Saturday, August 18, 2018

Long-term retention rates of antiepileptic drugs used in acute seizures.

Toledo M, Fonseca E, Olivé M, Requena M, Quintana M, Abraira-Del-Fresno L, Salas-Puig X,  Santamarina E. Long-term retention rates of antiepileptic drugs used in acute seizures. Seizure. 2018 Aug 11;61:78-82. doi:10.1016/j.seizure.2018.08.007. [Epub ahead of print]


A number of antiepileptic drugs (AEDs) are currently available for treating acute seizures. It is recommended to select the initial treatment option according to the type of epileptic syndrome and the patient's clinical characteristics, but little is known about the long-term retention rates of AEDs started in the emergency department.

We recruited patients admitted with seizures over a two-year period. All patients underwent early neurological assessment, EEG testing, and neuroimaging. The treatments received at baseline and at one year of follow-up were compared.

In total, 225 patients were included. Overall, monotherapy with levetiracetam was the regimen most often used in patients with new-onset seizures, whereas other AEDs were mainly used in patients previously treated with other drugs. Lacosamide use was most likely associated with the presence of lesion related seizures in elderly patients, and carboxamides with focal onset seizures of unknown cause. The mean retention rate of the total of AED treatments was nearly 70%. The main cause leading to discontinuation was the development of intolerable adverse events. Levetiracetam use decreased as lacosamide use increased in the overall group of patients.

Our study shows that there is a trend to use newer AEDs, particularly levetiracetam, as the first option in new-onset seizures in the emergency room. However, levetiracetam use significantly decreased over follow-up, mainly because of the development of adverse events. The use of other, better-tolerated AEDs, such lacosamide predominated in elderly patients and patients with lesion related seizures, or carboxamides in epilepsies of unknown etiology.

•Levetiracetam was the most common antiepileptic drug used in acute seizures.
•At long-term follow-up, 60%–80% of antiepileptic drugs remained as chronic treatment.
•Antiepileptic drugs used as monotherapy were more likely changed than those added to the patients’ active baseline treatment.
•At long-term follow-up, the number of patients treated with lacosamide increased.
•The development of adverse events was the most common reason for discontinuation of any antiepileptic drug.

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