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Moreau M, Coo H, Pattathil N, Kukreti V, Brooks SC, Sehgal A. Investigating Associations Between Nonadherence to Guideline-Recommended Treatment of Pediatric Seizures and Adverse Outcomes: A Canadian Feasibility Study. Pediatr Neurol 2024; 156:113-118. [PMID: 38761642 DOI: 10.1016/j.pediatrneurol.2024.04.021] [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: 10/11/2023] [Revised: 03/04/2024] [Accepted: 04/22/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Emerging evidence suggests that nonadherence to treatment guidelines for seizures may affect patient outcomes. We examined the feasibility of conducting a larger investigation to test this hypothesis in the pediatric population. METHODS We retrospectively reviewed charts of patients aged ≤18 years who presented with seizure to the emergency departments of two Ontario hospitals in 2019 to 2021. Patients were grouped by seizure duration (<5 minutes [n = 37], ≥5 minutes [n = 41]). We examined nonadherence to guideline-recommended treatment, adverse outcomes (hospitalization, length of stay, respiratory complications), and missing values for key variables. RESULTS Of 78 patients, 34 (44%) did not receive guideline-recommended treatment. Nonadherence was similar in the two groups (<5 minutes: 46%; ≥5 minutes: 41%). Common deviations included administering an antiseizure medication (ASM) for seizures of less than five minutes (46%), a delay (>10 minutes) between the first and second ASM doses (50%), and use of a benzodiazepine for the third dose (45%). Hospitalizations were common in both seizure duration groups (∼90%), whereas respiratory complications were relatively rare. Time of seizure onset was missing in 51% of charts, and none contained the time of first contact with emergency services when patients were transported by ambulance. CONCLUSION We found evidence of substantial nonadherence to guideline-recommended treatment of pediatric seizures. Medical records do not contain sufficient information to comprehensively investigate this issue. A multicenter prospective study is the most feasible option to examine the association between nonadherence to guideline-recommended treatment and patient outcomes.
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Affiliation(s)
- Meaghan Moreau
- Department of Pediatrics, Queen's University, Kingston, Ontario; Kingston Health Sciences Centre, Kingston, Ontario
| | - Helen Coo
- Department of Pediatrics, Queen's University, Kingston, Ontario
| | | | - Vinay Kukreti
- Department of Pediatrics, Queen's University, Kingston, Ontario; Department of Pediatrics, Lakeridge Health, Oshawa, Ontario
| | - Steven C Brooks
- Kingston Health Sciences Centre, Kingston, Ontario; Department of Emergency Medicine, Queen's University, Kingston, Ontario
| | - Anupam Sehgal
- Department of Pediatrics, Queen's University, Kingston, Ontario; Kingston Health Sciences Centre, Kingston, Ontario.
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Hajji EB, Traore B, Hassoune S, Bellakhdar S, Rafai MA, Lakhdar A. Antiseizure medication adherence and epilepsy surgery attitude in people with epilepsy in Morocco: A cross-sectional study. Epilepsy Behav Rep 2024; 26:100672. [PMID: 38770278 PMCID: PMC11103368 DOI: 10.1016/j.ebr.2024.100672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
We determine the proportion of non-Antiseizure Medication Adherence (non-AMA) and refusal attitude towards Epilepsy Surgery (ES) and their associated factors in Moroccan People With Epilepsy (PWE). A cross-sectional study was conducted (December 2021-December 2022) among adult Moroccan PWE. PWE were interviewed for their reactions to AMA and the ES attitude. Their medical files were processed to complete their sociodemographic and clinical data. Data were analyzed by the Statistical Package for Social Sciences (SPSS) software 21.0. A Chi-square test was performed to compare variables and multivariate logistic regression was used to highlight associations. Statistical tests were considered significant at a p-value ≤ 0.05 for a Confidence Interval (CI) of 95 %. The median age of our sample (n = 294) was 38 years (IQR: 25.00-55.00). Non-AMA was noted in 24.5 % with indifference as the main reason (55.6 %). ES refusal was found in 33.3 %, attributed mostly to apprehension (61.2 %). In the multivariate analysis, male sex (aOR = 1.94; 95 %CI: 1.03-3.64) and the existence of a family history of epilepsy (aOR = 1.96; 95 %CI: 1.02-3.75) were the factors associated with the non-AMA, whereas the use of allopathic treatments (aOR = 2.32; 95 %CI: 1.20-4.51), exclusively focal or generalized (not combined) seizures (aOR = 2.66; 95 %CI: 1.36-5.21) and the combination of a generic with the originator ASM (aOR = 2.64; 95 %CI: 1.12-6.18) were the predictive factors with the ES refusal attitude. The proportions found of non-AMA and ES refusal were relatively low compared to other studies, which may indicate the effort that medical staff have devoted recently to raising awareness of the importance of PWE's therapeutic involvement.
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Affiliation(s)
- El Bachir Hajji
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Boubacar Traore
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Direction de la Pharmacie et du Médicament (DPM), Bamako, Mali
| | - Samira Hassoune
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Laboratory of Cellular and Molecular Pathology, Team “Epidemiology and Histology of Chronic and Cancerous Diseases”, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Salma Bellakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Department of Neurology, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Mohammed Abdoh Rafai
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Department of Neurology, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Abdelhakim Lakhdar
- Laboratory of Research on Neurologic, Neurosensorial Diseases and Disability, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Department of Neurosurgery, IBN ROCHD University Hospital, Casablanca, Morocco
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Gündüz Oruç F, Atan G, Şeker D. The relationship between medication adherence and complementary medicine use in epilepsy patients. Epilepsy Behav 2024; 154:109761. [PMID: 38547768 DOI: 10.1016/j.yebeh.2024.109761] [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: 01/13/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE The aim of this research is to examine the usage of Complementary and Integrated Medicine (CIM) in individuals with epilepsy and the impact of CIM usage on medication adherence. MATERIALS AND METHODS This descriptive and cross-sectional study was conducted in a university hospital in northern Turkey between July and October 2023, involving 101 individuals with epilepsy (PWE). Descriptive information forms and the Morisky Medication Adherence Scale-4 (MMS-4) were used as data collection tools. Descriptive statistics, t-tests, ANOVA, and post-hoc LSD analyses were employed for data evaluation. RESULTS The participants consisted of 65.3 % males, 25.7 % were not working due to epilepsy, and 61.4 % with generalized epilepsy. The average MMS-4 score was found to be 3.08 ± 0.96. MMS-4 scores showed significant differences based on epilepsy type (F = 3.998, p = 0.021; η2 = 0.07). 76.2 % (n = 21) of the participants who used at least one CIM technique preferred "having a religious person read a prayer." CONCLUSION Medication adherence in PWE was at a moderate level. Individuals with focal and secondary generalized epilepsy showed better medication adherence compared to those with generalized types. Of those participant who used at least one CIM technique to improve their general health or control seizures, the most common was "having a religious person read a prayer."
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Affiliation(s)
- Fatma Gündüz Oruç
- Giresun University, Faculty of Health Sciences, Department of Internal Medicine Nursing, Giresun, Turkey.
| | - Gülden Atan
- Van Yüzüncü Yıl University, Department of Internal Medicine Nursing, Van, Turkey
| | - Demet Şeker
- Department of Neurology, Faculty of Medicine, Giresun University, Giresun, Turkey
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Su Y, Wang X, Xing Y, Wang Z, Bu H, Cui X, Yang Y, Cai B. The analysis of factors affecting medication adherence in patients with myasthenia gravis: a cross-sectional study. Ther Adv Neurol Disord 2024; 17:17562864231206877. [PMID: 38654744 PMCID: PMC11036929 DOI: 10.1177/17562864231206877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/27/2023] [Indexed: 04/26/2024] Open
Abstract
Background Clinically, patients with myasthenia gravis are generally treated with drugs to improve their physical condition, and poor medication adherence can hinder their recovery. Many studies have shown the importance of medication adherence for effective treatment. Various factors may affect a patient's medication adherence; however, studies concerning medication adherence in patients with myasthenia gravis are rare. Objectives This study aimed to identify the factors related to medication adherence in patients with myasthenia gravis, and determine the possibility of predicting medication adherence. Methods This cross-sectional observational study was conducted among inpatients and outpatients with myasthenia gravis of the First Affiliated Hospital of Guangzhou University of Chinese Medicine in China. Data on patient demographics, disease-related characteristics, and medical treatment were collected. We evaluated medication adherence of the patients using the Morisky Medication Adherence Scale-8, Beliefs about Medicines Questionnaire, and the Self-efficacy for Appropriate Medication Use Scale. Results We distributed 200 questionnaires and finally retrieved 198 valid questionnaires. A total of 139 (70.2%) women participated in this study, and 81 (40.9%) among the 198 participants were aged 40-59 years. In total, 103 (52.0%) participants exhibited bad adherence to pharmacological treatment, and factors such as taking medication irregularly [odds ratio (OR) = 0.242, 95% CI = 0.093-0.627], the necessity of taking medicine (OR = 1.286, 95% CI = 1.142-1.449), the concerns of taking medicine (OR = 0.890, 95% CI = 0.801-0.988), and the self-efficacy for taking medications under difficult circumstances (OR = 1.194, 95% CI = 1.026-1.389) had statistically significant impacts on medication adherence. Conclusion Our study shows that taking medication irregularly and concerns of taking medicine are the risk factors for medication adherence. Meanwhile, the necessity of talking medicine and self-efficacy for taking medications under difficult circumstances are the protective factors for medication adherence. Our findings can help medical staff to enhance patients' medication adherence by informing patients necessary medical knowledge, emphasizing the necessity for medication, relieving patients' concerns regarding medication, and improving the self-efficacy for taking medications under difficult circumstances.
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Affiliation(s)
- Yining Su
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinxian Wang
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuemeng Xing
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhenni Wang
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hailing Bu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyan Cui
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yunying Yang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.16 Airport Road, Baiyun District, Guangzhou, Guangdong 510405, China
| | - Bingxing Cai
- The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing 400010, China
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Ernawati I, Yasin NM, Setyopranoto I, Ikawati Z. Effect of Mobile Health Applications on Improving Self-Management Knowledge and Seizure Control in Epilepsy Patients: A Scoping Review. Healthc Inform Res 2024; 30:127-139. [PMID: 38755103 PMCID: PMC11098771 DOI: 10.4258/hir.2024.30.2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES Mobile health app-based interventions are increasingly being developed to support chronic disease management, particularly for epilepsy patients. These interventions focus on managing stress, monitoring drug side effects, providing education, and promoting adherence to medication regimens. Therefore, this scoping review aims to assess how mobile health applications improve epilepsy patients' knowledge and seizure control, and to identify the features of these apps that are frequently used and have proven to be beneficial. METHODS This scoping review was conducted using scientific databases such as ScienceDirect, PubMed, and Google Scholar, adhering to the Joanna Briggs Institute guidelines. The review framework consisted of five steps: identifying research questions, finding relevant articles, selecting articles, presenting data, and compiling the results. The literature search included all original articles published in English from 2013 to 2023. RESULTS Among six articles that discussed mobile applications for epilepsy patients, all featured similar functionalities, including education on epilepsy management and seizure monitoring. Four of the articles highlighted behavioral interventions, such as reminder systems, designed to improve medication adherence. The remaining two articles focused on a side-effect reporting system that enabled doctors or health workers to evaluate and regularly monitor adverse effects. CONCLUSIONS This scoping review reveals that mobile health applications employing a combination of educational and behavioral interventions for epilepsy patients significantly improve knowledge about patient self-management and medication adherence. These interventions can prevent seizures, increase awareness, enable better activity planning, improve safety, and reduce the frequency of seizures and side effects of antiepileptic drugs.
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Affiliation(s)
- Iin Ernawati
- Doctoral Program in Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
- Akademi Farmasi Surabaya, Surabaya,
Indonesia
| | - Nanang Munif Yasin
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
| | - Ismail Setyopranoto
- Department of Neurology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta,
Indonesia
| | - Zullies Ikawati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta,
Indonesia
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Guignet M, Vuong J, Martinez A, Ballapapinan T, White HS. Temporal relationship between levetiracetam nonadherence and breakthrough seizures in a preclinical model of temporal lobe epilepsy. Epilepsia 2024; 65:497-510. [PMID: 38031477 DOI: 10.1111/epi.17835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE Poor medication adherence remains a concern for individuals managing their epilepsy with antiseizure medicines (ASMs); however, ethical concerns around withholding medication make it impossible to study the causal relationship between missed doses and seizures in patients. Previous preclinical studies from our group suggest that mechanistically distinct ASMs have varying degrees of forgiveness when a dose is missed. However, with only a few ASMs studied in the context of nonadherence, we sought to expand on previous work to understand the relationship between levetiracetam (LEV) nonadherence and breakthrough seizures. METHODS Chronic oral dosing was initiated in rats with established epilepsy via our automated medication-in-food delivery system coupled to 24/7 video-electroencephalographic recording. Baseline seizure burden was established for 4 weeks before enrolling subjects into a 4-week treatment period with LEV in a 100% fully adherent (75 mg/kg four times daily) or 50% variably adherent paradigm. The temporal relationship between missed doses and breakthrough seizures was correlated with LEV plasma and brain concentrations in separate cohorts of animals. RESULTS Full adherence to LEV significantly improved seizure control by 50% in half of the animals. Poor adherence worsened seizure frequency by 85%, with most rats having more severe seizures that formed in clusters following missed doses. LEV concentrations remained below therapeutic levels (<10 μg/mL) in nonadherent animals, with brain and plasma levels directly correlating with the degree of adherence in a 24-h period. Missed doses of LEV immediately increased the risk of breakthrough seizures; however, this risk was significantly reduced with improved adherence in a 24-h period. SIGNIFICANCE These findings enhance our understanding of ASM nonadherence in preclinical models, highlighting that the timing of missed doses and their impact on seizures may vary between different ASMs. Notably, LEV demonstrates a robust pharmacokinetic reliance on missed doses leading to breakthrough seizures.
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Affiliation(s)
- Michelle Guignet
- Center for Epilepsy Drug Discovery, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Jonathan Vuong
- Center for Epilepsy Drug Discovery, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Alejandra Martinez
- Center for Epilepsy Drug Discovery, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Ticha Ballapapinan
- Center for Epilepsy Drug Discovery, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - H Steve White
- Center for Epilepsy Drug Discovery, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
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Büyükbayram Z, Aksoy M, Yılmaz R. The effects of concealment of epilepsy on medication adherence in people with epilepsy: A cross-sectional study. Epilepsy Res 2023; 196:107220. [PMID: 37699282 DOI: 10.1016/j.eplepsyres.2023.107220] [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: 06/07/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
AIM Adherence to antiseizure medication is of great importance in achieving seizure control and maintaining well-being for people with epilepsy. Therefore, it is important to assess medication adherence and factors affecting medication adherence in this patient group. This study aims to examine the effects of concealment of epilepsy on medication adherence in people with epilepsy. METHOD This cross-sectional study was conducted with 220 people with epilepsy. Data were collected using a patient information form, the Morisky Medication Adherence Scale-8 (MMAS-8), and the Concealment of Epilepsy Scale (CES) and analyzed using descriptive statistics and multiple linear regression analysis. RESULTS The mean age of the participants was 49.84 ± 9.43 years, and 53.6% of them were male. Their mean MMAS-8 score was 4.25 ± 1.99%, and 72.3% had low medication adherence. Additionally, their mean CES score was 49.84 ± 9.43. The CES scores of the participants negatively predicted their MMAS-8 scores (p < 0.05), and medication adherence was positively predicted by female gender, the duration of diagnosis, the single administration of drugs per day, and employment status, whereas it was negatively predicted by the annual number of seizures (F=19.256, p < 0.001). CONCLUSION In this study, people with epilepsy were found to have low medication adherence and a high tendency to conceal epilepsy. Furthermore, the tendency to conceal epilepsy had a negative effect on medication adherence. IMPLICATIONS Psychosocial interventions aimed at reducing the tendency to conceal epilepsy can contribute to medication adherence in people with the condition.
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Affiliation(s)
- Zeliha Büyükbayram
- Siirt University, Faculty of Health Sciences, Department of Internal Medicine Nursing, Siirt, Turkey
| | - Meyreme Aksoy
- Siirt University, Faculty of Health Sciences, Department of Nursing Fundamentals, Siirt, Turkey.
| | - Rıdvan Yılmaz
- Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
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Tanveer M, Tahir AH, Iqbal M, Aslam F, Ahmed A. Health-related quality of life and medication adherence of people living with epilepsy in Pakistan: A cross-sectional study. Brain Behav 2023; 13:e3127. [PMID: 37515419 PMCID: PMC10498081 DOI: 10.1002/brb3.3127] [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: 04/10/2023] [Revised: 05/05/2023] [Accepted: 06/06/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The primary purpose of this study was to determine adherence and health-related quality of life (HRQoL) in PWE. Secondary aims were to assess association between adherence and HRQoL and determine predictors of HRQoL in PWE in Pakistan. METHODS A descriptive cross-sectional study was conducted among PWE receiving treatment from two tertiary care hospitals of Pakistan. The HRQoL and adherence were assessed with Urdu versions of Quality of Life in Epilepsy-31 (QOLIE-31), and Medication Adherence Rating Scale (MARS). Relationship between HRQoL and adherence was assessed by Pearson's product-moment correlation coefficient. Forced entry multiple linear models were used to determine relationship of independent variables with HRQoL. RESULTS 219 PWE with a mean (±standard deviation) age, 34.18 (± 13.710) years, participated in this study. The overall weighted mean HRQoL score was (51.60 ± 17.10), and mean score for adherence was 6.17 (± 2.31). There was significant association between adherence and HRQoL in PWE (Pearson's correlation = 0.820-0.930; p ≤ .0001). Multiple linear regression found adherence (B = 16.8; p ≤ .0001), male gender (B = 10.0; p = .001), employment status (employed: B = 7.50; p = .030), level of education (Tertiary: B = 0.910; p = .010), duration of epilepsy (>10 years: B = -0.700; p ≤ .0001), and age (≥46 years: B = -0.680; p ≤ .0001), and ASM therapy (polypharmacy: B = 0.430; p = .010) as independent predictors of HRQoL in PWE from Pakistan. CONCLUSIONS The findings suggest PWE from our center have suboptimal adherence which affects HRQoL. Independent factors such as male gender, employment status and duration of epilepsy are predictors of HRQoL.
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Affiliation(s)
- Maria Tanveer
- Department of PharmacyQuaid‐I‐Azam UniversityIslamabadPakistan
| | - Azhar Hussain Tahir
- Department of PharmacyQuaid‐I‐Azam UniversityIslamabadPakistan
- Primary and Secondary Healthcare DepartmentGovernment of PunjabLahorePakistan
| | - Mansoor Iqbal
- Neurology DepartmentPakistan Institute of Medical Sciences (PIMS)IslamabadPakistan
| | - Faiza Aslam
- Department of PsychiatryRawalpindi Medical UniversityRawalpindiPakistan
| | - Ali Ahmed
- Department of PharmacyQuaid‐I‐Azam UniversityIslamabadPakistan
- Riphah Institute of Pharmaceutical SciencesRiphah International UniversityIslamabadPakistan
- Monash University Health Economics Group (MUHEG)School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
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Crook CL, Margolis SA, Goldstein A, Davis JD, Gonzalez JS, Grant AC, Nakhutina L. Medication self-management in predominantly African American and Caribbean American people with epilepsy: The role of medication beliefs and epilepsy knowledge. Epilepsy Behav 2023; 146:109313. [PMID: 37544193 DOI: 10.1016/j.yebeh.2023.109313] [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: 03/30/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Suboptimal medication adherence is common in people with epilepsy (PWE) and disproportionally prevalent among racially/ethnically diverse patients. Understanding reasons and risks of suboptimal adherence is critical to developing interventions that reduce negative health outcomes. This cross-sectional study characterized common barriers to medication self-management, prevalence of negative medication beliefs, and gaps in epilepsy knowledge among predominantly African American and Caribbean American PWE and examined their interrelationships. MATERIALS AND METHODS Sixty-three PWE (Age = 42.1 ± 13.2; 60% female; 79% Black; 19% Hispanic/Latino) completed validated self-report questionnaires about medication self-management, medication beliefs, and epilepsy knowledge. Correlations and t-tests examined interrelationships. RESULTS Four barriers to medication self-management were common, including not taking antiseizure medications at the same time every day, forgetting doses, not planning refills before running out, and spreading out doses when running low. More than half the sample believed medications were overused by prescribers. Nearly one-third believed medications were harmful, and nearly a quarter believed their antiseizure medications were minimally necessary with almost half reporting elevated concerns about negative consequences of antiseizure medications. Poorer medication self-management was associated with stronger beliefs that medications in general are harmful/overused by prescribers. Individuals who were "accepting" of their antiseizure medications (i.e., high perceived necessity, low concerns) were less likely to spread out time between doses when running low compared to non-accepting counterparts. Knowledge gaps related to the cause of seizures/epilepsy, chronicity of epilepsy treatment, and seizure semiology/diagnosis were common. Nevertheless, epilepsy knowledge was unrelated to medication self-management and medication beliefs. CONCLUSIONS In these PWE, the most prevalent reasons for suboptimal medication self-management were behaviorally mediated and potentially modifiable. Negative medication beliefs and misconceptions about epilepsy and its treatment were common. Results further suggest that interventions addressing negative medication beliefs will be more effective than knowledge-based psychoeducation alone to improve medication self-management in this patient population.
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Affiliation(s)
- Cara L Crook
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA; Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
| | - Seth A Margolis
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA; Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA.
| | | | - Jennifer D Davis
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 222 Richmond St., Providence, RI 02903, USA; Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave., Bronx, NY 10461, USA; Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, USA
| | - Arthur C Grant
- SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11203, USA
| | - Luba Nakhutina
- SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY 11203, USA
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10
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Solomon Y, Teshome Y, Ejigu S, Bezabih M. Prevalence of anti-seizure medication nonadherence and its associated factors, among people with epilepsy in North Shewa, Ethiopia, 2021. Epilepsy Behav 2023; 145:109301. [PMID: 37336134 DOI: 10.1016/j.yebeh.2023.109301] [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: 12/23/2022] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Epilepsy is a worldwide neurologic illness, characterized by recurrent unprovoked epileptic seizures and can affect people of all age groups. Patients who are receiving drug therapy for chronic diseases, such as epilepsy, must fit complex medication regimens into their everyday routines. Managing medication schedules may pose a significant burden on patients' lives. Anti-seizure medication choices should therefore be tailored to patients' factors that may limit medication use. The study aimed to determine the prevalence and Predictors of anti-seizure medication nonadherence among patients with epilepsy. METHODOLOGY An institutional-based cross-sectional study was conducted among 352 people with epilepsy who were selected by systematic random sampling method at government hospitals in North Shewa Ethiopia. Data were collected by reviewing patients' charts and interviewing people with epilepsy by using structured and pretested questionnaires. Data obtained were encoded into EPI-INFO software and exported to SPSS version 25 for analysis. Logistic regression was employed to assess independent factors associated with medication non-adherence. RESULT The prevalence of anti-seizure medication non-adherence was 40%. Being female [AOR = 3.37, 95%, CI: 1.84, 6.18], Divorced [AOR = 9.13, 95%, CI: 1.80, 46.34], Being jobless [AOR = 7.33, 95%, CI: 3.24, 16.56], Perceived poor social support [AOR = 2.73, 95%, CI: 1.28, 5.82], perceived stigma [AOR = 5.07, 95%, CI: 2.40, 10.68], polytherapy [AOR = 2.23, 95%, CI: 1.06, 4.71], drug side effects[AOR = 6.03, 95%, CI: 3.17, 11.45], buying medications [AOR = 5.81, 95%, CI: 3.63,16.79] and duration of stay on treatment [AOR = 4.31, 95%, CI: 1.863, 9.97] were significant predictors of anti-seizure medication non-adherence. CONCLUSION Non-adherence to anti-seizure medication among people with epilepsy in the study area was relatively higher as compared with study reports from different parts of the country. Health and clinical, socio-economy, and patients' psychological mindset were among the determinant factors affecting the consistency of epilepsy treatment adherence. Enhanced professional, health education for patients as well as for society and financial support, are basic pillars to reduce the constraints of effective treatment.
