Effect of add‐on melatonin on seizure outcome, neuronal damage, oxidative stress, and quality of life in generalized epilepsy with generalized onset motor seizures in adults: A randomized controlled trial

Abstract

Epilepsy treatment is challenging because of multiple impediments like lack of efficacy of monotherapy, adverse drug reactions, and different comorbidities. Add-on therapy to first-line antiepileptics may be the option to overcome therapeutic hurdles. The present randomized, double-blind, add-on placebo-controlled clinical trial was conducted to evaluate the effect of add-on melatonin in the treatment of generalized epilepsy with generalized onset motor seizure in adults. The control group (n = 52) received add-on placebo, and the test group (n = 52) received add-on melatonin (3 mg/day) with valproate (20 mg/kg in two divided doses). Clinical evaluation of seizure frequency, Chalfont-National Hospital seizure severity scale (NHS3), Pittsburgh sleep quality index (PSQI), quality of life in epilepsy inventory, Epworth sleepiness scale (ESS), and biochemical estimation of serum neuron-specific enolase (NSE) and glutathione reductase were done at baseline and compared with follow-up at 8 weeks. Among 104 patients randomized [mean (SD) age of 27.6 (11.5); 84 (80.8%) male], 88 (84.6%) completed the trial. The responder rate and seizure-free rate in the test group were significantly (p = 0.006 and 0.034) higher than the control group.There was a significantly higher reduction in the frequency of seizures (p = 0.016) and NHS3 (−2.39; 95%CI: −4.56 to −0.21; p = 0.032) in the test group compared to the control group. Similarly, improvement in PSQI (−1.40; 95%CI: −2.64 to −0.15; p = 0.029) was significantly better in the test group. There was no significant difference in the change in ESS (p = 0.621) and quality of life scoring (p = 0.456) between the study groups. The decrease in serum NSE was significantly higher with the test group compared to the control group (−2.01; 95% CI: −3.74 to −0.27; p = 0.024).Add-on melatonin increased serum glutathione reductase significantly (p = 0.038), but there was no significant difference between the groups (p = 0.685). Add-on melatonin with valproate for generalized epilepsy with generalized onset motor seizures | 1619 VERMA Et Al. 1 | INTRODUC TI ON Epilepsy is a chronic disabling disorder with neurobiological, cognitive, psychological, and social comorbidities leading to impaired quality of life (Yogarajah & Mula, 2019). Despite the abundance of antiepileptic drugs (AEDs), even after long-term treatment of 6-8 years, 30% of patients continue having seizures (Brigo et al. 2016). Treatment with valproate for generalized epilepsy is associated with weight gain, gastrointestinal distress, alopecia, dizziness, depression, idiosyncratic toxicities like hepatotoxicity, pancreatitis, thrombocytopenia etc. and hence, therapeutic drug monitoring is required to prevent dose-related toxicities. Moreover, comorbidities like sleep disorders, cognitive impairment, anxiety disorders, and depression make the treatment challenging. Sleep disorders in patients with epilepsy are prevalent, and previous studies proved that seizure and sleep are reciprocally related (Ekizoglu et al. 2011). Sleep architect...

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