Abstract
Introduction: Epilepsy is one of the most common neurological diseases in the world that affects millions of people. We aimed to characterize antiseizure medications (ASM) and to evaluate their clinical behavior in terms of treatment adherence and seizure control of patients treated for epilepsy in two hospitals in Bogotá, Colombia: San José Centro and San José Infantil, between 2019 and 2022.
Methods: We performed a retrospective review of patients treated for epilepsy in two hospitals in Bogota, Colombia: San José Centro and San José Infantil. The study was approved by the faculty and ethics committee of Fundación Universitaria de Ciencias de la Salud (FUCS). We surveyed patients who met the International League Against Epilepsy (ILAE) criteria for epilepsy. The survey included demographic, social impact, clinical, and treatment data. Statistical analysis was done with Stata v.17 and Jamovi V2.3.26.
Results: The study included 797 patients who met the criteria for epilepsy diagnosis. A total of 44.1% of the patients needed only one medication to control their seizures adequately. We found that patients who used the new generation of antiseizure medications had better control of epilepsy, primarily due to greater adherence in this study population.
Discussion: New-generation antiseizure medications demonstrate similar efficacy to older drugs but with better adherence, fewer adverse effects, and lower treatment abandonment. No additional benefit was observed with polytherapy, emphasizing the importance of a rational treatment approach. Reduced drug interactions make these medications particularly beneficial for vulnerable populations. Additionally, failure to achieve seizure control with the first medication increases the risk of pharmacoresistance, highlighting the need for individualized management.
Conclusion: The new generation of antiseizure medications shows a clinical response comparable to that of older drugs, with a better adherence rate, fewer adverse effects, and a lower rate of treatment abandonment.
References
Beydoun A, DuPont S, Zhou D, Matta M, Nagire V, Lagae L. Current role of carbamazepine and oxcarbazepine in the management of epilepsy. Seizure. 2020;83:251-263. https://doi.org/10.1016/j.seizure.2020.10.018
O` Rourke G, O` Brien JJ. Identifying the barriers to antiepileptic drug adherence among adults with epilepsy. Seizure. 2017;45:160-168. https://doi.org/10.1016/j.seizure.2016.12.006
Bosak M, Cyranka K, Dudek D, Kowalik M, Mo?ek P, S?owik A. Psychiatric comedication in patients with epilepsy. Epilepsy Behav. 2018;83:207-211. https://doi.org/10.1016/j.yebeh.2018.03.033
Pinilla-Monsalve GD, Vergara-Aguilar JP, Machado-Noguera B, Gutiérrez-Baquero J, Cabezas-Vargas Z, Bejarano-Hernández J. Estudio de la epidemiología neurológica en Colombia a partir de información administrativa (ESENCIA). Resultados preliminares 2015-2017. Salud IUS. 2021;53:e317. https://doi.org/10.18273/saluduis.53.e:21025
Ministerio de Salud y Protección Social. Epilepsia: mucho más que convulsiones. [Internet]. Bogotá (Colombia): El Ministerio; 2017 [updated 2021 Oct 10; Boletín de prensa No. 016 de 2017, Abecé de la Epilepsia]. Available from: https://www.minsalud.gov.co/Paginas/Epilepsia-mucho-mas-que-convulsiones.aspx
O`Dwyer M, Peklar J, Mulryan N, McCallion P, McCarron M, Henman MC. Prevalence and patterns of anti-epileptic medication prescribing in the treatment of epilepsy in older adults with intellectual disabilities. J Intellect Disabil Res. 2018;62(3):245-261. https://doi.org/10.1111/jir.12461
Chen Z, Brodie MJ, Liew D, Kwan P. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: A 30-year longitudinal cohort study. JAMA Neurol. 2018;75(3):279-286. https://doi.org/10.1001/jamaneurol.2017.3949
Campos MS, Ayres LR, Morelo MR, Marques FA, Pereira LR. Efficacy and tolerability of antiepileptic drugs in patients with focal epilepsy: Systematic review and network meta-analyses. Pharmacotherapy. 2016;36(12):1255-1271. https://doi.org/10.1002/phar.1855
Nevitt SJ, Sudell M, Weston J, Tudur Smith C, Marson A, Cividini S. Antiepileptic drug monotherapy for epilepsy: A network meta-analysis of individual participant data. Cochrane Database Syst Rev. 2022;4:CD011412. https://doi.org/10.1002/14651858.CD011412.pub4
Nasir BB, Berha AB, Gebrewold MA, Yifru YM, Engidawork E, Woldu MA. Drug therapy problems and treatment satisfaction among ambulatory patients with epilepsy in a specialized hospital in Ethiopia. PLoS One. 2020;15(1):e0227359. https://doi.org/10.1371/journal.pone.0227359
Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342(5):314-319. https://doi.org/10.1056/NEJM200002033420503
Lezaic N, Roussy J, Masson H, Jetté N, Keezer MR. Epilepsy in the elderly: Unique challenges in an increasingly prevalent population. Epilepsy Behav. 2020;102:106724. https://doi.org/10.1016/j.yebeh.2019.106724
