Patterns and prognostic markers for treatment response in generalized epilepsies
Joanna Gesche1, Helle Hjalgrim1, Guido Rubboli1
1From the Department of Neurology (J.G., C.P.B.) and Open Patient Data Explorative Network (C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense; Epilepsy Hospital Filadelfia (H.H.), Dianalund; Amplexa Genetics A/S (H.H., G.R.), Odense; and University of Copenhagen (G.R.), Denmark.
Neurology
|August 21, 2020
Summary
Predicting epilepsy treatment response is challenging. Clinical factors do not reliably predict how patients with idiopathic generalized epilepsy (IGE) will respond to lamotrigine, levetiracetam, or valproic acid.
Area of Science:
- Epilepsy research
- Clinical neurology
- Pharmacology
Background:
- Idiopathic generalized epilepsy (IGE) affects numerous adults worldwide.
- Treatment selection for IGE is often empirical, with variable patient responses.
- Identifying predictors of treatment success is crucial for optimizing patient care.
Purpose of the Study:
- To investigate treatment response patterns in patients with IGE.
- To determine if clinical and neurophysiological parameters predict response to specific antiepileptic drugs (AEDs): lamotrigine, levetiracetam, and valproic acid.
Main Methods:
- Retrospective analysis of 328 adult IGE patients' medical data.
- Inclusion of demographic, imaging, EEG, treatment history, outcome, and side effect data.
- Evaluation of seizure freedom, side effects, and drug retention rates for specific AEDs.
Main Results:
- Only 18.6% achieved seizure freedom with acceptable side effects on first AED attempt.
- Differential response rates observed: valproic acid (71.1%), levetiracetam (47.5%), lamotrigine (39.8%).
- Valproic acid had higher side effects (23.7%) and lower retention (53.7%) despite efficacy.
Conclusions:
- Achieving initial seizure control with acceptable side effects is difficult due to drug efficacy/side effect trade-offs.
- Routinely assessed clinical parameters do not predict response to lamotrigine, levetiracetam, or valproic acid in IGE patients.
- Class II evidence indicates no reliable clinical biomarkers for predicting specific AED responses in IGE.
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