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Affiliation(s)
- Yerukneh Solomon
- Department of Biomedical Sciences, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Yonas Teshome
- Department of Biomedical Sciences, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Solomon Ejigu
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Mihret Bezabih
- Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
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Babateen O, Aldharman SS, Mogharbel G, Badawi AS, Aljohani SA, Alsharif MM, Al-Jallal MS, Samkari JA. Medication Adherence Status and Its Association With Quality of Life Among Individuals With Neurological Conditions in Saudi Arabia. Cureus 2023; 15:e40508. [PMID: 37461796 PMCID: PMC10350288 DOI: 10.7759/cureus.40508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Chronic disorders commonly require long-term therapies. Medication non-adherence can cause major morbidity and mortality in chronic illness individuals, as well as increase the financial burden on the healthcare system. It is considered that patients who adhere to their treatment may improve their quality of life (QoL). There is a scarcity of updated comprehensive data on medication adherence among Saudi patients with neurological disorders. Therefore, this study aimed to assess the medication adherence status among individuals with neurological conditions and its association with QoL. METHOD A cross-sectional questionnaire-based study was conducted. The study included subjects individuals who have neurological conditions aged at least 18 from different regions of Saudi Arabia. The questionnaire measured medication adherence by using the 10-item version of the Medication Adherence Report Scale (MARS-10, ©Professor Rob Horne). The QoL was measured by employing validated Euro Quality of Life 5-dimension scale (EQ-5D). RESULTS A total of 370 participants were included. Respondents aged 18 to 35 years represented 62.4% of the sample. More than half of the participants were females (65.7%). The most frequently reported chronic conditions were migraine (29.2%), epilepsy (20.8%), and multiple sclerosis (20.5%). The reliability of the EQ-5D questionnaire was acceptable (Cronbach's alpha = 0.764). In general, more than half of the participants indicated that had problems due to pain/discomfort (60.3%) and anxiety/depression (62.2%). The most common pattern of non-adherence was taking the medication only when a patient needed it followed by avoiding taking the medication as possible. Non-adherence to medications was less prevalent among participants with epilepsy (68.8%) and multiple sclerosis (65.8%). On the other hand, medication adherence was higher among respondents with migraine compared to participants without the condition (86.1% vs 73.7%, p = 0.009). A significantly lower proportion of participants who had some or extreme problems with self-care were non-adherent to medications compared to those who had no problems (68.1% vs 80.3%, respectively, p = 0.016). Results of the regression analysis showed that participants with epilepsy and multiple sclerosis were less likely to be non-adherence to medications. Furthermore, respondents with moderate and severe problems in self-care were less likely to be non-adherent. CONCLUSION It was found that more than half of the participants had problems regarding their QoL due to pain/discomfort and anxiety/depression. The most prevalent pattern of non-adherence was taking the medication only when needed. Participants with epilepsy and multiple sclerosis were less likely to be non-adherent to medications. Furthermore, respondents with moderate and severe problems in self-care were less likely to be non-adherent. We recommend serial studies on the issue should be conducted to gather more evidence regarding this topic.
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Affiliation(s)
- Omar Babateen
- Department of Physiology, Umm Al-Qura University, Makkah, SAU
| | - Sarah S Aldharman
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | | | | | | | - Jamil A Samkari
- Department of Family and Community Medicine, King Abdul Aziz University, Jeddah, SAU
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Bayane YB, Senbeta BS. Pattern of anti-epileptic medications nonadherence and associated factors at ambulatory clinic of Jimma Medical Center, Southwestern Ethiopia: A prospective observational study. SAGE Open Med 2023; 11:20503121231160817. [PMID: 36969722 PMCID: PMC10031813 DOI: 10.1177/20503121231160817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/13/2023] [Indexed: 03/19/2023] Open
Abstract
Objective: This study is designed to assess the pattern of nonadherence, and associated factors among ambulatory patients with epilepsy at Jimma Medical Center, Southwestern Ethiopia, from November 2020 to April 2021. Methods: A hospital-based prospective observational study was employed. A consecutive sampling method was used to recruit study participants. Nonadherence was assessed by the Hill–Bone compliance to the high blood pressure therapy scale. A threshold of 18 scores was used to classify adherence status. Epi-Data manager version 4.6 was used for data entry and all statistical analysis was performed by Statistical Package for Social Science 25.0. Multivariable logistic regression was performed to explore associated factors. Results: A survey included 334 patients with epilepsy. One hundred twenty-two (36.52%) of the study participants were found to be non-adherent. The factors associated with nonadherence were poor involvement of the patient in the therapeutic decision (adjusted odds ratio = 1.74; 95% confidence interval: 1.04–2.90; p = 0.034), per month income of lesser than1000 Ethiopian birr (adjusted odds ratio = 2.66; 95% confidence interval: 1.03–6.84; p = 0.042), recent seizure episodes (adjusted odds ratio = 1.97; 95% confidence interval: 1.20–3.23; p = 0.007), adverse drug reaction (AOR = 2.13; 95% confidence interval: 1.31–3.47; p = 0.002), and negative medication belief (adjusted odds ratio = 1.28; 95% confidence interval: 1.53–2.25; p = 0.043). Conclusions: In our setting, the magnitude of nonadherence was substantially high. Hence, providing regular health-related information about the disease and treatment, supplying free antiepileptic drugs, routine assessment of adverse drug reactions, and a multidisciplinary approach involving patients may improve adherence.
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Affiliation(s)
- Yadeta Babu Bayane
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
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13
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Narducci F, Lanzone J, Ricci L, Marrelli A, Piccioli M, Boscarino M, Vico C, Sancetta B, Di Lazzaro V, Tombini M, Assenza G. Determinants of medication adherence in people with epilepsy: A multicenter, cross-sectional survey. Epilepsy Behav 2023; 138:109029. [PMID: 36512930 DOI: 10.1016/j.yebeh.2022.109029] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Poor medication adherence in people with epilepsy (PwE) increases mortality, hospitalization, and poor quality of life, representing a critical challenge for clinicians. Several demographic, clinical, and neuropsychological factors were singularly found associated with medication adherence in several studies, but the literature lacks a comprehensive study simultaneously assessing all these variables. METHODS We performed a multicenter and cross-sectional study using online questionnaires with the following clinical scales: Morisky Medication Adherence Scale (MMAS-8), Quality of Life in Epilepsy Inventory 31 (QoLIE-31), Beck Depression Inventory-II (BDI-II), Generalized Anxiety Disorder-7 (GAD-7) and 14-item Resilience scale (RES14) in a population of 200 PwE. We used the ANOVA test and Spearman's correlation to evaluate the relationship between medication adherence and demographic, clinical (seizure frequency, number of anti-seizure medications), and neuropsychological characteristics. We trained separate machine learning models (logistic regression, random forest, support vector machine) to classify patients with medium-high adherence (MMAS-8 ≥ 6) and poor adherence (MMAS-8 < 6) and to identify the main features that influence adherence. RESULTS Women were more adherent to medication (p-value = 0.035). Morisky Medication Adherence Scale -8 showed a direct correlation with RES14 (p-value = 0.001) and age (p-value = 0.001), while was inversely correlated with BDI-II (p-value = 0.001) and GAD-7 (p-value = 0.001). In our model, the variables mostly predicting treatment adherence were QoLIE-31 subitems, followed by age, resilience, anxiety, years of school, and disease duration. CONCLUSION Our study confirms that gender, age, and neuropsychological traits are relevant factors in predicting medication adherence to PwE. Furthermore, our data provided the first evidence that machine learning on multidimensional self-report questionnaires could help to develop a decisional support system in outpatient epilepsy clinics.
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Affiliation(s)
- F Narducci
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - J Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Milan Institute, Italy.
| | - L Ricci
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - A Marrelli
- UOC Neurophysiopathology, Ospedale San Salvatore, L'Aquila, Italy
| | - M Piccioli
- UOC Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - M Boscarino
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - C Vico
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - B Sancetta
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - V Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - M Tombini
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
| | - G Assenza
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy
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Premature discontinuation among individuals with epilepsy participating in epilepsy self-management research interventions. Epilepsy Res 2022; 187:107034. [DOI: 10.1016/j.eplepsyres.2022.107034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 11/22/2022]
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Awan SA, Khawaja I, Babar M, Khan F. Prevalence of Non-adherence to Antiepileptic Drugs in Patients With Epilepsy Presenting to Emergency With Fits. Cureus 2022; 14:e27072. [PMID: 35989764 PMCID: PMC9389025 DOI: 10.7759/cureus.27072] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/11/2022] Open
Abstract
Background Epilepsy is considered when a patient has at least two unprovoked seizures that occurred more than a day apart. Seizure control depends upon several factors, including adequate treatment and its dosage, patients' daily activities, and adherence to antiepileptic medications. The study aimed to assess the rate of adherence to antiepileptic drugs (AED) in patients with epilepsy. Methodology A cross-sectional study was conducted at the Department of Neurology, Ayub Teaching Hospital, Abbottabad, Pakistan, between November 2019 and October 2020. All participants who presented to the emergency room with complaints of seizures, had a known diagnosis of epilepsy, aged above 18 years, with no cognitive dysfunction or severe psychiatric disorders were included in the study. Patients with other neurological disabilities (brain tumors, cerebral palsy, neuromuscular disorder) or severe psychotic episodes and those with undiagnosed cases of epilepsy were excluded from the study. A predefined proforma was used to assess the level of adherence and non-adherence among patients and they were then divided into their respective groups. Results A total of 150 participants were included in the study. Of patients, 110 were adherent to AED treatment while 40 were non-compliant. It was found that the most frequent cause of non-adherence was that patients forgot their pills (72.5%). Of patients, 7.5% stopped taking the medication when symptoms were relieved. About 12.5% reported affordability to be the reason for non-adherence. The rate of poor seizure control was significantly higher in non-adherent patients as compared to adherent patients (77.5% vs. 49.1%, p = 0.001). It was also found that a greater number of non-adherent patients experienced convulsive seizures in the past year as compared to those who were adherent to their medications (p = 0.006). Conclusion To enhance treatment adherence, the practice of prescribing more simpler treatment regimens among physicians can result in better seizure control, as the complexity of the regimen is found to be a major challenge for adjustment of AED regimens in this regard.
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Abstract
Drug-resistant epilepsy is associated with poor health outcomes and increased economic burden. In the last three decades, various new antiseizure medications have been developed, but the proportion of people with drug-resistant epilepsy remains relatively unchanged. Developing strategies to address drug-resistant epilepsy is essential. Here, we define drug-resistant epilepsy and emphasize its relationship to the conceptualization of epilepsy as a symptom complex, delineate clinical risk factors, and characterize mechanisms based on current knowledge. We address the importance of ruling out pseudoresistance and consider the impact of nonadherence on determining whether an individual has drug-resistant epilepsy. We then review the principles of epilepsy drug therapy and briefly touch upon newly approved and experimental antiseizure medications.
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Kutubudin AFM, Wan Mohammad WMZ, Md Noor SS, Shafei MN. Risk Factors Associated with Defaulted Follow-Up and Sharp Injury Management among Health Care Workers in a Teaching Hospital in Northeastern Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116641. [PMID: 35682226 PMCID: PMC9180157 DOI: 10.3390/ijerph19116641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 12/10/2022]
Abstract
Sharp injury is a serious occupational risk for healthcare workers (HCWs). This study aimed to determine the distribution and associated factors of sharp injury cases among HCWs working at a teaching hospital in northeastern Malaysia. This was a retrospective cohort study on all reported sharp injury cases from 2015 to 2020. The secondary data were examined using descriptive and multiple logistic regression. Statistical significance was determined for associated factors of HCWs who did not attend immediate treatment after a sharp injury or any of the subsequent follow-up variables, with a p-value of less than 0.05. A total of 286 cases fulfilled the study criteria. The mean (SD) age of sharp injury was 29.4 (5.38) years. The overall defaulted rate for follow-up was 51.4%. Multiple logistic regression revealed a significant relationship between defaulted follow up on sharp injury management and job category as well as the type of device used. Being a doctor (Adj OR 2.37; 95% CI: 1.40, 4.03; p = 0.010) and those using other sharp instruments such as Coupland and drip sets (Adj OR 4.55; 95% CI: 1.59, 13.02; p = 0.005) had a higher odds to default follow up on sharp injury management. In conclusion, although there is a link between defaulting the follow-up and both the work category and the type of device that caused the injury, a deeper analysis is needed to uncover any additional factors and determine the appropriate intervention strategies to ensure follow up adherence.
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Affiliation(s)
- Ahmed Farrasyah Mohd Kutubudin
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia; (A.F.M.K.); (W.M.Z.W.M.)
| | - Wan Mohd Zahiruddin Wan Mohammad
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia; (A.F.M.K.); (W.M.Z.W.M.)
| | - Siti Suraiya Md Noor
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia;
| | - Mohd Nazri Shafei
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia; (A.F.M.K.); (W.M.Z.W.M.)
- Correspondence: ; Tel.: +60-9767-6646
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Buainain RP, Oliveira CTP, Marson FAL, Ortega MM. Epidemiologic Profile of Patients With Epilepsy in a Region of Southeast Brazil: Data From a Referral Center. Front Neurol 2022; 13:822537. [PMID: 35620790 PMCID: PMC9128524 DOI: 10.3389/fneur.2022.822537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Epilepsy affects about 50 million people worldwide, 80% of whom live in low- and middle-income countries. In Brazil, epidemiological studies are outdated and restricted to specific regions, mostly due to the continental size of country. Objective We aimed to present the first evidence-based study on the epidemiological aspects of individuals with epilepsy, mapping the characteristics of this disease in a referral center in a region of Southeast Brazil. Methods A retrospective study was carried out from January 2010 to March 2021. Patients were selected according to the International League Against Epilepsy Criteria. Results From a total of 618 selected patients, 317 (51.3%) were men and 301 (48.7%) were women with an average age of 34.03 ± 20.66 years. The average age at the first seizure was 15.16 ± 17.61 years. The prevalence ratio was 1.30 cases/1,000 habitants. Childhood febrile seizure was present in 44 patients (7.9%) and family history of epilepsy in 231 (37.4%) patients. The predominant type of seizure was focal in 401 (64.9%) patients. The most frequent etiologies were structural in 254 (41.1%) patients and unknown in 238 (38.5%) patients. Most of the patients' treatments were based on anti-seizure drugs in monotherapy [389 (62.9%)] with 398 (64.4%) drug-responsive patients. Conclusions Our epilepsy prevalence rate was lower than other studies in the Southeast Region of Brazil. In addition, the structural epilepsy type was predominant in our study compared with unknown causes, which is more frequent in other Brazilian regions and worldwide studies. The differences may be attributed to our region, which presents a high prevalence of neuroinfection, specially neurocysticercosis, and a referral center for traumatic brain injury. Moreover, the contrasting results reinforce the need for an adequate epidemiological assessment of epilepsy incidence in a region of Southeast Brazil.
