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ABSTRACT
Purpose: The objective of this study was to determine the approach and management of specialists in patients with unclassified epileptic seizures in outpatient clinics in Spain. Methods: Observational, multicenter, and cross-sectional study. Ninety-three neurologists or neuropediatricians documented consecutive patients with a history of at least two difficult to classify or unclassified epileptic seizures. Patient demographics, quality of life (QOLIE-10-P), disease characteristics, and anticonvulsant treatment were captured. Physicians were asked about their therapeutic approach for the selection of an antiepileptic drug and underlying reasons. Results: A total of 725 patients were included. At the time of the survey, 81% were treated (69% with monotherapy). Most frequently given reasons for starting antiepileptic therapy were ([mean] on a scale of 1–5) efficacy, (3.9), safety (3.61), and broad-spectrum effectiveness (3.5). Reasons given for switching therapy (226/725) included need for broader spectrum of action: 70 (31.0%); simpler dosing regimen: 25 (11.1%); quality of life considerations: 24 (10.6%); lack of adherence to therapy: 24 (10.6%); comorbidities: 13 (5.8%); drug interactions: 12 (5.3%); and possibility of pregnancy 6 (2.7%). Conclusions: When deciding on starting or switching therapy for patients with difficult to classify or unclassified epilepsy, the most important consideration for the specialists included efficacy, safety, and broad-spectrum efficacy.