Abstracts

Rationale: Epilepsy is a health problem in developing countries, the estimated prevalence is 14-57/1000 in latin-america. New antiepileptic drugs (AED) are expensive and unaffordable for our patients. The rational use of a simplified therapeutic scheme, would have a deep impact in primary care settigs regarding epilepsy control. Methods: We performed an observational, descriptive and retrospective study of 341 ambulatory epileptic patients from our Epilepsy Clinic was made. We aim to evaluate, along with epidemiologic data, the AED used to specific seizure type, the estimated control rate, effectiveness, tolerance and economic impact. We applied descriptive statistics software of Microsoft Excel™. Results: 457 patients were identified as ambulatory in our clinic, we eliminate 116 because (52 lack of files, and 64 ambiguous data). 341 patients were included, 189 female (55.43%), of 31.1 years old (5-85 years). The most frequent seizure type was secondarily generalized partial onset crisis (49.56%), followed by tonic-clonic generalized crisis (23.75%), complex-partial crisis (15.84%), simple-partial crisis (3.23%) and others (abscence, atonic, myoclonic, etc) in 7.33%. The overall control rate (<5 seizures per month or >50% in frecuency) was 74.78%. Monotherapy in 197 patients (57.77%) with a 71.72% control rate. Carbamacepine in 79 patients(39.89%), phenytoin (53, 26.90%), valproic acid (34, 17.25%) and topiramate (10, 5.07%). Two AED were used in 105 patients (30.79%), with 82.86% of control rate. The most frequent, second-line AED was primidone (48 patients, 45.71%), valproic acid (28, 26.66%), levetiracetam (16, 15.23%), carbamacepine (15, 14.28%) and topiramate (12, 11.42%). 39 patients received three or more AED (11.44% of total), with 69.23% of control rate. Again, primidone, topiramate, lamotrigine and levetiracetam were the most commonly prescribed. With this results we designed a simplified antiepileptic scheme as follows: 1) FIRST LINE AEDs: for primary generalized seizures (abscence, atonic, mioclonic, clonic, tonic)=valproic acid; for secondarily generalized partial seizures or primary generalized tonic-clonic seizures= carbamacepin or phenytoin; for simple or complex-partial crisis= carbamacepin or phenytoin. 2) SECOND LINE AED: primidone. 3) THIRD LINE AED: topiramate or lamotrigine. Note that in our Public Healthcare System these drugs are available. Aditionally, we recommend the use folic acid in every patient, specially in women. The scheme includes general recomendations, draws of seizure types and contact information (24 hours-telephone and address) of our epilepsy center. Conclusions: We find our simplified antiepileptic scheme not only as a real and economic option, but also as an effective strategy for epilepsy control. Based on this data, we are currently applying this model in 20 rural clinics in our state, trainning primary care physicians in order to facilitate the evaluaton, treatment and integral attention of our epileptic patients. It is easy to understand the potential impact of this approach in developing countries.