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Affiliation(s)
- Renata Parissi Buainain
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, São Paulo, Brazil
| | | | - Fernando Augusto Lima Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, São Paulo, Brazil
| | - Manoela Marques Ortega
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, São Paulo, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, São Paulo, Brazil
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Drug therapy problems and predicting factors among ambulatory epileptic patients in Jimma Medical Center, Southwest Ethiopia. PLoS One 2022; 17:e0267673. [PMID: 35482756 PMCID: PMC9049505 DOI: 10.1371/journal.pone.0267673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background The care of epileptic patients is complicated by the cognitive adverse effect of the drug, disease, pharmacokinetics, and pharmacodynamics properties of antiepileptic drugs which in turn intensify the risk of drug therapy problems among epileptic patients. Objective To assess drug therapy problems and predicting factors among ambulatory epileptic patients at Jimma University Medical Center, Southwest Ethiopia, from September 2020 to May 2021. Methodology A hospital-based prospective observational study was conducted. A semi-structured questionnaire was used to collect data from patients as well as from charts. Drug therapy problems were identified using Cipolle’s, Morley, and Strand drug therapy problem identification and classification method. Data were entered into Epi data manager version 4.6 and exported to statistical software package for social science version 23.0 for analysis. Multiplestepwise backward logistic regression analysis was carried out to identify predictors of drug therapy problems. The 95% CI was used to show an association between the dependent and independent variables. P-value < 0.05 was considered as statistically significant. Results Of the total 320 epileptic patients 224(70.0%) patients had at least one drug therapy problem. A total of 395 drug therapy problems were identified among two hundred twenty-four patients with an average of 1.2 drug therapy problems per patient. The frequently identified drug therapy problems were non-compliance 115(29.11), adverse drug reaction 110(27.84%), and dose too low 103(26%). Getting of a drug by purchasing [AOR = 4.6,95%CI:(2.05–10.7)], poorly involvement of the patients in therapeutic decision making [AOR = 3.02,95%CI:(1.5–6.06)], the number of medications ≥ two [AOR = 5.3,95%CI:(1.2–22.9)] and having had uncontrolled seizure [AOR = 10.9,95%CI:(4.9–24.2)] were independent predictors of drug therapy problems. Conclusions Drug therapy problems were common among epileptic patients in the study area. Patients who were getting their drugs by purchasing, poorly involved in therapeutic decision making, having had an uncontrolled seizure, and taking two and above drugs were more likely to experience drug therapy problems. Therefore, due attention should be given to patients with the aforementioned problems to decrease the occurrence of drug therapy problems and improve overall outcomes among epileptic patients.
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Ershadi F, Mousavi Mirzaei SM, Tabrizi N, Roshanravan B, Sahebnasagh A, Avan R. Evaluation of family planning methods in married women with epilepsy. Epilepsy Behav 2022; 129:108618. [PMID: 35257991 DOI: 10.1016/j.yebeh.2022.108618] [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: 11/05/2021] [Revised: 01/13/2022] [Accepted: 02/05/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Epilepsy is one of the most common neurologic unit diseases that have different prevalence in different parts of the world. Antiepileptic drugs (AEDs) are associated with major fertility risks for women of childbearing age. Due to the fact that studies on family planning methods in married women with epilepsy (WWE) have not been conducted in Iran, the aim of this study was to evaluate the family planning methods in married WWE in Birjand, Iran. METHODS An analytical-descriptive study was performed on 126 married WWE hospitalized in the neurology ward or referred to Vali-e-Asr specialized and sub-specialized clinic in Birjand. Demographic information of patients as well as data on the type of used AED, and various methods of family planning were collected in a questionnaire. Data analysis was performed using Chi-square and Fisher tests. All of the above analyses were considered at a significance level of less than 5% by SPSS v.19 software. RESULTS The mean age of the patients was 33.41 ± 9.15 years. The mean age of experiencing the first seizure and the onset of menstruation were 24.82 and 13.79 years, respectively. Fifty (35.5%), 38 (27%), 15 (10.6%), 14 (9.9%), and 14 (9.9%) patients used sodium valproate, carbamazepine, phenytoin, levetiracetam, and lamotrigine, respectively. The results showed that 72 sexually active patients (70.6%) used family planning methods, of which 43 patients (59.7%) used withdrawal method, 20 patients (27.8%) used condoms, and 6 patients (8.3%) used oral contraceptive pills (OCP). Eight patients (9.6%) had a history of unintended pregnancy and 3 patients (3.6%) had a history of abortion. CONCLUSION It is recommended to apply effective family planning methods in married WWE to prevent unintended pregnancies and the subsequent adverse effects in the fetus, considering the fact that a significant percentage of WWE did not use effective family planning methods and 8 cases of unintended pregnancies were reported. Because of high consumption of valproate in women of childbearing age in our study and concerning issue about its fetal malformation, it is recommended to reduce the administration of valproate in this population. Moreover, regarding the low consumption of folic acid, especially for women of childbearing age and pregnant WWE who are taking AED, the necessary recommendations should be made by our physicians.
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Affiliation(s)
- Faranak Ershadi
- Medical Student, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Nasim Tabrizi
- Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Adeleh Sahebnasagh
- Clinical Research Center, Department of Internal Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Razieh Avan
- Department of Clinical Pharmacy, School of Pharmacy, Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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Moseley BD, Gupta S, Way N, Wright J, Rowland JC, Barghout VE, Frech F, Plauschinat C. Patient-Reported Outcome Measures in Adult Patients Diagnosed with Epilepsy Being Treated with Perampanel. Patient Relat Outcome Meas 2022; 13:39-52. [PMID: 35173501 PMCID: PMC8841652 DOI: 10.2147/prom.s343302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/14/2022] [Indexed: 12/04/2022] Open
Abstract
Background Epilepsy is a complex disorder that can affect patients’ medical, psychological, and social well-being. The purpose of this study was to evaluate the patient-reported outcome (PRO) measures of health-related quality of life (HRQoL), satisfaction, and adherence in adult patients diagnosed with epilepsy treated with perampanel in the United States (US). Methods A US-based, multicenter, observational cross-sectional survey was completed by 61 patients taking perampanel with or without other antiseizure medications (ASMs). Respondents were ≥18 years old, had a physician-confirmed diagnosis of epilepsy, used perampanel for ≥4 months, and provided informed consent. Patients responded to questions concerning their demographic characteristics, treatment history, experiences before perampanel, experiences while taking perampanel, HRQoL, treatment satisfaction, and medication adherence. Results Patients (N=61) were 42.8 years old on average; majority were female (63.9%) and white (75.4%). Mean time on perampanel was 2.5 years, with sodium channel blockers often (55.7%) used concomitantly with perampanel. Patients reported, on average, 5.5 (standard deviation [SD]=13.2) seizures/month after initiating perampanel, whereas these same patients reported experiencing 20.4 (SD=60.0) seizures/month prior to perampanel. When comparing their experience on perampanel with their experience with previous ASMs, more patients “strongly agreed” that perampanel allowed them to live a more normal life (36.1% vs 27.5%) and worked as intended if they missed taking a dose (16.4% vs 7.8%). Average satisfaction scores were high, with ratings of 71.8 for effectiveness, 84.0 for convenience, and 71.9 for global satisfaction (0–100 scores). Perampanel use was associated with improvements in HRQoL and fewer symptoms of depression and anxiety. The majority of patients were adherent (62.3%) to perampanel. Discussion Perampanel use was associated with reductions in number of seizures, better HRQoL, and high adherence rates. These results provide initial evidence that perampanel can be an effective, tolerable, and valid option for patients with epilepsy in the real world.
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Affiliation(s)
- Brian D Moseley
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA
| | - Shaloo Gupta
- Real World Evidence, Cerner Enviza, Malvern, PA, 19355, USA
| | - Nate Way
- Real World Evidence, Cerner Enviza, Malvern, PA, 19355, USA
| | | | - John C Rowland
- Real World Evidence, Cerner Enviza, Malvern, PA, 19355, USA
| | | | - Feride Frech
- Health Economics, Outcomes Research, and Real World Evidence, Eisai Inc., Nutley, NJ, 07110, USA
| | - Craig Plauschinat
- Health Economics, Outcomes Research, and Real World Evidence, Eisai Inc., Nutley, NJ, 07110, USA
- Correspondence: Craig Plauschinat, Eisai Inc, 200 Metro Blvd, Nutley, NJ, 07110, USA, Tel +1 551-284-9216, Fax +1 201-692-1804, Email
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22
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Mroueh L, Al-Hajje A, Salameh P, Preux PM, Boumediene F, Ratsimbazafy V, Jost J. Management of epilepsy in Lebanon: medication reviews and drug-related problems. Pharmacoepidemiol Drug Saf 2022; 31:583-591. [PMID: 35084792 DOI: 10.1002/pds.5409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/27/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE The goal of epilepsy treatment is to control seizures without drug related problems (DRPs). The evaluation of anti-seizure drugs (ASD) strategies and identification of DRPs are rarely studied. This study aimed primarily to evaluate the choice of ASD according to international guidelines and secondarily to identify and describe anti-seizure drug-related problems. METHODS A cross-sectional study was conducted during one year among Lebanese adults with epilepsy attending neurology clinics. The choice of ASD was compared to National Institute for Health and Care Excellence guidelines. Drug-drug interactions were evaluated by the Lexicomp database, and the DRP classification was performed using the Pharmaceutical Care Network Europe classification. RESULTS Four hundred and four patients with epilepsy were included. The prescription for an ASD was in accordance with the indication set in guidelines in 75.0% of population, and 1078 DRPs were identified. The main DRPs detected were adverse drug reactions (51.0%), inappropriate combinations of drugs (50.0%), and suboptimal drug regimens (46.3%). Single and divorced patients, who living in Mount Lebanon, and who took the old with the new generation had a less risk to have an inadequate prescription to guidelines. However, female gender, controlled epilepsy, multiple ASDs, and living in a rural region increased DRPs. CONCLUSIONS This study showed that quarter of the population used ASDs contraindicated according to international guidelines. Since DRPs were related to the number and type of ASD prescribed, it is important to assess the case of each patient by a clinical pharmacist to prevent drug-drug interactions and iatrogenic issues.
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Affiliation(s)
- Lara Mroueh
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,IRD, Associated Unit, Tropical Neuroepidemiology, Limoges, France.,Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Pascale Salameh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,IRD, Associated Unit, Tropical Neuroepidemiology, Limoges, France
| | - Farid Boumediene
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,IRD, Associated Unit, Tropical Neuroepidemiology, Limoges, France
| | - Voa Ratsimbazafy
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,IRD, Associated Unit, Tropical Neuroepidemiology, Limoges, France.,CHU Limoges, Department of Pharmacy, 87000, Limoges, France
| | - Jeremy Jost
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,IRD, Associated Unit, Tropical Neuroepidemiology, Limoges, France.,CHU Limoges, Department of Pharmacy, 87000, Limoges, France
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23
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Mota SM, Amaral de Castro L, Riedel PG, Torres CM, Bragatti JA, Brondani R, Secchi TL, Sanches PRS, Caumo W, Bianchin MM. Home-Based Transcranial Direct Current Stimulation for the Treatment of Symptoms of Depression and Anxiety in Temporal Lobe Epilepsy: A Randomized, Double-Blind, Sham-Controlled Clinical Trial. Front Integr Neurosci 2021; 15:753995. [PMID: 34955774 PMCID: PMC8693513 DOI: 10.3389/fnint.2021.753995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
We conducted a double-blind randomized clinical trial in order to examine the effects and the safety of home-based transcranial direct current stimulation (tDCS) on depressive and anxious symptoms of patients with temporal lobe epilepsy (TLE). We evaluated 26 adults with TLE and depressive symptoms randomized into two different groups: active tDCS (tDCSa) and Sham (tDCSs). The patients were first submitted to 20 sessions of tDCS for 20 min daily, 5 days a week for 4 weeks and then received a maintenance tDCS application in the research laboratory once a week for 3 weeks. The intensity of the current was 2 mA, applied bilaterally over the dorsolateral prefrontal cortex, with the anode positioned on the left side and the cathode on the right side. Participants were evaluated on days 1, 15, 30, and 60 of the study using the Beck Depression Inventory II (BDI). A follow-up evaluation was performed 1 year after the end of treatment. They were also evaluated for quality of life and for anxious symptoms as secondary outcomes. The groups did not differ in clinical, socioeconomic or psychometric characteristics at the initial assessment. There was no statistically significant difference between groups regarding reported adverse effects, seizure frequency or dropouts. On average, between the 1st and 60th day, the BDI score decreased by 43.93% in the active group and by 44.67% in the Sham group (ΔBDIfinal – initial = −12.54 vs. −12.20, p = 0.68). The similar improvement in depressive symptoms observed in both groups was attributed to placebo effect and interaction between participants and research group and not to tDCS intervention per se. In our study, tDCS was safe and well tolerated, but it was not effective in reducing depressive or anxiety symptoms in patients with temporal lobe epilepsy. Clinical Trial Registration: [ClinicalTrials.gov], identifier [NCT03871842].
