Epileptology最新文献

Much time, money and effort on behalf of patients, doctors, statisticians, pharmaceutical personnel and regulators are spent in planning and undertaking clinical trial programmes that result in antiepileptic drugs reaching the marketplace and thereafter becoming available for treating people with epilepsy in everyday clinical practice. Rather unusually, both the American and European Authorities require separate trial programmes to licence each drug for their adjunctive and monotherapy use. These studies also often contribute to clinical guideline development. This short paper discusses the design of these trials and their clinical value to the clinician.

In women, from puberty, during pregnancy and to menopause, epilepsy presents several unique challenges to physicians and other health-care providers. Women with epilepsy have increased risks of sexual dysfunction, menstrual disturbances, premature menopause, and infertility; and seizure activity and severity can be influenced by the cyclic variations of sex hormones. Oral contraceptive efficacy can be affected by antiepileptic drugs and vice versa. Furthermore, the offspring of women receiving antiepileptic drugs are at increased risk for congenital malformations, and this risk is associated with specific drug regimens. Physicians have to understand and respond to these specific issues to ensure sufficient therapeutic decisions throughout the reproductive stages.

Idiopathic generalized epilepsies (IGEs) are eight epilepsies defined in the 1989 ILAE Classification usually starting in childhood or adolescence. Since IGEs treatment is dependent on syndromic characterization, the clinical features are still the cornerstone of accurate classification and selection of appropriate treatment. We reviewed evidence-based data on treatment with antiepileptic drugs, as well as prognostic factors in IGEs. Evidence-based data support the use of valproate and ethosuximide in monotherapy for treatment of childhood absence epilepsy; topiramate in monotherapy for primarily generalized tonic–clonic seizures (PGTCS); and, as adjunctive therapy, of lamotrigine, levetiracetam and topiramate for PGTCS and levetiracetam for myoclonic seizures.

Assessment of a first seizure (FS) presentation requires a comprehensive and systematic approach to address the complexity of this condition and all of the open questions with regards to accurate interpretation of the initial event, necessary diagnostic steps, prognosis and need for antiepileptic drugs (AED). Counseling about key life style issues and safety considerations in daily life are a major component in the first meeting; which should allow enough time to help to create trust in this vulnerable situation. “Treatment” in this review is therefore used in a holistic way and is not restricted to medication only. Pharmacological treatment of a FS aims to restore normal neuronal function and helps to suppress further seizures. Choosing pharmacological intervention must be guided by incorporating all available clinical information, structural–functional relationships, the underlying pathology, which may specifically include a treatable systematic disease, and the individual's requirements and inclination. Pharmacological treatment should always be considered if the index seizure is not the “first seizure” but actually reflects newly diagnosed epilepsy. AED treatment after a FS is also reasonable, if additional functional and structural tests suggest an epileptic process or if comorbid medical conditions exist (e.g. polytrauma, anticoagulation in an elderly patient with prior stroke) in which any further seizure would lead to additional harm. A comprehensive systematic approach incorporating 10 key principles is presented.