NICE issues guidance on newer epilepsy drugs
Guidance on using newer
drugs for treating epilepsy in children has been issued by the National Institute for Clinical Excellence. It recommends the use of newer antiepileptic agents in children who have not benefited from treatment with older drugs, or for whom the older drugs are unsuitable.
Gabapentin, lamotrigine, oxcarbazepine, tiagabine, topiramate and vigabatrin
(as an adjunctive therapy for partial seizures) are recommended within
their licensed indications for children who have failed to benefit from
agents such as carbamazepine or sodium valproate. Newer drugs are also
recommended in children who have contraindications to older drugs, where
the older agents are poorly tolerated by the child or where the older
medicines could interact with other drugs the child is taking (notably
oral contraceptives).
In girls of childbearing potential, including young girls who are likely
to need treatment into their childbearing years, the guidance says that
the risk of drugs causing harm to an unborn child and the possibility
of interaction with oral contraceptives should be discussed with the
child and/or her carer, and an assessment made as to the risks and benefits
of treatment with individual drugs.
It is recommended that children should be treated with a single agent
wherever possible, and another drug should only be tried if
initial treatment is unsuccessful. Combination therapy should only be
considered when
attempts at monotherapy have not resulted in freedom from seizures.
Vigabatrin is recommended as first line therapy for the management of
infantile spasms (West’s syndrome).
NICE advises that all children who have had a first non-febrile seizure
should be seen by a specialist in epilepsy as soon as possible and that
treatment should be reviewed at regular intervals.
Richard Appleton, consultant paediatric neurologist, Alder Hey Children’s
Hospital, warned that the evidence on which NICE had based its guidelines
was extremely limited because few trials had been carried out on paediatric
epilepsy, particularly in newly diagnosed children (studies had focused
on add-on therapy or epilepsy that was difficult to control). He stood
by the guideline’s
advice to start children on older drugs such as sodium valproate or carbamazepine
before using newer drugs. However, he hoped that a trial reporting next
year would clarify which agents to use first.
Dr Appleton added that it is essential for specialists to be informed
about children who are having problems with their existing medication,
such as side effects or lack of control. |
The
Pharmaceutical Journal
Acrobat
Reader