[Difficulties and obstacles during medical treatment of epilepsies]

MULTIPLE OBSTACLES: There are many and various difficulties and obstacles during the medical treatment of epilepsy. They may create major stumbling blocks and largely jeopardize the control of this type of disease. POOR COMPLIANCE: Particularly frequent (30 to 50% of epileptics), it is one of the principle causes of pseudo-pharmaco-resistance. THE SIDE EFFECTS OF DRUGS: These are also frequent (15 to 30% of cases). Whatever their severity, they may be an important obstacle to the success of the treatment. Some of these effects are idiosyncratic, dose-independent, whereas others, non-idiosyncratic, are dose and time-dependent. THE AGGRAVATION OF EPILEPSY WITH ANTIEPILEPTIC AGENTS: This is possible and is usually due to an error in diagnosis, either in the type of seizure or the type of epilepsy in cause and which leads the physician to select an inappropriate treatment. Pregnancy may aggravate the progression of epilepsy in around a quarter of cases. Strict monitoring of the treatment is required. Intercurrent diseases and/or their treatment may have an impact on the epilepsy and its treatment. The diseases may be common affections or bacterial infections, psychiatric problems, lupus erythematosus or HIV infection. Likewise, the possible impact of commonly prescribed drugs such as those for gastric ulcers, asthma, cardiovascular diseases or even immunosuppressor treatments should be known. Renal failure and hepatic diseases often have a negative impact on antiepileptic treatments.