Authors :
Presenting Author: Daniel San-Juan, MD, MS – National Institute of Neurology and Neurosurgery. Mexico City, Mexico
Miguel Morales-Morales, MD – National Institute of Neurology and Neurosurgery Manuel Velasco Suárez
Emilio García-Gómez, MD – National Institute of Neurology and Neurosurgery Manuel Velasco Suárez
Carlos Trenado, MD, PhD – Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University
Daniela Carolina Pimentel-Saona, MD – National Institute of Neurology and Neurosurgery Manuel Velasco Suárez
Yazmin Palomares-Salazar, MD – National Institute of Neurology and Neurosurgery. Mexico City, Mexico
Clio Rubinos, MD, MS, FACNS – University of North Carolina, Chapel Hill, North Carolina, USA.
Manuel Alejandro Del Río-Quiñones, MD, MSc – National Institute of Neurology and Neurosurgery Manuel Velasco Suárez
Jesús Iván Ruiz-Gutierrez, MD – Faculty of Medicine, University of Guadalajara,
Mónica Alejandra Montalvo-Hérnandez, MD – Faculty of Medicine, Autonomous University of Puebla
Christopher De Jesús-Fernández, MD – Faculty of Medicine, Autonomous University of Puebla
Rationale:
Antiseizure medications (ASMs) remain the cornerstone of epilepsy treatment, aiming to prevent seizures while minimizing adverse effects. Although new ASMs are continuously introduced worldwide, prescription trends are primarily documented in high-income countries (HICs), with limited evidence on evolving patterns in developing nations. This study evaluates changes in ASM utilization, efficacy, and safety across two distinct periods at a tertiary care center in Mexico.
Methods:
A retrospective cohort study was conducted, divided into two phases: Phase 1 (January 2011– December 2013, n=100) and Phase 2 (January 2021– December 2023, n=128). Data on seizure freedom rates, adverse effects, and ASM prescription patterns were analyzed using descriptive statistics, chi-squared tests, and t-tests. Additionally, a mathematical network analysis in MATLAB assessed the influence of individual ASMs through centrality and modularity measures, identifying key drug combinations and their therapeutic impact.
Results:
A total of 228 epilepsy patients were included. Seizure freedom rates significantly improved from 9% in Phase 1 to 25.8% in Phase 2 (p=0.001). Valproic acid remained a cornerstone ASM (44% in Phase 1 vs. 64% in Phase 2), while levetiracetam gained prominence (49% in Phase 2), as reflected in PageRank values. Adverse effects increased from 10% to 17%, despite a slight reduction in polytherapy (93% to 87.5%). Modularity analysis identified clusters of ASMs linked to seizure freedom, such as valproic acid, lamotrigine, and topiramate, whereas adverse effects were associated with phenobarbital and lamotrigine combinations.
Conclusions:
This study highlights the enduring role of valproic acid and the rising influence of newer ASMs in Mexico. The observed improvements in seizure freedom underscore advancements in personalized therapeutic strategies, while the persistence of adverse effects emphasizes the need for continuous evaluation of ASM combinations to optimize treatment outcomes.
Funding:
None, this research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors