N.A. Ermolenko , I.G. Rudakova , G.V. Kalmykova , Yu.A. Kornukova , O.M. Mihailova , G.V. Piskovatskaya , K.V. Tyagunova , L.V. Fedorova , A.A. Gelazhis
Abstract
A meeting of the Central Federal District Neurologists-Epileptologists Expert Council dedicated to the issue of antiepileptic therapy in the CFD regions relative to global data and Russian guidelines was held on December 10, 2022. The priority issues of selecting initial therapy, tactics of patient management considering clinical, gender-related and social features in different age groups were discussed during the meeting. The paper reports conclusions of the meeting of the working group of the CFD experts in neurology and epileptology . The results obtained are the reason to revise the treatment tactics and the guidelines on introduction of new approaches to treatment of patients with epilepsy.
Key words: epilepsy, monotherapy, therapy efficacy, antiepileptic drugs, Sazar, lamotrigine, drug tolerability, comorbidity
About the Author
N.A. Ermolenko 1 , I.G. Rudakova 2 , G.V. Kalmykova 3 , Yu.A. Kornukova 4 , O.M. Mihailova 5 , G.V. Piskovatskaya 6 , K.V. Tyagunova 1 , L.V. Fedorova 7 , A.A. Gelazhis 81 Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russia
2 Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
3 Belgorod State National Research University, Belgorod, Russia
4 Voronezh Region Clinical Hospital No1, Epileptology Center, Voronezh, Russia
5 Children's polyclinic No5 Yaroslavl Region, Yaroslavl, Russia
6 Kursk Clinical Psychiatric Hospital named after Panteleimon, Kursk, Russia
7 Bryansk Regional Psychiatric Hospital No1, Bryansk, Russia
8 Kaluga Regional Clinical Hospital, Kaluga, Russia
References
1. Moosa AN. Antiepileptic drug treatment of epilepsy in children. Continuum (Minneap Minn). 2019; 25 (2): 381–407. DOI: 10.1212/CON. 0000000000000712
2. Резолюция заседания экспертов Российской Противоэпилептической Лиги по вопросам терапии женщин с эпилепсией. Эпилепсия и пароксизмальные состояния. 2019; 11 (2): 195–9.
Resolution of the meeting of experts of the Russian Antiepileptic League on the treatment of women with epilepsy. Epilepsy and paroxysmal states. 2019; 11 (2): 195–9. (in Russian)
3. Campos MS, Ayres LR, Morelo MR et al. Efficacy and tolerability of antiepileptic drugs in patients with focal epilepsy: systematic review and network meta-analyses. Pharmacotherapy. 2016; 36 (12): 1255–71. DOI: 10.1002/phar.1855
4. Marson A, Al-Kharusi A, Alwaidh M et al. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblindedrandomised controlled trial. Lancet. 2007; 369; 1000–15. DOI: 10.1016/S0140-6736(07)60460-7
5. Marson A, Burnside G, Appleton R et al. The SANAD II study of the effectiveness and cost-effectiveness of valproate versus levetiracetam for newly diagnosed generalised and unclassifiable epilepsy: an open-label, non-inferiority, multicentre, phase 4, randomized controlled trial. Lancet 2021; 397: 10282 (April 10): 1375–86. DOI: 10.1016/S0140-6736(21)00246-4
6. NICE. Epilepsies: diagnosis and management. Clinical guideline. 15.07.2021. Available at: https://www.nice.org.uk/guidance/cg137
7. French JA et al. Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2004; 62 (8): 1261–73. DOI: 10.1212/01.wnl.0000123695.22623.32
8. Campos MS, Ayres LR, Morelo MR et al. Comparative efficacy of antiepileptic drugs for patients with generalized epileptic seizures: systematic review and network meta-analyses. Int J Clin Pharm 2018; 40 (3): 589–98. DOI: 10.1007/s11096-018-0641-9
9. Гусев Е.И., Бурд Г.С. Эпилепсия: ламиктал в лечении больных эпилепсией. Mосква: Буклет, 1994.
Gusev EI, Burd GS. Epilepsy: lamictal in the treatment of patients with epilepsy. Moscow: Booklet, 1994. (in Russian)
10. Зенков Л.Р. Ламиктал в лечении эпилепсии. Москва, 2006.
Zenkov LR. Lamictal in the treatment of epilepsy. Moscow, 2006. (in Russian)
11. Chung-Chin Kuo. A Common Anticonvulsant Binding Site for Phenytoin, Carbamazepine, and Lamotrigine in Neuronal Na+ Channels. Molecular Pharmacology. 1998; 54 (4): 712–21.
