Abstracts

Rationale: Epilepsy is a chronic condition with complex effects on a person’s social, vocational, and psychological function. There is more to managing epilepsy than seizure control alone. It has been proposed that newer AEDs, such as levetiracetam (LEV), are better tolerated than the older drugs such as carbamazepine (CBZ) and sodium valproate (VPA), therefore potentially improving quality of life. The rationale of this project was to test medical and psychosocial outcomes from treatment with LEV versus two standard older drugs, CBZ and VPA, used as substitution monotherapy. Methods: KONQUEST is a randomised open-label study. Participants were recruited from outpatient clinics in an Australian Centre. Patients with partial epilepsy on monotherapy with an older AED and had failed treatment either due to lack of efficacy or due to adverse effects, were invited to participate. Participants taking Phenytoin (PHT), or CBZ were randomised to either LEV or VPA and participants taking VPA were randomised to LEV or CBZ. Balanced randomisation was used based on Hospital Anxiety Depression Scale (HADS) anxiety scores. Assessments were performed at baseline, 3 and 12 months using validated questionnaires for seizure control, anxiety and depression (HADS), psychiatric distress (Symptom Checklist 90 - SCL 90), Quality of Life in Epilepsy (QOLIE 89), adverse effects (Liverpool Adverse Effects Profile - LAEP) and, a computerized neuropsychological assessment tool, IntegNeuro. Outcome analysis was performed on the basis of intention to treat. Results: 106 patients were enrolled, with 98 satisfactorily completing their three month visit: 51 in the LEV group and 47 in the older AED group (randomised to VPA, n=26, or CBZ, n=21). There were significant improvements across all assessments including LAEP scores (p < 0.05), QOLIE 89 scores (p < 0.001), SCL 90 scores (p < 0.05), and HADS scores (p < 0.05), over the 3 month period regardless of the treatment groups. No significant differences were observed between the two groups. A similar proportion of patients in both groups experienced recurrent seizures (~ 33%). Conclusions: These observations provide evidence that tolerability, adverse effects, psychological symptomatology and quality of life all improve with substitution monotherapy at three months. This effect is similar with levetiracetam as with the established AEDs (CBZ and VPA).