title: Seizure control in patients with epilepsy: the physician vs. medication factors.
abstract: BACKGROUND
  Little is known about the relationship between types of healthcare providers and outcomes in patients with epilepsy. This study compares the relative effects of provider type (epileptologist vs. other neurologist) and pharmacologic treatment (newer vs. older antiepileptic drugs) on seizure control in patients with epilepsy.
  
  
  METHODS
  We conducted a retrospective study of patients with medication-resistant epilepsy. Consecutive charts of 200 patients were abstracted using a standard case report form. For each patient, data included seizure frequency and medication use prior to, and while being treated by an epileptologist. Changes in seizure frequency were modeled using a generalized linear model.
  
  
  RESULTS
  After transferring care from a general neurologist to specialized epilepsy center, patients experienced fewer seizures (p < 0.001) and were more frequently seizure-free (p < 0.001). The improved seizure control was not related to treatment with newer vs. older antiepileptic drugs (p = 0.305).
  
  
  CONCLUSIONS
  Our findings suggest an association between subspecialty epilepsy care and improved seizure control in patients with medication-resistant epilepsy. Further research should prospectively determine whether patients with medication-resistant epilepsy would benefit from being routinely referred to an epilepsy specialist.
authors.affiliation: Department of Neurology and the Cincinnati Epilepsy Center, University of Cincinnati Academic Health Center, Cincinnati, OH, USA. jerzy.szaflarski@uc.edu
authors.forename: Jerzy P
authors.initials: JP
authors.lastname: Szaflarski
authors.forename: Angela Y
authors.initials: AY
authors.lastname: Rackley
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: Magdalena
authors.initials: M
authors.lastname: Szaflarski
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Yates
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use*; D002983:Clinical Competence; D015331:Cohort Studies; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants