Special Issue "Antiepileptic Drugs"

Guest Editor
Prof. Dr. Sandra L. Helmers
Department of Neurology/Epilepsy, The Emory Clinic, 1365-A Clifton Road, NE, Suite A3400, Atlanta, GA 30322, USA
E-Mail: shelmer@emory.edu
Interests: treatment of pediatric and adult epilepsy; anticonvulsants in the treatment of epilepsy; quality indicators in epilepsy care; economic analysis of epilepsy treatments

Dear Colleagues,

This special issue will address the pharmacologic treatment of epilepy and seizures. We will explore current understandings of mechanism of actions of anticonvulsants, efficacy and side effect profiles of currently available anticonvulsants, and look at the anticonvulsant "pipeline".

Prof. Dr. Sandra L. Helmers
Guest Editor

Submission

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• anticonvulsant medications
• mechanism of action
• epilepsy
• seizures
• anticonvulsant pharmacology
• drug interactions
• anticonvulsant side effects
• anticonvulsant efficacy
• economic analysis

Type of Paper: Review
Title: Generic Drugs in Epilepsy Treatment—Indications and Caveats
Author: Andreas Schulze-Bonhage
Affiliation: Epilepsy Center, University Hospital Freiburg, Germany; E-Mail: andreas.schulze-bonhage@uniklinik-freiburg.de
Abstract: Presently, an increasing number of second generation antiepileptic drugs becomes available as generics. This offers chances to save costs, and may be an incentive for pharmaceutical companies to develop new agents. There is, however, an ongoing debate as to whether bioequivalence as defined by regulatory authorities is sufficient for epilepsy treatment. In many antiepileptic drugs, there is a narrow therapeutic range which renders patients prone to a loss of efficacy on the one hand, and to side effects on the other hand with limited changes in drug concentrations. Available evidence is reviewed under which conditions generics offer advantages and when they should be avoided in the treatment of epilepsy.

Title: The Art of Managing Conversions Between Antiepileptic Drugs: Maximizing Patient Tolerability and Quality of Life
Author: Erik K. St. Louis
Affiliation: Center for Sleep Medicine, Department of Neurology, Mayo Clinic and Foundation, 200 1st Street Southwest

Type of paper: Review
Title: Antiepileptic drugs in absence epilepsy
Authors: Gilles van Luijtelaar and Clementina van Rijn
Affiliation: Biological Psychology, Radboud University, Nijmegen, The Netherlands; E-mail: g.vanluijtelaar@nici.ru.nl
Abstract: The pharmacological profile of absence seizures, typical for various types of patients with a form of idiopathic generalized epilepsy, is different from that in other types of epilepsy. GABA-mimetic drugs are efficient drugs in many seizure types, however, they aggravate absence seizures. Furthermore, ethosuximide, one of the drugs of choice, is only active in absence epilepsy, and not in other seizures types. In this review we will discuss the various antiepileptic drugs with proven efficacy in various types of absence epilepsy, including some of the proposed mechanisms. Considering that some types of absence epilepsy are refractory, some ideas about rationale polytherapy will be discussed. Next, the neuronal network in which absence seizures can be found, will be described. This will be mainly based on basic studies in genetic animal models for absence epilepsy, such as WAG/Rij rats and GAERS. This network will be used to understand how and in which way putative new drugs, e.g. metabotropic glutamate receptors antagonists and endocannabinoid receptor might work in aggevating of blocking absence seizures. Finally, drugs will be discussed that might prevent the process of epileptogenesis of absence epilepsy, a challenging new approach in epilepsy research.

Title: Cost-Effectiveness of Current Available Epilepsy Treatment Modalities: A Comprehensive Analysis and a New Care Paradigm Proposal
Authors: Georges Naasan ¹ and Zeina El-Chemali ²
Affiliation: ¹ University Hospitals, Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
² Brigham and Women’s Hospital, Neuropsychiatry Unit, Harvard Medical School, Boston, MA, USA; E-Mail: E-Mail: ZELCHEMALI@PARTNERS.ORG
Abstract: Epilepsy is prevalent equally in both genders and among all age groups. Its diagnosis and treatment are both challenging and costly. It results in a great deal of medical and social burden and significantly impacts quality of life. In an era where medical advances are ahead of financial stability, it is hard to understand and determine the cost-effectiveness of the available treatment modalities for epilepsy. Whether in older generation antiepileptic drugs (AED), newer generation AED, epilepsy surgery or vagal nerve stimulation, total costs are impacted by “behind-the-scene” factors such as diagnostic tests including prolonged video monitoring, pre-surgical evaluation, transport and emergency department visits, decreased productivity in work place, falling behind on academic demands and system burden vis-à-vis epilepsy stigma. Similarly, while effectiveness could be defined as seizure freedom, one would need to factor in measures of social functioning and quality of life for patients and their family members. With access and delivery of care limited by costs and a changing healthcare system, the authors will propose a medical and economic paradigm to epilepsy care with an emphasis on cost-effectiveness of current regimens and Disability-Adjusted Life Year (DALY) as a measure of disease burden.
Keywords: Epilepsy, cost of care, treatment effectiveness, DALY, quality of life