Abstracts

RATIONALE: Juvenile myoclonic epilepsy (JME) is typically, but not always, responsive to valproate (VPA), but not all patients respond. VPA is associated with adverse effects, like tremor, weight gain, sedation, and menstrual irregularities, often resulting in discontinuation. Newer antiepileptic drugs (AEDs) (e.g., lamotrigine (LTG), topiramate (TPM), zonisamide (ZNS), and levetiracetam (LEV)) are associated with fewer adverse effects. However, data describing the newer AEDs for JME and direct comparisons in JME are lacking. A retrospective chart review of patients with JME in our clinic, treated with one of these AEDs, is ongoing. Preliminary results are reported in this abstract.
METHODS: A search of the epilepsy clinic database at UAB was done using the terms, JME, myoclonic, absence, and generalized tonic-clonic seizures. Inclusion criteria are age [gt] 15 years, administration of a new AED, a diagnosis of JME, and initiation of a new AED in our clinic. Exclusion criteria are concurrent administration of more than 1 new AED, except for [lt] 12 wk transition to another drug, and insufficient documentation of seizure frequency. Outcomes evaluated are frequency of myoclonic (MYO), absence (AB), and generalized tonic-clonic (GTC) seizures, doses of VPA, adverse effects, administration of other AED, weight, and new AED discontinuation. Comparisons are made between treatment prior to initiation of the new AED (data from up to 3 clinic visits prior to new AED start) and treatment with the new AED. If the new AED is discontinued, data for up to 3 clinic visits after discontinuation is evaluated.
RESULTS: Sixty-eight patients are evaluated at this point. Of these, 21 were excluded for no new AED, 17 for no JME diagnosis, and 9 for concomitant administration of more than 1 new AED. Data from 21 patients (11 LTG, 6 TPM, and 4 ZNS) are included in the preliminary comparison. Myoclonic seizures increased 192% for LTG, 110 % for TPM, and 83 % for ZNS. Generalized tonic-clonic seizures decreased 13% for LTG, 94% for TPM, and 85% for ZNS. Absence seizures increased with LTG and decreased with ZNS. Mean daily VPA doses increased 5% for LTG and decreased 26% and 6% for TPM and ZNS, respectively. Weight decreased 6% for LTG, 25% for TPM, and increased 2% for ZNS.
CONCLUSIONS: Preliminary analysis of patients receiving LTG, TPM, or ZNS for JME indicates that administration of LTG is associated with an increase in MYO, AB, and GTC seizures. Additionally, there is an increase in VPA doses following initiation of LTG. TPM and ZNS are associated with a decrease in AB and GTC seizures and a decrease in VPA doses. There appears to be a smaller increase in MYO with TPM and ZNS compared to LTG. LTG may be less effective in this group of JME patients compared to TPM and ZNS.[table1]
[Supported by: Elan Pharmaceuticals]; (Disclosure: Grant - Elan Pharmaceutical, Consulting - Elan Pharmaceutical, Ortho-McNeil Pharmaceutical, UCB Pharma, Glaxo SmithKline, Honoraria - Ortho-McNeil, Glaxo SmithKline, UCB Pharma, Elan Pharmaceutical)