Abstracts

The National Sentinel Clinical Audit of Epilepsy-related Death (2002) revealed longstanding inadequate care for people with epilepsy throughout the United Kingdom. Recommendations include providing better support and education for patients and improving patient access to specialists in epilepsy. Specialists in epilepsy are scarce and the availability of new antiepileptic drugs (AEDs), their differing pharmacokinetics, efficacy, tolerability and potential interactions, has further complicated treatment. To improve care for patients with refractory epilepsy a new service that involves an epilepsy nurse specialist (ENS) giving patients and General Practitioners (GPs) treatment advice by telephone has recently been established a the National Hospital for Neurology and Neurosurgery (NHNN).
Patients are referred to the ENS by one of six Epilepsy Group Consultants. GPs and patients are encouraged to contact the ENS by telephone for treatment advice should problems arise between outpatient appointments. Over a two-week period there were 60 treatment-related telephone or outpatient consultations out of a total of 124 contacts. A treatment-related consultation is defined as any consultation where treatment issues, including AEDs, their side effects or seizure control were the main topics discussed.
17/60 were [lsquo]new[rsquo] patients to the ENS. The number of AEDs taken were: nil AED 1, 1AED 8, 2AEDs 5, 3AEDs 19, 4AEDs 6. Of 25 patients taking 3 or more AEDs all had different AED combinations. Among 43/60 undertaking changes to the AED regimen contact was for: AED side effects 17, ongoing seizures 12, recurrence or exacerbation of seizures 11, improvement in seizures 4, seizure related injury 2, AED overdose 1, new seizure presentation 1, prolonged post-ictal aggression 1.
Among17/60 with no recent AED change, contact was for: ongoing or worsening seizures 8, AED side effects 6, anxiety about or clarification of AED regimen 3, advice about AED interaction with co-medication 2, post-surgical complication 1. AED side effects reported were: headache 9, ataxia 8, cognition problems 8, anxiety 6, low mood 6, visual disturbance 3, fatigue 3, dizziness 2, nausea 2, insomnia 2, eye pain 2, aggression 2, depression 1, irritable mood 1, dysphasia 1, weakness 1, tremor 1, flu symptoms 1. The ENS recommended changes to the AED regimen in 44/60 patients, and notified the GP by letter in 31/44. Three patients were referred to a counselor, 2 to the Consultant, 2 to the ENS outpatient clinic and 1 to the GP.
New AEDs increase seizure free rates but also magnify the potential AED combinations, drug interactions and treatment complications in refractory epilepsy. Common complications including worsening seizures and AED side effects. Rapid access to the ENS improves continuity of care, GP and patient support and the treatment of epilepsy and minimises morbidity. The ENS service is cost effective and meets many of the recommendations for improving care made by the National Sentinel Clinical Audit of Epilepsy-related Death.