Adjunctive pregabalin for uncontrolled partial-onset seizures: findings from a prospective audit

Area of Science:

• Neurology
• Clinical Pharmacology

Background:

• Pregabalin (PGB) approved in Europe in 2004 as an add-on antiepileptic drug (AED) for partial-onset seizures.
• Uncontrolled seizures necessitate evaluating the efficacy and tolerability of adjunctive treatments.

Purpose of the Study:

• To assess the clinical response to adjunctive pregabalin in patients with inadequately controlled epilepsy.
• To identify factors influencing PGB efficacy and reasons for discontinuation.

Main Methods:

• A prospective audit of 135 patients (aged 18-76) receiving adjunctive PGB for uncontrolled seizures.
• PGB titration continued until seizure freedom (≥6 months), significant reduction (≥50%), minimal reduction (<50%), or withdrawal due to adverse effects/lack of efficacy.

Main Results:

• 10.4% of patients achieved ≥6 months of seizure freedom with a median PGB dose of 300 mg/day.
• An additional 24.4% experienced ≥50% seizure reduction.
• 50.4% discontinued PGB, primarily due to adverse effects (sedation, weight gain, ataxia) or lack of efficacy.

Conclusions:

• Adjunctive PGB demonstrated benefit in approximately 50% of patients, but sustained seizure freedom was achieved by only 10%.
• Adverse effects, including dose-related weight gain, frequently led to treatment discontinuation.
• Audits of novel AEDs provide valuable real-world data complementing randomized controlled trials.