NEWLY DIAGNOSED EPILEPSY Treatment response in mesial temporal

lobe epilepsy with hippocampal atrophy (N=14; 2.5% population)

Non-responders(42%)

Remission (50%)

Immediate responders

(21%)

Relapse (7%)

Mohanraj R, Brodie MJ. Seizure 2005;14:318-23

Responders (57%)

NEWLY DIAGNOSED EPILEPSY

1840 1860 1880 1900 1920 1940 1960 1980 20000

5

10

15

20

BromidePhenobarbital

Phenytoin Primidone

Ethosuximide

Sodium Valproate

Benzodiazepines

Carbamazepine

Calendar year

Antiepileptic drugs

Vigabatrin

ZonisamideLamotrigine

FelbamateGabapentin

Topiramate Fosphenytoin

OxcarbazepineTiagabine

LevetiracetamPregabalin

StiripentolRufinamide

Lacosamide

NEWLY DIAGNOSED EPILEPSY

There is no reliable evidence to suggest any difference in efficacy between

carbamazepine and phenytoin

carbamazepine and valproate

phenytoin and valproate

phenobarbital and carbamazepine

phenobarbital and phenytoin

for partial or generalized tonic-clonic seizures

THE COCHRANE LIBRARY

Lamotrigine versus Carbamazepine (3), Gabapentin (2), Phenytoin

Oxcarbazepine versus Phenytoin (2), Carbamazepine, Valproate

Vigabatrin versus Carbamazepine

Gabapentin versus *Carbamazepine (2), Lamotrigine

Topiramate versus *Carbamazepine, *Valproate

Levetiracetam versus Controlled-release carbamazepine

* fixed doses

NEWLY DIAGNOSED EPILEPSY Randomized, head-to-head, double-blind trials with

modern antiepileptic drugs(N = 18)

NEWLY DIAGNOSED EPILEPSY Drug choice

As there are no major differences in efficacy among

first-line antiepileptic drugs, tolerability and longterm

safety must be the paramount consideration in patients

with often mild newly diagnosed epilepsy

Kwan P, Brodie MJ. Neurology 2003; 60 (suppl 4): S2-S12

Efficacy

Tolerability

EFFECTIVENESS

The sum of two parts

NEWLY DIAGNOSED EPILEPSY Observations from the Glasgow database

1098 adolescent and adult patients starting on

their first antiepileptic drug between 1982

and 2005 and follow-up for at least 2 years

NEWLY DIAGNOSED EPILEPSY Response rates (%) in an expanding cohort

Recruitment n One AED Combination Total

1982-19971 470 61 3.0 64.0

1982-20012 780 59 5.4 64.4

1982-20053 1098 61.9 6.4 68.3

1Kwan P, Brodie MJ. N Engl J Med 2000; 342: 314-92Mohanraj R, Brodie MJ. Eur J Neurol 2006; 13: 277-82

3 Bamagous G, Kwan P, Brodie MJ, in preparation

NEWLY DIAGNOSED EPILEPSY Successful combinations*

2 AEDs 67

3 AEDs 2

4 AEDs 1

Total 70

*Seizure free for at least the previous year

FONDE STUDY Following Outcomes in Newly Diagnosed Epilepsy

A prospective observational study of the

pharmacological and lifestyle consequences of newly

diagnosed epilepsy

FONDE STUDY Objectives

To monitor pharmacological and social outcomes

over a prolonged period under conditions of care that mirror everyday clinical practice

in relation to a variety of clinical, investigational and environmental prognostic factors

across a range of clinical settings from general neurology to specialist epilepsy services

FONDE STUDY

All information at study visits will be entered into an electronic case record form and submitted to the

Central Data Management Centre in Milan

Separate data entry for children and adults

Dina Battino data manager Marco DeZordo system designer Patrick Kwan webmaster John Norrie statistician Martin Brodie principal investigator

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