title: Use of phenytoin for the long-term treatment of partial seizures: Results of a survey conducted during the 2004 meeting of the American Academy of Neurology.
abstract: BACKGROUND
  Epilepsy is a chronic disorder that typically requires lifelongpharmacologic treatment. The choice of an antiepileptic drug (AED), therefore, requires careful consideration of efficacy and tolerability. However, the majority of patients with new-onset seizures are initially treated by physicians in the emergency department (ED) or by non-ED physicians (primary care physicians or internists), with phenytoin being the most common AED prescribed for initial therapy, and the long-term adverse effects of AEDs are often overlooked.
  
  
  OBJECTIVE
  The aim of this survey was to examine the perspectives of neurologistsand epileptologists concerning initial therapies prescribed by ED physicians and non-ED physicians for newly diagnosed partial seizures, particularly phenytoin, and the suitability of these therapies for long-term management of the disease.
  
  
  METHODS
  A computerized survey was conducted during the 2004 AmericanAcademy of Neurology meeting. The survey consisted of 10 questions concerning the use of AEDs in the initial and long-term treatment of newly diagnosed partial seizures.
  
  
  RESULTS
  The responses of 268 practitioners were analyzed. Survey participants indicated that 71% of patients referred to them by ED physicians were receiving phenytoin, whereas 59% of patients referred to them by non-ED physicians were receiving phenytoin. Seventy-six percent of survey participants responded that they would switch a patient having partial seizures referred from the ED to another AED. Seventy-eight percent indicated that they did not believe that the medications being received by patients with newly diagnosed partial seizures in the ED were suitable for long-term epilepsy treatment.
  
  
  CONCLUSIONS
  Although appropriate treatment might vary in the acute and chronic settings, and phenytoin is used as a primary agent for acute treatment of seizures presenting in the ED, the results of the present survey suggest a discrepancy between the medications that primary care and ED physicians prescribe for newly diagnosed partial seizures and those that specialists prescribe for long-term therapy.
authors.affiliation: Henry Ford Hospital and Health System, Detroit, Michigan, USA.
authors.forename: Brien
authors.initials: B
authors.lastname: Smith
keywords: antiepileptic drugs; bone; bone mineral density; epileptologist; neurologist; partial epilepsy; phenytoin; survey