Patterns of treatment response in newly diagnosed epilepsy
Exclusive author commentary
Brodie MJ et al. – Most patients with newly diagnosed epilepsy had a constant course which could usually be predicted early. The chance of seizure freedom declined with successive drug regimens, most markedly from the first to the third and among patients with localization–related epilepsies.Methods
- Patients in whom epilepsy was diagnosed and the first antiepileptic drug prescribed between July 1, 1982, and April 1, 2006, were followed up until March 31, 2008.
- Outcomes were categorized into 4 patterns:
- Early and sustained seizure freedom
- Delayed but sustained seizure freedom
- Fluctuation between periods of seizure freedom and relapse
- Seizure freedom never attained.
- Probability of seizure freedom with successive drug regimens was compared.
- Seizure freedom was defined as no seizures for ≥1 year.
- A total of 1,098 patients were included (median age 32 years, range 9-93).
- At the last clinic visit, 749 (68%) patients were seizure-free, 678 (62%) on monotherapy.
- Outcome pattern A was observed in 408 (37%), pattern B in 246 (22%), pattern C in 172 (16%), and pattern D in 272 (25%) patients.
- There was a higher probability of seizure freedom in patients receiving 1 compared to 2 drug regimens, and 2 compared to 3 regimens (p < 0.001).
- The difference was greater among patients with symptomatic or cryptogenic than with idiopathic epilepsy.
- Less than 2% of patients became seizure-free on subsequent regimens but a few did so on their sixth or seventh regimen.
Dr. Kwan (05/21/2012) comments:
1. Patients who have not responded to 2 antiepileptic medications should be referred to specialist centres for evaluation of diagnosis and consideration of non-drug therapies. 2. 1 in 6 patients have a remitting-relapsing course. Thus if other treatment options, such as surgery, are not appropriate, further pharmacological modifications can still occasionally produce a worthwhile and sustained response.