From the Guidelines
Focal epilepsy should be initially treated with antiepileptic medications, with approximately 60-70% of patients achieving seizure control, and for drug-resistant cases, surgical options or other interventions may be considered. Treatment typically starts with medications such as carbamazepine (200-1200 mg/day), lamotrigine (25-600 mg/day), levetiracetam (1000-3000 mg/day), or lacosamide (100-400 mg/day) 1. Medication selection depends on seizure type, patient age, gender, comorbidities, and potential side effects. According to the European Journal of Nuclear Medicine and Molecular Imaging, pharmacotherapy with antiseizure medications (ASMs) is the initial treatment of choice for the vast majority of patients with epilepsy 1.
Key Considerations
- Approximately 30% of patients with focal epilepsy do not respond to two ASMs and are considered drug-resistant 1.
- For drug-resistant focal epilepsy, surgical options like resection of the seizure focus, responsive neurostimulation, vagus nerve stimulation, or deep brain stimulation may be considered 1.
- Patients should avoid seizure triggers like sleep deprivation, alcohol, and stress, and should not drive until seizure-free for a period determined by local regulations (typically 6-12 months).
- Regular follow-up with a neurologist is essential to monitor medication effectiveness and side effects.
Diagnostic Approaches
- MRI is the first imaging investigation for patients with focal epilepsy, enabling the clinician to decide if there is a structural aetiology for the patient’s epilepsy 1.
- Molecular neuroimaging with interictal [18 F]fluorodeoxyglucose ([18 F] FDG) positron emission tomography (PET), ictal perfusion SPECT, or ictal subtraction perfusion SPECT may be useful in localizing the seizure onset for a tailored resection 1.
Management
- The development of molecular neuroimaging has influenced and impacted the presurgical management of epilepsy patients, not only for the investigation of non-lesional, but also lesional epilepsy regarding postsurgical seizure outcome 1.
- Beside scalp video/EEG telemetry, structural MRI, neuropsychological and neuropsychiatric assessment, Wada test, functional MRI, NM imaging procedures, and intracranial EEG electrodes are of additional value depending on the epilepsy type 1.
From the FDA Drug Label
Levetiracetam is indicated as adjunctive treatment of partial onset seizures in adults and children 4 years of age and older with epilepsy. The answer is: Focal epilepsy is also known as partial onset seizures, levetiracetam is indicated as adjunctive treatment for this condition in adults and children 4 years of age and older with epilepsy 2.
- Key points:
- Indicated for adjunctive treatment of partial onset seizures
- Approved for adults and children 4 years of age and older with epilepsy
- Dosage: Treatment should be initiated with a daily dose of 1000 mg/day for adults, and 20 mg/kg in 2 divided doses for pediatric patients.
From the Research
Focal Epilepsy Treatment Options
- Focal epilepsy is a type of epilepsy characterized by seizures that originate in one area of the brain 3, 4, 5, 6, 7
- Several antiepileptic drugs are available for the treatment of focal epilepsy, including lamotrigine, levetiracetam, zonisamide, and oxcarbazepine 3, 4, 5, 6, 7
Efficacy of Antiepileptic Drugs
- Lamotrigine has been shown to be effective in treating focal epilepsy, with a higher seizure-free rate compared to other drugs such as oxcarbazepine 3, 4, 7
- Levetiracetam has also been found to be effective, with a similar seizure-free rate to lamotrigine 3, 4, 5, 7
- Zonisamide has been shown to be effective in treating focal epilepsy, particularly in patients with a high risk of non-compliance 6
- Oxcarbazepine has been found to have a lower seizure-free rate compared to lamotrigine and levetiracetam 7
Safety and Tolerability
- Levetiracetam has been found to have milder adverse events compared to oxcarbazepine and lamotrigine 7
- Zonisamide has been shown to have a low interaction potential, making it a safe option for elderly patients and those with a high risk of non-compliance 6
- Lamotrigine has been found to have a higher risk of adverse events, such as drowsiness and headache, compared to levetiracetam 3, 4
Treatment Recommendations
- Lamotrigine and levetiracetam are recommended as first-line treatments for focal epilepsy due to their high efficacy and relatively good safety profiles 3, 4, 7
- Zonisamide may be considered as a first-line treatment option for patients with a high risk of non-compliance or those who require a once-daily dosing regimen 6
- Oxcarbazepine may be considered as an alternative treatment option, but its lower efficacy and higher risk of adverse events should be taken into account 7