Abstracts

Long-term prognosis of epilepsy is dependent on how patients respond to prolonged therapy. This study aims to assess the epilepsy specialist[apos]s perspective on factors influencing long-term retention on anti-epileptic drug (AED) therapy. An electronic, nine-item, forced-choice questionnaire was distributed via email to 1,998 epilepsy specialists and neurologists from the US, Europe, Australia and Japan. The sample population comprised registered delegates from the 2003 American Epilepsy Society congress in addition to physicians from specialist epilepsy centres in Europe. Data analysis was performed on 238 (148 from the US; 90 from Europe, Japan and Australia combined) completed questionnaires. On average, epilepsy patients comprised 68% of all clinic visits and epilepsy accounted for more than 50% of clinic visits for 75% of respondents. Respondents saw a primarily adult patient population, with 69% of clinic visits made by adults in the US and 75% in Europe, Japan and Australia combined.
Respondents reported that an average of 29% of newly diagnosed patients discontinue or seek to discontinue AED therapy. The most frequently cited reasons for discontinuation were dose-related side effects, cognitive side effects and inadequate seizure control (ranked in the top three by 68%, 56% and 51% of respondents respectively). Young adults, women of child-bearing age and highly refractory patients were selected as particular patient groups for whom long-term retention is most difficult to achieve. Among the consequences of low long-term retention rates, emergency room consultations, breakthrough seizures and more frequent physician visits ranked most frequently (ranked in the top three by 63%, 53% and 43% of respondents respectively). When asked to select attributes of AED therapy that would improve long-term retention, prolonged seizure freedom for longer than 6 months, seizure freedom in refractory patients and no cognitive side effects were reported most frequently (ranked in the top three by 78%, 74% and 68% of respondents respectively). The survey respondents represent epilepsy specialists and neurologists who see a high volume of adults with epilepsy. Inadequate seizure control and drug-related side effects were confirmed as key factors contributing to patients discontinuing AED therapy. Results indicate that treatment discontinuation has major implications for healthcare resources and patient outcomes. Prolonged seizure freedom, proven efficacy in refractory patients and no cognitive side effects were considered to be the most important AED attributes for improved long-term retention on therapy. (Supported by unrestricted educational grant from UCB.)