About one-third of people with focal epilepsy do not respond well to available treatments, but a recent study led by NYU Langone Health suggests that many of these patients may experience improvement over time. The research was part of the international Human Epilepsy Project and focused on individuals considered treatment resistant—those who continue to have seizures after trying at least four different medications.
Researchers monitored nearly 150 treatment-resistant adults for up to three years. The results showed that almost 70 percent of participants had fewer seizures during the study period. According to lead author Ojas Potnis, MD, a resident in the Department of Neurology at the NYU Grossman School of Medicine, “Our findings challenge the assumption that once a patient with focal epilepsy has failed a certain number of anti-seizure drugs, their chances of finding relief are small and not worth the effort.”
Although complete seizure freedom was rare, longer periods between episodes were observed. Nearly 13 percent went at least three months without a seizure, about 8 percent were seizure-free for six months or more, and 3 percent experienced no seizures for at least a year. Dr. Potnis noted that these percentages are higher than those reported in earlier studies, which followed patients for shorter periods.
The study was published online on October 20 in JAMA Neurology and is the second report from the Human Epilepsy Project. A previous investigation found that even people who eventually respond well to medication often continue having seizures for at least a year before an effective drug and dose are identified.
Ten epilepsy centers across the United States participated in this study from 2018 to 2021. Patients kept electronic diaries tracking daily seizure activity and recorded information about their medications and other treatments such as surgery or neuromodulation devices.
Data showed that taking new anti-seizure medications contributed to improvements; more than half of those with reduced seizures started a new drug during the study. The number of previously failed medications did not affect the likelihood of improvement.
“These results offer hope that focal epilepsy will get better over time for most people,” said co-senior author Jacqueline A. French, MD, professor in the Department of Neurology at NYU Grossman School of Medicine and co-principal investigator of the Human Epilepsy Project. “Healthcare providers should keep searching for the best treatment regimen for their patients no matter how many therapies they may need to try.” Dr. French also cautioned that it remains unclear whether improvement comes from ongoing management or natural changes in treatment-resistant epilepsy.
The next phase of research will focus on generalized epilepsy, which affects about one-quarter of people with epilepsy.
Funding for this work came from UCB, Neurelis, and SK Life Science. Co-senior authors included Ruben Kuzniecky, MD (Northwell Health), and Daniel Lowenstein, MD (University of California, San Francisco). Other contributors represented institutions such as University of Notre Dame, Johns Hopkins Hospital, Epilepsy Foundation (Maryland), University of Alabama at Birmingham, and Yale University.
Dr. French disclosed financial relationships with several pharmaceutical companies and organizations related to her research activities; all relationships are managed according to NYU Langone Health policies.
NYU Langone Health is recognized nationally for its clinical outcomes and quality standards. Vizient Inc. has ranked it No. 1 among comprehensive academic medical centers nationwide for four consecutive years; U.S. News & World Report recently named four NYU Langone specialties as best in the country. The health system operates seven inpatient locations along with outpatient sites in New York and Florida; it includes two tuition-free medical schools and supports significant research initiatives.
