Treatment Outcomes of People with Newly Diagnosed Focal Epilepsy: Findings from the Human Epilepsy Project (HEP)
Abstract number :
2.274
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2024
Submission ID :
862
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Sarah Barnard, MD, MIPH – Monash University
Zhibin Chen, PhD – Monash University
Manisha Holmes, MD – 3. Westchester Medical Center Health Network, New York Medical College
Andres Kanner, MD – Miller School of Medicine, University of Miami
Manu Hegde, MD, PhD – University California, San Francisco
Ruben Kuzniecky, MD – Lenox Hill Hospital/Northwell Health
Daniel Lowenstein, MD – University California, San Francisco
Jacqueline French, MD – New York University Comprehensive Epilepsy Center
Rationale: While studies have explored outcomes in people with newly diagnosed epilepsy, few have focused on focal epilepsy.
Methods: HEP is a 6-year international, prospective cohort study of people with newly diagnosed focal epilepsy aimed at identifying clinical and biological markers predictive of disease outcome. Treatment outcomes were determined by review of ASMs and self-reported seizures in an online seizure diary and medical records. A period of seizure freedom was defined, using the International League Against Epilepsy (ILAE) definition, as having no seizures for 12 months or 3 times their greatest pre-treatment seizure free interval, whichever was longer. Participants were classified as treatment sensitive if they achieved a period of seizure freedom on ≤2 ASM trials, or resistant following the failure of 2 ASM trials. Failure of an ASM was defined as at least 1 seizure on a therapeutic dose of an appropriate ASM, where no seizure free period was achieved on that ASM. Change in post treatment seizure frequency was reported as change in seizure density from pre-treatment frequency. To account for periods of dose titration, the first 2 months following treatment initiation were excluded.
Results: 448 participants were enrolled. The median duration of follow up was 3.13 years (IQR 2.33-3.55). 245 (54.7%) participants were considered Treatment Sensitive, 102 (22.8%) Treatment Resistant and 101 (22.5%) Indeterminate. 267 (59.6%) participants achieved at least 1 period of seizure freedom and 121 participants did so on their first ASM (45.3% of ever seizure free; 27.0% of all participants). 168 (37.5%) participants never achieved a period of seizure freedom. Of those, almost half were treatment resistant (n=81, 48.2%) and a third were indeterminate due to < 2 adequate ASM trials (n=52, 31.0%). Of those who were treatment resistant, 20.6% (21/102) later achieved a period of seizure freedom. The median event time from treatment initiation to start of first-ever seizure freedom was 12.1 months (n=435, 95% CI: 9.7–16.1). Median time to treatment resistance (date of failure of 2nd ASM) was 5.8 months (n=102, IQR: 2.4-11.2). 40% of participants had 100% reduction in seizures in the 6 months following stable treatment initiation (Figure 1). By one year, the reduction was sustained in only 32% (Figure 2).
Conclusions: Our preliminary findings suggest that over half of people newly diagnosed with focal epilepsy will be sensitive to treatment. Only one third can expect to sustain seizure freedom 1 year post stable treatment initiation. Treatment resistance can generally be determined within 6 months from treatment initiation. One fifth of ILAE defined treatment resistant patients will later achieve seizure freedom. One third of those who never achieved seizure freedom in our study had tried only one ASM.
Funding: The Epilepsy Study Consortium (ESCI): a non-profit organization dedicated to accelerating epilepsy research.
Clinical Epilepsy