Abstracts

Prediction of the response to antiepileptic drug (AED) treatment in newly diagnosed epilepsy could help to refine pharmacological decision making and provide a rationale for early surgical intervention.
Outcomes in unselected patients in whom a diagnosis of epilepsy was made and first AED begun at the Epilepsy Unit in Glasgow since 1982 will be presented.
Data are available from 780 previously untreated patients (males 52%, females 48%; median age 29 years, range 9-93 years; median follow up 79 months, range 2-22 years). Overall 504 (65%) patients reported at least one years[rsquo] seizure freedom, 42 (5%) of whom subsequently relapsed after a median 25 months (range 12-97 months) and never again become seizure free. Adequate seizure control was never achieved in the remaining 276 (35%) patients. 92% of the 462 (60%) patients achieving remission did so within 3 years of starting treatment. 53% of these never had another seizure after taking the first dose of AED treatment. 92% of the patients in remission received monotherapy with the first (n=359) or second (n=53) AED. Only 37 (8%) patients went into remission on duotherapy, while just one patient each remained controlled on 3 or 4 drugs respectively. Patients with idiopathic epilepsy (n=222; 66% remission) did better than those with cryptogenic (n=314; 57% remission, p[lt]0.05) or symptomatic (n=244; 56% remission, p[lt]0.05) epilepsy. Outcomes in patients with cerebrovascular disease (n=63; 70% remission, p[lt]0.01) and cerebral atrophy (n=42; 71% remission, p=0.028) did better, while those with post-traumatic epilepsy (n=65; 35% remission, p[lt]0.001), did worse than the remainder of the symptomatic group. Remission rates in patients with underlying cortical dysplasia (n=15; 60% remission), hippocampal sclerosis (n=14; 50% remission) and brain tumours (n=25; 57% remission) were not significantly different from other patients with symptomatic epilepsy.
This analysis supports our previous observation ¹ of 2 populations of epilepsy patients, i.e. those that respond to AED therapy usually with the first or second choice treatment and those with refractory epilepsy de novo in whom a different therapeutic strategy may be required. Outcomes in patients with newly diagnosed epilepsy on the basis of underlying cortical dysplasia and hippocampal sclerosis were no worse than with other causes of symptomatic epilepsy. A patient who does not attain seizure control with the first 2-3 AED regimens within 2-3 years of starting treatment is unlikely ever to have a useful period of remission and can be said to have refractory epilepsy.
Reference :
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