|NI FEATURE: JOURNEY THROUGH THE EONS - COMMENTARY
|Year : 2021 | Volume
| Issue : 5 | Page : 1514-1515
Remembering Prof. Baldev Singh: FROM 2 TO 22 AEDs-Still Compliance is the Key
Prahlad K Sethi
Department of Neurology, Sir Ganga Ram Hospital, New Delhi, India
|Date of Submission||25-Dec-2019|
|Date of Decision||09-Feb-2020|
|Date of Acceptance||18-May-2020|
|Date of Web Publication||30-Oct-2021|
Prahlad K Sethi
Sir Ganga Ram Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sethi PK. Remembering Prof. Baldev Singh: FROM 2 TO 22 AEDs-Still Compliance is the Key. Neurol India 2021;69:1514-5
In the summer of 1967, I was a young captain in the Army Medical Corps (AMC) posted to All India Institute of Medical Sciences (AIIMS), Delhi, to establish a research cell for Armed Forces Medical Services. Under the guidance of Prof. Baldev Singh [Figure 1], I chose to study nerve conduction velocities, H reflex and the reaction time of soldiers at sea level (Delhi) and high altitude (Leh). As I was conducting this research study, I had the unique opportunity to attend neurology rounds and teaching programs under Prof. Singh.
In the neurology OPD clinic, we would present cases to him. At that time, there were only two antiepileptic drugs (AEDs) available namely phenytoin and phenobarbital. We would narrate the patient's history and examination. Many of these patients came from various corners of our country to have a second opinion from Prof. Singh as their epilepsy was uncontrolled. Prof. Singh was the most recognized neurologist in North India. After carefully listening to their histories, he would talk to the patients and their relatives. Many of these patients were already on one or at times both above AEDs. After careful consideration, he would advise some of them to switch from am to pm dosing. On follow-up, many of these patients come back with surprisingly good seizure control.
The half-life of both phenytoin and phenobarbital is long permitting once a day dosing and I often ponder why after consulting Prof. Singh so many of these previously refractory patients responded so well. I feel it was Prof. Baldev Singh's name and the faith they had in his professional opinion that encouraged many of these previously AED non-compliant patients to became compliant with AED therapy. Compliance with AED therapy led to better seizure control.
Now many more AEDs are available in the Indian market; the total number being close to around 22. Surprisingly despite these 22 AEDs, 30% of epilepsy patients remain refractory. Kwan and Brodie in their landmark study concluded that patients who have many seizures before therapy or who have an inadequate response to initial treatment with antiepileptic drugs are likely to have refractory epilepsy. While the newer AEDs have different mechanisms of actions compared to phenytoin or phenobarbital, fewer side effects especially on bone health, the percentage of refractory epilepsy patients remains largely unchanged. It is possible that some epilepsies are refractory to begin with and no AED makes a significant difference highlighting an unmet need for new AEDs, innovation and development of drugs with novel mechanisms of action.
So, while the search for new and better AEDs continues and should continue, frequently it is not the specific AED used rather the compliance with AED therapy that matters the most when it comes to seizure control. Prof. Baldev Singh recognized this early and patients responded because they had faith in his professional expertise, and he emphasized compliance with AED therapy by advising patients to take their medication at a particular time every day.
| » References|| |
Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med 2000;342:314-9.
Brodie MJ. Do we need any more new antiepileptic drugs? Epilepsy Res 2001;45:3-6.