Patterns of Antiseizure Medication Use and Therapeutic Load in Adults with Developmental and Epileptic Encephalopathies: A Single-center Study
Fernando Vasquez Lopez1, Juan Vera1, Maximiliano Salgado-Deza1, Salvador Martinez-Medina1, Stefan Narvaez-Labuhn1, Irving Fuentes-Calvo1, Betsy C. Vázquez-Cruz1, Jimena Gonzalez-Salido1, Jimena Colado-Martinez1, Eithel A. Valenzuela-Mendivil1, Iris E. Martínez Juárez1
1Epilepsy Clinic, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez"
Objective:
To describe patterns of antiseizure medication (ASM) use, common combinations, and their clinical associations with therapeutic load in adults with developmental and epileptic encephalopathies (DEEs).
Background:
Developmental and epileptic encephalopathies (DEEs) are characterized by drug-resistant seizures and developmental delay or regression. (1) Despite multiple studies, therapeutic and surgical interventions do not consistently achieve seizure freedom. (2)
Design/Methods:
A retrospective cross-sectional study of 82 adult patients with DEEs who were followed at an epilepsy center was conducted. Clinical data were collected, including ASM use, combinations, and therapeutic load (high [≥3 ASMs] vs low [1-2 ASMs]), and were recorded. Descriptive analyses were performed. Spearman’s correlations assessed the relationship between epilepsy duration and the number of ASMs. Logistic regression was used to evaluate predictors of high therapeutic load.
Results:
Eighty-two patients were included, 29 (35.4%) female and 53 (64.6%) male, with a mean age of 33.3 ± 8.7 years and a mean follow-up of 13.2 years. The most frequent seizure type was generalized, 52 (63.4%).
The most frequent ASM combination was
lamotrigine-topiramate-valproate in 7 (8.5%), followed by clobazam-lamotrigine-levetiracetam-valproate in 4 (4.9%), clobazam-levetiracetam-valproate in 4 (4.9%), and clonazepam-lamotrigine-valproate in 4 (4.9%). Valproate was included in 63 (76.8%) combinations. The mean number of ASMs per patient was 3.3 ± 0.96. No significant correlation was found between epilepsy duration and number of ASMs (Spearman’s
ρ = −0.09, p = 0.41). Logistic regression showed no significant association between etiology and high therapeutic load
(OR 0.78, 95% CI 0.56–1.08, p = 0.13).Conclusions:
In this cohort of adults with DEEs, therapeutic load was not associated with disease duration or etiology. Valproate-based polytherapy remains the cornerstone of treatment despite the availability of newer ASMs. These findings highlight stable prescribing patterns and the need for individualized long-term strategies in the management of adult patients with DEEs.
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