Mlinar S, Petek D, Coti? Ž, Mencin ?eplak M, Zaletel M. Persons with epilepsy: Between social inclusion and marginalisation. Behav Neurol. 2016;2016:2018509. https://doi.org/10.1155/2016/2018509
Tudur Smith C, Marson AG, Williamson PR. Carbamazepine versus phenobarbitone monotherapy for epilepsy. Cochrane Database Syst Rev. 2003(1):CD001904. https://doi.org/10.1002/14651858.CD001904
Strzelczyk A, Haag A, Reese JP, Nickolay T, Oertel WH, Dodel R, et al. Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany. Epilepsy Behav. 2013;27(3):433-438. https://doi.org/10.1016/j.yebeh.2013.03.007
Brodie MJ. Antiepileptic drug therapy the story so far. Seizure. 2010;19(10):650-655. https://doi.org/10.1016/j.seizure.2010.10.027
Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Hauser WA, Mathern G, et al. Definition of drug resistant epilepsy: Consensus proposal by the ad hoc task force of the ILAE commission on therapeutic strategies. Epilepsia. 2010 Jun;51(6):1069-1077. https://doi.org/10.1111/j.1528-1167.2009.02397.x
Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol. 2006;61(3):246-255. https://doi.org/10.1111/j.1365-2125.2005.02529.x
Abou-Khalil BW. Update on antiepileptic drugs 2019. Continuum (Minneap Minn). 2019;25(2):508-536. https://doi.org/10.1212/CON.0000000000000715
Besag FM, Vasey MJ. Neurocognitive effects of antiseizure medications in children and adolescents with epilepsy. Paediatr Drugs. 2021;23(3):253-286. https://doi.org/10.1007/s40272-021-00448-0
Louis EK, Rosenfeld WE, Bramley T. Antiepileptic drug monotherapy: The initial approach in epilepsy management. Curr Neuropharmacol. 2009;7(2):77-82. https://doi.org/10.2174/157015909788848866
Kim D, Kim JM, Cho YW, Yang KI, Kim DW, Lee ST, et al. Antiepileptic drug therapy for status epilepticus. J Clin Neurol. 2021;17(1):11-19. https://doi.org/10.3988/jcn.2021.17.1.11
Velez A, Gutiérrez-Álvarez A, Palau D, Quintero-Cusguen P, Ortiz-Salas P. Caracterización de pacientes adultos mayores con epilepsia en dos hospitales de Bogotá (Colombia). Rev Cienc Salud. 2011;9(3):259-269.
Zaccara G, Lattanzi S, Russo E. Pharmacokinetic drug interactions between antiseizure medications and drugs for comorbid diseases in children with epilepsy. Expert Opin Drug Metab Toxicol. 2021;17(5):595-610. https://doi.org/10.1080/17425255.2021.1903429
Tomson T, Battino D, Perucca E. Teratogenicity of antiepileptic drugs. Curr Opin Neurol. 2019;32(2):246-252. https://doi.org/10.1097/WCO.0000000000000659
Karlov VA, Vlasov PN, Kozhokaru AB, Orlova AS. The efficacy and tolerability of extended release carbamazepine in adult patients with new-onset epilepsy using epileptiform activity index. Zh Nevrol Psikhiatr Im S Korsakova. 2021;121(3):31-38. https://doi.org/10.17116/jnevro202112103131
Odom N, Bateman LM. Sudden unexpected death in epilepsy, periictal physiology, and the SUDEP-7 Inventory. Epilepsia. 2018;59(10):e157-e60. https://doi.org/10.1111/epi.14552
Verducci C, Hussain F, Donner E, Moseley BD, Buchhalter J, Hesdorffer D, et al. SUDEP in the North American SUDEP registry: The full spectrum of epilepsies. Neurology. 2019;93(3):e227-e36. https://doi.org/10.1212/WNL.0000000000007778
Stephen LJ, Brodie MJ. Antiepileptic drug monotherapy versus polytherapy: Pursuing seizure freedom and tolerability in adults. Curr Opin Neurol. 2012;25(2):164-172. https://doi.org/10.1097/WCO.0b013e328350ba68
Löscher W, Klein P. Correction to: The pharmacology and clinical efficacy of antiseizure medications: from bromide salts to cenobamate and beyond. CNS Drugs. 2021 Sep;35(9):935-963. https://doi.org/10.1007/s40263-021-00853-6
Anderson GD, Hakimian S. Pharmacokinetic factors to consider in the selection of antiseizure drugs for older patients with epilepsy. Drugs Aging. 2018;35(8):687-698. https://doi.org/10.1007/s40266-018-0562-2
Castro-Rodríguez A, Orozco-Hernández JP, Marín-Medina DS. Polifarmacia y prescripción de medicamentos potencialmente no necesarios en ancianos. Rev Med Risaralda. 2016;22(1):52-57.
Baši? S, Markovi? I, Sporiš D, Šušak-Sporiš I, ?olak Z, Sven Župani? R. Antiepileptics and drug interactions. Neurology Today. 2019;28(1):13-22.
Barreto Acevedo E, Becerra Zegarra A, Villafuerte Espinoza M, Llaja-Rojas V. Cirugía de epilepsia en patología dual abordada con estimulación cortical directa y electrocorticografía intraoperatoria. Primer caso en el Hospital Rebagliati. Rev Neuropsiquiatría. 2016;79(2):127-134. https://doi.org/10.20453/rnp.v79i2.2836
French JA, Perucca E. Time to start calling things by their own names? the case for antiseizure medicines. Epilepsy Curr. 2020;20(2):69-72. https://doi.org/10.1177/1535759720905516
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