IDIOPATHIC GENERALIZED EPILEPSY: INADEQUATE MANAGEMENT IS COMMON
Abstract number :
2.257
Submission category :
Year :
2003
Submission ID :
2523
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Selim R. Benbadis, William O. Tatum, Maria Gieron, Leanne Heriaud Comprehensive Epilepsy Program, University of South Florida & Tampa General Hospital, Tampa, FL
The idiopathic generalized epilepsies (IGE), formerly referred to as [quot]primary[quot] generalized epilepsies, are a distinct group of epilepsies that are genetically determined, have no structural or anatomic cause, and usually begin early in life. In general, IGE are very responsive to treatment, with 80-90% becoming fully controlled. However, not all antiepileptic drugs (AEDs) are equal for the treatment of IGE, some being ill-advised. The purpose of this study was to determine how often patients with IGE are placed on inappropriate AEDs before being seen at the epilepsy center.
We retrospectively reviewed patients with IGE diagnosed over a 1-year period at our epilepsy program (July 2001-June 2002). Patients were evaluated by 3 (two adult and one pediatric) epileptologists, and we selected patients in whom the diagnosis of IGE was confirmed by a clear abnormal EEG. We then reviewed their history of AEDs used and made appropriate changes when indicated. Follow up was obtained at routine clinic visits. The group of [quot]adequate[quot] AEDs was defined as valproate (VPA), ethosuximide (ETX), lamotrigine (LTG), topiramate (TPM), levetiracetam (LEV), and zonisamide (ZNS), whereas the group of [quot] inadequate[quot] AEDs included phenytoin (PHT), carbamazepine (CBZ), oxcarbazepine (OXC), gabapentin (GBP), and tiagabine (TGB).
We identified 58 patients with IGE (juvenile myoclonic epilepsy 14, childhood absence epilepsy 8, other IGE 36). When initially seen, patients were on PHT 26, CBZ 21, GBP 9, OXC 2, VPA 13, LTG 4, TPM 4, LEV 2, ETX 2, ZNS 2. Seventeen (29%) were on broad-spectrum (adequate) AEDs only, 28 (48%) on inadequate AEDs only, and 13 (22%) on a combination of both. Four had never been on VPA. Of the 41 patients who were receiving inadequate AEDs, 32 were changed to an adequate regimen and 25 became fully controlled.
A large proportion (the majority) of patients with IGE receive inadequate AEDs. The fact that some AEDs are ill-advised in IGE is underestimated. As expected, the majority of patients with IGE become controlled on appropriate AEDs, with only a small proportion being truly refractory.