Abstracts

To examine a large population with idiopathic generalised epilepsy (IGE), and estimate the overall remission rates for the IGEs and sub-syndromes. Remission rates on valproate (VPS), lamotrigine (LTG), and topiramate (TPM), and combinations of these AEDs are also estimated and factors predictive of outcome examined.
All patients with IGE were identified from a computerised database and EEG records at two adult and one paediatric regional epilepsy clinics. Data was retrospectively recorded on demographics and clinical information, seizure types and syndrome diagnosis, AED treatment details and remission rates. Main outcome measures were 1, 2, and 5 year remissions on each AED regime, and retention rates on each regime. Kaplan-Meier analysis was used to compare retention, and the proportional hazards model to identify factors predictive of outcome.
488 of the 899 patients (54%) who had been diagnosed for longer than one year 54% had achieved a one year period of remission. This was most likely with VPS monotherapy (52%), with lower rates for LTG and TPM (17% and 35% respectively). The combination of VPS and LTG achieved a remission rate of 15%. The factor most predictive of remission was the rank order in which an AED regime was given in that it was more likely the earlier it was given in the disease course. Retention was significantly better with VPS monotherapy when compared with LTG and TPM monotherapy (p[lt]0.01), with predicted retention at 2 years of 66%, 50%, and 55% respectively. The presence of absence seizures or generalised spike-wave on EEG were independent predictors of treatment discontinuation (relative risks of 38% and 28% respectively).
VPS appears to be the most effective AED in the treatment of the IGEs, and combination therapy should be initiated if an adequate trial of VPS monotherapy is not efficacious, rather than a switch to alternative monotherapy.