Clinical features associated with a successful or unsuccessful response to high dose antiepileptic drug therapy were evaluated prospectively in 82 patients with chronic complex partial seizures. Complete seizure control was observed during high dose drug therapy in 18 patients at plasma concentrations of either 9-35 micrograms/ml phenytoin, 32 and 40 micrograms/ml phenobarbitone, 8 micrograms/ml carbamazepine, or a combination of 25 micrograms/ml phenobarbitone and 4 micrograms/ml carbamazepine. Patients who became free of seizures had a markedly lower number of three seizures (range: 1-29) in the year before the high dose treatment as compared to 40 seizures (range: 3-328) in patients with an increased or unchanged seizure frequency (p less than 0.0001). Complex partial seizures without automatism were found only in patients with complete seizure control (22%). Patients whose seizures remained uncontrolled more frequently gave a history of severe depression or psychotic episodes, clusters of complex partial seizures, two or more seizures per day, and an aura preceding the attack. The results suggest that taking a careful history will uncover clinical features associated with a successful or unsuccessful response to high dose antiepileptic drug therapy in an epileptic out-patient with chronic complex partial seizures.
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