KONQUEST: Keppra versus Older AEDS and Neuropsychiatric, Neurocognitive and QUality of life outcomes in treatment of Epilepsy as Substitution monoTherapy

  • Dr Tahir Hakami, Department of Medicine, the University of Melbourne, Parkville, VIC, Australia., Australia
  • Dr Marian Todaro, Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia., Australia
  • A Roten, Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia., Australia
  • T Bright, Department of Medicine, the University of Melbourne, Parkville, VIC, Australia, Australia
  • S Petrovski, Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia., Australia
  • L MacGregor, Department of Medicine, the University of Melbourne, Parkville, VIC, Australia, Australia
  • Dr R Yerra, Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia., Australia
  • Professor T O'Brien, Department of Medicine, the University of Melbourne, Parkville, VIC, Australia., Australia

Objective: To compare a broad range of epileptic and psychological outcome measures in patients who had substitution monotherapy with levetiracetam (LEV) versus one of two older anti-epileptic drugs (AEDs), carbamazepine (CBZ) or valproate (VPA).
Methods: KONQUEST was a single-centre, randomised, open-label study. Participants had partial epilepsy on monotherapy which had “failed” either due to lack of efficacy or adverse effects. Participants taking phenytoin (PHT) or CBZ were randomised to either LEV or VPA, and participants taking VPA were randomised to LEV or CBZ. Assessments were performed at baseline, 3 months, and 12 months using questionnaires measuring seizure control, anxiety and depression (HADS), psychiatric distress (Symptoms Checklist 90 – SCL 90), Quality of Life in Epilepsy (QOLIE 89), adverse effects (Liverpool Adverse Effect Profile - LEAP) and, neurocognitive performance (IntegNeuro™). Outcomes analysis was performed on the basis of intention to treat.
Results: 96/106 (90.6%) of enrolled patients completed the study: 52 in the LEV and 44 in the older AED groups (VPA, n=25, CBZ, n=19). All assessments improved from baseline at both 3 and 12 months (P<0.05); however, we found no differences between the LEV and older AED treatment groups (P>0.05). A similar proportion of patients in both groups experienced recurrent seizures (36% vs. 34%, P>0.05)
Conclusion: Switching to a different AED in patients who are experiencing ongoing seizures or adverse effects to their first AED is associated with improvement on a wide variety of epilepsy and psychosocial measures. This effect is similar for both LEV and the older AEDs.