Misperceptions on the chance of seizure freedom with antiseizure medications after two failed trials

Blond, Benjamin N.; Hirsch, Lawrence J.; Mattson, Richard H.

doi:10.1111/epi.16594

Cited by 11 publications

(13 citation statements)

References 10 publications

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“…Recent studies have concluded that between 23 and 31% of epilepsy cases do not respond adequately to anti-seizure medication (ASM) (7,(11)(12)(13). However, DRE has been found to range from 15 to 60% depending on the definition criteria, cohort selection, and sample size.…”

Section: Introductionmentioning

confidence: 99%

Definitions and Risk Factors for Drug-Resistant Epilepsy in an Adult Cohort

et al. 2021

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Background: Less than one-third of people with epilepsy will develop drug-resistant epilepsy (DRE). Establishing the prognosis of each unique epilepsy case is an important part of evaluation and treatment.Most studies on DRE prognosis have been based on a pooled, heterogeneous group, including children, adults, and older adults, in the absence of clear recognition and control of important confounders, such as age group. Furthermore, previous studies were done before the 2010 definition of DRE by the International League Against Epilepsy (ILAE), so data based on the current definitions have not been entirely elucidated. This study aimed to explore the difference between 3 definitions of DRE and clinical predictors of DRE in adults and older adults.Methods: Patients with a new diagnosis of epilepsy ascertained at a Single Seizure Clinic (SSC) in Saskatchewan, Canada were included if they had at least 1 year of follow-up. The first study outcome was the diagnosis of DRE epilepsy at follow-up using the 2010 ILAE definition. This was compared with 2 alternative definitions of DRE by Kwan and Brodie and Camfield and Camfield. Finally, risk factors were analyzed using the ILAE definition.Results: In total, 95 patients with a new diagnosis of epilepsy and a median follow-up of 24 months were included. The median age of patients at the diagnosis of epilepsy was 33 years, and 51% were men. In the cohort, 32% of patients were diagnosed with DRE by the Kwan and Brodie definition, 10% by Camfield and Camfield definition, and 15% by the ILAE definition by the end of follow-up. The only statistically significant risk factor for DRE development was the failure to respond to the first anti-seizure medication (ASM).Conclusion: There were important differences in the percentage of patients diagnosed with DRE when using 3 concurrent definitions. However, the use of the ILAE definition appeared to be the most consistent through an extended follow-up. Finally, failure to respond to the first ASM was the sole significant risk factor for DRE in the cohort after considering the age group.

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Section: Introductionmentioning

confidence: 99%

Definitions and Risk Factors for Drug-Resistant Epilepsy in an Adult Cohort

et al. 2021

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“…Medical management does control seizures in a sizable minority of patients with DRE: Speculations on how and why Medical management of DRE results in 15-18% of patients achieving remission regardless of whether an optimization protocol is implemented. The finding that a sizable minority of patients with DRE can achieve remission is not novel, though it is not always adequately acknowledged (for a more detailed discussion, see [5]. Therefore, it is important that this finding is reproduced, discussed, and divulged.…”

Section: A Protocol Of Medical Management Optimization Of Dre Is Necessarymentioning

confidence: 99%

How much can medical management alone improve the outcome of adult drug-resistant epilepsy? An exploratory study on possibilities and limitations of combining multiple therapeutic actions

Serafini

2021

Epilepsy & Behavior

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Failure to control epileptic seizures with two medications, adequately chosen and dosed, indicates drug-resistant epilepsy (DRE). The chance of pharmacologically controlling seizures is low for patients with DRE and uncontrolled seizures who are not candidates for surgery, who have already undergone surgery, or who already had a vagus nerve stimulator (VNS) placed. Patients experiencing these conditions must instead rely on medical management of their seizures, and there is no breakthrough solution on the horizon.Medical care of DRE might be optimized by systematically considering factors that promote and inhibit breakthrough seizures. For example, seizure control could be enhanced through measures such as increasing the frequency of follow-up visits, tracking treatment plan compliance, treating sleep disorders, rational polypharmacy, adjusting drug administration to achieve higher levels when seizures are more likely and educating patients on seizure triggers. A systematic and simultaneous implementation of all of these measures is likely to yield a sizable, clinically relevant, improvement.This paper presents an exploratory study on the effects of implementing such an approach, specifically evaluating this method's impact on seizure frequency. Methods: I performed a retrospective chart review of 659 consecutive adult patients with epilepsy followed up at the University of Utah and at the Salt Lake City VA Medical center using the multimodal approach described above. I identified 27 patients who had DRE and uncontrolled seizures and in whom a medical management optimization protocol was implemented. I measured these patients' seizure frequency at the beginning and the end of the study period and compared the results with those of a matching control group of 48 patients. Results: The optimization protocol did not increase the number of seizure-free patients with DRE; however, it was effective in minimizing seizure frequency in patients whose seizures remained uncontrolled. Among these patients, the median seizure frequency dropped by 64% in the optimization group but did not change in the control group. Conclusions: Despite the high occurrence of DRE, there is no accepted protocol for the related medical management. This paper describes an effective approach that can be implemented in a clinically relevant and readily achievable manner.

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“…We read with interest the letter from Blond et al in a recent issue of Epilepsia discussing seizure freedom with antiseizure medications (ASMs). 1 The authors sought to clarify misperceptions of a 2018 article by Chen et al 2 Blond et al accurately state that a third ASM trial resulted in seizure freedom for 23.6% and that even a sixth ASM trial led to seizure freedom in 14% instead of the inaccurate assertion that individuals have only a 5% chance of seizure freedom after a second ASM. 2 However, as Blond et al note in their own letter, seizure freedom is not entirely accurate, as the 2018 study definition indicated seizure control after lack of seizures for the previous 12 months or longer.…”

Section: The Challenges Of Continued Antiseizure Medicine Trialsmentioning

confidence: 99%

“…The authors conclude that continued ASM trials remain of value, particularly for lessthan-ideal surgical candidates. 1 Additional context helps define the challenges in suggesting additional ASM trials to drug-resistant epilepsy (DRE) patients as a meaningful path to long-term seizure freedom. When examining perhaps a natural course of DRE, Brodie et al found 16% have a "relapsing/remitting" course, a course accurately not viewed as seizure freedom.…”

Section: The Challenges Of Continued Antiseizure Medicine Trialsmentioning

confidence: 99%