Out with the old and in with the new…epilepsy drugs
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For personal use. Only reproduce with permission The Lancet Publishing Group. THE LANCET Neurology Vol 3 May 2004 http://neurology.thelancet.com 261 Newsdesk The UK National Institute of Clinical Excellence (NICE) has recommended that doctors in England and Wales should use the newer epilepsy drugs gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagibine, topiramate, and vigabatrin to treat epilepsy in adults who have not benefited from treatment with older drugs, such as carbamazepine or sodium valproate. The American Academy of Neurology will release similar guidelines at its annual meeting in San Francisco (April 24–May 1). NICE—part of the UK National Health Service set up to provide “authoritative, robust and reliable guidance on current best practice”— have also recommended that the newer drugs should be given to any patient who: has any contra- indications while taking or who does not tolerate the older drugs; is on any other medication known to react with the older drugs, such as oral contraceptives; or is a woman of childbearing age. The newer drugs, some of which have been available for over 10 years, are associated with a better quality of life, fewer drug interactions, and more convenient dose regimens. NICE also recommends that patients should be treated with monotherapy wherever possible. If initial treatment is unsuccessful, monotherapy with an alternative drug should be tried. Combination therapy should only be an option when treatment with monotherapy has failed to prevent seizures. Lamotrigine, oxcarbazepine, and topiramate are licensed in the UK for use as monotherapy; all the drugs are licensed for use in combination therapy. John Duncan, who was a member of the development group that helped draw up the guidelines, said he welcomed the fact that NICE and the NHS were taking epilepsy seriously and hoped the guidelines would encourage review of new therapies. However, Duncan, who is based at the Institute of Neurology, London, UK pointed out that the limitation of the guidelines was that they oversimplified the disorder and did not fully take into account the “enormous heterogeneity of seizures, epilepsy syndromes, and individual patient factors such as age, lifestyle, and comorbidity”. Carl Bazil, Associate Professor of Clinical Neurology (Columbia University, NY, USA) told The Lancet Neurology that the NHS guideline was very practical, accurate, and up-to-date and explained that the US guidance would be very similar. NICE are expected to publish further guidance on use of the newer drugs in children later this year. Louise Marshall Out with the old and in with the new . . . epilepsy drugs The prevalence of disability after stroke is similar in South Africa to that in more affluent countries, despite the prevalence of stroke itself being two or three times lower than in high-income countries. “We don’t yet know as much as we would like to about the nature of stroke on the field site”, says Margaret Thorogood (University of Warwick, UK) “but our findings suggest a high proportion of victims are left with disability.” Thorogood and researchers for the Southern African Stroke Prevention Initiative (SASPI) studied 42 378 people age >15 years in the deprived rural Agincourt sub-district of Limpopo Province in South Africa. 103 survivors of stroke were identified; after correction for missing data, the crude prevalence of stroke was 300 per 100 000 people (Stroke 2004; 35: 627–32). Two-thirds of the survivors of stroke needed help with at least one activity of daily living; in more developed countries only a fifth of survivors of stroke have disability. “This research shows that global health epidemiology is changing, with more stroke burden being placed in low income, less developed countries”, says Valery Feigin (University of Auckland, New Zealand). These population-specific prev- alence data, Feigin explains, allow precise estimates of rehabilitation services requirement in South Africa, highlight the need for acute and post acute stroke care, identify promising preventive strategies (focusing the management of hypertension), and show the clear need for further research of stroke incidence and risk factors, as well as prevention and management stategies of stroke in Africa. The differences in stroke outcome and prognosis between developed countries and developing countries are likely determined by the higher proportion of haemorrhagic strokes and the poorer health care in developing countries, says Feigin. SASPI hope their work will help to develop and test interventions, to learn more about the nature of stroke, and to track the prevalence of cardiovascular risk factors in the community. “Our goal”, Thorogood told The Lancet Neurology, “is to reduce the burden of cardiovascular disease in a country already coping with the huge demands of HIV/AIDS and poverty.” Myles Connor (University of Witwatersand, Gauteng Province, South Africa) explains that “the prevalence work is only one component of the SASPI work”. They have also assessed people’s understanding of illness (specifically stroke) access to health care (including traditional medicine), and cardiovascular-risk- factor prevalence . In June this year, WHO, the International Stroke Society, and the World Federation of Neurology will launch the Global Stroke Initiative to develop stroke surveillance, pre- vention, and control with a focus on middle-income and low-income countries. Peter Hayward Stroke disability in South Africa matches more affluent nations
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Transcript of Out with the old and in with the new…epilepsy drugs
For personal use. Only reproduce with permission The Lancet Publishing Group.
