UK Epilepsy Research Articles

Knowledge of and attitudes expressed toward epilepsy by carers of people with epilepsy: A UK perspective

Objective The aim of this study was to investigate the knowledge and attitudes possessed by carers of people with epilepsy. Methods A postal survey of 2000 carers recruited from the membership list of a UK epilepsy charity was conducted using a standard set of questions. The questions covered their knowledge of epilepsy (e.g., estimating prevalence and identifying causes of epilepsy) and their attitudes (e.g., about the characteristics of people with epilepsy). Results Overall, 651 carers responded. Only 29% of carers were male, with the majority between 40 and 60 years of age. The majority of respondents (76%) overestimated the prevalence of epilepsy. Twenty-five percent believed that epilepsy was caused by stress. The majority of respondents believed that people with epilepsy were treated differently by others. Only a small percentage believed that people with epilepsy should be barred from such professions as teaching and nursing. Conclusions Carers of people with epilepsy generally possessed high levels of knowledge about most aspects of epilepsy, and their attitudes toward those with epilepsy were benign. There were, however, particular groups who were more likely to hold more positive attitudes, and these included younger and better-educated individuals. Limitations of this study include that the sample was self-selected and that only a third of the people to whom the questionnaire was mailed responded.

Opinion of Belgian neurologists on antiepileptic drugs: Belgian Study on Epilepsy Treatment (BESET)

To describe the choice of treatment in adult patients with epilepsy in Belgium, to detect the presence or absence of consensus among neurologists in epilepsy treatment, and to analyze the gaps between current guidelines and prescriptions. Hundred Belgian neurologists were systematically interviewed between May and June 2003 using a structured questionnaire (modified Rand method). Initial monotherapy was the preferred treatment strategy. Valproate was the first choice in idiopathic generalized epilepsy (IGE) and carbamazepine in focal epilepsy (FE). The new antiepileptic drugs (AED) were usually recommended in second-line. However, in special treatment situations, they were considered first-line, e.g., lamotrigine in case of women of childbearing age. Neurologists reached consensus for most questions on epilepsy treatment. In 2003, monotherapy with valproate and carbamazepine was the common treatment strategy in Belgium, whereas lamotrigine and to a lesser extent levetiracetam, topiramate, and oxcarbazepine were predominantly prescribed in second-line. This is in agreement with the recently published UK epilepsy guidelines but not in agreement, however, with the US guidelines, that for new onset epilepsy, new and old drugs are equally effective. Belgian neurologists, except for some special situations still prefer old drugs as first line.

Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register

Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register

Levetiracetam in pregnancy: Preliminary experience from the UK Epilepsy and Pregnancy Register

It is not known whether the antiepileptic drug (AED) levetiracetam can be used safely in human pregnancy. As part of a study to determine the risks of major congenital malformations (MCMs) for infants exposed to AEDs in utero, we identified all cases exposed to levetiracetam. Three of 117 exposed pregnancies had an MCM (2.7%; 95% CI 0.9% to 7.7%); all 3 were exposed to other AEDs.

Do the Results of Pregnancy Registries Contradict One Another?

