Nearly 70% of patients with focal treatment-resistant epilepsy experienced substantial seizure reductions over time, according to a recent large prospective study.
Among 126 participants involved in the study, 86 of them experienced reduced seizure frequency in the latter half of follow-up compared with the first, and repeated-measures modeling demonstrated a mean modeled monthly seizure frequency reduction of 68.73%. Declines were consistent across all exposure cohorts, with mean modeled reductions of 67.76% among the patients followed less than 12 months, 36% among those followed 12 to 24 months, and 66.03% among those followed more than 24 months. Seventeen participants achieved at least 3 months without seizures, 10 achieved at least 6 months, and 4 remained seizure-free for at least 12 months.
The Human Epilepsy Project 2 (HEP2) enrolled patients aged 16 to 65 years with focal treatment-resistant epilepsy who had didn't respond in at least four prior antiseizure drug trials and had a minimum of two focal seizures per month prior to enrollment. The participants recorded seizure activity using daily electronic diaries and completed monthly coordinator check-ins, with seizure and medication data confirmed through medical record review. Monthly seizure counts were aggregated from these data. Investigators compared seizure frequency between the first and second half of each participant’s follow-up and stratified the patients into three follow-up cohorts based on duration.
Among the 128 participants with adequate seizure reporting, seizure declines were observed across all cohorts and were statistically significant. Improvement didn't correlate with baseline seizure frequency, age, sex, or number of previously failed antiseizure drugs. Medication adjustments were common, with more than 50% of the participants adding an antiseizure drug. Two-thirds of those who added drugs experienced seizure reduction, although only six patients achieved seizure freedom directly following an addition. Neuromodulation devices, including deep brain stimulation, vagal nerve stimulation, and responsive neurostimulation, didn't produce seizure trajectories that differed significantly from those in participants without devices.
“Findings from the HEP2 study imply that [focal treatment-resistant epilepsy] improves over time, [antiseizure drug] additions had low probability of achieving seizure freedom but contributed to seizure reduction, and device-treated participants exhibited similar seizure trajectories to those without devices,” noted lead study author Ojas Potnis, MD, of the Department of Neurology at New York University Langone Health, and colleagues.
The investigators reported that several of them received research funding, consulting fees, or travel support from pharmaceutical companies, nonprofit organizations, and federal agencies, whereas others held advisory roles or leadership positions in professional or research institutions.
Source: JAMA Neurology
