Discrepancies between physicians' prescriptions and patients' use of antiepileptic drugs.

OBJECTIVES: The purpose of this study was to investigate whether prescribed antiepileptic drugs (AEDs) were consistent with what patients actually used, and to explore challenges in treatment and reasons for possible discrepancies according to patients' view of their medication. MATERIAL AND METHODS: Anonymized data were collected from a questionnaire distributed to in- and outpatients and their physicians at the National Center for Epilepsy, Norway. They were asked to report AEDs and dosages currently used. Additionally, 20 patients were interviewed regarding AED treatment. This information was analyzed qualitatively. RESULTS: Answers from 174 patients and their physicians were analyzed. The patients' mean age was 43 years (21-83 years), 85 (49%) were women, and 56% used AED polytherapy (2-5 AEDs). For 56 patients (32%), there was a discrepancy regarding either dosage (n = 70) or prescribed drug (n = 32) (12%). There were discrepancies for all top 10 used drugs, with a similar distribution of patients stating lower or higher doses. Based upon interviews of 20 patients, concerns and challenges in AED treatment were addressed. Polytherapy and adverse effects which reduced the patients' quality of life were the most important obstacles for adherence to the treatment. CONCLUSIONS: This study revealed that 32% of the patients had one or more discrepancies between what the physician had prescribed and what the patients actually used, in either the type or the dosages of AEDs. Polytherapy, adverse effects, and poor adherence were common challenges. Improved communication and information about AEDs may improve adherence and thus treatment outcome.

Withdrawal of antiepileptic drugs during presurgical video-EEG monitoring: an observational study for evaluation of current practice at a referral center for epilepsy.

OBJECTIVES: Withdrawal of antiepileptic drugs (AEDs) before and during video-EEG-monitoring is commonly implemented to reduce time needed to register a sufficient number of seizures during presurgical evaluation. There are, however, few guidelines regarding withdrawal rate and observation time. MATERIAL AND METHODS: We performed an observational study including sixty patients admitted to the national Norwegian epilepsy centre and registered tapering of AEDs and their effect on seizure rate and possible complications. RESULTS: The mean daily seizure rate before admission to the EMU was 0.4 (range 0.02-4) increasing to 1.1 (range 0-8) at the EMU. 29 patients (48%) followed a slow tapering rate whereas 31 (52%) had an intermediate tapering rate. There was no significant difference between the patients with a daily seizure rate during LTM of more or <0.7 seizures per day, an increase of seizure frequency from habitual to during LTM of more or <3.3 or 6.9 with regard to rate of tapering (slow vs intermediate) etiology or AED monotherapy vs polytherapy. Twenty-six patients (43%) had a sufficient number of seizures registered within 3 days to conclude regarding the presurgical evaluation. Two patients received escape treatment while 25 patients did have 24 h-seizure-clusters. There was no serious event. CONCLUSIONS: Less than 50% of the patients got a sufficient number of seizures for a conclusive result within 3 days. An increase in the registration period could increase the number of successful registrations.