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Affiliation(s)
- Suelen Mandelli Mota
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Carolina Machado Torres
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centro para Tratamento de Epilepsia Refratária (CETER), Basic Research and Advanced Investigations in Neuroscience (BRAIN), Serviço de Neurologia do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - José Augusto Bragatti
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centro para Tratamento de Epilepsia Refratária (CETER), Basic Research and Advanced Investigations in Neuroscience (BRAIN), Serviço de Neurologia do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Rosane Brondani
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centro para Tratamento de Epilepsia Refratária (CETER), Basic Research and Advanced Investigations in Neuroscience (BRAIN), Serviço de Neurologia do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Thais Leite Secchi
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Wolnei Caumo
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Engenharia Biomédica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Dor & Neuromodulação, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marino Muxfeldt Bianchin
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Centro para Tratamento de Epilepsia Refratária (CETER), Basic Research and Advanced Investigations in Neuroscience (BRAIN), Serviço de Neurologia do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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24
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Abraira L, Salas-Puig J, Quintana M, Seijo-Raposo IM, Santamarina E, Fonseca E, Toledo M. Overnight switch from levetiracetam to brivaracetam. Safety and tolerability. Epilepsy Behav Rep 2021; 16:100504. [PMID: 34901817 PMCID: PMC8640256 DOI: 10.1016/j.ebr.2021.100504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/26/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022] Open
Abstract
Brivaracetam has a more selective action to SV2A binding site than levetiracetam. Neuropsychological adverse events improved in 76% of patients that switched. An overnight switch is well-tolerated in our relatively small Spanish sample.
Brivaracetam is a newer antiseizure medication than levetiracetam. It has a more selective action on the synaptic vesicle glycoprotein 2A binding site, and it seems to provide a more favorable neuropsychiatric profile. The aim of this study was to assess the safety and tolerability of an overnight switch from levetiracetam to brivaracetam. This was a retrospective descriptive study including patients with epilepsy treated with levetiracetam, who switched due to inefficacy or previous adverse events (AEs). In total, forty-one patients were included (mean age 40.9 ± 17.8 years, women 48.8%). Focal epilepsy represented 75.6% (n = 31) of patients (structural cause [n = 25], unknown cause [n = 6]). Four patients had idiopathic generalized epilepsy, two had developmental and epileptic encephalopathy and four patients were unclassified. The reason to start brivaracetam was inefficacy in 53.7% (n = 22), AEs in 65.9% (25/27 neuropsychiatric) and both in 19.5% (n = 8). Brivaracetam-related AEs were reported in 24.4%. Neuropsychological AEs associated with the previous use of levetiracetam improved in 76% of patients. Treatment was discontinued in 19.5% patients. Patients’ reported seizure frequency improved, worsened and remained stable in 26.8%, 12.2%, and 61.0% of the cases, respectively. An overnight switching to brivaracetam is safe and well tolerated. This treatment can improve levetiracetam-related neuropsychiatric AEs.
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Affiliation(s)
- L Abraira
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - J Salas-Puig
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - M Quintana
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - I M Seijo-Raposo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - E Santamarina
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - E Fonseca
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - M Toledo
- Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
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25
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Dayapoğlu N, Turan GB, Özer Z. Evaluation of medication adherence and medication beliefs among patients with epilepsy. Epilepsy Behav 2021; 124:108366. [PMID: 34757264 DOI: 10.1016/j.yebeh.2021.108366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 01/05/2023]
Abstract
AIM This study explored medication adherence and medication beliefs of patients with epilepsy and evaluated the relationship between these two factors. METHODS This descriptive, cross-sectional, correlational study was conducted with 174 patients with epilepsy who were referred to the neurology outpatient clinic of a university hospital in Erzurum, Turkey, between February 10, 2020 and December 30, 2020. The data were collected using the Descriptive Information Form, The eight-item Morisky Medication Adherence Scale (MMAS-8), and the Beliefs about Medicines Questionnaire (BMQ-T). RESULTS The mean age of the patients was 33.06 ± 11.94 years, and the mean duration of time since diagnosis was 12.91 ± 10.73 years. In terms of demographic information, 60.3% of the patients were single, 58% had low income or were unemployed, 53.4% had five or more seizures within the last year, 40.8% had focal onset seizures, 69% had no other chronic disease, and 76.4% used more than one medicine. The patients' mean MMAS-8 score was 3.25 ± 2.13. The mean scores for the specific concern subscale was 3.65 ± 0.85, 1.81 ± 0.75 for the specific necessity subscale, 4.19 ± 0.76 for the general overuse subscale, and 3.14 ± 1.41 for the general harm subscale. The regression analysis revealed that general overuse and general harm negatively affected the MMAS-8 total score. CONCLUSION Patients with epilepsy reported low medication adherence and were found to have concerns about the harms and side effects of the medicines they were using; they had negative perceptions of the purpose of medicines; they had high beliefs about the harms of medicines; and they had low beliefs about their personal treatment needs. The patients were generally found to have negative beliefs about medicines, which negatively affected their medication adherence.
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Affiliation(s)
| | | | - Zülfünaz Özer
- Department of Nursing, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
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26
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Booth S, Meller S, Packer RM, Farquhar R, Maddison JE, Volk HA. Owner compliance in canine epilepsy. Vet Rec 2021; 188:e16. [PMID: 34651709 DOI: 10.1002/vetr.16] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/15/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Poor medication compliance by human epilepsy patients is one of the leading causes of treatment failure and increased seizure frequency. The aim of this cross-sectional study was to analyse owner compliance in pharmacological treatment of canine idiopathic epilepsy and to identify factors associated with poor compliance. METHODS The number of antiseizure drug tablets was recorded to determine if the patient received sufficient tablets to cover the time period between prescriptions and to assess compliant prescription cycles. Additionally, compliance was assessed by an online survey of owners. RESULTS For the prescription monitoring data from 94 cases from three small animal practices in the United Kingdom revealed an overall median compliance of 56%. Thirt-three per cent of owners were >80% compliant, while 21% were 100% compliant. During a non-compliant prescription cycle, a patient missed a median of 6 days (0.11-519 days) of treatment. Patients on polytherapy had higher compliance rates than on monotherapy (p = 0.031). The survey (229 respondents from online canine epilepsy groups) showed that low daily dosing was associated with better compliance (p = 0.049). CONCLUSION Owner compliance was subpar in this study and could represent a significant issue in epilepsy management, which needs to be considered by veterinary surgeons when treating canine epilepsy.
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Affiliation(s)
- Samantha Booth
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Sebastian Meller
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Rowena Ma Packer
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | | | - Jill E Maddison
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK.,Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
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27
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Contier ATR, Alonso NB, Araújo NS, Taura M, Cavalheiro EA. Challenges in the treatment of a chronic disease: A study of narratives of people with juvenile myoclonic epilepsy. Seizure 2021; 90:74-79. [DOI: 10.1016/j.seizure.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/28/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022] Open
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28
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Amha H, Memiah P, Getnet A, Mengist B, Gedfew M, Ayenew T, Akalu TY, Mulugeta H, Bewket B, Kebede B, Petrucka P. Antiseizure medication nonadherence and its associated factors among Epileptic patients in Ethiopia, a systematic review and meta-analysis. Seizure 2021; 91:462-475. [PMID: 34340192 DOI: 10.1016/j.seizure.2021.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The majority of patients with epilepsy in resource-poor countries never receive proper treatment, and those who are started on anti-seizure medications quickly discontinue them. Medication noncompliance is extremely common, with estimates ranging from 26 to 79 percent. Non-adherence to antiseizure medications is associated with poor seizure control, increased morbidity, increased hospitalization time, poor quality of life, increased health care costs, and increased mortality in adults. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guideline was used for this systematic review and meta-analysis. The databases Pub Med, Cochrane Library, Scopus Online, and Google Scholar were all searched. STATA™ version 11 software was used for the meta-analysis. The I2 test and Egger's tests were used to assess heterogeneity and publication bias. The random-effects method was used to estimate the pooled adherence level with a 95 percent confidence interval. RESULTS This meta-analysis included twelve Ethiopian studies involving a total of 3416 epileptic patients. The national pooled prevalence of antiseizure medication non-adherence was 41.96%. Patients who paid for their medications, took them for more than a year, had co-morbidity, and felt stigmatized were more likely to be non-adherent than their counterparts. CONCLUSION According to this systematic review and meta-analysis, more than two out of every five epileptic patients did not take their antiseizure medications as prescribed. Clinicians must educate epileptic patients about the importance of medication adherence. SYSTEMATIC REVIEW REGISTRATION The review has been registered on an International Prospective Register of Systematic Review with registration number CRD42019142905.
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Affiliation(s)
- Haile Amha
- Lecturer of Psychiatry, Department of Nursing, College of Health Science, Debre Markos University, Ethiopia.
| | - Peter Memiah
- Division of Epidemiology and Prevention Director of Continuous Quality Improvement (CQI) Biosecurity, Institute of Human Virology, University of Maryland School of Medicine, USA.
| | - Asmamaw Getnet
- Lecturer of Psychiatry, Department of Nursing, College of Health Science, Debre Markos University, Ethiopia.
| | - Belayneh Mengist
- Lecturer of Epidemiology, Department of Public Health, College of Health Science, Debre Markos University, Ethiopia.
| | - Mihretie Gedfew
- Lecturer of Nursing, department of Nursing, College of Health Science, Debre Markos University, Ethiopia.
| | - Temesgen Ayenew
- Lecturer of Nursing, department of Nursing, College of Health Science, Debre Markos University, Ethiopia.
| | - Tadesse Yirga Akalu
- Lecturer of Nursing, department of Nursing, College of Health Science, Debre Markos University, Ethiopia.
| | - Henok Mulugeta
- Lecturer of Nursing, department of Nursing, College of Health Science, Debre Markos University, Ethiopia.
| | - Bekalu Bewket
- Lecturer of Nursing, department of Nursing, College of Health Science, Debre Markos University, Ethiopia.
| | - Bekalu Kebede
- Lecturer of Pharmacy, Department of Pharmacy, College of Health Science, Debre Markos University, Ethiopia.
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada; School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania.
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29
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Abebaw N, Girma N, Yasin M. Non-Adherence to Anti-Epileptic Drugs and Associated Factors among Epileptic Patients in Dessie Town Public Hospitals, Northeast Ethiopia. J Epilepsy Res 2021; 11:39-48. [PMID: 34395222 PMCID: PMC8357546 DOI: 10.14581/jer.21006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Patients who are non-adherent to their medication are frequently hospitalized with prolonged lengths of stay and make repeated emergency department visits. They are also more likely to miss work or school due to the seizure effects. In Ethiopia, although there is little evidence concerning anti-epileptic drug adherence, some studies were conducted with some controversy with studies done in another country. This study was therefore conducted to assess non-adherence to antiepileptic drugs and associated factors among adult epileptic patients attending in Dessie town public hospitals, northeast Ethiopia. Methods Hospital-based cross-sectional study design was employed on 368 patients from January 16, 2018 to March 16, 2018. A systematic random sampling technique was employed to recruit study participants. The collected data were entered into EpiData 3.1 and exported to SPSS version 22.0 for analysis. All covariates that were significant at p-value <0.25 in the bivariate logistic regression analysis were considered for further multivariable logistic regression analysis level of statistical significance at p-value <0.05. Results Among the respondents, 37.5% (95% confidence interval [CI], 32.1–42.9) of them were non-adhered to antiepileptic drugs. Patients who were unable to write and read (adjusted odds ratio [aOR], 22.30; 95% CI, 5.84–85.21), primary education level (aOR, 5.63; 95% CI, 1.90–16.69), being male (aOR, 2.37; 95% CI, 1.33–4.23), experience adverse effect (aOR, 13.68; 95% CI, 3.27–56.97), patients got medication by payment (aOR, 2.06; 95% CI, 1.04–4.11) were statistically associated with non-adherence. Conclusions This study revealed that over one-third of participants were non-adherent to antiepileptic drugs. Sex, educational level, adverse effect, and medication source were independent factors for non-adherence to antiepileptic drugs. Therefore, educations and instructions about the importance of recommended drug use can improve antiepileptic drug adherence in patients with epilepsy.
