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Titolo:
Assessing risk to benefit ratio in antiepileptic drug therapy
Autore:
Perucca, E; Beghi, E; Dulac, O; Shorvon, S; Tomson, T;
Indirizzi:
Univ Pavia, Clin Pharmacol Unit, I-27100 Pavia, Italy Univ Pavia Pavia Italy I-27100 Clin Pharmacol Unit, I-27100 Pavia, Italy Ist Ric Farmacol Mario Negri, Milan, Italy Ist Ric Farmacol Mario Negri Milan Italy acol Mario Negri, Milan, Italy San Gerardo Hosp, Ctr Epilepsy, Monza, Italy San Gerardo Hosp Monza Italy n Gerardo Hosp, Ctr Epilepsy, Monza, Italy Hop St Vincent de Paul, Dept Pediat, F-75674 Paris, France Hop St Vincent de Paul Paris France F-75674 ediat, F-75674 Paris, France Univ Coll London, Dept Neurol, London, England Univ Coll London London England ll London, Dept Neurol, London, England Karolinska Inst, Karolinska Hosp, Dept Clin Neurosci, Div Neurol, S-10401 Stockholm, Sweden Karolinska Inst Stockholm Sweden S-10401 urol, S-10401 Stockholm, Sweden
Titolo Testata:
EPILEPSY RESEARCH
fascicolo: 2, volume: 41, anno: 2000,
pagine: 107 - 139
SICI:
0920-1211(200009)41:2<107:ARTBRI>2.0.ZU;2-0
Fonte:
ISI
Lingua:
ENG
Soggetto:
TEMPORAL-LOBE EPILEPSY; QUALITY-OF-LIFE; NEWLY-DIAGNOSED EPILEPSY; COMPLEX PARTIAL SEIZURES; COMPARATIVE MONOTHERAPY TRIAL; MULTICENTER COMPARATIVE TRIAL; ACUTE INTERMITTENT PORPHYRIA; REFRACTORY PARTIAL EPILEPSY; NATIONAL GENERAL-PRACTICE; TYPICAL ABSENCE SEIZURES;
Keywords:
antiepileptic drugs; epilepsy; risk/benefit ratio; toxicity;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
273
Recensione:
Indirizzi per estratti:
Indirizzo: Perucca, E Univ Pavia, Clin Pharmacol Unit, Piazza Botta 10, I-27100 Pavia, Italy Univ Pavia Piazza Botta 10 Pavia Italy I-27100 00 Pavia, Italy
Citazione:
E. Perucca et al., "Assessing risk to benefit ratio in antiepileptic drug therapy", EPILEPSY R, 41(2), 2000, pp. 107-139

Abstract

Assessment of risk to benefit ratio in patients with epilepsy is crucial in determining the need for treatment, the choice of drugs and the use of monitoring tools such as laboratory tests and other investigations. Active epilepsy per se carries significant risks in terms of increased mortality, susceptibility to psychopathology and physical injury, and reduced quality oflife as a result of restricted lifestyle, stigma and prejudice. By preventing the occurrence of seizures, antiepileptic drugs (AEDs) attenuate or eliminate altogether seizure-related risks, but other risks may arise due to the side effects of the drugs, all of which have a relatively narrow therapeutic index. While there are no major differences in the degree of efficacy between AEDs which are effective in any given seizure type, side effect profiles differ considerably from one agent to another and represent a major factor in determining choice of treatment. Assessment of risk to benefit ratio should also take into consideration patient-specific factors such as type and severity of the epilepsy, age, sex, childbearing potential, medical and drug history, associated disease, use of concomitant medication (including the contraceptive pill) and the prospected patient's compliance. In somebenign epilepsy syndromes, such as idiopathic partial epilepsy with centro-temporal spikes, the risk of side effects from AEDs may outweigh potentialbenefits in terms of seizure control, and treatment is generally not indicated. At the opposite end of the spectrum, the serious morbidity and mortality associated with severe epileptic encephalopathies, such as the Lennox-Gastaut syndrome, justifies aggressive treatment even with drugs associated with a relatively high risk of life threatening side effects such as felbamate. The present article will provide an overview of specific risks associated with epilepsy and with the various drugs used for its treatment, and will attempt to evaluate the complex balance between these risks and therapeutic benefits in different categories of patients. (C) 2000 Elsevier ScienceB.V. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 02/10/20 alle ore 01:52:45