Factors Which Influence the Effectiveness of Treatment of Epilepsy

Abstract

Despite recent advances in the management of epilepsy, some patients continue to have seizures which defy therapeutic intervention. To examine factors which may influence the successful application of therapy a survey was carried out of 103 patients, with a previous diagnosis of epilepsy, who had a seizure for which an ambulance was called. It was evident that anticonvulsants are not always used to their maximum potential or under optimal conditions. Problems which were identified in treatment included the widespread use of polypharmacy. Patients contributed to failure of seizure control by lack of compliance with therapy (29 patients) and by excessive alcohol consumption (19 patients).

Seizures and Seizure Care in an Emergency Department

“…This observation has been confirmed in other studies (Bryant and Ereshefsky, 1981;Lambie et al, 1986;McGlone and Pritty, 1986), and prior reports also support our conclusion that these subtherapeutic AED levels relate more to noncompliance than to inadequate therapy (Peterson et al, 1982;Pippenger and Lesser, 1984). This observation has been confirmed in other studies (Bryant and Ereshefsky, 1981;Lambie et al, 1986;McGlone and Pritty, 1986), and prior reports also support our conclusion that these subtherapeutic AED levels relate more to noncompliance than to inadequate therapy (Peterson et al, 1982;Pippenger and Lesser, 1984).…”

“…Among treated epilepsy patients presenting with seizures, AED blood levels were often subtherapeutic and noncompliance was common (Tables 7 and 8). This observation has been confirmed in other studies (Bryant and Ereshefsky, 1981;Lambie et al, 1986; McGlone and Pritty, 1986), and prior reports also support our conclusion that these Epilepsia , Vol. 30, No.…”

“…EDs now principally stress acute seizure care, such as initial diagnosis and cessation of convulsions. Yet seizures, particularly in patients with epilepsy, although presenting as acute emergencies, may be associated with important nonemergency or chronic medical problems and psychosocial factors that also require attention (Ullman et al, 1975; Earnest and Yarnell, 1976; Eisner et al, 1986; Lambie et al, 1986). However, the problems presented by seizures in EDs are neither well defined nor studied.…”