'Unexplained' Drug Load in Patients With Epilepsy
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There is a largely 'unexplained' anti-epileptic drug (AED) load in patients with epilepsy that is unrelated to disease severity or seizure frequency, new research shows.

Results of a large, single center, cross-sectional study reveal only a marginal link between total drug load indices and markers of disease severity.

"The current findings do not support the view that a higher AED load necessarily reflects more severe epilepsy, but rather indicate that the individual AED load is determined by additional factors in the majority of patients," the investigators write.

This study aimed to ascertain factors that are related to the antiepileptic drug load in epilepsy.

In this cross-sectional study, researchers analyzed a large cohort of conservatively treated patients with epilepsy (n = 1135) and a smaller homogeneous group of presurgical patients with neuropathologically confirmed unilateral hippocampal sclerosis (n = 91). Considered clinical variables comprised (1) presence of an underlying cerebral lesion, (2) onset and (3) duration of epilepsy, (4) seizure frequency, (5) generalized or focal to bilateral tonic-clonic seizures, (6) ictal impairment of awareness, and (7) a history of convulsive status epilepticus. In the presurgical sample, they additionally considered (8) the degree of pathology (hippocampal neuronal cell densities) instead of (1) presence of a cerebral lesion and (9) an overall rating of epilepsy severity (GASE scale). Drug load was quantified as (a) the number of concomitant antiepileptic drugs (AEDs) and (b) the total defined daily dose (DDD).

Results:
-- Analyses disclosed only small correlations between clinical variables and drug load indices.

-- In the conservatively treated cohort, the multiple regression analyses revealed that epilepsy onset, cerebral lesion, history of convulsive status epilepticus, and seizure frequency combined explained only 6%–10% of variance in drug load.

-- Nearly the same variance (5%–8%) could be explained by duration of epilepsy alone.

-- Degree of hippocampal pathology and the epilepsy severity ratings were not related to drug load indices.

Clinical markers of epilepsy severity were only marginally associated with drug load. Findings rather indicate that patients seem to accumulate drugs due to the chronicity of epilepsy. Overall, the drug load remained largely unexplained. The findings nevertheless call for scrutinizing multidrug therapies in patients with long-lasting epilepsies.

Source: https://onlinelibrary.wiley.com/doi/10.1111/epi.16720
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