To view this page ensure that Adobe Flash Player version 11.1.0 or greater is installed.

Epilepsy Optimising Epilepsy Therapy – Searching for the Evidence – Looking Beyond the Data Proceedings of a Symposium Presented at the 1st Meeting of the European Academy of Neurology, 22 June 2015, Berlin Expert reviewed by: Mar Carreño, 1 Eugen Trinka 2 and Martin Holtkamp 3 1. Clinical Institute of Neurosciences, Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain; 2. Department of Neurology, Christian Doppler Medical Centre, Paracelsus Medical University, Austria; Centre for Cognitive Neuroscience, Austria 3. Epilepsy-Center Berlin-Brandenburg, Department of Neurology, Charité – Universitätsmedizin Berlin, Germany Abstract There is now an extensive range of anti-epileptic drugs (AEDs) available including older established treatments and a newer generation of medications. The choice of drugs and what constitutes optimal therapy, however, is unclear due to limitations in the data supporting their use, particularly among the newer treatments. In clinical trials of monotherapy, a treatment is required to show only non-inferiority to another benchmark treatment. In trials of polytherapy, comparisons are limited to placebo. It is therefore necessary to look beyond the study data and consider other parameters to ascertain the most suitable treatment for the individual patient. Available evidence suggests that efficacy is similar among most AEDs, but this does not mean they are all the same. Some show efficacy in early and refractory epilepsy and some improve depression and quality of life (QOL) in epilepsy. AEDs are associated with a range of adverse events (AEs) that can limit their usefulness. AE classifications include type A (augmented and dose related) including tiredness, fatigue, insomnia, dizziness, vertigo, imbalance, ataxia, tremor and cognitive impairment; type B (bizarre and idiosyncratic) including various hypersensitivity reactions; type C (chronic long-term toxicity) including hirsutism, alopecia, weight gain and obesity; and type D (teratogenesis and carcinogenesis). The newer AEDs have been more thoroughly assessed for AEs than older drugs and risks are better understood. In AED safety, it is not better to follow a policy of ‘better the devil you know’ but rather to carefully monitor AE incidence and be prepared to switch drugs to improve tolerability and avoid non-compliance and treatment failure. Keywords Anti-epileptic drugs, safety, tolerability, efficacy, monotherapy, polytherapy, clinical trials Disclosure: Mar Carreño has acted as a paid consultant to UCB, Eisai, Bial, GSK, Medtronic, Shire and Cyberonics. She has received research funding from UCB and Eisai and has received speaker’s honoraria from GSK, Eisai, Bial, UCB, Cyberonics and Shire. Eugen Trinka has acted as a paid consultant to UCB, Eisai, Bial, Medtronics, EVER Neuro Pharma, Biogen-Idec, Takeda and Sunovion. He, or his institution, has received research funding from GSK, Biogen-Idec, Eisai, Novartis, Red Bull, Bayer, and UCB. He has received speaker’s honoraria from GSK, Böhringer Ingelheim, Eisai, Bial, UCB, Cyberonics, and Sanofi-Aventis and is CEO of Neuroconsult GmbH. Martin Holtkamp has received speaker honoraria and/or consultancy fees from Cyberonics, Desitin, Eisai, GSK, Janssen-Cilag, UCB and ViroPharma. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Acknowledgements: Editorial assistance was provided by James Gilbart at Touch Medical Media and funded by Eisai and Bial. This article reports the proceedings of a sponsored satellite symposium and as such has not been subject to the journal’s usual peer-review process. Received: 30 July 2015 Published Online: 2 November 2015 Citation: European Neurological Review, 2015;10(2):164–70 Correspondence: Mar Carreño, Head, Epilepsy Unit, Department of Neurology, Hospital Clínic, Barcelona, Spain. E: Support: The publication of this article was supported by Eisai and Bial. The views and opinions expressed are those of the authors and not necessarily those of Eisai and Bial. All the speakers received an honorarium fee to talk at the symposium. Epilepsy is one of the most common serious neurological disorders and has far-reaching consequences, not only for patients living with the condition, but also for their families and society as a whole. 1 It is useful therefore to evaluate whether the advent of newer anti-epileptic drugs (AEDs) has progressed the safety and tolerability of epilepsy therapy. These newer treatments have been designed to overcome some of the safety issues of older treatments that have a major impact on the quality of life (QoL) of people with epilepsy. 2–5 The newer drugs have been more extensively evaluated in post-marketing surveillance, which has uncovered safety concerns that may not have been apparent during short-term clinical trials. Comparing the efficacy of available 164 AEDs is difficult due to the absence of head-to-head trials. 6 The effective management of epilepsy not only involves controlling seizures, but also other factors such as impact on comorbidities. 7 Real-world studies are important in supporting the efficacy findings of randomised clinical trials, but they have limitations. 8,9 This article reports a symposium on optimising epilepsy therapy that was convened at the first Congress of the European Academy of Neurology in Berlin in June 2015. The symposium aimed to provide practical advice that could be applied to current daily practice and focussed on how the appropriate AEDs should be chosen, the need to consider the personal circumstances and goals of individual patients during this process. ■ © TOUC H ME D IC AL ME D IA 2014