Abstracts

Rationale: Carbamazepine (CBZ) and valproate (VPA) are still the most commonly prescribed antiepileptic drugs (AEDs) in Europe, although there have been apprived ten new AEDs with partial approval for monotherapy. This has not only led to a broadening of the options of AED therapy but also to some confusion for the prescribing physicians. Because guidelines are mainly based on the regulatory studies and not on head-to-head comparisons, they can only partially solve this problem. Therefore we adopted a questionnaire for experts which has already been used twice in the US (Karceski S et al, Epilepsy Behav 2001; 2, Suppl.: A1–A50, and Epilepsy Behav 2005;7 Suppl 1: S1-64) to the situation in the three German speaking countries.Methods: We sent an updated questionnaire to 47 experts in the field of adult epileptology (“opinion leaders”) in Germany, Austria, and Switzerland in the second half of December, 2006. The questionnaire consisted of 28 case histories in the treatment of idiopathic as well as symptomatic or presumably symptomatic (cryptogenic) epilepsies. The experts were asked to give their opinion for 22 possible alternative treatments (in addition to all available AEDs as well ketogenic diet and vagus nerve stimulation) on a 9-point scale (with '9' being most appropriate and '1' least appropriate). This had to be done irrespective of the current approval status based on personal experience and opinion.Results: Forty-four out of the 47 contacted experts answered until the end of January 2007. For symptomatic or presumably symptomatic epilepsies with focal seizures out of the new AEDs lamotrigine (LTG) and levetiracetam (LEV) were considered as treatment of first choice, for some situations oxcarbazepine and topiramate (TPM) as well. In comparison, CBZ was evaluated less favorable. For idioptahic epilepsies with generalized seizures VPA was in general considered to be most appropriate (with execeptions for women with childbearing potential). Gabapentin was only regarded as treatment of choice for selected patients gruops like the comorbid elderly. In comparison to the most recent US study from 2005 the expert ratings were better for LEV, whereas TPM and zonisamide from the newer drugs as well as phenytoin from the established AEDs were evaluated less favorably. Conclusions: Although expert opinions are class 4 data, they can be of complimentary usefulness to existing guidelines for treatment of adult patients with epilepsy.