Abstracts

After FDA approval of once-a-day DepakoteER for the treatment of epilepsy, the pharmacy at our county hospital stopped carrying delayed release Depakote(DR). Since the majority of our adult epilepsy out-patients obtain their medications at no cost from the hospital pharmacy, a cohort of patients were switched from Depakote(DR) to DepakoteER in a relatively short period of time. We monitored this group prospectively for changes in seizure frequency, medication adverse effects and preparation preference and now report those findings., At the patient[apos]s index visit, we obtained data on seizure frequency over the previous 6 months, as well as information about possible medication side effects (fatigue, GI upset, hair loss and weight change). Patients completed a scored 20 item questionaire about the effect, if any, of hand tremor on various daily activities and were asked to copy an Archimedes spiral. The patient was weighed. At this initial visit, Depakote(DR) was switched to DepakoteER (with an approximately 20% increase in total dose).
The same information was obtained at 3 and 6 month follow-up visits.
Change in seizure frequency was analyzed using the Wilcoxon signed-rank test. Before and after questions concerning specific side effects were analyzed using McNemar[apos]s test. Spirals were graded on a 1 to 5 scale (best to worst) by 2 trained, blinded raters. The pateints were asked which Depakote preparation they preferred and what schedule they actually used for DepakoteER., Forty seven patients were enrolled. Thirty eight completed all 3 visits, 5 completed 2 visits and 4 were lost to follow-up after the initial evaluation. There was no significant change in seizure frequency in the 6 month period following the switch to DepakoteER (a non-significant trend for improvement in seizure frequency was observed, P=0.08). Concerning side effects, before and after questions about fatigue, GI upset and hair loss indicated no change (P[gt]0.2) after the switch to DepakoteER. There was no significant weight change at 6 months (P=0.4). Scoring of Archimedes spirals showed no significant change at 3 or 6 months. The questionaire about hand tremor in various activities showed significant improvement at 3 (P=0.03) and 6 (P=0.05) months using the paired T-test. Most patients (62%)preferred DepakoteER but more than a quarter used it more than once daily (10 twice, 2 three times a day)., DepakoteER was as effective as Depakote(DR) for control of seizures. Side effect measurements were unchanged except for improvement in patients[apos] perception of hand tremor in daily activities. Most patients preferred DepakoteER, though some continued to use BID or TID dosing., (Supported by Abbott Laboratories.)