Unanticipated improvement in seizure control in drug-resistant epilepsy - real world observations

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dc.contributor.author Moloney, Patrick B.
dc.contributor.author Costello, Daniel J.
dc.date.accessioned 2020-11-24T12:33:57Z
dc.date.available 2020-11-24T12:33:57Z
dc.date.issued 2020-11-21
dc.identifier.citation Moloney, P. B. and Costello, D. J. (2020) 'Unanticipated improvement in seizure control in drug-resistant epilepsy - real world observations', Seizure - European Journal of Epilepsy. doi: 10.1016/j.seizure.2020.11.005 en
dc.identifier.issn 1059-1311
dc.identifier.uri http://hdl.handle.net/10468/10785
dc.identifier.doi 10.1016/j.seizure.2020.11.005 en
dc.description.abstract Objectives: To determine the clinical features and anti-seizure medication (ASM) strategies associated with an unanticipated substantial improvement in seizure control in patients with drug-resistant epilepsy (DRE). Methods: This retrospective analysis of patients attending a tertiary care epilepsy clinic between 2008 and 2017 identified all patients with active DRE (at least 1 seizure per month for 6 months, despite treatment with 2 different ASMs). All treatment interventions were recorded from when DRE was first identified to the end of the study. The primary end points were seizure freedom or meaningful reduction in seizure frequency (greater than 75 %) sustained for at least 12 months after a treatment intervention. Results: Three hundred and twenty-two patients were included in the analysis. Overall, 10 % became seizure free following ASM adjustment and an additional 10 % had a greater than 75 % improvement in seizure control (median follow-up, 4 years). An ASM introduction was ten times more likely than an ASM dose increase to improve seizure control. Combined focal and generalized epilepsy, intellectual disability and prior treatment with more than 5 ASMs were more frequently observed in those with continued pharmacoresistance. ASM responders were more likely to have primary generalized epilepsy. Rational polytherapy (combining ASMs with different mechanisms of action) was almost ubiquitous amongst ASMs responders (95 % taking at least 2 drugs with different mechanistic targets). Of the ASM additions that heralded improved seizure control, 85 % were maintained at submaximal doses. Conclusions: This retrospective analysis of a large number of ‘real-world’ patients provides evidence to persist with ASM trials in DRE. Early rotation of ASMs if a clinical response is not observed at a substantial dose and rational ASM polytherapy may yield better clinical outcomes in patients with DRE, although a prospective study would need to be conducted to validate these findings. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Elsevier B.V. en
dc.rights © 2020, Elsevier B.V. All rights reserved. This manuscript version is made available under the CC BY-NC-ND 4.0 license. en
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/ en
dc.subject Drug-resistant epilepsy en
dc.subject Anti-seizure medication en
dc.subject Unanticipated treatment response en
dc.subject Rational polytherapy en
dc.title Unanticipated improvement in seizure control in drug-resistant epilepsy - real world observations en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Daniel Costello, Medicine, University College Cork, Cork, Ireland. +353-21-490-3000 Email: daniel.costello@hse.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication by request of the publisher. en
dc.check.date 2021-11-21
dc.date.updated 2020-11-24T12:21:07Z
dc.description.version Accepted Version en
dc.internal.rssid 545102483
dc.description.status Peer reviewed en
dc.identifier.journaltitle Seizure - European Journal of Epilepsy en
dc.internal.copyrightchecked Yes
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress daniel.costello@hse.ie en
dc.internal.bibliocheck In press. Check vol / issue / page range. Amend citation as necessary. en


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© 2020, Elsevier B.V. All rights reserved. This manuscript version is made available under the CC BY-NC-ND 4.0 license. Except where otherwise noted, this item's license is described as © 2020, Elsevier B.V. All rights reserved. This manuscript version is made available under the CC BY-NC-ND 4.0 license.
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