Seizure Burden Improves Over Time in Treatment-Resistant Focal Epilepsy
More than two-thirds of patients with treatment-resistant focal epilepsy experienced a significant reduction of seizures over up to 3 years of follow-up, according to a study published in JAMA Neurology.
“Our findings challenge the assumption that once a patient with focal epilepsy has failed a certain number of antiseizure drugs, their chances of finding relief are small and not worth the effort,” said Ojas Potnis, MD, a resident in the NYU Grossman School of Medicine Department of Neurology, New York, New York, and lead author of the study.
The study analyzed seizure frequency trends in 126 patients with treatment-resistant focal epilepsy at 10 US epilepsy centers. The patients, who had at least 4 antiseizure medication failures, were treated with multiple interventions at their physicians’ discretion between May 2018 and September 2021 and were followed for 18 to 36 months.
Patients used an electronic diary daily to track any seizures as well as the seizure time, duration, episode type, and other notes. Antiseizure medications, devices, and surgical interventions were also reported.
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In the second half of study participation, 68.3% of the patients had a significant reduction in monthly seizure frequency compared with the first half. Among 69 patients who had an antiseizure medication added to their treatment, 66.7% experienced a reduction in seizure frequency, including seizure freedom, according to the study.
Overall, more than 13% of patients were seizure-free at least 3 months, and nearly 8% were seizure-free at least 6 months. Seizure freedom lasted a year or longer for 3.1%.
The number of antiseizure medications failures a patient experienced had no effect on the likelihood of seizure reduction, the team reported.
“These results offer hope that focal epilepsy will get better over time for most people,” said study co-senior author Jacqueline French, MD, a neurologist and professor at NYU Grossman School of Medicine. “Health care providers should keep searching for the best treatment regimen for their patients no matter how many therapies they may need to try.”
Whether seizure improvements reflected the natural history of treatment-resistant focal epilepsy or active management is unclear, the authors noted.
“Improvement in seizure burden over time independent of intervention type suggests cautious interpretation of open-label studies that posit disease-modifying effects to explain seizure improvement in similar time courses,” they advised.
