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Newer Generation Antiepileptic Drugs Help Treatment-Resistant Patients Become Seizure-Free: Greater Chance of Seizure Freedom for Resistant Patients With Epilepsy Who Try More New-Generation Anti-Convulsants: Presented at AES

By John Otrompke

SAN ANTONIO, Texas --– December 130, 2010 -- Patients with epilepsy who are pharmacoresistant are more likely to find a drug that helps them become seizure-free if they try as many as 3 medications, according to a poster presented at the 64th Annual Meeting of the American Epilepsy Society (AES). annual meeting of the American Epilepsy Society (AES). This is a radical change from the common thinking during the prior generations of anti-epilepsy medications.

“With the new generation of anti-convulsants, patients have a slightly higher chance of seizure freedom if they use 3 different medications. The chance is 15% -- as opposed to 3% for the older generation [of medications],” noted Pavel Klein, MB, BChir, Mid-Atlantic Epilepsy and Sleep Center, Bethesda, Maryland.

About 35% of patients with epilepsy are pharmacoresistant to the prior generation of drugs, added Klein, speaking here at a poster presentation on December 5.

The prior generation included drugs such as phenobarbitolphenobarbital, phenytoindilantin, tegritol, and carbamazepine, according to Klein. Drugs in the newer generation include levetiracetam, oxcarbazepine, zonisamide, pregabalin, and lacosamide.

This In the well-powered study comprised, 583 patients (median age, 42 years; range: 11- to 89 years;). Of the patients, 367 (63%) were female), and thewith a median duration of epilepsy was of 17.5 years. Localisation-related epilepsy was the ailment in 510237 (87.48%) of patients, while 73 patients (12.52%) had primary generalised epilepsy.

In all, 237 of the patients (40.7%) became seizure-free. Of the patients with localised epilepsy, 38.2% became seizure-free during treatment with the new class of drugs, and 57.5% of patients with generalised epilepsy.

Patients in the first group experienced diminishing returns, the data showed. Of 510 patients in the localised group, 62 (12.2%) responded to the first medication, 48 (9.4%) to the second medication (including both monotherapy and polytherapy), and 30 (5.9%) became seizure-free with the third medication. With the fourth medication, however, the percentage of responders increased to 10.9%, declining again thereafter.

For patients with generalised epilepsy, on the other hand, the chance of becoming seizure-free appeared to increase as patients tried more drugs. In this group, 12.3% responded to the first medication, 13.7% responded to the second, and 17.8% responded to the third medication.

Of localised patients, 22.8% responded to monotherapy and 15.5% responded to polytherapy. Among generalised patients, 42.5% responded to monotherapy and 15.1% responded to polytherapy.

With the older class of medications, 60% would become seizure-free when first prescribed a medication for epilepsy, according to Klein.

While some patients were as young as 11 years of age, 97% were over the age of 17, and only 1% had Lennox-Gastault epilepsy, Klein noted. These results should not be generalised to a paediatric population, he added.

[Presentation title: Response to AED Ttreatment in a Ttertiary eEpilepsy Ccenter in 2003-09. Abstract 2.154]

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