Treatment Outcomes of Newly Diagnosed Epilepsy: A Systematic Review and Meta-analysis

Janmohamed, Mubeen; Hakeem, Haris; Ooi, Suyi; Hakami, Suhailah; Vu, Lily Chi; Perucca, Piero; O’Brien, Terence J.; Antonic‐Baker, Ana; Chen, Zhibin; Kwan, Patrick

doi:10.1007/s40263-022-00979-1

Cited by 5 publications

(4 citation statements)

References 59 publications

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“…Epilepsy is one of the most prevalent chronic central nervous system disorders, affecting around 70 million people worldwide 1 . Despite the introduction of numerous new generation antiseizure medications (ASMs) over the last decade, recent findings from a meta‐analysis of 39 studies spanning 1995–2021, involving over 20,000 patients with epilepsy (PWE), suggest that the rate of seizure freedom has not improved 2 . Thus, more effective ASMs with acceptable tolerability are urgently needed to address these persistently frustrating findings.…”

Section: Introductionmentioning

confidence: 99%

“…Cenobamate (CNB) is a novel ASM that was recently introduced to clinical practice. Its precise mode of action is yet to be fully elucidated 2–7 . So far, two potentially complimentary mechanisms have been delineated.…”

Section: Introductionmentioning

confidence: 99%

“…Its precise mode of action is yet to be fully elucidated. 2 , 3 , 4 , 5 , 6 , 7 So far, two potentially complimentary mechanisms have been delineated. The first involves the reduction of repetitive neuronal discharges by CNB via the inhibition of voltage‐dependent sodium channels.…”

Section: Introductionmentioning

confidence: 99%

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The cenobamate KORK study—A prospective monocenter observational study investigating cenobamate as an adjunctive therapy in refractory epilepsy, with comparisons to historical cohorts treated with add‐on lacosamide, perampanel, and brivaracetam

Steinhoff,

Georgiou,

Intravooth

2024

Epilepsia Open

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ObjectiveIn Europe, cenobamate has been approved for use as an adjunctive therapy in adult patients with epilepsy (PWE) with focal‐onset seizures (FOS) who have not responded satisfactorily to treatment with at least two antiseizure medications (ASMs). Pivotal trials and real‐world observational studies have demonstrated a high efficacy of cenobamate, even in very difficult‐to‐treat epilepsies. Our aim was to investigate the efficacy of add‐on cenobamate in adult PWE who were prospectively monitored. We compared these results with those previously obtained for add‐on lacosamide, perampanel, and brivaracetam therapy.MethodsPatients were enrolled from the CENKORK study, which is a prospective, non‐interventional, open‐label, monocenter cohort study of adult PWE experiencing FOS. The titration of cenobamate was performed according to the guidelines outlined in the summary of product characteristics. The primary outcome measure was the retention rate at 6 months and 1 year. In addition, we assessed seizure‐free rates, the proportion of patients achieving at least a 50% seizure reduction, adverse events, and the reasons for treatment discontinuation. These outcome measures were compared with historical controls treated with adjunctive lacosamide, perampanel, or brivaracetam at our center.ResultsBetween June 2021 and 2022, 172 PWE with ongoing FOS were included. 22 cases were lost to follow‐up, leaving 150 cases for the 1‐year assessment. The retention rates at 6 months and 1 year were 88.7% and 80%, respectively. Seizure freedom was achieved in 14% of patients at both the 6‐month and 1‐year marks, while the ≥50% responder rates were 50% and 61%, respectively. The 6‐month retention rate was significantly higher in cenobamate than in other ASMs (p < 0.001 for each comparator). Adverse events were significantly more common with perampanel (p < 0.001).SignificanceAdd‐on cenobamate proved to be particularly efficacious compared to our experience with other recently introduced ASMs.Plain Language SummaryThis observational study was carried out in 172 adult patients with difficult‐to‐treat epilepsy who were treated with adjunctive cenobamate. After 1 year, the data of 150 patients could be analyzed. Seizure freedom, in the preceding 3 months, was achieved in 14%. The rate of PWE continuing cenobamate was 80%. In our hands, cenobamate showed promising efficacy and tolerability even when compared to other recently introduced antiseizure medications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The cenobamate KORK study—A prospective monocenter observational study investigating cenobamate as an adjunctive therapy in refractory epilepsy, with comparisons to historical cohorts treated with add‐on lacosamide, perampanel, and brivaracetam

