Recommendations for the treatment of epilepsy in adult patients in general practice in Belgium: an update.

Paul Boon,Kenou Van Rijckevorsel,Michel Ossemann,Katrien Smets,Henri Hauman,Lieven Lagae,Etienne Urbain,Benjamin Legros,An Jansen,Sebastiaan Engelborghs,Bernard Sadzot

doi:10.1007/s13760-012-0070-9

Abstract

In 2008, a group of Belgian epilepsy experts published recommendations for antiepileptic drug (AED) treatment of epilepsies in adults and children. Selection of compounds was based on the registration and reimbursement status in Belgium, the level of evidence for efficacy, common daily practice and the personal views and experiences of the authors. In November 2011 the validity of these recommendations was reviewed by the same group of Belgian epilepsy experts who contributed to the preparation of the original paper. The recommendations made in 2008 for initial monotherapy in paediatric patients were still considered to be valid, except for the first choice treatment for childhood absence epilepsy. This update therefore focuses on the treatment recommendations for initial monotherapy and add-on treatment in adult patients. Several other relevant aspects of treatment with AEDs are addressed, including considerations for optimal combination of AEDs (rational polytherapy), pharmacokinetic properties, pharmacodynamic and pharmacokinetic interaction profile, adverse effects, comorbidity, treatment of elderly patients, AED treatment during pregnancy, and generic substitution of AEDs.

Highlights

The number of antiepileptic drugs (AEDs) currently registered in Belgium is considerable and still increasing
In 2008, recommendations for the AED treatment of epilepsies in general practice in Belgium were published [1]. These recommendations were prepared by a group of Belgian epilepsy experts, based on guidelines for the treatment of epilepsies published by the International League against Epilepsy (ILAE, 2006 [2]), the American Academy of Neurology (AAN, 2004 [3, 4]), the Scottish Intercollegiate Guidelines Network (SIGN, 2003 [5]), and the UK National Institute for Clinical Excellence (NICE, 2004 [6]), and relevant publications of controlled clinical trials with AEDs published after the cut-off dates used in these guidelines
The discussions resulted in recommendations for initial monotherapy and add-on treatment in adults and for initial monotherapy in paediatric patients (\16 years) [1]

Summary

Introduction

The number of antiepileptic drugs (AEDs) currently registered in Belgium is considerable and still increasing. To provide guidance for the management of epilepsy in general practice in Belgium, a group of experts published recommendations for AED treatment of epilepsies in adults and children in 2008 [1]. The following definitions are used in the present paper: First choice First treatment choice Alternative first choice Compound recommended when certain patient factors (e.g. comorbidity, concomitant medication) or AED-related factors (e.g. pharmacokinetic properties, interaction potential, contraindications, adverse effect profile) preclude the use of the first choice compound.

Results

Conclusion