Current trends in epileptology: priorities, challenges, tasks and solutions

Within a field meeting of experts from the Russian branch of the League Against Epilepsy (RLAE), diagnostic and treatment aspects of epilepsy were discussed with the emphasis on the female population (girls, women of childbearing and older ages). All experts underscored the special features and unique needs of female patients with epilepsy. Experimental and clinical studies on efficacy and safety of traditional and novel antiepileptic drugs (AEDs) applied to women with epilepsy were discussed. It was commonly agreed that the new generation of AEDs did not yet find an appropriate place in the clinical practice, and that they were mainly used as add-on therapy in order to overcome drug resistance. The current use of AEDs in the treatment of epilepsy is, by large, not gender-specific and is not related enough to age, sociodemographic characteristics, and comorbid disorders. It should be noted that the new AEDs are addressed specifically to individual, socio-demographic, gender and clinical features of the patient. The potential of some AEDs (lamotrigine), in fact, remains underestimated by practitioners. Due to the current restrictions in using valproic acid, lamotrigine is the alternative medication for women with epilepsy. Having a balanced profile of efficacy and safety, lamotrigine is recommended as the first choice drug for initial therapy, as well as an alternative monotherapy for epilepsy in women.

These data were presented at the Russian League Against Epilepsy (RLAE) on-site meeting “Epilepsy and Woman” 18 September 2019 (Ohrid, Makedonia).

1. Avakyan G.N. Questions modern epileptology. Epilepsia i paroksizmalʹnye sostoania / Epilepsy and Paroxysmal Conditions (In Russ.). 2015; 7 (4):16-21.

2. Zenkov L.R. Lamictal in the treatment of epilepsy. Moscow. 2006; s. 39. (In Russ.).

3. Karlov V.A., Vlasov P.N., Zhidkova I.A., Petrukhin V.A., Adamyan L.V., Kushlinskii N.E. Epilepsy in women. Chapter 32. Guides for doctors. Edited by V.A. Karlova. Second edition. Moscow. 2019; 654-701. (In Russ.).

4. Resolution of the Russian Antiepileptic League expert meeting on treatment of women with epilepsy. Epilepsia i paroksizmalʹnye sostoania / Epilepsy and Paroxysmal Conditions. 2019; 11 (2): 195-199. (In Russ.).

5. Avakyan G.N., Voronina T.A., Khromykh E.A. Epilepsy Pathogenesis. Pathogenetic therapy. A manual for doctors. Moscow. 2007. 148 s. (In Russ.).

6. Avakyan G.N., Badalyan O.L., Burd S.G., Valdman E.A., Voronina T.A., Nerobkova L.N., Krikova E.V., Avakyan G.G., Chukanova A.S., Stoyko M.I., Savenkov A.A. Experimental and clinical epileptology. Epilepsia i paroksizmalʹnye sostoania / Epilepsy and Paroxysmal Conditions. 2010; 2 (4): 41-54. (In Russ.).

7. Pylaeva O.A., Mukhin K.Y., Mironov M.B. Efficacy, safety and tolerability of lamotrigine in the treatment of epilepsy. Russian Journal of Child Neurology. 2012; 7 (4): 41-54. (In Russ.). https://doi. org/10.17650/2073-8803-2012-7-4-41-54.

8. Chen Z., Brodie M., Liew D. et al. Treatment outcomes in patients with newly diagnosed epilepsy and new antiepileptic drugs: A 30-year lobgitudinal cohort study. JAMA Neurol. 2018; 75 (3): 279-286.

9. Baumgartner C. et al. Lack of association between ABCC2 gene. variants and treatment response in epilepsy. Pharmacogenomics. 2012; 13 (2): 185-90. https://doi.org/10.2217/pgs.11.143.

10. Baulac M., Brodie M.J., Patten A. et al. Efficacy and tolerability of zonisamide versus controlled-release carbamazepine for newly diagnosed partial epilepsy: a phase 3, randomised, double-blind, non-inferiority trial. Lancet Neurol. 2012; 11 (7): 579-88.

11. Baulac M. et al. Efficacy, safety, and tolerability of lacosamide monotherapy versus controlled-release carbamazepine in patients with newly diagnosed epilepsy: a phase 3, randomised, double-blind, non-inferiority trial. Lancet Neurol. 2017; 16: 43-54.

12. Typical Absense Seizures. ILAE [Electronic resource] URL: https:// www.epilepsydiagnosis.org/seizure/absence-typical-relatedsyndromes.html. Accessed: 29.09.2019.

13. Gossman W. et al. Absence SeizureStatPearls. Treasure Island (FL): StatPearls Publishing. 2019 Jul 11.

14. Avakyan G.N., Blinov D.V., Lebedeva A.V., Burd S.G., Avakyan G.G. ILAE classification of the epilepsies: the 2017 revision and update. Epilepsia i paroksizmalʹnye sostoania / Epilepsy and Paroxysmal Conditions. 2017; 9 (1): 6-25 (In Russ.). https://doi.org/10.17749/2077- 8333.2017.9.1.006-025.

