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6 results

  • 9 - What to Do When Your Patient Fails Two Antiseizure Medicines

  • Patrick Landazuri, University of Kansas Medical Centre, Nuria Lacuey Lecumberri, University of Texas Health Science Center, Houston, Laura Vilella Bertran, University of Texas Health Science Center, Houston, Mark Farrenburg, University of Kansas Medical Centre, Samden Lhatoo, University of Texas Health Science Center, Houston
  • Book:
    Seizure and Epilepsy Care
    Published online:
    28 January 2023
    Print publication:
    09 February 2023, pp 156-174

  • Summary

    Around a third of patients have drug-resistant epilepsy (DRE). This is crucially and easily determined if a patient continues to have seizures after being on two adequately dosed and appropriately selected antiseizure medicines (ASMs). For these patients, your initial efforts to make a specific and localized diagnosis will inform next treatment decisions. If a patient presents suddenly with DRE, it is key to assess for a possible autoimmune cause, as a separate treatment pathway should be considered. Otherwise, consider epilepsy surgery as an effective treatment. These treatments include brain resections and neuromodulation. Minimally invasive techniques have recently become more common, including laser surgery as well as stereotactically placed depth electrodes. Given the prevalence of neurostimulators, consideration for obtaining MRIs in patients with these devices is addressed, as pathways exist for all of these patients to safely undergo MRI testing.

  • Chapter 4.1 - Medication-Related Stroke

  • from 4 - Drug-Related Stroke
  • Edited by Derya Uluduz, Istanbul Üniversitesi
  • Anita Arsovska
  • Book:
    Rare Causes of Stroke
    Published online:
    06 October 2022
    Print publication:
    01 September 2022, pp 185-189

  • Summary

    A 53-year-old woman, with no vascular risk factors or significant previous medical history experienced first ischemic stroke and was successfully treated with thrombolysis. A thorough diagnostic work-up and long term follow up did not reveal any cardiovascular condition, the patient had been on hormone replacement therapy for 7 years at the time of the cerebrovascular accident. Effect of hormone replacement therapy and the role of other commonly prescribed drugs on the stroke burden risk are briefly discussed. Individualized therapeutic plan balancing risks, benefits, comorbidities and patients choice is recommended to reduce stroke burden especially in patients needing polytherapy

  • 3 - Pharmacogenetic aspects

  • from Part I - Introduction
    • By Matthew C. Walker, Pharmacology and Therapeutic Unit, Department of Clinical and Experimental Epilepsy, Institute of Neurology, Queen Square, London, UK, Michael R. Johnson, Division of Neurosciences and Psychological Medicine, Imperial College London, Charing Cross Hospital, London, UK, Philip N. Patsalos, Pharmacology and Therapeutic Unit, Department of Clinical and Experimental Epilepsy, Institute of Neurology, Queen Square, London, UK
  • Edited by Jerzy Majkowski, Blaise F. D. Bourgeois, Harvard University, Massachusetts, Philip N. Patsalos, Institute of Neurology, London, Richard H. Mattson, Yale University, Connecticut
  • Book:
    Antiepileptic Drugs
    Published online:
    07 September 2009
    Print publication:
    26 May 2005, pp 26-44

  • Summary

    Pharmacogenetics and pharmacogenomics are fields which show how the genetic make-up of an individual can influence drugs effects. Genetic polymorphisms can influence antiepileptic drug (AED) responses and, during polytherapy, their interaction profile by influencing metabolism, central nervous system penetration, pharmacodynamics and adverse events. This chapter considers the evidence for each of these and reviews the uses and pitfalls of genetic screening. The point of action for AEDs is the brain, and so AEDs have to be able to cross the blood-brain barrier. GABAA receptors are the target for a number of AEDs since alterations in GABAA receptor-mediated transmission have been implicated in the pathogenesis of epilepsy. The predictive value of a pharmacogenetic test can be viewed from a genetic epidemiological perspective. Clinical and cost effectiveness of pharmacogenetic tests may need to be established in prospective randomized trials and their use may require new professional standards of testing and test interpretation.

