NEWLY DIAGNOSED EPILEPSY Treatment response in mesial temporal lobe epilepsy with hippocampal...
-
Upload
kirsten-hynes -
Category
Documents
-
view
233 -
download
0
Transcript of NEWLY DIAGNOSED EPILEPSY Treatment response in mesial temporal lobe epilepsy with hippocampal...
NEWLY DIAGNOSED EPILEPSY Treatment response in mesial temporal
lobe epilepsy with hippocampal atrophy (N=14; 2.5% population)
Non-responders(42%)
Remission (50%)
Immediate responders
(21%)
Relapse (7%)
Mohanraj R, Brodie MJ. Seizure 2005;14:318-23
Responders (57%)
NEWLY DIAGNOSED EPILEPSY
1840 1860 1880 1900 1920 1940 1960 1980 20000
5
10
15
20
BromidePhenobarbital
Phenytoin Primidone
Ethosuximide
Sodium Valproate
Benzodiazepines
Carbamazepine
Calendar year
Antiepileptic drugs
Vigabatrin
ZonisamideLamotrigine
FelbamateGabapentin
Topiramate Fosphenytoin
OxcarbazepineTiagabine
LevetiracetamPregabalin
StiripentolRufinamide
Lacosamide
NEWLY DIAGNOSED EPILEPSY
There is no reliable evidence to suggest any difference in efficacy between
carbamazepine and phenytoin
carbamazepine and valproate
phenytoin and valproate
phenobarbital and carbamazepine
phenobarbital and phenytoin
for partial or generalized tonic-clonic seizures
THE COCHRANE LIBRARY
Lamotrigine versus Carbamazepine (3), Gabapentin (2), Phenytoin
Oxcarbazepine versus Phenytoin (2), Carbamazepine, Valproate
Vigabatrin versus Carbamazepine
Gabapentin versus *Carbamazepine (2), Lamotrigine
Topiramate versus *Carbamazepine, *Valproate
Levetiracetam versus Controlled-release carbamazepine
* fixed doses
NEWLY DIAGNOSED EPILEPSY Randomized, head-to-head, double-blind trials with
modern antiepileptic drugs(N = 18)
NEWLY DIAGNOSED EPILEPSY Drug choice
As there are no major differences in efficacy among
first-line antiepileptic drugs, tolerability and longterm
safety must be the paramount consideration in patients
with often mild newly diagnosed epilepsy
Kwan P, Brodie MJ. Neurology 2003; 60 (suppl 4): S2-S12
Efficacy
Tolerability
EFFECTIVENESS
The sum of two parts
NEWLY DIAGNOSED EPILEPSY Observations from the Glasgow database
1098 adolescent and adult patients starting on
their first antiepileptic drug between 1982
and 2005 and follow-up for at least 2 years
NEWLY DIAGNOSED EPILEPSY Response rates (%) in an expanding cohort
Recruitment n One AED Combination Total
1982-19971 470 61 3.0 64.0
1982-20012 780 59 5.4 64.4
1982-20053 1098 61.9 6.4 68.3
1Kwan P, Brodie MJ. N Engl J Med 2000; 342: 314-92Mohanraj R, Brodie MJ. Eur J Neurol 2006; 13: 277-82
3 Bamagous G, Kwan P, Brodie MJ, in preparation
NEWLY DIAGNOSED EPILEPSY Successful combinations*
2 AEDs 67
3 AEDs 2
4 AEDs 1
Total 70
*Seizure free for at least the previous year
FONDE STUDY Following Outcomes in Newly Diagnosed Epilepsy
A prospective observational study of the
pharmacological and lifestyle consequences of newly
diagnosed epilepsy
FONDE STUDY Objectives
To monitor pharmacological and social outcomes
over a prolonged period under conditions of care that mirror everyday clinical practice
in relation to a variety of clinical, investigational and environmental prognostic factors
across a range of clinical settings from general neurology to specialist epilepsy services
FONDE STUDY
All information at study visits will be entered into an electronic case record form and submitted to the
Central Data Management Centre in Milan
Separate data entry for children and adults
Dina Battino data manager Marco DeZordo system designer Patrick Kwan webmaster John Norrie statistician Martin Brodie principal investigator
- - - - -