Prescriptionmedicine for focal sezuire and marajara

What is the effect of Keppra and Lamictal on focus seizures?
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Abstract
There is limited attention to the effect of Keppra and Lamictal on focus seizures due to the paucity of evidence in this field. Available facts on the two drugs indicate that these two drugs are effective in the control of epileptic seizures as first-line treatments. However, the use of these drugs as the first choices is dependent on the objectives of the treatment process and pharmacokinetic attributes, for example, even though both Lamictal and Keppra can be used among pregnant women, the side effects linked to each type of drug are unique. There are different types of focal seizures and different pharmacotherapies have different effects depending on the type of seizure. Both lamotrigine and levetiracetam have been proved to be effective for partial seizures (otherwise known as focal seizures). However, their use depends largely depend on the balance achieved after weighing the intended benefits and associated side effects. Even though credible investigational corroboration is lacking, marijuana is used as a therapy for severe epilepsy that is not responsive to conventional pharmacotherapy.

The terms focal seizures and partial seizures are used interchangeably, but the term focal/focus seizures is often used because the term partial seizures tends to indicate the possibility of having a seizure; yet, a seizure can only be present or absent. Focal seizures are three types: “simple partial seizures, complex partial seizures, and secondarily generalized tonic-clinic seizures” (Spencer, 2017).

Classification of these seizures is based on the extent of spread. The simple partial seizure is limited to the region of origin, and one’s consciousness is not affected; hence the term simple. Complex partial seizures affect a portion of both hemispheres of the brain. Secondarily generalized tonic-clinic seizures spread to involve the entire brain. Various approaches to management have been used in this case, but this paper will focus on the pharmacotherapy effect of Keppra, Lamictal, and marijuana to inform in making a choice in the treatment of focal seizures.
Lamictal, also known as Lamotrigine, is a relatively new drug that has been in use for around three decades. The drug was endorsed as an adjunctive treatment to redress focal seizures in 1991 in the United Kingdom and in 1994 in the United States. This drug is used as a remedy for various types of seizures though it can aggravate others like the myoclonic seizures among infants and adolescents (Ebrahimi & Ebrahimi, 2012). Unfortunately, circumstances resulting in the aggravation of these seizures have not been well-examined. The antiepileptic action of Lamotrigine is attributed to its ability to inhibit the release of glutamate and stabilize the neuronal membranes (Tatum IV, Kaplan, & Jallon, 2009). Lamictal is advantageous when compared to other modes of treatment in the sense that it is linked to reduced cognitive impairment. Studies on animal models indicate that this drug is associated with reduced mortality rates and increased lifespan. Due to its effectiveness, Lamotrigine is approved by the Food and Drug Administration as an adjunct drug among children from 2 years. The study by Ebrahimi and Ebrahimi (2012) indicated that Lamotrigine helps to control the focal seizures. Being a new generation antiepileptic drug, Lamotrigine has been shown to be safe for women in their childbearing age because it is not associated with congenital malformations.
The drug has several side effects, but it should be introduced gradually to minimize these effects and achieve the intended efficacy. These side effects are not significant as to interfere with the tolerance of the drug. Nonetheless, it is important to note that the drug is associated with allergic reactions and cutaneous reactions have the highest prevalence. Other reactions include the Stevens-Johnson syndrome, dopa-responsive dystonia, and thrombocytopenia, which lead to the withdrawal of the drug. Unlike Keppra, as shown below, the interaction of Lamictal with other drugs is dependent on dosage, and failure to use optimal doses accelerates the occurrence of these allergic reactions as shown by Tatum IV et al. (2009).
Keppra is another newly developed drug that is used as an adjunctive therapy for the focal seizures (Gambardella, Labate, Colosimo, Ambrosio, & Quattrone, 2008). Gambardella et al. (2008) go further to indicate that the mechanism of action of this drug has not yet been well-defined, but it has a prominent anticonvulsant activity in chronic epilepsy. Also, studies with selected refractory cases, as recommended, indicate that this drug is effective in adjunctive treatment due to its advantages. It is recommended as a first-line treatment for focal seizures because of these advantageous pharmacokinetic attributes. Other than no drug interaction, this drug does not require blood-level monitoring and its can be administered either orally or intravenously. It is not associated with cognitive side effects and is totally excreted by the kidneys; thereby, making it a safe drug for use even in pregnancy. The drug has indicated successful transition to monotherapy and use as a single agent.
The drug is associated with various side effects: “dizziness, lethargy, and somnolence”, according to Gambardella et al. (2008). These side effects, however, cannot be solely associated with Keppra because, in their study, Gambardella et al. showed that there were no significant differences in the occurrence of these side effects between the intervention and the placebo groups. Hence, it is evident that Keppra is not likely to exacerbate the progress of a disease because there is no conclusive evidence that shows adverse side effects linked to it. The drug does not interfere with the pharmacokinetic properties of other drugs because there their levels are not altered when used along with Keppra. Also, the effects of Keppra when used alone, and when used with other therapies indicate the same outcomes. These outcomes justify the fact that Keppra can be used as a single agent or in monotherapy because whether used with other therapies or as a single entity, the outcomes are the same.
Despite the fact that there are various reviews in the popular press that indicate the probable positive effects of marijuana on focal seizures, there is insufficient evidence to ascertain these claims. However, current empirical support indicates anecdotal support for the drug when seizures remain uncontrolled and alternative interventions remain unavailable (Kolikonda, Srinivasan, Enja, Sagi, & Lippmann, 2016). Also, the legality of this drug remains restricted in various jurisdictions. There is no absolute evidence that indicates that marijuana is ideal for the control of epilepsy, and there is no indication that the drug can interact with other approved anticonvulsant medicines. The use of marijuana is compromised by various medical and ethical reasons that range from lack of credible studies, legal restrictions in various parts of the world, lack of approval of the drug for medical purposes, and dysregulated preparations in the proportions of delta-9-tetrahydrocannabinol (THC): cannabidiol (CBD). THC is the psychoactive neuro-active component of marijuana that tends to influence the endocannabinoid system, which plays the vital role of providing on-demand protection against convulsive activity; thereby, playing the regulatory role of the central nervous system (Kolikonda et al., 2016).
In conclusion, it is evident that Keppra and Lamictal are effective pharmacotherapies of focal seizures. Both Keppra and Lamictal are approved as adjunctive therapies for focal seizures, but there is no indication that when used together or alongside other therapies, better health outcomes will be realized. The selection of either drug as a first-line treatment for controlling seizures in epilepsy should be made after careful review of both the type focal seizure and associated side effects. This discussion has indicated that even though both Keppra and Lamictal are effective for focal seizures, but it is evident that Keppra has better pharmacokinetic properties that enhance its use as a safe drug. Future studies should strive to determine the safety and efficacy of various combined therapies involving the drugs discussed herein.

References
Ebrahimi, H. A., & Ebrahimi, F. (2012). The effect of lamotrigine on epilepsy. Iranian Journal of Neurology, 11(4), 162–163.
Kolikonda, M. K., Srinivasan, K., Enja, M., Sagi, V., & Lippmann, S. (2016). Medical Marijuana for Epilepsy? Innovations in Clinical Neuroscience, 13(3-4), 23–26.
Koubeissi, M. (2013). Levetiracetam: More Evidence of Safety in Pregnancy. Epilepsy Currents, 13(6), 279–281.
Spencer, D. C. (2017). Navigating life with epilepsy. New York: Oxford University Press.
Tatum IV, W. O., Kaplan, P. W. & Jallom, P. (2009). Epilepsy A to Z: A concise encyclopedia (2nd ed.). New York, NY: Demos Medical Publishing books.