J Clin Outcomes Manage
Optimizing antiepileptic treatment
Parkerson KA, Pathmanathan JS, Milligan TA
Abstract Objective: To describe the properties of the available antiepileptic drugs (AEDs) and to provide a framework for tailoring antiepileptic therapy to the individual patient. Methods: Review of the literature. Results: The decision of when to begin antiepileptic therapy is a challenging one, and the benefits of treatment must be carefully weighed against the risk of adverse effects and costs. The number of therapeutic options is staggering, and a framework is needed to make appropriate drug choices. Decisions must take into account (1) efficacy against specific seizure types and epileptic syndromes, (2) pharmacologic properties, and (3) potential adverse effects and interactions with other medications. In general, drug monotherapy is the ideal strategy for seizure control. Approximately 50% of newly diagnosed patients become seizure-free on the first drug initiated and approximately 70% with switching to a second or third drug. Conclusion: Approximately 70% of those with epilepsy can achieve successful remission (5 or more years without a seizure) with medical therapy. For refractory cases, there have also been advances. However, epilepsy remains a difficult and in some cases disabling chronic illness.
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