Focal Epilepsy Patients Face Delays in Effective Treatment

A recent study led by NYU Langone Health shows that while most patients with focal epilepsy eventually achieve seizure control with medication, it often takes a year or more to find the right drug or dosage. The research, which followed nearly 450 newly diagnosed patients across 34 epilepsy centers worldwide, highlights the challenges of initial treatment choices and underscores the need for a longer adjustment period before effective results are seen.

Results reveal that although over half of participants eventually found an effective medication or regimen, meaningful seizure control took an average of 12 months. Many patients required an even longer period to achieve relief. Jacqueline French, Co-Principal Investigator, Human Epilepsy Project, says that these findings highlight the long adjustment period required to determine the most suitable treatment.

The study suggests that initial drug choice may contribute to delays in seizure control. Neurologists frequently prescribe levetiracetam, a drug that targets multiple seizure types and has few interactions with other medications. However, only about a quarter of patients became seizure-free on their first try with levetiracetam, which was prescribed to 57% of participants.

Researchers collected comprehensive data on medical histories, demographic factors, seizure frequency, age of onset, and MRI readings. Participants tracked seizure activity daily using electronic diaries and reported details about their medications, including dosage and reasons for discontinuing specific treatments. Patients were considered seizure-free if they did not experience a seizure for at least one year.

The study found that 63% of participants experienced ongoing or worsening seizures during the first year of therapy. Those with infrequent seizures before treatment were more likely to respond to medication, while individuals with prior psychological disorders such as anxiety or depression were nearly twice as likely to resist treatment.

French says that effective treatment often involves optimizing existing therapies rather than waiting for new drugs. The research team plans to further investigate patients who did not become seizure-free during the study period.

The Human Epilepsy Project is a global collaboration of researchers, physicians, and healthcare professionals focused on understanding how patients with epilepsy respond to therapies. The study was funded by the Epilepsy Study Consortium, supported by pharmaceutical companies including UCB, Eisai Co., Pfizer, Lundbeck, and Sunovion Pharmaceuticals, as well as foundations including the Andrews Foundation, the John and Barbara Vogelstein Foundation, and FACES, a nonprofit affiliated with NYU Langone’s Comprehensive Epilepsy Center.

Epilepsy can affect individuals of any age or social background and is marked by seizures caused by abnormal and excessive neuronal discharges. While it is often linked to genetic or hereditary factors, it may also result from secondary causes such as neurocysticercosis, perinatal injury, cerebrovascular events, head trauma, or cases of unknown origin, reports Mexico’s Ministry of Health. Globally, around 70 million people have epilepsy; in Mexico, it is estimated to have a prevalence of between 10.8 and 20 cases per 1,000 inhabitants.