A decade of modern epilepsy therapy in institutionalized mentally retarded patients.

OBJECTIVE

To evaluate epilepsy therapy in an institutionalized mentally retarded (MR) population involved in a long-term program to reduce anti-epilepsy drugs.

DESIGN

An open 10-year study in 244 epileptic MR patients. An interim evaluation was performed in 1987 and a final evaluation in 1991.

PATIENTS

MR patients, with a history of symptomatic generalized and partial seizures, at Southside Virginia Training Center (SVTC), Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services.

METHODS

In 1981, an evaluation was made of the clinical condition and anti-epilepsy drug (AED) therapy for each patient. AED therapy was tapered for patients who were seizure-free, performance-impairing agents were discontinued for patients receiving polytherapy, and therapy was re-evaluated for patients with poor seizure control. Adverse drug reactions were quantitatively assessed and sedative agents reduced. The staff was educated regarding identification of seizures and adverse drug reactions.

RESULTS

A 19% reduction in polytherapy was accomplished. AEDs were discontinued in 12.7% of patients, however, nearly half required reinitiation of therapy. The percentage of patients receiving monotherapy increased from 36.5% to 58.1% with no observed loss in seizure control. Administration of barbiturates was reduced and a decrease in sedation was observed. Some patients required an increase in drug dosage. The drug reductions remained successful for up to 10 years.

CONCLUSIONS

Anti-epilepsy drugs for many institutionalized MR patients can be simplified from polytherapy to monotherapy without loss of seizure control and resulting in improved quality of life. A reduction in drug-related toxicities may be accomplished by removal or reduction in barbiturate use.