12/26/2023 0 Comments Nocturnal epilepsy cure![]() ![]() ![]() The pharmacokinetics of some AEDs are non-linear, so specialist knowledge is needed to interpret drug levels. Regular blood test monitoring is not recommended as routine and should be done only if clinically indicated.Positive relationships between healthcare professionals, the child, young person or adult with epilepsy and their family and/or carers.Reducing the stigma associated with the condition. ![]() Educating children, young people and adults and their families and/or carers in the understanding of their condition and the rationale of treatment.Adherence to treatment can be optimised with the following:.If management is straightforward, continuing AED therapy can be prescribed in primary care if local pathways and/or licensing allow.Continuing AED therapy should be planned by a specialist as part of an agreed treatment plan and the needs of the child, young person or adult and their family and/or carers should be taken into account.Maintain a high level of vigilance for adverse effects of treatment.Routine switching between different manufacturers of AEDs should be avoided. Formulations of AEDs are not interchangeable and generic substitution should not be routinely made.The effect may be monitored by patient-recorded seizure frequency. The dose of each medication should be titrated slowly to the maximally tolerated dose or the maximum level as recommended in the British National Formulary.Brain imaging shows a structural abnormality.The patient or their family or carers consider the risk of having a further seizure unacceptable.The electroencephalograph (EEG) shows unequivocal epileptic activity (however a normal EEG should not be used to exclude the diagnosis of epilepsy, and should prompt consideration of a sleep-deprived EEG).AED therapy should be considered and discussed after a first unprovoked seizure if: Treatment with AED therapy is generally recommended after a second epileptic seizure.AED therapy should be initiated by a specialist. AED therapy should only be started once the diagnosis of epilepsy is confirmed, except in exceptional circumstances.Be aware that some drugs used in clinical practice can exacerbate seizures in those with absence or myoclonic seizures, including juvenile myoclonic epilepsy.Third-line add-on treatments include phenobarbital, phenytoin, tiagabine and vigabatrin.At this point, management in a tertiary service should be considered and NICE makes this mandatory if cenobamate is used. If all of the first-line add-on therapies are unsuccessful, consider second-line add-on therapies brivaracetam, cenobamate, eslicarbazepine acetate, perampanel, pregabalin or sodium valproate (within MHRA guidance on pregnancy).If monotherapy is unsuccessful, consider any of the drugs listed above, or topiramate, as first-line add-on options, considering other drugs from this list if the first one tried is unsuccessful.Consider lacosamide as third-line monotherapy if all the second-line drugs are unsuccessful.Try all of these three in turn if the first one is unsuccessful. If both of these first-line monotherapies are unsuccessful, consider a second-line monotherapy option, choosing between carbamazepine, oxcarbazepine or zonisamide.First-line treatment: offer lamotrigine or levetiracetam, moving to the other of these two drugs if the first one tried is unsuccessful.Unsuccessful treatment is defined as treatment which either does not reduce or stop seizures, or has intolerable side-effects. The National Institute for Health and Care Excellence (NICE) advice on treatment of focal seizures is as follows. Withdrawal of medication, if wanted, should be done slowly, with the acknowledgement that it always carries a risk of further seizures. The chances of remission vary with the type of epilepsy, the response to antiepileptic drugs ( AEDs) and the frequency of seizures. Approximately 70% of all adults and children with epilepsy will go into remission. Not all epilepsy is lifelong and it is defined as having resolved when people have remained seizure-free for more than ten years, with no drug treatment for at least five years. Antiepileptic drugs used for focal seizures ![]()
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