Abstracts

RATIONALE: At the end of this activity the participants should be able to discuss the types of epilepsies seen in a general neurology practice.
Prior work has shown that less than 30% of patients seen in tertiary epilepsy centers are referred by neurologists (Gilliam et al. Epilepsia 2001;42(suppl 7):288). The type and severity of epilepsy seen by general neurologists in the United States is not known.
METHODS: Effective January 2001, one of Greater Cincinnati[scquote]s largest managed care organizations dropped the region[scquote]s largest private practice general neurology group. This group provides the majority of general neurologic care in Greater Cincinnati. Subsequently a large number of epilepsy patients were seen by epilepsy specialists at the University of Cincinnati Medical Center. All patients had their epilepsy care taken over by an epilepsy specialist and were not specifically referred for subspecialty care. We reviewed the charts for patients with a diagnosis of epilepsy who were seen by an epileptologist between January 1, 2001 and December 31, 2001. All patients had medical records available for review from their prior treating neurologist. Intractable epilepsy was defined as less than one year seizure free and failing 3 or more antiepileptic drugs (AEDs).
RESULTS: Fifty-six patients (39 females) were seen in 2001. Mean age was 39.2 years. Mean epilepsy duration was 14.4 years (standard deviation [s.d.] 12.5). 48.2% were not seizure free for the prior year. Mean monthly seizure frequency was 4.9 seizures per month (s.d. 14.8). Mean number of AED failures was 2.0 (s.d. 1.7) and 25% of patients had intractable epilepsy. If the definition of intractable epilepsy was changed to having failed 2 or more AEDs, then 37.5% had intractable epilepsy. 10 patients had a repeat MRI scans performed after being seen in the epilepsy center. Four of the ten patients had discovery of previously undetected abnormality (hippocampal atrophy in 3, focal encephalomalacia in 1). 21 patients had a repeat EEG performed after seeing the epileptologist. Only 2 of 21 had an abnormality on EEG that was not previously seen on prior EEG. A change in treatment plan was instituted by the epileptologist in 37.5% of the 56 patients: 33.9% had their AED changed, 3.6% of patients underwent video/EEG recordings for diagnostic purposes and 8.9% began an epilepsy surgery evaluation. Five patients (8.9%) had a change in their diagnosis after seen at the epilepsy center (4 patients had their presumed epilepsy syndrome changed from partial to generalized and 1 patient was subsequently diagnosed with psychogenic nonepileptic seizures). 43 patients were seen in follow-up (mean duration 6.9 months). 44.2% of patients were not seizure free on follow-up. The mean seizure frequency after seeing an epileptologist was 2.0 seizures per month (s.d. 6.6, p = 0.04, signed rank test). No patient had yet had epilepsy surgery.
CONCLUSIONS: Roughly half of patients with epilepsy treated by general neurologists continue to have seizures. 25 to 37.5% have intractable epilepsy depending on the definition used. Although after evaluation and treatment at an epilepsy center, a similar percentage of patients continued to have seizures, there was a significant reduction in seizure frequency.
[Supported by: NINDS 5K23NS002170]