Epilepsy
People who have epilepsy suffer from an abnormality of their brain that causes them to have seizures — generalized convulsions of their body (muscle spasms) or more subtle mental or physical behavioral disturbances lasting from seconds to minutes and typically recurring at varying intervals.[1] Some types of seizures manifest as strange sensations or emotional states, and others, unconsciousness.
In technical terms, the U.S. National Library of Medicine, citing Adams et al.,[2] defines epilepsy as "a disorder characterized by recurrent episodes of paroxysmal [sudden, intense] brain dysfunction due to a sudden, disorderly, and excessive neuronal discharge [discharge of electrical activity by nerve cells]. Epilepsy classification systems are generally based upon: (1) clinical features of the seizure episodes (e.g., motor seizure), (2) etiology [cause] (e.g., post-traumatic [after an injury]), (3) anatomic site of seizure origin (e.g., frontal lobe seizure), (4) tendency to spread to other structures in the brain, and (5) temporal [time related] patterns."[3]
Historical notes relating to epilepsy
The ancient Greeks recognized epilepsy, calling it the Sacred Disease, as they regarded it as inflicted by the gods. But Hippocrates of Cos (460 BCE - ?360 BCE), who discovered that diseases had natural causes, recognized it as a natural disorder of the brain:[4]
It is thus with regard to the disease called Sacred: it appears to me to be nowise more divine nor more sacred than other diseases, but has a natural cause from the originates like other affections....this disease seems to me to be no more divine than others; but it has its nature such as other diseases have, and a cause whence it originates, and its nature and cause are divine only just as much as all others are, and it is curable no less than the others, unless when, the from [the length] of time, it is confirmed, and has became stronger than the remedies applied....the brain is the cause of this affection, as it is of other very great diseases, and in what manner and from what cause it is formed, I will now plainly declare….
Classification
Benign neonatal epilepsy
Partial epilepsy
Febrile seizures
Generalized epilepsy
Landau-Kleffner syndrome
Myoclonic epilepsy
Post-traumatic epilepsy
Reflex epilepsy
Status epilepticus
Treatment
Many medications are available that vary in efficacy, drug toxicity, and costs.[5]Due to the narrow therapeutic window of these medications, generic substitution should be done carefully according to a clinical practice guideline.[6]
For idiopathic generalised epilepsy or difficult to classify epilepsy, the SANAD randomized controlled trial compared valproate, lamotrigine, or topiramate and concluded:[7][8]
- "valproate remains the clinically most effective drug, although topiramate may be a cost-effective alternative for some patients".
- Regarding drug toxicity
- lamotrigine had more hypersensitivity (allergic) reactions
- valproate had more weight gain
- topiramate had more fatigue, behavioral changes, problems and weight loss
For partial epilepsy, the SANAD randomized controlled trial compared carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate and concluded:[9]
- lamotrigine had similar efficacy to carbamazepine
- lamotrigine had less drug toxicity than carbamazepine
References
- ↑ Epilepsy. MedlinePlus, U.S. National Library of Medicine and National Institutes of Health.
- ↑ Ropper, Allan H.; Adams, Raymond Delacy; Victor, Maurice (1997). Principles of Neurology (in English), 6th. New York: McGraw-Hill, Health Professions Division, 313. ISBN 0-07-067439-6.
- ↑ National Library of Medicine. Epilepsy. Retrieved on 2008-05-23.
- ↑ Hippocrates. (400 BCE). On the Sacred Disease. Translated by Francis Adams.
- ↑ (June 2008) "Drugs for epilepsy". Treat Guidel Med Lett 6 (70): 37–46. PMID 18497720. [e]
- ↑ Liow K, Barkley GL, Pollard JR, Harden CL, Bazil CW (April 2007). "Position statement on the coverage of anticonvulsant drugs for the treatment of epilepsy". Neurology 68 (16): 1249–50. DOI:10.1212/01.wnl.0000259400.30539.cc. PMID 17438213. Research Blogging.
- ↑ Marson AG, Al-Kharusi AM, Alwaidh M, et al (2007). "The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial". Lancet 369 (9566): 1016–26. DOI:10.1016/S0140-6736(07)60461-9. PMID 17382828. Research Blogging. ACP Journal Club summary
- ↑ Marson AG, Appleton R, Baker GA, et al (2007). "A randomised controlled trial examining the longer-term outcomes of standard versus new antiepileptic drugs. The SANAD trial". Health technology assessment (Winchester, England) 11 (37): 1–154. PMID 17903391. [e]
- ↑ Marson AG, Al-Kharusi AM, Alwaidh M, et al (March 2007). "The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial". Lancet 369 (9566): 1000–15. DOI:10.1016/S0140-6736(07)60460-7. PMID 17382827. PMC 2080688. Research Blogging.