A discussion on how to determine goals of therapy and efficacy in patients with varying classifications of epilepsy.
Trevor Resnick, MD: One of the other issues that comes up in our counseling with patients is the issue of how we define efficacy. And from a patient’s standpoint, efficacy equals seizure freedom. The reason for that is if you look at quality of life in patients with epilepsy, patients who are seizure free, their quality of life is significantly better—reported by patients—than having 1 seizure every 6 months. And it’s not that that 1 seizure every 6 months necessarily affects the quality of life for the 6 months before and the 6 months after it, it’s that the patient is living with the fear of when they’re going to have another seizure, in addition to the limitations of what they can and can’t do because of the fact that they could have another seizure at any time within the next 6 months. That’s why it’s not ultimately the seizure itself, not that that’s unimportant, but it’s the extent to which that seizure fits quality of life that makes it so important for us as neurologists to always have the goal of seizure freedom for the patient. And the patient needs to know that that’s our goal for them.
Now there is a disclaimer, and that is that we all have patients who we know are not going to achieve seizure freedom. And we know that a reasonable goal is a gratifying reduction in seizure frequency. But for a large percentage of our patients, a reasonable goal will always be seizure freedom.