An update of the Hong Kong Epilepsy Guideline: consensus statement on the use of antiepileptic drugs in Hong Kong.
OBJECTIVE
New information about antiepileptic drugs has arisen since the publication of the Hong Kong Epilepsy Guideline in 2009. This article set out to fill the knowledge gap between 2007 and 2016 on the use of antiepileptic drugs in Hong Kong.


METHODS
Between May 2014 and April 2016, four consensus meetings were held in Hong Kong, where a group comprising 15 professionals (neurologists, paediatricians, neurosurgeons, radiologists, and clinical psychologists) from both public and private sectors aimed to review the best available evidence and update all practising physicians on a range of clinical issues including drug-related matters. All participants were council members of The Hong Kong Epilepsy Society.


METHODS
A literature review of the clinical use of antiepileptic drugs as monotherapy suggested Level A evidence for levetiracetam and Level B evidence for lacosamide. No change in the level of evidence was found for oxcarbazepine (Level A evidence) or pregabalin (undesignated), and no evidence was found for perampanel. A literature review on the clinical use of antiepileptic drugs as adjunctive therapy suggested Level A evidence for both lacosamide and perampanel. No change to the level of evidence was found for levetiracetam (Level A evidence), oxcarbazepine (Level A evidence), or pregabalin (Level A evidence). A literature search on the use of generic antiepileptic drugs suggested Level A evidence for the use of lamotrigine in generic substitution.


METHODS
Three lead authors of the Subcommittee drafted the manuscript that consisted of two parts-part A: evidence on new antiepileptic drugs, and part B: generic drugs. The recommendations on monotherapy/adjunctive therapy were presented during the meetings. The pros and cons for our health care system of generic substitution were discussed. The recommendations represent the 'general consensus' of the participants in keeping with the evidence found in the literature.


CONCLUSIONS
Recommendations for the use of levetiracetam, lacosamide, oxcarbazepine, pregabalin, and perampanel were made. The consensus statements may provide a reference to physicians in their daily practice. Controversy exists over the use of generic products among patients who are currently taking brand medications. In this regard, approvals from prescriber and patient are pivotal. Good communication between doctors and patients is essential, as well as enlisting the assistance of doctors, nurses, and pharmacists, therapeutic blood monitoring if available, and the option of brand antiepileptic drug as a self-financed item. The physical appearance of generic drugs should be considered as it may hamper drug compliance. Support from medical services is recommended. In the longer term, the benefit of flexibility and the options to have a balance between the generic and brand drug market may need to be addressed by institutions and regulatory bodies.
Private practice, Hong Kong.
J Ky
JK
Fong
Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong.
E Ly
EL
Chan
Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.
H
H
Leung
Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong.
I
I
Chan
Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong.
R Sk
RS
Chang
Private practice, Hong Kong.
G Cy
GC
Fong
Department of Paediatrics, Prince of Wales Hospital, Shatin, Hong Kong.
E Lw
EL
Fung
Department of Medicine, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong.
C Ht
CH
Lui
Department of Medicine, United Christian Hospital, Kwun Tong, Hong Kong.
B Bh
BB
Fung
Department of Surgery, Queen Elizabeth Hospital, Jordan, Hong Kong.
T L
TL
Poon
Department of Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong.
D
D
Siu
Department of Surgery, Kwong Wah Hospital, Yaumatei, Hong Kong.
H T
HT
Wong
Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
E
E
Yeung
Department of Paediatrics, Queen Mary Hospital, Pokfulam, Hong Kong.
A Wy
AW
Yung
Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong.
C Xl
CX
Zhu
D000081:Acetamides / Q000627:therapeutic use; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002220:Carbamazepine / Q000031:analogs & derivatives / Q000627:therapeutic use; D032921:Consensus; D016568:Drugs, Generic / Q000627:therapeutic use*; D004827:Epilepsy / Q000188:drug therapy*; D006723:Hong Kong; D006801:Humans; D000078334:Lacosamide; D000077213:Lamotrigine; D000077287:Levetiracetam; D000078330:Oxcarbazepine; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D014227:Triazines / Q000627:therapeutic use
D000081:Acetamides; D000927:Anticonvulsants; D016568:Drugs, Generic; D014227:Triazines; D002220:Carbamazepine; D000077287:Levetiracetam; D000078334:Lacosamide; D000077213:Lamotrigine; D000078330:Oxcarbazepine; D010889:Piracetam
Anticonvulsants; Epilepsy/drug therapy; Practice guidelines as topic