NEWLY DIAGNOSED EPILEPSY Treatment response in mesial temporal lobe epilepsy with hippocampal atrophy (N=14; 2.5% population) Non-responders (42%) Remission (50%) Immediate responders (21%) Relapse (7%) Mohanraj R, Brodie MJ. Seizure 2005;14: Responders (57%)

NEWLY DIAGNOSED EPILEPSY Bromide Phenobarbital Phenytoin Primidone Ethosuximide Sodium Valproate Benzodiazepines Carbamazepine Calendar year Antiepileptic drugs Vigabatrin Zonisamide Lamotrigine Felbamate Gabapentin Topiramate Fosphenytoin Oxcarbazepine Tiagabine Levetiracetam Pregabalin Stiripentol Rufinamide Lacosamide

NEWLY DIAGNOSED EPILEPSY There is no reliable evidence to suggest any difference in efficacy between carbamazepine and phenytoin carbamazepine and valproate phenytoin and valproate phenobarbital and carbamazepine phenobarbital and phenytoin for partial or generalized tonic-clonic seizures THE COCHRANE LIBRARY

Lamotrigine versus Carbamazepine (3), Gabapentin (2), Phenytoin Oxcarbazepine versus Phenytoin (2), Carbamazepine, Valproate Vigabatrin versus Carbamazepine Gabapentin versus *Carbamazepine (2), Lamotrigine Topiramate versus *Carbamazepine, *Valproate Levetiracetam versus Controlled-release carbamazepine * fixed doses NEWLY DIAGNOSED EPILEPSY Randomized, head-to-head, double-blind trials with modern antiepileptic drugs (N = 18)

NEWLY DIAGNOSED EPILEPSY Drug choice As there are no major differences in efficacy among first-line antiepileptic drugs, tolerability and longterm safety must be the paramount consideration in patients with often mild newly diagnosed epilepsy Kwan P, Brodie MJ. Neurology 2003; 60 (suppl 4): S2-S12

Efficacy Tolerability EFFECTIVENESS The sum of two parts

NEWLY DIAGNOSED EPILEPSY Observations from the Glasgow database 1098 adolescent and adult patients starting on their first antiepileptic drug between 1982 and 2005 and follow-up for at least 2 years

NEWLY DIAGNOSED EPILEPSY Response rates (%) in an expanding cohort Recruitment n One AED Combination Total Kwan P, Brodie MJ. N Engl J Med 2000; 342: Mohanraj R, Brodie MJ. Eur J Neurol 2006; 13: Bamagous G, Kwan P, Brodie MJ, in preparation

NEWLY DIAGNOSED EPILEPSY Successful combinations* 2 AEDs67 3 AEDs 2 4 AEDs 1 Total70 *Seizure free for at least the previous year

FONDE STUDY F ollowing O utcomes in N ewly D iagnosed Epilepsy A prospective observational study of the pharmacological and lifestyle consequences of newly diagnosed epilepsy

FONDE STUDY Objectives To monitor pharmacological and social outcomes  over a prolonged period under conditions of care that mirror everyday clinical practice  in relation to a variety of clinical, investigational and environmental prognostic factors  across a range of clinical settings from general neurology to specialist epilepsy services

FONDE STUDY All information at study visits will be entered into an electronic case record form and submitted to the Central Data Management Centre in Milan Separate data entry for children and adults Dina Battino data manager Marco DeZordo system designer Patrick Kwan webmaster John Norrie statistician Martin Brodie principal investigator