RT Journal Article
SR Electronic
T1 Patterns of treatment response in newly diagnosed epilepsy
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1548
OP 1554
DO 10.1212/WNL.0b013e3182563b19
VO 78
IS 20
A1 M.J. Brodie
A1 S.J.E. Barry
A1 G.A. Bamagous
A1 J.D. Norrie
A1 P. Kwan
YR 2012
UL http://n.neurology.org/content/78/20/1548.abstract
AB 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. AED=antiepileptic drug; ILAE=International League Against Epilepsy; IQR=interquartile range; NGPSE=National General Practice Study of Epilepsy.