4 Suppl 2:S25–38.
29.Meador, KJ. Cognitive and memory effects of the new antiepileptic drugs. Epilepsy Res. 2006;68(1):6367.
30.Yang, CY, Dao, RL, Lee, TJ, et al. Severe cutaneous adverse reactions to antiepileptic drugs in Asians. Neurology. 2011;77(23):20252033.
31.Mockenhaupt, M, Messenheimer, J, Tennis, P, Schlingmann, J. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptics. Neurology. 2005;64(7):11341138.
32.Gelisse, P, Genton, P, Kuate, C, et al. Worsening of seizures by oxcarbazepine in juvenile idiopathic generalized epilepsies. Epilepsia. 2004;45(10):12821286.
33.Perucca, E, Gram, L, Avanzini, G, Dulac, O. Antiepileptic drugs as a cause of worsening seizures. Epilepsia. 1998;39(1):517.
34.Vecht, CJ, van Breemen, M. Optimizing therapy of seizures in patients with brain tumors. Neurology. 2006;67(12 Suppl 4):S10–13.
35.Michelucci, R. Optimizing therapy of seizures in neurosurgery. Neurology. 2006;67(12 Suppl 4):S14–18.
36.Bazil, CW. Antiepileptic drugs in the 21st century. CNS Spectr. 2001;6(9):756762, 765.
37.Lacerda, G, Krummel, T, Sabourdy, C, Ryvlin, P, Hirsch, E. Optimizing therapy of seizures in patients with renal or hepatic dysfunction. Neurology. 2006;67(12 Suppl 4):S28–33.
38.Israni, RK, Kasbekar, N, Haynes, K, Berns, JS. Use of antiepileptic drugs in patients with kidney disease. Semin Dial. 2006;19(5):408416.
39.Sheth, RD. Metabolic concerns associated with antiepileptic medications. Neurology. 2004;63(10 Suppl 4):S24–29.
40.Ahmed, SN, Siddiqi, ZA. Antiepileptic drugs and liver disease. Seizure. 2006;15(3):156164.
41.Mula, M, Hesdorffer, DC, Trimble, M, Sander, JW. The role of titration schedule of topiramate for the development of depression in patients with epilepsy. Epilepsia. 2009;50(5):10721076.
42.Pack, AM, Morrell, MJ, Marcus, R, et al. Bone mass and turnover in women with epilepsy on antiepileptic drug monotherapy. Ann Neurol. 2005;57(2):252257.
43.Pack, A. Effects of treatment on endocrine function in patients with epilepsy. Curr Treat Options Neurol. 2005;7(4):273280.
44.Pack, AM, Morrell, MJ, Randall, A, McMahon, DJ, Shane, E. Bone health in young women with epilepsy after one year of antiepileptic drug monotherapy. Neurology. 2008;70(18):15861593.
45.Dulac, O, Leppick, IE, Chadwick, DW, Specchio, L. Starting and stopping treatment. In: Engel, J, Pedley, TA, Aicardi, J, eds., Epilepsy: A Comprehensive Textbook. 2nd edn. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008:13011310.
46.Camfield, P, Camfield, C. The frequency of intractable seizures after stopping AEDs in seizure-free children with epilepsy. Neurology. 2005;64(6):973975.
47.Nakazawa, Y, Ishida, S, Maeda, H, Sakurai, S, Motooka, H. Prognosis of epilepsy withdrawn from antiepileptic drugs. Psychiatry Clin Neurosci. 1995;49(3):163168.
48.Specchio, LM, Tramacere, L, La Neve, A, Beghi, E. Discontinuing antiepileptic drugs in patients who are seizure-free on monotherapy. J Neurol Neurosurg Psychiatry. 2002;72(1):2225.
49.So, NK. Recurrence, remission, and relapse of seizures. Cleve Clin J Med. 1993;60(6):439444.
50.Armijo, JA, Adin, J. [Pharmacological basis for withdrawal of antiepileptic drugs]. Rev Neurol. 2000;30(4):336350.
51.Sirven, JI, Sperling, M, Wingerchuk, DM. Early versus late antiepileptic drug withdrawal for people with epilepsy in remission. Cochrane Database Syst Rev. 2001(3):Cd001902.
52.Berg, AT, Shinnar, S. Relapse following discontinuation of antiepileptic drugs: a meta-analysis. Neurology. 1994;44(4):601608.
53.Tennison, M, Greenwood, R, Lewis, D, Thorn, M. Discontinuing antiepileptic drugs in children with epilepsy: a comparison of a six-week and a nine-month taper period. N Engl J Med. 1994;330(20):14071410.
54.Peters, AC, Brouwer, OF, Geerts, AT, et al. Randomized prospective study of early discontinuation of antiepileptic drugs in children with epilepsy. Neurology. 1998;50(3):724730.
55.Duncan, JS, Shorvon, SD, Trimble, MR. Withdrawal symptoms from phenytoin, carbamazepine and sodium valproate. J Neurol Neurosurg Psychiatry. 1988;51(7):924928.
56.Schmidt, D, Loscher, W. Uncontrolled epilepsy following discontinuation of antiepileptic drugs in seizure-free patients: a review of current clinical experience. Acta Neurol Scand. 2005;111(5):291300.