Abstracts

Rationale: Failure to respond to the initially prescribed antiepileptic drug (AED) is a major predictor of poor seizure control. However, no data exists on whether first AED failure also predicts outcome in terms of adverse health status. We performed a case-control study to investigate major adverse health events rates and health assessment ratings in relation to first AED response in patients with newly diagnosed epilepsy. Methods: Adult patients who were diagnosed and started on AED treatment at the Columbia Comprehensive Epilepsy Center in 2001-2003 and who had at least 5-year follow-up data since diagnosis were identified through chart review. After obtaining written informed consent, eligible patients were interviewed to review data extracted from medical charts and were asked to complete reliable and valid health assessments, including the Quality of Life in Epilepsy (QOLIE)-89, the Adverse Event Profile (AEP), and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). We compared rates of major adverse health events (loss of driving privileges, unemployment, divorce/separation, injury, emergency room admission, hospitalization, and death) over 5-7 years after diagnosis between patients who failed the first AED trial (cases) and those who did not (controls). We also evaluated between-group differences in QOLIE-89, AEP, and NDDI-E scores at 5-7 years since diagnosis, adjusting for age and gender. Results: We enrolled 33 cases and 30 controls. The rates of major adverse health events were similarly high in both groups in the first year after diagnosis (mean SD: 2.64 0.99 for cases and 2.50 1.14 for controls), but decreased to a greater extent in controls than in cases thereafter, with a significant between-group difference (p<0.001). Two cases died during follow-up, both of sudden unexpected death in epilepsy (SUDEP). Cases had worse QOLIE-89 scores compared to controls (p=0.02), while there was no significant between-group difference in AEP and NDDI-E scores. Conclusions: Patients who fail the first AED trial are at increased risk of experiencing an adverse health outcome. Our findings may support earlier consideration of referral for potential epilepsy surgery.