Treatment of epilepsy in daily clinical practice: have outcomes improved over the past 10 years?

Abstract

In the past decade, many new antiepileptic drugs have become available, but their influence on patient outcomes in daily practice is not well known. In a community-based study, we assessed changes in epilepsy treatment and outcomes over a 10-year period. We compared two cross-sectional community-based samples that were obtained from the same Dutch suburban region in 2000 and 2010 using pharmacy records for recruitment, including 344 and 248 epilepsy patients, respectively. The main outcome was self-reported quality of life (QoL, using the QOLIE-31). Potential predictors of QoL (adverse effects, seizure control, seizure acceptability, demographic, epilepsy- or treatment-related determinants) were assessed by multivariable linear regression. New antiepileptic drugs were used by 9 % of patients in 2000 and 34 % in 2010, P < 0.001. More than 80 % in both samples reported to be treated by a neurologist. We found no significant differences in QOLIE-31 scores (72.57 vs. 72.44), or in the proportion of patients with complete seizure control (51 vs. 54 %), between the two study samples. Seizure control and adverse effects were important independent predictors of quality of life, explaining 58 % of the variance. We found no evidence that in this community the QoL of epilepsy patients has improved in the last decade, despite unrestricted availability of healthcare resources, including accessibility to new AEDs. The relatively low proportion with complete seizure control and the high rate of adverse effects in these community-based samples suggest that the effectiveness of epilepsy treatment is still far from optimal.

Anti-epileptic drug changes and quality of life in the community

“…Our approach included people not under specialized care who are frequently neglected in treatment outcome research (17). The low response rate was partly due to our design, as discussed previously (17). The inability to send reminders is likely to have further reduced the response rate (18).…”

“…Pharmacy records, thus, usually cover a person's medication almost completely (16). Our approach included people not under specialized care who are frequently neglected in treatment outcome research (17). The low response rate was partly due to our design, as discussed previously (17).…”

Seizure precipitants in Dravet syndrome: What events and activities are specifically provocative compared with other epilepsies?

“…mail approach to 1894 patients, 575 (30%) responded, and, in 248 of them, a definite epilepsy diagnosis was confirmed by evaluation of medical data and questionnaires [15]. Both studies were approved by the Institutional Medical Ethics Committee.…”

Sudden cardiac arrest in people with epilepsy in the community

“…OPPEC is a cross-sectional, communitybased study, designed to assess the clinical, demographic, genetic, and pharmacologic determinants of antiepileptic drug (AED) treatment response in an outpatient cohort of people with epilepsy in a (sub)urban region in the center of the Netherlands (het Gooi-Utrecht). 16,17 Participants were recruited during an 18-month period (July 2010-December 2011) from the databases of 30 pharmacies, covering a population of about 250,000 inhabitants. Those who had at least 2 prescriptions for any AED dispensed in the previous 2 years (indicating long-term use) were asked to participate: response rate was 30%.…”

“…Those who had at least 2 prescriptions for any AED dispensed in the previous 2 years (indicating long-term use) were asked to participate: response rate was 30%. 16 The hospital and general practitioner (GP) records were reviewed to confirm a diagnosis of epilepsy (see Definition of epilepsy).…”