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Seizure Freedom is the ultimate goal of seizure management

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Seizure freedom is recognised as the goal of epilepsy treatment1

According to NICE guidelines, clinically meaningful outcomes for patients are seizure freedom (100% reduction) or near seizure freedom (90% reduction).2

  • The main aim of treatment is to retain or regain independence by prolonged and reliable periods of seizure freedom2
  • Patient experts highlighted that there is a big difference between having seizures and seizure freedom, such as independence and the ability to drive or work2,3
  • Higher levels of treatment response are associated with higher health-related quality of life and lower healthcare resource use2

Despite this, one-third of healthcare professionals (HCPs) who treat patients with epilepsy think there is too much focus around seizure freedom and do not include seizure freedom in discussions with patients.4

Is seizure freedom a reasonable goal to pursue?

Seizure freedom is imperative for significant improvement in health-related quality of life (HRQoL) to occur, at least in some patient populations.5

These results support striving for seizure freedom as an epilepsy treatment goal.5

However, the probability of achieving seizure freedom diminishes with each subsequent anti-seizure medication (ASM) regimen tried6

 

  • Drug-resistant epilepsy (DRE) is defined as when a person with epilepsy has failed to become and stay seizure free with adequate trials of 2 ASMs2
  • At least 30% of people with epilepsy have DRE and remain refractory to pharmacological treatment2

Patient and HCP perspectives on seizure freedom

NS, no significant differences in probability of seizure freedom between the third, fourth, fifth and greater numbers of ASM regimens.

What is key is that patients consider their unmet needs are being addressed and can feel free of the burden of seizures. The STEP survey† identifies a clear need to understand patients' individual life goals to optimise treatment decisions.4

For example, 64% of patients rated being able to ‘feel in control’ as ‘extremely important’4

Stepping towards seizure freedom by supporting the patient’s attainment of their life goals can be as important as achieving actual seizure freedom.4

Footnotes:

†The STEP survey was completed by 400 adult patients with epilepsy, 201 caregivers, and 258 HCPs (112 general neurologists, 96 epileptologists, 50 nurse practitioners/physician assistants).4

© NICE 2021 Cenobamate for treating focal onset seizures in epilepsy. Technology appraisal guidance TA753. Available from https://www.nice.org.uk/guidance/ta753. All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

Abbreviations

ASM, anti-seizure medicine; CI, confidence interval; DRE, drug-resistant epilepsy; HCP, healthcare professional; HR, hazard ratio; HRQoL, health-related quality of life; NICE, National Institute for Health and Care Excellence; NS, not significant; QOLIE, Quality Of Life In Epilepsy; STEP, Seize the Truth About Epilepsy Perceptions.

  1. Halford JJ, Edwards JC. Acta Neurol Scand. 2020;142(2):91-107.
  2. NICE Technology Appraisal Guidance [TA753]. Cenobamate for treating focal onset seizures in epilepsy. Published 15 December 2021. Available at: https://www.nice.org.uk/guidance/ta753 (last accessed August 2023).
  3. Elizebath R, et al. Epilepsy Behav. 2021;116:107796.
  4. Becker DA, et al. Epilepsy Behav. 2021;117:107816.
  5. Birbeck GL, et al. Epilepsia. 2002;43(5):535-8.
  6. Chen Z, et al. JAMA Neurol. 2018; 75(3): 279-86.

UK17045P | August 2023

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