Bergin AM, Connolly M. New antiepileptic drug therapies. Neurol Clin. 2002;20(4):1163-1175.
This is a review article of 12 recent or adjuvant anticonvulsants: topiramate, vigabatrin, oxcarbazepine, gabapentin, levetiracetam, zonisamide, lamotrigine, tiagabine, felbamate, fosphenytoin, sulthiame, and stiripentol. Mechanism of action and pharmokinetics are discussed, including peak plasma concentration time, half-life, and mechanism of elimination. Effects on more common monotherapeutic anticonvulsants are noted.
The authors cite numerous studies to note which medication is most efficacious for various seizure classifications. Common side effects are mentioned. A helpful guide to dosing and dispensing is also included. Several of the medications are not available in the United States. This may be beneficial for international readers and professionals here who treat patients referred from other countries.
Although the information presented is readily available in other sources, this article is a good, compact resource for those who are routinely involved with patients with posttraumatic seizures.
Chang BS, Lowenstein DH. Practice parameter: Antiepileptic drug prophylaxis in severe traumatic brain injury. Neurology. January 2003;60(1):10-16.
The Quality Standards Subcommittee of the American Academy of Neurology is assigned to develop practice parameters for neurologists. This report presents their recommendations regarding the prophylactic use of anticonvulsants in patients with severe traumatic brain injury. More specifically, does the prophylactic use of anticonvulsants reduce the risk of early seizures? And, second, does prophylactic use of anticonvulsants decrease the risk of late posttraumatic seizures?
Close to 1,000 references were identified. After screening these references, 54 articles, which addressed the clinical use of anticonvulsants for posttraumatic seizure prophylaxis in humans, were identified. Articles were then graded (classes I-IV) based on the quality of the evidence with Class I assigned to low risk of bias (randomized, masked, placebo/controlled studies) and Class IV consisting of studies with high risk of bias such as uncontrolled studies, case reports, and expert opinion.
The committee's conclusions are consistent with recommendations made previously by other national organizations. There was sufficient evidence to recommend use of phenytoin to reduce the risk of early posttraumatic seizures. There was no clear evidence for use of prophylactic anticonvulsants beyond that period.
Recommendations for future research were also made. Topics for consideration include use of seizure prophylaxis in moderate and mild brain injury, studies specifically directed at the pediatric population, and use of electroencephalograph in traumatic brain injury.
The definitions of early and late seizures are discussed. Seven days is the most widely used dividing point for early and late seizures. The committee found this distinction to be arbitrary and has recommended a more rational definition. It notes that seizures that may occur in the first month after injury are not early seizures but clearly may have more significance than those that occur months later. The committee also found several studies that defined early seizures as 1-4 weeks after injury. The committee believes if data were collected with strict time guidelines, current treatment standards could be altered.
The information contained in this report is not new. However, it may be a useful resource when coordinating management of seizures with a neurologist.