The safety of treating newly diagnosed epilepsy

ABSTRACT

Introduction: Epilepsy is a serious chronic neurological disorder manifested by an enduring symptomatic predisposition to seizures. Newly diagnosed individuals face increased morbidity, mortality, and socioeconomic costs. Anti-epileptic drug therapy is the treatment usually prescribed, which has efficacy in seizure control and mitigating long-term mortality.

Areas covered: Safety of anti-epileptic drug therapy in adults with a focus in newly diagnosed patients. Areas covered include the most commonly experienced adverse drug effects, as well as those with the highest impacts on drug tolerability, quality of life, morbidity and mortality. Evidence was also reviewed to identify clinical strategies to improve the safety of anti-epileptic drug therapy.

Expert opinion: Anti-epileptic drugs (AEDs) are mostly effective and well tolerated. However, a lack of standardised reporting of adverse drug effects in trials and in clinical practice provides an obstacle for evaluation of which adverse drug effects need to be prioritised in management. Improvement in the reporting of cognitive and other effects, as well as improved precision medicine and pharmacogenomics to target the incidence of high-mortality idiosyncratic reactions, will help to reduce the harm of AEDs in people newly diagnosed with epilepsy.

KEYWORDS:

• Epilepsy
• anti-epileptic drug therapy
• pharmacogenomics
• precision medicine
• safety in treating epilepsy

Article highlights

• Anti-epileptic drugs are both tolerable and effective for most patients with newly diagnosed epilepsy

• Numerous study designs have been used to assess adverse effect profiles and clinical safety comparing different anti-epileptic drugs

• Anti-epileptic drug adverse effects are an important barrier to achieving seizure freedom and these can be dose-related, idiosyncratic, chronic, teratogenic or due to drug interactions

• Individuals with epilepsy are at particular risk of cognitive adverse drug effects and the systematic assessment of these is poor

• Advances in pharmacogenomics will assist in identifying people vulnerable to severe idiosyncratic drug reactions

This box summarizes the key points contained in the article.

Declaration of interest

P Kwan received grants and non-financial support from UCB Pharma while conducting the present study. P Kwan also received grants from Biscayne, grants and personal fees from Eisai, grants from GW Pharmaceuticals, grants, and personal fees from LivaNova, grants and personal fees from UCB Pharma, and grants from Zynerba outside of the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

P Kwan is supported by the Medical Research Future Fund Practitioner Fellowship (APP1136427).