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Published on: May 16, 2019
Treatment initiation in epilepsy: an expert consensus in Spain.
V Villanueva1, J C Sánchez-Álvarez, P Peña
1Hospital Universitario La Fe, Valencia, Spain. vevillanuevah@yahoo.es
Epilepsy & Behavior : E&B
|September 28, 2010
Summary
Experts reached a consensus on initiating antiepileptic drug (AED) therapy after the first seizure if EEG or MRI abnormalities are present. Second-generation AEDs are preferred over first-generation options, especially with comorbidities.
Area of Science:
- Neurology
- Pharmacology
Background:
- Epilepsy management requires careful consideration of treatment initiation and drug selection.
- Establishing consensus among experts is crucial for optimizing antiepileptic therapy.
Purpose of the Study:
- To explore criteria for initiating antiepileptic therapy.
- To establish expert consensus on selecting initial monotherapy for adult epilepsy patients.
Main Methods:
- Modified Delphi method utilizing questionnaires with 60 experts.
- Evaluated criteria for treatment initiation, drug selection by epilepsy type, and drug selection by comorbidity.
Main Results:
- Consensus reached on 148 out of 194 items after two rounds.
- Treatment initiation favored after the first seizure with specific EEG/MRI findings or in elderly patients.
- Levetiracetam and lamotrigine recommended for generalized tonic-clonic seizures; levetiracetam for myoclonic epilepsy; valproic acid, ethosuximide, levetiracetam, lamotrigine for absence epilepsy; carbamazepine, levetiracetam, lamotrigine, oxcarbazepine for partial epilepsy.
- Second-generation antiepileptic drugs (AEDs) were preferred over first-generation AEDs, particularly with comorbidities. Levetiracetam, lamotrigine, valproic acid, and topiramate showed high consensus.
Conclusions:
- A trend towards initiating antiepileptic treatment after the first seizure, contingent on diagnostic test results.
- First-generation AEDs are less recommended, especially with comorbid conditions.
- Study reflects expert opinions; treatment outcome impact requires further evaluation.
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