Abstracts

Over the past decade, many new therapies for the treatment of epilepsy have emerged. The clinician must now decide which therapy, or combination of treatments, is best for a given individual. Controlled clinical trials may not answer this question clearly. In 2001, a survey was published reflecting expert opinion on the treatment of epilepsy. We repeated the survey in a group of US epileptologists in 2004. 43 epileptologists received a mail-in a questionnaire regarding the treatment of adolescent and adult epilepsy syndromes: symptomatic localization related epilepsy (SLRE) and idiopathic generalized epilepsy (IGE). The questions were formatted to simulate clinical situations. The experts rated the treatment options using a modified RAND 9-point scale. Statistical analysis of data was performed as defined by the [italic]expert consensus method.[/italic] 67% of the experts had participated in the first survey. For initial monotherapy in the treatment of idiopathic generalized epilepsy (generalized tonic-clonic (GTC), absence, and myoclonic seizures), the group selected valproate as the treatment of choice. For IGE-GTCs, lamotrigine and topiramate were identified as being usually appropriate for initial monotherapy. For IGE-absence seizures, ethosuximide was a treatment of choice, and lamotrigine was considered usually appropriate. For SLRE, treatment options were framed within the seizure type: simple partial seizures (SPS), complex partial seizures (CPS), and secondarily generalized tonic-clonic seizures (GTC). In SLRE-SPS and SLRE-GTC, carbamazepine and oxcarbazepine were selected as treatments of choice, while lamotrigine and levetiracetam were usually appropriate. In SLRE-CPS, carbamazepine, oxcarbazepine and lamotrigine were treatment of choice, while levetiracetam was usually appropriate.
For both syndromes, in women who were either pregnant or trying to conceive, lamotrigine was the treatment of choice. In the elderly, the treatment of choice was lamotrigine, while levetiracetam was considered usually appropriate. In persons with HIV and epilepsy, lamotrigine and levetiracetam were usually appropriate. In people with seizures and depression, lamotrigine was identified as the treatment of choice. In a person with seizures and renal disease, lamotrigine was usually appropriate. In hepatic disease, lamotrigine and levetiracetam were appropriate for IGE; in SLRE, levetiracetam was treatment of choice, while gabapentin was usually appropriate. The panel of experts reached consensus on many treatment options. There are limitations to this type of data. However, the expert consensus method concisely summarizes expert opinion: this opinion may be helpful in situations where the medical literature is either scant or lacking. This type of information is most helpful when combined with evidence-based information. (Supported by UCB Pharma, GlaxoSmithKline, Abbott.)