New Epilepsy Treatment GuidelinesDuring the past decade, there has been a notable shift in the recommended treatment of epilepsy in adolescents and adults. First, there is a marked shift towards an increased use of single anti-seizure medications (AEDs) before trying a combination of therapies. There is also an increased recognition of the need for special treatment strategies for specific groups, including women and seniors, who until recently have tended to be overlooked in clinical studies.
Expert Consensus Guidelines is published in the November issue of
Epilepsy and Behavior, a journal widely distributed to physicians in the USA. Based on the clinical practice of 45 epilepsy specialists (with long- standing practices and recent publications) from throughout that country, it was overseen by Martha Morrell, MD (Director of Columbia Comprehensive Epilepsy Center of New York-Presbyterian Hospital and professor of neurology at Columbia University College of Physicians and Surgeons, New York).
We are fortunate to have numerous anti-seizure medications today, but this may complicate the selection and sequence of potential therapies, especially for physicians who do not treat persons with a seizure disorder routinely. The new Guidelines attempt to integrate the full range of AEDs — including newer therapies — into optimal treatment strategies, based on seizure type and individual patient needs. The use of a single medication may help to attain the best degree of seizure control with the least likelihood of side effects. At least 2, or possibly 3, trials with a single AED is recommended for persons with a new diagnosis before considering combinations of AEDs, regardless of the type of epilepsy.
The Guidelines also address the distinct needs of specific patient populations (women of childbearing years, seniors, persons with clinical depression, persons with intellectual impairment) about whom the scientific literature is evolving. Research demonstrates that many AEDs can compromise reproductive health for women, and impair the cognitive ability and cause dizziness and/or sedation of older persons.
Issues of reproductive health faced by women living with epilepsy may include pregnancy and breast-feeding; difficulties in becoming pregnant; an increased risk for birth defects; menstrual irregularities or absent menses; infertility; ovarian cysts; obesity; unwelcome changes in facial and body structure and/or hair; and polycystic ovarian syndrome (PCOS), which itself causes infertility. Published studies show that some oral contraceptives are less reliable when taken with specific "liver-enzyme inducing" AEDs. Also, there is concern that some AEDs may potentially lead to premature osteoporosis.
Among seniors, epilepsy may be caused by stroke, cardiovascular disease, Alzheimer's disease or brain tumours. Common side effects associated with many AEDs include dizziness, sedation, and impairment of cognitive function. Both patient and caregiver may confuse these side effects with symptoms of other conditions, resulting in unnecessary treatment. Or, side effects may be glossed over as part of the natural aging process. Being more likely to require medications for a variety of conditions, seniors are also at an increased the risk of drug interactions. Too often, a senior's ability to participate in daily activities is needlessly compromised.
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