15. Koutroumanidis M. et al. The role of EEG in the diagnosis and classification of the epilepsy syndromes: a tool for clinical practice by the ILAE Neurophysiology Task Force (Part 1). Epileptic Disord. 2017 Sep 1; 19 (3): 233-298.

16. Karlov V.A., Vlasov P. N., Petruhin V.A., Krasnopol’skii V.I. Therapeutic tactics for epilepsy during pregnancy. Methodological instructions of the Ministry of Health of the Russian Federation. Moscow. 2001; 130: 19. (In Russ.)

17. Stephan L., Wishart A., Brodie M.J. Psychiatric side effects and antiepileptic drugs: Observations from prospective audits. Epilepsy and Behavior. 2017; 71L73-76.

18. Ruiz-Giménez J. et al. Antiepileptic treatment in patients with epilepsy and other comorbidities. Seizure. 2010 Sep; 19 (7): 375-82.

19. Stephan l. et al. Psychiatric side effects and antiepileptic drugs: Observations from prospective audits. Epilepsy and Behavior. 2017; 71L73-76.

20. Sale M.E, Natarajan S., Biton V., Vuong V., Hammer A.E., Messenheimer J.A., Blum D. A dosing algorithm for converting from valproate monotherapy to lamotrigine monotherapy in patients with epilepsy. Epilepsy and Behavior. 2005; 6: 63-70.

21. Gromov S.A., Kissin M.Ya., Yakunina O.N. et al. Epilepsy. Personality changes. Treatment. SPb. 2006; 320 s.

22. Kissin M.Ya. The structure and dynamics of mental disorders in patients with epilepsy. Psikhiatriya. 2006; 7: 361-371. (In Russ.).

23. Altshuler L. Depression and epilepsy. Epilepsy and behavior / O. Devinsky, W.H. Theodore (eds). New York. 1991; 47-65.

24. Kanner A.M., Balabanov A. Depression and epilepsy: how closely related are they? Neurology. 2002; 58 (8 Suppl 5): 27-39.

25. Dudra-Jastrzebska M., Andres-Mach M.M., Łuszczki J.J. et al. Mood disorders in patients with epilepsy. Pharmacol. Rep. 2007; 59 (4): 369-378.

26. Jacoby A., Baker G.A., Steen N. et al. The clinical course of epilepsy and its psychosocial correlates: findings from a U.K. Community study. Epilepsia. 1996; 37 (2): 148-161.

27. Schmitz B. Depression and Mania in Patients with Epilepsy. Epilepsia. 2005; 46 (4): 45-49.

28. Gilliam F.G. Diagnosis and treatment of mood disorders in persons with epilepsy. Curr. Opin. Neurol. 2005; 18 (2): 129-133.

29. Ketter T.A., Post R.M., Theodore W.H. Positive and negative psychiatric effects of antiepileptic drugs in patients with seizure disorders. Neurology. 1999; 53 (2): 53-67.

30. Kalinin V.V., Zheleznova E.V. Anticonvulsant and psychotropic properties of antiepileptic drugs in the treatment of patients with epilepsy. Moscow. 2008; 29 s. (in Russ).

31. Kalinin V.V. Suicidality and antiepileptic drugs. Is there a Link? Drug Saf. 2007; 30 (2): 123-142.

32. Lambert M.V., Robertson M.M. Depression in epilepsy: etiology, phenomenology and treatment. Epilepsia. 1999; 40 (10): 21-47.

33. Gil-Nagel A., López-Muñoz F., Serratosa J.M. et al. Effect of lamotrigine on sexual function in patients with epilepsy. Seizure. 2006; 15 (3): 142-149.

34. Cramer J.A., Blum D., Reed M. The influence of comorbid depression on seizure severity. Epilepsia. 2003; 44 (12): 1578-1584.

35. Aldenkampf A.P. Antiepileptic drug treatment and epileptic seizure effect on cognitive function. The Neuropsychiatry of Epilepsy / M. Trimble, B. Schmitz (eds). Cambrige, 2002; 256-267.

36. Ettinger A.B. Psychotropic effects of antiepileptic drugs. Neurology. 2006; 67 (11): 1916-1925.

37. Barry J.J. The recognition and management of mood disorders as a comorbidity of epilepsy. Epilepsia. 2003; 44 (4): 30-40.

38. Avakyan G.N., Blinov D.V., Avakyan G.G., Akarachkova E.S., Burd S.G., Vlasov P.N., Voronkova K.V., Guzeva V.I., Zhidkova I.A., Katunina E.A., Korabelnikov D.I., Lebedeva A.V., Lipatova L.V., Morozova E.A., Oleinikova O.M., Rudakova I.G. Restrictions on the use of valproate in female patients of reproductive age: the updated recommendations based on recent clinical data. Epilepsia i paroksizmalʹnye sostoania / Epilepsy and Paroxysmal Conditions. 2019;11 (2):110-123 (In Russ.). https://doi.org/10.17749/2077-8333.2019.11.2.110-123.