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.