THE LANCET Neurology Vol 3 May 2004 http://neurology.thelancet.com 261
Newsdesk
The UK National Institute of ClinicalExcellence (NICE) has recommendedthat doctors in England and Walesshould use the newer epilepsy drugsgabapentin, lamotrigine, levetiracetam,oxcarbazepine, tiagibine, topiramate,and vigabatrin to treat epilepsy inadults who have not benefited fromtreatment with older drugs, such ascarbamazepine or sodium valproate.The American Academy of Neurologywill release similar guidelines at itsannual meeting in San Francisco (April24–May 1).
NICE—part of the UK NationalHealth Service set up to provide“authoritative, robust and reliableguidance on current best practice”—have also recommended that thenewer drugs should be given to anypatient who: has any contra-indications while taking or who doesnot tolerate the older drugs; is on anyother medication known to react withthe older drugs, such as oral
contraceptives; or is a woman ofchildbearing age.
The newer drugs, some of whichhave been available for over 10 years,are associated with a better quality oflife, fewer drug interactions, andmore convenient dose regimens.
NICE also recommends thatpatients should be treated withmonotherapy wherever possible. Ifinitial treatment is unsuccessful,monotherapy with an alternative drugshould be tried. Combination therapyshould only be an option whentreatment with monotherapy hasfailed to prevent seizures.Lamotrigine, oxcarbazepine, andtopiramate are licensed in the UK foruse as monotherapy; all the drugs arelicensed for use in combinationtherapy.
John Duncan, who was a memberof the development group that helpeddraw up the guidelines, said hewelcomed the fact that NICE and the
NHS were taking epilepsy seriouslyand hoped the guidelines wouldencourage review of new therapies.
However, Duncan, who is based atthe Institute of Neurology, London,UK pointed out that the limitation ofthe guidelines was that theyoversimplified the disorder and didnot fully take into account the“enormous heterogeneity of seizures,epilepsy syndromes, and individualpatient factors such as age, lifestyle,and comorbidity”.
Carl Bazil, Associate Professor ofClinical Neurology (ColumbiaUniversity, NY, USA) told TheLancet Neurology that the NHSguideline was very practical, accurate,and up-to-date and explained that the US guidance would be verysimilar.
NICE are expected to publishfurther guidance on use of the newerdrugs in children later this year.Louise Marshall
Out with the old and in with the new . . . epilepsy drugs
The prevalence of disability afterstroke is similar in South Africa to thatin more affluent countries, despite theprevalence of stroke itself being two orthree times lower than in high-incomecountries.
“We don’t yet know as much as wewould like to about the nature ofstroke on the field site”, says MargaretThorogood (University of Warwick,UK) “but our findings suggest a highproportion of victims are left withdisability.”
Thorogood and researchers for theSouthern African Stroke PreventionInitiative (SASPI) studied 42 378people age >15 years in the deprivedrural Agincourt sub-district ofLimpopo Province in South Africa.103 survivors of stroke were identified;after correction for missing data, thecrude prevalence of stroke was 300 per100 000 people (Stroke 2004; 35:627–32). Two-thirds of the survivorsof stroke needed help with at least oneactivity of daily living; in moredeveloped countries only a fifth ofsurvivors of stroke have disability.
“This research shows that globalhealth epidemiology is changing, withmore stroke burden being placed inlow income, less developed countries”,says Valery Feigin (University ofAuckland, New Zealand).
These population-specific prev-alence data, Feigin explains, allowprecise estimates of rehabilitationservices requirement in South Africa,highlight the need for acute and postacute stroke care, identify promisingpreventive strategies (focusing themanagement of hypertension), andshow the clear need for furtherresearch of stroke incidence and riskfactors, as well as prevention andmanagement stategies of stroke inAfrica.
The differences in stroke outcomeand prognosis between developedcountries and developing countries arelikely determined by the higherproportion of haemorrhagic strokesand the poorer health care indeveloping countries, says Feigin.
SASPI hope their work will help todevelop and test interventions, to learn
more about the nature of stroke, andto track the prevalence ofcardiovascular risk factors in thecommunity. “Our goal”, Thorogoodtold The Lancet Neurology, “is toreduce the burden of cardiovasculardisease in a country already copingwith the huge demands of HIV/AIDSand poverty.”
Myles Connor (University ofWitwatersand, Gauteng Province,South Africa) explains that “theprevalence work is only one componentof the SASPI work”. They have alsoassessed people’s understanding ofillness (specifically stroke) access tohealth care (including traditionalmedicine), and cardiovascular-risk-factor prevalence .
In June this year, WHO, theInternational Stroke Society, andthe World Federation of Neurologywill launch the Global Stroke Initiativeto develop stroke surveillance, pre-vention, and control with a focus onmiddle-income and low-incomecountries.Peter Hayward
Stroke disability in South Africa matches more affluent nations
