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

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dc.check.date2021-11-21
dc.check.infoAccess to this article is restricted until 12 months after publication by request of the publisher.en
dc.contributor.authorMoloney, Patrick B.
dc.contributor.authorCostello, Daniel J.
dc.date.accessioned2020-11-24T12:33:57Z
dc.date.available2020-11-24T12:33:57Z
dc.date.issued2020-11-21
dc.date.updated2020-11-24T12:21:07Z
dc.description.abstractObjectives: 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.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationMoloney, 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.2020.11.005en
dc.identifier.doi10.1016/j.seizure.2020.11.005en
dc.identifier.issn1059-1311
dc.identifier.journaltitleSeizure - European Journal of Epilepsyen
dc.identifier.urihttps://hdl.handle.net/10468/10785
dc.language.isoenen
dc.publisherElsevier 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.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectDrug-resistant epilepsyen
dc.subjectAnti-seizure medicationen
dc.subjectUnanticipated treatment responseen
dc.subjectRational polytherapyen
dc.titleUnanticipated improvement in seizure control in drug-resistant epilepsy - real world observationsen
dc.typeArticle (peer-reviewed)en
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