An outcome audit at the epilepsy clinic: results from 1000 consecutive referrals

Tobias, Edward S.; Brodie, Adam F.; Brodie, Martin J.

doi:10.1016/s1059-1311(05)80161-x

Cited by 36 publications

(18 citation statements)

References 20 publications

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“…Only those who had never received AED therapy before were included in the analysis. During the first clinic visit, a structured questionnaire was used to collect information from the patients and any witnesses to the seizure (13). Investigations, in particular surface electroencephalography and brain imaging, were carried out as clinically indicated.…”

Section: Methodsmentioning

confidence: 99%

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Effectiveness of First Antiepileptic Drug

2001

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Summary:Purpose: To investigate the interaction among efficacy, tolerability, and overall effectiveness of the first antiepileptic drug (AED) in patients with newly diagnosed epilepsy.Methods: The 470 patients were diagnosed, treated and followed up from January 1984 at a single center. Outcome was classified as seizure freedom for at least the last year or failure of initial treatment because of inadequate seizure control, adverse events, or for other reasons.Results: Overall, 47% of patients became seizure-free with the first prescribed AED. A higher proportion (p ‫ס‬ 0.025) of patients with symptomatic or cryptogenic epilepsy changed treatment because of intolerable side effects (17%), and a lower proportion (p ‫ס‬ 0.007) became seizure-free (43.5%) compared with those with idiopathic epilepsy (8.5% and 58%, respectively). Most patients (83%) received carbamazepine (CBZ; n ‫ס‬ 212), sodium valproate (VPA; n ‫ס‬ 101), or lamotrigine (LTG; n ‫ס‬ 78). The majority of seizure-free patients required only a moderate daily AED dose (93.1% with Յ800 mg CBZ, 91.3% with Յ1,500 mg VPA, 93.8% with Յ300 mg LTG), with commonest dose ranges being 400-600 mg for CBZ, 600-1,000 mg for VPA, and 125-200 mg for LTG. Most withdrawals due to poor tolerability also occurred at or below these dose levels (CBZ: 98%; VPA: 100%; LTG: 75%). Patients taking CBZ (27%) had a higher incidence of adverse events necessitating a change of treatment than did those treated with VPA (13%) or LTG (10%), resulting in fewer becoming seizure-free (CBZ vs. VPA, p ‫ס‬ 0.02; CBZ vs. LTG, p ‫ס‬ 0.002).Conclusions: Nearly 50% of newly diagnosed patients became seizure-free on the first-ever AED, with >90% doing so at moderate or even modest dosing. Tolerability was as important as efficacy in determining overall effectiveness.

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Section: Methodsmentioning

confidence: 99%

“…Patients who persistently did not comply with the treatment regimen were excluded from the study at the time of analysis. Each patient's demographic data, clinical history, investigation results, and progress on treatment were recorded in a database (13).…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of First Antiepileptic Drug

2001

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“…Sixty per cent of patients were maintained on one, 38% on two and 2% of patients on three antiepileptic medications. Tobias et al (1994) audited the practice of a large British outpatient epilepsy service through 1000 consecutive referrals which permitted some comparison between people with and without intellectual disability. The above study again showed a trend towards a reduction in barbiturate prescribing.…”

Section: Treatmentmentioning

confidence: 99%

Epilepsy and intellectual disability

Bowley

Kerr

2000

J intellect Disabil Res

149

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A Medline and Psychline literature review of epilepsy in people with intellectual disability was performed. The review has highlighted the importance of the impact of epilepsy on the lives of individuals and their families, affecting physical morbidity, leading to an increased mortality and increasing the care-giving burden. Interventions with a strong evidence base are mainly pharmacological with an increasing body of work on the novel antiepileptic drugs. Surprisingly little research exists into the quality of service provision for this population. The authors suggest three areas for future work: (1) an increasing application of research methodologies such as direct observation and qualitative studies into this field; (2) an exploration of the broad impact of treatment and (3) the possibility that epilepsy is a barrier to care provision.

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“…6 One study showed that after a 40-year median follow-up, 93% of patients with childhood-onset seizures had entered 1-year or more 1-year remissions, although this proportion is much lower in the partial epilepsies group, mainly in mesial temporal lobe epilepsy (MTLE). [8][9][10][11] The commonest pathologic finding associated with poor prognosis in MTLE is hippocampal scle-rosis (HS) on histology, 2,12 whose most common MRI signs are hippocampal atrophy (HA) and increased T2 signal. [8][9][10][11] The commonest pathologic finding associated with poor prognosis in MTLE is hippocampal scle-rosis (HS) on histology, 2,12 whose most common MRI signs are hippocampal atrophy (HA) and increased T2 signal.…”

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confidence: 99%