NEW YORK, Feb 03 (Reuters Health) -- Epileptics who have many seizures and
those who respond poorly to their first medications are more likely to suffer
from difficult-to-treat seizures later in life, results of a study suggest.
Up to 30% of epileptics continue to have seizures despite drug treatment.
Identifying such patients early on could lead to more aggressive treatments,
such as drug combinations or surgery, that might prove more effective, according
to Drs. Patrick Kwan and Martin Brodie from Western Infirmary in Glasgow,
Scotland. Their report is published in the February 3rd issue of The New England
Journal of Medicine.
The new results indicate that response to the first antiepileptic drug is
a "powerful" indicator of how well a patient will do, the authors note.
In their 16-year study of 525 epilepsy patients, the investigators found
most people -- 63% -- were free of seizures while taking medication or shortly
after stopping medication. This is similar to previous studies and, indicates
that the overall hope for seizure control is good, according to the report.
However, those patients who had 20 or more seizures before they started
drug treatment were less likely to achieve complete control of their seizures.
Overall, epilepsy was controlled in 71% of patients who had 20 or fewer seizures
before treatment began, compared with only 49% of those with more than 20
seizures.
The response to the first antiseizure medication also proved to be a good
indicator of how the patient would fare over time.
Only 55% of patients who had a bad reaction to their first drug
subsequently became seizure-free. Patients in whom the first medication simply
failed to control their epilepsy did worse -- only 11% became seizure-free.
Patients whose epilepsy resulted from a known brain defect did not respond
well to medications, the authors note, suggesting that surgery to correct the
defect should be considered as soon as treatment with two drugs fails.
For other patients, Kwan and Brodie conclude, the inability to control
their seizures can be predicted early on. These patients should be candidates
for combination drug therapy or surgery to correct the cause of their seizures.
