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PubMed1994

Investigational antiepileptic drugs for the treatment of childhood seizure disorders: a review of efficacy and safety.

Pediatric epileptology is very different from adult epileptology. Although some epileptic disorders occur in both children and adults (e.g., localization-related epilepsy with complex partial seizures and primary generalized epilepsy with tonic-clonic seizures), other disorders can be called the catastrophic epilepsies of childhood (e.g., infantile spasms and the Lennox-Gastaut syndrome). They occur, or at least begin, exclusively in childhood and are often associated with mental retardation. Many of these pediatric disorders are notoriously unresponsive to currently available antiepileptic drugs (AEDs). Although there are undoubtedly many reasons for this, one possible explanation is that the methods used to screen potential AEDs use animal models of adult epilepsy. No screening program uses an animal model of seizures that begin during development and lead to functional decline.

Anti-Anxiety Agents↗
PubMed1998

Subsidence of seizure induced by stereotactic radiation in a patient with hypothalamic hamartoma. Case report.

The authors report on a patient who exhibited intractable epilepsy due to an inaccessible hypothalamic hamartoma and subsequently underwent stereotactic radiosurgery. This 25-year-old man had a 24-year history of intractable gelastic and tonic-clonic seizures. Magnetic resonance (MR) imaging performed at examination as well as that performed 30 months earlier demonstrated a nonenhancing and nonprogressive spherical mass, approximately 10 mm in diameter, located on the patient's right side at the floor of the third ventricle. Focal radiation treatment performed with a gamma knife unit administered 36 Gy to the center and 18 Gy to the periphery of the lesion. This treatment resulted in an improvement in seizure control. Before the patient underwent radiosurgery, he suffered from three to six generalized seizures per month in spite of attentive compliance with an anticonvulsant medication regimen. After irradiation of the harmatoma, the frequency of the seizures transiently increased and then subsided 3 months posttreatment. The patient has been free of seizures for the last 21 months, with no neurological or endocrinological complications. Magnetic resonance imaging performed 12 months posttreatment demonstrated complete disappearance of the lesion.

Adult↗
PubMed2002

Antiepileptic drug therapy for adults: when to initiate and how to choose.

Although antiepileptic drugs (AEDs) are commonly used to control and prevent seizures, their long-term use carries a considerable risk of morbidity. The decision to start AEDs is made once the risks of further seizures outweigh the risks of treatment. Despite a large body of literature on the subject, this common clinical issue perplexes many practitioners because of its neurologic, psychological, and, at times, legal implications. Adding to the confusion is the recent approval of several new AEDs. This article summarizes the current evidence to support individual clinical decisions regarding initiation of AEDs in adults and considers the use of AEDs as seizure prophylaxis. Recently approved AEDs are discussed to help the practitioner understand when to initiate and how to choose the appropriate AED for the patient with seizures.

Acetates↗
PubMed2001

[Clinical features and treatment of refractory epilepsy in children].

Clinical features of refractory epilepsy in children are symptomatic localization-related epilepsy, especially frontal lobe epilepsy, the onset in young age less than 3 years-old, and complication of developmental retardation. The treatments usually start with one drug of choice for specific seizure type. In the idiopathic epilepsy group, valproic acid was effective in 82% of the patients with generalized epilepsy and in 45% of localization-related epilepsy while carbamazepine was effective in 71% and 67%, respectively. However, in the refractory group which did not react to the drugs of choice at the initial treatment and continued to have seizures, no specific drugs were effective. Therefore, various kind of drugs, new or old, should be tried in sequence irrespective of the type of seizures. The seizure control was attained only in 10% (in the cases of CZP), and 17% (CLB) in localization-related epilepsy and in 9% (VPA), 12% (NZP) and 20% (ZNS) in generalized one in the refractory group. Although new drugs developed, the patients with refractory epilepsy do not tend to decrease in frequency and overall management including daily life or surgical therapy is mandatory for the children with refractory epilepsy.

Adolescent↗
PubMedDate not supplied

A casuistic rationale for the treatment of spastic and myocloni in a childhood neurodegenerative disease: neuronal ceroid lipofuscinosis of the type Jansky-Bielschowsky.

GOAL: The casuistic of a child suffering from late infantile neuronal ceroid lipofuscinosis (NCL) of the type Jansky-Bielschowsky aims to provide a description of possible therapeutic options for the severe spastic and the debilitating myocloni that occur within the context of this disorder. Moreover, it also should include a discussion of potential indications for the application of delta 9-Tetrahydrocannabinol (THC) (Dronabinol, Marinol) in childhood.

Analgesics, Non-Narcotic↗
PubMed2003

The ideal pharmacokinetic properties of an antiepileptic drug: how close does levetiracetam come?

The pharmacokinetic properties of a drug are the primary deter-minant of the extent and duration of drug action, and influence susceptibility to clinically important drug interactions. Most of the older-generation antiepileptic drugs (AEDs) are far from ideal in terms of pharmacokinetics and interaction potential. For example, phenytoin, carbamazepine, and valproic acid exhibit non-linear kinetics; carbamazepine and valproic acid have relatively short half-lives; and most of these drugs cause either enzyme induction (phenytoin, phenobarbital, primidone, carbamazepine) or enzyme inhibition (valproic acid). Compared with older agents, certain new-generation AEDs offer a num-ber of pharmacokinetic advantages, particularly in terms of reduced inter-patient variability in drug clearance and a lower interaction potential. One of the most recently developed of these drugs, levetiracetam, comes especially close to fulfilling the desirable pharmacokinetic characteristics for an AED: (1) it has a high oral bioavailability, which is unaffected by food; (2) it is not significantly bound to plasma proteins; (3) it is eliminated partly in unchanged form by the kidneys and partly by hydrolysis to an inactive metabolite, without involvement of oxidative and conjugative enzymes; (4) it has linear kinetics; and (5) it is not vulnerable to important drug interactions, nor does it cause clinically significant alterations in the kinetics of concomitantly administered drugs. Although its half-life is relatively short (6 to 8 hours), its duration of action is longer than anticipated from its pharmacokinetics in plasma, and a twice-daily dosing regimen is adequate to produce the desired response.

Acetates↗