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Treating Newly Diagnosed Epilepsy: The Canadian Choice

Published online by Cambridge University Press:  02 December 2014

J. G. Burneo  and
R. S. McLachlan
J. G. Burneo
Affiliation:
Epilepsy Programme, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
R. S. McLachlan
Affiliation:
Epilepsy Programme, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
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Abstract

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Background:

Choosing an antiepileptic medication to treat a patient with epilepsy can be a complicated process during which the treating physician must base her or his decision on efficacy and safety of each of many available drugs. The lack of comparative studies between medications is one of the reasons.

Methods:

We conducted a survey on the management of newly diagnosed epilepsy in adult patients. The surveyed were adult and pediatric neurologists with a subspecialty interest in epilepsy who were working in academic institutions or private practice across Canada. Scenarios presented were grouped in categories according to the epilepsy syndrome (absence epilepsy, juvenile myoclonic epilepsy, undetermined idiopathic generalized epilepsy, symptomatic or cryptogenic partial epilepsy, and unclassified epilepsy), the patient's gender and age. First and second step in medical treatment for status epilepticus were surveyed as well.

Results:

Forty one of 64 experts responded the survey (responder rate of 66%). The results revealed a consensus among Canadian epileptologists that the first choice of antiepileptic medication in generalized epilepsies was between valproate in men (chosen by 88% of respondents) and lamotrigine in women. In localization-related epilepsies, carbamazepine was the preferred drug of choice (chosen by 90% of respondents). In the treatment of status epilepticus, an initial intravenous dose of lorazepam (95% of respondents), followed by a second dose of lorazepam or intravenous phenytoin in case the initial dose of lorazepam failed, were the treatments preferred.

Résumé:

RÉSUMÉ:Contexte:

Le choix d'un antiépileptique pour traiter un patient épileptique peut être un processus compliqué. Le médecin traitant doit baser sa décision sur l'efficacité et la sécurité de chacun des nombreux médicaments disponibles. Le manque d'études comparatives entre les médicaments est une des raisons à la base de ce problème.

Méthodes :

Nous avons effectué une enquête sur le traitement des nouveaux cas d'épilepsie chez l'adulte auprès des neurologues pédiatriques et adultes, ayant un intérêt particulier pour l'épilepsie et travaillant en milieu académique ou en pratique privée au Canada. Les scénarios présentés étaient regroupés en catégories selon le syndrome épileptique (absence épileptique, épilepsie myoclonique juvénile, épilepsie généralisée idiopathique indéterminée, épilepsie partielle cryptogénique ou symptomatique et épilepsie non classée), le sexe et l'âge du patient. On a également inclus la première et la seconde étape du traitement médical de l'état de mal épileptique.

Résultats :

Quarante et un des soixante et quatre experts ont répondu à l'enquête (taux de réponse de 66%). Les résultats ont montré qu'il existe un consensus parmi les épileptologues Canadiens concernant le choix de la médication antiépileptique dans les épilepsies généralisées, soit le valproate chez l'homme (choisi par 88% des répondants) et la lamotrigine chez la femme. Dans les épilepsies dont le foyer est localisé, la carbamazépine était le médicament de choix de 90% des répondants. Dans le traitement de l'état de mal épileptique, 95% des répondants ont opté pour une dose initiale intraveineuse de lorazépam, suivie d'une seconde dose de lorazépam ou de l'administration intraveineuse de phénytoï si la dose initiale de lorazépam n'a pas été efficace.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 34 , Issue 2 , May 2007 , pp. 230 - 236
Copyright
Copyright © The Canadian Journal of Neurological 2007

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