Abstracts

Rationale: The increasing ability to treat and promote survival within stroke patients, is leading to a population that suffers from new partial onset epilepsy. Since 2005 The World Health Organization (WHO) has been reporting that there is a rising incidence of epilepsy in the elderly. In a 2008 the WHO further reports stroke as one of the leading causes (32 percent) of geriatric onset epilepsy. Treatment of epilepsy in this population is complicated by polytherapy. This population has a variety of co-morbidities leading them to be on antihypertensive agents, antiplatelet agents, anticoagulation agents, lipid lowering agents, diabetic control drugs and antiarrhythmic agents. These agents can be either small or biologic molecules. All of which have their own contraindications. In addition generic medications are not required to have the same release profile and bioavailability as the brand.Methods: Systematic review of FDA and EMA labels, specifically looking at their indications and contraindications for Cardiology and Epilepsy disease conditions.Results: Antiepileptic agents are a diverse drug class. While the newer drugs have less known interactions with other medications, they are sometimes prohibitively expensive in both brand and generic preparations. Older agents are well known to alter the ability of patients to metabolize multiple drug classes, as well as for their interactions with multiple medications. It can be challenging to find a correct medication for the patient, taking into the account finances, comorbidities, including liver and renal metabolism, and polypharmacy.Conclusions: Large prospective observational studies need to be performed in the population of stroke survivors, suffering from both acute post infarct seizures, as well as those diagnosed with chronic epilepsy, to obtain data regarding medication safety and efficacy in this growing population. Some of the questions hopefully addressed by this study would include, the interactions between above mentioned medications used for stroke prophylaxis and antiepileptic medications, effects of antiepileptic medications on physical and occupational rehabilitation, adherence rates, and adverse events in this population in terms of both stroke and seizure recurrence in this population. Such a study would help establish guidelines in terms of monitoring medication levels, optimum follow-up intervals, and medication selection.