  • 1 - Combination therapy of diseases: general concepts

  • from Part I - Introduction
  • Edited by Jerzy Majkowski, Blaise F. D. Bourgeois, Harvard University, Massachusetts, Philip N. Patsalos, Institute of Neurology, London, Richard H. Mattson, Yale University, Connecticut
  • Book:
    Antiepileptic Drugs
    Published online:
    07 September 2009
    Print publication:
    26 May 2005, pp 3-15

  • Summary

    Combination therapy has been used since therapeutics was first practiced. A scientific basis for the value of combination therapy was established in the 1940s. This chapter treats the term polytherapy as synonymous with combination therapy, a term that is more widely accepted across the spectrum of therapeutics and throughout Europe and the USA. Combinations of medicines with different spectra of adverse drug reactions may allow reduction of dose of each compound to levels that are less likely to produce clinically relevant toxicity. One of the principles of combination therapy in cancer is that the agents should have non-overlapping toxicity. The use of combination therapy means that the patient has to take more tablets, unless the drugs have been formulated in a combined preparation. Combination therapy is an essential therapeutic tool, although one that can all too often be misused, to the detriment of the patient.

  • 20 - Antiepileptic drugs in non-epileptic health conditions: possible interactions

  • from Part IV - Drug interactions in specific patient populations and special conditions
    • By Jerzy Majkowski, Center for Epilepsy Diagnosis and Treatment Foundation of Epileptology, Warsaw, Poland
  • Edited by Jerzy Majkowski, Blaise F. D. Bourgeois, Harvard University, Massachusetts, Philip N. Patsalos, Institute of Neurology, London, Richard H. Mattson, Yale University, Connecticut
  • Book:
    Antiepileptic Drugs
    Published online:
    07 September 2009
    Print publication:
    26 May 2005, pp 369-391

  • Summary

    This chapter emphasizes the spectrum and scale of antiepileptic drugs (AED) usage in medical disciplines other than epilepsy, and to increase awareness of unpredicted drug interactions when combination therapy with two/three drugs is used. There are many pharmacological reasons why AEDs have therapeutic effects in non-epileptic neurological and psychiatric conditions. The fact that over-the-counter drugs and nutritional supplements are increasingly being self-administered by patients creates the risk of drug interactions. In many countries folk medicine is frequently used for various reasons. Carbamazepine (CBZ) is one of the most commonly used AEDs in epilepsy and other neurological and psychiatric disorders. Many drug interactions can be demonstrated but only a few of them are so clinically significant that they require adjustment of drug dosages. Case reports of toxic effects due to drug interactions are presented in the chapter as a warning signal calling for attention when polytherapy has to be used.

  • 22 - Cognitive side-effects due to antiepileptic drug combinations and interactions

  • from Part IV - Drug interactions in specific patient populations and special conditions
    • By Albert P. Aldenkamp, Department of Neurology, University Hospital of Maastricht, The Netherlands; Department of Behavioral Science, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; University of Amsterdam, SCI Kohnstamm Research Institute, Amsterdam, The Netherlands, Mark de Krom, Department of Neurology, University Hospital of Maastricht, The Netherlands, Irene Kotsopoulos, Department of Neurology, University Hospital of Maastricht, The Netherlands, Jan Vermeulen, Epilepsy centre SEIN, Heemstede, The Netherlands
  • Edited by Jerzy Majkowski, Blaise F. D. Bourgeois, Harvard University, Massachusetts, Philip N. Patsalos, Institute of Neurology, London, Richard H. Mattson, Yale University, Connecticut
  • Book:
    Antiepileptic Drugs
    Published online:
    07 September 2009
    Print publication:
    26 May 2005, pp 403-418

  • Summary

    This chapter reviews some of our knowledge about a specific subgroup of central nervous system (CNS)-related chronic side-effects of antiepileptic drug (AED) treatment, that is, cognitive side-effects: the adverse effects of drug treatment on information-processing systems. Cognitive AED effects may be examined through an analysis of the relationship between test scores of subjects and their individual serum drug levels, and this approach seems to offer a way out of the problem. Although the psychometric studies generally show a tendency of cognitive impairments in polytherapy compared to monotherapy, this merely suggests a drug interaction effect. Systematic analysis of subjective patients complaints about side-effects of AEDs show that the impact of side-effects may be larger than hitherto suspected both in number of patients involved and the frequency of the complaints. Formal psychometric studies are much more difficult to interpret, especially when formal scientific standards in line with evidence-based medicine are applied.