PA Keck School of Medicine at University of Southern California Medical Center
Rationale: Rationale: Prior reports of changes in RNS System electrographic data after patients are started on a new antiseizure medication (ASM) have demonstrated decreases in detections of epileptiform activity (EA) when that ASM is effective. These changes are observed within the first four weeks after the AED was started.1,2 Epidiolex was not evaluated in these published studies. We evaluated the EA changes following the start of Epidiolex in patients at two centers. Methods: Methods: A retrospective chart and RNS System data review was performed on all RNS System patients with medically refractory focal epilepsy who were started on Epidiolex at USC and Henry Ford Hospital over 1.5 years. Demographics and RNS System lead placement were collected. Response to Epidiolex was defined as a > 50% reduction in clinical seizures following the start of treatment (“start”). RNS System detection settings were held constant the month before and month after the start. Daily detection counts of EA during the month prior and the month following the start were obtained for comparison. Results:
Results: Eighteen patients were started on Epidiolex. Fourteen patients had seizure response data available and had stable RNS System detection settings. In all patients, < 2.5 mg/kg/d of Epidiolex was administered during the first month. Demographics and epilepsy histories can be found in Table 1. Six of the 14 patients (43%) responded to Epidiolex, and five of the six responding patients had a decrease in EA (median: -12%, mean: -18%, range: +16% to -89%) within the first month. Eight patients did not respond and had varying changes in epileptiform activity within the first month (median: -10%, mean: -2%, range: -26 to +27%) Conclusions:
Conclusion: Epidiolex was effective in six patients, five of whom had a decrease in detections of EA within the first month of treatment. Patients who did not respond to Epidiolex had a wide range of changes in EA, with a lower mean reduction. Further study is needed to determine if changes in epileptiform activity can help predict the effectiveness of Epidiolex in individual patients. The initial doses of Epidiolex trialed in these patients were lower than clinical trial doses3. A subsequent analysis will be performed once these patients reach higher Epidiolex doses.
References:
Skarpaas,TL, et al. Epilepsy and Behavior, 2018
Quraishi, IH, et al. Epilepsia, 2020
Seker, K, and Pack, A. F1000 Research, 2019
Funding: Please list any funding that was received in support of this abstract.: There was no funding for this abstract. Click here to view image/table
