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תרופות אנטיאפילפטיות מהדור החדש

תרופות אנטיאפילפטיות מהדור החדש. ד"ר אביבה מימוני בלוך נוירולוגיה ילדים בי"ח שניידר. Introduction. Epilepsy – recurrent unprovoked seizures 30% continue to have seizures despite treatment. “Older” AEDs. Bromide 1850 Phenobarbital 1912 Dilantin, Hydantoin (phenytoin) 1938

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תרופות אנטיאפילפטיות מהדור החדש

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  1. תרופות אנטיאפילפטיות מהדור החדש ד"ר אביבה מימוני בלוך נוירולוגיה ילדים בי"ח שניידר

  2. Introduction • Epilepsy – recurrent unprovoked seizures • 30% continue to have seizures despite treatment

  3. “Older” AEDs • Bromide 1850 • Phenobarbital 1912 • Dilantin, Hydantoin (phenytoin) 1938 • Prysoline (primidone) 1952 • Zarontin (ethosuximide) 1960 • Tegretol (carbamazepine) 1974 • Depalept,Valporal (valproate) 1978

  4. The ideal antiepileptic drug • Broad spectrum • Safe and without drug-drug interactions • No cognitive and behavioral side effects • No teratogenicity • “Antiepileptogenic” instead of anti “seizures”

  5. Considerations in selection of antiepileptic drugs • Seizure type and epilepsy syndrome • Side effect profile, teratogenicity, other medical problems • Drug interaction • Number of doses • Ease and speed of drug initiation • Need for laboratory monitoring • Cost

  6. Newer AEDS • Vigabatrin(Sabril) 1989 • Gabapentin (Neurontin) 1994 • Lamotrigine (Lamictal) 1995 • Topiramate (Topamax) 1996 • Levetiracetam (Keppra) 1999 • Oxcarbazepine(Trileptil) 2000

  7. Newer AEDs • Equally effective as older AEDs • Most are better tolerated than older AEDs • Most have fewer interactions with other medications than older AEDs • All are expensive

  8. Partial szs ± generalization, Benign Rolandic Epilepsy Neuropathic pain Gabapentin (Neurontin)

  9. ADVANTAGES No interactions with other drugs No serious side effects Can be started quickly Well-tolerated Gabapentin (Neurontin)

  10. DISADVANTAGES Three-times-a-day dosing Narrow spectrum - partial Gabapentin (Neurontin)

  11. ADVANTAGES Minimal effect on other medications Broad spectrum - works for most types of seizures Very well tolerated Minimal sedation Probably safe in pregnancy Approved for >2 y Lamotrigine (Lamictal)

  12. DISADVANTAGES Rash in up to 5-10 % Severe rash(1%) Lamotrigine (Lamictal)

  13. DISADVANTAGES Rash occurs more in children, with VPA, if started quickly Must start slowly (~2 months to full dose) Dizziness, headache, ataxia, diplopia May worsen myoclonus Lamotrigine (Lamictal)

  14. ADVANTAGES Minimal interactions with other medications Probably works for all seizure types Approved for >2 y Sprinkle form Approved for migraine prevention Topiramate (Topamax)

  15. DISADVANTAGES Cognitive side effects – attention, language Weight loss Metabolic acidosis 1-2% renal stones Tingling/pins and needles Oligohydrosis and hyperthermia In adults - glaucoma Can decrease efficacy of oral contraceptives Topiramate (Topamax)

  16. Vigabatrin - Sabril • Effective for West Syndrome – Hypssarhythmia • Toxicity - Concentric visual field defect- up to 40%

  17. As effective and better tolerated than Tegretol Partial onset szs Fewer interactions than Tegretol, no autoinduction Approved for children > 4 Approved for first-line monotherapy Oxcarbazepine (Trileptal)

  18. Hyponatremia – not less than tegretol Less rash – but 30% of those with rash due to tegretol will have a rash Lessens effectiveness of birth control pill Oxcarbazepine (Trileptal)

  19. Partial onset szs Absence, Atypical absence, refractory mixed Levetiracetam (Keppra)

  20. ADVANTAGES No interactions Works for most seizure types Can start quickly Well tolerated Levetiracetam (Keppra)

  21. DISADVANTAGES Behavioral/psychiatric side effects Twice per day Levetiracetam (Keppra)

  22. Conclusion • Many new AEDs • Most better tolerated and fewer drug interactions than the older AEDs • Most patients can find an AED that is effective and causes minimal or no side effects • More advances coming every year…

  23. Cool stuff for the (near) future • New Drugs • Prevention of Epilepsy • New Diets • Brain Stimulation • etc

  24. תודה!

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