Delayed diagnosis of complex partial (temporal lobe) epilepsy - abstract

ABSTRACT

Twelve patients with complex partial epilepsy (CPE) are reviewed. The diagnosis was delayed from two to 43 years of 16.1 ñ 11.6 years (mean ñ S.D.) after fits began. The previous diagnoses had been petit mal (1), petit mal and grand mal (2), grand mal and bad behaviour (1), "not classical grand mal", (1), chronic epilepsy, retardation and tantrums (1), epilepsy and cerbral palsy (1), fits and strange feelings (1) and "epilepsy" (2). Nine patients were referred because of poor control. In three others the diagnosis was suspected from information on the drug-assay request form that control was poor and a phenothiazine was being prescribed. Control was poor in spite of three anti-epileptics in one patient and two in eight patients (various combinations of five different drugs.) Of these nine patients, five were also receiving a phenothiazine. Two patients were receiving one anti-epileptic and a phenothiazine and one patient a single anti-epileptic. Three patients had clinical toxicity and toxic blood levels at the time of referral. Four had subtherapeutic and two therapeutic levels. Three came to attention before therapeutic drug monitoring was available. Perfect or near perfect control was achieved in two patients, good control in seven and improved control in two. Nine patients were controlled on a single drug (carbamazepine in seven and phentoin in two). The others required both drugs. Phenothiazines were discontinued in all. There is little attempt to type seizures in Barbados and most CPE is undiagnosed. Greater awareness of CPE and more assiduous history-taking would obviate costly diagnostic errors. Seizure control can be dramatically improved by appropriate drug selection (preferably carbamazepine) and meticulous dose titration, with the aid of therapeutic drug monitoring (AU)