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Content Update

Jan. 10, 2018

Newly Approved Medications for Lennox-Gastaut and Dravet Syndromes: The U.S. FDA approved two new medications for additional seizure control in patients who are resistant to standard therapies alone. Cannabidiol (Epidiolex) was approved as an adjunctive treatment for seizures related to Dravet and Lennox-Gastaut Syndromes and stiripentol (Diacomit) is indicated for patients with Dravet Syndrome who are also taking clobazam. Both medications have proven to be effective in decreasing the percentage of drop seizures over a trial period compared to placebo. Though these medications appear effective, the true long-term impact cannot be accurately assessed with the data presented. Both of these drugs will be available in the United States over the course of 2019.

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Describe the epidemiology and social impact of epilepsy.

  2. Define terminology related to epilepsy, including seizure, convulsion, and epilepsy.

  3. Describe the basic pathophysiology of seizures and epilepsy.

  4. Differentiate and classify seizure types given a description of the clinical presentation of the seizure and electroencephalogram.

  5. Identify key therapeutic decision points and therapeutic goals in the treatment of epilepsy.

  6. Discuss nonpharmacologic treatments for epilepsy.

  7. Recommend an appropriate pharmacotherapeutic regimen with monitoring parameters for the treatment of epilepsy.

  8. Devise a plan for switching a patient from one antiepileptic regimen to a different regimen.

  9. Manage potential drug interactions with antiepileptic drugs (AEDs).

  10. Determine when and how to discontinue AED therapy.

  11. Educate a patient or caregiver on epilepsy and pharmacotherapy for this disorder.

EPIDEMIOLOGY

Epilepsy is a disorder that afflicts approximately 2 million individuals in the United States, with an age-adjusted prevalence of approximately 4 to 7 cases per 1000 persons.1 The incidence of epilepsy in the United States is estimated at 35 to 75 cases per 100,000 persons per year.2,3 In developing countries, the incidence is higher at 100 to 190 cases per 100,000 persons per year. About 8% of the US population will experience a seizure during their lifetime. New-onset seizures occur most frequently in infants younger than 1 year and in adults after age 55.2

SOCIAL IMPACT

Epilepsy has a profound impact on a patient’s life. Due to restrictions on driving, individuals who have recently had a seizure face major impediments to engaging in simple activities.4 Fifty percent of patients with epilepsy report cognitive and learning difficulties.5,6 Underemployment and unemployment are major concerns for individuals with epilepsy, due to limited transportation options, cognitive and learning difficulties, and seizures, resulting in problems paying for health care. Additionally, the social stigma of embarrassment or injury due to seizures in public results in isolation of the patient.7

Patients with epilepsy often depend on ...

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