Arvo building, Yellow Hall F025, address: Arvo Ylpön katu 34.
Doctoral defence of Lic.Med. Jussi Mäkinen
The field of science of the dissertation is Neurology.
The opponent is professor Morten Lossius (University of Oslo, Norway). Professor Jukka Peltola acts as the custos.
The language of the dissertation defence is English.
Optimizing antiepileptic drug therapy
Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. Seizures are transient events that include symptoms and/or signs of abnormal excessive hypersynchronous activity in the brain. A variety of seizure types exist, and epilepsy is not a single entity but rather a collection of disorders that have in common the occurrence of seizures.
If the patient has recurrent seizures, if the diagnosis of epilepsy is conclusively established and if epilepsy surgery will most unlikely to be fruitful, then it is recommended that further attempts at optimizing the medical therapy should be pursued. Nowadays, the potential choices of antiepileptic drugs as combination or monotherapy are so numerous that it is impossible to try every permutation in a single lifetime. Currently, the rational choice of antiepileptic drug combinations is often based on avoidance of pharmacological AEDs and patient comorbidities. This study aimed to enhance the options for clinical management of epilepsy by producing practical information for optimizing the antiepileptic drug treatment in terms of minimizing the adverse-events while maximizing the therapeutic effect.
Some patients with focal epilepsy might benefit from the newer antiepileptic drugs as an adjunctive therapy to help achieve seizure-freedom. These data should encourage clinicians to continue active drug trials on those with persistent seizures. There are differences in effectiveness between the eight most commonly used antiepileptic drugs as adjunctive therapy for focal refractory epilepsy. The options for first line AEDs with similar mechanisms of actions should be considered if adverse events emerge, as our data indicate that safe transition can be accomplished. Discontinuation of carbamazepine in seizure-free patients seems to carry a moderate, but legitimate risk of relapse. Conversely, carbamazepine might have unfavorable effects on serum lipid profile, sex hormone binding globulin, and free testosterone. Most importantly, the importance of good communication between patient and treating physician is underlined in all situations.
The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2356, Tampere University Press, Tampere 2018. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1862, Tampere University Press 2018.