Abstracts

RATIONALE: The idiopathic generalized epilepsies (IGEs) are genetically determined conditions, which usually have a favourable prognosis when treated with valproate. However, there is heterogeneity within the IGEs as a whole and within specific syndromes eg JME. Some patients do not respond to valproate (VPS) and while lamotrigine (LTG) and topiramate (TPM) are thought to be efficacious no direct comparisons have been made. Furthermore the utility of specific drug combinations is not known.
METHODS: A retrospective review of the case-records of 700 patients with IGE attending regional and satellite adult and paediatric epilepsy clinics. Data is being collected on history of febrile convulsions, family history of epilepsy, learning disability, EEG result, Epilepsy syndrome, treatment history and outcome. Treatment history will include whether or not the patient was seen from diagnosis, the order of drugs used, maximun dose and reason for discontinuation. Comparison between drugs will include incidence of 1,2 and 5 year remission and retention time using Kaplan-Meier survival curves. A logistic regression model wil determine independent predictors of outcome.
RESULTS: To date 282 case-records have been analysed. Retention rates for monotherapy are 84/179 (47%) for VPS, 46/78 (59%) for LTG, and 24/30 (80%) for TPM. Those who have achieved one year seizure freedom are 57/179 (32%) for VPS, 10/78 (13%) for LTG and 3/30 (10%) for TPM. This is provisional data, and with further patient analysis comparisons between these drugs will be made as outlined.
CONCLUSIONS: This study will provide information on the relative efficacy of individual AEDs and combination of AEDs in IGE. In advance of a randomized controlled trial (SANAD) this will determine whether choice of treatment or other inherent factors determine the prognosis of the IGEs.
Support: Janssen-Cilag.
Disclosure: Salary - Included in research grant from Janssen-Cilag for A Nicolson. Royalties - Nil. Honoraria - Nil. Other - Nil.