1 / 12

Non-responders (42%)

Responders (57%). Remission (50%). Non-responders (42%). Relapse (7%). Immediate responders (21%). NEWLY DIAGNOSED EPILEPSY Treatment response in mesial temporal lobe epilepsy with hippocampal atrophy (N=14; 2.5% population). Mohanraj R, Brodie MJ. Seizure 2005;14:318-23.

mshort
Download Presentation

Non-responders (42%)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Responders (57%) Remission (50%) Non-responders (42%) Relapse (7%) Immediate responders (21%) NEWLY DIAGNOSED EPILEPSYTreatment response in mesial temporal lobe epilepsy with hippocampal atrophy (N=14; 2.5% population) Mohanraj R, Brodie MJ. Seizure 2005;14:318-23

  2. NEWLY DIAGNOSED EPILEPSY Lacosamide Antiepileptic drugs Rufinamide Stiripentol 20 Pregabalin Levetiracetam Oxcarbazepine Tiagabine 15 Fosphenytoin Topiramate Gabapentin Felbamate Lamotrigine Zonisamide 10 Vigabatrin Sodium Valproate Carbamazepine Benzodiazepines Ethosuximide 5 Phenytoin Primidone Phenobarbital Bromide 0 1840 1860 1880 1900 1920 1940 1960 1980 2000 Calendar year

  3. NEWLY DIAGNOSED EPILEPSY There is no reliable evidence to suggest any difference in efficacy between carbamazepine and phenytoin carbamazepine and valproate phenytoin and valproate phenobarbital and carbamazepine phenobarbital and phenytoin for partial or generalized tonic-clonic seizures THE COCHRANE LIBRARY

  4. NEWLY DIAGNOSED EPILEPSY Randomized, head-to-head, double-blind trials with modern antiepileptic drugs (N = 18) Lamotrigine versus Carbamazepine (3), Gabapentin (2), Phenytoin Oxcarbazepine versus Phenytoin (2), Carbamazepine, Valproate Vigabatrin versus Carbamazepine Gabapentin versus*Carbamazepine (2), Lamotrigine Topiramate versus*Carbamazepine, *Valproate Levetiracetam versus Controlled-release carbamazepine * fixed doses

  5. NEWLY DIAGNOSED EPILEPSYDrug choice As there are no major differences in efficacy among first-line antiepileptic drugs, tolerability and longterm safety must be the paramount consideration in patients with often mild newly diagnosed epilepsy Kwan P, Brodie MJ. Neurology 2003; 60 (suppl 4): S2-S12

  6. Efficacy Tolerability EFFECTIVENESS The sum of two parts

  7. NEWLY DIAGNOSED EPILEPSY Observations from the Glasgow database 1098 adolescent and adult patients starting on their first antiepileptic drug between 1982 and 2005 and follow-up for at least 2 years

  8. NEWLY DIAGNOSED EPILEPSY Response rates (%) in an expanding cohort Recruitment n One AED Combination Total 1982-19971 470 61 3.0 64.0 1982-20012 780 59 5.4 64.4 1982-20053 1098 61.9 6.4 68.3 1Kwan P, Brodie MJ. N Engl J Med 2000; 342: 314-9 2Mohanraj R, Brodie MJ. Eur J Neurol 2006; 13: 277-82 3 Bamagous G, Kwan P, Brodie MJ, in preparation

  9. NEWLY DIAGNOSED EPILEPSY Successful combinations* 2 AEDs 67 3 AEDs 2 4 AEDs 1 Total 70 *Seizure free for at least the previous year

  10. FONDE STUDY FollowingOutcomesinNewlyDiagnosedEpilepsy A prospective observational study of the pharmacological and lifestyle consequences of newly diagnosed epilepsy

  11. FONDE STUDY Objectives To monitor pharmacological and social outcomes • over a prolonged period under conditions of care that mirror everyday clinical practice • in relation to a variety of clinical, investigational and environmental prognostic factors • across a range of clinical settings from general neurology to specialist epilepsy services

  12. FONDE STUDY All information at study visits will be entered into an electronic case record form and submitted to the Central Data Management Centre in Milan Separate data entry for children and adults Dina Battino data manager Marco DeZordo system designer Patrick Kwan webmaster John Norrie statistician Martin Brodie principal investigator - - - - -

More Related