Abstract
PurposeEpilepsy in multiple sclerosis (MS) is rare, and longitudinal clinical studies evaluating treatment with antiseizure medications (ASMs) are difficult to conduct. We instead designed a nationwide register study to estimate retention rates of ASMs prescribed as initial monotherapy for epilepsy in MS and investigated factors influencing their retention. Methodsmultiple sclerosis patients with a first prescription of ASM for epilepsy were identified by cross-referencing the Swedish MS register with comprehensive national registers. One and five-year retention rates of ASMs were estimated using Kaplan–Meier analysis. Cox proportional regression was employed to estimate hazard ratios (HR) of discontinuation for different ASMs as well as for baseline predictors. Results: One hundred and twenty-nine MS patients were included. The most commonly prescribed ASMs were: carbamazepine (n = 38, 29.5%), lamotrigine (n = 33, 25.6%) and levetiracetam (n = 19, 14.7%). One-year retention rates (95% CI) were: lamotrigine 87.5% [76, 98.9], carbamazepine 60.5% [45, 76], levetiracetam 60.2% [37.2, 83.2], valproate 51.3% [23, 79.6] and phenytoin 44.4% [11.8, 77]. Fiveyear retention rates (95% CI) were: lamotrigine 74.4% [57.3, 91.5], carbamazepine 52.2% [34.9, 69.4], valproate 51.3% [23.1, 79.5] and phenytoin 14.8% [0, 40.9]. With carbamazepine as reference, lamotrigine was the only ASM that displayed a lower hazard of discontinuation, HR 0.41 [0.17, 0.99]. We could not identify any baseline factors that influenced the risk of discontinuation. ConclusionLamotrigine displayed the lowest risk of discontinuation when prescribed as initial monotherapy for epilepsy in MS. Newer ASMs generally compared well to older ones, at least suggesting non-inferiority.
Highlights
Multiple sclerosis (MS) is a severe demyelinating disease of the central nervous system
In a recent Swedish study using patient records, a trend of higher retention rates was noted for newer Antiseizure medication (ASM) used for epilepsy in MS compared to older ones, the differences were not statistically significant
We included a total of 129 patients with MS and epilepsy (Fig. 1)
Summary
Multiple sclerosis (MS) is a severe demyelinating disease of the central nervous system. Sometimes it is complicated by epileptic seizures, and the prevalence of epilepsy in MS has been estimated to be 3% [1]. Registers can provide an alternative to clinical studies and have been used previously to estimate retention rates of ASMs [8]. In a recent Swedish study using patient records, a trend of higher retention rates was noted for newer ASMs used for epilepsy in MS compared to older ones, the differences were not statistically significant. We used nationwide Swedish registers to test the hypothesis that newer ASMs have higher retention rates than older ASMs when prescribed as initial monotherapy in MS. We aimed to investigate baseline factors that could predict discontinuation of the initial ASM
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
