ANTI-EPILEPTIC DRUGS

Anti-epileptic drugs (AEDs) are the preference for the treatment of epilepsy. These AEDs will control seizures for most people with epilepsy, but there will be a minority of people for whom these AEDs are less effective. AEDs are effective in stabilizing the electrical brain activity that causes seizures, particularly if the cause is idiopathic. AEDs do not provide a cure for epilepsy, but enable the majority of people to live without the fear of having seizures.

As a student or carer of an adult with learning disabilities who has epilepsy, it is essential that you familiarize yourself with the AEDs used by the adult with a learning disability whom you are caring for. All drugs or medications have two names: the ‘generic’ name, which is the drug’s ‘chemical’ name, and its ‘brand’ name, which the drug manufacturer gives it. For example, carbamazepine is the generic name, and its brand name is Tegretol. However, you must ensure that the adult whom you are supporting always takes the same ‘brand’ of drug, as there may be subtle differences in the way in which drugs are prepared by different manufacturers, and this could have an effect on their effectiveness in controlling seizures.

AEDs work to prevent the abnormal electrical activity that triggers seizures. AEDs are absorbed into the bloodstream and transported to the brain. AEDs need to remain at a constant level in the bloodstream throughout a 24-hour period, and therefore AED levels need to be maintained. This means that AEDs should be taken at the same time every day, at the same dose, to maintain this delicate balance, as too little or too much of the drug can result in more seizures occurring. Some AEDs are taken only once per day, as this helps to maintain a constant level throughout the day and night (Epilepsy Scotland 2005).

AEDs affect the brain in different ways, therefore, some AEDs are more effective for some types of epilepsy than others. As a student or carer, you need to make yourself aware of the type(s) of seizure that the service users have and the side effects of the AEDs that they are taking. This is so that you can monitor and identify any potential side effects of the AEDs and ensure that any other factors relevant to their health status are noted and acted on, if necessary.

An epilepsy specialist should ensure that each adult with epilepsy has an individualized AED treatment plan that is based on the type(s) of seizure pattern, other associated health problems and other medication she or he may be taking. The first consideration should be that the person is started on one AED (monotherapy). Only if this fails to work adequately should another drug be tried. Stokes et al. (2004) state that ‘If an AED has failed because of adverse effects or continued seizures, a second drug should be started (which may be an alternative first-line or second-line drug) and built up to an adequate or maximum tolerated dose and then the first drug should be tapered off slowly’ (Stokes et al. 2004, p. 56). Combination therapy (more than one AED) ‘should only be considered when attempts at mono-therapy with AEDs have not resulted in seizure freedom’ (Stokes et al. 2004, p. 56).

During the past 12 years, newer AEDs have been introduced to supplement more established AEDs, such as sodium valporate (Epilim), phenytoin (Epanutin) and carbamazepine (Tegretol). Newer AEDs include lamotrigine (Lamictal), levetiracetam (Keppra), tiagabine (Gabitril) and gabapentin (Neurontin), amongst others. These newer AEDs are suggested for treatment where other AEDs have not benefited the person in controlling seizures. However, newer AEDs may not be more effective in controlling seizures, despite hopes that they will improve the quality of life for people with epilepsy. Indeed, the National Institute for Clinical Excellence (NICE) (2004) recommends that the first-line treatment of epilepsy in adults should continue to be based on established medications such as sodium valporate. This NICE report states that these newer epilepsy drugs do not improve seizure control or quality of life when compared with the standard treatments (sodium valporate or carbamazepine). It concludes that the newer AEDs should only be used when more established standard treatments are unsuitable or unsuccessful in managing seizures. The NICE Health Technology Appraisal (2004) reviewed the evidence and they based their advice on both the clinical effectiveness and the cost of drugs reviewed for the treatment of epilepsy in adults.

It is essential that AEDs are monitored, and that the person who has epilepsy is started on the lowest possible dose. The purpose of this is twofold: firstly, it will help to lessen potential side effects; secondly, the rate at which the dosage of the AED is increased will help the epileptologist decide on an appropriate dose that provides the maximum control of seizures with the fewest side effects. Monotherapy is the preferred approach to treatment with AEDs (NICE Health Technology Appraisal 2004).

Many adults with moderate and severe learning disabilities may have other associated health conditions (co-morbidity) which could be a complicating factor both in diagnosing epilepsy, but also in ensuring that AEDs do not interact with any other medication that they may be taking for their health condition. As the carer or student, you will need to help the service users to self-monitor or monitor on their behalf any side effects from the AED and any other medication. The range of side effects varies, depending on the AED being used. For example, possible side effects of carbamazepine include blurred or double vision, headaches, drowsiness and skin rashes. In addition, for women, rarely, there may be foetal abnormalities (British Medical Association and the Royal Pharmaceutical Society 2005). Many AEDs also cause some weight gain, and therefore you need to help adults with learning disabilities to maintain a healthy diet, as obesity can be a problem for adults with learning disabilities (Wood 1994).

Regular monitoring should help to identify both changes in the degree or severity of side effects and an increase in seizure activity, necessitating changes in the AED dosage until maximum control is achieved. As the carer or student, you may need to ensure that the service user takes the AED at regular intervals, to maintain the AED in the bloodstream. If a service user misses a dose, advice must be sought from the epileptologist as to the best course of action, if it is not already outlined in his/her care plan. It is also important to note that service users need to continue taking AEDs until the epileptologist outlines a supervised withdrawal, where this may be appropriate (Epilepsy Scotland 2005).

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مواضيع ذات صلة

STEPS TO TAKE WHEN AN ADULT HAS A SEIZURE

PARTIAL (OR FOCAL SEIZURES)

CLASSIFICATION OF SEIZURES GENERALISED SEIZURES

DEFINITION OF A SEIZURE

CATEGORIES OF EPILEPSY IDIOPATHIC EPILEPSY

DIAGNOSING EPILEPSY

CAUSES OF EPILEPSY

PREVALENCE

Epilepsy and Adults with Learning Disabilities

Mental Health Issues and Adults with Learning Disabilities CONCLUSION

PSYCHOLOGICAL INTERVENTIONS/NON-PHYSICAL INTERVENTIONS

ELECTROCONVULSIVE THERAPY (ECT)