Abstracts

Rationale: 40 % of all patients with epilepsy are resistant to anti-epileptic drugs. Patients with focal epilepsies are than considered to be evaluated for epilepsy surgery. It is supposed that part of these patients are only pseudo-resistant to drug treatment because of inadequate drug dosage. We studied the improvement of seizure control by only increasing the dosage of the already prescribed drug at the time of the admission of the patients to the level IV epilepsy center.Methods: Analyzed were retrospectively the records of 272 (128 males, 144 females) consecutively admitted patient to the level IV epilepsy center. The average duration of the epilepsy was 16,54 years. The reason for admission was improvement of treatment response and pre-surgical evaluation. 35 patients had a carbamazepine monotherapy and 41 patient valproic acid monotherapy. The average follow up period was 6 month. Results: From 35 patients with carbamazepine monotherapy 8 patients (23 %) became seizure free and additional 3 patients (8,6 %) had a more than 50 % seizure reduction. The average dosage increase was 450 mg and the average increase of the serum level was 3.17microgramm /ml. From 41 patients with valproic acid monotherapy 20 patients (48,8%) became seizure free and 5 (12%) had a more than 50% seizure reduction. The average dosage increase in these cases was 700mg and the average increase of serum level was 31 microgramm /ml.Conclusions: Inadequate dosing is a major cause of pseudo pharmaco resistance. One third of the patients with CBZ-monotherapy and two third of patients with VPA-monotherapy became seizure free or had more than 50% seizure reduction. The first treatment step of an increase of the dosage results in an impressive improvement of outcome. A cost intensive pre-surgical evaluation can be avoided in those cases.