Andrew N. Wilner, MD


April 03, 2013

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American Academy of Neurology Meeting: 4 Important Epilepsy Trials

Welcome. This is Dr. Andrew Wilner reporting from Medscape with highlights from the 65th Annual Meeting of the American Academy of Neurology in San Diego, California. Today I will be summarizing 4 interesting posters on epilepsy.

The first poster, by Liu and colleagues, is titled, "The New Antiepileptic Drugs (Levetiracetam and Oxcarbazepine) Compared with Traditional Antiepileptic Drugs (Carbamazepine and Valproate) in the Initial 52 Weeks of Monotherapy for Epilepsy Induced by MELAS -- An Open-Label, Prospective, Randomised Controlled Multicenter Study."[1] MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) is caused by mutations in mitochondrial DNA. The major findings of this study are shown in the Table.

Table. Major Findings

Drug Dosage Seizure-Free at 52 Weeks Adverse Events
Carbamazepine 300 mg/day 57.1% 57.1%
Levetiracetam 2000 mg/day 57.1% 57.1%
Topiramate 200 mg/day 49.2% 71.4%
Valproate 1000 mg/day 4.8% 95.2%


Although one could take issue with the dosages used, all of the antiepileptic drugs were similar in terms of efficacy and adverse events with the exception of valproate. This study is important because it provides guidance for selecting antiepileptic drugs in the uncommon but important cases of MELAS.

Seizures in Epilepsy After Stroke

The next poster is titled, "Seizures and Epilepsy After Stroke: Resources and Costs Assessment," by Guekht and colleagues.[2] In this study, there were 298 patients with stroke, as follows:

30 patients (10%) had seizures;

24 patients (8%) had early seizures;

3 patients (1%) had both early and late seizures; and

3 patients (1%) had late seizures only.

These patients were compared with control patients who had similar National Institutes of Health stroke scale scores (10.5 in cases vs. 9.5 in controls). Cases with seizures had a mortality rate of 50%, whereas control patients had a mortality rate of only 5.7%. The group with seizures spent more days in the intensive care unit; had a higher number of CT scans and MRIs; and underwent more consultations, x-rays, and endoscopic procedures. Stroke patients who have seizures need prompt attention for their seizure treatment, but this study demonstrates that stroke is also a marker for a stormy course, and stroke patients with seizures should receive greater attention.