TY - JOUR
T1 - Practice guideline update summary
T2 - Efficacy and tolerability of the new antiepileptic drugs II: Treatmentresistant epilepsy
AU - Kanner, Andres M.
AU - Ashman, Eric
AU - Gloss, David
AU - Harden, Cynthia
AU - Bourgeois, Blaise
AU - Bautista, Jocelyn F.
AU - Abou-Khalil, Bassel
AU - Burakgazi-Dalkilic, Evren
AU - Park, Esmeralda Llanas
AU - Stern, John
AU - Hirtz, Deborah
AU - Nespeca, Mark
AU - Gidal, Barry
AU - Faught, Edward
AU - French, Jacqueline
N1 - Funding Information:
C. Harden receives royalties from UpToDate and Wiley; serves on the speakers bureau for UBC; and has received research support from the National Institute of Neurological Disorders and Stroke (NINDS) of the NIH and the Epilepsy Therapy Project.
Funding Information:
J. French serves on the scientific advisory board of Anavex Life Science Corp.; receives travel funding from Upsher-Smith, Marinus Pharmaceuticals, Pfizer, SK Life Science, Biotie, GW Pharmaceuticals, UCB, and Takeda; serves as an editor for Epilepsia; receives research support from Acorda, Biotie, Eisai, GlaxoSmithKline, Impax, Johnson & Johnson, Marinus Pharmaceuticals, Novartis, Pfizer, Sunovion, SK Life Science, Supernus, and the NINDS of the NIH.
Funding Information:
B. Abou-Khalil has served on but declined honoraria from scientific advisory boards for Sunovion and GlaxoSmithKline; served on the editorial board for Epilepsy Research and Clinical Neurophysiology; and received royalties for Atlas of EEG & Seizure Semiology. His institution received research support from UCB, GlaxoSmithKline, Valeant, Sunovion, Upsher-Smith, Pfizer, Cy-beronics, and SK Life Science, from the NIH for the Epilepsy Phe-nome/Genome Project and from the Human Epilepsy Project.
Funding Information:
This guideline was developed with financial support from the American Academy of Neurology (AAN). Authors who serve as AAN subcommittee members or methodologists (E.A., D.G., C.H., and J.F.) were reimbursed by the AAN for expenses related to travel to subcommittee meetings where drafts of manuscripts were reviewed.
Publisher Copyright:
© 2018, American Epilepsy Society.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85052088688&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85052088688&partnerID=8YFLogxK
U2 - 10.5698/1535-7597.18.4.269
DO - 10.5698/1535-7597.18.4.269
M3 - Article
AN - SCOPUS:85052088688
VL - 18
SP - 269
EP - 278
JO - Epilepsy Currents
JF - Epilepsy Currents
SN - 1535-7597
IS - 4
ER -