After First Antiepileptic Drug Failure, Remission Still Feasible

the MPR take:

A high number of patients with epilepsy achieve 12-month remission even after failure of a first antiepileptic drug reports a new study in the journal Neurology. One group of 1,721 patients (89% with focal epilepsy) were randomized to receive treatment with carbamazepine, gabapentin, lamotrigine, topiramate, or oxcarbazepine, while a second group of 716 patients were randomized to receive lamotrigine, topiramate, or valproate. Forty-four percent of the patients experienced first treatment failure, but 75% of these patients subsequently achieved 12-month remission after a six year follow-up. About 50% of those who failed a first treatment also failed their second, with factors for this including total number of tonic-clonic seizures at first treatment failure, CT/MRI scan result, and reason for first treatment failure. Young patients (without tonic-clonic seizures, with normal CT/MRI scan) who failed treatment due to unacceptable adverse drug effects had the highest likelihood of 12-month remission after first treatment failure. For reasons currently unknown, men were more likely to experience 12-month remission than women; the authors posit that it is unclear if this is due to differences in treatment management or an underlying biological difference that impacts drug response.

After First Antiepileptic Drug Failure, Remission Still Feasible
After First Antiepileptic Drug Failure, Remission Still Feasible

Objectives: We assessed the likelihood of 12-month seizure remission and treatment failure after failure of a first antiepileptic drug, and identified factors influencing these outcomes. Patients were followed up to study completion, even if they were switched from their randomized treatment. ...

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