M. J. Brodie

Antiepileptic Drug Therapy and Sexual Function in Men with Epilepsy

Summary: Purpose: To study the effects of antiepileptic drugs (AEDs) on sex hormone levels and sexual activity in a group of men attending a hospital‐based epilepsy clinic.

Sexual Function in Women with Epilepsy

Summary: Purpose: To examine certain aspects of sexual behaviour and attitudes in a group of women with epilepsy using a validated questionnaire (Sexuality Experience Scales), and effects of antiepileptic drugs (AEDs) on sex hormone binding globulin (SHBG), total testosterone (TT), and free testosterone (FT).

Lamotrigine versus other antiepileptic drugs : a star rating system is born

Summary: With the launching worldwide of a range of new antiepileptic drugs (AEDs), the prescriber has a much wider choice than ever before. Comparative studies between new and established AEDs are few, and those between new AEDs are rarely performed. This report considers the strengths and weaknesses of nine new and established AEDs. Scores ranging from ‐2 to +2 are given under six headings: mechanism of action, pharmacokinetics, efficacy, side effects, drug interactions, and a comfort factor. Perceived advantages and disadvantages in their clinical use are summarized and a final “star rating” produced for each. This process is illustrated by a detailed critique of lamotrigine (LTG). The star system is intended to stimulate dialogue among epileptologists in reaching a consensus in the pharmacologic management of the epileptic patient.

Adjuvant Vigabatrin in Refractory Epilepsy: A Ceiling to Effective Dosage in Individual Patients?

A double‐blind, randomized, cross‐over study of additional vigabatrin (γ‐vinyl‐GABA, VGB, 1.0 g twice daily for 6 weeks, followed by 1.5 g twice daily for 6 weeks) and matched placebo was undertaken in 24 patients with refractory epilepsy. Nineteen completed the trial satisfactorily. Fewer seizure days were reported during VGB treatment [placebo 41, VGB 23, p < 0.05, 95% confidence interval (CI) −1.5 to −14]. An overall reduction in median seizure numbers failed to reach statistical significance (n = 19; placebo 52, VGB 32, NS, 95% CI −18 to + 24). Subgroup analysis, however, showed a significant reduction in partial seizures (n = 17) with 2 g VGB daily (placebo 22, VGB 13, p < 0.05, 95% CI −0.5 to −16.5), but not with higher dosage (placebo 28, VGB 22, NS, 95% CI − 18 to + 11). A deterioration in control of partial seizures as compared with the equivalent placebo phase was observed when patients were changed from 2 to 3 g/day VGB (2 g VGB 13, 3 g VGB 22, p = 0.05, 95% CI 0 to +20). Loss of efficacy was noted in 3 patients, and seizure control worsened slightly in 5 others. One previously resistant patient developed a therapeutic response, and 2 other patients reported an additional useful reduction in seizures. In the remaining 8 patients, seizure frequency did not change. VGB did not appear to benefit tonic‐clonic seizures. Serum VGB concentrations were higher during treatment with 3 g (15.5 ± 8.9 mg/L) daily than with 2 g (13.5 ± 11.2 mg/L). No important alterations were noted in the concentrations of concomitantly administered antiepileptic drugs (AEDs) throughout the trial. VGB is useful adjuvant therapy for treatment of partial seizures. There may be a ceiling to effective dosage. This demands individual dose titration for each patient.

An audit of treated epilepsy in Glasgow

An audit of patients receiving antiepileptic drug therapy for epilepsy was carried out in 25 general practices in Glasgow. Patients were identified from computerized records of repeat prescriptions for antiepileptic drugs. Overall, 1052 (0.72%) of 145,609 screened patients had treated epilepsy. Only 5% were children, while 19% were over 65 years. Twenty-nine per cent were diagnosed by a neurologist, and in 24% no record was available of who had made the diagnosis. Fifty per cent had tonic-clonic seizures only. Partial seizures occurred in 39%, absences in 4%, and myoclonic jerks in 3%. In only 39% of case records was current seizure control documented. Seventy-four per cent and 41% of patients had surface electroencephalography and computerized tomographic brain scanning, respectively. In more than 80% of patients the presence or absence of birth injury, febrile convulsions in childhood, and a family history of epilepsy were not mentioned. Seventy-six per cent of patients were receiving anticonvulsant monotherapy. The most commonly prescribed drugs were carbamazepine (43%), phenytoin (34%), sodium valproate (22%) and phenobarbitone (15%). Eighty-four per cent had attended a hospital clinic with their epilepsy, and 19% had been admitted to hospital with seizures or complications. A standard record form for the assessment and follow-up of epileptic patients in general practice would help in providing optimal management and in facilitating the setting up of a shared-care programme.