SummaryBackground-Carbamazepine is widely accepted as a drug of first choice for patients with partial onset seizures. Several newer drugs possess efficacy against these seizure types but previous randomised controlled trials have failed to inform a choice between these drugs. We aimed to assess efficacy with regards to longer-term outcomes, quality of life, and health economic outcomes.

SummaryBackground-Valproate is widely accepted as a drug of first choice for patients with generalised onset seizures, and its broad spectrum of efficacy means it is recommended for patients with seizures that are difficult to classify. Lamotrigine and topiramate are also thought to possess broad spectrum activity. The SANAD study aimed to compare the longer-term effects of these drugs in patients with generalised onset seizures or seizures that are difficult to classify.

Most researchers do not approach survey data collection ab initio, but rather draw on "conventional wisdom", often encapsulated in existing textbooks or in what they have been taught at undergraduate or postgraduate level. We thought, therefore, that it would be appropriate to preface our review of empirical studies with a summary of current "expert opinion" and then to seek confirming or refuting evidence from primary research. Sources of expert opinion were key texts on survey methods (e.g. 1,5,13,40 ). These were identified through the personal and institutional libraries of the research team. DatabasesIn our search for primary research studies, previous literature reviews and theoretical articles, we initially prioritised four electronic databases for searching:This review should be reviewed as a guide to best practice, not a definition of best practice. It is a decision aid, not a substitute for critical appraisal of the options available.

Summary: Purpose:To study the impact of epilepsy and its treatment on people with epilepsy in Europe. We therefore aimed to collect data from as many countries as possible.Methods: Clinical and demographic details and information. about psychosocial functioning was collected using selfcompleted questionnaires mailed to members of epilepsy support groups.Results: Quality of life data was collected from >5,000 patients living in 15 countries in Europe. Over a third of all respondents had frequent seizures, and a fifth believed that their seizures were not well enough controlled by antiepileptic medication. Reported levels of side effects from medication were high. A significant number of respondents reported changing their medication because of side effects or poor control. Respondents reported that epilepsy and its treatment had a significant impact on a number of different aspects of their daily lives. Half of all respondents felt stigmatised by their epilepsy. There were significant differences by seizure type and frequency in the way respondents scored on measures of the perceived impact of their condition, the stigma associated with it and their health status as measured by a generic scale, the SF36.Conclusions: This study confirms the findings of previous smaller-scale studies that reducing side effects and achieving better control of seizures are key to improving the quality of life of people with epilepsy, as is reducing the stigma and handicap associated with it. Key Words: Epilepsy-Quality of life-European-Psychosocial-Adverse drug effects.Epilepsy, like many other chronic conditions, is characterized by uncertainty. Its severity and prognosis are variable, and seizures, its outward manifestation, are unpredictable. Some chronic conditions are also stigmatizing; and epilepsy, for reasons rooted deep in its history, is a stigmatizing condition par excellence. Because of its clinical uncertainty and its social meaning, the impact of epilepsy on a person's quality of life (QOL) can be significant.Earlier studies have highlighted several areas of particular concern to people with epilepsy (14). People with epilepsy are prone to have poorer self-esteem and higher levels of anxiety and depression than people with epilepsy (5,6). diminish the quality of everyday life in this group (16). In the remaining 20-30% whose seizures are chronic and intractable, the outlook may be less optimistic (17). However, the work of the investigators cited herein (1, 6,123) clearly shows that the relationship between the severity of epilepsy and its impact on QOL is complex and may be mediated by a number of different factors, including patients' own perceptions of themselves, their condition, and its treatment.To date, no large-scale cross-cultural studies of QOL for people with epilepsy have been performed. We wished to collect information about QOL and the impact of treatment in persons living in 15 countries across Europe. We describe the QOL of our study respondents and compare groups of patients with epilepsy of differing s...

Changes to information and presentation resulted in efficient recruitment acceptable to patients and clinicians. Embedding this controversial trial within qualitative research improved recruitment. Such methods probably have wider applicability and may enable even the most difficult evaluative questions to be tackled.