12. Grunze H, Von Wegerer J, Greene RW, Walden J. Modulation of calcium and potassium currents by lamotrigine. Neuropsychobiology. 1998; 38 (3): 131–8. DOI: 10.1159/000026528
13. Wang SJ, Sihra TS, Gean PW. Lamotrigine inhibition of glutamate release from isolated cerebrocortical nerve terminals (sinaptosomes) by supression voltage-activated calcium channel activity. Neuroreport. 2001; 20 (100): 2255–8. DOI: 10.1097/00001756-200107200-00042
14. Карлов В.А. Эпилепсия у детей и взрослых женщин и мужчин. Руководство для врачей. 2-е изд. Москва: БИНОМ, 2019.
Karlov VA. Epilepsy in children and adult women and men. A guide for doctors. 2nd ed. Moscow: BINOM, 2019. (in Russian)
15. Tomson T, Battino D, Bromley R et al. Management of epilepsy in pregnancy: a report from the International League Against Epilepsy Task Force on Women and Pregnancy. Epilepsia. 2019; 21 (6): 497–17. DOI: 10.1684/epd.2019.1105
16. Тomson T, Battino D, Bonizzoni E et al. Declining malformation rates with changed antiepileptic drug prescribing: an observational study. Neurology. 2019; 93 (90): e831-e840. DOI: 10.1212/WNL. 0000000000008001
17. Морозова Т.В. Ведение беременных женщин с эпилепсией в Ульяновской области. Материалы заседания Совета Экспертов эпилептологического сообщества региона Волга. Самара. 15 ноября 2022.
Morozova TV. Management of pregnant women with epilepsy in the Ulyanovsk region. Materials of the meeting of the Council of Experts of the Epileptological community of the Volga region. Samara. November 15, 2022. (in Russian)
18. Shorvon SD et al. Antiepileptic drug treatment of generalized tonic–clonic seizures: An evaluation of regulatory data and five criteria for drug selection. Epilepsy Behavior. 2018; 82: 91–103. DOI: 10.1016/j.yebeh.2018.01.039
19. Stöllberger C, Finsterer J. Interactions between non-vitamin K oral anticoagulants and antiepileptic drugs. Epilepsy Res. 2016; 126: 98–101. DOI: 10.1016/j.eplepsyres.2016.06.003
20. Taha M, Li W, Schmidt CM et al. The interactions between anticonvulsants and non-vitamin K antagonist oral anticoagulant agents: A systematic review. Epilepsy Res. 2020; 162: 106304. DOI: 10.1016/j.eplepsyres.2020.106304
21. U.S. Food and Drug Administration. Medwatch: The FDA Safety Information and Adverse Event Reporting program. Available at: https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program. Accessed: May 26, 2020.
22. Larsson D et al. Association Between Antiseizure Drug Monotherapy and Mortality for Patients With Poststroke Epilepsy. JAMA Neurol. 2022; 79 (2): 169–75. DOI: 10.1001/jamaneurol.2021.4584
23. Клинические рекомендации. Ишемический инсульт и транзиторная ишемическая атака у взрослых. Москва, 2022. Available at: https://evidence-neurology.ru/evidentiary-medicine/klinicheskie-rekomendatsii
Clinical recommendations. Ischemic stroke and transient ischemic attack in adults. Moscow, 2022. Available at: https://evidence-neurology.ru/evidentiary-medicine/klinicheskie-rekomendatsii (in Russian)
24. Josephson CB, Lowerison M, Vallerand I et al. Association ofdepression and treated depression with epilepsy and seizure outcomes: a multicohort analysis. JAMA Neurol. 2017; 74 (5): 533–9. DOI: 10.1001/jamaneurol.2016.5042
25. Stephen LJ, Wishart A, Brodie MJ. Psychiatric side effects and antiepileptic drugs: observations from prospective audits. EpilepsyBehav 2017; 71 (Pt. A): 73–8. DOI: 10.1016/j.yebeh.2017.04.003
26. Fakhoury TA. Lamotrigine in patients with epilepsy and comorbid depressive symptoms. Epilepsy Behav. 2007; 10 (1): 155–62. DOI: 10.1016/j.yebeh.2006.11.003
27. Witt JA, Helmstaedter C. How can we overcome neuropsychological adverse effects of antiepileptic drugs? Expert Opin Pharmacother. 2017; 18 (6): 551–54. DOI: 0.1080/14656566.2017.1309025
28. Эпилепсия и эпилептический статус у взрослых и детей. Клинические рекомендации. Москва, 2022. URL: https://ruans.org/Text/Guidelines/ epilepsy-2022.pdf
Epilepsy and epileptic status in adults and children. Clinical recommendations. Moscow, 2022. URL: https://ruans.org/Text/Guidelines/epilepsy-2022.pdf (in Russian)
29. Бадалян О.Л., Савенков А.А. Возможные варианты применения препарата ламотриджин для эффективного лечения эпилепсии детей и подростков. Consilium Medicum. Neurology and Rheumatology. 2018; (1): 14–9.
