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.
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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