Pregabalin add-on for drug-resistant partial epilepsy

Area of Science:

• Neurology
• Pharmacology

Background:

• Epilepsy affects 1% of the UK population, with one-third experiencing persistent seizures despite treatment.
• New antiepileptic drugs, including pregabalin, aim to improve outcomes for individuals with drug-resistant epilepsy.

Purpose of the Study:

• To evaluate the efficacy and tolerability of pregabalin as an add-on therapy for drug-resistant partial epilepsy.
• To summarize evidence from randomized controlled trials (RCTs) on pregabalin's effectiveness.

Main Methods:

• Searched multiple databases (Cochrane Epilepsy Group, CENTRAL, MEDLINE) and contacted the manufacturer for relevant trials.
• Included RCTs comparing pregabalin with placebo or other antiepileptic drugs for drug-resistant partial epilepsy.
• Analyzed outcomes such as 50% seizure reduction, seizure freedom, and treatment withdrawal rates.

Main Results:

• Six industry-sponsored trials with 2009 participants were included.
• Pregabalin significantly increased the likelihood of a 50% or greater seizure reduction (RR 2.61) and seizure freedom (RR 2.59) compared to placebo.
• Patients were more likely to withdraw from pregabalin due to adverse events (RR 2.69), with common side effects including ataxia, dizziness, and somnolence.

Conclusions:

• Pregabalin demonstrates significant efficacy as an add-on treatment for drug-resistant partial epilepsy, improving seizure reduction and freedom.
• Efficacy was observed for doses between 150 mg/day and 600 mg/day, with higher doses showing increased effectiveness.
• Short trial durations necessitate longer-term studies to fully inform clinical decision-making regarding pregabalin use.