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Affiliation(s)
- Nigusie Abebaw
- Department of Midwifery, Samara University School of Medical and Health Sciences, Samara, Ethiopia
| | - Natnaiel Girma
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Miftah Yasin
- Department of Midwifery, Samara University School of Medical and Health Sciences, Samara, Ethiopia
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30
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Şenadım S, Alpaydın Baslo S, Uygun E, Erdoğan M, Balçik ZE, Tekin B, Ataklı D. The strategies for coping with stress of epilepsy patients. Neurol Sci 2021; 42:4265-4270. [PMID: 34142262 DOI: 10.1007/s10072-021-05372-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aims to compare the styles of coping with stress between patients with epilepsy and healthy individuals and to examine the effects of clinical features on methods of coping with stress. METHODS The study enrolled 120 patients diagnosed with epilepsy. Forty healthy individuals were included as control group. Sociodemographic and clinical characteristics of the patients were recorded. The patients and controls completed the Coping Strategies with Stress Inventory (COPE), which comprises 60 items distributed into 15 scales. The COPE scores of the patients and controls were compared. RESULTS Comparing the COPE scores of the patients and controls, the substance use score was higher in the controls. In terms of gender, seeking instrumental social support, active coping, seeking emotional social support, acceptance, and emotion-focused total coping scores were higher in women among patients. In terms of marital status, the positive reinterpretation and growth score of single patients was significantly higher than that of married patients. In patients with a history of febrile convulsions, the active coping, seeking emotional social support, and denial scores were higher. In terms of treatment, for the patients receiving polytherapy, the suppression of competing activities, focus on and venting of emotions, and dysfunctional total coping scores were higher than in patients receiving monotherapy. CONCLUSION Epilepsy and stress are intertwined conditions. Epilepsy patients, confronted with stress, avoided using alcohol and substances compared to healthy individuals. There were differences among epilepsy patients according to gender, marital status, febrile convulsion history, number of medications, and approaches to coping with stress.
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Affiliation(s)
- Songül Şenadım
- Department of Neurology, Faculty of Medicine, Istanbul Aydın University, Istanbul, Turkey
| | - Sezin Alpaydın Baslo
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
| | | | - Mücahid Erdoğan
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Ezgi Balçik
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
| | - Betül Tekin
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey.
| | - Dilek Ataklı
- Department of Neurology, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
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31
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Mehta D, Davis M, Epstein AJ, Wensel B, Grinnell T, Williams GR. Comparative Economic Outcomes in Patients with Focal Seizure Initiating First-Line Eslicarbazepine Acetate Monotherapy versus Generic Antiseizure Drugs. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:251-261. [PMID: 33907433 PMCID: PMC8064618 DOI: 10.2147/ceor.s303079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/12/2021] [Indexed: 01/12/2023] Open
Abstract
Objective To examine the association between initiating first-line (1L) monotherapy with eslicarbazepine acetate (ESL) vs a generic antiseizure drug (ASD) and healthcare resource utilization (HCRU) and charges in adults with treated focal seizures (FS). Methods This was a retrospective analysis of Symphony Health’s Integrated Dataverse® open-source claims data. Two cohorts were identified as having initiated 1L monotherapy with ESL or literature-defined generic ASDs. Linear regression models with person fixed effects and inverse probability treatment weights assessed the relative additional changes in HCRU and charges among patients who received ESL compared to generic ASD. Results A total of 250 and 43,220 patients initiated ESL (48.3 years; 57.2% female) or a generic ASD (54.5 years; 58.1% female), respectively. Compared to patients initiating a generic ASD, patients treated with ESL had additional reductions of 11.8 percentage points in the likelihood of any all-cause outpatient visits (P<0.001), 7.4 percentage points in the likelihood of any emergency department (ED) visits (P=0.013), and 22.7 percentage points in the likelihood of any FS-related outpatient visits (P<0.001). Patients initiating ESL had greater reductions in mean charges for all-cause medical ($2620; P=0.002), outpatient ($1995; P=0.005), and non-FS-related medical ($2708; P<0.001) services. Patients initiating ESL had greater relative increases in mean total prescription ($1368; P<0.001) and ASD-related prescription ($1636; P<0.001) charges, but greater relative reductions in non-ASD prescription ($269; P=0.032) charges. The increases in prescription charges were of a lower magnitude than the decreases in medical charges. Conclusion Initiation of ESL as 1L monotherapy was associated with statistically significantly greater reductions in any use of several all-cause and FS-related services, number of visits, and charges compared to initiation of a generic ASD as 1L monotherapy in patients with FS. Initiation of a generic ASD as 1L monotherapy was associated with significantly smaller increases in total prescription charges and ASD-related prescription charges.
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Affiliation(s)
| | | | | | - Brian Wensel
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | - Todd Grinnell
- Medical Affairs, Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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Junaid Farrukh M, Makmor Bakry M, Hatah E, Hui Jan T. Medication adherence status among patients with neurological conditions and its association with quality of life. Saudi Pharm J 2021; 29:427-433. [PMID: 34135668 PMCID: PMC8180465 DOI: 10.1016/j.jsps.2021.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/03/2021] [Indexed: 11/26/2022] Open
Abstract
Background/Aim Medication non-adherence may cause significant morbidity and mortality in patients with chronic diseases and may increase the economic burden on the healthcare system. The prevalence of neurological disorders is increasing in Malaysia; however, comprehensive data on medication adherence among Malaysian patients with these disorders is limited. This study was conducted to determine the association of medication non-adherence with quality of life in patients with neurological problems. Methods A cross-sectional survey was performed in 370 patients diagnosed with epilepsy, Parkinson's disease, stroke and Alzheimer's disease at Neurology clinic. Patients aged 18 years or older, without documented physical or psychiatric illness such as schizophrenia and major depression, were included. Patient-administered questionnaires, such as the Malaysian Medication Adherence Scale and Medication Possession Ratio were used to determine medication adherence. An established EQ-5D-3L questionnaire was used to determine quality of life. Data were analysed using descriptive and inferential analysis. Results The overall prevalence of medication non-adherence among patients with neurological disorders was 59.2%. Among these neuromedical diseases, 69.2% (n = 9/13) of Alzheimer's disease, 66.7% (n = 98/147) of epilepsy, 62.1% (n = 36/58) of Parkinson's disease and 48.7% (n = 74/152) of stroke patients were found non-adherent. There was a significant difference in EQ-5D index scores (p = 0.041) between adherent and non-adherent patients. Conclusion A high prevalence of medication non-adherence was found among patients with neurological disorders. The rate of non-adherence varied among different neurological conditions. There was a significant difference in quality of life between adherent and non-adherent patients.
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Affiliation(s)
- Muhammad Junaid Farrukh
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Mohd Makmor Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Tan Hui Jan
- Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Malaysia
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Chen HF, Tsai YF, Fan JY, Chen MC, Hsi MS, Hua MS. Evaluation of a self-management intervention for adults with epilepsy in Taiwan: A longitudinal randomized controlled trial. Epilepsy Behav 2021; 117:107845. [PMID: 33621815 DOI: 10.1016/j.yebeh.2021.107845] [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: 12/11/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Epilepsy is a neurological disease that causes recurrent seizures and can have a significant impact on a person's quality of life (QOL). A self-management intervention (SMI) can allow adults with epilepsy to modify behaviors in order to manage their seizures and evaluate the impact of medication and treatments on their daily lives. The purpose of this study was to investigate the effects of a SMI for adults with epilepsy. METHODS This was a longitudinal randomized controlled trial. Adults with epilepsy between the age of 20 and 65 years were recruited from a medical center in northern Taiwan. Participants were assigned to an intervention group (IG) or control group (CG) through simple randomization. Data regarding demographic and clinical characteristics were collected at baseline (T0). In addition, participants answered nine validated self-report questionnaires, which were used as outcome measures. Following collection of baseline data, the CG received routine monthly counseling over the next 3 months. The IG received the routine monthly counseling, as well as individual face-to-face health counseling on self-management 1 h/month and remote counseling via the phone or computer network at least twice per month. After the first month (T1) and at the end of the third (T2) and sixth months (T3) participants answered the nine questionnaires again. Differences in outcomes between the IGs and CGs were analyzed by comparing scores for the nine outcome variables at T0 with scores at T1, T2, and T3 with generalized estimating equations. RESULTS A total of 210 adults agreed to participate in the study; however, only 155 participants completed the questionnaires for all three time points: 75 in the CG and 80 in the IG. The mean age of the 155 participants was 39.6 years (SD = 10.9). There was no significant difference between demographic or clinical variables between the two groups. The only difference in baseline scores (T0) among the nine self-report questionnaires was in epilepsy knowledge, measured with the Epilepsy Knowledge Profile questionnaire, which were significantly higher for the CG (mean = 32.28, SD = 3.92) than the IG (mean = 23.01, SD = 2.79) (p < 0.001). Generalized estimating equations (GEE) analysis showed scores decreased significantly at T3 from baseline for the CG for epilepsy knowledge and QOL (p < 0.001). Improvements in scores for sleep quality, anxiety, depression, self-efficacy, coping, and social support did not differ between groups. Classification of the IG by gender showed a significantly greater increase for males compared with females from baseline to T3 for epilepsy knowledge (p < 0.001). If we further classified the IGs by seizure frequency, participants with a seizure frequency of ≥1 per year had a more significant increase in epilepsy knowledge and increase in QOL compared with participants with a seizure frequency of <1 per year at T3 compared with T0. CONCLUSION The lack of improvement in health-related quality of life (HRQoL) following the SMI may indicate that additional time is required to change behaviors that impact this variable for patients with epilepsy. Additional research should focus on variables associated with medication compliance, epilepsy knowledge, medicine symptom distress, self-efficacy, anxiety, and HRQoL.
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Affiliation(s)
- Hsiu-Fang Chen
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Yun-Fang Tsai
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; School of Nursing, Chang Gung University, Tao-Yuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
| | - Jun-Yu Fan
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan; Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Min-Chi Chen
- Graduate Institute of Biomedical Sciences, Chang Gung University, Tao-Yuan, Taiwan
| | - Mo-Song Hsi
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Mau-Sun Hua
- Department of Psychology, National Taiwan University, Taipei, Taiwan
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Govil N, Chahal S, Gupta N, Kaloti AS, Nadda A, Singh P. Factors Associated with Poor Antiepileptic Drugs Adherence in Below Poverty Line Persons with Epilepsy: A Cross-Sectional Study. J Neurosci Rural Pract 2021; 12:95-101. [PMID: 33531765 PMCID: PMC7846329 DOI: 10.1055/s-0040-1721200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background
Adherence to antiepileptic drugs (AED) is essential for adequate seizure control in epilepsy. People with low socioeconomic status are more vulnerable to poor adherence to AED. The present study aimed to explore factors associated with poor adherence to antiepileptic drugs in below poverty line (BPL) persons with epilepsy (PWE).
Methods
The research had a cross-sectional design with inclusion of persons aged 18 to 65 years and an established diagnosis of epilepsy. Holding a BPL card (Yellow card) was taken as a measure for BPL criteria. Adherence to antiepileptic drugs was assessed using medication adherence rating scale (MARS). Univariate analysis with Chi-square test was used to determine the association between various variables and AED adherence, while the predictors of adherence were identified using multivariate logistic regression analysis.
Results
There was a total of 88 BPL PWE. The mean age of male and female patients was 35.0 ± 15.0 & 32.0 ± 10.1 years, respectively. Adherence for drugs were found to be 30.7% and nonadherence to be 44.3%. Low (illiterate or primary) education (OR 0.041 [0.01–0.21]), polytherapy (OR 0.088 [0.02–0.40]), and substance abuse (OR 0.05 [0.01–0.58]) were found to have significant association with nonadherence to AEDs. Age, gender, marital status, family composition, occupation, rural urban background, distance from health care facility, duration of epilepsy, and side effects of AED were not found to have significant association with adherence.
Conclusion
There is a need for psychoeducational programs for the people having low education status and polytherapy to form positive beliefs in AEDs. Substance abuse should also be addressed while treating them.
