Seizure-freedom with combination therapy in localization-related epilepsy.
We analyzed the effect of combination therapy on seizure frequency in all adult patients (N=193) with focal epilepsy followed at a single institution in a cross-sectional study. One hundred and thirty-five patients were on two AEDs, of them, 37 (27%) were seizure-free, 50 patients were on three AEDs including 5 (10%) seizure-free patients (p<0.01 for seizure-freedom with two AEDs versus three AEDs). Thirty-five different combinations were used in patients on two AEDs and 40 combinations on patients on three drugs emphasizing the difficulties involved in evaluation of the efficacy and tolerability of specific combinations. The significant proportion of seizure-free cases (27%) on duotherapy is suggesting the usefulness of combination therapy in achieving seizure-freedom in epilepsies refractory to single drug treatment. The material in the study was not from a randomized trial and therefore the comparability of patients on different AEDs is uncertain, but on the other hand the clinical practice followed provides a natural experiment suitable for comparative, non-randomized assessment of treatment outcomes.
Peltola
Jukka
J
Department of Neurology and Rehabilitation, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland. jukka.peltola@pshp.fi
Peltola
Maria
M
Raitanen
Jani
J
Keränen
Tapani
T
Kharazmi
Elham
E
Auvinen
Anssi
A
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D001921:Brain / Q000033:anatomy & histology* / Q000503:physiopathology*; D002220:Carbamazepine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D005632:Fructose / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D000077213:Lamotrigine; D000077287:Levetiracetam; D008297:Male; D009557:Nipecotic Acids / Q000627:therapeutic use; D009778:Occipital Lobe / Q000503:physiopathology; D000078330:Oxcarbazepine; D010296:Parietal Lobe / Q000503:physiopathology; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D012640:Seizures / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D013702:Temporal Lobe / Q000503:physiopathology; D000078308:Tiagabine; D000077236:Topiramate; D016896:Treatment Outcome; D014227:Triazines / Q000627:therapeutic use; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D009557:Nipecotic Acids; D014227:Triazines; D000077236:Topiramate; D005632:Fructose; D002220:Carbamazepine; D000077287:Levetiracetam; D014635:Valproic Acid; D000077213:Lamotrigine; D000078330:Oxcarbazepine; D000078308:Tiagabine; D010889:Piracetam