From the Journals

Successive antiepileptic drug treatments offer diminished chances for seizure freedom


 

FROM JAMA NEUROLOGY

The odds of seizure control in epilepsy patients declines significantly with each successive unsuccessful treatment regimen, despite the wide availability of a variety of new antiepileptic drugs, according to Zhibin Chen, PhD, and his associates

The study included a total of 1,795 patients who were treated at the epilepsy unit of the Western Infirmary in Glasgow, Scotland, from July 1, 1982, to Oct. 31, 2012, and followed until Oct. 31, 2014, or until their deaths. They had a median follow-up of 11 years. Of this group, 1,144 patients were seizure free for a year or longer, including 816 who achieved seizure freedom after the first antiepileptic drug and 212 after receiving their second antiepileptic drug.

The odds ratio for each successive antiepileptic drug regimen’s failing if the first regimen failed was 1.73. The first antiepileptic drug regimen offered about a 50% probability of seizure freedom for 1 year or longer, but the probability of success was only 12% with the second regimen and 4% with the third. Attempts after the third regimen all had a probability of seizure freedom of around or below 1%. Patients who had a greater number of seizures prior to treatment, reported recreational drug use, or had first-degree relatives with a history of seizure were significantly less likely to achieve seizure freedom in a multivariate regression analysis.

“A paradigm shift in treatment and research strategies is needed to improve the long-term outcomes of newly diagnosed epilepsy. Patients with drug-resistant epilepsy should be considered early for nonpharmacological therapies, such as resective surgery and brain stimulation techniques,” the study investigators wrote.

SOURCE: Chen Z et al. JAMA Neurol. 2017 Dec 26. doi: 10.1001/jamaneurol.2017.3949

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