Tolerability of Antiseizure Medications in Individuals With Newly Diagnosed Epilepsy

Abstract

IMPORTANCE Tolerability is a key determinant of the effectiveness of epilepsy treatment. It is important to evaluate whether the overall tolerability has improved.OBJECTIVE To identify factors associated with poor tolerability of antiseizure medications (ASMs) and examine temporal changes in tolerability. DESIGN, SETTING, AND PARTICIPANTSThis was a longitudinal cohort study at a specialist clinic in Glasgow, Scotland. Patients with newly diagnosed and treated epilepsy between July 1982 and October 2012 were included from 2282 eligible individuals. They were followed up until April 2016 or death. Data analysis was completed in August 2019. EXPOSURES Antiseizure medications.MAIN OUTCOMES AND MEASURES Univariable and multivariable survival analyses were performed to examine associations between potential risk factors and development of intolerable adverse effects (AEs). Intolerable AE rates of the ASMs as the initial monotherapy were compared between 3 epochs (

Characteristics and treatment outcomes of newly diagnosed epilepsy in older people: A 30‐year longitudinal cohort study

“…Patients were included in this analysis if they commenced treatment at or after 65 years of age. They formed part of the previous analyses on seizure outcome and treatment tolerability that included patients of all ages seen at the unit 9,10 . Patients were followed prospectively until April 30, 2016 or death.…”

“…They formed part of the previous analyses on seizure outcome and treatment tolerability that included patients of all ages seen at the unit. 9,10 Patients were followed prospectively until April 30, 2016 or death. The study was approved by the research ethics committee of Western Infirmary, Glasgow, which waived the requirement to obtain informed consent.…”

“…Similar to our previous study, intolerable adverse effects (AEs) were defined as those stated as the main reason of discontinuation within 180 days of commencement of the ASM. 10 The ASMs prescribed that were launched before 1980 were considered as first-generation ASMs (eg, valproate, carbamazepine, and phenytoin), and those introduced after that date were classified as second-generation ASMs (eg, lamotrigine, gabapentin, oxcarbazepine, topiramate, levetiracetam, and lacosamide). To assess the change in ASM prescribing practice and treatment outcomes of the initial ASM regimen over time, the study period was divided into two epochs according to the ASM start date (ie, July 1, 1982 to December 31, 1999, and January 1, 2000 to April 30, 2016.…”

The challenges of continued antiseizure medicine trials

“…2 Further analysis of that data found the risk of intolerable adverse events (AEs) from ASM increased with each subsequent ASM trial, particularly if an ASM had been previously changed due to an AE. 9 In sum, the accurate clarification that 5% of people as a whole become seizure-free after a failed second ASM is certainly important. The misperception that an individual has a <5% seizure-free chance after that second ASM should not be perpetuated.…”

Er nye legemidler mot epilepsi bedre enn gamle?

“…Dette skyldes først og fremst bedre tolerabilitet (8). I den skotske oppfølgingsstudien over nesten 30 år, var imidlertid andelen av tidlig seponering på grunn av bivirkninger uforandret til tross for økende bruk av nyere legemidler (16).…”