Abstracts

RATIONALE: To assess and compare the impact of Lamotrigine (LTG), Topiramate (TPM), Tiagabine (TGB) and Vagus Nerve Stimulator (VNS) on behavior and seizure control in mentally handicapped individuals with epilepsy. METHODS: We reviewed The PADS database to identify the mentally handicapped population who received newer antiepileptic drugs (AED) including LTG, TPM and TGB, or VNS. Past neurological history, behavioral problems and institutionalized status were reviewed. Duration of treatment, effect of AED on behavior and reason for treatment discontinuation were determined. Increased or new behavioral problems were assessed at follow-up visits. RESULTS: The database included 1743 entries; LTG: 425, TPM: 772, TGB: 294 and VNS: 252. 359 subjects who were defined as mentally handicapped were identified, including 134 institutionalized individuals. Number of mentally handicapped subjects by AED: LTG: 47/425, TPM: 213/772, TGB: 57/294, VNS: 41/252. Prior behavioral problems included LTG: 25/47, TPM: 10/213, TGB: 10/57, VNS: 6/41 subjects. Behavioral related side effects occurred in 5/47 LTG, 2/213 TPM, 8/57 TGB, 1/41 VNS (not statistically significant by chi-square). AED/VNS was discontinued in 55% of LTG (26/47); 49% of TPM (105/213); 59% of TGB (34/57); 7% of VNS (3/41). Discontinuation due to behavioral problems occurred for LTG 5/26 (19%), TPM 12/105 (11%), TGB 5/34 (15%) and VNS 1/3 (33%) subject. In all groups, major criteria for discontinuation of treatment included loss of efficacy 26% (44/168), behavior related side effects 14% (23/168) and increased seizure 12% (21/168). CONCLUSIONS: These 4 treatments did not differ significant in terms of seizure control, loss of efficacy, increased seizure or behavior in the mentally handicapped population. This data may change as the cohort exposed to TGB and VNS increases. Behavioral problems were significant less than reported for other treatments in this population.