Abstract
To guide health care professionals in Belgium in selecting the appropriate antiepileptic drugs (AEDs) for their epilepsy patients, a group of Belgian epilepsy experts developed recommendations for AED treatment in adults and children (initial recommendations in 2008, updated in 2012). As new drugs have become available, others have been withdrawn, new indications have been approved and recommendations for pregnant women have changed, a new update was pertinent. A group of Belgian epilepsy experts (partly overlapping with the group in charge of the 2008/2012 recommendations) evaluated the most recent international guidelines and relevant literature for their applicability to the Belgian situation (registration status, reimbursement, clinical practice) and updated the recommendations for initial monotherapy in adults and children and add-on treatment in adults. Recommendations for add-on treatment in children were also included (not covered in the 2008/2012 publications). Like the 2008/2012 publications, the current update also covers other important aspects related to the management of epilepsy, including the importance of early referral in drug-resistant epilepsy, pharmacokinetic properties and tolerability of AEDs, comorbidities, specific considerations in elderly and pregnant patients, generic substitution and the rapidly evolving field of precision medicine.
Highlights
Epilepsy is one of the most common neurological diseases, affecting approximately 50,000,000 people worldwide [1]
The initial recommendations for the management of epilepsy in general neurological practice in Belgium [6] and the updated recommendations [7] were based on guidelines by the ILAE [14], the American Academy of Neurology (AAN [15, 16]), the Scottish Intercollegiate Guidelines Network (SIGN [17]) and the United Kingdom National Institute for Health and Care Excellence (NICE [18]), and relevant articles on controlled clinical trials published after the cut-off dates used in these guidelines
No updates to the ILAE guidelines were found but an updated evidence review of antiepileptic drugs (AEDs) efficacy and effectiveness as initial monotherapy was published in 2013 [23], and a report on the management of epilepsy during pregnancy in 2019 [24]
Summary
Epilepsy is one of the most common neurological diseases, affecting approximately 50,000,000 people worldwide [1]. In 2017, the International League Against Epilepsy (ILAE) updated their classification of seizure types, using seizure onset as their basis. More than 20 different AEDs are registered in Belgium [5] While this large number allows tailoring treatment to individual patients’ needs, it makes selection of the most suitable compound complex. To guide health care professionals in Belgium in making this choice, a group of experts developed recommendations for the management of epilepsy in adults and children in general neurological practice in Belgium in 2008 [6] and updated these in.
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