A recently published study found that one-year seizure-free rates
for epilepsy patients have hovered at 64 percent for 30 years. More than
one-third of patients experience epilepsy that is uncontrolled.1 Seizure
frequency has not greatly changed. Adding, or substituting, antiepileptic drugs
(AED) did not significantly lead to complete seizure control.
For those patients who stayed seizure-free for a year,
87 percent were taking just one AED and 90 percent achieved freedom from
seizures with either the first or the second AED. If the initial AED failed,
the second and third regimens provided only an additional 12 percent and 4
percent likelihood, respectively, of seizure freedom. Reductions in seizure
frequency for treatment-resistant patients on each new AED, however, are not
insignificant. But, only 2 percent achieved optimal seizure control with
subsequent AEDs.
Current AEDs do not modify the underlying cause, i.e., the
pathobiology of epilepsy.
Most patients in the study initially took Carbamazepine
(Tegretol), valproate (Depakote) and phenytoin (Dilantin) in the 1980’s and
1990’s. Later, levetiracetam (Keppra) and lamotrigine (Lamictal) were the
initial AEDs. Although some newer drugs have novel anti-seizure mechanisms,
they did not improve long-term seizure control.
Worse prognosis for control was associated with: a) the
number of seizures that occurred prior to treatment; b) a family history of
epilepsy in first-degree relatives and; c) a history of recreational drug use
in epilepsy patients.
Research into interfering with or reversing the
underlying seizure-inducing process, rather than just suppressing seizures, continues.
The secondary benefits of newer AEDs should be kept in
mind compared with older AEDs: these include lower risks for birth defects,
improved cognitive profiles and minimal drug interactions.
Newer drugs in the pipeline hold promise. Experience
will reveal their efficacy.
Genetic manipulations and immune therapies are exciting
research areas to improve or cure epilepsy.
Epilepsy-surgery can be curative in properly selected
patients.
- Chen Z, Brodie MJ, Liew D, et. al. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs. A 30-year longitudinal cohort study. JAMA Neurology 2018; 75 (3): 279-286.
Lance Fogan, M.D. is Clinical Professor of Neurology at the David
Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a
mother’s dramatic story that teaches
epilepsy, now available in eBook, audiobook and soft cover editions.
