It’s time to change the name of the medications used to treat seizures. The medications currently used are effective in aborting or preventing seizures through a purely symptomatic effect, that is, they have no known impact on the disease process in patients at risk of developing epilepsy or in those who have epilepsy, but the current name is “antiepileptic drugs (AEDs)”. Referring to these medications as "antiepileptics" rather than "anticonvulsants" misrepresents what these compounds actually are.
A PubMed search conducted on November 10, 2019, using the term "antiepileptic drugs" returned 156,499 results, compared to 383 results for "antiseizure medications." In this article, the authors review the pros and cons of abandoning the term "antiepileptics", and systematically referring to "anticonvulsant drugs (FACs)" when dealing with medications intended to have a symptomatic effect.
| Four good reasons to use the term "FAC" when referring to symptomatic medications |
Drug names are best defined by their effects. The medications currently used to treat epilepsy are symptomatic. Medications used to treat people with epilepsy treat the symptoms of seizures. In fact, "antiepileptic" is suggestive of an action for which these agents were not developed clinically or preclinically. The ability of currently used medications to prevent or abort seizures has clearly demonstrated that the term "FAC" reflects precisely those effects.
International problems . Some have argued that the term "anticonvulsant," while useful in English-speaking regions, would be problematic for regions where there is no name for "seizure." This should not be considered a barrier. In some cultural contexts, medications used to treat people with epilepsy are named in ways that have no semantic relationship to "epilepsy" or "seizures."
In several Latin languages, for example, these medications are sometimes called "anticomiciales" (Spanish), "anticomitiaux" (French), or "anticomiziali" (Italian), which some consider advantageous because they can minimize the potential stigma associated with the name. of the disease or its manifestations. However, the origin of these terms is actually even more stigmatizing. Regardless of their origin, these terms are problematic as they do not transparently reflect the actual effect of medications.
Misleading names can facilitate inappropriate use . Long-term prophylaxis with drugs that have no antiepileptic effect but are inappropriately named "AEDs" is performed in several circumstances. A single-center study in Canada found that more than 25% of patients who had no history of seizures and had undergone surgery for malignant glioma were inappropriately prescribed these medications beyond the first perioperative week.
Other studies documented wide variation between centers in prophylactic use in children with severe traumatic brain injury. There could be many reasons for the appropriate use of these medications as prophylaxis, but it cannot be excluded that at least in some cases such use is motivated by the misconception that epilepsy can be prevented.
Renaming these medications as “anti-seizure medications” will certainly improve communication with patients. This will allow for a necessary discussion between prescriber and patient that symptomatic treatment will only be effective when taken at regular intervals. The concept of prolonged drug regimens needed to manage rather than cure a condition is difficult to understand in some settings and may be an important determinant of nonadherence.
New classes of drugs are being developed that target the underlying disease. Over the last decade, major advances in the elucidation of the mechanisms involved in epileptogenesis have led to the identification of a wide range of attractive targets to prevent epilepsy or modify its course. Additionally, progress has been made in the discovery of biomarkers that can be used to identify patients at high risk of developing epilepsy.
Thanks to these advances, it is increasingly feasible to conduct clinical trials of possible disease-modifying treatments, treatments aimed at preventing epilepsy and/or its comorbidities in individuals exposed to epileptogenic conditions, such as traumatic brain injury, stroke, and certain disorders. genetic. It is essential that appropriate terminology be developed to differentiate them from treatments that are purely symptomatic.
| Is there any good reason to retain the term “AEDs” when referring to symptomatic medications? |
The term "antiepileptic" is too well established to change. Although it is known that many people feel tied to tradition, the fact that incorrect terminology is very common is not a justification for perpetuating it. The introduction of a new term by legal decree or by recommendation of a scientific society cannot lead to its immediate use by everyone, but requires gradual adoption.
Unlike "antiepileptic," "anticonvulsant" cannot be effectively translated into many languages. Each community/culture must ultimately decide what is the best terminology to express a given concept in its language. The authors do not advocate a literal translation of the term "seizure" in all languages, but simply argue that in English the term "FAC" is most appropriate to designate medications that act solely against seizures.
| Conclusions |
An impressive effort is underway in industry and academia to develop truly innovative treatments that are not “anticonvulsants” but instead aim to prevent the development and progression of epilepsy and/or its comorbidities.
A natural consequence of this paradigm shift is that new terms must be introduced to describe compounds that have "anti-epileptogenic" effects or, in a broader sense, "disease-modifying" effects. It is not surprising that in this scenario it has become clear that the adjective "antiepileptic", which suggests an effect on the underlying disease, should be abandoned and replaced by "anticonvulsant" when referring to treatments that are merely symptomatic.
In the present article, the authors reviewed the arguments for or against the use of the term "FACs." For the reasons explained above, we firmly believe that "FACs" is the most appropriate when referring to treatments that specifically target the main symptom of epilepsy, i.e. seizures. The adoption of new terms is a gradual process, but the use of the term "anticonvulsant" when referring to medications currently in use is increasing rapidly in the medical literature.
