Retention of antiseizure medications for epilepsy in multiple sclerosis: A retrospective observational study

Multiple sclerosis and epilepsy

Epilepsy is a notable comorbidity in multiple sclerosis (MS), with a prevalence significantly higher than in the general population. This co-occurrence suggests shared pathophysiological mechanisms, including cortical demyelination, chronic inflammation and neurodegeneration, which predispose MS patients to seizures. Advanced imaging studies highlight the role of cortical lesions and atrophy in epileptogenesis, while inflammatory processes further lower the seizure threshold. Additionally, MS-associated network dysfunction disrupts normal neural activity, contributing to seizure susceptibility. This review synthesizes epidemiological, neuroimaging, and clinical evidence to elucidate the complex relationship between epilepsy and MS. It emphasizes the importance of personalized care and the need for further research to refine treatment protocols, improve outcomes, and enhance the quality of life for this unique patient population.

Potential for improved retention rate by personalized antiseizure medication selection: A register-based analysis

OBJECTIVE

The first antiseizure medication (ASM) is ineffective or intolerable in 50% of epilepsy cases. Selection between more than 25 available ASMs is guided by epilepsy factors, but also age and comorbidities. Randomized evidence for particular patient subgroups is seldom available. We asked whether register data could be used for retention rate calculations based on demographics, comorbidities, and ASM history, and quantified the potential improvement in retention rates of the first ASM in several large epilepsy cohorts. We also describe retention rates in patients with epilepsy after traumatic brain injury and dementia, patient groups with little available evidence.

METHODS

We used medical, demographic, and drug prescription data from epilepsy cohorts from comprehensive Swedish registers, containing 6380 observations. By analyzing 381 840 prescriptions, we studied retention rates of first- and second-line ASMs for patients with epilepsy in multiple sclerosis (MS), brain infection, dementia, traumatic brain injury, or stroke. The rank of retention rates of ASMs was validated by comparison to published randomized control trials. We identified the optimal stratification for each brain disease, and quantified the potential improvement if all patients had received the optimal ASM.

RESULTS

Using optimal stratification for each brain disease, the potential improvement in retention rate (percentage points) was MS, 20%; brain infection, 21%; dementia, 14%; trauma, 21%; and stroke, 14%. In epilepsy after trauma, levetiracetam had the highest retention rate at 80% (95% confidence interval [CI] = 65-89), exceeding that of the most commonly prescribed ASM, carbamazepine (p = .04). In epilepsy after dementia, lamotrigine (77%, 95% CI = 68-84) and levetiracetam (74%, 95% CI = 68-79) had higher retention rates than carbamazepine (p = .006 and p = .01, respectively).

SIGNIFICANCE

We conclude that personalized ASM selection could improve retention rates and that national registers have potential as big data sources for personalized medicine in epilepsy.