Abstracts

Epilepsy treatment has advanced since FDA approval of seven new antiepileptic drugs (AEDs) in the last decade and practice parameters have been developed by epilepsy experts. However, little is known whether the access of new AEDs influences the prescribing patterns of community-based physicians practicing outside epilepsy centers. The aim of this study was to identify the practice trends of referring physicians with respect to use of old vs new AEDs, folic acid, vitamin D, calcium supplements and screening for osteoporosis. In addition, we evaluated the changes in AEDs recommended by an epilepsy specialist after initial evaluation. Following IRB approval, we identified new referrals to Henry Ford (HF) epilepsy clinics in the last three years by searching the electronic database of the HF Medical Group. We only included patients older than 18 with a confirmed diagnosis of epilepsy. We collected data on the use of AEDs upon and after initial evaluation, use of folic acid and AED of high teratogenicity in women of reproductive age, calcium and vitamin D supplements before evaluation, and screening for osteoporosis. Descriptive statistics and z-test for comparison of proportions were used for analysis. Data on 206 consecutive epilepsy patients (age 18-91; women=111) were analyzed. Eighty-seven patients (42.2%) remained on the same AED before and after evaluation by a specialist. Upon referral 86 patients (42%) were on old AED mono- or polytherapy and after evaluation 50 patients (24.5%) remained on these (p[lt] 0.001). On initial evaluation only 37 (18.1%) patients were on new AEDs as mono-or polytherapy, while 71 patients (34.8%) were on these (p [lt] 0.001) following evaluation by an epileptologist. No difference was found in those patients who were on a combination of old and new AEDs before or after evaluation (39.7% vs 40.7%, p = 0.76, respectively). Upon referral, 19 out of 60 (31.6%) women of reproductive age on no contraception were on valproic acid and 6 (10%) were on phenobarbital. Overall, only 14 (23.3%) of female referrals of childbearing age were on folic acid on initial evaluation. The majority of elderly patients were on phenytoin mono- or polytherapy (65%) and only 30.8% were on calcium and vitamin D supplements. Screening for osteoporosis was never recommended by community-based physicians for patients treated with old AEDs. We found that despite the increased availability of new AEDs with improved tolerability and reduced interaction potential, old generation AEDs are extensively used outside specialized epilepsy centers. Phenytoin is still the most commonly prescribed AED for the elderly. Routine use of vitamin D and calcium is not recommended. Folic acid is not strongly reinforced to women with epilepsy of reproductive age. The current practice trends in AED therapy differ significantly between community-based physicians and epilepsy specialists.