Abstracts

Aims To assess the diagnostic accuracy and therapeutic efficacy among community-based patients receiving antiepileptic drug (AED) therapy for diagnosed epilepsy not being followed up by a neurologist. Methods All relevant patients in an area of North Wales were given the opportunity to be assessed by a neurologist (JPL or DS) at a local hospital. Patient interview determined the nature of their original and continuing symptoms and a full treatment history. The results of any prior investigations were also documented. On this basis, we assessed the diagnostic accuracy and degree of control (i.e. the proportion seizure-free for at least one year). Results As of April 2000, 46 patients on AEDs had been interviewed (data from a further 300 patients is expected by November). Among this 46, time since diagnosis ranged from 2-54 years (median 16.5 years). Thirty three patients (73.3%) were felt to have a sustainable diagnosis of epilepsy, while three (6.7%) had a single seizure. Ten patients (21.7%) were felt to have been wrongly diangosed as having undergone any ictal phenomena. 24 patients had probable partial epilepsy, only 15 of whom (41.7%) were in remission. Of six patients with probable idiopathic generalised epilepsy, only two had been seizure-free for one year. Three patients were felt to have unclassifiable seizures. Four of the non-epilepsy patients were females exposed to AEDs at some point in their reproductive years. Sixty percent of those thought not to have epilepsy continued to have attacks despite AED use. Conclusions Even at this stage, we have shown evidence of an unmet need for input into patients with epilepsy in an area where there is access to specialist epilepsy and neurology services. We base this on: 1) The high take-up rate even among seizure-free patients who were keen to discuss a number of issues (driving allowance, pregnancy counselling, drug withdrawal). 2) The high incidence of misdiagnosed epilepsy with resultant dangers of unnecessary AED exposure. 3)Lower than expected remission rates due to suboptimal AED use. We feel that epilepsy is not best managed by general physicians or family practitioners.