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| PARTICIPANTS |
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William Rosenfeld, MD
Director, Comprehensive Epilepsy Care Center for Children and Adults, PC, St. Luke's Hospital
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Blanca Vazquez, MD
Director, Clinical Trials Epilepsy Program, New York University Medical Center
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| EDITORIAL CONSULTANT |
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WILLIAM ROSENFELD, MD: What happens with epilepsy is that there's some abnormal brain discharges. We all have millions of normally functioning brain cells. What happens is: Think of it as telephone wires. If one or two wires are at fault, the telephone doesn't work. Well, that's the same thing that happens with epilepsy.
ANNOUNCER: Epilepsy is a neurologic condition that makes people susceptible to seizures. A seizure causes a brief change in sensation, awareness, or behavior.
WILLIAM ROSENFELD, MD: In adults probably 75 to 85% of seizures start focal or partial in onset. With those seizures, sometimes the patient may just get a funny feeling in an arm or a leg, or an urge to go the bathroom or may have some visual or auditory hallucinations and that, by the way is called a partial simple seizure.
With alteration or loss of consciousness, that's what we call a partial complex seizure. What that can simply be is as simple as staring straight ahead. Many times the patient will have some lip-smacking or automatic movements or picking at their clothing. Many people are familiar with the grand mal or generalized tonic-clonic seizure, where someone may fall to the ground and have generalized stiffening and jerking of the body.
ANNOUNCER: It turns out that a substantial number of Americans have some form of epilepsy.
It's a very common disorder. It occurs, on a conservative estimate, at least 1% of the population, maybe as high as three out of every 100 people could be defined as having epilepsy.
ANNOUNCER: For many years there have been medications to control seizures, but there are some drawbacks to these drugs.
BLANCA VAZQUEZ, MD: Those medicines have side effects for being more tired. Some of them can produce osteoporosis or weakening of the bones. Some of them produce imbalance of hormones and may have long-term side effects of not learning or having more difficulty with cognition.
ANNOUNCER: Now, there is a new group of medications that also controls the symptoms of epilepsy. They may be easier for a patient to tolerate than the older drugs.
WILLIAM ROSENFELD, MD: The newer drugs have less potential side effects than the older drugs. The newer drugs will often have less problems in terms of cognitive side effects.
Of the newer anticonvulsants, there are several that I feel are particularly the most efficacious, and that's where I would probably put oxcarbazepine and Topiramate. The others fall probably somewhere in between, and that includes lamotrigine, levetiracetam and zonisamide.
The biggest asset is that if they're equally effective, you clearly would rather be on the drug that gives you at least the same or better efficacy and less problems.
ANNOUNCER: Eliminating seizures is, of course, the most important goal, but there are other considerations in deciding on therapy
WILLIAM ROSENFELD, MD: The second part is that patients would like to be on monotherapy if at all possible, meaning by that one-drug therapy. And the reason is, if you can take one drug, there is less potential for side effects to the patient.
ANNOUNCER: This is good news for those with partial epilepsy, a form of the condition that affects a majority of patients.
BLANCA VAZQUEZ, MD: The newer generations of drugs are approved for partial epilepsy. In monotherapy, we have two: lamotrigine and Trileptal.
While taking one drug can help avoid side effects, it also cuts down the chances for drug interaction
ANNOUNCER: If you use two medicines, they can potentially add side effects So monotherapy continues to be the gold standard to treat epilepsy.
WILLIAM ROSENFELD, MD: Whenever possible, you'd always like to go for monotherapy right from the start. Now, many patients are already on one drug and we add a second drug on with the hope of getting them to monotherapy with the second drug.
If the new drug is then doing well, I try to slowly taper the other drug off. To, in other words, convert the patient to monotherapy.
ANNOUNCER: However for some patients, a cocktail of more than one drug is the answer.
WILLIAM ROSENFELD, MD: I think the days of being on three-, four-, five-drug therapy should clearly be over or lessened. But there are some patients that simply need two drugs to control their epilepsy, and in a few rare cases, more than that.
ANNOUNCER: Decreasing side effects without losing effectiveness is important to people with epilepsy. Now that, plus the goal of freedom from seizures seems more attainable than ever.
BLANCA VAZQUEZ, MD: When we simplify the regimen, we use one drug in monotherapy, the side effects are better, better tolerated, less complex in terms of interaction. With the new drugs, we believe strongly that the best advantage is cognition. Patients feel better. They're more able to understand; they're more able to function and work and be able to lead the quality of life that we aim for.
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