神经系统疾病

Successful, Short-Term Drug Exchange Protocol in Epilepsy: Transient Addon of Intravenous Anti-Epileptic Drugs

Abstract

Tomofumi Fukuda, Masayuki Shimono, Masahiro Ishii, Ayako Senju, Yumeko Matsuda, Shiho Takano, Naoki Shiota and Koichi Kusuhara

Newer antiepileptic drugs (AEDs) are supposed to be more beneficial at controlling seizures than older AEDs. We substituted newer AEDs for older AEDs while conducting a transient add-on of an intravenous (IV) antiepileptic drug (AED) as a base therapy (AED adjustment), and in the present paper we evaluate the efficacy and safety of this method. The study participants were 40 consecutive referral patients with intractable epilepsy who had been treated with two or more AEDs but had epileptic seizure which spoiled their quality of life. Five of the patients were excluded because any IV AEDs exacerbated their clinical seizures and electro-encephalography (EEG). The mean age of the remaining 35 patients was 7.5 (range: 1.2 - 20.5). The patients had been on two to five AEDs (mean 3.3), and experienced seizures ranging from 0.2 to 100 times/day (mean 13.0). We kept the patients on one or two key oral AEDs and terminated the other oral AEDs simultaneously while they were treated with a base IV AED. After adjusting their dose, the patients were on two to four oral AEDs (mean 2.8) two years later, and the frequency of seizures was reduced to 0 to 10 times/day (mean 1.4). It took about one month of hospitalization to adjust the AEDs, and both seizure frequency and the number of drugs decreased significantly after AED adjustment (p<0.001). There were no serious side effects of clinical seizures or in their blood and chemistry tests. The adjusted AEDs included newer ones, and the older ones were still necessary. AED adjustment was possible and useful for epileptic patients once a transient add-on of intravenous antiepileptic drugs was done.