Modern approach to epilepsy treatment

Abstract

Introduction: Long regular use of antiepileptic drugs aimed at reducing frequency of seizures or stopping them completely without any significant side-effects is by far the main principle of epilepsy treatment. Attention is drawn to the issues of tolerability of antiepileptic therapy and compliancy, mutual understanding between the physician and the patient. Purpose and Objectives: To determine the response to treatment of patients presenting with different types of seizures and the possibility of efficient therapeutic care of patients with epilepsy. Materials and methods: This study is based on retrospective analysis of medical documentation of patients hospitalized in 1MSP SCP. The study group was represented by 36 patients (19 men and 17 women) diagnosed with epilepsy. Results: During this study, we have evaluated the response to antiepileptic treatment given to patients presenting with different types of seizures. 21 patients (58%) had polymorphic seizures and 15 patients (42%) generalized tonic-clonic seizures. 26 patients (72%) received monotherapy and 10 patients (28%) were treated using polytherapy. Carbamazepine was used as monotherapy in 88% (23 patients) and valproate in 12% of the cases (3 patients). The polytherapy included double-therapy in 25% of cases (9 patients) and triple-therapy in 3% of the cases (1 patient). As the end result of the treatment in patients with epilepsy, we have obtained an adequate control of seizures (absence of seizures) in 36% of the cases (13 patients). A reduction of seizures’ frequency by more than 50% was observed in 36% (13 patients) and the seizures’ frequency was unchanged in 28% of the cases (10 patients). Reported treatment failure was most likely due to the short term of treatment, although refractory epilepsy in these patients is not excluded. Analyzing the adherence to treatment in ambulatory conditions, we found that 24 patients (67%) complied with the recommendations and continued treatment at home, while 12 patients (33%) dropped out of therapy. Conclusions: The study shows that polymorphic seizures are better controlled by monotherapy (37.5%-complete control) versus polytherapy (16.6%-complete control), whereas generalized tonic-clonic seizures show positive response to polytherapy (50%) versus monotherapy (30.7%). Polymorphic seizures have a good response (reduction o f >50% of seizures’ frequency) with polytherapy (50%) versus monotherapy (37.5%), whereas generalized tonic-clonic seizures, show similar response to both monotherapy and polytherapy. We’ve concluded that polymorphic seizures have a better response to treatment when compared with generalized tonic-clonic seizures, both in monotherapy and in polytherapy.