Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33238
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dc.contributor.authorTomson, Torbjörn-
dc.contributor.authorZelano, Johan-
dc.contributor.authorDang, Yew Li-
dc.contributor.authorPerucca, Piero-
dc.date2023-
dc.date.accessioned2023-07-14T02:26:47Z-
dc.date.available2023-07-14T02:26:47Z-
dc.date.issued2023-06-29-
dc.identifier.citationEpileptic Disorders : International Epilepsy Journal with Videotape 2023-06-29en_US
dc.identifier.issn1950-6945-
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/33238-
dc.description.abstractThe pharmacological treatment of epilepsy entails several critical decisions that need to be based on an individual careful risk-benefit analysis. These include when to initiate treatment and with which antiseizure medication (ASM). With more than 25 ASMs on the market, physicians have opportunities to tailor the treatment to individual patients´ needs. ASM selection is primarily based on the patient's type of epilepsy and spectrum of ASM efficacy, but several other factors must be considered. These include age, sex, comorbidities, and concomitant medications to mention the most important. Individual susceptibility to adverse drug effects, ease of use, costs, and personal preferences should also be taken into account. Once an ASM has been selected, the next step is to decide on an individual target maintenance dose and a titration scheme to reach this dose. When the clinical circumstances permit, a slow titration is generally preferred since it is associated with improved tolerability. The maintenance dose is adjusted based on the clinical response aiming at the lowest effective dose. Therapeutic drug monitoring can be of value in efforts to establish the optimal dose. If the first monotherapy fails to control seizures without significant adverse effects, the next step will be to gradually switch to an alternative monotherapy, or sometimes to add another ASM. If an add-on is considered, combining ASMs with different modes of action is usually recommended. Misdiagnosis of epilepsy, non-adherence and suboptimal dosing are frequent causes of treatment failure and should be excluded before a patient is regarded as drug-resistant. Other treatment modalities, including epilepsy surgery, neuromodulation, and dietary therapies, should be considered for truly drug-resistant patients. After some years of seizure freedom, the question of ASM withdrawal often arises. Although successful in many, withdrawal is also associated with risks and the decision needs to be based on careful risk-benefit analysis.en_US
dc.language.isoeng-
dc.subjectantiseizure medicationen_US
dc.subjectepilepsyen_US
dc.subjectpharmacotherapyen_US
dc.titleThe pharmacological treatment of epilepsy in adults.en_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleEpileptic Disorders : International Epilepsy Journal with Videotapeen_US
dc.identifier.affiliationDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.en_US
dc.identifier.affiliationDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Swet of Neurology, Sahlgrenska den.;DepartmenUniversity Hospital, Gothenburg, Sweden.;Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Gothenburg, Sweden.en_US
dc.identifier.affiliationComprehensive Epilepsy Programen_US
dc.identifier.affiliationEpilepsy Research Centre, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia.;Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.;Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.;Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.en_US
dc.identifier.affiliationMedicine (University of Melbourne)en_US
dc.identifier.doi10.1002/epd2.20093en_US
dc.type.contentTexten_US
dc.identifier.orcid0000-0003-0554-5352en_US
dc.identifier.orcid0000-0001-9445-4545en_US
dc.identifier.orcid0000-0002-0570-5398en_US
dc.identifier.orcid0000-0002-7855-7066en_US
dc.identifier.pubmedid37386690-
local.name.researcherPerucca, Piero
item.grantfulltextnone-
item.openairetypeJournal Article-
item.languageiso639-1en-
item.fulltextNo Fulltext-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.cerifentitytypePublications-
crisitem.author.deptNeurology-
crisitem.author.deptComprehensive Epilepsy Program-
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