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Displaying 1-3 out of 3 published
6 August 2012
Carbamazepine and oxcarbazepine are indicated as first line drug for generalised tonic clonic seizures, however, in some specific generalised epileptic syndromes which may have generalised tonic clonic seizures as part of the presentation the use of these drugs may agravate the condition with worsening seizures. A good example of this would be Juvenile Myoclonic Epilepsy, which often presents with generalised tonic clonic seizures and in which carbamazepine and oxcarbazepine are best avoided.
Competing interests: FRG has received honorariums and travel expenses from UCB, GlaxoSmithKline, and Eisai; JWS has received research support, honorariums, and travel expenses from UCB, Janssen-Cilag, GlaxoSmithKline, Viropharma, and Eisai; JWS and FRG are based at University College London Hospitals/University College London, which received a proportion of funding from the Department of Health’s National Institute for Health Research Biomedical Research Centres funding scheme.
UCL Institute of Neurology, Queen Square, London WC1N 3BG
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+26 July 2012
Dear Editor
I believe there is an error in the table entitled "NICE guidelines on antiepileptic drug treatment" as carbamazepine and oxcarbazepine are shown as being both "first line treatment" and in the "do not consider" category for the treatment of Generalised Tonic Clonic Epilepsy.
Yours sincerely
Competing interests: None declared
unaffiliated, Bow, Devon
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+21 July 2012
Dear Editor,
In the section of other non-epilepsy drugs which may later the seizure threshold, it is important not to forget fluoroquinolones which are commonly used by clinicians who may not be aware of this. They are thought to increase seizure risk by inhibiting the GABA receptor complex (1). Central nervous side effects from fluoroquinolones are more likey with increasing age and when taking NSAIDs (2). Cases are also more likely to occur when there are electrolyte imbalances, failure to adjust to a "renal" dose and when co-prescribed with other agents reducing the seizure threshold (3), for example theophyllines, which are another commonly used drug not mentioned in this group worth remembering, which may cause seizures via free radical generation and adenosine-independent mechanisms(4).
References:
1) Unseld E, Ziegler G, Gemeinhardt A. Possible interaction of fluoroquinolones with the benzodiazepine-GABA-receptor complex. Br J Clin Pharmacol 1990; 30:63-70
2) Medford AR, France AJ. Psychosis due to ciprofloxacin and diclofenac combination. J Royal Coll Phys Edinb 2004; 34(1): 79.
3) Kushner JM, Peckman HJ, Snyder CR. Seizures associated with fluoroquinolones. Ann Pharmacother 2001; 35(10): 1194-8.
4) Methylxanthines, seizures, and excitotoxicity. Handb Exp Pharmacol 2011; 200: 251-66.
Competing interests: None declared
North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB
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