Steinhoff,

Georgiou,

Intravooth

2024

Epilepsia Open

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“…pilepsy is a debilitating chronic disorder affecting approximately 3.4 million people in the United States and more than 65 million people worldwide. [1][2][3] Over one-third of patients suffering from epilepsy are resistant to antiseizure medications, with uncontrolled seizures leading to an increased risk for further cognitive deterioration, decreased quality of life, and increase mortality. [4][5][6] Various surgical interventions have proven to be safe and efficacious for the treatment of drug-resistant epilepsy (DRE).…”

mentioning

confidence: 99%

Trends in the Utilization of Surgical Modalities for the Treatment of Drug-Resistant Epilepsy: A Comprehensive 10-Year Analysis Using the National Inpatient Sample

Ghaith,

El-Hajj,

Sanchez-Garavito

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Epilepsy is considered one of the most prevalent and severe chronic neurological disorders worldwide. Our study aims to analyze the national trends in different treatment modalities for individuals with drug-resistant epilepsy and investigate the outcomes associated with these procedural trends in the United States. METHODS: Using the National Inpatient Sample database from 2010 to 2020, patients with drug-resistant focal epilepsy who underwent laser interstitial thermal therapy (LITT), open surgical resection, vagus nerve stimulation (VNS), or responsive neurostimulation (RNS) were identified. Trend analysis was performed using piecewise joinpoint regression. Propensity score matching was used to compare outcomes between 10 years prepandemic before 2020 and the first peak of the COVID-19 pandemic. RESULTS: This study analyzed a total of 33 969 patients with a diagnosis of drug-resistant epilepsy, with 3343 patients receiving surgical resection (78%), VNS (8.21%), RNS (8%), and LITT (6%). Between 2010 and 2020, there was an increase in the use of invasive electroencephalography monitoring for seizure zone localization (P = .003). There was an increase in the use of LITT and RNS (P < .001), while the use of surgical resection and VNS decreased over time (P < .001). Most of these patients (89%) were treated during the pre-COVID pandemic era (2010-2019), while a minority (11%) underwent treatment during the COVID pandemic (2020). After propensity score matching, the rate of pulmonary complications, postprocedural hematoma formation, and mortality were slightly higher during the pandemic compared with the prepandemic period (P = .045, P = .033, and P = .026, respectively). CONCLUSION: This study indicates a relative decrease in the use of surgical resections, as a treatment for drug-resistant focal epilepsy. By contrast, newer, minimally invasive surgical approaches including LITT and RNS showed gradual increases in usage.

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Recent Advances in Pharmacologic Treatments of Drug-Resistant Epilepsy: Breakthrough in Sight

Klein,

Friedman,

Kwan

2024

CNS Drugs

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Treatment Outcomes of Newly Diagnosed Epilepsy: A Systematic Review and Meta-analysis

Cited by 5 publications

References 59 publications

The cenobamate KORK study—A prospective monocenter observational study investigating cenobamate as an adjunctive therapy in refractory epilepsy, with comparisons to historical cohorts treated with add‐on lacosamide, perampanel, and brivaracetam

The cenobamate KORK study—A prospective monocenter observational study investigating cenobamate as an adjunctive therapy in refractory epilepsy, with comparisons to historical cohorts treated with add‐on lacosamide, perampanel, and brivaracetam

Trends in the Utilization of Surgical Modalities for the Treatment of Drug-Resistant Epilepsy: A Comprehensive 10-Year Analysis Using the National Inpatient Sample

Recent Advances in Pharmacologic Treatments of Drug-Resistant Epilepsy: Breakthrough in Sight

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