Reports such as this that use previous study results not originally designed to answer the questions of interest require too many compromises to be useful in a meaningful way in the treatment of PWE. The AHRQ report’s conclusions and the subsequent critical reaction in the epilepsy community highlight the pitfalls of relying on such an analysis. The casual reader may not have the time or the inclination to dissect the details of such a report and may instead rely on the conclusions published for individual treatment and, possibly, policy decisions, all to the potential peril for PWE.
If the question is how equal are the classes of AEDs studied in the AHRQ report, properly designed, prospective comparative effectiveness studies considering all the challenges facing PWE should be completed. Given the totality of the current situation, the epilepsy community and especially PWE should demand and receive nothing less. The potential use of this report in its current form in policy decisions and in the management of PWE should be done with extreme caution, if at all.
The report is available at bit.ly/wv6YXT.
Dr. Drazkowski is an associate professor of neurology at the Mayo Clinic College of Medicine. He is the program director of Mayo’s fellowship in clinical neurophysiology, EEG, and epilepsy. He also directs the EEG laboratory and codirects the epilepsy monitoring unit at the Mayo Clinic in Arizona. His research interests have been focused primarily on social issues that confront patients with epilepsy (especially driving and quality of life).