Removal of sedative-hypnotic antiepileptic drugs from the regimens of patients with intractable epilepsy
✍ Scribed by William H. Theodore; Dr Roger J. Porter
- Publisher
- John Wiley and Sons
- Year
- 1983
- Tongue
- English
- Weight
- 481 KB
- Volume
- 13
- Category
- Article
- ISSN
- 0364-5134
No coin nor oath required. For personal study only.
✦ Synopsis
Sedative-hypnotic antiepileptic drugs have potentially toxic effects, but their removal is often thought to be difficult and dangerous. We completely withdrew all barbiturates and benzodiazepines from 7 8 patients with intractable epilepsy (48 inpatients and 30 outpatients). Initially, 19 patients had plasma levels of sedative drugs above the therapeutic range; 28 were taking more than one of these drugs. Dosages of nonsedative antiepileptic drugs were adjusted to provide optimal seizure control.
After 6 months of outpatient follow-up, 6 9 patients remained on a nonsedative regimen: 35 (51%) showed improvement in both drug toxicity and seizure control, 13 (19%) in toxicity alone, 8 (12%) in seizure control alone; 12 (16%) were unchanged, and 1 was worse. Of 9 patients restarted on sedative antiepileptic drugs by their private physicians, 4 had more toxic symptoms than at discharge, 1 had more frequent seizures, 3 were unchanged, and 1, who had had a temporal lobectomy after drug withdrawal, had less frequent seizures.
Sedative drugs are not necessary for optimal seizure control, even in intractable epilepsy, and they may be safely withdrawn.
Theodore WH, Porter RJ Removal of sedative-hypnotic antiepileptic drugs from the regimens of patients with intractable epilepsy. Ann Neurol 13. 320-324, 1983 In spite of their possible toxic effects, the barbiturates, benzodiazepines, and other sedative-hypnotic drugs are widely used to treat epilepsy. Moreover, the toxicity may be compounded by the simultaneous administration of several such drugs.