Reluctance to change treatment is a problem in epilepsy
Considerable scope for improving care of patients
with epilepsy has been identified by a new study.
Researchers from the Institute of Neurology, University
College London, studied the treatment of 564 patients with epilepsy between
1984 and 1997 (median follow-up 11.8 years).
Practice was found to be acceptable in areas including
initial use of monotherapy, substitution rather than addition of a second
drug and restriction of initial monotherapy to conventional cheaper drugs.
However, short-comings in practice were also identified. These included
not changing medication when seizures were continuing and a reluctance
to use newer antiepileptic drugs in patients with resistant epilepsy.
A total of 77 per cent of patients were started
on drug therapy. In patients where the index seizure was the first seizure,
15 per cent were prescribed medication immediately although because of
a high rate of seizure recurrence 70 per cent were eventually treated.
About one-third of patients remained on long-term therapy.
Phenytoin and carbamazepine were the most commonly
prescribed drugs for initial therapy, given in 29 and 27 per cent of cases,
respectively. Valproate was given to 15 per cent of all patients.
A lack of efficacy led to 16 per cent of patients
changing therapy and 5 per cent had their medication changed for a second
time for the same reason. However, one-third of those who switched therapy
because of lack of control on the first drug failed to gain control on
the second drug. Of the patients having more than one seizure a week,
one-third remained on their initial therapy.
New drugs, such as gabapentin, lamotrigine, vigabatrin
and topiramate, were only used in 11 per cent of patients with recurrent
seizures.
The researchers comment: "It is probable that there
are many people in the pool of patients with chronic epilepsy who have
not been adequately treated." They add that while it is not known how
many of these patients would have benefited from more aggressive therapy,
some medical and social complications would almost certainly have been
avoided (Journal of Neurology, Neurosurgery and Psychiatry 2001;71:632).
In the United Kingdom, around 30,000 people are
diagnosed with epilepsy each year.
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