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Patient_ep_refractory.qxdAAN Guideline Summary for PATIENTS and THEIR FAMILIES
EFFICACY AND TOLERABILITY OF THE
NEW ANTIEPILEPTIC DRUGS FOR
TREATMENT OF REFRACTORY EPILEPSY
If you or a loved one has epilepsy, this fact sheet will help you and your doctor talk about medicines—called
antiepileptic drugs (AEDs)—that offer hope for people with refractory epilepsy. People with refractory epilepsy continue
to have seizures, even after trying several medications. This fact sheet is based on the recommendations of a group of
experts in neurology and epilepsy who have reviewed all available information on how well the newer antiepileptic
drugs work in people who have hard to control seizures.
What are seizures?
the new drugs are in the treatment of children and adults Seizures happen when there are sudden changes in the with refractory epilepsy. In some cases, there was not way normal brain cells interact electrically. During a enough information to decide one way or another. seizure, a sudden wave of electrical energy swamps partor all of the brain, disrupting normal brain activity.
What do the guidelines say?
Consciousness, movement, sensation, speech, mood, The AAN and AES expert team made recommendations memory, and emotions can all be affected during the one for treatment of partial epilepsy—seizures affecting one area of the brain; generalized epilepsy—seizures affectingthe whole brain, and the Lennox Gastaut syndrome— What are antiepileptic drugs—or AEDs—and how
can they help?
Antiepileptic drugs are chemical compounds that affect
The experts did not review the information about the older the brain. There are more than 20 drugs used in the drugs, which also can be used to treat many of the conditions treatment of epilepsy. Antiepileptic drugs do not cure the discussed in this brochure. Studies have not been done condition but will often control seizures completely if the to determine whether the newer drugs could be used in AEDs are taken regularly. Some AEDs prevent seizures by all conditions. Even if the experts did not find enough controlling electrical signals in the brain.
information to recommend the use of one of the drugs, yourdoctor may recommend the AED. The risks, benefits, and If you have epilepsy, your physician will choose an AED options for treatment should be discussed with your doctor.
based upon your seizure type, your age, and potential sideeffects. There is often a trial and error period to determine Partial epilepsy
the best course of therapy for each individual patient. The experts determined that all the newer antiepilepticdrugs are effective when taken in addition to another Why did the experts decide to develop new
antiepileptic drug—or add-on therapy—for adults with guidelines for use of these drugs?
partial seizures. The drug known by its generic name* Many widely used antiepileptic drugs have been available gabapentin was found to be effective for the treatment of for twenty, thirty, and even more than fifty years. Their mixed seizure. Gabapentin, lamotrigine, oxcarbazepine, positive and negative effects have been widely studied.
and topiramate were recommended for children with However, physicians do not know as much about the refractory partial seizures. In a previous guideline, the newer antiepileptic drugs that have been approved by the experts found that felbamate, another new antiepileptic U.S. Food and Drug Administration over the past ten years. drug, is also effective in partial seizures. Felbamate hasspecial risks that should be considered by you and your Neurologists from the American Academy of Neurology (AAN) doctor before you make a decision to use it.
who specialize in diseases of the brain and central nervoussystem, including epilepsy, and experts in epilepsy from the The experts who carefully looked at the data wanted to American Epilepsy Society (AES), believe you should know determine which of the newer drugs are effective as about the options for treating and managing your epilepsy.
monotherapy—or when taken as a single drug—by peoplewith partial seizures. They concluded that oxcarbazepine, The experts decided to look carefully at all the currently topiramate, and possibly lamotrigine are effective in available information on the new antiepileptic drugs.
preventing refractory partial seizures when taken as These experts wanted to find out how safe and effective Generalized epilepsy
The newer AEDs give people with epilepsy the option When the experts studied the data for generalized epilepsy, to possibly experience fewer side effects. While all only topiramate was shown to be effective in people who medications have some side effects, the choice of which have been diagnosed with generalized epilepsy and who drug and which side effects can be tolerated depends on have not had success with other drug therapies. Studies the individual person. Your doctor should discuss serious had not been done for the other drugs.
side effects, if any, when starting any of the newantiepileptic drugs. It is important to discuss possible Lennox Gastaut syndrome
side effects with your doctor and how willing you are to People with Lennox Gastaut syndrome have many seizures each day. These may include drop attacks, in which theindividual experiences a sudden total loss of muscle What should you know about AED side effects?
control and falls abruptly to the floor. The expert group Some of the side effects are short term, others continue recommended that lamotrigine and topiramate may be as long as the medication is taken. Some side effects may used to treat drop attacks associated with the Lennox be linked to dosage—the higher the dose needed to control Gastaut syndrome in adults and children. In a previous seizures, the greater the risk of side effects. Side effects guideline, felbamate was also found to be effective in the for each AED are different, and most will go away when Lennox Gastaut syndrome. The special risks of felbamate the medication is stopped. The newer antiepileptic drugs (discussed in a previous guideline) should be considered are in general safer than some of the older ones. You should ask your doctor if there are any serious sideeffects that might be irreversible.
*Glossary of generic to name brand drugs
AEDs may affect women with epilepsy in their reproductive years. Some of the seizure medications available can decrease the effectiveness of hormone contraception and some seizure medications can increase the risk of birth defects. If you are a woman with epilepsy of childbearingage, ask your doctor before you become pregnant about any safety measures you should consider to minimize Talk to your neurologist
Together you and your doctor can determine which ofthe many antiepileptic drugs now available will be the If you have questions about whether you—or your child safest and most tolerable. Thanks to the new AAN and —are candidates for any of these medications, ask your AES guidelines, you and your doctor have more information from which to make a decision.
How will these recommendations affect
It is important that your doctor check your progress at quality of life?
regular visits, especially during the first few months of These drugs often enhance the quality of life for people your treatment with antiepileptic drugs. This will allow with epilepsy. Antiepileptic drugs can make seizures less your doctor to adjust your dose, if necessary, and will frequent or they can help people with epilepsy lead a help reduce any unwanted side effects.
For further information about epilepsy and its treatment, call 1-800-332-1000 or visit www.epilepsyfoundation.org. This is an evidence-based educational service of the American Academy of Neurology. It is designed to provide members with evidence-basedguideline recommendations to assist with decision-making in patient care. It is based on an assessment of current scientific and clinical information,and is not intended to exclude any reasonable alternative methodologies. The AAN recognizes that specific patient care decisions are the prerogative of the patient and the physician caring for the patient, based on the circumstances involved. Physicians are encouraged to carefullyreview the full AAN guidelines so they understand all recommendations associated with care of these patients.
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