Two-year Follow-up Study On Drug Therapy For Newly Diagnosed Patients With Focal Epilepsy

BackgroundThe majority of the epileptic patients is characterized as focal epilepsy.For the newly diagnosed patients with focal epilepsy,the drug therapy is the major measure,and single drug treatment is preferred,thus,the drug selection,especially the initial ones are of great importance,since the prognosis of the epileptic patients could be affected.In the past decade,With the extensively clinical use of new anti-epileptic drugs,the traditional drug,such as Carbamazepine and Valproic acid,have not been completed replaced.The drug therapy on epilepsy,especially on the focal epilepsy is a standard and long-term process,so far,the use of new anti-epileptic drug on the focal epilepsy still lacks of evidence.For the initial drug selection on newly diagnosed patients,the traditional drugs have not been overwhelmed by new ones,which still needs further investigation.ObjectiveIn this study,the efficacy and side effects of five commonly used anti-epileptic drugs were compared in order to provide guide for initial drug selection in patients with focal epilepsy in the future clinical use.MethodThe patients with focal epilepsy admitted to department of neurology in the Second Affiliated Hospital to Xinxiang Medical University from January,2006 to November,2014 were recruited.The patients were systematically analyzed by the neurologist and treated with Oxcarbazepine(OXC),Carbamazepine(CBZ),Lamotrigine(LTG),Valproic acid(VPA),and Topiramate(TPM),respectively.And follow-up studies were also conducted for more than 2 years.The comparison of curative effect,tolerance and adverse reaction in each group was made by a couple of indexes,and the risk factors which could affect patient retention were also analyzed.ResultTotal 268 patients completed the study,namely,57 in OXC group,74 in CBZ group,44 in LTG group,61 in VPA group and 32 in TPM group.The onset time of first seizure after initial drug administration and non-attack continuity duration within 2 year in TPM group were significantly better than those in CBZ group and LTG group(both P<0.05).The adverse reaction rate in OXC group was significantly lower than that in other four groups(all P<0.05),and adverse reaction rate in CBZ group and TPM group were significantly higher than that in OXC,LTG,VPA groups(all P<0.05).The effective rate,non-seisure rate,one-year retention rate and two-year retention rate in five groups were not statistically different(all P>0.05).In general,the major reasons of non-retention were poor curative effect(76.8%),followed by rash(12.5%);the risk factors,such as previous positive history of brain diseases,neuroimaging abnormalities and frequent seizure(>5)prior to drug administration,were independent factors for the single drug retention failure in newly diagnosed epileptic patients(P<0.05).ConclusionAmong the five drugs,the new anti-epileptic drug OXC has exhibited the best efficacy and tolerance.However,given the retention rate of aggregate indexes,the new anti-epileptic drugs,such as OXC,LTG,TPM has no advantage over the traditional ones,such as VPA and CBZ.Previous positive history of brain diseases,neuroimaging abnormalities and frequent seizure(>5)prior to drug administration suggests poor retention in patients.