Epileptology最新文献

Background

Seizures as well as adverse effects of antiepileptic drugs (AED) affect quality of life among patients with epilepsy.

Aims

to give a review of instruments for the assessment of patient-reported adverse effects of AED and discuss their strengths and limitations.

Methods

MEDLINE search supplemented by other internet searches, citations of articles, personal communications and abstracts.

Results

Eight standardized instruments for the assessment of patient-reported adverse effects were included in the review. These instruments differ considerably in regard to scope, complexity and psychometric evaluation. Three questionnaires aimed primarily at patient reported cognitive dysfunction caused by AED. Some instruments were not psychometrically evaluated or corresponding information was only sparse. If reported, reliability, validity and responsiveness was satisfactory. However, confounding factors, especially comorbid depression and anxiety disorders may bias the reporting of adverse effects.

Conclusions

Assessment of patient-reported adverse drug effects appears useful for the optimizing of the AED therapy and for improving patients' quality of life. For this purpose, some standardized and validated questionnaires/checklists are available meanwhile. Further development of methods to evaluate the severity and clinical relevance of patient-reported adverse effects of AED would be beneficial.

Both, the development of novel antiepileptic drugs as well as ongoing research regarding the mechanism of action of established antiepileptic drugs, are continuously increasing the level of complexity in the spectrum of molecular targets relevant for epilepsy therapy. Although we are far from a reliable prediction of the optimal choice for polytherapy in individual patients, evidence exists that the mechanisms of action of the combination partners can matter regarding tolerability and efficacy. Moreover, the current state of knowledge as well as the limitations in our understanding should guide future research aiming for a more detailed elucidation of the exact mechanisms of target modulation as well as a more comprehensive investigation of the impact of genetics and pathophysiological mechanisms on interindividual differences in expression and function of antiepileptic drug targets.

Therefore, this review gives a short overview of the mechanism of action of currently marketed antiepileptic drugs.

Although a wide variety of antiepileptic drugs (AEDs) are available, counseling women of childbearing age with epilepsy is still a challenge.

Are there treatment alternatives available for these women? Are there data in the studies and registries allowing women to use VPA under certain circumstances? Is there enough knowledge available to council women and how can this be done?

For generalized and unclassified epilepsies, valproate (VPA) should still be considered the gold standard. In many cases, VPA cannot be replaced in patients suffering from idiopathic generalized epilepsy (IGE). There are many reasons for contraindicating the use of VPA in female patients, e.g. increasing risk for Major congenital malformations (MCM) and influence on cognition. These risks are dose dependent and there is evidence that low dose therapy reduces the risks considerable. If VPA proves to be indispensable, then administering the lowest dose possible is mandatory.