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Aricò M, Mastrangelo M, Di Noia SP, Mabusi MS, Kalolo A, Pisani F. The impact of a newly established specialized pediatric epilepsy center in Tanzania: An observational study. Epilepsy Behav 2023; 148:109454. [PMID: 37776594 DOI: 10.1016/j.yebeh.2023.109454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/24/2023] [Accepted: 09/16/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE This study evaluated the impact of a newly established clinic for the diagnosis of pediatric epilepsy in a resource-limited center (Ifakara, Tanzania). METHODS Patients aged 0-18 years referred to the Pediatric Epilepsy Unit of Saint Francis Referral Hospital were recruited. Demographic and clinical data were collected through Kobo Toolbox and analyzed through a descriptive analysis.. RESULTS 143 patients were evaluated, and for 48 of them an EEG was recorded (abnormalities were detected in 80.85% of the cases). The diagnosis of epilepsy was confirmed in 87 patients. Focal epilepsy was diagnosed in 57 patients, generalized epilepsy in 24 patients, and forms of unknown onset in 6 patients. Epilepsy was excluded for 9 children. Etiologies included hypoxic-ischemic encephalopathy (39%), central nervous system infections (3.4%), and genetic diseases (3.4%). A specific epilepsy syndrome was diagnosed in 16 patients. 74 patients were under treatment; the most used antiseizure medication (ASM) was phenobarbital (43.36%), followed by carbamazepine (16.08%), sodium valproate (11.19%), phenytoin (2.8%), and lamotrigine (0.7%). Therapeutic changes were proposed to 95 patients, more frequently consisting of withdrawing phenobarbital (39.16%), switching to sodium valproate (27.97%), switching to or adjusting carbamazepine dosage (27.27%), and starting prednisone (2.8%). 76% of the patients with confirmed epilepsy achieved complete seizure freedom at the fourth follow-up consultation. CONCLUSIONS Our data depicted the epilepsy spectrum and highlighted the prognostic implications of improving the availability of ASMs such as sodium valproate and second- and third-generation ones in resource-limited countries.
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Affiliation(s)
- Miriam Aricò
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; UOC Neuropsichiatria Infantile, Azienda Unità Sanitaria Locale Bologna, Italy
| | - Mario Mastrangelo
- Department of Women/Child Health and Urological Science, Sapienza-University of Rome, Italy; Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria Policlinico Umberto I, Rome, Italy.
| | - Sofia Pia Di Noia
- Division of Child and Adolescent Neurology and Psychiatry, Azienda Ospedaliero Universitaria Ospedali Riuniti Foggia, Italy; Department of Neuroscience, University of Florence, Florence, Italy
| | - Mgabo Siboti Mabusi
- Outpatients Department, Pediatric Epilepsy Unit, Saint Francis Referral Hospital, Ifakara, Tanzania
| | - Albino Kalolo
- Department of Public Health, Saint Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Francesco Pisani
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria Policlinico Umberto I, Rome, Italy
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Biresaw MS, Irawan A, Halász P, Szucs A. Unfavorable public attitude toward people with epilepsy in Ethiopia: A systematic review and meta-analysis study. Epilepsia Open 2023; 8:1054-1063. [PMID: 37394990 PMCID: PMC10472419 DOI: 10.1002/epi4.12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/30/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE This systematic review and meta-analysis aims to show the pooled prevalence of unfavorable public attitude toward people with epilepsy (UPATPWE) as well as the effect estimates of associated factors in Ethiopia. METHODS Between December 1 and 31, 2022, we searched for the English version of published research reports on public attitude toward epilepsy in Ethiopia in PubMed/Medline, Science Direct, Cochrane Library, Google Scholar, and PsycINFO. The research reports' quality was assessed using the Newcastle-Ottawa Scale. We extracted the relevant information from the searched papers in a Microsoft Excel format and imported it to STATA version 15.0, for analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reports guideline was used. A random-effects meta-analysis model was used to estimate the Der Simonian and Laird's pooled prevalence of unfavorable public attitude and its associated factors. RESULTS Nine out of the accessed 104 research papers meeting the pre-specified criteria were included in this study. The overall pooled prevalence of UPATPWE in Ethiopia is 52.06 (95% CI: 37.54, 66.59), resulting in excommunication, physical punishments, and assaults against people with epilepsy as well as frequent lack of diagnosis and proper treatment. The pooled effect estimates for witnessing a seizure episode were done and it was (AOR = 2.70 [95% CI: 1.13, 6.46]). SIGNIFICANCE As interventions and new strategies to change attitudes and facilitate a supportive, positive, and socially inclusive environment for PWE may root in education and scientific research outputs, our result hopefully evokes the policy makers' attention for building a well-designed and comprehensive health education and campaign strategy.
