Seizure Relapse in New Onset Epilepsy: It is Not Always Drug Resistance

Published in Epilepsia

In a recent study, researchers examined why patients with new-onset epilepsy (NOE) experience seizure relapses during the first 5 years after diagnosis. The research team started with 740 patients diagnosed with NOE between 2005 and 2019, but only 330 patients had at least 5 years of follow-up.

The study found that relapses were common but became less frequent over time. Notably, seizure recurrence was particularly concentrated in the first year after diagnosis. Among the 181 patients with post-treatment relapses, only 32% had relapses attributed to treatment ineffectiveness. The remaining 68% had other explanations, particularly inadequate treatment or poor adherence.

Almost all cases involved subtherapeutic dosing, rather than choosing the wrong anti-seizure medication (ASM). Poor adherence accounted for roughly 27%–38% of relapses each year, without a significant change over the 5-year period. Ultimately, only about 7% of the entire cohort had persistent drug-resistant epilepsy (DRE) after 5 years.

Researchers also found there was a strong association between generalized tonic–clonic seizures (GTCS) and poor adherence. Relapses caused by treatment ineffectiveness were also more often non-GTCS seizures. The study suggests that in newly diagnosed epilepsy, most early seizure relapses are potentially modifiable rather than evidence of true drug resistance.

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