Many things in medicine have changed for the better in medicine over the last 30 years. Some “innovations” have resulted in unintended consequences and costs, and, unfortunately, a few have ultimately proven harmful.
And then some just haven’t changed.
This rather depressing look at anti-epileptic therapy comes from an observational cohort in Scotland, monitoring the various outcomes and seizure frequencies in epilepsy over the last thirty years. There has been an explosion of new options for control of epilepsy – at no small cost – and, one would hope newer would be better.
After following changes in therapy and outcomes in 1,795 patients across 30 years, starting in 1982, the unfortunate conclusion is: little improvement. Starting from an era of primarily carbamazepine, phenytoin and valproic acid, despite the addition of a wide variety of modern options, the proportion of patients with 1-year seizure freedom has not changed. The primary driver of this observation appears to be little change in successful control of refractory epilepsy, in which patients failing to be controlled on their initial agent – about half – remain difficult to control, regardless of changes or additions to therapy.
I would not go so far as to say no benefit is derived from newer agents, as this study does not delve into safety profiles, adverse effects, and other reasons for discontinuation. I suspect, unfortunately however, this generally mirrors results from across the practice of medicine – where expectations and perceptions of efficacy do not match reality.
“Treatment Outcomes in Patients with Newly Diagnosed Epilepsy Treated With Established and New Antiepileptic Drugs A 30-Year Longitudinal Cohort Study”