Antiepileptic pharmacotherapy is the leading factor in the induced pathomorphosis of epilepsy

Abstract

Aim – to elucidate the role of antiepileptic pharmacotherapy in pathomorphosis of focal epilepsy in adult patients.Materials and methods. We examined 91 patients with focal epilepsy (main group, G); among them, 37 (41%) men (M) and 54 (59%) women (W). At the time of the first visit, 82 (90%) of them [33 (89%) M and 49 (91%) W] were under antiepileptic therapy. The age of patients ranged from 18 to 78 years (average 37.5 years). The debut of epilepsy was observed at the ages from 4 to 71 years. The duration of the disease ranged from 1 to 52 years, with the average of 16.1 years. All patients were then followed up for 1 to 2.5 years. Clinical and neurological examinations were conducted in all patients; laboratory and instrumental diagnostic tests were used if indicated. The medical history of patients was analyzed from the onset of epilepsy; if needed, new therapies were prescribed or the existing therapies were modified. The therapeutic efficacy was assessed using the data from the daily-seizures diary. The differences between the groups were tested for their significance using the Chi-square test or the exact Fisher test if there were less than five observations in the group. Results. Only 47 (52%) patients of group G [21 (57%) M and 26 (48%) W] received an antiepileptic therapy from the debut of the disease; the therapy was then adjusted in 41 (45%) cases [19 (51%) M and 22 (41%) W (р>0.05)]. Of the 82 patients receiving therapy at the time of examination, 37 (45%) received the basic, 20 (24%) – the updated, and 24 (29%) – a combination of the basic and updated AED; in about 2% of cases, a combination with the 1st generation drugs was prescribed. Monotherapy was used in 45 (55%), and polytherapy – in 37 (45%) patients. Of the 19 patients taking KBZ as the starting monotherapy, 10 (52%) received the drug in the non-prolonged form, twice a day. Relapse after long-term remission (12 months or more) in 80% of cases was associated with changes in the AED regimen. Side effects were observed in 43 (52%) patients under the treatment [15 (45%) M and 28 (57%) W]. Among those, who underwent MRI examination, structural epileptogenic changes were detected in 37 (54%) patients [21 (72%) M and 16 (40%) W (p<0.05)]. Comorbidity and the associated co-therapy were detected in 88% M and 90% W who were >50 years old.Conclusion. Antiepileptic pharmacotherapy is a leading factor that induces evolutionary changes in the clinical and neurophysiological picture of epilepsy. With a timely and rational approach, the use of AED allows for creating favorable development of pathomorphosis of the disease. Full patients awareness of the AED therapeutic regimens and the associated risks may increases the compliance, reduce the risk of decompensation and improve the prognosis of epilepsy.

Keywords

• epilepsy
• pathomorphоsis
• antiepileptic pharmacotherapy
• generic aed analogues