NeurologyLive® Year in Review 2023: Top Stories in Epilepsy and Seizure Disorders

In 2023, the NeurologyLive^® staff was a busy bunch, covering clinical news and data readouts from around the world across a number of key neurology subspecialty areas. From major study publications and FDA decisions to societal conference sessions and expert interviews, the team spent all year bringing the latest information to the website's front page.

Among our key focus areas is epilepsy and related seizure disorders, a field that features complex diseases that are often medically refractory and difficult to manage. Although major news items often appear among the top pieces our team produces, sometimes smaller stories reach those heights for other reasons—clinical impact and interest, or concerns about the small- or big-picture parts of care, for example. Whatever the reason for the attention these stories got, their place here helps provide an understanding of the themes in this field in 2023.

Here, we'll highlight some of the most-read content on NeurologyLive^® this year. Click the buttons to read further into these stories.

1. Levetiracetam Outperforms Lamotrigine as First-Line Treatment for Females With Juvenile Myoclonic Epilepsy

Findings from a comparative effectiveness research study showed that use of levetiracetam and lamotrigine as first-line treatments have similar efficacy on idiopathic generalized epilepsy (IGE) syndromes in females; however, levetiracetam was more effective in treating juvenile myoclonic epilepsy. Further studies are still needed to identify the most effective antiseizure medication alternative in other IGE syndromes.

2. FDA Warns of Serious Adverse Effects for Using Levetiracetam and Clobazam in Epilepsy

The FDA has issued a warning for the use of antiseizure medicines levetiracetam (Keppra, Keppra XR, Elepsia XR, Spritam) and clobazam (Onfi, Sympazan), which can cause drug reaction with eosinophilia and systemic symptoms, known as DRESS, a rare but serious adverse effect. The reaction may start as a rash but can quickly progress, resulting in injury to internal organs, the need for hospitalization, and even death. As a result, the FDA is requiring new warnings about this risk to be added to the prescribing information and patient medication guides for these medicines.

3. FDA Clears Dry-Sensor, At-Home EEG Headset

According to an announcement from Cumulus Neuroscience, the FDA has granted clearance to its novel, dry-sensor EEG headset, a user-friendly device that enables self-directed use and generates clinical-grade data for remote physician review. The Cumulus EEG device, designed for both adult and adolescent patients, is available in 4 sizes, and is easily self-applied with guidance from the Cumulus mobile app. The platform combines clinical-grade, at-home data with machine learning analytics and a large real-world database of annotated, longitudinal, matched data.

4. Incident Epilepsy and Antiseizure Medications Independently Associated With Osteoporosis Risk in Adults

Using a large-scale cohort of electronic health records, recently published findings identified robust and clinically meaningful independent associations between incident epilepsy and both epilepsy/enzyme-inducing antiseizure medication use with incident osteoporosis. These data highlight the need for enhanced vigilance and consideration of prophylaxis for all patients with epilepsy.

5. Antiseizure Therapy Fenfluramine Continues to Show Pronounced Benefits in Rare, Developmental Epilepsies

At the 35th International Epilepsy Congress, held September 2-6, 2023, in Dublin, Ireland, UCB Pharma presented several posters showcasing the clinical benefits of fenfluramine (Fintepla) across multiple forms of epilepsy, including rare epileptic disorders such as Dravet syndrome (DS), Lennox-Gastaut syndrome (LGS), and CDKL5 deficiency disorder. The first presentation was a review of 13 studies assessing the impact of the therapy on generalized tonic-clonic or tonic-clonic seizures in a cohort of rare epilepsy syndromes; another abstract assessed the safety and efficacy of adult patients with DS who did not participate in the phase 3 clinical trials but enrolled in the open-label extension study de novo; and a comparative analysis of clinical trial data further highlighted fenfluramine’s impact on drop seizure frequency (DSF) in dose-capped patients with LGS.

6. The Advantages of Microburst Vagus Nerve Stimulation for Drug-Resistant Epilepsy

Cornelia Drees, MD, senior associate consultant in the Department of Neurology at Mayo Clinic, provided insight on an early feasibility study on the clinical impact of microburst vagus nerve stimulation in patients with drug-resistant epilepsy, presented at the 2023 American Academy of Neurology (AAN) Annual Meeting, held April 22-27, in Boston, Massachusetts.

7. Intermittent Use of Midazolam Shows Continued Favorable Profile in Seizure Clusters

A post hoc analysis newly published in Epilepsy & Behavior on the phase 3 open-label extension (OLE) study (NCT01529034) assessing midazolam (Nayzilam; UCB), an FDA-approved nasal spray, showed that 90 minutes was the estimated median time to return to full baseline functionality (RTFBF) regardless of treatment with 1 or 2 doses among patients who experienced seizure clusters (SCs). These findings suggest that the dose of midazolam did not influence the time to RTFBF in SC episodes and further support the favorable profile of repeated intermittent use of midazolam in patients with SCs.

8. Fetal Outcomes Largely Unaffected by Antiseizure Medication Lacosamide

Using data from spontaneous and solicited reports, findings from a new analysis showed that lacosamide (Vimpat; UCB Pharma), an antiseizure medication, was safe to use during pregnancy, with most exposed pregnancies resulting in live births. Lacosamide, listed as a Pregnancy Category C medication, had no new safety concerns associated with its use in data presented at the 2023 American Epilepsy Society (AES) annual meeting, held December 1-5, in Orlando, Florida.

9. Midazolam Shows Suboptimal Efficacy as First-Line Therapy for Prehospital Seizures

Data from a published retrospective analysis of adolescents and children presenting with seizures showed that midazolam is not an effective first-line therapy in prehospital settings, indicated by the nearly 40% of patients who required rescue therapy. Published in JAMA Network, the study featured 1172 children with a mean age of 5.7 years for whom a mobile intensive care unit was dispatched for an active seizure.

10. Rapid Administration of Diazepam Results in Improved Seizure Cluster Cessation, Shorter Seizures

New post hoc data from a recently completed phase 3 trial (NCT02721069) assessing diazepam nasal spray (Valtoco; Neurelis), an FDA-approved antiseizure medication (ASM), indicated that faster time to administration was associated with shorter time to seizure cluster cessation and overall shorter seizure duration. Over 12 months, investigators also noticed a statistically significant change in SEIzure interVAL, or the time between seizure clusters, that was independent of the age of changes with concomitant ASMs.