A one year-review of anti-epileptic drug monitoring in Trinidad

OBJECTIVE: To audit anti-epileptic drug monitoring in tertiary hospitals in Trinidad. METHODS: Epileptic patients, from hospital clinics, who were receiving maintenance therapy and were referred for plasma drug level monitoring, gave informed consent and were enrolled. Blood collection was at trough levels of drug and coded plasma samples were analysed by competitive immunoassay on the TDx Monitoring system. RESULTS: All 93 patients consented to participate. Phenytoin and carbamazepine were the two major drugs prescribed. The use of multiple drugs did not influence the occurrence of seizures in the patients; (31 percent) receiving polytherapy. Phenobarbital was the most frequent agent added to the drug regime in 24/9 patients (83 percent). Low plasma levels of drugs were detected in 58 percent and 36 percent of patients receiving polytherapy with phenytoin and carbamazepine respectively; but an association was not found between the range of drug levels and the frequency of seizures. Seventy-seven (83 percent) patients reported good compliance. Plasma drug levels were significantly below normal (p=0.004) in patients who reported poor compliance. CONCLUSIONS: Multiple drug therapy did not influence the prognosis of seizure control in this study. Suspected non-compliance, drug toxicity and failure to individualize dosing are considerations for plasma level drug monitoring in the protocol for management of epilepsy.(Au)

Epilepsy at the General Hospital, Port-of-Spain - abstract

In 1987, the discharge diagnosis on 264 patients admitted to 5 medical wards at the General Hospital, Port-of Spain was fits/epilepsy/seizures. This prompted us to review the cases of epilepsy attending the Neurology Clinic at the institution over a 3-month period, May-August, 1988. There were 182 cases aged 8 to 80 years. Common seizure patterns were tonic/clonic 124 (685), and complex partial become generalized 37 (21 percent). Monotherapy was used in 117 (64 percent), 2 drugs in 51 (28 percent), and 3 drugs in 6 (3 percent) patients. The most commonly used drug was dilantin, drugs included phenobarbitone in 49 cases, mostly in combination and tegretol in 42 cases (21 cases each, singly and in combination). The commonest combination was dilantin and phenobarbitone in 31 cases (17 percent). Antiepileptic drug (AED) levels were done on 297 Specimens from 107 patients and, overall, 117 (39 percent) were in the therapeutic range. Only 59 patients (32 percent) were in good control, i.e. there were no seizures in the 6 months prior to the visit. Epilepsy is not satisfactorily controlled in these patients. This partly reflects lack of compliance, lack of regular supplies of medication, supervision by staff not well-informed in the management of epilepsy, frequent change of clinic staff and lack of awareness of the nature of the illness by patients (AU)

Multiple sclerosis in Trinidad and Tobago - abstract

No studies have been reported on the incidence or prevalence or multiple sclerosis in Trinidad and Tobago. This paper reports on 15 cases presenting between 1976 and 1986, seen either at the Port-of-Spain General Hospital (9) or privately (6) by one of us (P.R.). All the cases fit into one of the categories defined by Poster et al (1983): 3 are laboratory supported, definite; 9 are clinically definite; and 3 are clinically probable. One is an expatriate who was born and lived in Scotland for more than 30 years. Fourteen were born in the West Indies - 3 in Jamaica and 11 in Trinidad. The male: female ratio is 12:2. Of the 11 patients from Trinidad, 4 are of East Indian origin; 1 of African origin and 6 mixed (at least 1 grandparent white). Of the 3 born in Jamaica, 2 are mixed and one probably of pure African origin. The age of onset of symptoms was between 11 and 39 years. Most of the patients were diagnosed within 2 years of their first symptoms. Three died, 2 of African origin (aged 37 and 43), both 6 years after diagnosis and 1 East Indian, 4 years after diagnosis. Of the 14 West Indian born patients, 64 percent presented with visual symptoms; 78 percent had optic neuritis/atrophy during the illness. In temperate climates, the prevalence of optic neuritis is 25-40 percent. Tests for HTLV-1 antibodies were done in 8 patients; 1 case was positive. CSF from 5 patients was examined for oligoclonal banding and 3 were positive. The fact that 8 of the 14 patients are of mixed (African and White) ancestry is a point in favour of some predisposing gene from a white ancestor (AU)