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A P Sempere - One of the best experts on this subject based on the ideXlab platform.
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[Generic drugs in the Treatment of Epilepsy].
Rev. Neurol., 2005Co-Authors: J. González De Dios, C Ochoa-sangrador, A P SempereAbstract:AIM: We discuss some controversial aspects with prescription of generic drugs (GD) and the problems concerning bioequivalence, mainly in the case of drugs with non-linear pharmacokinetics and/or narrow therapeutic rank, like the antiepileptic drugs (AED). DEVELOPMENT: There is considerable debate about GD in the Treatment of Epilepsy, with clearly advantages (cost saving) and disadvantages (loss of seizure control or drug toxicity) in prescribing generics anticonvulsants. We make a systematic review of the literature in primary (PubMed) and secondary (Tripdatabase and Cochrane Library) bibliographic databases in relation to GD and AED. The main information is about classical AED (phenytoin, carbamazepine, valproic acid and primidone) and we don't found studies in this area about the new AED. The level of evidence is, generally, weak, based on case-series and expert opinion without explicit critical appraisal (except in phenytoin with level of evidence moderate, based on some analytical studies). In Spain, at this moment, there are only two generic AED, one-classical (carbamazepine) and one-new (gabapentin). CONCLUSION: The American Academy of Neurology and Epilepsy Foundation maintains that the individual and physician should be notified and give their consent before a switch in antiepileptic medications is made, whether it involves generic substitution for brand name products, or generic to generic substitutions.
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Generic drugs in the Treatment of Epilepsy
REVISTA DE NEUROLOGIA, 2005Co-Authors: J G De Dios, C Ochoa-sangrador, A P SempereAbstract:Aim. We discuss some controversial aspects with prescription of generic\ndrugs (GD) and the problems concerning bioequivalence, mainly in the\ncase of drugs with non-linear pharmacokinetics and/or narrow therapeutic\nrank, like the antiepileptic drugs (AED). Development. There is\nconsiderable debate about GD in the Treatment of Epilepsy, with clearly\nadvantages (cost saving) and disadvantages (loos of seizure control or\ndrug toxicity) in prescribing generics anticonvulsivants. We make a\nsystematic review of the literature in primary (PubMed) and secondary\n(Tripdatabase and Cochrane Library) bibliographic databases in relation\nto GD and AED. The main information is about classical AED (phenytoin,\ncarbamazepine, valproic acid and primidone) and we don't found studies\nin this area about the new AED. The level of evidence is, generally,\nweak, based on case-series and expert opinion without explicit critical\nappraisal (except in phenytoin with level of evidence moderate, based on\nsome analytical studies). In Spain, at this moment, there are only two\ngeneric AED, one-classical (carbamazepine) and one-new (gabapentin).\nConclusion. The American Academy of Neurology and Epilepsy Foundation\nmaintains that the individual and physician should be notified and give\ntheir consent before a switch in antiepileptic medications is made,\nwhether it involves generic substitution for brand name products, or\ngeneric to generic substitutions.
Dieter Schmidt - One of the best experts on this subject based on the ideXlab platform.
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drug Treatment of Epilepsy in adults
BMJ, 2014Co-Authors: Dieter Schmidt, Steven C SchachterAbstract:Epilepsy is a serious, potentially life shortening brain disorder, the symptoms of which can be successfully treated in most patients with one or more antiepileptic drug. About two in three adults with new onset Epilepsy will achieve lasting seizure remission on or off these drugs, although around half will experience mild to moderately severe adverse effects. Patients with Epilepsy, especially the 20-30% whose seizures are not fully controlled with available drugs (drug resistant Epilepsy), have a significantly increased risk of death, as well as psychiatric and somatic comorbidities, and adverse effects from antiepileptic drugs. Newer drugs have brought more Treatment options, and some such as levetiracetam cause fewer drug interactions and less hypersensitivity than older ones. However, they do not reduce the prevalence of drug resistant Epilepsy or prevent the development of Epilepsy in patients at high risk, such as those with a traumatic brain injury. The development of antiepileptic drugs urgently needs to be revitalized so that we can discover more effective antiseizure drugs for the Treatment of drug resistant Epilepsy, including catastrophic forms. Antiepileptogenic agents to prevent Epilepsy before the first seizure in at risk patients and disease modifying agents to control ongoing severe Epilepsy associated with progressive underlying disease are also needed.