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Affiliation(s)
| | - Anggi Irawan
- Doctoral School of Mental Health SciencesSemmelweis UniversityBudapestHungary
| | - Peter Halász
- Department of NeurologyUniversity of Pécs Medical SchoolPécsHungary
- Epilepsy CenterNational Institute of NeurosurgeryBudapestHungary
| | - Anna Szucs
- Department of Behavioral SciencesSemmelweis UniversityBudapestHungary
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Hailemariam FH, Shifa M, Kassaw C. Availability, price, and affordability of antiseizure medicines in Addis Ababa, Ethiopia. Epilepsia Open 2023; 8:1123-1132. [PMID: 37469205 PMCID: PMC10472410 DOI: 10.1002/epi4.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVE Up to 70% of people living with epilepsy could become seizure-free with the appropriate use of antiseizure medicines. However, three quarters of people with epilepsy living in low-income countries do not get the treatment they need and also do not access antiseizure medicines. The purpose of this study was to assess the availability, price, and affordability of antiseizure medicines in Addis Ababa, Ethiopia. METHODS A cross-sectional study was done in selected pharmacies using a questioner developed after the modification of World Health Organization/Health Action International methodology. Data on the availability and price of lowest-priced generics and originator brand antiseizure medicines from essential medicines list in Ethiopia were collected from seven public sectors, five private sectors, and seven other sectors (five Kenema Public Community and two Red Cross Pharmacies) in Addis Ababa between 09 May and 31 2022. The data were analyzed using the modified World Health Organization/Health Action International workbook part I excel sheet. Descriptive results were reported in text and table format. RESULTS The overall availability of lowest-priced generics medication was 52%. The availability of lowest-priced generics was 62.86%, 30%, 55%, and 50% in public, private, Red Cross, and Kenema Public Community Pharmacies, respectively. The median price ratio in the public, private, Red Cross, and Kenema Public Community Pharmacy was 1.45, 3.72, 1.46, and 1.7, respectively. All the medications were unaffordable. Patients may be required to pay more than 6-month wage to purchase standard treatment for 1 month only. SIGNIFICANCE The overall availability of antiseizure medicines was lower than the WHO target for noncommunicable diseases. All the available medicines were unaffordable.
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Affiliation(s)
- Fikreselam Habte Hailemariam
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health ScienceAddis Ababa UniversityAddis AbabaEthiopia
| | - Mekdes Shifa
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health ScienceAddis Ababa UniversityAddis AbabaEthiopia
| | - Chalelgn Kassaw
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health ScienceAddis Ababa UniversityAddis AbabaEthiopia
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Adassi MB, Ngoupaye GT, Yassi FB, Foutsop AF, Kom TD, Ngo Bum E. Revealing the most effective anticonvulsant part of Malvaviscus arboreus Dill. Ex Cav. and its acute and sub-acute toxicity. JOURNAL OF ETHNOPHARMACOLOGY 2023; 303:115995. [PMID: 36509255 DOI: 10.1016/j.jep.2022.115995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGY RELEVANCE Different parts of Malvaviscus arboreus Dill. Ex Cav. (M. arboreus) are traditionally used in the West Region of Cameroon to treat many diseases, including epilepsy. AIM OF THE STUDY To determine which part of M. arboreus offers the best anticonvulsant effect, and to assess the acute and sub-acute toxicity of the part of interest. MATERIALS AND METHODS the anticonvulsant effect of the aqueous lyophilisate of the decoction of flowers, leaves, stems and roots of M. arboreus at various doses was evaluated and compared on the model of acute epileptic seizures induced by pentylenetetrazole (PTZ) (70 mg/kg), injected 1 h after oral administration of the various extracts. Out of these plant parts, the leaves were then selected to prepare the hydroethanolic extract and its anticonvulsant effect against PTZ at the doses of 122.5, 245 and 490 mg/kg, as well as its acute toxicity were compared with those of the aqueous lyophilisate of the leaves. The anticonvulsant effect of the aqueous lyophilisate of M. arboreus leaves was further evaluated on models of acute epileptic seizures induced by picrotoxin (PIC) (7.5 mg/kg), strychnine (STR) (2.5 mg/kg) and pilocarpine (350 mg/kg). The 28 days sub-acute toxicity, as well as the quantitative phytochemistry and the in vitro antioxidant potential (FRAP, DPPH, ABTS+) of the aqueous lyophilisate of the leaves of M. arboreus were also evaluated. RESULTS M. arboreus leaves showed the best anticonvulsant effect and the aqueous lyophilisate was the best extract. The latter significantly protected the animals against convulsions induced by PTZ (71.43%) (p < 0.01), PIC (57.14%) (p < 0.05) and STR (42%) and had no effect on pilocarpine-induced seizures. Furthermore, it showed no acute or sub-acute toxicity, and revealed a high content of flavonoids, saponins, tannins and alkaloids, and antioxidant activity in vitro. CONCLUSION The aqueous lyophilisate of the leaves of M. arboreus offers the best anticonvulsant effect on the extraction solvent used, and it would act mainly via a potentiation of the inhibitory systems of the brain (GABA, Glycine). In addition, its richness in bioactive compounds gives it an antioxidant potential, and it is not toxic in acute and sub-acute toxicity. All this justifies at least in part its empirical uses, and makes M. arboreus a candidate for the alternative treatment of epilepsy.
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Affiliation(s)
- Maxwell Blesdel Adassi
- Department of Biological Sciences, Faculty of Science, University of Maroua, P.O. Box 814, Maroua, Cameroon
| | - Gwladys Temkou Ngoupaye
- Animal Physiology and Phytopharmacology Research Unit, Department of Animal Biology, University of Dschang, P.O. Box 67, Dschang, Cameroon.
| | - Francis Bray Yassi
- Department of Biological Sciences, Faculty of Science, University of Ngaoundéré, P.O. Box, Ngaoundéré, 454, Cameroon
| | - Aurelien Fossueh Foutsop
- Animal Physiology and Phytopharmacology Research Unit, Department of Animal Biology, University of Dschang, P.O. Box 67, Dschang, Cameroon
| | - Tatiana Diebo Kom
- Department of Biological Sciences, Faculty of Science, University of Maroua, P.O. Box 814, Maroua, Cameroon
| | - Elisabeth Ngo Bum
- Department of Biological Sciences, Faculty of Science, University of Maroua, P.O. Box 814, Maroua, Cameroon
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Woldegeorgis BZ, Anjajo EA, Korga TI, Yigezu BL, Bogino EA, Tema HT, Alemu HB, Boda TI, Daba DA, Gobena N, Obsa MS. Ethiopians' knowledge of and attitudes toward epilepsy: A systematic review and meta-analysis. Front Neurol 2023; 14:1086622. [PMID: 36925943 PMCID: PMC10011168 DOI: 10.3389/fneur.2023.1086622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
Background Epilepsy remains one of the world's most common neurological diseases, but it appears to be widely misunderstood, particularly in under-resourced countries like Ethiopia. Improving individuals' knowledge and attitude toward epilepsy is critical for reducing the multifaceted impacts of epilepsy. Therefore, in this study, we sought to estimate the pooled levels of good knowledge and a favorable attitude toward epilepsy and also identify the associated factors using available data collected from different segments of the population. Methods Articles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 16 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. The random-effect meta-analysis model was used to estimate Der Simonian-Laird's pooled effect. Statistical heterogeneity of the meta-analysis was checked via Higgins and Thompson's I 2 statistics (0-100%), and Cochran's Q test at P < 0.10. Subgroups, based on the study regions, and sensitivity analyses were also performed. Publication bias was examined subjectively using funnel plots and objectively using the nonparametric rank correlation test of Begg and the regression-based test of Egger for small study effects with P < 0.05 considered to indicate potential publication bias. Furthermore, the Trim-and-fill method of Duval and Tweedie was used to explore sources of publication bias for the favorable level of attitudes toward epilepsy. Result A total of 12 studies with 6,373 study participants and 10 studies with 5,336 study participants were included to estimate the pooled level of good epilepsy knowledge and favorable attitudes respectively. The overall estimated levels of good epilepsy knowledge and favorable attitudes toward epilepsy among Ethiopians were 47.37% [(95% CI: 35.00, 59.74), I 2 = 99.2, P < 0.001] and 46.83%[(95% CI: 32.75, 60.90), I 2 = 99.2, P < 0.001] respectively. Subgroup analysis revealed that the pooled level of good epilepsy knowledge was 48.51% [(95% CI: 38.95, 58.06), I 2 = 95.6%, P < 0.001] in the Amhara region. Conclusion In the current review, we found out that there is a huge knowledge gap and an unfavorable level of attitudes towardepilepsy, which demand immediate public health action as well as a targeted policy intervention.
