Magazine article Clinical Psychiatry News

New-Generation Anticonvulsants Offer Hope for Refractory Patients

Magazine article Clinical Psychiatry News

New-Generation Anticonvulsants Offer Hope for Refractory Patients

Article excerpt

SAN ANTONIO -- If at first you don't succeed, try, try, and even try again when it comes to finding an effective antiepileptic drug for your treatment-resistant patients, Dr. Pavel Klein concluded from the findings of a retrospective study evaluating newer drugs.

"With the new generation of anticonvulsants, patients have a slightly higher chance of seizure freedom if they use three or even four different medications than they had with the older-generation drugs," Dr. Klein of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, Md., said at the meeting.

The most recent studies of antiepileptic drug (AED) response suggest that seizure freedom occurs in less than 4% of patients who fail three AEDs or who are treated with polytherapy. But these studies were conducted before the widespread use of the "second wave" of new-generation AEDs, including levetiracetam, oxcarbazepine, zonisamide, pregabalin, and lacosamide. This second wave is part of 12 new AEDs that have been introduced since 1993, Dr. Klein said.

To assess patient response rates with the current arsenal of AEDs more accurately, Dr. Klein and his colleagues retrospectively studied AED response in 583 patients who were evaluated and treated consecutively at their tertiary epilepsy center during 2003-2009. These patients had a mean age of 42 years and a mean epilepsy duration of 17.5 years.

The investigators found that approximately 11% achieved seizure freedom after failing three AEDs. …

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