2001 issue 1

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Volume 10, issue 1

Neurologia

Practical aspects of drug choice in pharmacotherapy of epilepsy

BARBARA CHMIELEWSKA1
1. Katedry i Kliniki Neurologii Akademii Medycznej w Lublinie
Postęp Psychiatrii i Neurologii, 2001, 10, 7-19
Keywords: epilepsy, antiepileptic drugs, efficacy, toxicity

Abstract

Although the number of new AEDs available has considerably increased in recent years, still the choice of the best treatment for a given patient with epilepsy ought to be preceded by the diagnosis of the type of seizures or epileptic syndrome, his clinical status and individual needs. VPA and CBZ are the first-line conventional AEDs for monotherapy of all types of generalized and partial seizures, respectively. PHT and PB are also wide-spectrum and patent AEDs, but their usefulness is limited by their toxicity. If no symptomatic diagnosis is evident, then the safest are wide-spectrum AEDs (VP A) that do not evoke seizures of other types (PHT, PB, CBZ). New generation AEDs (VGB, LTG, TGB, GBP, TPM, FBM) are used as adjunctive to those of first choice in polytherapy of patients with drug resistant epilepsy. The effective dose of a chosen drug should be built step-by-step on the grounds of clinical assessment of its efficacy and toxicity in each case. A possibility of not only acute dose-dependent side effects, but also idiosyncratic or allergic reactions and chronic toxicity of AEDs should be taken into account. Monitoring of serum drug concentrations is presently considered to be of limited value for the evaluation of treatment efficacy.

Address for correspondence:
Dr Barbara Chmielewska,
Katedra i Klinka Neurologii Akademii Medycznej,
ul. Jaczewskiego 8,
20-954 Lublin, tel.fax: (0-81) 7425420, e-mail: basiach@ asklepios.am.lublin.pl