Therapeutic Strategies

Commission Members

Aims

• To develop evidence-based guidelines for pharmacological treatment of epilepsy.
• To address the phenomenon of tolerance to antiepileptic drug effects and the problems in evaluating long-term efficacy.
• To address methodological problems related to the process of registration of new antiepileptic drugs for monotherapy.
• To update Practice Guidelines for Therapeutic Drug Monitoring

Achievements prior to July 2003

The full commission has had three meetings from 2002 until June 2003, the first on 7 April 2002 in Taormina, Italy, at the Eilat Conference on New Antiepileptic Drugs. The second meeting took place on 6 October 2002 in Madrid, Spain, on the occasion of the European Congress on Epileptology. The third meeting was held in Seattle, WA, in conjunction with the annual meeting of the American Epilepsy Society on 7 December 2002. The subcommission on Evidence-based Treatment Guidelines has met on three occasions to develop a guidelines manuscript: in Gothenburg, Sweden in August 2002, in Florida, USA in March 2003 and in San Servolo, Italy in July 2003 with follow-up tele-conferences. Chaired by Santiago Arroyo, the Subcommission on Long-term Efficacy and Tolerance of AEDs arranged a workshop with 14 active international delegates in Milwaukee, USA on 31 January 2003. The topic was “Long-term efficacy of AEDs and the phenomenon of tolerance.” Drafts of the Evidence-based Treatment Guidelines have been presented and discussed by Richard Mattson at the Asian-Oceanian Epilepsy Congress in Japan in September 2002 and Elinor Ben-Menachem at several other international meetings in 2003.

Commission Activities July 31, 2003 to June 30, 2004

The commission has had four business meetings since 1 July, 2003: in San Servolo, Italy, 13 July in Lisbon on 13 October at the IEC; on 7 December at the AES meeting in Boston; and on 30 May 2004, in Vienna at the ECE. In collaboration with the Commission on European Affairs and the European Epilepsy Academy, the Commission organised a 10-day course on pharmacological treatment, 10-19 July 2003. This international course, “From basic knowledge to rational prescribing in epilepsy” was the second in the Epilepsy Summer School series held at Venice International University on San Servolo Island, Venice, Italy. The course attracted approximately 60 participants representing 47 different countries. Faculty was mainly formed by members of the organising commissions. The Subcommission on Methodological Issues Related to Monotherapy Trials chaired by Michel Baulac organised a workshop on the possibility of using Historical Controls for Monotherapy Studies in San Servolo, Italy, 13 July 2003. Delegates included representatives from academia as well as regulatory bodies. The initiative was further discussed in a formal presentation by Jaqueline French at the Seventh Eilat Conference on New Antiepileptic Drugs in Sardinia, Italy, May 2004. On the request of the ILAE president, the Commission has reviewed and commented on the “Guide your journey”—women’s initiative launched as a part of the Global Campaign. The Commission organised two scientific sessions at the 25th IEC in Lisbon, Portugal, October 2003: one on “Teratogenic effects of antiepileptic drugs” in collaboration with the Commission on Genetics, and the second on “Surrogate markers of AED outcome.” A new Subcommission on Therapeutic Drug Monitoring has been established under the chairmanship of Philip Patsalos. This subcommission will review the old TDM guidelines from 1993 and aim to produce an update. The first meeting of this group was held on 30 May 2004 in Vienna.

Upcoming Activities

The Subcommission on Evidence-based Treatment Guidelines is expected to finalise a manuscript on recommendations on the choice of pharmacological treatment of children and adults with newly diagnosed epilepsy, which eventually is also intended for publication on the ILAE website. The guidelines will be discussed at the AES meeting in New Orleans, USA in December 2004 and a presentation of the guidelines is planned as a session for the 26th IEC in Paris, 2005. The Subcommission on Methodological Issues Related to Monotherapy Trials is discussing the feasibility to synthesise and model existing data from randomised controlled trials to predict outcome of treatment vs. no treatment in newly diagnosed epilepsy.

Torbjörn Tomson
Chair