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Affiliation(s)
- Nikhil Govil
- Department of General Medicine, Kalpana Chawla Government Medical College (KCGMC), Karnal, Haryana, India
| | - Savita Chahal
- Department of Psychiatry, Kalpana Chawla Government Medical College (KCGMC), Karnal, Haryana, India
| | - Nishu Gupta
- Department of Paediatrics, PGIMER Satellite Centre Sangrur, Punjab, India
| | - Amandeep Singh Kaloti
- Department of General Medicine, Kalpana Chawla Government Medical College (KCGMC), Karnal, Haryana, India
| | - Anuradha Nadda
- Department of Community Medicine, Gian Sagar Medical College, Banur, Patiala, Punjab, India
| | - Parmal Singh
- Department of Community Medicine, Adesh Medical College, Ambla, Haryana, India
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Farrukh MJ, Makmor-Bakry M, Hatah E, Jan TH. Impact of complementary and alternative medicines on antiepileptic medication adherence among epilepsy patients. BMC Complement Med Ther 2021; 21:50. [PMID: 33541336 PMCID: PMC7863518 DOI: 10.1186/s12906-021-03224-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the knowledge, attitude, and practice of complementary and alternative medicine (CAM) and its impact on antiepileptic drug (AED) adherence among patients with epilepsy. METHODS A cross-sectional study was carried out on 100 epilepsy patients, aged 18 years or older that did not have any physical or psychiatric illness. A patient-administered questionnaire was used to assess their knowledge, attitude towards, practice, and perceived effectiveness (KAPP) of CAM. Established adherence assessment tools were used to determine patient medication adherence. RESULTS The prevalence of CAM usage was found to be at 58%. CAM was used more frequently by males (n = 32, 60.4%) than by females (n = 26, 55.3%; p = 0.609). The most commonly used CAM included vitamins and minerals (36%), ginseng (16%), antioxidants (15%), and acupuncture (12%). A significant number of patients had low knowledge of (59%) and a positive attitude (54%) toward complementary and alternative medicine. Main reasons for using CAM were a lower price, better availability, and inadequate seizure control by AEDs. About 43% of the patients who used CAM informed their doctor. Prevalence of non-adherence to AED therapy was found to be 68%. A significant association was found between non-adherence and CAM usage (p < 0.01). CONCLUSION A high prevalence of CAM usage and non-adherence to AEDs among epilepsy patients was identified. CAM usage was associated with a non-adherence to AED therapy. This study highlights the need to explore CAM usage with patients before making clinical decisions to achieve the best outcomes from AED therapy.
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Affiliation(s)
- Muhammad Junaid Farrukh
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.,Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Tan Hui Jan
- Faculty of MedicinePusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
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Mesraoua B, Kissani N, Deleu D, Elsheikh L, Ali M, Melikyan G, Hail HA, Wiebe S, Asadi-Pooya AA. Complementary and alternative medicine (CAM) for epilepsy treatment in the Middle East and North Africa (MENA) region. Epilepsy Res 2021; 170:106538. [PMID: 33444903 DOI: 10.1016/j.eplepsyres.2020.106538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/03/2020] [Accepted: 12/18/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study is to provide the reader with a review on Complementary and Alternative Medicine (CAM) treatment in epilepsy in the Middle East and North Africa (MENA) region, to describe the extent and factors associated with its use among patients with epilepsy (PWE), and to recommend how effectively we will be able to reduce this alarming use. MATERIAL AND METHODS Retrospective literature search from 1945 to December 2019, regarding CAM use in the MENA region, using electronic databases (PubMed, Scopus, Google Scholar, Web of Science). CONCLUSION The use of CAM and consultation of traditional healers for the treatment of epilepsy has so far been widespread practice for centuries in the MENA region. Lack of health professionals and non-adherence to conventional epilepsy treatment are strongly associated with the use of CAM. Improvement in the level of knowledge of epilepsy among PWE, healthcare professionals, including traditional healers, will educate PWE and their caregivers on potentially unsafe practices and promote adherence to Antiseizure Drugs (ASDs). Additionally, randomized controlled trials are needed to study the role and value of various CAM treatment options in PWEs.
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Affiliation(s)
- Boulenouar Mesraoua
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College-Qatar, Qatar.
| | - Najib Kissani
- University Hospital Mohammed VI, Marrakech, Morocco.
| | - Dirk Deleu
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College-Qatar, Qatar.
| | | | - Musab Ali
- Hamad Medical Corporation, Doha, Qatar.
| | - Gayane Melikyan
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College-Qatar, Qatar.
| | - Hassan Al Hail
- Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medical College-Qatar, Qatar.
| | - Samuel Wiebe
- Cumming School of Medicine, University of Calgary, Canada.
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA.
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Mehta D, Davis M, Epstein AJ, Wensel B, Grinnell T, Thach A, Williams GR. Comparative economic outcomes in patients with focal seizures initiating eslicarbazepine acetate versus brivaracetam as their first adjunctive ASD. J Med Econ 2021; 24:939-948. [PMID: 34311671 DOI: 10.1080/13696998.2021.1960682] [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] [Indexed: 10/20/2022]
Abstract
AIMS To study the association between initiation of first adjunctive therapy with eslicarbazepine acetate (ESL) vs. brivaracetam (BRV) on healthcare resource utilization (HCRU) and charges among patients with treated focal seizures (FS). MATERIALS AND METHODS Symphony Health's Integrated Dataverse (IDV) claims data (1 April 2015 to 30 June 2018) were used to identify two cohorts as first adjunctive therapy with ESL or BRV following a generic anti-seizure drug (ASD). The index date was the earliest claim for a new ESL or BRV prescription. Key inclusion criteria were only 1 generic ASD in the 12 months before the index date; ≥1 medical claim with an FS diagnosis. Unit of analysis was the 90-day person-time-block. Changes in HCRU and charges were assessed using a difference-in-differences framework. Both unadjusted and adjusted analyses were performed. The adjusted model utilized person-specific fixed effects and propensity score-based weighting to control for differences in baseline covariates. Bias-corrected bootstrap confidence intervals (CIs) were calculated for charge outcomes. RESULTS 208 and 137 patients initiated first adjunctive therapy with ESL (43.7 years, 51.9% female) or BRV (39.3 years, 51.8% female). Patients in the ESL cohort had numerically larger reductions in all-cause and FS-related inpatient hospitalizations and outpatient visits and FS-related emergency department visits. Compared to patients initiating BRV, patients treated with ESL had significantly larger reductions in total charges (-$3,446, CI: -$13,716, -$425), all-cause (-$3,166, CI: -$13,991, -$323) and FS-related (-$2,969, CI: -$21,547, -$842) medical charges, all-cause (-$3,397, CI: -$15,676, -$818) and FS-related (-$2,863, CI: -$19,707, -$787) outpatient charges, and non-ASD-related prescription charges (-$420, CI: -$1,058, -$78). LIMITATIONS Claims may be missing, or miscoded; outcomes may be influenced by variables not accounted for in the analysis; only information on submitted charges was included. CONCLUSIONS Among patients with FS, initiation of first adjunctive therapy with ESL was associated with significantly larger reductions in medical and non-ASD-related prescriptions charges compared to BRV.
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Affiliation(s)
| | | | | | - Brian Wensel
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
| | | | - Andrew Thach
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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Mehta D, Davis M, Epstein AJ, Lee A. Impact of Formulary Restrictions on Antiepileptic Drug Dispensation Outcomes. Neurol Ther 2020; 9:505-519. [PMID: 32474812 PMCID: PMC7606428 DOI: 10.1007/s40120-020-00195-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The aim of this analysis was to assess the relationship between formulary restrictions and antiepileptic drug (AED) dispensation in patients with focal seizure (FS). STUDY DESIGN A retrospective cohort analysis was conducted using data from Symphony Health's Integrated Dataverse® (1 April 2015-30 June 2018). METHODS This study included two patient populations: the overall patient population (N = 54,097) and a pediatric population (< 18 years) (N = 12,610). Cohorts were defined based on approval or rejection of the index AED claim. Study outcomes were prescription life cycle analysis, proportion of patients with dispensation, time to dispensation, and likelihood of successful dispensation. A multivariable Cox proportional hazards model was estimated to study the association between formulary restriction and likelihood of successful AED dispensation. RESULTS Among patients in the overall population with a rejected claim (n = 9133), 8.0% did not receive any AED and 77.6% received approval for the index AED following an appeal. Among the pediatric patients with a rejected claim (n = 3081), 6.0% did not receive any AED and 81.7% received approval for the index AED after an appeal. In both populations, formulary restrictions were associated with significant delays in index AED dispensation (6.9 and 5.3 days, respectively; P < 0.0001 for each population), compared to approved AED claims. In the overall and pediatric populations, formulary-related rejections of AEDs were associated with a 35% (hazard ratio [HR] 0.65; 95% confidence interval [CI] 0.64-0.66; P < 0.0001) and 27% (HR 0.73; 95% CI 0.69-0.76; P < 0.0001) lower likelihood of successful dispensation of the index AED, respectively. CONCLUSIONS Formulary restrictions of AEDs were associated with significant delays in treatment and significantly lower likelihood of successful AED dispensation in patients with FS.
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Affiliation(s)
- Darshan Mehta
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
| | | | | | - Andrew Lee
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA
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Sunny AA, Iyer RS, Kumaran SG, Bunshaw NG, Shanmugham K, Govindaraj U. Affordability, availability and tolerability of anti-seizure medications are better predictors of adherence than beliefs: Changing paradigms from a low resource setting. Seizure 2020; 83:208-215. [PMID: 33227659 DOI: 10.1016/j.seizure.2020.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/11/2020] [Accepted: 11/07/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Anti-seizure medication (ASM) non-adherence contributes to treatment gap and increases mortality and morbidity associated with epilepsy. Beliefs about medications are considered better predictors of ASM non-adherence than clinico-demographic factors. We aimed to look into ASM non-adherence rates among adults with epilepsy (AWE), identify the contributing barriers and determine whether medication beliefs were more powerful predictors than clinico-demographic factors. METHODS This was a cross-sectional study of AWE receiving ASMs. Participants (n = 304) were assessed by validated questionnaires, for non-adherence (8-item Morisky Medication Adherence Scale) and perceptions of ASMs (Beliefs about Medicines Questionnaire) along with clinico-demographic details. RESULTS Our group with high literacy and low-income had a high non-adherence rate (55 %) despite having positive beliefs (Mean necessity-concern differential [NCD] = 2.86). Among the beliefs, ASM non-adherence was significantly associated with ASM-concern (t = 4.23, p < 0.001) and NCD (t = -4.11, p < 0.001). Stepwise multiple linear regression analysis showed that non-adherence was significantly associated with per-capita income (β -0.215, p < 0.001), ASM side effects (β 0.177, p = 0.001), high seizure frequency (β 0.167, p = 0.002), ASM availability (β -0.151, p = 0.004), ASM costs (β -0.134, p = 0.013 and NCD (β -0.184, p = 0.001). NCD accounted for 2.9 % of the variance in non-adherence whereas the other clinico-demographic variables together accounted for 14.6 %. CONCLUSION We describe a paradigm shift in AWE with high non-adherence to ASMs, wherein clinico-demographic variables emerge as better predictors of non-adherence than beliefs. High literacy facilitates the perception of need for ASMs whereas costs and side effects hamper adherence.
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Affiliation(s)
- Anita Ann Sunny
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rajesh Shankar Iyer
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
| | - Soumya Gopalan Kumaran
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Nadiya Grace Bunshaw
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Karthikeyan Shanmugham
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Uma Govindaraj
- Department of Statistics, PSG College of Arts & Science, Coimbatore, Tamil Nadu, India
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O'Dwyer R. Epilepsy: Workup and Management in Adults. Semin Neurol 2020; 40:624-637. [PMID: 33176373 DOI: 10.1055/s-0040-1719069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
When managing epilepsy, there is a temptation to focus care with respect to the last and the next seizure. However, epilepsy is a multifaceted chronic condition and should be treated as such. Epilepsy comes with many physical risks, psychological effects, and socioeconomic ramifications, demanding a long-term commitment from the treating physician. Patients with epilepsy, compared to other chronically ill patient populations, have a worse quality of life, family function, and less social support. The majority of patients are well controlled on antiseizure drugs. However, approximately one-third will continue to have seizures despite optimized medical management. The primary aim of this article is to explore the long-term management of chronic epilepsy, and to address some of the particular needs of patients with chronic epilepsy.
