12
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Adjunctive therapy for the treatment of primary generalized tonic-clonic seizures: focus on oncedaily lamotrigine

      ,

      Drug Design, Development and Therapy

      Dove Medical Press

      lamotrigine, GTC, IGE, generalized seizures, treatment

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Idiopathic generalized epilepsies are frequently encountered by neurologists, and providing an accurate diagnosis and effective treatment(s) are the necessary components of successful patient care. With the introduction of new antiepileptic medications, physicians are better equipped for this goal. The immediate-release formulation of lamotrigine (LTG-IR) has been approved for primary generalized tonic-clonic seizures since 2006. The extended-release formulation of lamotrigine (LTG-XR) was approved for adjunctive therapy in patients with primary generalized tonic-clonic seizures in 2010. Although its exact mechanism of action is not yet fully elucidated, studies have demonstrated multiple possible pathways. Although both the LTG-IR and LTG-XR formulations have similar side effects and are generally well tolerated, LTG-XR may be preferable for its ease of use, which may increase patient compliance and decrease fluctuations in serum drug levels. The ease of conversion between the formulations also makes lamotrigine an attractive treatment option for patients with primary generalized tonic-clonic seizures. LTG-IR has demonstrated efficacy in treatment-resistant idiopathic generalized epilepsies in both adults and children. Although there are still some questions regarding all possible applications of LTG-XR, as further research is being done, it is clear that LTG-XR may hold some advantages when compared with other anticonvulsants.

          Related collections

          Most cited references 30

          • Record: found
          • Abstract: found
          • Article: not found

          Report of the ILAE classification core group.

           Jerome Engel (2006)
          A Core Group of the Task Force on Classification and Terminology has evaluated the lists of epileptic seizure types and epilepsy syndromes approved by the General Assembly in Buenos Aires in 2001, and considered possible alternative systems of classification. No new classification has as yet been proposed. Because the 1981 classification of epileptic seizure types, and the 1989 classification of epilepsy syndromes and epilepsies are generally accepted and workable, they will not be discarded unless, and until, clearly better classifications have been devised, although periodic modifications to the current classifications may be suggested. At this time, however, the Core Group has focused on establishing scientifically rigorous criteria for identification of specific epileptic seizure types and specific epilepsy syndromes as unique diagnostic entities, and is considering an evidence-based approach. The short-term goal is to present a list of seizure types and syndromes to the ILAE Executive Committee for approval as testable working hypotheses, subject to verification, falsification, and revision. This report represents completion of this work. If sufficient evidence subsequently becomes available to disprove any hypothesis, the seizure type or syndrome will be reevaluated and revised or discarded, with Executive Committee approval. The recognition of specific seizure types and syndromes, as well as any change in classification of seizure types and syndromes, therefore, will continue to be an ongoing dynamic process. A major purpose of this approach is to identify research necessary to clarify remaining issues of uncertainty, and to pave the way for new classifications.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Dynamic time course of typical childhood absence seizures: EEG, behavior, and functional magnetic resonance imaging.

            Absence seizures are 5-10 s episodes of impaired consciousness accompanied by 3-4 Hz generalized spike-and-wave discharge on electroencephalography (EEG). The time course of functional magnetic resonance imaging (fMRI) changes in absence seizures in relation to EEG and behavior is not known. We acquired simultaneous EEG-fMRI in 88 typical childhood absence seizures from nine pediatric patients. We investigated behavior concurrently using a continuous performance task or simpler repetitive tapping task. EEG time-frequency analysis revealed abrupt onset and end of 3-4 Hz spike-wave discharges with a mean duration of 6.6 s. Behavioral analysis also showed rapid onset and end of deficits associated with electrographic seizure start and end. In contrast, we observed small early fMRI increases in the orbital/medial frontal and medial/lateral parietal cortex >5 s before seizure onset, followed by profound fMRI decreases continuing >20 s after seizure end. This time course differed markedly from the hemodynamic response function (HRF) model used in conventional fMRI analysis, consisting of large increases beginning after electrical event onset, followed by small fMRI decreases. Other regions, such as the lateral frontal cortex, showed more balanced fMRI increases followed by approximately equal decreases. The thalamus showed delayed increases after seizure onset followed by small decreases, most closely resembling the HRF model. These findings reveal a complex and long-lasting sequence of fMRI changes in absence seizures, which are not detectable by conventional HRF modeling in many regions. These results may be important mechanistically for seizure initiation and termination and may also contribute to changes in EEG and behavior.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The relationship between poor medication compliance and seizures.

              Predictors and consequences of inadequate compliance with seizure medications were assessed using a 10-item postal survey. Dose omissions were reported by 71% of the 661 respondents (2+/-2 doses of seizure medications), with 45% of patients reporting a seizure after a missed dose, at some time during treatment. Dose omission was more likely with longer use of seizure medications (more than 5 years, P<0.01). Having seizures after missed doses was associated with number of seizure medication doses (P=0.04) and number of seizure medication tablets/capsules (P=0.01). Odds ratios showed that each increase in dose frequency (one, two, three, or four doses daily) increased the likelihood of a seizure after a missed dose by 36%. Taking larger numbers of tablets/capsules increased the odds of having a seizure after missed doses by 43%. These data provide evidence that medication compliance remains an important issue in epilepsy treatment.
                Bookmark

                Author and article information

                Journal
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                Drug Design, Development and Therapy
                Dove Medical Press
                1177-8881
                2010
                18 November 2010
                : 4
                : 337-342
                Affiliations
                Department of Neurology and Cincinnati Epilepsy Center, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
                Author notes
                Correspondence: Jerzy P Szaflarski, Department of Neurology, University of Cincinnati Academic Health Center, 260 Stetson Street, Cincinnati, OH 45267-0525, USA, Tel +1 513 558 5440, Fax +1 513 558 4305, Email Jerzy.Szaflarski@ 123456uc.edu
                Article
                dddt-4-337
                10.2147/DDDT.S11175
                2998806
                21151621
                © 2010 Steinbaugh and Szaflarski, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Review

                Pharmacology & Pharmaceutical medicine

                lamotrigine, gtc, ige, generalized seizures, treatment

                Comments

                Comment on this article