This observational study also found AED load was not a factor in causing adverse effects, but suggests that individual susceptibility, type of AEDs used, and physicians' skills determine which patients suffer adverse effects. Results of this study are available today in Epilepsia, a journal published by Wiley-Blackwell on behalf of the International League Against Epilepsy.
There are more than 20 different AEDs used to treat epilepsy. However, only about one-half of patients become seizure-free with the first prescribed AED; an additional 20% of patients may find complete relief from seizures through a polytherapy AED regimen. The medical community has extensively debated the value of monotherapy versus polytherapy, not only for relative efficacy in reducing frequency of seizures, but also for impact on health-related quality of life (HRQOL). Past studies have indicated that polypharmacy treatment provides only modest advantages in controlling seizures, with the added burden of potentially increasing adverse effects. In contrast, other studies suggest AED toxicity may be better correlated with 'drug load' (the sum of ratios between actual prescribed daily doses and the average therapeutic dose of each drug) than with the number of AEDs administered.
In the current study, 809 epileptic patients were enrolled at 11 tertiary referral centers with 709 participants (344 men and 465 women) having localization-related epilepsy. Mean duration of epilepsy in the study group was over 20 years and the median seizure frequency was 2.5 seizures per month. The most common AEDs prescribed for single AED therapy were carbamazepine, oxcarbazepine, or lamotrigine; one-fourth of participants were treated with monotherapy. In the 627 subjects (77.7%) subjects on polytherapy, levetiracetam was the most commonly co-prescribed drug.
Adverse effects were assessed using the Adverse Event Profile (AEP) questionnaire and through unstructured interviews with participants. Nervousness and/or agitation, tiredness, sleepiness, and memory problems were the most commonly reported adverse effects in the AEP questionnaire. At the unstructured interviews, about one-third of participants reported at least one adverse effect, and 13.6% reported two or more adverse effects.
"There was no major difference in frequency of the recorded adverse effects between patients on monotherapy and patients on polytherapy," confirmed Emilio Perucca, M.D., of the University of Pavia and lead author of the SOPHIE (Study of Outcome of PHarmacoresistance In Epilepsy) study. This finding differs from prior studies that suggest poorer HRQOL is associated with polytherapy and improved HRQOL after conversion from multi-AED treatment to monotherapy.
Results also showed that polytherapy patients had higher drug loads than monotherapy patients. However, researchers did not find a correlation between the AED drug load and the number of adverse effects in individual patients. "Our findings suggest that adverse effects can be attributed to individual reaction to the treatment regimen, the type of AED or combination prescribed, and the physicians' skills at treatment," concluded Dr. Perucca. "Further studies of AED therapies and associated adverse effects are needed to uncover fundamental factors such as gender, mood status, treatment duration, and other co-morbidities that influence HRQOL."
Article: " Relationship between adverse effects of antiepileptic drugs, number of coprescribed drugs, and drug load in a large cohort of consecutive patients with drug-refractory epilepsy." Maria Paola Canevini, Giovambattista De Sarro, Carlo Andrea Galimberti, Giuliana Gatti, Laura Licchetta, Ambra Malerba, Giancarlo Muscas, Angela La Neve, Pasquale Striano, and Emilio Perucca on behalf of the SOPHIE Study Group. Epilepsia; Published Online: April 20, 2010 (DOI: 10.1111/j.1528-1167.2010.02520.x).
This study is published in Epilepsia. Media wishing to receive a PDF of this article may contact firstname.lastname@example.org.
Epilepsia is the leading, most authoritative source for current clinical and research results on all aspects of epilepsy. As the journal of the International League Against Epilepsy, subscribers every month will review scientific evidence and clinical methodology in: clinical neurology, neurophysiology, molecular biology, neuroimaging, neurochemistry, neurosurgery, pharmacology, neuroepidemiology, and therapeutic trials. For more information, please visit http://www3.interscience.wiley.com/journal/117957420/home.
Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or www.interscience.wiley.com.
A promising target for kidney fibrosis
21.04.2017 | Brigham and Women's Hospital
Stem cell transplants: activating signal paths may protect from graft-versus-host disease
20.04.2017 | Technische Universität München
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
Two researchers at Heidelberg University have developed a model system that enables a better understanding of the processes in a quantum-physical experiment...
Glaciers might seem rather inhospitable environments. However, they are home to a diverse and vibrant microbial community. It’s becoming increasingly clear that they play a bigger role in the carbon cycle than previously thought.
A new study, now published in the journal Nature Geoscience, shows how microbial communities in melting glaciers contribute to the Earth’s carbon cycle, a...
20.04.2017 | Event News
18.04.2017 | Event News
03.04.2017 | Event News
21.04.2017 | Physics and Astronomy
21.04.2017 | Health and Medicine
21.04.2017 | Physics and Astronomy