title: Antiepileptic drugs in migraine and epilepsy: Who is at increased risk of adverse events?
abstract: Background The impact of adverse events (AEs) of antiepileptic drugs (AEDs) have an impact on compliance and dropouts. We compared tolerability of AEs of AEDs among patients with migraine, epilepsy, or both. Methods Overall, 335 patients (epilepsy (n = 142), migraine (n = 131), and both (n = 62)), were evaluated with the Liverpool Adverse Events Profile (LAEP) to assess the magnitude, profile and occurrence rate of the AEs of valproate, topiramate, and lamotrigine. Results AEs were significantly more common with topiramate treatment (71.0%) and among migraineurs (69.5%), the latter being more prone to discontinue AEDs (46.6%). The profile of AEs with topiramate and valproate differed among groups. Moreover, treatment with both topiramate and valproate was associated, for all groups, with a worse tolerability profile compared to lamotrigine. Conclusion Our data suggest a specific drug and disease AE profile of AEDs. Specifically, migraineurs are the most affected by AEs, even though they receive very low dosages of AEDs. This finding might be considered a clinical implication of central sensitization mechanisms. Both the profile and tolerability of AEs, highly influencing quality of life, depended on the underlying conditions, and deeply impacted on treatment dropout. Therefore, before starting, switching or stopping AED treatment, all options need to be considered.
authors.affiliation: 1 Neurology Clinic, University Hospital of Perugia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Romoli
authors.affiliation: 1 Neurology Clinic, University Hospital of Perugia, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Costa
authors.affiliation: 1 Neurology Clinic, University Hospital of Perugia, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Siliquini
authors.affiliation: 1 Neurology Clinic, University Hospital of Perugia, Italy.
authors.forename: Ilenia
authors.initials: I
authors.lastname: Corbelli
authors.affiliation: 2 Regional Health Authority of Umbria, Perugia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Eusebi
authors.affiliation: 1 Neurology Clinic, University Hospital of Perugia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bedetti
authors.affiliation: 1 Neurology Clinic, University Hospital of Perugia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Caproni
authors.affiliation: 3 Neurology Division, Sant'Eugenio Hospital, Rome, Italy.
authors.forename: Letizia Maria
authors.initials: LM
authors.lastname: Cupini
authors.affiliation: 1 Neurology Clinic, University Hospital of Perugia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabresi
authors.affiliation: 1 Neurology Clinic, University Hospital of Perugia, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Sarchielli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000009:adverse effects*; D002648:Child; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000077213:Lamotrigine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D000077236:Topiramate / Q000009:adverse effects; D014635:Valproic Acid / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D000077236:Topiramate; D014635:Valproic Acid; D000077213:Lamotrigine
keywords: Tolerability; adverse events; antiepileptic drugs; epilepsy; migraine; neuropharmacology