title: Audit of the management of patients with refractory epilepsy.
abstract: Achieving rational management for patients with refractory epilepsy can be difficult. We audited our management of 55 patients with refractory epilepsy by comparing two 3-month periods each 9 months apart. Despite attempts to rationalize antiepileptic drug therapy, a smaller proportion of patients were managed with monotherapy by the second analysis (16% vs 22%); however fewer patients were taking three or more AEDs (28% vs 43%). A substantial impact on seizure frequency was made in only six patients whilst 22 patients had a significant deterioration in seizure number (P = 0.005). Monitoring of AED levels was of little value with only six clinical decisions based on 305 AED levels performed at a cost of 2525 pounds. The newer AEDs accounted for a disproportionate expenditure (65% of the total AED cost in the second 3-month period) considering their lack of therapeutic impact. We confirm the need for audit in this patient group to ensure that pre-defined targets are met.
authors.affiliation: Department of Neurology, Leicester Royal Infirmary, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Martin
authors.forename: P A
authors.initials: PA
authors.lastname: Millac
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000097:blood / Q000191:economics / Q000627:therapeutic use; D004827:Epilepsy / Q000097:blood / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged
chemical_list: D000927:Anticonvulsants