currently available in Australia. It is important Epilepsy: Top of Mind
that vigorous clinical trials be conducted to compare the effectiveness of the newer AEDs against the older medications. These newer Advances medications have only been studied in trials as add-on medication and it is thought that some newer agents may be more effective than some of the older, first line (first treatment choice) agents. Many clinical trials only last three months which is too short a period to measure important aspects such as longer-term seizure control and tolerability, nor are they structured to measure other issues important to the patient, such as health economic or quality of life outcomes. Study comparing new and
old AEDs

Currently there is no Dr Philippe Ryvlin, a senior
Antiepileptic Drugs (SANAD) study – the miraculous drug to cure
largest of it’s kind – examined seizure Neurology and Epileptology of the Hospices control, tolerability, quality of life and health epilepsy. However, the Civils de Lyon in France, spoke at Epilepsy
increasing number of Action’s Epilepsy: Top of Mind symposium
in November last year about advances in the treatment’ AEDs, such as Carbamazepine anti-epileptic medications field of epilepsy medication and the many
(Tegretol) and Valporate (Epilim) over a now available is giving drugs (AED).
This is an important study as many patients doctors more options to
are treated with one medication and remain University Claude Bernard, Ryvlin explained on it for several years, while there may be a individualised treatment that many of the newer agents behave
more effective or more tolerable alternative for their patients. differently than the older drugs as they have
available as a first line treatment; however the an original or different mechanism of action effectiveness of these newer AEDs had not targeting specific channels, receptor sites or previously been measured for specific patient groups such as people with partial seizures or leads us “to imagine they might be more efficacious (effective) where others may with partial seizures and 716 patients with generalised seizures and found that newer AEDs are generally better tolerated, but not since the 1960s however this accelerated over the past ten to 15 years with the release of Drug Name
newer AEDs such as Gabapentin, Topiramate, Oxcarbazepine, Levetiracetam and Pregabalin. Rufinamide and Lacosamide, recently released on the European market and Retigabine soon to be released on the European market are not Benzodiazepine Valium, yes Carbamazepine Tegretol yesValporate Epilim Oxcarbazepine Trileptal yesLevetiracetam Keppra yesPregabalin Lyrica You play a significant role in the potential effectiveness of any drug treatment. Knowing medications is a start. It is also important and any potential unwanted effects of each medication, e.g. interference with Vitamin D metabolism, interaction with contraceptives or depletion of folate.
are unaware of the importance of telling their doctor about all their medications, including over-the-counter and natural or necessarily more effective than older AEDs. epilepsy that would also treat the migraine Efficacy is not the only factor to be considered; disorder rather than exacerbate it. Some AEDs taking. These can either increase or decrease the drug is of little benefit if it can control the are known to influence weight gain or severely the effectiveness of anti-epileptic medications seizures but the patient cannot tolerate the side depress the appetite while others are very and impact on seizure control or the potential effects. Tolerability is important as it strongly effective in treating major depression, bipolar influences a patient’s compliance with their people misunderstand the instructions for medication regime which, in turn, influences “Many clinicians take advantage of all of taking their medications while others have their chance of attaining seizure freedom and the drugs available to them to better tailor difficulty remembering to take them at the treatment choice in patients,” Professor Ryvlin said. “The situation is different for If you find that you, or the person you care important aspect for clinicians prescribing patients with drug-resistant epilepsy. They for, is experiencing difficulties with unwanted AEDs is the diversity of medications to choose may have tried all of the drugs available and effects, remembering to take medications, from. Basing their treatment decision not only their seizures are still not controlled. The ideal on the type of epilepsy but the type of actions for this patient with resistance to all previous removing tablets from the packaging, you of the drug, the patient’s age, gender, previous drugs is to get a new drug to finally make them may benefit from a Home Medicines Review. response to other AEDs and co-morbidities seizure free. That is what many patients are This free government service is available (other disorders). “Clinicians can now tailor in all states and territories and provided by the treatment to their patient’s characteristics Professor Ryvlin continued to say that a your GP and an Accredited Pharmacist. Any and the treatment can become more and more small percentage of patients who are refractory member of the health team, a carer or even to all previous drugs try a new one and become yourself can suggest a ‘Home Medicines seizure free. The medications are only studied Review’. The first step would be to speak for elderly patients, the clinician takes into for three months which is not enough time to with your pharmacist or GP. The pharmacist account any potential drug-to-drug interactions know if drug-resistant patients will become will answer your questions and refer you to between medications used for other conditions seizure free nor know how long that seizure your GP who will assess the need for a review and AEDs and monitors for any renal (kidney) against the set criteria.The pharmacist will or hepatic (liver) dysfunction. In children, the clinician’s preference would be to avoid any “There is no miraculous drug that has come where together with you and your carer if medication that impacts cognition while aiming onto the market in the last 15 years and there required, will conduct a thorough review of for maximum seizure control. When treating is not one expected to come onto the market all the medicines and treatments both past and women taking oral contraceptives, the clinician in the next five years,” he said. “Significant present you have taken, as well as assessing would aim to avoid or make adjustments for numbers of patients remain resistant to all any enzyme-inducing AED as they can reduce existing drugs which is why it is important to the effectiveness of the contraceptive and keep exploring new avenues. There have been increase the risk of an unwanted or unexpected advances in epilepsy medications; however, I would like to qualify those advances as limited. ‘anticipated resistance’ to particular AEDs and There has not been a miraculous drug that can may instead require a pre-surgical evaluation. control every seizure in every patient without practical strategies for better managing your side effects, which is the ideal goal. The medications and recommend the use of aides Drug treatment tailored to
progress has been sustained over the years and and devices if required. During a follow- individual patients
is on exactly the same track for the next five up consultation your GP will discuss the to 10 years. We might be surprised, however, plan with you and give both you and your beneficial affect or aggravate other conditions this cannot be anticipated. Today, I believe the patient may be living with. For example, For more information or to download a the patient with epilepsy may also experience optimal education of healthcare professionals brochure in one of more than 20 languages, migraines. The clinician would often opt for using available treatments than through the visit www.nps.org.au/consumers/ask_an_ an appropriate AED for the particular type of

Source: http://vps06.langoor.it/sites/default/files/PDFS/E360/Mar_2009/360_march09_P10_11.pdf

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Beers’ Criteria for Potentially Inappropriate By: Sheila L. Molony MS, APRN WHY: Recently published studies confirm that inappropriate medication use remains a serious problem for the elderly.1,2,3Increased nursing awareness of high-risk medications enables attentive monitoring for adverse effects and facilitatescollaborative efforts between nurses, primary care providers and pharmacists

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