Active Epilepsy and Seizure Control in Adults — United States, 2013 and 2015

Tian, Niu; Boring, Michael A.; Kobau, Rosemarie; Zack, Matthew M.; Croft, Janet B.

doi:10.15585/mmwr.mm6715a1

Cited by 104 publications

(68 citation statements)

References 9 publications

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“…Patients were also seen in dedicated tertiary hospital–based specialist clinics that may be biased toward those with more severe epilepsy. If so, it is possible that the rate of untreated epilepsy is higher in the community . Finally, our study included mainly adults (youngest age 15 years); hence the findings may not be extrapolated to children.…”

Section: Discussionmentioning

confidence: 98%

“…We observed in a well‐resourced, specialist clinic setting that 30% of patients were not started on ASM treatment at diagnosis, and approximately one in nine remained untreated at the end of follow‐up. Most previous studies in high‐income countries have generally reported untreated epilepsy rates of less than 10% . However, these cross‐sectional surveys were unable to capture the details of changes in treatment decisions over time, with no data on rate of treatment at diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Most previous studies in high-income countries have generally reported untreated epilepsy rates of less than 10%. 3,6 However, these cross-sectional surveys were unable to capture the details of changes in treatment decisions over time, with no data on rate of treatment at diagnosis. Using insurance claims databases, recent studies in the United States found that the untreated proportion of patients recently diagnosed with epilepsy was in excess of 50%.…”

Section: Discussionmentioning

confidence: 99%

“…To what extent people with epilepsy in high‐income countries are not treated has not been well studied, although the reported proportion has generally been considered small . In the National Health Interview Surveys conducted in 2013 and 2015 in the United States, 10% of adults self‐reported to have active epilepsy were not taking ASMs at the time of the surveys . However, a recent assessment of 1942 French patients with newly diagnosed epilepsy reported that approximately 28% of patients from neurologist survey were not treated at diagnosis .…”

Section: Introductionmentioning

confidence: 99%

“…3 In the National Health Interview Surveys conducted in 2013 and 2015 in the United States, 10% of adults self-reported to have active epilepsy were not taking ASMs at the time of the surveys. 6 However, a recent assessment of 1942 French patients with newly diagnosed epilepsy reported that approximately 28% of patients from neurologist survey were not treated at diagnosis. 7 In addition, two assessments of U.S. insurance claim databases identified more than 50 000 patients with incident epilepsy between 2010 and 2015 and examined the treatment rate in newly diagnosed epilepsy.…”

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confidence: 99%

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Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

et al. 2020

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Objective To examine the factors and reasons influencing treatment initiation decisions in patients with newly diagnosed epilepsy. Methods We assessed antiseizure medication initiation decisions in adults with newly diagnosed epilepsy seen at first seizure clinics in Western Australia between 1999 and 2016 and followed to 2018. Results Of 610 patients (median age 40 years, 61.0% male), 426 (69.8%) were diagnosed after two or more seizures and 184 (30.2%) after a single seizure with risk factors for recurrence. Treatment was commenced in 427 patients (70.0%) at diagnosis, 112 (18.4%) during follow‐up, mostly after further seizures, whereas 71 (11.6%) remained untreated at last follow‐up. Elders (≥65 years, odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.62‐5.80), more seizures (OR = 3.48, 95% CI: 2.03‐5.96), and epileptogenic lesions on neuroimaging (OR = 2.15, 95% CI: 1.26‐3.68) had a higher likelihood of treatment at diagnosis. Patients with less than one seizure per year within the preceding year (OR = 0.40, 95% CI: 0.21‐0.73) and of higher socioeconomic status (OR = 0.985, 95% CI: 0.977‐0.994) were less likely to be treated. For 93 patients (15.2%), treatment was not recommended at diagnosis, most commonly because only a single seizure had occurred. Ninety patients (14.8%) declined recommended treatment, mostly because they were unconvinced of the need for treatment or the diagnosis. Significance Thirty percent of adults with newly diagnosed epilepsy were not immediately treated. Treatment initiation in this real‐world cohort was influenced by age, number of seizures prior to diagnosis, imaging findings, patient preferences, and socioeconomic status.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

et al. 2020

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Introduction and Epidemiology

Sirven

Cascino

2021

Epilepsy

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Pharmacokinetics of Cenobamate: Results From Single and Multiple Oral Ascending‐Dose Studies in Healthy Subjects

Vernillet

Greene

Kamin

2020

Clinical Pharm in Drug Dev

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Cenobamate (YKP3089) is an antiepileptic drug recently approved by the Food and Drug Administration for the treatment of focal (partial-onset) seizures in adults. The objectives of a first-in-human single-ascending-dose study and 3 multiple-ascending-dose studies were to characterize the pharmacokinetics, safety, and tolerability of cenobamate after single-dose and multiple-dose administration in healthy subjects. The 4 randomized, placebo-controlled, doubleblind studies were conducted in 210 healthy subjects receiving single (5 to 750 mg) or multiple (50 to 600 mg/day) oral doses of cenobamate or placebo using capsule formulation. Safety assessments included treatment-emergent adverse events (TEAEs) and laboratory evaluations. Maximum plasma concentrations of cenobamate were observed between 0.8 and 4.0 hours after oral administration. C max increased in a dose-proportional manner for single-and multiple-dose administration across all tested doses. Although the AUC of cenobamate increased in a more than dose-proportional manner after single-dose administration, a dose-proportional increase in cenobamate AUC τ was observed after multiple dosing from 50 to 500 mg/day. Cenobamate exhibited low oral clearance (decreasing from approximately 1.4 to 0.50 L/h with dose increase) and long terminal half-life (range, approximately 30 to 76 hours with increasing dose). Steady-state was attained after approximately 2 weeks, and the accumulation ratio was approximately 5 over the 50 to 300 mg/day range. The pharmacokinetic characteristics of cenobamate are consistent with once-daily dosing. Most TEAEs were mild in severity, 2 serious TEAEs were reported, and no deaths occurred across all studies. Except for multiple daily doses of 600 mg, all doses were generally well tolerated.Despite the development of more than a dozen new antiepileptic drugs (AEDs) over the past 20 years, significant progress in improving the efficacy and tolerability of therapies for patients with epilepsy has been limited by the efficacy and safety of these compounds. [1][2][3][4][5] Approximately 30% to 56% of patients with epilepsy continue to experience uncontrolled seizures during therapy with existing AEDs. 2,3,5,6 Continued seizures despite AED treatment have been associated with increased risk of mood disorders, limitations in education and work opportunities, and greater stigma for patients. 7 Many patients report reduced quality of life because of the failure of existing AEDs to control seizures or because of their intolerable side effects. 7,8 Thus, there remains a clear unmet need for new AEDs that are effective, safe, and tolerable. Cenobamate (YKP3089) is an AED recently approved by the US Food and Drug Administration (FDA) for the treatment of adults with focal (partialonset) seizures (Supplemental Figure). Although the mechanism by which cenobamate exerts its therapeutic effect has yet to be fully elucidated, it has been shown to involve enhancement of fast and slow inactivation of

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Active Epilepsy and Seizure Control in Adults — United States, 2013 and 2015

Cited by 104 publications

References 9 publications

Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

Treatment initiation decisions in newly diagnosed epilepsy–A longitudinal cohort study

Introduction and Epidemiology

Pharmacokinetics of Cenobamate: Results From Single and Multiple Oral Ascending‐Dose Studies in Healthy Subjects

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