Overview
The provided abstracts do not specifically define or discuss the etiology of drug-induced epilepsy. Instead, they focus on the efficacy of antiepileptic drugs (AEDs) for new-onset epilepsy and best practices for therapeutic drug monitoring (TDM) of AEDs 12.Diagnosis
The provided abstracts do not offer specific diagnostic criteria or recommended tests for drug-induced epilepsy. They discuss the treatment of new-onset focal or generalized epilepsy 1.Management
New-onset focal epilepsy (adults): Lamotrigine should be considered to decrease seizure frequency (Level B). Levetiracetam and zonisamide may be considered (Level C) 1.
New-onset focal epilepsy (≥60 years): Lamotrigine should be considered (Level B), and gabapentin may be considered (Level C) 1.
Childhood absence epilepsy: Ethosuximide or valproic acid should be considered before lamotrigine to decrease seizure frequency (Level B) 1.
Therapeutic Drug Monitoring (TDM): Can guide patient management by establishing individual therapeutic concentrations, aiding in diagnosis of clinical toxicity, assessing compliance, and guiding dosage adjustments 2.Special Populations
Elderly: Lamotrigine (Level B) and gabapentin (Level C) may be considered for new-onset focal epilepsy in patients ≥60 years of age 1. TDM is useful due to increased pharmacokinetic variability 2.
Children: Ethosuximide or valproic acid are recommended for childhood absence epilepsy (Level B) 1. TDM is useful due to increased pharmacokinetic variability 2.
Pregnancy: TDM is useful when pharmacokinetic changes are anticipated 2.
Associated diseases/Comorbidities: TDM is useful for guiding dosage adjustment 2.Key Recommendations
Lamotrigine should be considered for decreasing seizure frequency in adults with new-onset focal epilepsy. (Evidence: Moderate) 1
Ethosuximide or valproic acid should be considered before lamotrigine to decrease seizure frequency in treating absence seizures in childhood absence epilepsy. (Evidence: Moderate) 1
Therapeutic drug monitoring can have a valuable role in guiding patient management, particularly for establishing individual therapeutic concentrations, diagnosing clinical toxicity, and assessing compliance. (Evidence: Weak) 2References
1 Kanner AM, Ashman E, Gloss D, Harden C, Bourgeois B, Bautista JF et al.. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2018. link
2 Patsalos PN, Berry DJ, Bourgeois BF, Cloyd JC, Glauser TA, Johannessen SI et al.. Antiepileptic drugs--best practice guidelines for therapeutic drug monitoring: a position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia 2008. link