Even a Single Epileptic Seizure is Too Much
Focal epileptic seizures resistant to pharmacotherapy represent an ongoing unmet medical need.
Chances of Achieving Seizure Freedom
A study conducted in 2000 showed that a third of adults with epilepsy still did not achieve adequate seizure control with antiepileptic drugs. In a study published 18 years later, including 1795 patients with newly diagnosed epilepsy treated with antiepileptic drugs for at least 2 years, 63.7% were seizure-free in the last year of follow-up. This indicates that there has been no improvement in seizure control over the past 18 years, despite the availability of numerous medications.1 In the study, 50.5% of patients were seizure-free for ≥ 1 year with initial treatment. If adequate seizure control was not achieved with the first antiepileptic drug, patients had a 1.73× higher probability of not responding to subsequent medication. In an older study, 47% of patients achieved seizure freedom with the first antiepileptic drug, and only 14% with the second or third medication.2 Each failed treatment significantly reduces the chances of achieving adequate seizure control.
Epilepsy affects approximately 6 million people in Europe.3 Over 60% of epilepsy patients have focal seizures, and it has been found that seizure control is less often achieved in these patients compared to those with generalized seizures.4 Patients with pharmacoresistant epilepsy have poorer seizure control, more adverse events, and a lower quality of life due to the severity of the condition and the number of medications already prescribed.4 Within 5 years, 3 out of 4 patients discontinue an antiepileptic drug due to lack of efficacy or adverse effects.5
Impact of Seizures on Patients' Lives
Every epileptic seizure has a lasting impact on a patient’s life. The effect of pharmacoresistant epilepsy goes beyond the seizure moment, negatively impacting the patient’s mental and physical well-being. Patients who had at least one seizure in the last 5 years are at increased risk of mood disorders, lower quality of life, and significant social stigma.6
Compared to individuals without epilepsy, patients with this condition are 6 times more likely to suffer from depression, 2 times more likely to have limited educational opportunities, 3 times more likely to have employment restrictions, and 4.5 times more likely to be denied a driver's license.6
A 2018 German study monitored 292 outpatient epilepsy patients, 75% of whom had focal seizures and most were treated with antiepileptic drugs. In 14% of the monitored patients, injuries due to epileptic seizures occurred over 3 months, including lacerations, abrasions, bruises, fractures, and burns. Almost 7% of cases required medical treatment for these injuries with hospitalization.7
Patients experiencing epileptic seizures often feel socially isolated, excluded from social contacts and relationships, and have reduced working capacity. This can lead to depression and anxiety.8
The risk of premature death in patients with epilepsy is 3 times higher than in the general population.9 However, the risk of death for patients with epileptic seizures compared to those without seizures is 9 to 13 times higher.10
The data underscores the need for more effective treatment for patients with pharmacoresistant epilepsy.
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Sources:
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2. Kwan P., Brodie M. J. Early identification of refractory epilepsy. N Engl J Med 2000; 342 (5): 314−319, doi: 10.1056/NEJM200002033420503.
3. Cross J. H. Epilepsy in the WHO European region: fostering epilepsy care in Europe. Epilepsia 2011; 52 (1): 187−188, doi: 10.1111/j.1528-1167.2010.02903.x.
4. Schmitz B., Montouris G., Schäuble B., Caleo S. Assessing the unmet treatment need in partial-onset epilepsy: looking beyond seizure control. Epilepsia 2010; 51 (11): 2231−2240, doi: 10.1111/j.1528-1167.2010.02759.x.
5. Lhatoo S. D., Wong I. C., Polizzi G., Sander J. W. Long-term retention rates of lamotrigine, gabapentin, and topiramate in chronic epilepsy. Epilepsia 2000; 41 (12): 1592−1596, doi: 10.1111/j.1499-1654.2000.001592.x.
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7. Willems L. M., Watermann N., Richter S. et al. Incidence, risk factors and consequences of epilepsy-related injuries and accidents: a retrospective, single center study. Front Neurol 2018; 9: 414, doi: 10.3389/fneur.2018.00414.
8. Laxer K. D., Trinka E., Hirsch L. J. et al. The consequences of refractory epilepsy and its treatment. Epilepsy Behav 2014; 37: 59−70, doi: 10.1016/j.yebeh.2014.05.031.
9. WHO. Epilepsy: a public health imperative. World Health Organization, Geneva, 2019. Available at: www.who.int/publications/i/item/epilepsy-a-public-health-imperative
10. Thurman D. J., Logroscino G., Beghi E. et al; Epidemiology Commission of the International League Against Epilepsy. The burden of premature mortality of epilepsy in high-income countries: a systematic review from the Mortality Task Force of the International League Against Epilepsy. Epilepsia 2017; 58 (1): 17−26, doi: 10.1111/epi.13604.
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