Relative importance of clinical outcomes and safety risks of antiseizure medication monotherapy for patients and physicians: Discrete choice experiment eliciting preferences in real-world study "VOTE"
Rosenow F., et al. 2021
Presented by Dr. Marco Perulli
4:19 - Study Aim and Scope: The study aimed to explore patient preferences and the trade-offs between treatment efficacy and side effects, involving patients from various European countries using a discrete choice experiment.
5:48 - Study Design and Methodology: The study design included a discrete choice experiment with 12 questions to assess patient preferences and compared patient views with those of physicians.
8:32 - Participant Baseline Characteristics: Baseline characteristics showed most participants were in their 40s with a history of epilepsy, having used medications like levetiracetam and lamotrigine.
9:42 - Patient and Physician Preferences: Results indicated both patients and physicians prioritized seizure freedom, but physicians placed more emphasis on efficacy and personality changes.
11:35 - Influence of Consultation on Preferences: There was no significant change in patient preferences before and after consultation, though patients felt strongly influenced by their doctors.
13:03 - Role of Physicians and Future Research: The study highlighted the role of physicians in presenting treatment options and assessing efficacy and side effects, suggesting areas for future research.
Discussion
3:06 - Parental Concerns About Side Effects: Parents of pediatric patients are particularly concerned about side effects like sleepiness. It's important to explain that sedation is usually temporary and medications are introduced slowly to minimize side effects.
5:53 - Childbearing Potential and Medication Choices: Considering childbearing potential when prescribing medications to female patients is crucial.
9:39 - Efficacy and Cost Considerations in the UK: In the UK, the choice of second-line medications is influenced by both efficacy and cost, with availability varying by region. Doctors provide patients with information on the efficacy of different options.
12:01 - Balancing Efficacy and Tolerability: Initially, tolerability is prioritized when prescribing the first drug, but as patients move to second or third-line treatments, efficacy becomes more important. The approach may vary based on the natural history of the patient's epilepsy.
14:50 - Listening to Patients' Concerns: Listening to patients and asking about adverse effects is important, as patients might endure significant side effects without reporting them due to fear of losing seizure control.
Epilepsy medication management: Addressing common treatment barriers to adopting cenobamate and other new antiseizure medications
Rosenfeld W.E., 2025
Presented by Dr. Hareesha Rishab Bharadwaj
2:06 - Epilepsy Medication Management: The presentation on epilepsy medication management focused on common barriers to adopting new anti-seizure medications, with an emphasis on achieving seizure freedom and managing side effects.
4:21 - Barriers to New Medications: The discussion highlighted barriers to adopting new anti-seizure medications, emphasizing the importance of addressing drug-resistant epilepsy and the potential solutions offered by new medications.
11:01 - Treatment Complacency: Treatment complacency was identified as a significant barrier to adopting new anti-seizure medications, with a focus on the need for physicians to aim for complete seizure freedom and engage in thorough discussions with patients about new treatment options.
17:11 - Rational Polytherapy: The importance of rational polytherapy was discussed, emphasizing the thoughtful combination of different anti-seizure medications to achieve seizure control and minimize side effects, along with a call for more high-quality evidence on specific ASM pairings.
18:59 - Restricting ASMs for Later Lines: The argument was made against reserving new anti-seizure medications for later lines of treatment, suggesting that using new medications earlier could improve seizure freedom rates and reduce overall costs.
Discussion
1:24 - Informing Patients About Newer ASMs: Challenges of informing patients in the UK about newer anti-seizure medications (ASMs) were discussed, emphasizing honest communication, the use of infographics, and advocating for increased funding for these drugs.
3:37 - Rational Polytherapy: The importance of rational polytherapy was highlighted, focusing on combining different modes of action to avoid adverse effects and improve efficacy, while emphasizing individualized treatment plans for drug-resistant patients.
5:24 - Combining Sodium Channel Blockers: An approach to combining sodium channel blockers, such as Sonova mate, with other medications was shared, emphasizing the importance of adjusting doses based on patient response and minimizing drug load.
7:36 - Patient Involvement in Polytherapy: The importance of involving patients in discussions about polytherapy, especially when introducing new medications, was stressed, along with having a plan for withdrawing less effective drugs to improve patient acceptance and outcomes.