Initial Monotherapy Failure in Idiopathic Generalized Epilepsy: To switch or to combine?
Abstract number :
776
Submission category :
7. Antiepileptic Drugs / 7C. Cohort Studies
Year :
2020
Submission ID :
2423114
Source :
www.aesnet.org
Presentation date :
12/7/2020 9:07:12 AM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Leonardo Pipek, Faculdade de Medicina FMUSP, Universidade de Sao Paulo; Henrique Pipek - Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.; Luiz Castro - Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.;;
Rationale:
Idiopathic generalized epilepsy (IGE) is characterized by adolescence onset, absence, myoclonic and generalized tonic clonic (GTC) seizures, and typical EEG findings. Treatment involves broad-spectrum antiepileptic drugs (AED), but VPA use is limited in women of childbearing potential. Other options (LEV and LTG) are probably less effective. Studies evaluating the efficacy of these AEDs in combination therapies are scarce. The objective of this study is to compare the efficacy of VPA, LEV and LTG, in mono- and combination therapy, and of clobazam as add-on therapy in a cohort of IGE patients treated by a single neurologist.
Method:
A series of IGE patients (defined by typical seizures and EEG pattern) treated with broad spectrum AEDs. Seizure outcomes were defined as: 1- Seizure-free (all types); 2- Only minor non-disabling seizures (absence or myoclonic) 3- Minor seizures and/or pseudoresistence (GTC exclusively with sleep deprivation or medication non-adherence). We analyzed survival curves for mono- and combination therapies of VPA, LEV and LTG. A treatment period was defined as at least six months on a stable regimen with a positive outcome, or any period for a treatment failure.
Results:
We evaluated 59 patients (156 treatment periods; treatment duration 71.2±54.4 months): 34/59 (57.6%) women, epilepsy onset age 17.2±8.3 years. 62% had a family history of epilepsy. 94.9% had GTC, 55.9% myoclonic and 33.9% absence seizures. VPA use was more common in men (84%) than in women (44%) (p< 0.05). VPA was the initial treatment in 39% of patients, LEV in 22% and LTG in 14.9%. Combination therapies were used in 46/159 (28.9%) of treatment periods. 25/59 (42.3%) patients had at least one GTC, and 17/59 (28.8%) had pseudoresistance. Duration of combination therapies (more commonly not used as an initial regimen) was shorter (21.3+/-23.2) than monotherapy regimens (30.2±34.7 months; p=0.057). VPA was superior to LEV and LTG for outcome 1 (p< 0.05), but not for 2 or 3. Combination therapies were more effective than LEV or LTG (p< 0.05), and, possibly, VPA monotherapy for outcomes 1 and 2, even when used as 2nd and 3rd trials. Initial treatment regimen (any drug) had better efficacy compared to 2nd (p=0.06) and 3rd (p=0.045) for outcome 3. Survival curves considering CLB use did not differ from the same regimen not including CLB.
Antiepileptic Drugs