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Affiliation(s)
| | | | | | - Berhanu Lijalem Yigezu
- Department of Obstetrics and Gynecology, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Efa Ambaw Bogino
- Department of Dermatovenereology, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | | | - Henok Berhanu Alemu
- Department of Internal Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tesfalem Israel Boda
- Department of Internal Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | | | - Negeso Gobena
- Department of Anesthesia, Hawasa University, Hawassa, Ethiopia
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6
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On epilepsy perception: Unravelling gaps and issues. Epilepsy Behav 2022; 137:108952. [PMID: 36306590 DOI: 10.1016/j.yebeh.2022.108952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
Epilepsy is one of the most common neurological diseases, but it can sometimes be under-reported or have a time delay in diagnosis. This data is not surprising if we consider that a person often seeks medical attention only after presenting a generalized tonic-clonic seizure. Epilepsy diagnostic delay is caused by several factors: under-reporting by patients, under-diagnosed epileptic manifestations by inexperienced clinicians, and lack of time in the emergency setting. The consequences of this delay are increased accidents, a high rate of premature mortality, and economic expanses for the healthcare system. Moreover, people with epilepsy have a higher probability of comorbidities than the general population, such as mood disorders or cognitive problems. Along with recurrent seizures, these comorbid diseases promote isolation and stigmatization of people with epilepsy, who suffer from discrimination at school, in the workplace, and even in social relationships. Public awareness of epilepsy and its comorbidities is necessary to prevent diagnostic delays and overcome social and professional iniquities for people with epilepsy.
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Marshall CR, Noyce AJ, Neligan A, Dobson R. Brain health: The hidden casualty of a humanitarian crisis. THE LANCET REGIONAL HEALTH. EUROPE 2022; 15:100374. [PMID: 35531495 PMCID: PMC9072995 DOI: 10.1016/j.lanepe.2022.100374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Charles R. Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Barts Health NHS Trust, London E1 1FR, UK
| | - Alastair J. Noyce
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Barts Health NHS Trust, London E1 1FR, UK
| | - Aidan Neligan
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Homerton University Hospital, London E9 6SR, UK
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
- Neurology Department, Barts Health NHS Trust, London E1 1FR, UK
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Suppliet M. Umbrella branding in pharmaceutical markets. JOURNAL OF HEALTH ECONOMICS 2020; 73:102324. [PMID: 32683146 DOI: 10.1016/j.jhealeco.2020.102324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 01/15/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
Umbrella branding is a marketing practice whereby multi-product firms leverage their reputation across different product categories. The paper investigates how advertising in the market for non-prescription drugs affects the decision to buy prescription drugs from the same firm. To estimate the effects of umbrella branding, I exploit the fact that consumer-directed advertising of prescription drugs is prohibited in Germany and identify advertising spillovers with an instrumental variable that builds on exogenous seasonality in the non-prescription drug industry. Umbrella branding results in market expansion, particularly for generic firms, and can have a positive effect on consumer welfare in under-treated therapeutic areas.
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Affiliation(s)
- Moritz Suppliet
- European Commission (Directorate-General for Competition); and Tilburg University (TILEC & Department of Economics), The Netherlands.
