Abstracts

Rationale: Use of recreational substances may affect seizure control and well being in people with epilepsy. Similarly, regular nutritional supplementation is important, especially when using enzyme inducing AEDs and in women of childbearing age. We examined these aspects in adults referred to a tertiary care epilepsy program. Methods: The University of Calgary Division of Neurology is the main tertiary referral centre for adults with epilepsy, serving 1.3 million people. We prospectively captured data on consecutive adults with the diagnosis of epilepsy at the 1st encounter in our outpatient epilepsy program, using a validated data capture and verification system, excluding patients with single seizures and children. We captured information on regular usage of alcohol, recreational (illicit) drugs, and tobacco, and on regular supplementation with folic acid, multivitamins, calcium and Vitamin D. We tabulated data and analyzed the association of use with pertinent clinical variables using chi-square statistics. Results: In 687 consecutive patients (52% women) the mean age and duration of epilepsy was 40 and 12 years respectively, 64.1% had focal epilepsy, 23% had idiopathic generalized epilepsy, and 21% were seizure free in the past year. Forty percent of patients regularly consumed alcohol (males 44%, females 36%, p=0.03), 26% smoked tobacco (males 32%, females 20%, p=0.001), and 12% used recreational drugs (males 11%, females 9%, p=ns). Seizure free and non-seizure free patients did not differ in their use of alcohol (41% vs 40%) and recreational drugs (7% vs 11%), but fewer seizure free patients smoked tobacco (17% vs 28%, p=0.03). There was no difference in use of alcohol in those with focal (38%) or generalized (40%) seizures. But fewer patients with focal seizures used recreational drugs (7% vs 12%, P=0.08) or smoked tobacco (21% vs 30%, p=0.03). There was no difference in the rate of use of these three substances between the group overall and those with self-reported anxiety or depression. More women than men used regular supplements of multivitamins (39% vs 32%, p=0.08), folic acid (10% vs 5%, p=0.01), calcium (29% vs 16%, p<0.001), and Vitamin D (30% vs 19%, p=0.001). Of 9 pregnant women only 3 were on folic acid. Seizure free and non-seizure free patients did not differ in their use of multivitamins (41% vs 33%), folic acid (7% vs 8%), calcium (27% vs 21%), and Vitamin D (28% vs 23%). Conclusions: Overall use of recreational substances was similar to that of the general population, but males were heavier users than females. Substances were used equally by patients who were and were not seizure free, raising the question of their role as seizure triggers. Fewer patients with focal seizures used substances, an observation requiring further exploration. Women were more likely to use nutritional supplements, but less than a third used calcium and Vitamin D, and only one third of pregnant women were on folic acid. Efforts need to be devoted to improving these health related behaviors in patients with epilepsy.