Abstracts

Rationale: Receiving epilepsy care in a specialized epilepsy center leads to improved seizure control (Zakaria et al, Neurology 2007;68:Suppl 1:A72). It is not known what factors contribute to such improvements. The goal of this study was to evaluate whether the use of second vs. first generation AEDs contributes to improved seizure control in populations of institutionalized and non-institutionalized patients and how these factors are modified by physician’s training/experience (epileptologist vs. general neurologist).Methods: A retrospective chart review was performed on 100 patients followed at an epilepsy center; 50 institutionalized patients vs. 50 patients matched for age, gender, and duration of epilepsy. The change in seizure frequency was the main outcome and whether or not the prior and current providers attempted to use new medications were the primary predictors. Paired t-tests were used to compare seizure frequency before and after the patients were seen at an epilepsy center; generalized linear models were used to assess the effect of provider prescription practice on seizure frequency. Patients with more than 100 seizures per month were excluded to prevent bias from these outliers (N = 6).Results: There were no differences in how the AEDs were used by general neurologists vs. epileptologists in the institutionalized vs. non-institutionalized patients (all p > 0.112). There was an overall decrease in seizure frequency (p < 0.001; delta = -10.1, 95CI 5.5 to 14.8) when the patients were treated by epilepsy specialist vs. general neurologist. The modeling suggest that if the general neurologist had tried a second generation AED prior to referring to the epileptologist, the change in seizure frequency was about -14 (p < 0.001), while if they had not tried the second generation AED, the change was significantly lower at about -4 (p = 0.046). This reflects the fact that the patients who were treated only with first generation AEDs prior to referral had on average much lower seizure frequency than other patients. Whether the current provider (epilepsy specialist) tried new medication or not, it did not affect the seizure frequency (p=0.814). When tested, there was no interaction between old and new provider attempts to use second generation AED (p=0.824).Conclusions: These findings indicate that improved seizure frequency in patients referred for further management in epilepsy centers is dependent on physician training and not on medication factors. In other words, there is better seizure control in patients cared for by an epilepsy specialist independently of what AED they use. This study was supported by UCB Pharma Young Investigator Research Project to AYR.