Therapeutic strategies against epilepsy in Mediterranean countries: a report from an international collaborative survey

A collaborative survey was performed to compare prescribing strategies for the treatment of epilepsy in Mediterranean countries, based on analysis of 500 questionnaires compiled by physicians in 14 different countries. For pa rtial seizures, carbamazepine was the drug of choice in most countries, whe reas the second choice of drug differed widely. For primarily generalized t onic-clonic seizures, valproic acid was usually preferred, but other drugs used widely in some countries included phenobarbital, phenytoin and carbama zepine. Lamotrigine was the most popular second-line drug for primarily gen eralized tonic-clonic seizures in the European countries. In patients where the initial drug failed, switching to an alternative monotherapy was usual ly the preferred strategy, but advocates of early use of combination therap y exceeded 30% in the respondents of seven countries. Most respondents, in all countries except Turkey, did not prescribe drugs to prevent recurrence of febrile seizures; however, intermittent prophylaxis with a benzodiazepin e was advocated by a considerable number of physicians, and continuous prop hylaxis was prescribed by a significant minority of respondents in France, Syria and Tunisia. New drugs were rarely used as first-line treatment due t o high cost and inadequate experience. Overall, this survey indicates that there is a wide variability in therapeutic practices between and within cou ntries. This information may be useful for the implementation of national e ducational activities and for the design of pragmatic trials aimed at compa ring different therapeutic strategies.