ANNOUNCER: Epilepsy, defined as the condition of chronic, recurrent, unprovoked seizures, affects approximately 3 million people in the United States. Epilepsy can be treated in a number of ways, including surgery and diet, but it's most commonly controlled through the use of anti-seizure medications.
TRACY GLAUSER, MD: Medications have been used for the treatment of epilepsy for almost 100 years, but they're really broken into two major groups. The most common medicines that were approved prior to 1993 include carbamazepine (also known as Tegretol), phenobarbital, phenytoin (also known as Dilantin), and valproic acid (also known as Depakote or Depakene).
Since 1993, eight new medicines have approved in the United States for the treatment of epilepsy: felbamate (also known as Felbatol), gabapentin (also known as Neurontin), lamotrigine (also known as Lamictal), levetiracetam (known as Keppra), oxcarbazepine (known as Trileptal), tiagabine (also known as Gabitril), topiramate (known as Topamax), and zonisamide (also known as Zonegran).
ANNOUNCER: Both the newer and older classes of medications seem to have similar efficacy, or ability to stop seizures. Their differences lay in their side effect profiles, with the newer medications tending to have milder side effects.
BLANCA VAZQUEZ, MD: The older antiepileptic drugs tend to have a heavier side effect profile, especially for cognition. The older drugs are associated with long-term use of and development of neuropathy, sedation, cognitive decline and mood changes. The newer antiepileptic drugs are also associated with some of those behavioral changes, but in a much milder level.
ANNOUNCER: And some side effects are related more closely to some drugs than others.
BLANCA VAZQUEZ, MD: The patients need to know what to look for or what side effects are not acceptable. For instance, the older antiepileptic drugs, like barbiturates, have a lot of sedation and mood changes. Dilantin is associated with major cognitive issues as well as bone loss and hormonal changes for female and male patients.
TRACY GLAUSER, MD: Medicines in general, such as Dilantin, can cause sedation, drowsiness, tiredness, wobbliness in walking and unsteadiness. A medicine like Dilantin can have the rare effect of causing a rash. In addition, chronic use of Dilantin can lead to changes in cosmetic features: coarsening of the facial bones, growing hair on the face, swelling of the gums. Tremor is more commonly seen in children taking valproic acid (also known as Depakote or Depakene).
BLANCA VAZQUEZ, MD: Depakote is associated with weight gain, hair loss and sedation, as well. Carbamazepine is probably one of the better tolerated of the older generation of medicines, but it's also associated with birth defects, associated with trouble with bones as well as cognition.
TRACY GLAUSER, MD: Tegretol is often associated with unsteadiness, double vision, wobbliness. Dizziness occurs more frequently associated with Trileptal, which is also known as oxcarbazepine, than with some other medicines.
BLANCA VAZQUEZ, MD: The Trileptal may have a drop in the sodium for elderly patients only, and that has to be monitored closely. Topamax is associated with cognitive side effects if the drug is used in very high dosages.
TRACY GLAUSER, MD: Decreased sweating can be seen with a medicine like topiramate. And it's more specific for that medicine than other medicines. Lamictal (also known as lamotrigine) is associated in some patients with a higher risk of rash, and this rash can take the form of a burn and potentially be life-threatening.
BLANCA VAZQUEZ, MD: If you use gabapentin, the patients may have weight gain and more somnolence. Levetiracetam, or Keppra, is a drug that is very well tolerated, but may have some behavioral toxicity in terms of mood and irritability. Zonisamide is a drug that is associated with also some irritability and mood, as well as weight loss.
TRACY GLAUSER, MD: Zonisamide (also known as Zonegran) is also associated with decreased sweating and can be associated with excessive sedation.
ANNOUNCER: With so many anti-seizure medications available, deciding on a drug regimen can be a difficult task. But regardless of the chosen regimen, physicians and their patients can help maximize results by both defining the goals of therapy and establishing the quality of life the patient expects to lead.
TRACY GLAUSER, MD: It's important to set expectations when you start either the first therapy or subsequent therapies. It's important to team with a health care provider who does not give up on you, who wants to try and get the best quality of life, the fewest seizures, the fewest side effects.
ANNOUNCER: If a patient feels that they're experiencing intolerable side effects, it's important for them to talk to their physician about possibly switching medicines.
TRACY GLAUSER, MD: &Intolerable side effects& has to be defined by the patient. Every patient has a different level that they can tolerate certain side effects, and an open and honest discussion with their health care professional about how they view the side effects they're experiencing is critical to make a decision about whether to switch medicines or maybe just to change the dose of the medicine.
ANNOUNCER: So how can a person with epilepsy gauge their progress with anti-seizure medications?
TRACY GLAUSER, MD: Three major questions that every patient should ask themselves are &How is my quality of life? Am I achieving what I want to achieve out of life?& The second major question is, &Am I having any seizures?& The goal is no seizures. The third question is, &Am I having any side effects? Am I experiencing or feeling different than I did before the medicine, and is that feeling -- are these potential side effects intolerable?&
If the answers to the question are, &I'm having a great quality of life, no seizures and no side effects,& then that therapy is working well for the patient.
ANNOUNCER: It has been estimated that 70 percent of people living with epilepsy can be expected to enter remission, defined as 5 or more years seizure free on medication. By actively working with their physician, most people with epilepsy can look forward to a long periods with little to no seizures.
TRACY GLAUSER, MD: It is very important for patients to feel empowered about their therapy. Getting education is appropriate. Communicating with their health care professionals is critical, and patients should feel they need to play an active role in their own treatment.
* Tegretol and Trileptal are registered trademarks of Novartis Pharmaceuticals. * Dilantin, Zarontin and Neurontin are registered trademarks of Pfizer Pharmaceuticals. * Depakote is a registered trademark of Abbott Laboratories. * Felbatol is a registered trademark of Wallace Laboratories. * Lamictal is a registered trademark of GlaxoSmithKline. * Keppra is a registered trademark of UCB Pharmaceuticals. * Mysoline is a registered trademark of AstraZeneca. * Gabitril is a registered trademark of Cephalon, Inc. * Zonegran is a registered trademark of Dainippon Pharmaceutical Co. Ltd. and is licensed exclusively to Eisai Inc. ** Topamax is approved as add-on therapy for people 2 years and older with primary generalized tonic-clonic seizures, partial-onset seizures, or seizures associated with Lennox-Gastaut syndrome.
Important Safety Information
Serious risks associated with TOPAMAX include increased eye pressure (glaucoma), decreased sweating, increased body temperature, kidney stones, sleepiness, dizziness, confusion, and difficulty concentrating. Tell your doctor immediately if you have blurred vision or eye pain. More common side effects in adults are nervousness, coordination problems, fatigue, speech problems, slowed thinking, memory difficulty, tingling in arms and legs, and double vision; and in children, fatigue, loss of appetite, nervousness, memory difficulty, aggressive behavior, and weight loss. Your doctor may do simple blood test to check for changes in electrolytes. Tell your doctor about other medications you take.
Please visit www.topamax.com for full Prescribing Information.