A survey of epilepsy management and control in a hospital out-patient setting - abstract

ABSTRACT

The majority of patients with a diagnosis of epilepsy, attending the medical or paediatric outpatient clinics or the Casualty Department of the QEH in the three months, August 5 to November 5, 1987, were identified and interviewed by a research nurse. Data were collected on employment, diagnosis, fit frequency, drug regime, and alcohol use. A venous plasma sample was taken for anti-epileptic drug analysis. Two hundred and seventy-nine patients were seen (54 percent male and 46 percent female) aged 26ñ12 years meanñSD). Sixty-two per cent of adults were unemployed, nearly four times the national figure of 18 percent. There had been no attempt to qualify or label the type of epilepsy in 61 percent of patients. Specific diagrams of grand mal, complex partial and focal seizures were made in 19 percent, 18 percent and 4 percent respectively. Petit mal (1 case) appeared to be grossly under-diagnosed. Twenty-nine per cent of patients had had their last fit in the previous week, 20 percent between one week and one month, 25 percent between one and six months, and 22 percent more than six months before. Thus, half were unsatisfactorily and half well controlled. Phenytoin was the most frequently prescribed drug (in 44 percent alone, plus 13 percent in combination) followed by carbamazepine (30 percent and 13 percent) and phenobarbitone (8 percent and 6 percent). Eighty-two per cent of patients were treated with one drug, 17 percent with two and only 1 percent with three. There was a clear positive correlation between drug dose and plasma concentration for phenobarbitone, a less good one for carbamazepine and a poor one for phenytoin. Concentrations fell at high doses, showing poor compliance. More careful dose titration is necessary, using plasma monitoring. This is essential for good epilepsy control. Both doctor and public re-education is needed if patients with epilepsy are to be given a "fair deal" in health-care and employment (AU)