Tailoring Treatment for Epilepsy
The landscape of epilepsy treatment has changed dramatically over the last 15
years, with seven new drugs hitting the market since 1990. To ensure that people
living with epilepsy receive the medication that best meets their needs,
treatment guidelines were recently released by the American Academy of Neurology
and the American Epilepsy Society.
"Because so many drugs were approved in such a short period of time, there was
an enormous amount of confusion." said Jacqueline French, MD, a professor of
neurology and co-director of the University of Pennsylvania Epilepsy Center in
Philadelphia. "Our primary motivation was to teach physicians about each of
The 24-member committee reviewed the evidence on the effectiveness, tolerability
and safety of the seven new anti-epileptic drugs and published their
recommendations in the April 27 issue of Neurology. The guidelines offer
recommendations for people with partial seizure disorders, in which abnormal
activity takes place in one part of the brain, and generalized seizure
disorders, which affect many parts of the brain.
Separate guidelines were created for newly diagnosed patients and for those with
epilepsy that has not responded to treatment. For newly diagnosed patients with
either partial or mixed seizure disorders, the authors recommend four drugs—gabapentin
(Neurontin), lamotrigine (Lamictal), topiramate (Topamax) and oxcarbazepine (Trileptal)—as
single-drug therapy, otherwise known as monotherapy. Epilepsy drugs can be given
alone or in combination. Most physicians and patients prefer monotherapy because
it is an easier regimen to follow and usually has fewer side effects.
Only oxcarbazepine has been approved as monotherapy by the Food and Drug
Administration for people with newly diagnosed epilepsy. According to Dr.
French, the authors of the guidelines believe that European studies have
established that the other three drugs are as effective as older anti-epileptic
medications, and are better tolerated by patients.
For people with treatment-resistant epilepsy, the guidelines state that the
medication choice should be tailored to the patient based, in part, on the type
of seizure disorder they have. For example, they recommend oxcarbazepine,
topiramate, or lamotrigine as monotherapy in adults with partial epilepsy. And
they advise that gabapentin, lamotrigine, oxcarbazepine and topiramate are
effective for children with partial seizures.
When selecting a medication, other factors that physicians should consider are
age, the presence of other health conditions, and the other medications someone
may be taking. For example, certain medications may increase risk of
osteoporosis. And many older medications may decrease the effectiveness of birth
"The guidelines were developed to remind people that there is significant choice
available to them and to show to what extent people have had their seizures
improved by having these drugs added to their regimen." Dr. French said.
"Doctors do tend to get into patterns where they use one drug for everyone, but
they need to fit the drugs to the patient."