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10/16/2020

Highlights

Michigan State Medical Society Annual Scientific Meeting 10/23/2020 Seizures and Epilepsy in Non-Neurologic Specialties: . Why more new seizure medications? Newer Anti-Seizure Medications . The newer AEDs, their MOA, advantages, disadvantages, and SE . Any other new option beside medications? Mounzer Kassab, M.D., M.A. Professor and Vice Chairman Department of Neurology Michigan State University Sparrow Health System

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Oxcarbazepine Why Newer AEDs? Some FDA approved Available AEDs Still no magic pill for epilepsy Still SE and drug-drug-interaction Aptiom Fycompa Still inconveniences in administration and preparations Potiga 10 Targets for newer AEDs: Better efficacy?? Less SE and drug-drug interactions 5 More friendly with better titration schedule, administration routs, and preparations

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The problem: brivaracetam “Briviact”

. Seizure freedom: . MOA: selective affinity for the target synaptic vesicle protein 2A. The . After first AED: 47% selectivity exclude AMPA receptors = less irritability SE . After second AED 13% . Dosing: initial dosage is 25mg or 50mg twice daily. Target dose is 100mg . After third AED 3% twice daily . : in blood, renal . Adv: Renal failure . SE: somnolence, dizziness and fatigue. Adv: No labs for toxicity . Formulations: pills, oral solution, IV injection solution

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(Xcopri) Nasal Sprays • MOA: inhibiting voltage-gated sodium currents and is a positive allosteric Seizure Clusters.. modulator of the γ-aminobutyric acid (GABAA) ion channel • SE: somnolence, dizziness, fatigue, diplopia, and headaches. • Dosage • Week 1 and 2: 12.5 mg once daily • Week 3 and 4: 25 mg once daily • Week 5 and 6: 50 mg once daily • Week 7 and 8: 100 mg once daily • Week 9 and 10: 150 mg once daily • Week 11 and thereafter 200 mg once daily

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Nasal Spray (Nayzilam) Nasal Spray (Valtoco)

• MOA and indications: Is a indicated for the acute treatment of acute repetitive seizures that are distinct from the patient’s usual seizure pattern . MOA and indications: is a benzodiazepine for the acute treatment of • No priming or assembly necessary intermittent frequent clusters of seizures. • Can be administered by almost anyone . Dose: 5, 10, 15, or 20 mg based on weight. Second dose may be given • SE: Somnolence and nasal discomfort no sooner than 4 hours after the first dose if needed. • Dose: one spray (5mg) into one nostril. If needed after 10 minutes, one spray (5mg) can be administered in the other nostril. . SE: nasal discomfort, epistaxis, cough, throat irritation somnolence in 1.5 to 5% of subjects

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Other new options in treatment?

. Resective surgery . VNS . RNS . DBS . Diet

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