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The achievement of treatment objectives for patients with epilepsy, as defined by the treating clinicians, was compared with scoring of clinimetric indexes. Patients with the treatment objectives "complete seizures remission" or "treatment impairment/benefit balance" were included in this study. The clinimetric indexes were also compared with a clinical status rating, as assessed by the clinician. No correlation was observed between clinimetric indexes and achievement of the treatment objective. The difference noted in outcome of treatment objectives and index scores may have resulted because the indexes were group-intended and the clinician's judgment was individual-oriented. The clinician's assessment of clinical status of the patient did correlate with the composite index of impairments (CII), however, a clinimetric scale for severity of impairments caused by epilepsy. The advantage of the CII over the clinical status rating is that the CII is constructed with objective data and shows the cause of change observed during follow-up.

To test the feasibility of comparing epilepsy treatment policies and outcome, a secondary and a tertiary epilepsy care facility have been audited in a previous study (1). Marked differences were observed in the treatment policies and outcome and in the distribution of seizure types and duration of epilepsy. For this reason the patients of that study were matched according to seizure type and duration of epilepsy, resulting in two groups each of 32 patients per centre. The outcome of treatment was assessed by using clinimetrical indexes for seizure frequency and severity and toxicity of medication, resulting in the Composite Index of Impairments (CII), reflecting all treatment-related impairments. For the statistical analysis the X2-test and the Kruskal-Wallis test were used. Differences were found to be statistically significant when p < 0.05. No distinct differences were found in the treatment policies of both centres. However, differences were observed in the outcome of treatment. The toxicity ratings in this study were significantly higher for the Epilepsy Centre. Also the Composite Index of Impairments (CII) was significantly higher at the Epilepsy Centre. The number of patients with a CII score of > 100 did not differ significantly for both centres. The finding that pharmacotherapy is similar in both centres, suggests that pharmacotherapy is pushed to its limits in both, and that referral to a tertiary facility is mainly for the non-pharmacotherapeutic care modalities available. For the corroboration of this assumption the use of a quality of life index would be more appropriate than the CII.

In order to test if it is feasible to compare epilepsy treatment policies, a secondary (University Hospital) and a tertiary referral care centre (i.e. an Epilepsy Centre) were compared with respect to their characteristics, the treatment approaches, and the outcome of treatment using clinimetric indexes. At the Epilepsy Centre a greater variety of seizure types was seen than at the University Hospital. At the University Hospital more patients were treated with monotherapy (62.5%) than at the Epilepsy Centre (28.0%). The Composite Index of Impairments (CII), which reflects all treatment related impairments i.e. seizures and adverse events, was significantly higher at the Epilepsy Centre than at the University Hospital. No difference was seen in the groups of patients with a high score of the CII (> 100). Further analysis is needed to obtain an answer as to why differences between the two groups exist.

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.