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Article history: Objective: The goal of this study was to survey a group of epileptologists in China regarding the treatment of
Received 25 September 2011 adult epilepsy.
Revised 13 October 2011 Methods: A questionnaire on treatment of adult epilepsy was sent to a group of opinion leaders in the eld of
Accepted 18 October 2011 epilepsy.
Available online 25 November 2011
Results: For initial monotherapy for idiopathic generalized epilepsy (IGE), valproate was rated as the treat-
ment of choice. In symptomatic localization-related epilepsy (SLRE)/simple partial seizures and SLRE/
Keywords:
Epilepsy
complex partial seizures, carbamazepine and oxcarbazepine were the respective treatments of choice,
Treatment whereas in SLRE/secondarily generalized tonicclonic seizures, carbamazepine, lamotrigine, and oxcarbaze-
Idiopathic generalized epilepsy pine were treatments of choice. For women who were pregnant or trying to conceive, lamotrigine was the
Symptomatic localization-related epilepsy treatment of choice for both IGE and SLRE. In people with epilepsy who were HBsAg positive, whether
Expert consensus liver function was normal or not, topiramate and levetiracetam were treatments of choice for IGE. Valproate
and levetiracetam were treatments of choice for seizures in the emergency department.
Conclusion: A high level of consensus was reached on most treatments of choice and rst-line treatments for
patients with epilepsy, which were in accordance with published US expert opinion.
2011 Elsevier Inc. All rights reserved.
1. Introduction 2. Methods
1525-5050/$ see front matter 2011 Elsevier Inc. All rights reserved.
doi:10.1016/j.yebeh.2011.10.018
P. Yu et al. / Epilepsy & Behavior 23 (2012) 3640 37
Vagus nerve stimulation and the ketogenic diet are not widely used in 3.1. General treatment strategy
China, so they were not included in this study. To address the high
prevalence of hepatitis B in China, we added questions on therapy Initial monotherapy was unanimously the preferred treatment
for patients who were HBsAg positive with or without impaired he- strategy for IGE (100%) and SLRE (100%). In case of failure, a second
patic function. Additionally, we included questions on AED therapy monotherapy was preferred by more than 90% of the experts for
in patients with behavioral problems and in patients with poststroke both types of epilepsy. In the case of a third step, approximately
epilepsy. As HIV is rare in patients with epilepsy in China, we did not half of the experts used a combination of two AEDs. In any following
include questions on this topic. steps, approaches varied (Figs. 1 and 2).
Two types of questions were used. The rst type was used to iden-
tify the overall approach used in the treatment of IGE or SLRE. The 3.2. Idiopathic generalized epilepsy
second type asked the experts to use a modied 9-point scale to
rate specic treatment choices. Valproate was the treatment of choice for all three seizure types
(tonicclonic, absence, and myoclonic) (Table 1). Topiramate and
lamotrigine were also regarded as rst-line treatment for generalized
2.3. Statistics tonicclonic seizures. If initial treatment for generalized tonicclonic
and absence seizures failed, the second choice for monotherapy was
For each option, we dened the presence or absence of consensus lamotrigine; levetiracetam was the preferred rst-line treatment for
as a distribution unlikely to occur by chance. This was done using a 2 myoclonic epilepsy (see Table 1). For all three seizure types, valproate
test (P b 0.05) with the distribution of scores divided into three cate- was the treatment of choice in the case of failure of other AEDs.
gories on the scale of appropriateness (13, 46, and 79). We calcu-
lated the mean, SD, and condence interval (CI) for each option. The 3.3. Symptomatic localization-related epilepsy
CI is calculated statistically, and indicates that if the survey were con-
ducted again, there is a 95% chance that the response would fall with- Carbamazepine and oxcarbazepine were rated as the treatment of
in this range. choice for all three types of seizures. Lamotrigine was rated as the
A categorical rating of rst, second, or third line was designated treatment of choice for secondarily generalized seizures. Table 2
for each option based on the lowest category into which its CI fell. also lists preferred treatment approaches after failure of a rst-line
Thus, options with a CI that fell entirely at or above 6.5 were assigned drug in cases of SLRE. Carbamazepine, oxcarbazepine, and lamotri-
a rst-line rating, whereas those with a CI between 3.5 and 6.49 were gine were treatments of choice after unsuccessful trials of the other
designated second line, and those with a CI below 3.5 were designat- AEDs. Lamotrigine was the treatment of choice after an unsuccessful
ed third line. First-, second-, and third-line options were determined trial of carbamazepine or oxcarbazepine.
for each clinical situation. Items that were rated treatment of choice
within the rst-line category were options that at least 50% of the 3.4. Combination therapy
experts thought were extremely appropriate, as indicated by a rating
of 9 on the appropriateness scale. Valproate was selected as the treatment of choice for IGE when
combined with other AEDs. For SLRE, carbamazepine or oxcarbaze-
pine in combination with topiramate, valproate, levetiracetam, lamo-
3. Results trigine, or gabapentin was considered the treatment of choice. In
combination with valproate, lamotrigine was considered the treat-
All 49 respondents held an M.D. degree. Among the respondents, ment of choice. Lamotrigine, valproate, and phenytoin were consid-
11 (22.4%) were female and 38 (77.6%) male. Their mean age was ered treatments of choice in combination with topiramate.
53.9 years, with a mean of 29.2 years in practice. Forty-six (93.9%)
worked in the epilepsy center of a tertiary referral hospital in China, 3.5. Special patient populations
and 43 (87.8%) reported having participated in a research project in-
volving patients with epilepsy during the previous 5 years. The ex- For women of reproductive age, whether planning to have a fam-
perts all reported that a median of 100 patients with epilepsy ily in the future or trying to conceive and planning to breastfeed,
visited their epilepsy clinic each month. The median time for comple- lamotrigine was the treatment of choice for both IGE and SLRE. For
tion of the survey was 2.75 hours. healthy elderly women and men, lamotrigine and oxcarbazepine
Fig. 1. Overall treatment strategy for patients with idiopathic generalized epilepsy.
38 P. Yu et al. / Epilepsy & Behavior 23 (2012) 3640
Fig. 2. Overall treatment strategy for patients with symptomatic localization-related epilepsy.
medical literature is scant or lacking. Using the survey data, clinicians Xishun Huang, Yuangui Huang, Liri Jin, Sengyang Lang, Guoliang Li,
can compare their own practices with those of a panel of experts. In Weiping Liao, Weihong Lin, Xiaorong Liu, Xingzhou Liu, Xiuqin Liu,
addition to aiding physician self-assessment, the recommendations Yuxi Liu, Zhenguo Liu, Qinchi Lu, Renfei Ma, Hui Reng, Xuzhong
reinforce the importance of studies comparing epilepsy therapies. Luan, Dinglie Shen, Hongbin Sun, Lan Tan, Xin Wang, Weiwei Wang,
As new data become available in China, the opinions of experts will Xuefeng Wang, Yuping Wang, Guohua Wei, Liwen Wu, Xun Wu,
continue to change, reecting these advances as well as their personal Guofeng Wu, Shijing Wu, Bo Xiao, Yong Yan, Liyun Yu, Liming
experience in the optimal use of these therapies. The recommenda- Zhang, Yindong Zhang, Qinjie Zhao, Zhongxin Zhao, Rongyuan Zhen,
tions in this publication reect the opinions of the experts and should Dong Zhou, Lieming Zhou, Guoxing Zhu, Suiqiang Zhu.
be evaluated in conjunction with evidence-based ndings.
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