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Epileptic Disorders - Editor's Choice

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February, 2015

Antiepileptic Drugs: Two articles

Epileptic Disorders December 2014

The clinical pharmacology of traditional antiepileptic drugs.
Vajda FJE, Eadie MJ. Epileptic Disorders 2014; 16: 395-408.

Interactions between antiepileptic drugs, and between antiepileptic drugs and other drugs.
Zaccara G, Perucca E. Epileptic Disorders 2014; 16: 409-432.

Commentary by Graeme J Sills PhD, Associate Editor.
Department of Molecular & Clinical Pharmacology, University of Liverpool, UK

There’s a festival of pharmacology in this issue of Epileptic Disorders! This month we have two Seminars in Epileptology articles, each provided by a duo of very eminent authors who are internationally renowned for their long-standing work in the field of epilepsy therapeutics. Together, these contributions provide an excellent overview of the clinical pharmacology of antiepileptic drugs and their associated pharmacokinetic interactions and are essential reading for those who may be unfamiliar with how some of our most widely-used drugs behave.

In the first article, Vajda & Eadie focus specifically on traditional antiepileptic drugs. They cover a huge volume of information, ranging from mechanisms of action, pharmacokinetics, clinical use and adverse effects, in an impressively succinct fashion. All of the major established agents are included and oxcarbazepine has even snuck in! The text is economical and to the point – if you want detailed discussions and lists of supportive references, you are advised to look elsewhere. If, however, you want facts and lots of them, plus some pithy clinical observations borne of years of experience, then this article is for you (and your trainees).

In the second article, Zaccara & Perucca regale the reader with everything they would ever want to know about pharmacokinetic interactions with antiepileptic drugs. It is important to remember that drugs used in the treatment of epilepsy are amongst the most notorious in terms of their propensity to elicit and/or succumb to drug-drug interactions. Everything from routes of elimination, mechanisms of interactions, and comprehensive lists, tables, and supplementary boxes on interactions with drugs from most major classes is here. The best part, however, is the colourful graphic that successfully illustrates, in one half page, the nature and extent of all pharmacokinetic interactions between existing antiepileptic drugs. This image also adorns the front cover of this issue and is a helpful point of reference for prescribers everywhere.

It is heartening to see pharmacology feature so prominently in this issue of Epileptic Disorders. Starting, stopping and adjusting antiepileptic medication is routine for a sizeable number of medical practitioners - not just epilepsy specialists - and yet the basic therapeutics of these agents is often over-looked or taken for granted. An occasional reminder of what these drugs do and how you can expect them to behave clinically does no harm whatsoever.


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