Abstracts

Rationale: When epilepsy does not respond to the initial antiepileptic drug (AED), the subsequent search for an effective AED is predominantly a matter of trial and error. Guidance to help predict efficacy of a particular AED is needed. We hypothesized that in familial epilepsy, affected family members share a common pathophysiology, and the identification of an effective AED in one member may be useful for the treatment of other affected members. We tested this hypothesis in siblings treated in our practice for epilepsy. Methods: In a thorough search of our clinic database, we identified 13 siblings from six affected families, all of whom were treated in our clinic. All patients were studied with EEG or EEG-video monitoring and had their seizure and epilepsy classification verified. We recorded prior AED therapy in each sibling and the eventual AED or AED combination that produced seizure control. Results: The patients were 5 women and 8 men, aged 23 to 44 years. The age at epilepsy onset varied from 4 to 29 years. Two of the families had generalized and four had partial epilepsy. All patients were drug-resistant at one point in their presentation. One set of siblings had recurrent episodes of status epilepticus. Five sets of siblings (11 individuals) became seizure-free or almost seizure-free (rare seizures related to compliance lapse or other precipitants in 4 individuals) with treatment modification. In these 5 families, the AED or AED combination that rendered one sibling seizure-free was used successfully in the other sibling(s). The medication that produced seizure freedom was lamotrigine in three families (including the siblings with recurrent status), lamotrigine-valproate combination in one family and lamotrigine-levetiracetam combination in the fifth family. In one remaining family with generalized epilepsy, one sibling was seizure-free on phenobarbital while the other had persistent seizures despite polytherapy. Conclusions: Siblings with epilepsy tend to have a similar profile of AED response. The AED that proves effective for one sibling will likely be effective for the other, and thus may save un-necessary AED trials. Lamotrigine was the most commonly efficacious AED in the current group of siblings.