Title: A Clinic Based Comparative Study on Monotherapy and Combination Therapy in Epilepsy

Authors: Abhinav. P, Ashok. D, Manjula. P

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i9.48

Abstract

The study was to evaluate and compare the effectiveness of single antiepileptic drugs with combination antiepileptic drugs in Idiopathic epilepsy in a routine clinical practice. Patients diagnosed with Idiopathic epilepsy and prescribed with a single antiepileptic drug and combinations of two antiepileptic drugs were included in the study. Out of 214 epilepsy patients, 8 patients were excluded for non-compliance and insufficient data. Patients were followed up for every 1-3 months in their outpatient clinic. Seizure activity was categorized into seizure freedom, reduction in seizure frequency and no change after therapy. We analyzed the effect of monotherapy and combination therapy on seizure frequency in patients with epilepsy (N = 206). 62 patients were on four different single antiepileptic drug and of them 32 were seizure free. 144 patients were on six different combinations of antiepileptic drugs and of them 87 were seizure free. We found the proportion of seizure-free cases with combination therapy was relatively less with monotherapy. We also found that the valproic acid (40.6%) had better outcome and a combination of levetiracetam with valproic acid (33.3%) had superior outcome measured against other AED combinations, concluding the suggestion for the use of combination therapy if initial monotherapy is unsuitable for the patients.

Keywords: Seizures, Anti-epileptic drugs, Monotherapy, Combination therapy.

References

  1. World Health Organization. Epilepsy; 2014 cited 2014 15 Feb. Available: http://www.who.int/mediacentre/factsheets/fs999/en/.
  2. Gina shaw. The Economic Burden of Neurologic Disease — $800 Billion Annually in the US. Neurology Today: June 22nd, 2017 - Volume 17 - Issue 12 - p 1,14–18.
  3. Senthil Amudhan, Gopalkrishna Gururaj Parthasarathy Satishchandra, Epilepsy in India I: Epidemiology and public health. 10.4103/0972-2327.160093.
  4. Brodie MJ, French JA. Management of epilepsy in adolescents and adults. Lancet. 2000;356 (9226):323-329.
  5. Margolis, PharmD; Bong-Chul Chu, PhD; Zhixiao J.Wang, PhD. Effectiveness of Antiepileptic Drug Combination Therapy for Partial-Onset Seizures Based on Mechanisms of Action. JAMA Neurol. 2014;71(8):985-993. doi:10.1001/jamaneurol.2014.808.
  6. St Louis EK. Truly “rational” polytherapy: maximizing efficacy and minimizing drug interactions, drug load, and adverse effects. Curr Neuropharmacol. 2009;7(2): 96-105.
  7. Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kalviainen R, et al. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2013; 54(3):551–563. doi: 10.1111/epi.12074 PMID: 23350722.
  8. Erik K. St. Louis1, William E. Rosenfeld and Thomas Bramley. Antiepileptic Drug Monotherapy: The Initial Approach in Epilepsy. Current Neuropharmacology, 2009, 7, 77-82.
  9. Ehsan M. Sarhana, Matthew C. Walkera, Caroline Selai. Evidence for Efficacy of Combination of Antiepileptic Drugs in Treatment of Epilepsy. J Neurol Res. 2015;5(6):267-276. doi: http://dx.doi.org/10.14740/jnr356w.
  10. Selim R Benbadis, MD, Hermann Stefan, MD, Diego Morita, MD. Pharmacologic Decision-making in the Treatment of Focal Epilepsy— A Critical Comparison of Antiepileptic Drugs. US Neurology, 2014;10(2):ePub ahead of print. DOI: 10.17925/USN.2014.10.02.2.
  11. Korby B, Penovich PE, Gates JR, Dickens DL, Moriarty GL. Levetiracetam mono-therapy. Epilepsia 2003;9:1–7.
  12. Daria Stepanova, Roy G. Beran. Measurement of levetiracetam drug levels to assist with seizure control and monitoring of drug interactions with other anti-epilepticmedications(AEMs). org/10.1016/j.seizure.2014.02.003.
  13. Depondt C, Yuen AW, Bell GS, Mitchell T, Koepp MJ, Duncan JS, Sander JW. The long term retention of levetiracetam in a large cohort of patients with epilepsy. J Neurol Neurosurg Psychiatry. 2006;77(1): 101-103.
  14. Ji Hyun Kim, Sang Kun Lee, Christian Loesch, Kyungsun Namgoong, Hyang Woon Lee. Comparison of levetiracetam and oxcarbazepine monotherapy among Korean patients with newly diagnosed focal epilepsy: A long-term, randomized, open-label trial. Epilepsia, 58(4):e70–e74, 2017 doi: 10.1111/epi.13707.
  15. Unsal Yılmaz , Tuba Sevim Yılmaz , Gulsen Dizdarer, Gulcin Akıncı , Orkide Guzel, Hasan Tekgul. Efficacy and tolerability of the first antiepileptic drug in children with newly diagnosed idiopathic epilepsy. Seizure 23 (2014) 252–259. doi.org/10.1016/j.seizure.2013.12.001.
  16. D. Knoester, A.Keyser, W.O.Renier. Effectiveness of lamotrigine in clinical practice: Results of a retrospective population-based study. doi.org/10.1016/j.eplepsyres.2005.05.005.
  17. Nicholas P. Poolos, Lindsay N. Warner, Sophia Z. Humphreys, et al. Comparative efficacy of combination drug therapy in refractory epilepsy. DOI 10.1212/WNL.0b013e31823ed0dd.
  18. Jukka Peltola, Maria Peltola, Jani Raitanen, Tapani Keranen, Elham Kharazmi, Anssi Auvinen. Seizure-freedom with combination therapy in localization-related epilepsy. doi:10.1016/j.seizure.2007.08.001.
  19. Rupa Joshi, Manjari Tripathi, Yogendra Kumar Gupta. Effect of clobazam as add-on antiepileptic drug in patients with epilepsy, Indian J Med Res 140, August 2014, pp 209-215.
  20. Jacqueline A. French, MD, FAAN; Deana M. Gazzola, MD. Antiepileptic Drug Treatment: New Drugs and New Strategies. Continuum (Minneap Minn) 2013;19(3):643–655.

Corresponding Author

P. Abhinav

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