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March 2018

Questioning the Effectiveness of Newer Antiseizure Medications

Author Affiliations
  • 1Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York
JAMA Neurol. 2018;75(3):273-274. doi:10.1001/jamaneurol.2017.3069

In a classic article published in 2000, Kwan and Brodie1 reported on seizure control among 525 consecutive patients with newly diagnosed epilepsy treated at a single health care center between 1984 and 1997. The researchers reported that about two-thirds of the patients were rendered seizure free, most typically by taking the first drug prescribed. The response rate was similar whether new or established drugs were used, and, for those who did not achieve seizure freedom after trying 3 different medication regimens, there was little benefit in terms of seizure control by additional or different medications. This analysis1 and a subsequent study by other authors2 identified predictors of failure to become seizure free. Failure was associated with epilepsy caused by symptomatic or cryptogenic mechanisms, a high number of seizures before the initiation of therapy, a longer duration of epilepsy before first treatment, a history of the use of recreational drugs, a family history of epilepsy, a history of psychiatric disease, and a history of febrile seizures.

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