Abstracts

Rationale: Understanding which unique antiepileptic drug (AED) regimens provide better efficacy in epilepsy can help clinicians formulate rational treatment. To date, there is limited data on comparative efficacy of AED regimens. We retrospectively compared treatment records of 757 patients with active localization-related epilepsy (LRE) to determine whether any unique AED regimens are associated with better efficacy. Methods: From an ongoing, retrospective, longitudinal observational study of AED response and tolerability, we identified patients meeting the following criteria: ● Active LRE, defined as ≥ 1 seizure while being seen at Columbia Epilepsy Center ● At least 2 unique AED regimens (mono-, duo-, or tritherapy) attempted for ≥ 6 continuous months or discontinued due to inefficacy Efficacy was determined by whether or not patients had seizure-free (remission) periods of ≥ 6 continuous months during the time of exposure to a specific regimen. First Analysis: We performed within-patient head-to-head efficacy comparisons between unique regimens when ≥ 15 patients had attempted both regimens. Second Analysis: We performed within-patient efficacy comparisons between unique regimens and the aggregate of other regimens to which each patient had been exposed. We also calculated an ""efficacy ratio"" for each regimen: the percentage of patients who had remission periods on that regimen divided by the percentage of all other attempted regimens that led to remissions. Third Analysis: We performed within-patient efficacy comparisons of aggregated mono-, duo-, and tritherapy regimens, including comparisons between monotherapy and both forms of polytherapy. To account for LRE severity, we stratified comparisons by the total number of regimens attempted per patient. Results: 757 patients (354 male) met our inclusion criteria. Mean age was 44.1 years (SD = 18.7). First Analysis: Lamotrigine monotherapy was more effective than three other regimens: phenytoin monotherapy (60% more patients had remissions; p < .001), lamotrigine/phenytoin (41% more patients had remissions; p = .016), and gabapentin/lamotrigine (26% more patients had remissions; p = .031). See Table 1.