Response to antiseizure medications in epileptic patients with malformation of cortical development

Wei Chen; Bo Jin; Thandar Aung; Chenmin He; Cong Chen; Shan Wang; Yao Ding; Fang Ding; Chao Wang; Hong Li; Biao Jiang; Zhe Zheng; Haibin Dai; Junming Zhu; Yu Geng; Meiping Ding; Shuang Wang

doi:10.1177/17562864211050027

Response to antiseizure medications in epileptic patients with malformation of cortical development

Ther Adv Neurol Disord. 2021 Oct 12:14:17562864211050027. doi: 10.1177/17562864211050027. eCollection 2021.

Authors

Wei Chen¹, Bo Jin², Thandar Aung³, Chenmin He⁴, Cong Chen⁴, Shan Wang⁴, Yao Ding⁴, Fang Ding⁵, Chao Wang⁶, Hong Li⁶, Biao Jiang⁶, Zhe Zheng⁷, Haibin Dai⁸, Junming Zhu⁷, Yu Geng², Meiping Ding⁴, Shuang Wang⁹

Affiliations

¹ Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China Department of Neurology, Linhai Second People's Hospital, Taizhou, China.
² Department of Neurology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
³ Epilepsy Center, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁴ Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁵ Department of Neurology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China.
⁶ Department of Radiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁷ Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁸ Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁹ Department of Neurology, Epilepsy Center, Second Afﬁliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.

Abstract

Background: Malformation of cortical development (MCD) is one of the most common causes of pharmacoresistant epilepsy. Improving the knowledge of antiseizure medications (ASMs) treatment response in epileptic patients with MCD is crucial for optimal treatment options, either pharmacological therapy or non-pharmacological intervention.

Aim: To investigate the patterns of medical treatment outcome and the predictors for seizure freedom (SF) with ASM regimens in epilepsy caused by MCD.

Methods: The epileptic patients with MCD were consecutively enrolled from March 2013 to June 2019. SF was defined as no seizures for at least 12 months or three times the longest pretreatment inter-seizure interval, whichever was longer. Outcomes were classified into three patterns: pattern A: patients achieved SF at one point and remained so throughout follow-up; pattern B: patients' seizures fluctuated between periods of SF and relapse; pattern C: SF never attained. The terminal SF was defined if the patients remained SF at the last follow-up visit.

Results: A total of 164 epileptic patients with MCD were included. Pattern A was observed in 22, pattern B in 42, and pattern C in 100 patients. SF was ever achieved in 64 (pattern A and B) patients. Twenty-nine patients had terminal SF after a median follow-up time of 4.3 years. With continuing ASM treatment, seizure relapse risk was very low after a 5-year seizure-free period. The pretreatment seizure frequency was the only independent predictor for pattern A and seizure relapse. Sodium channel blockers monotherapy (33.8%) was more effective than levetiracetam (4.5%) in rendering SF in the initial ASM regimen.

Conclusion: Medical treatment can be successful in a minority of epileptic patients with MCD, and pretreatment seizure frequency helps to predict the treatment outcome. An unequal efficacy of ASMs in epilepsy caused by MCD suggests etiological evaluation is vital in the management of focal epilepsy.

Keywords: antiseizure medications; epilepsy; malformation of cortical development.