Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2001 Nov;71(5):632–637. doi: 10.1136/jnnp.71.5.632

The dynamics of drug treatment in epilepsy: an observational study in an unselected population based cohort with newly diagnosed epilepsy followed up prospectively over 11-14 years

S Lhatoo 1, J Sander 1, S Shorvon 1
PMCID: PMC1737609  PMID: 11606675

Abstract

OBJECTIVES—To study prospectively long term dynamics and patterns of treatment in a population based cohort of patients with newly diagnosed epilepsy.
METHODS—564 patients with definite epilepsy entered the UK National General Practice Study of Epilepsy (NGPSE), between 1984 and 1987,and were prospectively followed up for between 11-14 years.
RESULTS—Treatment was started in 433 (77%) patients. Only 15% of single seizure patients had medication prescribed initially, although due to high seizure recurrence, more than 70% ultimately received antiepileptic medication. 209/564 patients (37%) were on drug therapy for epilepsy at the time of last follow up. 168/564 patients (30%) have stayed continuously on medication and another 41/564 patients (7%) restarted drug therapy because of seizure recurrence, having withdrawn medication. 98/209 (47%) of those on treatment are known to be in 5 year terminal remission. Phenytoin (29%) and carbamazepine (27%) were the most commonly preferred first line drugs followed by valproate (15%). Less than half of treated patients with partial seizures received carbamazepine as a first line drug and less than a third with generalised seizures were prescribed valproate as first choice drug. Nine out of 31 (29%) patients with one or more seizures a week at last follow up had never tried a second drug and only seven (23%) had tried four or more drugs. 11% of all treatment changes involved a new antiepileptic drug. Treatment changes were associated with low terminal remission rates.
CONCLUSIONS—Out of 30 000 patients with newly diagnosed epilepsy every year in the United Kingdom, about 6000 have inadequate seizure control in the long term. About a third of the patients in this group have one or more seizures every month. Only two thirds of these patients with frequent seizures are likely to switch medication to try and achieve better seizure control. There is probably still considerable room for improvement in prescribing practice in the United Kingdom.



Full Text

The Full Text of this article is available as a PDF (110.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cockerell O. C., Johnson A. L., Sander J. W., Hart Y. M., Goodridge D. M., Shorvon S. D. Mortality from epilepsy: results from a prospective population-based study. Lancet. 1994 Oct 1;344(8927):918–921. doi: 10.1016/s0140-6736(94)92270-5. [DOI] [PubMed] [Google Scholar]
  2. Cockerell O. C., Johnson A. L., Sander J. W., Hart Y. M., Shorvon S. D. Remission of epilepsy: results from the National General Practice Study of Epilepsy. Lancet. 1995 Jul 15;346(8968):140–144. doi: 10.1016/s0140-6736(95)91208-8. [DOI] [PubMed] [Google Scholar]
  3. Cockerell O. C., Johnson A. L., Sander J. W., Shorvon S. D. Prognosis of epilepsy: a review and further analysis of the first nine years of the British National General Practice Study of Epilepsy, a prospective population-based study. Epilepsia. 1997 Jan;38(1):31–46. doi: 10.1111/j.1528-1157.1997.tb01075.x. [DOI] [PubMed] [Google Scholar]
  4. Hart Y. M., Sander J. W., Johnson A. L., Shorvon S. D. National General Practice Study of Epilepsy: recurrence after a first seizure. Lancet. 1990 Nov 24;336(8726):1271–1274. doi: 10.1016/0140-6736(90)92960-p. [DOI] [PubMed] [Google Scholar]
  5. Hart Y. M., Sander J. W., Sharvon S. D. National General Practice Study of Epilepsy and Epileptic Seizures: objectives and study methodology of the largest reported prospective cohort study of epilepsy. National General Practice Study of Epilepsy and Epileptic Seizures (NGPSE). Neuroepidemiology. 1989;8(5):221–227. doi: 10.1159/000110186. [DOI] [PubMed] [Google Scholar]
  6. Hart Y. M., Shorvon S. D. The nature of epilepsy in the general population. I. Characteristics of patients receiving medication for epilepsy. Epilepsy Res. 1995 May;21(1):43–49. doi: 10.1016/0920-1211(95)00007-w. [DOI] [PubMed] [Google Scholar]
  7. Hauser W. A., Anderson V. E., Loewenson R. B., McRoberts S. M. Seizure recurrence after a first unprovoked seizure. N Engl J Med. 1982 Aug 26;307(9):522–528. doi: 10.1056/NEJM198208263070903. [DOI] [PubMed] [Google Scholar]
  8. Heller A. J., Chesterman P., Elwes R. D., Crawford P., Chadwick D., Johnson A. L., Reynolds E. H. Phenobarbitone, phenytoin, carbamazepine, or sodium valproate for newly diagnosed adult epilepsy: a randomised comparative monotherapy trial. J Neurol Neurosurg Psychiatry. 1995 Jan;58(1):44–50. doi: 10.1136/jnnp.58.1.44. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Mattson R. H., Cramer J. A., Collins J. F. A comparison of valproate with carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults. The Department of Veterans Affairs Epilepsy Cooperative Study No. 264 Group. N Engl J Med. 1992 Sep 10;327(11):765–771. doi: 10.1056/NEJM199209103271104. [DOI] [PubMed] [Google Scholar]
  10. Mattson R. H. Drug treatment of uncontrolled seizures. Epilepsy Res Suppl. 1992;5:29–35. [PubMed] [Google Scholar]
  11. Sander J. W., Shorvon S. D. Epidemiology of the epilepsies. J Neurol Neurosurg Psychiatry. 1996 Nov;61(5):433–443. doi: 10.1136/jnnp.61.5.433. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Shorvon S. D., Chadwick D., Galbraith A. W., Reynolds E. H. One drug for epilepsy. Br Med J. 1978 Feb 25;1(6111):474–476. doi: 10.1136/bmj.1.6111.474. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Shorvon S. D. The temporal aspects of prognosis in epilepsy. J Neurol Neurosurg Psychiatry. 1984 Nov;47(11):1157–1165. doi: 10.1136/jnnp.47.11.1157. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Snead O. C., 3rd, Hosey L. C. Exacerbation of seizures in children by carbamazepine. N Engl J Med. 1985 Oct 10;313(15):916–921. doi: 10.1056/NEJM198510103131503. [DOI] [PubMed] [Google Scholar]
  15. YAHR M. D., SCIARRA D., CARTER S., MERRITT H. H. Evaluation of standard anticonvulsant therapy in three hundred nineteen patients. J Am Med Assoc. 1952 Oct 18;150(7):663–667. doi: 10.1001/jama.1952.03680070033009. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES