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T. A. GLAUSER ET AL.
neurologic examinations, and laboratory studies, including an ECG). Patients were allowed the option to continue LEV therapy in a long-term safety follow-up trial.
Data analysis
The primary efficacy outcome variable was the 50%
responder rate (i.e., the percentage of patients achieving
a 50% reduction in seizure frequency during the evaluation period as compared with baseline). Secondary efficacy variables included (a) the percentage of patients
achieving a 75% reduction in seizure frequency during
the evaluation period as compared with baseline, (b) the
number of seizure-free patients during the evaluation
phase, (c) the change from baseline in seizure frequency
per week observed with LEV treatment, and (d) the number of patients on each dose.
Safety assessments included evaluation of adverse
events, physical and neurologic examination findings,
and laboratory test results, including blood chemistry,
hematology, and urinalysis. The nature, pattern, and severity of all adverse events were recorded at each visit,
and the relation of each adverse event to LEV therapy
was evaluated by the investigator.
RESULTS
Twenty-five patients entered the baseline phase, but
one patient failed to continue to satisfy inclusion criteria
during baseline and withdrew before receiving LEV
(Fig. 2) The remaining 24 children composed the study
population. The group was predominantly male (62.5%,
15 of 24) and white (87.5%, 21 of 24), with a mean age
of 9.4 2.2 years. The etiologies of the groups epilepsy
were varied and included unknown etiology in 14 (58%)
patients, congenital brain malformation in six (25%)
children, tuberous sclerosis in two (8%) patients, a history of cerebral infection in two (8%) children, and individual cases of stroke and diphtheria/pertussis/tetanus
interaction (4%). Two patients had multiple etiologies
identified for their epilepsy. Additional demographic and
clinical characteristics of these patients are presented in
Table 1. The study populations concomitant AEDs during baseline are listed in Table 2.
One patient withdrew during the titration phase because of lack of efficacy. The 23 patients entering the
evaluation phase composed the evaluable efficacy data
set. One patient withdrew from the evaluation phase because of an increase in seizure frequency. Overall 22
(91.7%) of the 24 patients who entered the titration phase
completed the study and elected to continue LEV in a
follow-up safety trial.
Efficacy analysis
In the evaluable patient population (i.e., those patients
completing titration and entering the evaluation phase),
12 (52.2%) of 23 patients showed a 50% reduction in
seizure frequency per week during the evaluation phase
compared with the baseline phase. A 75% reduction
was seen in five (21.7%) of 23 patients. Two patients
remained seizure free throughout the evaluation period.
The mean and median percentage reduction in seizure
frequency per week for all partial-onset seizures and
specific partial-onset seizure subtypes is shown in Table 3.
Each patients change in seizure frequency during the
evaluation phase relative to baseline is shown in Table 4.
An increase in total seizure frequency from baseline was
observed in four patients. One patient experienced an
increase from 133.0 seizures per week during baseline to
149.2 seizures per week during evaluation; a second patient experienced an increase from 2.2 seizures per week
during baseline to 8.1 seizures per week during evaluation (268% increase); and a third patient experienced an
TABLE 1. Demographic and clinical characteristics
at baseline
Characteristic
Type of seizure
Simple partial
Complex partial
Partial secondarily generalized
Mean SD (median) and range of age at
study entry, in years
FIG. 2.
N 24
7 (29.2%)
20 (83.3%)
8 (33.3%)
9.4 2.2 (median,
10) Range, 5.6 to
12.6
3.4 3.6 (median,
2.0) Range, 0 to 11
6.0 3.2 (median, 7)
Range, 1 to 12
19.2 28.0 (median,
9.9) Range, 0.5 to
133.0
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Antiepileptic medication
N 24
Carbamazepine, immediate or
extended-release formulation
Lamotrigine
Valproic acid or Divalproex sodium
Topiramate
Felbamate
Gabapentin
Primidone
6 (25%)
6 (25%)
5 (20.8%)
4 (16.7%)
1 (4.2%)
1 (4.2%)
1 (4.2%)
Mean %
reduction
Median %
reduction
29.8%
22.1%
13.5%
45.9%
53.0%
26.4%
46.9%
64.0%
23
7
19
8
24.5
0.5
10.3
0.9
16.3
1.6
29.8
9.7
29.4
4.2
39.8
26.4
56.8
4.2
3.2
9.5
10.2
7.7
8.4
133.0
16.9
1.0
2.2
0.0
0.0
0.4
0.1
1.9
0.4
8.8
3.6
11.2
1.8
18.7
12.4
31.0
2.6
2.2
6.8
8.4
6.4
8.2
149.2
20.0
2.0
8.1
100%
100%
96%
89%
88%
75%
70%
63%
62%
57%
53%
53%
45%
38%
31%
28%
18%
17%
2%
12%
18%
100%
268%
18.6/7.1
37.9/11.4
39.2/16.0
18.4/4.1
35.1/4.9
42.0/13.5
33.3/17.4
40.0/17.6
40.8/10.7
43.6/9.9
39.4/9.7
46.5/11.9
33.4/4.5
36.8/6.4
38.8/7.1
34.2/10.2
20.7/5.3
41.6/32.5
41.1/16.1
12.8/3.1
18.1/5.1
65.2/46.1
40.6/13.2
a
Patient 15 withdrew early (day 70) because of an adverse event.
Patient 24 withdrew before the evaluation phase and is not included in
this table.
b
Dose varied according to body weight at study entry.
c
Predose plasma concentrations on day 98, except for patient 15
(day 42).
AED
Carbamazepine (n 6)
Felbamate (n 1)
Gabapentin (n 1)
Lamotrigine (n 6)
Primidone (n 1)
Topiramate (n 4)
Valproic acid (n 5)
or Divalproex sodium
Patient
no.
Before LEV
7
14
15
16
19
22
5a
17
8a
10a
12
18
20
21
11a
3a
6a
9a
13a
8.5
8.8
11.4
12.2
11.9
10.5
110
4.6
4.1
9.4
5.9
8.4
17.0
13.0
9.8
31.1
29.9
26.8
12.8
9.9
10.8
11.1
10.5
8.9
12.4
110
8.6
2.0
1.7
4.9
7.0
13.0
11.0
<2.0
19.6
12.7
12.2
9.4
1
2a
4
24
23
124.6
149.0
132.6
97.6
108.0
126.3
111.5
99.4
87.5
95.1
a
Patients with adverse events leading to dosage reductions (see
Table 6).
522
T. A. GLAUSER ET AL.
Topiramate
Lamotrigine
Divalproex sodium
Felbamate
Primidone
1
1
1
Incidence
[n (%)]
8
8
6
6
5
5
5
4
4
3
3
3
3
3
3
(33.3)
(33.3)
(25.0)
(25.0)
(20.8)
(20.8)
(20.8)
(16.7)
(16.7)
(12.5)
(12.5)
(12.5)
(12.5)
(12.5)
(12.5)
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T. A. GLAUSER ET AL.