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Efficacy assessment of levetiracetam monotherapy in newly-diagnosed epilepsy in adults using epileptiform activity index

https://doi.org/10.17749/2077-8333/epi.par.con.2020.024

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Abstract

Abstract. Levetiracetam (LEV) is one of the most commonly prescribed antiepileptic drugs (AED). However, there were no studies on its efficacy and safety in terms of the correlation with epileptiform activity index (EAI) performed among the Russian population.

Aim. To evaluate the efficacy and tolerability of LEV monotherapy in patients with newly-diagnosed epilepsy using epileptiform activity index (EAI) assessment.

Materials and methods. The study included 107 patients (46 (43.0%) male and 61 (57.0%) female) with focal epilepsy (FE) (39.3%; n=42) or idiopathic generalized epilepsy (IGE) (60.7%; n=65). At each visit, video-electroencephalographic (video-EEG) monitoring was performed (baseline and in 1, 3, 6, and 12 months of the therapy). Therapeutic drug monitoring was performed at dose titration in 1 month of the therapy or in case of therapy correction. Treatment efficacy was assessed using the criteria of seizure absence (medically induced remission), seizure rate decrease by >50% (responders), seizure rate decrease by <50% – insufficient efficacy, a composite index of efficacy/tolerability (retention on treatment), and seizure rate increase compared to baseline and/or development of a new type of seizures (aggravation). Adverse events (AE) were assessed using the scale for side effects in AED treatment (SIDAED).

Results. Total EAI at baseline was 5.2-fold higher in patients with IGE compared to FE patients (23.4±3.0 and 4.5±0.97, respectively). After 1 month of LEV therapy, EAI decreased to 3.4±1.1 and 1.9±0.4 in patients with IGE and FE, respectively (p<0.01). The decrease continued during the whole follow-up period. Retention on monotherapy was achieved in 82.2% (n=88/107) patients; in 87.6% (n=57/65) patients with IGE and in 73.8% (n=31/42) with FE. The rate of serious AEs during the follow-up period was 8.4% (n=9).

Conclusions. LEV is an effective drug of choice for the initial treatment of newly-diagnosed FE and IGE in monotherapy along with a significant decrease in EAI. EAI is an objective measure of LEV treatment efficacy.

About the Authors

V. A. Karlov
A. I. Evdokimov Moscow State University of Medicine and Dentistry
Russian Federation

Vladimir A. Karlov – Honored Scientist of the Russian Federation, Associate Member of the Russian Academy of Sciences, MD, Dr Sci Med; Professor of Chair of Neurology, Department of General Medicine; President of the Russian League Against Epilepsy (RLAE) – ILAE Russian Chapter, Scopus ID: 7103065003, SPIN RSCI: 2726-9790, 20-1 Delegatskaya Str., Moscow 127473, Russia



A. B. Kozhokaru
State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency
Russian Federation

Angela B. Kozhokaru – MD, PhD, Head of the laboratory of clinical neurophysiology, Associate Professor, Department of Neurology, Central state medical Academy of the Presidential administration of the Russian Federation, SPIN RSCI: 1019434, Scopus Author ID: 28367717700, 46 Zhivopisnaya Str., Moscow 123182, Russia



P. N. Vlasov
A. I. Evdokimov Moscow State University of Medicine and Dentistry
Russian Federation

Pavel N. Vlasov – MD, Dr Sci Med, Professor, Department of Nervous Diseases, Faculty of Medicine, SPIN RSCI: 701071, Scopus Author ID: 7101688064, 20-1 Delegatskaya Str., Moscow 127473, Russia



A. S. Samoilov
State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency
Russian Federation

Alexander S. Samoilov – MD, Dr Sci Med, Professor, Corresponding Member of the Russian Academy of Sciences, General Director, SPIN RSCI: 738843, Scopus Author ID: 57200643078, 46 Zhivopisnaya Str., Moscow 123182, Russia



Yu. D. Udalov
State Research Center – Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency
Russian Federation

Yuri D. Udalov – MD, Dr Sci Med, Associate Professor, Deputy General Director for Medical Affairs, Scopus Author ID: 57194193916, SPIN RSCI: 912296, 46 Zhivopisnaya Str., Moscow 123182, Russia



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For citation:


Karlov V.A., Kozhokaru A.B., Vlasov P.N., Samoilov A.S., Udalov Yu.D. Efficacy assessment of levetiracetam monotherapy in newly-diagnosed epilepsy in adults using epileptiform activity index. Epilepsy and paroxysmal conditions. 2020;12(2):93-104. (In Russ.) https://doi.org/10.17749/2077-8333/epi.par.con.2020.024

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