Abstract
Approximately 70–80% of patients with epilepsy will become seizure free with presently available AEDs, and over half of these will be able to stop treatment successfully [1]. The remainder have epilepsy that is resistant to present antiepileptic medication, and less than 5% of such patients are suitable for curative epilepsy surgery. Recently launched AEDs, which are initially licensed for use in this refractory group, have had little impact, rendering fewer than 5% of this group seizure free [2,3]. Thus effective novel AEDs are still required for treatment of those with refractory epilepsy. Most of these patients have partial epilepsy, as the generalised epilepsies respond better to current AED treatment.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Sander JW. Some aspects of prognosis in the epilepsies: a review. Epilepsia 1993; 34: 1007–1016.
Wong IC, Chadwick DW, Fenwick PB, Mawer GE, Sander JW. The long-term use of gabapentin, lamotrigine and vigabatrin in patients with chronic epilepsy. Epilepsia 1999; 40: 1439–1445.
Walker MC, Sander JWAS. The impact of new antiepileptic drugs on the prognosis of epilepsy: seizure freedom should be the ultimate goal. Neurology 1996; 46: 912–914.
Mattson RH, Cramer JA, Collins JF, et al. Comparison of carbamazepine, phenobarbital, phenytoin and primidone in partial and secondary generalised tonic-clonic seizures. N Engl J Med 1985; 313: 145–151.
Walker MC, Sander JWAS. Overtreatment with antiepileptic drugs: how extensive is the problem? CNS Drugs 1994; 2: 335–340.
Walker MC, Patsalos PN. Clinical pharmacokinetics of new antiepileptic drugs. Pharmacol Ther 1995; 67: 351–384.
Shorvon SD, Johnson AL, Reynolds EH. Statistical and theoretical considerations in the design of anticonvulsant trials. In: Dam L, Gram L, Penry JK, editors. Advances in epileptology XIIth Epilepsy International Symposium. New York: Raven Press, 123–128.
Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 1981; 22: 289–501.
Elwes RDL, Johnson AL, Shorvon SD, Reynolds EH. The prognosis for seizure control in newly diagnosed epilepsy. N Engl J Med 1984; 311: 944–947.
Brodie MJ, Richens A, Yuen AWC. Double-blind comparison of lamotrigine and carbamazepine in newly diagnosed epilepsy. Lancet 1995; 345: 476–479.
Cockerell OC, Hart YM, Sander JWAS, Shorvon SD. The cost of epilepsy in the United Kingdom: an estimation based on the result of two population-based studies. Epilepsy Res 1994; 18: 244–260.
Reynolds EH, Shorvon SD. Monotherapy or polytherapy for epilepsy? Epilepsia 1981; 22: 1–10.
Chadwick D. Gabapentin: clinical use. In: Levy RH, Mattson RH, Meldrum BS, editors. Antiepileptic drugs, 4th edition. New York: Raven Press, 1995: 851–856.
Sachdeo R, Kramer LD, Rosenberg A, Sachdeo S. Felbamate monotherapy: controlled trial in patients with partial onset seizures. Ann Neurol 1992; 32: 386–392.
Faught E, Sachdeo RC, Remler MP, et al. Felbamate monotherapy for partial-onset seizures: an active-control trial. Neurology 1993; 43: 688–692.
Chadwick DW, Anhut H, Greiner MJ et al. A double-blind trial of gabapentin monotherapy for new diagnosed partial seizures. Neurology 1998; 51: 1282–1288.
Grant SM, Heel RC. Vigabatrin: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in epilepsy and disorders of motor control. Drugs 1991; 41: 889–926.
Richens A, Chadwick DW, Duncan JS, et al. Adjunctive treatment of partial seizures with tiagabine: a placebo-controlled trial. Epilepsy Res 1995; 21: 37–42.
Bourgeois B, Leppik IE, Sackellares JC, et al. Felbamate: a double-blind controlled trial in patients undergoing presurgical evaluation of partial seizures. Neurology 1993; 43: 693–696.
Anonymous. Gabapentin in partial epilepsy. UK Gabapentin Study Group. Lancet 1990; 335: 1114–1117.
Blum DE, Eskola J, Bortz JJ, Fisher RS. Patient awareness of seizures. Neurology 1996; 47: 260–264.
Anonymous. Efficacy of felbamate in childhood epileptic encephalopathy (Lennox-Gastaut syndrome). The Felbamate Study Group in Lennox-Gastaut Syndrome [see comments]. N Engl J Med 1993; 328: 29–33.
Vickrey BG, Hays RD, Engel J, et al. Outcome assessment for epilepsy surgery: the impact of measuring health-related quality of life. Ann Neurol 1995; 37: 158–166.
Walker MC, Sander JWAS. Topiramate: a new antiepileptic drug for refractory epilepsy. Seizure 1996; 5: 199–203.
Cramer JA. A clinimetric approach to assessing quality of life in epilepsy. Epilepsia 1993; 34 (Suppl 4): S8 - S13.
Ojemann LM, Wilensky AJ, Temkin NR, Chmelir T, Ricker BA, Wallace J. Long-term treatment with gabapentin for partial epilepsy. Epilepsy Res 1992; 13: 159–165.
Baker GA, Smith DF, Dewey M, Morrow J, Crawford PM, Chadwick DW. The development of a seizure severity scale as an outcome measure in epilepsy. Epilepsy Res 1991; 8: 245–251.
O’Donoghue MF, Duncan JS, Sander JW. The National Hospital Seizure Severity Scale: a further development of the Chalfont Seizure Severity Scale. Epilepsia 1996; 37: 563–571.
Vickrey BG, Hays RD, Rausch R, et al. Outcomes in 248 patients who had diagnostic evaluations for epilepsy surgery. Lancet 1995; 346: 1445–1449.
Smith D, Baker G, Davies G, Dewey M, Chadwick DW. Outcomes of add-on treatment with lamotrigine in partial epilepsy. Epilepsia 1993; 34: 312–322.
Marson AG, Kadir ZA, Chadwick DW. New antiepileptic drugs: a systematic review of their efficacy and tolerability. BMJ 1996; 313: 1169–1174.
Walker MC, Li LM, Sander JW. Long term use of lamotrigine and vigabatrin in severe refractory epilepsy: audit of outcome. BMJ 1996; 313: 1184–1185.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2001 Springer-Verlag London
About this chapter
Cite this chapter
Walker, M.C., Sander, J.W., Shorvon, S.D. (2001). Epilepsy: Ethics, Outcome Variables and Clinical Scales. In: Guiloff, R.J. (eds) Clinical Trials in Neurology. Springer, London. https://doi.org/10.1007/978-1-4471-3787-0_20
Download citation
DOI: https://doi.org/10.1007/978-1-4471-3787-0_20
Publisher Name: Springer, London
Print ISBN: 978-1-84996-856-0
Online ISBN: 978-1-4471-3787-0
eBook Packages: Springer Book Archive