Vol 10, No 2 (2015)

In spite of substantial progress in epileptology, complete seizure control cannot be achieved in a considerable proportion of patients (about 30 %); in this regard, the synthesis of new antiepileptic drugs (AEDs) and rational combinations of available AEDs in view of their mechanisms of action remains relevant. Of particular interest are drugs with different mechanisms of action in relation to other AEDs (these drugs include levetiracetam, lacosamide, perampanel, etc.). The authors provide a literature review dealing with one of the new drugs – levetiracetam (Keppra) that has a different mechanism of action, as compared with other AEDs. Levetiracetam has been approved for use as initial monotherapy for partial-onset epilepsy with or without secondary generalization in patients who are at least 16 years of age, as adjunctive treatment of partial-onset seizures with and without secondary generalization in babies who are at least 1 month old (oral solution) or in children who are at least 6 years old (tablets), and in patients who are at least 12 years of age as adjunctive treatment of myoclonic seizures in juvenile myoclonic epilepsy and as therapy for generalized tonic-clonic seizures in idiopathic generalized epilepsy. The review details the mechanism of action of levetiracetam, its pharmacokinetics, and data on its efficacy and tolerability in the treatment of epilepsy. The findings have led to the conclusion that levetiracetam is a well-studied and promising drug used in the monoand polytherapy of different forms of epilepsy. 

Attention deficit hyperactivity disorder (ADHD) is the most common cause of behavioral disorders and learning problems at preschool and school ages.
Patients with ADHD are frequently found to have comorbidities that present additional diagnostic and therapeutic problems and result in an even greater decrease in quality of life in patients. Thus, ADHD is frequently concurrent with epilepsy; in this case, not only the manifestations of ADHD are more common in epilepsy, but the latter is more often encountered in patients with ADHD than in those as a whole. The authors consider the epidemiological factors and causes, which may lead to a concurrence of these two diseases in the same patient, the principles of diagnosis and differential diagnosis of ADHD in epileptic patients, the specific features of treatment in this patient category. At the same time, the authors place emphasis on the fact that some antiepileptic drugs, such as barbiturates, may cause symptoms that mimic ADHD (in these cases, inattention and hyperactivity are adverse reactions of therapy and lessen or disappear after drug discontinuation) or enhance the manifestations of ADHD in patients with a concurrence of these two diseases. On the other hand, care should be also taken to choose drugs for the treatment of ADHD due to the possible higher frequency of seizures. So preference should be given to the drugs having no negative effect on the course of comorbidities or those having a positive therapeutic effect against both diseases.