ALTHOUGH THERE IS NO CURE FOR EPILEPSY, AROUND 70 PER CENT OF PEOPLE MAY BE CONSIDERED “SEIZURE FREE” WITH THE USE OF ANTIEPILEPTIC DRUGS
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epilepsy, and specialists must consider all available information in order to provide an individual with the correct diagnosis.
Treatment Although there is no cure for epilepsy, around 70 per cent of people may be considered “seizure free” with the use of antiepileptic drugs (AEDs). Treatment pathways are non-linear and the choice of AED is dependent on numerous factors such as seizure type, age, other medications and comorbidities. The AEDs discussed within this article are those commonly used to treat epilepsy and as such, will be regularly encountered by pharmacists. Particular counselling points are considered for each medication.
Lamotrigine Lamotrigine is offered first line if a patient is experiencing focal seizures, and if a patient is suffering generalised seizures, but sodium valproate is unsuitable. Lamotrigine is usually well tolerated by patients, though aggression, irritability and sleep disorders have been listed as common side effects and should be discussed
with patients newly taking lamotrigine. In addition, idiosyncratic reactions such as Stevens- Johnson syndrome occur in around five per cent of patients. Patients and their carers should also be alert for symptoms and signs suggestive of bone-marrow failure. Therefore, pharmacists should advise patients to report the appearance of any skin rashes, bruising, or infection, particularly those that appear when treatment begins or when dose adjustments occur.
Carbamazepine Carbamazepine is also offered first line if a patient is experiencing focal seizures as an alternative to lamotrigine. It is also useful in generalised seizures, with the exception of absence seizures and myoclonic jerks. There is a risk of idiosyncratic reactions such as Stevens-Johnson syndrome similarly to lamotrigine, therefore the same counselling points apply to carbamazepine. In addition, blurred vision, dizziness, nausea and vomiting are common symptoms often found when treatment is initiated and NICE guidelines suggest that controlled release formulations are
offered to patients taking carbamazepine. Furthermore, patients should be told how to recognise signs of blood and liver disorders, and advised to seek immediate medical attention if symptoms such as fever, rash, mouth ulcers, bruising, or bleeding develop.
Levetiracetam Levetiracetam should be avoided in those with mood disorders as around ten per cent of patients taking this drug experience mood changes such as irritability, aggression and depression. Otherwise, the drug is usually well tolerated by patients.
Sodium Valproate Sodium valproate should not be offered to women and girls of childbearing potential, unless other options are ineffective or not tolerated and a pregnancy prevention programme is in place. It is also contraindicated in patients with a history of severe hepatic dysfunction, as in rare cases the drug has been associated with hepatotoxicity. As such, pharmacists should encourage patients to report symptoms of blood and hepatic disorders, and pancreatitis (abdominal pain, nausea and vomiting). Furthermore, sodium valproate has been known to stimulate a patient’s appetite, and cause transient hair loss, so patients should be counselled accordingly.
Pharmacists are well placed to support patients newly diagnosed with epilepsy, whether that be through pharmacological treatment management, side effect management, or guidance on subjects such as driving, pregnancy or breastfeeding.
PHARMACISTS SHOULD ADVISE PATIENTS TO REPORT THE APPEARANCE OF ANY SKIN RASHES, BRUISING, OR INFECTION
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