Naslov
Rational polytherapy in patients with focal seizures - our experiences

Autori
Kovačević, Ivana ; Hajnšek, Sanja ; Nanković, Sibila ; Šulentić, Vlatko ; Petelin Gadže, Željka ; Bujan Kovač, Andreja

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Neurologia Croatica / Lušić, Ivo ; Bilić, Ivica ; Džamonja, Gordan - Zagreb : Denona, 2013, 39-40

Skup
VI. hrvatski neurološki kongres s međunarodnim sudjelovanjem

Mjesto i datum
Split, Hrvatska, 06.11.2013. - 10.11.2013

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
epilepsy; focal seizures; antiepileptic drug

Sažetak
In 53% of the patients with newly diagnosed epilepsy, seizure control cannot be achieved with monotherapy. In such cases or if the first antiepileptic drug (AED) has dose-dependent side effects or if the patient is pharmacoresistant, the selection of additional AED(s) is of great importance. Desirable characteristics that such drug should have: good tolerability, lack of interaction with other drugs and induction of liver enzymes, lack of teratogenic effects and impacts on cognitive function and good effect on the comorbidities in patients with epilepsy. Recent guidelines (NICE 2012) for the adjuvant treatment of focal seizures recommend the following AEDs: carbamazepine, clobazam, lamotrigine, levetiracetam, oxcarbazepine, sodium valproate, topiramate, eslicarbazepine acetate, lacosamide, phenobarbital, phenytoin, gabapentin, pregabalin, zonisamide, tiagabine and vigabatrin. Guided by our own experience, the most effective first line AEDs are the voltage-dependent sodium channels blockers, carbamazepine, oxcarbazepine and phenytoin, whose use is limited by side effects. Considering the effectiveness, pharmacokinetics and pharmacodynamics, side effects, good efficiency on comorbidities, and availability of AEDs in our country, we think that lamotrigine, pregabalin and clobazam play a significant role as second-line AEDs. In the Referral Centre for Epilepsy, we performed a statistical analysis of 150 patients with focal seizures with or without the secondary generalisation on lamotrigine and 150 patients who received pregabalin as adjuvant therapy, in order to evaluate the effectiveness and side effects of these AEDs. Most patients had symptomatic epilepsy of various etiology (mostly tumors, trauma, hemorrhage and ischemia), and more than 50% of the patients were refractory. Both drugs showed excellent tolerability, good efficiency, even in pharmacoresistant patients, regardless of the etiology, and a good effect on comorbidities.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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