Authors :
Presenting Author: L. Jimena Gómez-Rodríguez, MD – National Institute of Neurology and Neurosurgery
Mario A. Sebastián-Díaz, MD; MSc; PhD – Posgraduate Division – Posgraduate Division Anahuac University, Mexico State, Mexico; Diego A. Barrios-González, MD – Investigation Intership, Epilepsy Clinic, National Institute of Neurology and Neurosurgery; Michele L. Breda-Yepes, MD – Posgraduate Division – Posgraduate Division National Autonomous University of Mexico, Mexico; Elma M. Paredes-Aragón, MD – Epilepsy Clinic – National Institute of Neurology and Neurosurgery; Karen E. Guzmán-Sánchez, MD – Neurohpysiology Fellow, Neurophysiology Department, ABC Medical Center, Mexico city, Mexico; Fernando Sotelo-Díaz, MD – Epilepsy Clinic – National Institute of Neurology and Neurosurgery; Daniel A. Martínez-Piña, MD – National Institute of Neurology and Neurosurgery; Iracema Santizo-Nanduca, MD – Fellow, Epilepsy Clinic, National Institute of Neurology and Neurosurgery; Gissel A. Torrez-Lazcano, MD – Fellow, Epilepsy Clinic, National Institute of Neurology and Neurosurgery; Carlos D. Pérez-Baldioceda, MD – Fellow, Epilepsy Clinic, National Institute of Neurology and Neurosurgery; Juan C. Reséndiz-Aparicio, MD – National Institute of Neurology and Neurosurgery; Iris E. Martínez-Juárez*, MD; MSc; cPhD – Head of Epilepsy Clinic, Epilepsy Clinic, National Institute of Neurology and Neurosurgery
Rationale:
Over 70 million people worldwide have epilepsy. In Mexico, there is a prevalence over 10.8 to 20 cases per thousand.
The main objective of treatment is to have an early cessation of seizures once the patient has been diagnosed, while avoiding adverse effects that could diminish the quality of life. The first line of treatment, for most patients, consists of antiseizure drugs (ASD).
Until 1990, there were six ASD which were called “First Generation” ASD and included: Phenytoin (PTH), Phenobarbital (PB), Primidone (PRM), Carbamazepine (CBZ), Valproate (VPA) and Benzodiazepines (BZD).
New ASDs have been introduced in the market that were called “Second Generation'' ASDs, including: Levetiracetam (LEV), Lamotrigine (LTG), Oxcarbazepine (OXC), Topiramate (TPM). Also, “Third Generation” ASDs were introduced: Lacosamide (LCS), Brivaracetam (BRV) and Eslicarbazepine (ECBZ).
In 2012, Martínez-Juárez et al. described that the most prescribed ASD at the National Neurology and Neurosurgery Institute “Manuel Velasco Suárez'' (NINNMVS) in mono and polytherapy were VPA, CBZ, and PHT. 1
In 2020, the Epilepsy Prioritary Program (EPP) initiated the National Registry of Patients with Epilepsy all over Mexico. NNNIMVS participated in that project, which led to the obtention of sociodemographic and clinical data of patients attended at the Epilepsy Clinic at NNNIMVS.
The following study describes the use of new generation ASD versus traditional ones according to the National Registry of Patients with Epilepsy.
References:
1 Martínez-Juárez, Iris E., et al.
Methods:
An analytic, observational, ambispective cohort study was conducted rom 2020 through June 2023. A non-probabilistic sampling was realized by convenience, including patients that were attended at the Epilepsy Clinic. The data was obtained from medical records and from electronic records and captured in REDCAP ® and analyzed in SPSSV21. ® This research protocol was approved by the NNNIMVS Ethics and Research Comittees.
Results:
The National Registry of the EPP included 5,000 patients. From NNNIMVS, 500 patients (10%) were included. A total of 287 were female (57.4%). Mean age was 36.14 years 15 to 80 years. A total of 360 (72%) patients had focal seizures and 127 (25.4%) had generalized seizures. A total of 12 (2.4%) had an unknown onset.
Of a total of 1,056 prescriptions, 483 prescriptions were second Generation ASD, including: LEV 256 (24.24%), LTG 140 (13.25%), OXC 32 (3.03%), Pregabaline (PGB) 10 (0.94%), TPM 41 (3.88%), Rufinamide (RUF) 2 ( 0.18%), Vigabatrin (VGB), and Zonisamide (ZNS) 1 (0.09%). A total of 133 prescriptions of Third Generation ASDs: 6 (0.56%) of BRV, 52 (4.92%) of Clobazam (CLB), 71 (6.72%) of LCM, and 4 of Perampanel 4 (0.37%).
In contrast, there were 440 prescriptions of First Generation ASDs: Acetazolamide (ACZ) 4 (0.37%), CBZ 121 (11.45%), PB 4 (0.37%) , Clonazepam (CZP) 65 (6.15%), PHT 26 (2.46%), Primidone (PRM) 15 (1.42%), an VPA 205 (19.41%).
Conclusions:
At present the NNNIMVS prescribes Second and Third Generation ASDs in majority. This evidence shows a change in trends in prescriptions between 2012 (7) and 2023 in the same population with LEV, VPA, and LTG as the most prescribed ASD.
Funding: None