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Singh G, Sander JW. The global burden of epilepsy report: Implications for low- and middle-income countries. Epilepsy Behav 2020; 105:106949. [PMID: 32088583 DOI: 10.1016/j.yebeh.2020.106949] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 11/25/2022]
Abstract
The Global Burden of Epilepsy Report estimates that there are 13 million disability adjusted life years due to epilepsy each year. Estimates of years lived with disability attributed to uncontrolled and untreated epilepsies are particularly raised in comparison to controlled epilepsies in countries with low sociodemographic indices. There are 50 million people with epilepsy in the world and of these, 125,000 die each year, and over 80% of these deaths occur in low- and middle-income countries. Overall, a global decline in the number of epilepsy-related deaths has been seen between 1990 and 2016. The least improvements have been, however, recorded in countries with low sociodemographic indices. These countries include 13 African countries, which have recorded an increase in number of epilepsy deaths over the 26 years. The huge burden of untreated and uncontrolled epilepsy and of epilepsy-related deaths in low- and middle-income countries calls for urgent efforts to improve access to epilepsy management.
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St. Peter SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103SW, the Netherlands.
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Mogal Z, Aziz H. Epilepsy treatment gap and stigma reduction in Pakistan: A tested public awareness model. Epilepsy Behav 2020; 102:106637. [PMID: 31805506 DOI: 10.1016/j.yebeh.2019.106637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/28/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
High epilepsy treatment gap (ETG) and stigma remain a major issue globally. Addressing the basic problems is necessary, for advances in management to be effective. According to the 1987 population-based study, prevalence of active epilepsy in Pakistan is 0.98% with 98.1% ETG in rural and 72.5% in urban population and the presence of stigma. These dismal figures were a stimulus for our reported activities. Recognizing the problems faced by 2.2 million people with epilepsy (PWE) in the country, a group of volunteers mostly from the medical community has attempted to address these issues with an ongoing sustained awareness program over the last 18 years, working within the constraints of prevailing healthcare system, with gratifying results. In 2001, under a nongovernmental organization (NGO), the Comprehensive Epilepsy Control Programme of Pakistan (CECP) was launched to address the various paucities in knowledge, attitude, and practice about epilepsy; especially ETG and stigma. The CECP has two primary components: Epilepsy Support Pakistan (CECP-ESP) for awareness and mass education and National Epilepsy Centre (CECP-NEC) for holistic management of PWE, professional education, and research. Both work in tandem, and there is an overlap of their activities. This article only evaluates the outcome of sustained awareness activities of the CECP-ESP, through direct and indirect measures after 5 years of its initiation. A significant reduction in ETG and stigma exclusively through public awareness has been possible. This model can be easily replicated by any country, with involvement of the local population.
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Affiliation(s)
- Zarine Mogal
- National Epilepsy Centre, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Pakistan.
| | - Hasan Aziz
- National Epilepsy Centre, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Pakistan
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Kalilani L, Faught E, Kim H, Burudpakdee C, Seetasith A, Laranjo S, Friesen D, Haeffs K, Kiri V, Thurman DJ. Assessment and effect of a gap between new-onset epilepsy diagnosis and treatment in the US. Neurology 2019; 92:e2197-e2208. [PMID: 30971487 PMCID: PMC6537131 DOI: 10.1212/wnl.0000000000007448] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/11/2019] [Indexed: 01/06/2023] Open
Abstract
Objective To estimate the treatment gap between a new epilepsy diagnosis and antiepileptic drug (AED) initiation in the United States. Methods Retrospective claims-based cohort study using Truven Health MarketScan databases (commercial and supplemental Medicare, calendar years 2010–2015; Medicaid, 2010–2014) and a validation study using PharMetrics Plus Database linked to LRx claims database (2009–2014). Persons met epilepsy diagnostic criteria, had an index date (first epilepsy diagnosis) with a preceding 2-year baseline (1 year for persons aged 1 to <2 years; none for persons <1 year), and continuous medical and pharmacy enrollment without epilepsy/seizure diagnosis or AED prescription during baseline. Outcomes included percentage of untreated persons (no AED prescription) up to 3 years' follow-up and comparative outcomes (incidence rate ratio: untreated persons/treated persons), including medical events and health care resource utilization. Results In the primary study, 59,970 persons met selection (or inclusion) criteria; 36.7% of persons with newly diagnosed epilepsy remained untreated up to 3 years after diagnosis. In the validation study (N = 30,890), 31.8% of persons remained untreated up to 3 years after diagnosis. Lack of AED treatment was associated with an adjusted incidence rate ratio (95% confidence interval) of 1.2 (1.2–1.3) for medical events, 2.3 (2.2–2.3) for hospitalizations, and 2.8 (2.7–2.9) for emergency department visits. Conclusions One-third of newly diagnosed persons remain untreated up to 3 years after epilepsy diagnosis. The increased risk of medical events and health care utilization highlights the consequences of delayed treatment after epilepsy diagnosis, which might be preventable.
