Abstracts

Rationale: Phenytoin (PHT) has been the most widely used medication to treat both partial and generalized seizures. The availability of an IV formulation was a major advance in the acute management of seizures. However, over the past twenty years, a variety of new compounds have been released with comparable efficacy, fewer adverse effects, and more predictable pharmacokinetic properties. We surveyed neurologists and epileptologists to determine current practice patterns relating to the use of PHT. Methods: A survey instrument with 11 questions (Table I) was created using the website www.surveymonkey.com. A link to the website was emailed to all members of the American Epilepsy Society (AES) in the Society s fortnightly newsletter on two successive occasions. In addition, using the online AES membership roster, all clinical members of the society were individually emailed a link to the survey. Results: A total of 198 responses were obtained. Of the respondents, 78.1% were epilepsy specialists; 60% were adult practitioners, the remainder saw either only children or both adults and children. Four-fifth of the respondents practiced in the US. Almost all the respondents reported managing intractable epilepsy with the majority seeing between 20 and 40 patients per week. Only 2 respondents reported initiating more than 5 patients on PHT on a weekly basis. For new onset partial seizures only 10 respondents said PHT would be their first or second choice, while 45% reported that they would not consider PHT. Of all adult practitioners, 58% would use PHT among their first four choices for therapy of partial onset seizures as compared to 43% of pediatric specialists; the difference was non significant (p=0.1). However, every respondent felt that the drug was either very effective or somewhat effective in controlling seizures. Conclusions: In this internet based survey of epileptologists and neurologists, we have demonstrated that while respondents felt that PHT was effective in the treatment of epilepsy, most would not recommend this medication as the first or second choice for the treatment of partial seizures. This study shows that in the era of newer medications, the role of PHT has been placed in the category of a reserve medication in intractable epilepsy.