Adjunctive pregabalin for uncontrolled partial-onset seizures: findings from a prospective audit

Stephen LJ, Parker P, Kelly K, Wilson EA, Leach V, Brodie MJ. Adjunctive pregabalin for uncontrolled partial‐onset seizures: findings from a prospective audit.
Acta Neurol Scand: 2011: 124: 142–145.
© 2011 John Wiley & Sons A/S. Aims – Pregabalin (PGB) was licensed in Europe as an add‐on antiepileptic drug (AED) for the treatment of partial‐onset seizures in 2004. This audit assessed the response to adjunctive PGB in patients with uncontrolled seizures. Methods – PGB was titrated in 135 patients [73 men; 62 women, aged 18–76 (median 44 years) until one of the following occurred: ≥6 months’ seizure freedom, ≥50% or <50% seizure reduction over 6 months; PGB withdrawal because of adverse effects, lack of efficacy or both. Results – Of the 135 patients, 14 (10.4%) became seizure‐free for ≥6 months (median PGB dose 300 mg/day; range 75–600 mg). A ≥ 50% seizure reduction occurred in 33 (24.4%) patients; 20 (14.8%) had <50% reduction. PGB was withdrawn in 68 (50.4%) (40 adverse effects, seven lack of efficacy and 21 both). Commonest problems resulting in withdrawal were sedation (n = 18), weight gain (n = 14) and ataxia (n = 9). There was a positive correlation between increasing dose and weight gain (r = 0.42, P = 0.045). Conclusions – Add‐on PGB benefited 50% of patients, but only 10% achieved 6 months’ seizure freedom. Adverse effects, most commonly sedation, dose‐related weight gain and ataxia, led to drug discontinuation by 45%. Prospective audits of novel AEDs are a useful adjunct to randomized, controlled trials in managing epilepsy.