New medications for epilepsy treatment. How to choose epileptic seizure therapy correctly? 7
There are many anti-epileptic medications to treat epilepsy. Dr. Anton Titov, MD. How to choose correct anti-epileptic medications for different patients and different types of epilepsy? Dr. Tracey Milligan, MD. Our goal is to select epilepsy therapy medications that are going to work well and not cause side effects. Our goal in the treatment of epilepsy is always “no epileptic seizures, no side-effects”. Dr. Anton Titov, MD. Which anti-epileptic medications are the most likely to achieve this goal? Dr. Tracey Milligan, MD. It really depends on the type of epilepsy. We pick anti-epilepsy medications according to a specific type of epileptic seizures that the patient has. For example, I mentioned that there are focal epileptic seizures. They begin in one very specific part of the brain. Dr. Tracey Milligan, MD. There are also generalized epileptic seizures. Sometimes we don’t know where epileptic seizures originate. Sometimes we do not understand what type of epilepsy a patient has. It is important to choose anti-epilepsy medication that will work for both types. We have a list of anti-epileptic medications that will do that. Dr. Tracey Milligan, MD. Also we have some of the newer anti-epileptic medications. The newer anti-epileptic medications work just as well as the older anti-epileptic medications. But they have fewer side effects. In many parts of the world the newer anti-epileptic medications are not available. So a physician has to choose the best older epilepsy medication. Sometimes a patient has access to new anti-epileptic medications. Then, in general, new medications have fewer side effects. Dr. Tracey Milligan, MD. So we pick anti-epileptic medications that we know have a tendency towards fewer side effects. We prefer medications that will work well. They will be effective in the majority of epilepsy patients. What are major classes of anti-epileptic medications? Dr. Anton Titov, MD. What are common medications that could be used to treat epilepsy? Dr. Tracey Milligan, MD. There are medications that we think of working best for generalized epilepsy. In generalized epilepsy, epileptic seizures are beginning on both sides of the brain. The network involving both sides of the brain is a source of epileptic seizures. One of those anti-epileptic medications is divalproex sodium. The brand name for that is Depakote. That is the anti-epilepsy medication that I used in my patient. I discussed her story previously. She had been taking anti-epileptic medication like carbamazepine for most of her life. Dr. Tracey Milligan, MD. When I saw her, she was taking carbamazepine and gabapentin. All these anti-epileptic medications are popular. They have been on the market for a long time. Dr. Tracey Milligan, MD. Yes, they have been widely available. Divalproex sodium is also common medication. Valproic acid is another name. It works on the generalized epilepsy. In this patient Depakote worked very well. We avoid Valproic acid anti-epilepsy medication in younger women of childbearing age. Because Valproic acid is teratogenic. It means, it can cause birth defects. But in a 82-year-old woman that was not a concern. Other anti-epileptic medications that work well for generalized epilepsy include Levetiracetam, Lamotrigine, Zonisamide, Topiramate. Those medications have been around not quite as long as valproic acid. But they have been available for quite some time. They can work well when other anti-epileptic medications do not work. Sometimes patients have a generalized epilepsy. But they are misdiagnosed with a focal epilepsy. Dr. Tracey Milligan, MD. A patient may continue to have epileptic seizures despite taking carbamazepine or phenytoin or an anti-epilepsy medication like that. Then it is important to consider also whether they might do better on a broad spectrum anti-epileptic medication. That again underscores the necessity to see a proper epilepsy treatment expert. This expert have to be very knowledgeable. Dr. Tracey Milligan, MD. Expert must have knowledge specifically in the treatment of epilepsy. Because a lot of anti-epileptic medications are widely available. But it is the correct choice that has to be made for each patient. Dr. Anton Titov, MD. Correct choice of medication strictly depends on exact patient’s type of seizures. Correct choice of medications also depends on a clinical history and EEG information. Dr. Tracey Milligan, MD. Absolutely! Knowing the correct anti-epilepsy medication for a patient can also depend on the EEG interpretation. The EEG interpretation sometimes can be done easily by a non-expert. But there are some variations of EEG that really do require an expert eye. Dr. Anton Titov, MD. Only epilepsy expert can guarantee that EEG is interpreted correctly.
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