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Objective To evaluate the utilization profile of antiepileptic drugs in a population of adult patients with refractory epilepsy attending a tertiary center. Method Descriptive analyses of data were obtained from the medical records of 112 patients. Other clinical and demographic characteristics were also registered. Results Polytherapies with ≥3 antiepileptic drugs were prescribed to 60.7% of patients. Of the old agents, carbamazepine and clobazam were the most commonly prescribed (72.3% and 58.9% of the patients, respectively). Among the new agents, lamotrigine was the most commonly prescribed (36.6% of the patients). At least one old agent was identified in 103 out of the 104 polytherapies, while at least one new agent was prescribed to 70.5% of the population. The most prevalent combination was carbamazepine + clobazam + lamotrigine. The mean AED load found was 3.3 (range 0.4–7.7). Conclusion The pattern of use of individual drugs, although consistent with current treatment guidelines, is strongly influenced by the public health system. Objetivo Avaliar o perfil de utilização de fármacos antiepilépticos em uma população de pacientes adultos com epilepsia refratária atendidos em um centro terciário. Método Análises descritivas dos dados obtidos dos registros médicos de 112 pacientes. Também foram consideradas as características clínicas e demográficas. Resultados Foram prescritas politerapias com ≥3 antiepilépticos a 60,7% dos pacientes. Em relação aos fármacos de primeira geração, carbamazepina e clobazam foram os mais frequentemente prescritos (a 72,3% e 58,9% dos pacientes, respectivamente). Dentre os novos antiepilépticos, a lamotrigina foi o mais prescrito (36,6% dos pacientes). Ao menos um antiepiléptico de primeira geração foi encontrado em 103 das 104 politerapias; ao menos um novo antiepiléptico foi prescrito a 70,5% da população. A combinação mais prevalente foi carbamazepina+clobazan+lamotrigina. A carga média de antiepilépticos foi 3.3 (0.4 a 7.7). Conclusão O padrão de utilização de antiepilépticos, embora concordante com guias atuais, é fortemente influenciado pelo sistema público de saúde.

ResumenHay muchos aspectos por abordar en el manejo de las mujeres con epilepsia, relacionados con su rol en la reproducción. Algunos de éstos necesitan ser considerados en la adolescencia, otros están relacionados con el embarazo, afectando tanto a la madre como a su hijo, y algunos con el ciclo menstrual y la menopausia. Esta revisión considera la epilepsia catamenial, contracepción, fertilidad, teratogenicidad y menopausia. También se discuten los efectos del embarazo en el control de las crisis y los efectos de las crisis sobre el feto.SummaryThere are many aspects to the management of epilepsy in women related to their role in reproduction. Some of these need to be considered in adolescents, some are related to pregnancy, concerning both the mother and her infant, and others with the menstrual cycle and the menopause. This review considers catamenial epilepsy, contraception, fertility, teratogenicity, and menopause. It also discusses the effect of pregnancy on the control of epilepsy and the effect of seizures on the fetus.

ResumenHa habido debates importantes sobre bioequivalencia y sustitución de ciertos medicamentos de índice terapéutico estrecho, tales como los fármacos antiepilépticos. En este artículo revisamos los conceptos por detrás del tratamiento de la epilepsia, haciendo hincapié en las características específicas de estos medicamentos, así como los datos relacionados con las crisis epilépticas y el umbral epiléptico individual. Estas condiciones pueden volver vulnerables a los pacientes con epilepsia cuando se cambia sus fórmulas farmacéuticas, ya sea entre las de marca a los productos genéricos o similares y viceversa, así como entre los genéricos entre sí.SummaryThere has been considerable debate about bioequivalence and generic substitution of certain narrow therapeutic index drugs such as the antiepileptic drugs. Here we review concepts behind epilepsy treatment emphasizing specific characteristics of these medications as well as data related to seizures and individual epileptic threshold. These conditions may make patients with epilepsy vulnerable when switching of formulations is conducted, either between brand to generic or similar products and vice versa as well as between generics each other.

ResumenCasi 40% de los pacientes con epilepsia no responde a nuestra primera elección de fármacos antiepilépticos, (FAEs). Esto debería ser justificación suficiente para la búsqueda de nuevos compuestos. La mejora en eficacia de los 16 nuevos FAEs comercializados en los últimos 20 años parece modesta, si bien su tolerabilidad y comodidad de uso ha aumentado el número de combinaciones útiles potenciales, dentro de la corriente de la politerapia racional. El metabolismo de la mayoría de ellos, independiente de la inducción de sistemas enzimáticos hepáticos, es posiblemente la mejor ventaja competitiva frente a los FAEs más veteranos, lo que puede favorecer su situación en los estudios fármaco-económicos de coste-beneficio. La evidencia disponible hasta el momento es incompleta, especialmente a largo plazo, y se necesitan estudios más amplios para clarificar estas cuestiones.SummaryNearly 40% of patients with epilepsy will not respond to our first choice of antiepileptic drugs (AEDs). This should be reason enough to justify the appearence in the market of new compounds. The improvement in efficacy of the new 16 AEDs introduced in the last 20 years seems very modest. However, their tolerability and ease of use has increased the number of potentially succesful combinations according to the concepts of rational polytherapy. The noninducer metabolism of most of these drugs is probably its best competitive advantage versus traditional AEDs. This fact can also improve the position of these compounds in pharmacoeconomical studies of cost vs. benefit. However, the evidence available regarding these issues, especially in the long term, is still incomplete and further studies are needed to clarify these issues.