Badalyan OL, Savenkov AA. Possible options for the use of lamotrigine for the effective treatment of epilepsy in children and adolescents. Consilium Medicum. Neurology and Rheumatology. 2018; (1): 14–9. (in Russian)
30. Пылаева О.А., Мухин К.Ю. Эффективность и переносимость Сейзара (ламотриджин) в лечении эпилепсии (опыт Института детской неврологии и эпилепсии им. Свт. Луки). РЖДН; 15 (2): 17–41.
Pylaeva OA, Mukhin KYu. Efficacy and tolerability of Seizar (lamotrigine) in the treatment of epilepsy (experience of the Institute of Pediatric Neurology and Epilepsy named after Svt. Luke). Rus J Pediatric Neurology. 2020; 15 (2): 17–41. (in Russian)
31. Мухин К.Ю. и др. Ламотриджин (Сейзар) в лечении эпилепсии: результаты 4-летнего применения препарата в Объединении медицинских учреждений по диагностике, лечению и реабилитации заболеваний нервной системы и эпилепсии им. Святителя Луки. РЖДН. 2022; 17 (3): 8–36.
Mukhin KYu et al. Lamotrigine (Seizar) in the treatment of epilepsy: results of 4-year use of the drug in the Association of Medical Institutions for the diagnosis, treatment and rehabilitation of diseases of the nervous system and epilepsy. St. Luke.Rus J Pediatric Neurology. 2022; 17 (3): 8–36. (in Russian)
32. Бархатов М.В. и др. Оценка эффективности и переносимости ламотриджина (Сейзар®) в лечении идиопатической генерализованной эпилепсии у лиц женского пола: многоцентровое исследование. Эпилепсия и пароксизмальные состояния. 2021; 13 (4): 325–37. DOI: 10.17749/2077-8333/epi.par.con.2021.103
Barkhatov MV et al. Evaluation of the efficacy and tolerability of lamotrigine (Sazar®) in the treatment of idiopathic generalized epilepsy in women: a multicenter study. Epilepsy and paroxysmal states. 2021; 13 (4): 325–37. DOI: 10.17749/2077-8333/epi.par.con.2021.103 (in Russian)
33. Карлов В.А. Эпилепсия и женщина – женщина найдена! Эпилепсия и пароксизмальные состояния. 2022; 14 (3): 227–41. DOI: 10.17749/2077-8333/epi.par.con.2022.125.
Karlov VA. Epilepsy and a woman – a woman has been found! Epilepsy and paroxysmal states. 2022; 14 (3): 227–41. DOI: 10.17749/2077-8333/epi.par.con.2022.125. (in Russian)
34. Пивоварова А.М., Горчханова З.К. Оценка эффективности и переносимости ламотриджина (Cейзар) в моно- и политерапии при генерализованных и фокальных эпилепсиях. опыт применения ламотриджина (Cейзар) в НИКИ педиатрии им. Ю.Е. Вельтищева за период 2019–2021 гг. Вестник эпилептологии. 2021; с. 19–29.
Pivovarova AM, Gorchkhanova ZK. Evaluation of the efficacy and tolerability of lamotrigine (Seizar) in mono- and polytherapy in generalized and focal epilepsy. the experience of using lamotrigine (Sazar) in the Veltischev Institute of Pediatrics for the period 2019–2021. Bulletin of Epileptology. 2021; pp.: 19–29. (in Russian)
35. Ларина И.В. Aктуальные вопросы ведения беременности у пациенток с эпилепсией. Вестник эпилептологии. 2021; с. 36–47.
Larina IV. Topical issues of pregnancy management in patients with epilepsy. Bulletin of Epileptology. 2021; pp.: 36–47. (in Russian)
For citation:Ermolenko N.A., Rudakova I.G., Kalmykova G.V. et al. Assessment of treatment efficacy and tolerability in patients with epilepsy: Materials of the meeting of the Central Federal District Neurologists-Epileptologists Expert Council. Moscow, December 10, 2022. Clinical review for general practice. 2023; 4 (6): 13–19 (In Russ.). DOI: 10.47407/kr2023.4.5.00266
All accepted articles publish licensed under a Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.