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New US epilepsy treatment guidelines reflect significant changes in drug choices

27 November, 2001

A notable shift is reflected in new guidelines for the treatment of adolescents and adults with epilepsy, compared to just 10 years ago.

The Expert Consensus Guidelines, based on clinical practice of leading epilepsy experts in the USA, appear in the November/December issue of the journal Epilepsy and Behavior and will be distributed widely to doctors across the United States.

The new recommendations contain two major changes: first, increased use of single anti-epileptic drugs (AEDs) before turning to combination therapies; next, recognising the need for special treatment strategies for groups such as women and older adults, who until recently have been overlooked in clinical studies.

“We are fortunate to have so many anti-epileptic drugs today. But this also makes the selection and sequence of therapies more complex, especially for physicians who don’t routinely see patients with epilepsy,” said Dr Martha Morrell, senior author of the Expert Consensus Guidelines and director of the Columbia Comprehensive Epilepsy Center of New York-Presbyterian Hospital.

For the first time, the new Guidelines address how to integrate the full range of AEDs – including newer therapies – into optimal treatment strategies, based on seizure type and individual patient needs, noted Dr. Morrell.

According to Dr. Morrell, the use of single agents can help accomplish the goal of balancing the best degree of seizure control with the least likelihood of side effects that could impair a patient’s ability to function and participate in routine activities.

The Guidelines also reflect the distinct needs of specific patient populations such as women of childbearing years and older adults. New research has demonstrated that many AEDs can either compromise reproductive health for women, or impair the cognitive ability of older patients, as well as causing dizziness and sedation in the latter group.

“Epilepsy cannot be treated with a ‘one-size fits all’ approach. The expert opinions reflected here underscore the need to tailor AED choices to individual patient needs,” noted Dr Steven Karceski, one of the report's co-authors.