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drug Treatment of Epilepsy options and limitations
Epilepsy & Behavior, 2009Co-Authors: Dieter SchmidtAbstract:The modern antiepileptic drug (AED) era—spanning a period of more than 150 years from the first use of bromide in 1857 to 2008—has seen the introduction into clinical practice of a diverse group of effective and safe drugs. These AEDs have provided considerable benefits for those afflicted with Epilepsy of all kinds. In as many as 60–70% of newly treated patients, current AEDs lead to satisfactory control of seizures and a favorable risk–benefit balance for the great majority of patients, albeit with considerable differences in response depending on the type of seizure and Epilepsy syndrome and rare serious adverse events. Unfortunately, in 20–30% of patients, Epilepsy cannot be controlled. Patients with drug-resistant Epilepsy often have serious comorbidity, including injury, depression, anxiety, and increased mortality. The aim of antiepileptic Treatment should be to control seizures as quickly as possible with no or minimal side effects and with no negative impact on the quality of life. Improved seizure control is likely to reduce the morbidity and increased mortality associated with uncontrolled Epilepsy. In this short overview, the options and the limitations of treating patients with Epilepsy are briefly summarized. Antiepileptic drugs provide satisfactory control of seizures for most patients with Epilepsy. Seizures in about 65% of patients with new-onset Epilepsy respond, seizure recurrence occurs in 5%, and 35% have uncontrolled Epilepsy. Seizure precipitation can be avoided by lifestyle changes, particularly in adolescents with idiopathic generalized Epilepsy. If two or three drug regimens have not brought complete seizure control, the diagnosis of Epilepsy and of the Epilepsy syndrome should be reevaluated, and if refractory Epilepsy is confirmed, surgical options should be considered in suitable candidates. In this short overview, the options and the limitations of treating patients with Epilepsy are briefly summarized. For extensive discussion and detailed references, see textbooks and monographs [1–3].
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the clinical impact of pharmacogenetics on the Treatment of Epilepsy
Epilepsia, 2009Co-Authors: Wolfgang Loscher, Ulrich Klotz, Fritz Zimprich, Dieter SchmidtAbstract:Summary Drug Treatment of Epilepsy is characterized by unpredictability of efficacy, adverse drug reactions, and optimal doses in individual patients, which, at least in part, is a consequence of genetic variation. Since genetic variability in drug metabolism was reported to affect the Treatment with phenytoin more than 25 years ago, the ultimate goal of pharmacogenetics is to use the genetic makeup of an individual to predict drug response and efficacy, as well as potential adverse drug events. However, determining the practical relevance of pharmacogenetic variants remains difficult, in part because of problems with study design and replication. This article reviews the published work with particular emphasis on pharmacogenetic alterations that may affect efficacy, tolerability, and safety of antiepileptic drugs (AEDs), including variation in genes encoding drug target (SCN1A), drug transport (ABCB1), drug metabolizing (CYP2C9, CYP2C19), and human leucocyte antigen (HLA) proteins. Although the current studies associating particular genes and their variants with seizure control or adverse events have inherent weaknesses and have not provided unifying conclusions, several results, for example that Asian patients with a particular HLA allele, HLA-B*1502, are at a higher risk for Stevens-Johnson syndrome when using carbamazepine, are helpful to increase our knowledge how genetic variation affects the Treatment of Epilepsy. Although genetic testing raises ethical and social issues, a better understanding of the genetic influences on Epilepsy outcome is key to developing the much needed new therapeutic strategies for individuals with Epilepsy.
J. González De Dios - One of the best experts on this subject based on the ideXlab platform.
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[Generic drugs in the Treatment of Epilepsy].
Rev. Neurol., 2005Co-Authors: J. González De Dios, C Ochoa-sangrador, A P SempereAbstract:AIM: We discuss some controversial aspects with prescription of generic drugs (GD) and the problems concerning bioequivalence, mainly in the case of drugs with non-linear pharmacokinetics and/or narrow therapeutic rank, like the antiepileptic drugs (AED). DEVELOPMENT: There is considerable debate about GD in the Treatment of Epilepsy, with clearly advantages (cost saving) and disadvantages (loss of seizure control or drug toxicity) in prescribing generics anticonvulsants. We make a systematic review of the literature in primary (PubMed) and secondary (Tripdatabase and Cochrane Library) bibliographic databases in relation to GD and AED. The main information is about classical AED (phenytoin, carbamazepine, valproic acid and primidone) and we don't found studies in this area about the new AED. The level of evidence is, generally, weak, based on case-series and expert opinion without explicit critical appraisal (except in phenytoin with level of evidence moderate, based on some analytical studies). In Spain, at this moment, there are only two generic AED, one-classical (carbamazepine) and one-new (gabapentin). CONCLUSION: The American Academy of Neurology and Epilepsy Foundation maintains that the individual and physician should be notified and give their consent before a switch in antiepileptic medications is made, whether it involves generic substitution for brand name products, or generic to generic substitutions.
