Epilepsy treatment in The Netherlands. Comparison of matched groups of two medical centres.
To test the feasibility of comparing epilepsy treatment policies and outcome, a secondary and a tertiary epilepsy care facility have been audited in a previous study (1). Marked differences were observed in the treatment policies and outcome and in the distribution of seizure types and duration of epilepsy. For this reason the patients of that study were matched according to seizure type and duration of epilepsy, resulting in two groups each of 32 patients per centre. The outcome of treatment was assessed by using clinimetrical indexes for seizure frequency and severity and toxicity of medication, resulting in the Composite Index of Impairments (CII), reflecting all treatment-related impairments. For the statistical analysis the X2-test and the Kruskal-Wallis test were used. Differences were found to be statistically significant when p < 0.05. No distinct differences were found in the treatment policies of both centres. However, differences were observed in the outcome of treatment. The toxicity ratings in this study were significantly higher for the Epilepsy Centre. Also the Composite Index of Impairments (CII) was significantly higher at the Epilepsy Centre. The number of patients with a CII score of > 100 did not differ significantly for both centres. The finding that pharmacotherapy is similar in both centres, suggests that pharmacotherapy is pushed to its limits in both, and that referral to a tertiary facility is mainly for the non-pharmacotherapeutic care modalities available. For the corroboration of this assumption the use of a quality of life index would be more appropriate than the CII.
Institute of Neurology, University Hospital Nijmegen, The Netherlands.
M W
MW
Lammers
D J
DJ
Wijsman
Y A
YA
Hekster
A
A
Keyser
W O
WO
Renier
H
H
Meinardi
H
H
van Lier
D000293:Adolescent; D000328:Adult; D002220:Carbamazepine / Q000627:therapeutic use*; D003975:Diazepam / Q000627:therapeutic use*; D004827:Epilepsy / Q000178:diet therapy*; D005013:Ethosuximide / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D010634:Phenobarbital / Q000627:therapeutic use*; D010672:Phenytoin / Q000627:therapeutic use*; D011324:Primidone / Q000627:therapeutic use*; D011787:Quality of Health Care; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*; D020888:Vigabatrin; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use
D011324:Primidone; D002220:Carbamazepine; D005680:gamma-Aminobutyric Acid; D005013:Ethosuximide; D014635:Valproic Acid; D010672:Phenytoin; D020888:Vigabatrin; D003975:Diazepam; D010634:Phenobarbital