Abstracts

Rationale: Many FDA approved antiepileptic drugs (AEDs) are available on the market. Almost 30% of patients with epilepsy fail to have significant and sustained improvement of their seizures. This could be related to a “honeymoon” phenomenon. It is probable that some patients with epilepsy experience a transient benefit from AEDs that fades over time. We designed this cross-sectional study to determine if patients with uncontrolled partial-onset epilepsy endorse such a “honeymoon” effect to previously-tried AEDs. Methods: We designed and developed our own questionnaire since the “honeymoon” effect has not been assessed before. We asked patients to provide their experience with 13 of the currently available AEDs (carbamazepine, gabapentin, felbamate, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, tiagabine, topiramate, valproic acid and zonisamide). In order to assess the amount of decrease in seizures associated with each AED, patients marked an “X” on a 100 millimeter visual analog scale (VAS) reflecting the extent of seizure decrease from 0 (None) to 100 (Seizure-free). Beyond extent, we also asked patients about the duration of benefit by asking them to recall how long the benefit lasted (0, 1, 2, 3, 4, 5, or 6+ months) and the reason the AED was stopped. Additionally, pertinent demographic data was collected from the patient’s medical record. Results: Fifty patients with intractable partial-onset epilepsy were recruited from the Ohio State Epilepsy clinic. The mean age was 42.0±13.2 years, 50% were female, mean age of epilepsy onset was 16±14 years, and median monthly seizure frequency was three. The average number of AEDs that each patient had previously tried was 4.6. The most commonly-used AEDs were carbamazepine (n=39), phenytoin (n=38), and valproic acid (n=33). The mean decrease in seizure activity, based on the VAS, was 46.8 ± 9.1. The three AEDs that offered the highest decrease in seizure activity were lamotrigine, felbamate, and topiramate (61.3, 60.5 and 55, respectively). The three AEDs that offered the lowest decrease were gabapentin, phenytoin, and zonisamide (32.7, 34.5 and 39, respectively). Our definition of “honeymoon” effect was a transient benefit (decrease of seizures) from an AED that lasted for less than six months. Such benefit was reported by 17% of patients for a single AED, 5.7% for two different AEDs, and 7.5% for three different AEDs. Conclusions: The transient effect of AEDs (honeymoon), if confirmed, is a phenomenon that can change our methodology in treating epilepsy. Future studies that eliminate the limitations in our study (retrospective nature, small sample size, and dependence on patients’ recall) are needed to determine and further explore such phenomenon.