C Ochoa-sangrador - One of the best experts on this subject based on the ideXlab platform.
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[Generic drugs in the Treatment of Epilepsy].
Rev. Neurol., 2005Co-Authors: J. González De Dios, C Ochoa-sangrador, A P SempereAbstract:AIM: We discuss some controversial aspects with prescription of generic drugs (GD) and the problems concerning bioequivalence, mainly in the case of drugs with non-linear pharmacokinetics and/or narrow therapeutic rank, like the antiepileptic drugs (AED). DEVELOPMENT: There is considerable debate about GD in the Treatment of Epilepsy, with clearly advantages (cost saving) and disadvantages (loss of seizure control or drug toxicity) in prescribing generics anticonvulsants. We make a systematic review of the literature in primary (PubMed) and secondary (Tripdatabase and Cochrane Library) bibliographic databases in relation to GD and AED. The main information is about classical AED (phenytoin, carbamazepine, valproic acid and primidone) and we don't found studies in this area about the new AED. The level of evidence is, generally, weak, based on case-series and expert opinion without explicit critical appraisal (except in phenytoin with level of evidence moderate, based on some analytical studies). In Spain, at this moment, there are only two generic AED, one-classical (carbamazepine) and one-new (gabapentin). CONCLUSION: The American Academy of Neurology and Epilepsy Foundation maintains that the individual and physician should be notified and give their consent before a switch in antiepileptic medications is made, whether it involves generic substitution for brand name products, or generic to generic substitutions.
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Generic drugs in the Treatment of Epilepsy
REVISTA DE NEUROLOGIA, 2005Co-Authors: J G De Dios, C Ochoa-sangrador, A P SempereAbstract:Aim. We discuss some controversial aspects with prescription of generic\ndrugs (GD) and the problems concerning bioequivalence, mainly in the\ncase of drugs with non-linear pharmacokinetics and/or narrow therapeutic\nrank, like the antiepileptic drugs (AED). Development. There is\nconsiderable debate about GD in the Treatment of Epilepsy, with clearly\nadvantages (cost saving) and disadvantages (loos of seizure control or\ndrug toxicity) in prescribing generics anticonvulsivants. We make a\nsystematic review of the literature in primary (PubMed) and secondary\n(Tripdatabase and Cochrane Library) bibliographic databases in relation\nto GD and AED. The main information is about classical AED (phenytoin,\ncarbamazepine, valproic acid and primidone) and we don't found studies\nin this area about the new AED. The level of evidence is, generally,\nweak, based on case-series and expert opinion without explicit critical\nappraisal (except in phenytoin with level of evidence moderate, based on\nsome analytical studies). In Spain, at this moment, there are only two\ngeneric AED, one-classical (carbamazepine) and one-new (gabapentin).\nConclusion. The American Academy of Neurology and Epilepsy Foundation\nmaintains that the individual and physician should be notified and give\ntheir consent before a switch in antiepileptic medications is made,\nwhether it involves generic substitution for brand name products, or\ngeneric to generic substitutions.
Lennart Gram - One of the best experts on this subject based on the ideXlab platform.
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Drug Treatment of Epilepsy in the 1990s
Drugs, 1996Co-Authors: Anne Sabers, Lennart GramAbstract:There have been significant advances in the medical Treatment of Epilepsy in recent years. Improved formulations of several classical antiepileptic drugs (AEDs) have appeared, resulting in improved efficacy and decreased toxicity. A marked increase in the number of comparative investigations of AEDs has also made Treatment choice somewhat simpler. Rational methods applied in the search for new AEDs have resulted in the introduction of several new AEDs. So far, evidence seems to indicate that progress has been made with regard to developing compounds not necessarily with superior efficacy but with simpler pharmacokinetics, avoiding enzyme induction as well as decreasing the number of interactions, and improving adverse effect profiles, in comparison to the previous generation of AEDs. A novel approach to the clinical testing of AEDs has made. it possible to demonstrate unequivocal efficacy, as well as efficacy as mono-therapy, very early in the development of novel compounds. Results of studies from developing countries seem to raise doubt with regard to the value of the old dogmatic principle that early Treatment is important in terms of the long term prognosis for seizure control. Traditional ideas on the value of monotherapy have also been questioned on the basis of a novel concept of so-called ‘rational polytherapy’ which, however, still await scientific validation. On the basis of excellent epidemiological and large controlled clinical studies, our ideas of the necessary duration of AED Treatment have become much more optimistic than before.
