Authors :
Presenting Author: Suresh Gurbani, MD, PhD, FAES – Kaiser Permanente
Quinn Agatep, Student – Kaiser Permanente; Sirichai Chayasirisobhon, MD – Kaiser Permanente; Ryan Shabbak, High School Student – Kaiser Permanente
Rationale:
This study aims to analyze long term seizure freedom rates with appropriate, tolerated and optimal therapeutic dose anti-seizure medication regimen (ASMr) in patients with newly diagnosed epilepsy.
Methods:
This is a retrospective data analysis of consecutive 1146 patients with newly diagnosed epilepsy managed by a single epileptologist at Kaiser Permanente Epilepsy Center in Anaheim, California, USA from January 1986 to December 2022. The latest ILAE definitions and classification guidelines were used.
1,2,3,4 We analyzed data for the patients who were followed for a minimum of five years of seizure free interval after receiving appropriate, tolerated and optimal therapeutic dose first or second ASMr. Second ASMr was either a single drug or a two drug therapy.
Results:
Out of 1146 patients with newly diagnosed epilepsy, 853 (74.4%) remained seizure-free for five years after initiation of the first or second ASMr. The first ASMr group had 554 patients (48.3%) of whom 389 (70.2%) had focal epilepsy and 165 (29.8%) had generalized epilepsy. Remaining 592 patients with continued seizure activity were treated with the second ASMr, of which 299 patients (26.1%) became seizure-free. In this group 213 (71.2%) had focal epilepsy and 86 (28.8%) had generalized epilepsy, and 200 (66.9%) were on monotherapy and 99 (33.1%) on combined two drug therapy. Overall, out of 1146 patients 754 (65.8%) responded to a single drug therapy and 99 (8.6%) required two drug therapy. Drug resistant epilepsy was present in 293 (25.6%) patients.
Conclusions:
1) In patients with newly diagnosed epilepsy, seizure freedom was achieved and maintained for up to five years in 74.4% of the patients: a) 48.3% on the first ASMr, b) 26.1% more on the second ASMr. c) 65.8% on single drug therapy, and d) 8.7% with 2-drug therapy.
2) In the patient group which required a second ASMr, a 50.5% seizure freedom rate was achieved and was maintained for up to five years.
3) Drug-resistant epilepsy was present in 25.6% of the patients.
Funding: No funding was received or utilized.