Epilepsy: from consensus to daily practice
E. Ben-Menachem,
B. Scheepers,
S. Stodieck,
E. Ben-Menachem
Department of Clinical Neuroscience, Neurology Division, Sahlgrenska University Hospital, Gothenburg, Sweden
Search for more papers by this authorB. Scheepers
Learning and Disabilities Directorate, Cheshire Community Healthcare Trust, Crewe, UK
Search for more papers by this authorE. Ben-Menachem,
B. Scheepers,
S. Stodieck,
E. Ben-Menachem
Department of Clinical Neuroscience, Neurology Division, Sahlgrenska University Hospital, Gothenburg, Sweden
Search for more papers by this authorB. Scheepers
Learning and Disabilities Directorate, Cheshire Community Healthcare Trust, Crewe, UK
Search for more papers by this authorElinor Ben-Menachem, Department of Clinical Neuroscience, Neurology Division, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
Tel.: + 46 31 3422483
e-mail: [email protected]
Abstract
Most clinicians would accept that epilepsy treatment should begin with monotherapy, and in the majority of cases this is the preferred drug maintenance option. The clinical choice of one antiepileptic drug (AED) over another should be based on firm evidence of efficacy and tolerability as evaluated in comparative monotherapy studies and pharmacokinetics. This paper presents the findings of evidence-based reviews of AED monotherapy in patients newly diagnosed with epilepsy. The main study was conducted in the United Kingdom and investigated the clinical evidence supporting AEDs used as first-line monotherapy. In this paper the general treatment recommendations will focus on valproate, one of the mainstay drugs used in the fight against epilepsy. Finally, with these recommendations in mind, the principles behind AED drug selection in clinical practice will be discussed. Factors for consideration that impact on AED decision-making include: seizure and syndrome diagnosis, AED tolerability profiles, patient characteristics and pharmacokinetic/pharmacodynamic AED interactions.
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