Prädiktoren für Lebensqualität und Anfallsrezidive in derinitialen Monotherapie der Epilepsien - Ein Vergleich zwischen den Antikonvulsiva Lamotrigin und Levetiracetam

The analysis is based on the first study comparing the efficacy of the anticonvulsants lamotrigine and levetiracetam in the initial monotherapy of epilepsy. Both medications showed no significant differences in seizure recurrence and quality of life during the first 26 weeks of initial monotherapy. The analyses of predictors of seizure recurrence and quality of life showed following results: A: The strongest predictor of seizure recurrence is the initial number of seizures. We confirmed previous study results and thus identified an easy scorable variable for the daily medical practice. Surprisingly, a positive family family history of epilepsy was predictive of seizure recurrence and should be taken into account in further studies. A relevant and important result of our study is that medical treatment after a first seizure and additional relevant risk factors is justified. These risk factors are focal seizure semiology, epileptogenic lesion in the MRI or focal pathological EEG and were described in the literature previously. B: We saw a global improvement of quality of life during the first 26 weeks of initial monotherapy, the end of the study. Seizure recurrence was independent from the point in time the strongest predictor for a lower quality of life in epilepsy patients. Temporary effects on quality of life were shown for status of epilepsy diagnosis (first seizure vs. more than one seizure), co-morbidities and side effects of anticonvulsants during the study. At the beginning of therapy seizure worry and medication effects were the most relevant subscales for the patients. This differs from previously published results and should be validated in following trials. Further prospective randomized trials are necessary to investigate the better efficacy of levetiracetam to lamotrigine in patients with only one seizure before treatment. The focus of these investigations should be on possible differences in epileptogenesis and predisposing factors in these patients.