Comparison of Antiseizure Medications as Monotherapy in Focal and Generalized Epilepsy
Abstract number :
1.226
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2022
Submission ID :
2204186
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:23 AM
Authors :
Sidra Saleem, MD – University of Toledo COM LS; Fahham Asghar, MD – Research Assistant, Neurology, University of Toledo COM LS; Hira Pervez, MD – PGY-2 Resident, Neurology, University of Toledo COM LS; Vicki Ramsey Williams, MD PhD – Associate Professor, Neurology, University of Toledo COM LS; Bashar Saour, MD – Assistant Professor, Neurology, University of Toledo COM LS; Nicholas Delcimmuto, Medical Student – Medical Student, Neurology, University of Toledo COM LS; Rabia Zubair, MD – Assistant Professor, Neurology, University of Toledo COM LS; Ajaz Sheikh, MD – Associate Professor, Neurology, University of Toledo COM LS; Imran Ali, MD – Professor, Neurology, University of Toledo COM LS
Rationale: Lacosamide (LAC), lamotrigine (LTG), levetiracetam (LEV), and topiramate (TPM) are some of the most commonly utilized anti-seizure medications (ASM), but data comparing monotherapy is limited. Our purpose was to compare outcomes with monotherapy in patients with focal and generalized epilepsy when treated with these four ASM in clinical practice.
Methods: This is a cross sectional retrospective data analysis of 2270 patients being treated at a tertiary level epilepsy center. Patients treated for focal and generalized epilepsy with LAC, LTG, LEV, or TPM as monotherapy were identified and data analyzed for prescription frequency, seizure-free rates, mean duration of seizure freedom and most common adverse effects. Seizure freedom was defined as the absence of seizures for a period of at least three times longer than the longest pre-intervention, seizure-free interval.
Results: There are currently 2270 patients in the database, of which 1872 were diagnosed with either focal (1308) or generalized (564) epilepsy. These patients were 48.5% men and 51.5% women, mean age 39.7±25.6 years. The number of patients on monotherapy for focal epilepsy were 48.31 % (632/1308) and 49.6% (280/564) for generalized epilepsy. The most commonly prescribed drug for both types was levetiracetam, followed by lamotrigine, topiramate and lacosamide. Patients with focal epilepsy had seizure free rates (mean duration) as follows: 19.7% with LEV (18.2 months), 27.5% with LTG (20 months), 21% with TPM (12 months) and 27.7% with LAC (24.6 months). Patients with generalized epilepsy had seizure-freedom as follows: 39.5% with LEV (15.2 months), 46.5% with LTG (15.7 months), 42.1% with TPM (12.8 months) and 30% for LAC (10.8 months). _x000D_
_x000D_
21.9% of focal epilepsy patients were seizure-free on monotherapy with these medications, while the frequency was almost double at 40.8% in patients with generalized epilepsy. The mean duration of seizure freedom was 18.7 months (95% CI, 10.4-27) for focal-onset epilepsy patients and 13.6 months (95% CI, 10-17.2) for generalized epilepsy (Table 1). The most commonly observed adverse effects are listed in Table 2. _x000D_
Conclusions: LEV was most commonly prescribed ASM for both focal and generalized epilepsy in our practice. LTG was found to have the highest rate and duration of seizure freedom in patients with generalized as well as focal epilepsy. Although limited by a small sample size, our study demonstrated a high rate and duration of seizure freedom with lacosamide for some patients with focal epilepsy as well. Our study also supports previously published data regarding efficacy and tolerability of lamotrigine compared to other ASM in clinical practice.
Funding: None
Clinical Epilepsy