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Doctors Issue New Guidelines to Treat Epilepsy

Recommendations focus on promising new medications

TUESDAY, April 27, 2004 (HealthDayNews) -- For the first time in 10 years, doctors have issued new guidelines for the treatment of epilepsy, spelling out which new drugs are worth a try to control the seizures that are a hallmark of the disorder.

Experts from the American Academy of Neurology and the American Epilepsy Society announced the guidelines Monday at the annual meeting of the American Academy of Neurology in San Francisco.

Epilepsy affects 40 million people worldwide. Five percent to 10 percent of Americans will suffer a seizure during their lifetime. Of those people, 30 percent will go on to develop epilepsy, a brain disorder in which clusters of nerve cells -- called neurons -- sometimes signal abnormally. When the normal pattern of neuronal activity becomes disturbed, strange sensations, emotions and behavior can result, as well as convulsions and loss of consciousness.

"Epilepsy is not an esoteric disorder," said Dr. Jerome Engel Jr., the Jonathan Sinay Professor of Neurology and Neurobiology at the David Geffen School of Medicine at the University of California, Los Angeles, and one of the speakers at the conference. "It is actually one of the most common serious disorders of the brain."

Since the last guidelines were issued a decade ago, seven new drugs have been introduced to treat epilepsy. Experts from both organizations assessed all the available information from studies on the new drugs and made recommendations for treating newly diagnosed epilepsy and for treating "refractory" epilepsy -- defined as that which has already proved difficult to manage with the older drugs.

The guidelines include recommendations for partial epilepsy, defined as seizures affecting part of the brain; for generalized epilepsy, those seizures affecting the entire brain; and Lennox Gastaut syndrome, a severe form of epilepsy that involves several types of seizures.

For newly diagnosed epilepsy, the experts said there's evidence that four of the newer drugs -- gabapentin, lamotrigine, oxcarbazepine and topiramate -- are effective and can be used as single drug therapy for teens and adults.

For refractory epilepsy, the experts concluded that all the newer drugs are effective when used as adjunctive therapy with another drug for adults with partial seizures. Gabapentin was deemed effective for mixed seizures. And gabapentin, lamotrigine, oxcarbazepine and topiramate were recommended for children with refractory partial seizures.

Only oxcarbazepine, topiramate and possibly lamotrigine are effective in preventing refractory partial seizures when taken as single drug therapy, the experts said.

For generalized refractory epilepsy, only topiramate was deemed effective; studies on the other drugs had not been done for this condition. For Lennox Gastaut syndrome, lamotrigine and topiramate may be used to treat "drop attacks," in which the person has a total loss of muscle control, the experts said.

The guidelines are aimed at health-care professionals, some of whom may not be familiar enough with the newer medications to make an informed choice, the experts said.

"In order to improve the health care of people who suffer from epilepsy, we need to stop seizures, not just reduce them, and do it as soon as possible before these disabling seizures permanently disrupt their life," Engel said.

Among patients, those newly diagnosed and put on drugs soon are often among the easiest to treat, said Dr. Jacqueline French, a professor of neurology at the University of Pennsylvania, co-director of the university's Epilepsy Program, and another speaker. "Sixty percent will be controlled with anti-epilepsy drugs."

"The choice of the initial drug is immensely important," she said. "It can have a profound impact on that individual for years and years."

The goal of treatment is not just to get rid of seizures but to maintain and restore quality of life for the patient, said another speaker, Dr. Andres Kanner, a professor of neurological sciences at Rush University Medical Center in Chicago. "The older anti-epileptics have been shown to be effective, and there are large numbers who did well on them."

Doctors should consider the newer medications, however, Kanner and others said, if patients have adverse side effects or if the older drugs compromise their quality of life, such as making them constantly fatigued.

More information

To learn more about epilepsy, visit the National Institute of Neurological Disorders and Stroke or the American Academy of Neurology.

SOURCES: Andres Kanner, M.D., professor, neurological sciences, Rush University Medical Center, Chicago; Jerome Engel Jr., M.D., Ph.D., Jonathan Sinay Professor of Neurology and Neurobiology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), chief, epilepsy and clinical neurophysiology, UCLA Center for the Health Sciences, and director, UCLA Seizure Disorder Center, Reed Neurological Research Center, Los Angeles; April 26, 2004, presentation, American Academy of Neurology annual meeting, San Francisco
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