Abstracts

Rationale: The list of available antiepileptic drugs (AEDs) is continuously expanding, making the AED selection more challenging. Different considerations are taken into account when choosing an AED. The influence that each consideration has on AED selection may be different among neurologists and non-neurologists. This study aims at stratifying the considerations that influence different specialties when prescribing AEDs for seizures. Methods: An anonymous, electronic survey was sent to house-staff and faculty physicians in the departments of emergency medicine, internal medicine, neurology and neurosurgery. Physicians indicated their specialty and level of training. The survey evaluated the effect of age, gender, ethnicity, seizure type, seizure frequency, long-term side effects, short-term side effects, route of administration, frequency of dosing, ease of titration, drug interaction, generic availability and cost on AED selection. The considerations were ranked according to the following scale: 0 (no effect), 1 (minimal effect), 2 (some effect), 3 (strong effect) and 4 (very strong effect). In addition, physicians were asked to choose the AED that they would prescribe the most in partial seizures, generalized seizures and overall. All answers were compared between neurologists and non-neurologists, using the Fisher s exact test. Results: A total of 100 participants completed the survey, 47 neurologists and 53 non-neurologists. Among neurologists, the strongest considerations (scale?3) were given to seizure type (96 %), followed by long-term side effects (89%), and then drug-drug interactions (74%). Among non-neurologists, the strongest considerations (scale?3) were given to route of administration (55%), followed by drug-drug interaction (53%) and then long-term side effects (43%). Neurologists gave more importance to age, gender, seizure frequency , dosing schedule, ease of titration, generic availability and cost compared to non-neurologists (p<0.01). Ethnicity was given the lowest consideration (scale ?1) by both neurologists (87%) and non-neurologists (98%). Neurologists prescribed oxcarbazepine (60%) and levetiracetam (30%) for partial seizures, levetiracetam (47%) and valproate (34%) for generalized seizures and levetiracetam (76%) and lamotrigine (13%) overall. Non-neurologists prescribed levetiracetam (50%) and valproate (17%) for partial seizures, levetiracetam (65%) and phenytoin (27%) for generalized seizures and levetiracetam (76%) and lorazepam (14%) overall (p<0.0001, for all three comparisons). Conclusions: When choosing an AED, neurologists give the highest consideration to seizure type and tend to prescribe newer AEDs. Overall, levetiracetam appears to be the most prescribed AED by both neurologists and non-neurologists.