SEIZURE CONTROL AND EEG RESPONSE IN PRIMARY GENERALIZED EPILEPSY PATIENTS TREATED WITH TOPIRAMATE
Abstract number :
2.214
Submission category :
Year :
2002
Submission ID :
88
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Tricia Y. Ting, Susan Herman, Jacqueline A. French, Blaise F.D. Bourgeois, Paul M. Levisohn, William E. Rosenfeld. Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA; Children[ssquote]s Hospital, Boston, MA; Division of C
RATIONALE: Interictal epileptiform spike-wave activity indicates hyperexcitability and increased risk for clinical seizures. Although reduced spike-wave activity is a putative marker of seizure control, studies with broad-spectrum antiepileptic drugs (AEDs) show no consistent correlation between spike-wave activity and seizure control in primary generalized epilepsy. This study evaluated the effect of the broad-spectrum AED topiramate on interictal epileptiform discharges in patients with primary generalized epilepsy.
METHODS: Patients in this open-label, multicenter study had primary generalized epilepsy (newly diagnosed or on a stable AED regimen; typical absence, progressive myoclonic epilepsy excluded) and epileptiform activity on a 30-min EEG. TPM effect on spike-wave activity was evaluated by comparing 24-hr ambulatory outpatient EEGs at baseline and after 1 wk at optimum/maximally tolerated dose. EEG studies, staged by state (awake; sleep stages 1, 2, 3, 4,; REM sleep), were analyzed by a blinded independent reader.
RESULTS: Evaluable EEG data were available for 11 patients (all female, 8-48 yrs). Seizure control was improved in 7 (64%) patients; 4 (36%) had no seizures. Absence seizures were reduced in 5 of 7 patients. Mean spike frequency decreased in 7 patients (pretreatment: 2.42 spikes/hr; post-treatment: 1.65 spikes/hr). Two EEG Responders were seizure-free; 3 had improved seizure control; 2 had mixed responses. Two EEG Non-Responders were seizure-free; 2 had mixed responses. EEG Non-Responders had 5-fold higher baseline spike wave discharge frequency (11.12 spikes/hr) which was increased at post-treatment EEG (24.62 spikes/hr). Neither clinical nor EEG response correlated with TPM blood levels.
CONCLUSIONS: Seizures in primary generalized epilepsy, including absence seizures, were reduced with TPM treatment, epileptiform spike-wave activity was reduced in [gt]50% of patients. Epileptiform activity was less likely to be suppressed in patients with high baseline discharge frequencies. Consistent with findings in other studies of broad-spectrum AEDs, EEG response was not predictive of clinical response.
[Supported by: Ortho-McNeil Pharmaceutical]; (Disclosure: Grant - Ortho-McNeil/Johnson & Johnson UCB Pharma, Consulting - GlaxoSmithKline Novartis, Honoraria - Pfizer/Parke-Davis)