Table of Contents:
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
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.