Antiseizure medications help the majority of people with focal epilepsy, a common form of the neurological disorder. Yet most will still have episodes for at least a year after their treatment begins, until their doctors can find the right drug and dosage for them, a new study shows.
Accounting for about 60% of people with epilepsy, focal epilepsy occurs when nerve cells in a certain brain region send out a sudden, excessive burst of electrical signals. This uncontrolled activity, which is called a focal seizure, can cause problems such as abnormal emotions or feelings and unusual behaviours. Much attention has been paid to the minority of patients who do not respond well to available treatments, but the current study looks at another group: those who may not respond to the first medication or regimen prescribed but who might respond to another tried later.
Led by researchers at NYU Langone Health as part of the international Human Epilepsy Project, the study is among the first in a decade to focus on those whose seizures ultimately can be prevented or controlled with drugs. Results for nearly 450 men, women, and teens newly diagnosed with the disorder revealed that although more than half eventually received a medication or regimen that worked for them, major improvements were not achieved until an average of 12 months. Many needed even longer to find relief.
“Our findings suggest that those with focal epilepsy should expect a long adjustment period as their healthcare provider determines the best treatment regimen for them,” said study senior author and neurologist Jacqueline A. French, MD.
A possible explanation for this delay is that physicians are not selecting the ideal antiseizure therapy on their first try, adds Dr French, a professor in the Department of Neurology at the NYU Grossman School of Medicine and co-principal investigator of the Human Epilepsy Project.
Neurologists commonly start patients on levetiracetam, a drug that can target many types of seizures and has few interactions with other medications. Based on the new results, however, they may want to rethink this approach, says Dr French, noting that although 57% of the study participants were initially prescribed levetiracetam, only a quarter became seizure free on their first try.
A report on the findings appears in JAMA Neurology.
Thirty-four epilepsy centres in the United States, Europe, and Australia were involved in the study, which took place from 2012 to 2019. The team collected data about the patients’ medical histories, demographic factors, and the details of their epilepsy diagnoses. All were provided annual follow-ups for either three or six years.
During this time, participants tracked their seizure frequency in an electronic diary, describing each day as either “seizure-free” or “had a seizure.” The time, duration, and type of episode, along with other notes, were also recorded. The study volunteers also reported information about their antiseizure medications, noting the type, dose, and reasons for discontinuing a regimen.
Patients were considered seizure-free if they did not have an episode for at least a year (or longer if their seizures were infrequent).
The study further showed that together, 63% of all participants experienced ongoing or even worsening seizures during the first year of therapy, whether or not they would eventually find relief.
Notably, those who had seizures only a few times per year prior to treatment were more likely to respond to medication than those who had them weekly. In addition, participants with a history of psychological disorders such as anxiety and depression were almost twice as likely to resist the drugs than those without such a history.
“Our results show that the best way to a new treatment plan is sometimes through making better use of the tools we already have instead of always searching for the next breakthrough drug,” said Dr French, who is also a member of NYU Langone’s Comprehensive Epilepsy Center.
The researchers next plan to more closely examine those who did not become seizure-free during the study period, says Dr French.
Dr French cautions that the investigation did not directly assess the role of regimen choice, dose, or side effects on the way patients responded to treatment, and it did not exclude participants who failed to adhere to their prescribed regimen.
Source: NYU Langone Health