Malformation Risks of Antiepileptic Drugs in Pregnancy: A Prospective Study from the UK Epilepsy and Pregnancy Register J Morrow, A Russell, E Guthrie, L Parsons, I Robertson, R Waddell, B Irwin, R C, McGivern, P J Morrison, J Craig J Neurol Neurosurg Psychiatry 2006;77;193–198 Objective To assess the relative risk of major congenital malformation (MCM) from in utero exposure to antiepileptic drug (AED). Methods Prospective data collected by the UK Epilepsy and Pregnancy Register were analyzed. The presence of MCMs recorded within the first 3 months of life was the main outcome measure. Results Full outcome data were collected on 3,607 cases. The overall MCM rate for all AED exposed cases was 4.2% (95% confidence interval (CI): 3.6–5.0%). The MCM rate was higher for polytherapy (6.0%) ( n = 770) than for monotherapy (3.7%) ( n = 2,598) (crude odds ratio (OR) = 1.63 ( p = 0.010), adjusted OR = 1.83 ( p = 0.002)). The MCM rate for women with epilepsy who had not taken AEDs during pregnancy ( n = 239) was 3.5% (1.8–6.8%). The MCM rate was greater for pregnancies exposed only to valproate (6.2% (95% CI: 4.6–8.2)) than only to carbamazepine (2.2% (1.4–3.4%)) (OR = 2.78 ( p < 0.001)); adjusted OR = 2.97 ( p < 0.001)). There were fewer MCMs for pregnancies exposed only to lamotrigine than only to valproate. A positive dose response for MCMs was found for lamotrigine ( p = 0.006). Polytherapy combinations containing valproate carried a higher risk of MCM than combinations not containing valproate (OR = 2.49 (1.31—4.70)). Conclusions Only 4.2% of live births to women with epilepsy had an MCM. The MCM rate for polytherapy exposure was greater than for monotherapy exposure. Polytherapy regimens containing valproate had significantly more MCMs than those not containing valproate. For monotherapy exposures, carbamazepine was associated with the lowest risk of MCM. Maternal Valproate Dosage and Foetal Malformations Vajda FJ, Eadie MJ Acta Neurol Scand 2005;112(3):137–143 Objective To study the possible dose dependence of the foetal malformation rate after exposure to sodium valproate in pregnancy. Methods Analysis of records of all foetuses in the Australian Registry of Antiepileptic Drugs in Pregnancy exposed to valproate, to carbamazepine, lamotrigine or phenytoin in the absence of valproate, and to no antiepileptic drugs. Results The foetal malformation rate was higher ( p < 0.05) in the 110 foetuses exposed to valproate alone (17.1%), and in the 165 exposed to valproate, whether alone or together with the other antiepileptic drugs (15.2%), than in the 297 exposed to the other drugs without valproate (2.4%). It was also higher ( p < 0.10) than in the 40 not exposed to antiepileptic drugs (2.5%). Unlike the situation for the other drugs, the malformation rate in those exposed to valproate increased with increasing maternal drug dosage ( p < 0.05). The rate was not altered by simultaneous exposure to the other drugs. Valproate doses exceeding 1,400 mg per day seemed to be associated with a more steeply increasing malformation rate than at lower doses and with a different pattern of foetal malformations. Conclusions Foetal exposure to valproate during pregnancy is associated with particularly high, and dose-dependent risks of malformation compared with other antiepileptic drugs, and may possibly involve different teratogenetic mechanisms.

Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register

Objective: To assess the relative risk of major congenital malformation (MCM) from in utero exposure to antiepileptic drug (AEDs). Methods: Prospective data collected by the UK Epilepsy and Pregnancy Register...

