title: Seizure-freedom with combination therapy in localization-related epilepsy.
abstract: 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.
authors.affiliation: Department of Neurology and Rehabilitation, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland. jukka.peltola@pshp.fi
authors.forename: Jukka
authors.initials: J
authors.lastname: Peltola
authors.forename: Maria
authors.initials: M
authors.lastname: Peltola
authors.forename: Jani
authors.initials: J
authors.lastname: Raitanen
authors.forename: Tapani
authors.initials: T
authors.lastname: Keränen
authors.forename: Elham
authors.initials: E
authors.lastname: Kharazmi
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
mesh_terms: 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
chemical_list: 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