Comparative effectiveness of antiepileptic drugs in patients with mesial temporal lobe epilepsy with hippocampal sclerosis. (31st August 2017)

• Record Type: Journal Article
• Authors: Androsova, Ganna; Krause, Roland; Borghei, Mojgansadat; Wassenaar, Merel; Auce, Pauls; Avbersek, Andreja; Becker, Felicitas; Berghuis, Bianca; Campbell, Ellen; Coppola, Antonietta; Francis, Ben; Wolking, Stefan; Cavalleri, Gianpiero L.; Craig, John; Delanty, Norman; Koeleman, Bobby P. C.; Kunz, Wolfram S.; Lerche, Holger; Marson, Anthony G.; Sander, Josemir W.; Sills, Graeme J.; Striano, Pasquale; Zara, Federico; Sisodiya, Sanjay M.; Depondt, Chantal
• Other Names: Brodie Martin J. investigator.; Chinthapalli Krishna investigator.; de Haan Gerrit‐Jan investigator.; Doherty Colin investigator.; Gudmundsson Lárus J. investigator.; Heavin Sinead investigator.; Ingason Andres investigator.; Johnson Michael investigator.; Kennedy Clare investigator.; Krenn Martin investigator.; McCormack Mark investigator.; O'Brien Terence J. investigator.; Pandolfo Massimo investigator.; Pataraia Ekaterina investigator.; Petrovski Slave investigator.; Rau Sarah investigator.; Sargsyan Narek investigator.; Slattery Lisa investigator.; Stefánsson Kári investigator.; Stern William investigator.; Tostevin Anna investigator.; Willis Joseph investigator.; Zimprich Fritz investigator.
• Is Part Of: Epilepsia. Volume 58:issue 10(2017)
• Page Start: 1734
• Page End: 1741
• Publication Date: 2017-08-31
• Subjects: Retention -- Efficacy -- Adverse drug reactions -- Drug response -- Seizure freedom; Epilepsy -- Periodicals; 616.853
• DOI: 10.1111/epi.13871
• Languages: English
• ISSNs: 0013-9580

Abstract

Summary: Objective: Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE‐HS) is a common epilepsy syndrome that is often poorly controlled by antiepileptic drug (AED) treatment. Comparative AED effectiveness studies in this condition are lacking. We report retention, efficacy, and tolerability in a cohort of patients with MTLE‐HS. Methods: Clinical data were collected from a European database of patients with epilepsy. We estimated retention, 12‐month seizure freedom, and adverse drug reaction (ADR) rates for the 10 most commonly used AEDs in patients with MTLE‐HS. Results: Seven hundred sixty‐seven patients with a total of 3, 249 AED trials were included. The highest 12‐month retention rates were observed with carbamazepine (85.9%), valproate (85%), and clobazam (79%). Twelve‐month seizure freedom rates varied from 1.2% for gabapentin and vigabatrin to 11% for carbamazepine. Response rates were highest for AEDs that were prescribed as initial treatment and lowest for AEDs that were used in a third or higher instance. ADRs were reported in 47.6% of patients, with the highest rates observed with oxcarbazepine (35.7%), topiramate (30.9%), and pregabalin (27.4%), and the lowest rates with clobazam (6.5%), gabapentin (8.9%), and lamotrigine (16.6%). The most commonly reported ADRs were lethargy and drowsiness, dizziness, vertigo and ataxia, and blurred vision and diplopia. Significance: Our results did not demonstrate any clear advantage of newer versus older AEDs. Our results provide useful insights into AED retention, efficacy, and ADR rates in patients with MTLE‐HS.