Generalized Epilepsies: Modern Concepts and Therapeutic Approaches

Abstract

In recent years, the concepts of generalized epilepsy have undergone significant changes: focal features have been identified in generalized epilepsies and typical features of idiopathic generalized epilepsies in focal epilepsies. The closeness of these forms is also confirmed by genetic studies, when a variety of focal and generalized phenotypes are observed in different members of the same family with one genetic disorder. In this regard, the Terminology and Classification Commission of the International League Against Epilepsy (ILAE) proposes to abandon the distinction between epilepsy forms based on the focal-generalized principle, replacing it with the concept of a neural network involving various local and general mechanisms of the brain in each individual case. These neuropathophysiological concepts explain the reasons for the ineffectiveness and sometimes even aggravation of the severity of the disease of pharmacotherapy based on the focal-generalized seizures model. The modern approach makes it preferable to choose a drug with a broad spectrum of action (helping with any types of seizures and forms of epilepsy) taking into account its effectiveness, dose titration rate, dosage form, side effects and cost. Among the drugs with a broad spectrum of action (valproate - VPA, levetiracetam, lamotrigine, topiramate) as the first choice for the initial treatment of generalized epilepsies, the original forms of VPA with controlled release of the active substance - Depakine Chrono and Depakine Chronosphere are priority. The main pharmacokinetic and pharmacodynamic properties of drugs for the treatment of epilepsy and algorithms for the treatment of individual forms of generalized epilepsy are considered.