Blog #23: Epilepsy Treatment: How Effective?

(This blog was originally posted on May 29, 2012)

 

 

        Nearly one percent of the world’s population experiences recurrent seizures, i.e., epilepsy.  That’s approximately seventy million people, including three million in the United States. As patients and their physicians know, treatment often is unsatisfactory.

The May 15, 2012 issue of Neurology reports a study in which Brodie, et al. (1) followed almost 1100 newly-diagnosed epilepsy patients, ages 9-93, between July1, 1982 and March 31, 2008. Their epilepsy was due to various identified structural brain abnormalities (including injuries, strokes and scars, abnormal blood vessels and others), presumptive genetic causes, and unidentified causes.

Treatment consisted of initiation of a single antiepileptic drug considered appropriate for that patient. If the seizures continued then a different antiepileptic drug was substituted or added to the drug regimen. If seizures persisted a third antiepileptic drug was substituted for the other single drug or it was added on.

The researchers concluded that 68% of all of the seizure patients were seizure-free, i.e. had no seizures for at least one year without having to change the treatment. Among these almost 62% were on a single drug.  Forty-nine percent of the study population was seizure-free on the first antiepileptic drug tried. Any individual patient’s treatment success or failure usually became clear soon after initiation of treatment.

Brodie and co-investigators found there was a higher probability of freedom from seizures if only one drug was required for control; there was less confidence of full seizure control if more than one drug was required. Even less seizure control was experienced if more than two drug attempts were necessary. Less than 2% of patients who required multiple trials of medications, however, became seizure free.

This data is helpful for physicians in their discussions with patients with epilepsy. It can reinforce patient compliance with treatment. We can tell our patients that there is significant hope for a good prognosis in treating their newly diagnosed epilepsy.

1.Brodie, MJ, Barry, SJE, Bamagous, GA, et al. Patterns of treatment response in newly diagnosed epilepsy. Neurology. 2012; 78: 1548-1554.

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. DINGS is his first novel.