Patterns of treatment response in newly diagnosed epilepsy
Abstract
Objective:
To delineate the temporal patterns of outcome and to determine the probability of seizure freedom with successive antiepileptic drug regimens in newly diagnosed epilepsy.
Methods:
Patients in whom epilepsy was diagnosed and the first antiepileptic drug prescribed between July 1, 1982, and April 1, 2006, were followed up until March 31, 2008. Outcomes were categorized into 4 patterns: A) early and sustained seizure freedom; B) delayed but sustained seizure freedom; C) fluctuation between periods of seizure freedom and relapse; and D) seizure freedom never attained. Probability of seizure freedom with successive drug regimens was compared. Seizure freedom was defined as no seizures for ≥1 year.
Results:
A total of 1,098 patients were included (median age 32 years, range 9–93). At the last clinic visit, 749 (68%) patients were seizure-free, 678 (62%) on monotherapy. Outcome pattern A was observed in 408 (37%), pattern B in 246 (22%), pattern C in 172 (16%), and pattern D in 272 (25%) patients. There was a higher probability of seizure freedom in patients receiving 1 compared to 2 drug regimens, and 2 compared to 3 regimens (p < 0.001). The difference was greater among patients with symptomatic or cryptogenic than with idiopathic epilepsy. Less than 2% of patients became seizure-free on subsequent regimens but a few did so on their sixth or seventh regimen.
Conclusions:
Most patients with newly diagnosed epilepsy had a constant course which could usually be predicted early. The chance of seizure freedom declined with successive drug regimens, most markedly from the first to the third and among patients with localization-related epilepsies.
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Copyright © 2012 by AAN Enterprises, Inc.
Publication History
Received: June 8, 2011
Accepted: October 26, 2011
Published online: May 9, 2012
Published in print: May 15, 2012
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Authors
Author Contributions
M.J.B. is Director of the Epilepsy Unit where the data were collected and conceived the project. S.J.E.B. and G.A.B. analyzed and managed the data under the supervision of J.D.N. and M.J.B. M.J.B. and P.K. coordinated the data analysis plan and interpretation and drafted the paper. All authors contributed to the revision for important intellectual content and approved the final version.
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