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Affiliation(s)
- Linda Kalilani
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC.
| | - Edward Faught
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Hyunmi Kim
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Chakkarin Burudpakdee
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Arpamas Seetasith
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Scott Laranjo
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - David Friesen
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Kathrin Haeffs
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - Victor Kiri
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
| | - David J Thurman
- From UCB Pharma (L.K.), Raleigh, NC; Department of Neurology (E.F., D.J.T.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (H.K.), Stanford University School of Medicine, Palo Alto, CA; IQVIA (C.B., A.S.), Fairfax, VA; UCB Pharma (S.L.), Smyrna, GA; UCB Pharma (D.F.), Ascot, Berkshire, UK; UCB Pharma (K.H.), Monheim am Rhein, Germany; and FV & JK Consulting Ltd. (V.K.), Guildford, Surrey, UK. S.L. is currently employed by Aerie Pharmaceuticals, Durham, NC
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Exploring the needs and challenges of parents and their children in childhood epilepsy care: A qualitative study. Epilepsy Behav 2018; 88:268-276. [PMID: 30321756 DOI: 10.1016/j.yebeh.2018.09.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/15/2018] [Accepted: 09/16/2018] [Indexed: 11/23/2022]
Abstract
Because of the nature of epilepsy, and the unpredictability of seizure recurrence, epilepsy requires long-term treatment with medications. As a consequence, epilepsy has a negative pervasive impact in children with epilepsy (CWE), and their parents. Hence, our aim was to explore the needs and challenges of parents and their CWE. In-depth interviews (IDIs) were conducted with 15 families (12 mothers and 3 fathers) and 15 CWE (aged 8-18 years). Data were transcribed verbatim and thematically analyzed using the descriptive phenomenology approach. The experiences of parents and their CWE could be divided into two time frames: "experiences during a child's first seizure" and "experiences whilst growing up with epilepsy". Parents' main concerns and worries were regarding their child's physical health, psychological and emotional wellbeing, academic achievement, and future. The children's main concerns were restrictions imposed, their interpersonal relationship with peers, and being independent in the future. Parents reported that they needed epilepsy-related information, continuity of care, and a parental support group, while CWE reported that their main needs were independence and autonomy. The views of parents and their child with epilepsy were similar in physical functioning and academic achievement. However, parents and children had different views on how epilepsy impacted on the child emotionally, as well as behavioral and interpersonal relationship with peers.
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Deresse B, Shaweno D. General public knowledge, attitudes, and practices towards persons with epilepsy in South Ethiopia: A comparative community-based cross-sectional study. Epilepsy Behav 2016; 58:106-10. [PMID: 27070859 DOI: 10.1016/j.yebeh.2016.02.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Despite being a common disorder, epilepsy is misunderstood by the general public, leading to fear, secrecy, stigmatization, and the risk of social discrimination. OBJECTIVE This study aimed to compare knowledge, attitudes, and practices (KAP) towards persons with epilepsy among rural and urban dwellers in South Ethiopia. METHODS A comparative cross-sectional community-based study was conducted among 1316 (656 from rural and 660 from urban) adult respondents in South Ethiopia. RESULTS The most cited causes of epilepsy were brain disease (40.6%) by urban respondents and evil spirits (34.6%) by rural respondents. More urban (21.7%) than rural (16.5%) respondents believed that epilepsy is contagious (P=0.016). About 39% of rural compared with 7% of urban respondents would not allow their children to associate with a person with epilepsy (P<0.001), and 56.7% of rural compared with 24.8% of urban respondents objected to themselves or their children marrying someone with epilepsy (P<0.001). The majority of the respondents in both groups (75.5% from urban and 56.4% from rural) would recommend a medical doctor for the treatment of epilepsy, but herbal medicine and spiritual treatments such as prayers and Holy water were still commonly practiced. CONCLUSION This study demonstrated a significant difference in epilepsy KAP between urban and rural dwellers, with the former having more positive attitudes. A comprehensive epilepsy educational campaign is necessary to advance understanding among the general population, thereby improving patient care.
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Affiliation(s)
- Birrie Deresse
- Neurology Unit, Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Debebe Shaweno
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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