Abstracts

Rationale: The antiepileptic drugs (AEDs) Lamotrigine (Lamictal), Carbamazepine (Tegretol), Oxcarbazepine (Trileptal), and Lacosamide (Vimpat) all have the common documented side effect of dizziness which is dose related. Patient descriptions of dizziness vary and are often too subjective to be reliably useful in the telephone management of the side effect. Determination of the extent of the toxic side effect can be challenging, without examining the patient in clinic. Dose adjustments are often needed. This study is developed to determine if we whether patients can use an easy and reliable measure enabling the provider to direct medication changes without the need to examine the patient in clinic. Methods: This is an observational study carried out using a modified timed walking test based upon the Motor Examination subsection of the Unified Parkinson Disease Rating Scale (UPDRS parts 27, 28, 29) and the Time Up & Go (TUG) test. Both tests are widely recognized and accepted, but have not yet been adapted for other disease states. This study is done in a tertiary care facility in the outpatient epilepsy clinic. Patients are recruited from within the clinic population by convenience sampling, with a control group of the patients significant others. We obtained IRB approval to enroll 40 patients in the treatment arm with an additional 40 in the control arm. A Quality of Life in Epilepsy (QOLIE) - 31 survey is self administered by patients and all are distributed a packet with a premeasured string for uniformity of distance walked for the tandem gait test. Patients are given a data collection sheet to record the number of times needed to reach out for hand hold to stabilize their gait. Gait testing is done just prior to AED dosing and 60 minutes after ingestion. At the time of consent, training is provided to the patients for the gait testing.Results: Of currently enrolled subjects, (n=28) 39% are on Lamictal, 11% are on Vimpat, and 7% each are on Tegretol and Trileptal. The remaining 36% are on a combination of two of the aforementioned drugs. There is a trend at this time showing that Tegretol is producing gait alterations post dosing. Conclusions: Our preliminary results are encouraging with a high response rate to date. The gait test is within the reach of our patient population to perform accurately. We anticipate that this test can be added to the armamentarium currently in use for telephone care of patients with epilepsy. We hope to use this preliminary data to develop a study validating this testing. It serves to help eliminate the subjective terminology of AED side effects currently reported by patients with the objective measure. Our hope is that this will more efficiently inform rational medication changes over the phone in response to the self-reported side effect of dizziness.