Introduction

Epilepsy is a disease characterized by unprovoked patient seizures. Seizures are classified as partial seizures (localized within the brain) and generalized seizures (involving both hemispheres of the brain). Partial seizures are further split into simple and complex categories; simple seizures are those that do not impair consciousness, whereas the complex ones do impair consciousness. Generalized seizures are split into

From: Handbook of Drug Monitoring Methods Edited by: A. Dasgupta © Humana Press Inc., Totowa, NJ

a number of categories, including absence (patient becomes vacant and unresponsive), myoclonic (brief muscle contraction), clonic (myoclonus regularly repeating at a rate of 2-3 per second), tonic-clonic (initial spasm, followed by rhythmic convulsions), and atonic (loss of muscle tone, causing the patient to fall to the ground). Lastly, there is a condition called status epilepticus that refers to continuous seizure activity with no recovery between successive seizures, and this can be life threatening requiring emergency medical attention.

According to the Epilepsy Foundation, it is estimated that there are approximately 2.7 million people affected by epilepsy in the USA, with approximately 200,000 new cases of epilepsy and seizures reported every year, and the World Health Organization (WHO) estimates that as many as 50 million people worldwide may be affected by epilepsy. The cause of epilepsy can be attributed to structural or metabolic abnormalities in the brain stemming from acute injury such as stroke or trauma, infectious disease, and neurosurgical complications. Alternatively, it can be caused by an inherited condition such as ring chromosome 20 syndrome. In some cases, epilepsy is classified as idiopathic, meaning that it is of unknown origin.

The frontline therapy for epilepsy is pharmacotherapy. The first drug for epilepsy, bromide, was introduced in 1857, followed by drugs such as phenobarbital, phenytoin, primidone, ethosuximide, carbamazepine, valproic acid, clobazam, and clonazepam. These drugs are the first generation of antiepileptic drugs. The next generation of anticonvulsants began to be introduced in 1990, after a gap of almost 20 years between development and introduction. These include drugs such as vigabatrin, lamotrigine, gabapentin, topiramate, tiagabine, levetiracetam, oxcarbazepine, and zonisamide. Some of these newer anticonvulsant drugs are also utilized to manage patients with chronic neuropathic pain.

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