Elsicarbazepine Appears to be a Good Option for Focal Seizures

Newer drugs like elsicarbazepine are useful in the treatment of partial-onset seizures, now referred to as focal seizures. A review on this and other new treatments for focal seizures was published in the US Pharmacist. Focal seizures are seizures that affect only a part of the body. During a focal seizure, the patient may be fully conscious, in which case it is referred to as a focal seizure without dyscognitive features. In other cases where the patient is unable to respond during the focal seizure and loses awareness of the environment, the seizure is called a focal seizure with dyscognitive features. Patients with dyscognitive seizures remain disoriented for some time following the seizure.

It must be noted that not all people who suffer from seizures suffer from epilepsy. Epilepsy is said to be present if the patient suffers from two unprovoked seizures more than 24 hours apart, or one unprovoked seizure with a high chance of developing more over the next 10 years, or is diagnosed with an epilepsy syndrome.

Medications that are used in the treatment of focal seizures include the older drugs like carbamazepine, phenytoin, valproate, phenobarbital as well as the relatively newer drugs levetiracetam, lamotrigine, gabapentin, lacosamide, oxcarbazepine, topiramate, vigabatrin and zonisamide.

The article discussed some of the newly approved drugs approved for the treatment of focal seizures, which are mentioned below:

Elsicarbazepine is similar to the older anti-epileptics carbamazepine and oxcarbazepine in structure and mechanism of action. Some of its characteristics include the following:

• Elsicarbazepine does not induce its own metabolism but can interact with other treatments that the patient takes including oral contraceptives, warfarin, any statins or clopidogrel.
• Its dosage should be reduced to half in patients with moderate-to-severe kidney failure. It should not be used in patients with severe liver disease.
• It is administered once a day, which is very convenient for the patient. The initial dosage is 400 mg per day which can be increased to 800 to 1600 mg/day.
• Side effects include dizziness, drowsiness, nausea, headache, vomiting, fatigue, blurred vision, double vision, tremors, rash and reduced blood sodium levels. It may also damage the liver and cause thyroid hormone abnormalities.
• The medication should be tapered down slowly when it is decided to reduce the dosage to prevent withdrawal symptoms.

Other newer drugs that have recently obtained approval for the treatment of focal seizures include:

Brivaracetam, which is similar to levetiracetam, perampanel and lacosamide. Another drug ezogabine can cause permanent vision loss and is therefore approved only for those patients who have failed other treatments for focal seizures, and in whom the benefit of taking the medication outweighs the risk.

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The authors also emphasize the importance of the pharmacist in epilepsy treatment. Once the drug is prescribed for the treatment of epilepsy, the pharmacist could counsel the patient to ensure that the patient takes the medication correctly to achieve maximum benefit of the treatment.

Reference:

1. Barton L, Gore L, Hornekar J, Hilaire M. Eslicarbazepine and Other Treatment Advances for Focal Seizures. US Pharm. 2017;42(1):HS21-HS24

Source-Medindia