We defined by consensus criteria for selecting an antiseizure medication (ASM) for first add-on use.
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Key criteria identified include efficacy, adverse effects, drug interactions, mechanism of action, and ease of use.
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Among key factors, interaction potential and mode of action are especially relevant to add-on use.
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The need to optimize adherence and to tailor drug selection to individual characteristics was emphasized.
Abstract
Introduction
When monotherapy used alone or sequentially fails to achieve seizure control, a trial of combination therapy may be considered.
Objective
To define optimal criteria to guide choice of an antiseizure medication (ASM) for use as first add-on.
Methods
A standardized Delphi procedure was applied to produce a list of consensus statements. First, an Expert Board consisting of 5 epileptologists agreed on a set of 46 statements relevant to the objective. The statements were then finalized through an iterative process by a Delphi Panel of 84 Italian pediatric and adult neurologists with expertise in the management of epilepsy. Panel members provided anonymous ratings of their level of agreement with each statement on a 9-point Likert scale.
Results
Consensus, defined as agreement by at least 80% of Panel members, was reached for 36 statements. Medication-related factors considered to be important for drug selection included efficacy, tolerability and safety, interaction potential, mechanism of action, and ease of use. The need to optimize adherence and to tailor drug selection to individual characteristics was emphasized.
Conclusions
Choice of an ASM for first add-on requires consideration of many factors, many of which also apply to choose initial treatment. Factors more specifically relevant to add-on use include drug interaction potential and the preference for an ASM with a different mechanism of action.
