What is epilepsy?

From the Guidelines

Epilepsy treatment should prioritize antiepileptic drugs (AEDs) such as levetiracetam (Keppra, 500-1500mg twice daily), lamotrigine (Lamictal, 25-200mg twice daily), or carbamazepine (Tegretol, 200-400mg twice daily) as the initial treatment of choice, with medication selection depending on seizure type, patient age, comorbidities, and potential side effects 1.

Key Considerations

• Approximately 30% of patients with epilepsy do not respond to two AEDs and are considered drug-resistant, with options including additional medications, vagus nerve stimulation, responsive neurostimulation, or surgical intervention 1.
• Epilepsy management also involves safety precautions such as avoiding swimming alone and, in some regions, restrictions on driving until seizure-free for a specified period 1.
• The underlying mechanism of epilepsy involves an imbalance between excitatory and inhibitory neurotransmission, leading to hyperexcitable neural networks that generate seizures 1.

Treatment Approach

• Treatment usually starts with a single medication at a low dose, gradually increasing until seizures are controlled or side effects occur 1.
• If the first medication fails, another monotherapy is typically tried before considering combination therapy 1.
• Patients should take medications consistently, avoid seizure triggers like sleep deprivation and alcohol, and maintain regular follow-ups with their neurologist 1.

Additional Options

• For patients who fail to experience sufficient seizure reduction with pharmacologic therapies, surgical resection of epileptogenic areas can be highly effective, with approximately 65% of patients becoming seizure-free 1.
• Vagus nerve stimulation and responsive neurostimulation are also options for drug-resistant epilepsy, with varying degrees of success 1.

From the FDA Drug Label

The effectiveness of levetiracetam as adjunctive therapy (added to other antiepileptic drugs) in patients 12 years of age and older with juvenile myoclonic epilepsy (JME) experiencing myoclonic seizures was established in one multicenter, randomized, double-blind, placebo-controlled study, conducted at 37 sites in 14 countries The primary measure of effectiveness was the proportion of patients with at least 50% reduction in the number of days per week with one or more myoclonic seizures during the treatment period (titration + evaluation periods) as compared to baseline. Table 5 displays the results for the 113 patients with JME in this study Placebo(N=59)Levetiracetam(N=54)

• statistically significant versus placebo Percentage of responders23.7%60. 4%* The effectiveness of levetiracetam as adjunctive therapy (added to other antiepileptic drugs)in patients 6 years of age and older with idiopathic generalized epilepsy experiencing primary generalized tonic-clonic (PGTC) seizures was established in one multicenter, randomized, double-blind placebo-controlled study, conducted at 50 sites in 8 countries The primary measure of effectiveness was the percent reduction from baseline in weekly PGTC seizure frequency for levetiracetam and placebo treatment groups over the treatment period (titration + evaluation periods). Table 6: Median Percent Reduction From Baseline In PGTC Seizure Frequency Per Week Placebo(N=84)Levetiracetam(N=78)
• statistically significant versus placebo Percent reduction in PGTC seizure frequency44.6%77. 6%*

Epilepsia treatment with levetiracetam is effective for:

• Myoclonic seizures in patients 12 years of age and older with juvenile myoclonic epilepsy (JME), with a responder rate of 60.4% compared to 23.7% for placebo 2
• Primary generalized tonic-clonic (PGTC) seizures in patients 6 years of age and older with idiopathic generalized epilepsy, with a median percent reduction from baseline in PGTC seizure frequency of 77.6% compared to 44.6% for placebo 2

From the Research

Epilepsia

• Epilepsia es una condición neurológica común en la que las descargas eléctricas anormales del cerebro causan convulsiones recurrentes no provocadas 3, 4.
• Se cree que con un tratamiento farmacológico efectivo, hasta el 70% de las personas con epilepsia activa pueden potencialmente volverse libres de convulsiones y entrar en remisión a largo plazo poco después de iniciar la terapia con un solo fármaco antiepiléptico (AED) en monoterapia 3, 4.

Tratamiento

• La elección del tratamiento antiepiléptico de primera línea para las personas con convulsiones de nuevo diagnóstico es de gran importancia 3, 4.
• Los fármacos carbamazepina y lamotrigina son tratamientos de primera línea recomendados para las convulsiones parciales de nuevo comienzo y como tratamiento de primera o segunda línea para las convulsiones tónico-clónicas generalizadas 3, 4.
• La zonisamida es una opción de primera línea para la epilepsia focal, ya que puede administrarse una vez al día y tiene un bajo potencial de interacción 5.

Eficacia y seguridad

• Los estudios han demostrado que la lamotrigina es significativamente menos probable que la carbamazepina ser retirada debido a efectos adversos, pero los resultados para el tiempo hasta la primera convulsión sugirieron que la carbamazepina puede ser superior en términos de control de las convulsiones 3, 4.
• La calidad de la evidencia para los resultados de eficacia (primera convulsión, remisión) se consideró alta para las personas con convulsiones parciales y moderada para las personas con convulsiones generalizadas 3, 4.

Consideraciones adicionales

• La selección de un fármaco antiepiléptico debe basarse en la diagnosis del tipo de convulsión, la seguridad, la tolerabilidad y el potencial de interacciones farmacológicas 6.
• La cirugía es una opción para las personas con epilepsia resistente a los fármacos, especialmente para aquellos con epilepsia del lóbulo temporal mesial 6, 7.