Clinimetrics and epilepsy care

In order to study the practicability of rating scales in the regular care of people with epilepsy, indices have been developed and tested on their validity. These indices consist of the Index of Seizures, representing seizure activity, and the Composite Index of Impairment concerning the severity of impairment caused by the seizure type and frequency and the side-effects of anti-epileptic drug treatment. The indices have been applied in a retrospective quantitative evaluation of anti-epileptic drug therapy. The medical records of 250 randomly selected patients registered at an adult out-patient clinic have been reviewed. Their seizures have been classified as generalized tonic-clonic, simple partial and/or complex partial. The distribution of this population according to these indices has been studied, which leads us to the following conclusions: the global indices are valid for clinical application; in 18.6% of the patients studied there was severe impairment and unacceptable seizure control; combined types of seizure are difficult to control; no significant difference is demonstrated between monotherapy and polytherapy regarding the amount of neurotoxicity. The indices can be determined rapidly and therefore may become valuable aids for the physician in an out-patient clinic to support a decision whether or not to revise current anti-epileptic drug therapy.