Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs II: Treatmentresistant epilepsy

Andres M Kanner, Eric Ashman, David Gloss, Cynthia Harden, Blaise Bourgeois, Jocelyn F. Bautista, Bassel Abou-Khalil, Evren Burakgazi-Dalkilic, Esmeralda Llanas Park, John Stern, Deborah Hirtz, Mark Nespeca, Barry Gidal, Edward Faught, Jacqueline French

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To update the 2004 American Academy of Neurology (AAN) guideline for managing treatment-resistant (TR) epilepsy with second- and third-generation antiepileptic drugs (AEDs). Methods: 2004 criteria were used to systematically review literature (January 2003 to November 2015), classify pertinent studies according to the therapeutic rating scheme, and link recommendations to evidence strength. Results: Forty-two articles were included. Recommendations: The following are established as effective to reduce seizure frequency (Level A): immediate-release pregabalin and perampanel for TR adult focal epilepsy (TRAFE); vigabatrin for TRAFE (not first-line treatment; rufinamide for Lennox-Gastuat syndrome (LGS) (add-on therapy). The following should be considered to decrease seizure frequency (Level B): lacosamide, eslicarbazepine, and extendedrelease topiramate for TRAFE (ezogabine production discontinued); immediate- and extended-release lamotrigine for generalized epilepsy with TR generalized tonic-clonic (GTC) seizures in adults; levetiracetam (add-on therapy) for TR childhood focal epilepsy (TRCFE) (1 month to 16 years), TR GTC seizures, and TR juvenile myoclonic epilepsy; clobazam for LGS (add-on therapy); zonisamide for TRCFE (6-17 years); oxcarbazepine for TRCFE (1 month to 4 years). The text presents Level C recommendations. AED selection depends on seizure/syndrome type, patient age, concomitant medications, and AED tolerability, safety, and efficacy. This evidence-based assessment informs AED prescription guidelines for TR epilepsy and indicates seizure types and syndromes needing more evidence. A recent FDA strategy allows extrapolation of efficacy across populations; therefore, for focal epilepsy, eslicarbazepine and lacosamide (oral only for pediatric use) as add-on or monotherapy in persons =4 years of age and perampanel as monotherapy received FDA approval.

Original languageEnglish (US)
Pages (from-to)269-278
Number of pages10
JournalEpilepsy Currents
Volume18
Issue number4
DOIs
StatePublished - Jul 1 2018

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Practice Guidelines
Anticonvulsants
Epilepsy
Partial Epilepsy
Seizures
Therapeutics
zonisamide
etiracetam
Juvenile Myoclonic Epilepsy
Guidelines
Vigabatrin
Drug Prescriptions
Generalized Epilepsy
Pediatrics
Safety

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Practice guideline update summary : Efficacy and tolerability of the new antiepileptic drugs II: Treatmentresistant epilepsy. / Kanner, Andres M; Ashman, Eric; Gloss, David; Harden, Cynthia; Bourgeois, Blaise; Bautista, Jocelyn F.; Abou-Khalil, Bassel; Burakgazi-Dalkilic, Evren; Park, Esmeralda Llanas; Stern, John; Hirtz, Deborah; Nespeca, Mark; Gidal, Barry; Faught, Edward; French, Jacqueline.

In: Epilepsy Currents, Vol. 18, No. 4, 01.07.2018, p. 269-278.

Research output: Contribution to journalArticle

Kanner, AM, Ashman, E, Gloss, D, Harden, C, Bourgeois, B, Bautista, JF, Abou-Khalil, B, Burakgazi-Dalkilic, E, Park, EL, Stern, J, Hirtz, D, Nespeca, M, Gidal, B, Faught, E & French, J 2018, 'Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs II: Treatmentresistant epilepsy', Epilepsy Currents, vol. 18, no. 4, pp. 269-278. https://doi.org/10.5698/1535-7597.18.4.269
Kanner, Andres M ; Ashman, Eric ; Gloss, David ; Harden, Cynthia ; Bourgeois, Blaise ; Bautista, Jocelyn F. ; Abou-Khalil, Bassel ; Burakgazi-Dalkilic, Evren ; Park, Esmeralda Llanas ; Stern, John ; Hirtz, Deborah ; Nespeca, Mark ; Gidal, Barry ; Faught, Edward ; French, Jacqueline. / Practice guideline update summary : Efficacy and tolerability of the new antiepileptic drugs II: Treatmentresistant epilepsy. In: Epilepsy Currents. 2018 ; Vol. 18, No. 4. pp. 269-278.
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AU - Bourgeois, Blaise

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AU - Abou-Khalil, Bassel

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