This piece is sponsored by Eisai Inc.

The path to seizure freedom can be a long and frustrating journey. We often have to try different medications or combine several treatments before finding a suitable treatment with minimal side effects. 1,2 For this reason, it is essential that we try to get our patients on the right treatment plan right from the start. The challenge HCPs and patients face is that each patient’s needs are different and reaching the right dose of an anti-seizure medication (ASM) is a journey unique to every patient. Understanding the barriers patients often face can steer us to the right path for a smoother journey.

The Challenge of Dosing

One of the biggest challenges in treating epilepsy is the process of getting patients to their target dose of anti-seizure medication by increasing the dose incrementally (called titration) as quickly and safely as possible while minimizing side effects. However, reaching the target dose is a journey, and each patient’s journey is different.1,3 During this process, the number of doctor visits increases for the patient as the care team monitors how well the drug is working and how side effects are tolerated.1,4 Each patient’s response to treatment is also different and unfortunately, we can’t know if a drug is effective for someone until their titration is complete. Meanwhile, the financial and time burdens associated with these additional visits and testing can add stress for patients and their families.1,3,4

Another significant part of the seizure freedom journey is finding the right dose frequency (dosage) for a patient that also fits the needs of their lifestyle.  For many medications, the higher the dose, the more chances for adverse events to interfere with quality of life.5 At the same time, the complexity of the regimen, such as multiple drugs or multiple doses per day, may lead to poor compliance. Knowing details of a patient’s day-to-day living, such as a change in diet or a new work schedule, can be incredibly useful when making treatment decisions and considering dosing schedules right from the start.

Balancing the Effects of Dose Titration

Juggling multiple medications and adjusting to treatment schedules can be stressful for a patient. There is also the related worry that a seizure can occur while waiting for the new medication to reach its target dose.

Medications requiring shorter titration periods may help avoid uncontrolled seizures by getting patients to their target dose faster.6 Additionally, drugs that stay in the patient’s body longer, sometimes referred to as a longer half-life, may help in the inevitable case of missed doses.7,8 These drugs require less frequent dosage, are associated with better adherence and may mitigate concentration fluctuations in the body.7,9

As health care professionals, it is important that we consider a dosing plan as we explore an appropriate treatment regimen for each patient. Our goal is to get patients on the most effective dose of medication with the simplest regimen for them as quickly as possible while minimizing side effects.1 But to achieve that, we need to engage our patients in a clear, ongoing discussion about their lifestyle, causes of missed doses, tolerance for side effects, and potential solutions that make sense for that individual.

By having these discussions, we can help reduce the burden of repeat office visits, minimize the risk of ongoing seizures, and lower overall healthcare costs, all of which leads to an overall better patient experience—something we should all strive for in our practices.1,7

For resources and more information about uncontrolled seizures and approaches on achieving seizure control, visit EPILAPSEY.com.

References

  1. Fishman J, Kalilani L, Song Y, Swallow E, Wild I. Antiepileptic drug titration and related health care resource use and costs.  J Manag Care Spec Pharm. 2018;24(9):929-938.
  2. Garnett WR, St. Louis EK, Henry TR, Bramley T. Transitional polytherapy: tricks of the trade for monotherapy to monotherapy AED conversions.  Curr Neuropharmacol. 2009;7(2): 83–95.
  3. Fishman J, Greg C, Colin J, Ann Marie C, Srikanth B, Ying Z, Imane W. Patient emotions and perceptions of antiepileptic drug changes and titration during treatment for epilepsy. Epilepsy Behav. 2017;69;44-52
  4. Grabowski D, Fishman J, Wild I, Lavin B. Changing the neurology policy landscape in the United States: Misconceptions and facts about epilepsy. Health Policy. 2018;122;797-802
  5. St. Louis EK. Truly “Rational” Polytherapy: Maximizing Efficacy and Minimizing Drug interactions, Drug Load, and Adverse Effects. Current Neuropharmacology. 2009;7;96;105
  6. Medic G, Kyoko H, Kavi L, Teresa D, Ola G, Rene K. Dosing frequency and adherence in chronis psychiatric disease: systematic review and meta analysis. Neuropsychiatric Disease and Treat. 2013;9;119-131
  7. Cramer JA, Yan T, Tieu R, et al. Risk of hospitalization among patients with epilepsy using long versus short half-life adjunctive antiepileptic drugs. Epilepsy Behav. 2020;102:106-634.
  8. Cramer JA, Wang Z, Chang E, et al. Health-care costs and utilization related to long- or short-acting antiepileptic monotherapy use. Epilepsy Behav. 2015;44:40–46.
  9. Wheless JW, Phleps SJ. A clinician’s guide to oral extended-release drug delivery systems in epilepsy. J Pediatr Pharmacol Ther. 2018;23(4):277–292.