London, UK: The Chalfont Centre for epilepsy

The National Hospital for the Paralysed and the Epileptic was founded at Queen Square, London in 1857. This Hospital has since been renamed the National Hospital for Neurology and Neurosurgery. Early physicians at the National Hospital, who established the foundations of the modern understanding of epilepsy and its treatment, included Sir William Gowers, John Hughlings Jackson, Sir David Ferrier, Sir Victor Horseley and William Aldren Turner. The National Society for the Employment of Epileptics was founded in 1892. This was an initiative of the physicians at the National Hospital, in collaboration with philanthropic charities. There have been close links between the charity and the hospital ever since. In 1894, the society purchased a farm in Chalfont St. Peter, Buckinghamshire, establishing the Chalfont Centre for Epilepsy. The name of the society was changed to the National Society for Epilepsy (NSE) in 1907. The NSE has provided residential care and public education from that time at its Chalfont site and, since its beginning over a century ago, has been the largest UK epilepsy charity that supports research and provides care for those with epilepsy. In 1972, following a report by the UK Department of Health on the care of patients with epilepsy, a new National Health Service treatment unit was established at the Chalfont Centre, specially for patients with severe and complicated epilepsy. This Unit, termed the Special Assessment Unit, was run jointly by the National Hospital and the NSE and is the origin of the current National Health Service clinical inpatient and outpatient service for epilepsy at the Chalfont Centre. In 1950, the Institute of Neurology was founded as a postgraduate Institute of the University of London. The Institute has been closely linked with the National Hospital over the last half century. The unique tripartite arrangement of the current era between charity (NSE), university (Institute of Neurology of University College London) and hospital (the National Hospital for Neurology and Neurosurgery—NHNN) was established in 1983, with the joint appointment of Dr Shorvon as a Senior Lecturer in Neurology at the Institute of Neurology, and Consultant Neurologist at the NHNN and at the NSE. In 1988, the role of Medical Director of the NSE, was added to the existing posts of Senior Lecturer in Neurology at the Institute of Neurology and Consultant Neurologist at the National Hospital. This led to the restructuring and reorganisation of the clinical and research work of the NHNN, NSE and Institute of Neurology. The result was a co-ordinated and comprehensive spectrum of clinical care and research at the Chalfont and Queen Square sites and stimulated the rapid development and expansion of the range and quality of endeavours in these areas. Since its beginning in 1894, the Chalfont Centre for Epilepsy has provided residential care for those with epilepsy and associated disorders, who were not able to live in the community.

London, UK: The Chalfont Centre for Epilepsy

The National Hospital for the Paralysed and the Epileptic was founded at Queen Square, London in 1857. This Hospital has since been renamed the National Hospital for Neurology and Neurosurgery. Early physicians at the National Hospital, who established the foundations of the modern understanding of epilepsy and its treatment, included Sir William Gowers, John Hughlings Jackson, Sir David Ferrier, Sir Victor Horseley and William Aldren Turner. The National Society for the Employment of Epileptics was founded in 1892. This was an initiative of the physicians at the National Hospital, in collaboration with philanthropic charities. There have been close links between the charity and the hospital ever since. In 1894, the society purchased a farm in Chalfont St. Peter, Buckinghamshire, establishing the Chalfont Centre for Epilepsy. The name of the society was changed to the National Society for Epilepsy (NSE) in 1907. The NSE has provided residential care and public education from that time at its Chalfont site and, since its beginning over a century ago, has been the largest UK epilepsy charity that supports research and provides care for those with epilepsy. In 1972, following a report by the UK Department of Health on the care of patients with epilepsy, a new National Health Service treatment unit was established at the Chalfont Centre, specially for patients with severe and complicated epilepsy. This Unit, termed the Special Assessment Unit, was run jointly by the National Hospital and the NSE and is the origin of the current National Health Service clinical inpatient and outpatient service for epilepsy at the Chalfont Centre. In 1950, the Institute of Neurology was founded as a postgraduate Institute of the University of London. The Institute has been closely linked with the National Hospital over the last half century. The unique tripartite arrangement of the current era between charity (NSE), university (Institute of Neurology of University College London) and hospital (the National Hospital for Neurology and Neurosurgery—NHNN) was established in 1983, with the joint appointment of Dr Shorvon as a Senior Lecturer in Neurology at the Institute of Neurology, and Consultant Neurologist at the NHNN and at the NSE. In 1988, the role of Medical Director of the NSE, was added to the existing posts of Senior Lecturer in Neurology at the Institute of Neurology and Consultant Neurologist at the National Hospital. This led to the restructuring and reorganisation of the clinical and research work of the NHNN, NSE and Institute of Neurology. The result was a co-ordinated and comprehensive spectrum of clinical care and research at the Chalfont and Queen Square sites and stimulated the rapid development and expansion of the range and quality of endeavours in these areas. Since its beginning in 1894, the Chalfont Centre for Epilepsy has provided residential care for those with epilepsy and associated disorders, who were not able to live in the community.