Correlation between prescribed daily dose seizure

Authors: László Horváth Klára Fekete Sándor Márton István Fekete

Publish Date: 2017/03/02

Volume: 39, Issue: 2, Pages: 459-467

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Abstract

Background Although defined daily doses DDD for antiepileptic drugs AED have been assigned only in combination therapy based on the literature most patients take them in monotherapy Furthermore discrepancies between DDD and prescribed daily dose PDD were observed Objective First to determine PDDs of AEDs and to reveal PDD/DDD ratio among seizure free versus not seizure free patients in everyday clinical practice Second to test the applicability of 75 cutoff of DDD to achieve seizure freedom Furthermore to find out what factors might influence PDD Setting Outpatient data files at a Hungarian university hospital were studied Methods A retrospective 20year crosssectional database was compiled from 1282 epileptic outpatients’ files Main outcome measure Seizure freedom and PDD were used as outcome measures Results The mean DDD of all prescribed AEDs increased steadily from monotherapy through bitherapy towards polytherapy p  00001 Most seizure free patients took AEDs in doses in the range of ≤75 of DDDs in monotherapy and bitherapy Older AEDs carbamazepine and valproate were given in a significantly higher mean dose in bitherapy in the seizure free group Among the newer types only levetiracetam and lamotrigine had a significantly higher DDD in mono bi and polytherapy Confirmed by logistic regression analysis gender age type of epilepsy and number of AEDs had a significant impact on the value of 75 DDD Conclusion No significant unfavourable impact of the lower ratio of PDD/DDD on the outcome of achieving seizure freedom has been confirmed As a measure of seizure freedom 75 of DDD may be used although individual therapy must be emphasised Precisely quantified DDD would provide a more accurate calculation of other derived values

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