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Affiliation(s)
- Rebecca O'Dwyer
- Department of Neurological Science, Rush University Medical Center, Chicago, Illinois
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Mroueh L, Boumediene F, Jost J, Ratsimbazafy V, Preux PM, Salameh P, Al-Hajje A. Quality of life and stigma in Lebanese people with epilepsy taking medication. Epilepsy Res 2020; 167:106437. [DOI: 10.1016/j.eplepsyres.2020.106437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/07/2020] [Accepted: 08/01/2020] [Indexed: 11/24/2022]
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Nonadherence to Antiepileptic Medications and Its Determinants among Epileptic Patients at the University of Gondar Referral Hospital, Gondar, Ethiopia, 2019: An Institutional-Based Cross-Sectional Study. Neurol Res Int 2020; 2020:8886828. [PMID: 33194230 PMCID: PMC7641705 DOI: 10.1155/2020/8886828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Nonadherence to antiepileptic medication is the extent of a patient's passive failure to follow the prescribed therapeutic regimen. The prevalence and impact of nonadherence to antiepileptic medication are high globally. The main purpose of this study was to assess nonadherence to antiepileptic medications and its associated factors among epileptic patients at the University of Gondar Referral Hospital, Gondar, Ethiopia, 2019. Methods An institutional-based cross-sectional study was conducted among 365 epileptic patients at the University of Gondar Referral Hospital, who were selected by a systematic random sampling technique. Data were collected by face to face interviews using a structured pretested questionnaire. Data were entered into EPI Info version 7 and then exported to SPSS version 22 for analysis. The data were described by descriptive statistics. Binary logistic regression analysis was used as a model, and variables with a p value of less than 0.05 were considered as statistically significant with nonadherence to antiepileptic medications. Results A total of 356 epileptic patients participated in the study yielding a response rate of 97.5%. The overall prevalence of nonadherence to antiepileptic medications among epileptic patients attending at the University of Gondar Referral Hospital was 38.5% (95% CI: 33.1–43.8). Divorced and/or widowed marital status (AOR: 3.38 (95% CI: 1.54, 7.44)), treatment duration of 3–5 years (AOR = 3.58 (95% CI: 1.38, 9.29)), treatment duration of 5 and above years (AOR: 3.49 (95% CI: 1.53, 7.95)), comorbidity (AOR: 2.42 (95% CI: 1.08, 5.43)), side effects of antiepileptic medications (AOR: 3.36 (95% CI: 1.67, 6.74)), absence of health information (AOR: 1.98 (95% CI: 1.11, 3.52)), epilepsy-related stigma (AOR: 2.81 (95% CI: 1.57, 5.02)), and negative attitude towards antiepileptic medications (AOR: 2.46 (95% CI: 1.36, 4.45)) were significantly associated with nonadherence to antiepileptic medications. Conclusions Prevalence of nonadherence to antiepileptic medications among epileptic patients at the University of Gondar Referral Hospital was found to be high. Hence, giving health information about epilepsy and its management will help to reduce antiepileptic medications' nonadherence.
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Abd Wahab ES, Al Omar M, Altabakha MMAM. Adherence to Antiepileptic Drugs among Patients Attending the Neuro Spinal Hospital in the United Arab Emirates. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2020; 12:499-507. [PMID: 33679099 PMCID: PMC7909063 DOI: 10.4103/jpbs.jpbs_367_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/20/2020] [Accepted: 05/29/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Adherence to antiepileptic drugs (AEDs) is an integral component of epilepsy management. There are no previous data in the United Arab Emirates (UAE). Objectives: The aim of this study was to assess the prevalence of AED adherence among patients attending the Neuro Spinal Hospital in UAE and to identify the predictors of nonadherence. Materials and Methods: A cross-sectional study was conducted between April 2018 and May 2019, and included consecutive patients with epileptic who were receiving AEDs for at least 6 months. A validated interviewer-administered questionnaire was used. Adherence was assessed by four-item Morisky’s Medication Adherence Scale with a score between 0 and 4. Patients were considered adherent or nonadherent for a score of zero, or 1 and more, respectively. Chi-square test, binary, and multiple logistic regression analysis were used. Results: The study included 315 respondents, 70.8% (n = 223) were adherent, the rest were nonadherent. The most common factor affecting adherence was forgetfulness. Lower education level and having a seizure within the last 6 months were significant risk of nonadherence (odds ratio [OR] 95% confidence interval [CI] = 2.6 (1.2–5.8) and 2.5 (1.3–5.2), respectively), whereas levetiracetam intake reduces the risk of nonadherence (OR: 0.5 [0.2–0.9]). Conclusions: The prevalence of AED adherence was 70.8%. Education level and having a seizure in the last 6 months were significant predictors of nonadherence, whereas levetiracetam intake reduces the risk of nonadherence.
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Affiliation(s)
- Enas S Abd Wahab
- Department of Pharmacy, Neuro Spinal Hospital, Dubai, United Arab Emirates
| | - Muaed Al Omar
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Moawia M A M Altabakha
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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Suzuki H, Mikuni N, Ohnishi H, Yokoyama R, Enatsu R, Ochi S. Forgetting to take antiseizure medications is associated with focal to bilateral tonic-clonic seizures, as revealed by a cross-sectional study. PLoS One 2020; 15:e0240082. [PMID: 33002061 PMCID: PMC7529199 DOI: 10.1371/journal.pone.0240082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 09/19/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives To evaluate the effects of nonadherence to antiseizure medications (ASMs) and clinical characteristics on seizure control, we employed a prospective cohort cross-sectional study using self-reports and medical records of patients with epilepsy (PWEs). Methods Eight hundred and fifty-five PWEs taking ASMs were enrolled from fourteen collaborative outpatient clinics from January 2018 to March 2019. Questions from the Morisky Medication Adherence Scale were used as adherence self-reports. If a PWE’s questionnaire indicated that they had missed doses of their ASMs, outpatient physicians asked them directly about the details of their compliance, including the timing of intentionally or unintentionally missed doses. The association between lack of seizure control and utilization outcomes, such as missed doses, demographics, and clinical characteristics of the PWEs, were assessed by univariate and multivariate analyses. Results Multivariate analysis revealed that forgetting to take ASMs was associated with lack of seizure control and the existence of focal to bilateral tonic–clonic seizures. Dementia, younger age, use of three or more antiepileptic agents, and living in a one-person household were associated with the risk of forgetting to take ASMs. Significance For PWEs with poor drug management or a high incidence of missed doses of ASMs, efforts to improve adherence could facilitate better seizure control and decrease focal to bilateral tonic–clonic propagation.
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Affiliation(s)
- Hime Suzuki
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
- * E-mail:
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University, Sapporo, Japan
| | - Rintaro Yokoyama
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Satoko Ochi
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
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Khdour M, Awadallah HB, Al-Hamed DH. Assessment of treatment satisfaction and adherence amongst diabetic patients in governmental primary care clinic of Ramallah, West-Bank. Hosp Pract (1995) 2020; 49:27-33. [PMID: 32901519 DOI: 10.1080/21548331.2020.1822083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to assess treatment satisfaction and its association with medication adherence among patients with diabetes. METHODS Participants in this study were outpatients at the governmental Primary Healthcare Unit in Ramallah. Adherence was measured with the 4-item Morisky Green-Levine (MGL) questionnaire, and treatment satisfaction with the Treatment Satisfaction Questionnaire for Medication version 1.4. Glycemic control was measured as the last value of an HbA1c test, with HbA1c ≤7 considered good. RESULTS Of the participants, 220 (57.9%) were classified as having high adherence to their medications, and 160 (42.1%) as having low adherence. Regarding glycemic control, 174 (45.7%) of patients had good control, while 206 (54.2%) had poor control. Satisfaction with treatment effectiveness showed a significant mean difference with adherence level (78.61 vs. 74.2; p = 0.04). Glycemic controlled patients had a higher and significant adherence mean in the global satisfaction domain (69.19 vs. 62.08; p = 0.01). However, glycemic control level had no significant differences in means of effectiveness, side effects, and convenience domains (P = 0.31, 0.49, 0.37) respectively. CONCLUSIONS Treatment satisfaction level is lower among low adherence and poor glycemic control. Addressing the specific needs of these patients might be effective in improving their satisfaction, thus having a positive influence on other clinical outcomes.
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Affiliation(s)
- Maher Khdour
- Department of Pharmacy, Al Quds University , Jerusalem, Israel
| | | | - Dua'a H Al-Hamed
- Department of Pharmacy, Ramallah and Al-bireh health directorate , West Bank, Palestine
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Teh KX, Henien NPB, Wong LS, Wong ZKH, Raja Ismail RZ, Achok HN, Mariapun J, Yunos NM. A cross-sectional study on the rate of non-adherence to anti-seizure medications and factors associated with non-adherence among patients with epilepsy. PLoS One 2020; 15:e0235674. [PMID: 32649723 PMCID: PMC7351198 DOI: 10.1371/journal.pone.0235674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background Non-adherence to anti-seizure medication (ASM) therapy is an important contributing factor to the higher mortality rate and treatment failure of epilepsy. This study aimed to determine the rate and factors associated with non-adherence to ASM therapy through the WHO five dimensions of medication adherence framework. Methods We conducted a cross-sectional study at an outpatient Neurology Clinic of a tertiary government hospital in Malaysia. Between March and July 2019, we identified 217 patients with a confirmed diagnosis of epilepsy, receiving oral ASM therapy and able to administer their medications. We performed a semi-structured interview to gather information on sociodemographic background, clinical and medication history, and perceptions on healthcare services. Adherence to ASM therapy was evaluated using the Medication Compliance Questionnaire (MCQ). Patient’s illness perception was assessed by the Brief Illness Perception Questionnaire (B-IPQ). Results 208 patients participated in this study. The median age of the study participants was 35 years (IQR 26–44). 58.2% were females and majority, 55.8%, were from the Malay ethnic group. Based on the MCQ scoring, 89 patients (42.8%) were non-adherent. Multiple logistic regression demonstrated that being employed or students (adjusted odds ratio [aOR] 2.26, 95%CI: 1.19–4.29 p = 0.012) and having an average or below average perceived access to pharmacy services (aOR 2.94, 95%CI: 1.38–6.24, p = 0.005) were significant contributors to non-adherence. Conclusion Being employed or students and having an average or below average perceived access to pharmacy services were associated with ASM non-adherence Efforts to improve ASM adherence should adopt a comprehensive approach considering the success of adherence is contingent on the interrelationship of multiple dimensions.
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Affiliation(s)
- Kai Xuan Teh
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Nevein Philip Botross Henien
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
- * E-mail:
| | - Lyang Shenz Wong
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Zoe Kee Hui Wong
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Raja Zarina Raja Ismail
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Hamdi Najman Achok
- Department of Medicine, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Jeevitha Mariapun
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Nor’azim Mohd Yunos
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
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Belayneh Z, Mekuriaw B. A systematic review and meta-analysis of anti-epileptic medication non-adherence among people with epilepsy in Ethiopia. ACTA ACUST UNITED AC 2020; 78:23. [PMID: 33072315 PMCID: PMC7562694 DOI: 10.1186/s13690-020-00405-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/05/2020] [Indexed: 02/07/2023]
Abstract
Background Epilepsy is the common neurological disorder in the world, affecting approximately 50 million people. Anti-epileptic medication non-adherence can be a reason for long term hospitalization, repeated emergency seizure attacks, increased health care cost and frequent absence of work due to poor seizure control. Existed studies of anti-epileptic medication non-adherence in Ethiopia have reported great discrepant and inconsistent results which calls a growing demand of systematic review and meta-analysis. Therefore, this review aimed to show the pooled prevalence of anti-epileptic medication non-adherence among people with epilepsy attending outpatient department. Methods Literatures were searched from the PubMed/Medline, Science Direct, PsycINFO, Hinnari and Google Scholar for grey literatures. The data were extracted using a prepared data extraction Microsoft Excel format. The data were analyzed using STATA- version 14 (software). The I2 test was used to check the heterogeneity between primary studies with a corresponding 95% confidence interval. Results A total of fourteen primary studies of anti-epileptic medication non-adherence were included in the review showing the pooled prevalence of anti-epileptic medication non-adherence to be 39.77 (95% CI: 32.44, 47.10). The highest prevalence [44.13 95% CI: (29.92, 58.34)] was observed among studies used both self-report and medical record review together, and studies used only self-report to screen medication none adherence had the lowest prevalence [37.95% (24.50, 51.41)]. Presence of co-morbid illness [2.27 (95%CI: 1.01, 5.12)], medication side effects [1.84(95% CI: 1.43, 2.38)], substance use or drug abuse [2.01(95% CI: 1.27, 3.20)] had statistically significant association with anti-epileptic medication non-adherence. Conclusion In this review, we found that there is a high burden of anti-epileptic medication non-adherence among people with epilepsy in Ethiopia. This demonstrates a need for clinicians to give more attention for the monitoring and evaluation of anti-epileptic medication adherence in the health care service. We also highly recommended for the adoption of a standardized and contextualized adherence screening tools. Trial registration PROSPERO registration number- [CRD42019137631].
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Affiliation(s)
- Zelalem Belayneh
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Birhanie Mekuriaw
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
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Banks J, Varley J, Fitzsimons M, Doherty CP. Self-reported antiepilepsy medication adherence and its connection to perception of medication error. Epilepsy Behav 2020; 104:106896. [PMID: 31986441 DOI: 10.1016/j.yebeh.2019.106896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/20/2019] [Accepted: 12/29/2019] [Indexed: 11/25/2022]
Abstract
Although 70% of people with epilepsy (PWE) achieve seizure freedom following an appropriate antiepileptic drug (AED) regime, evidence suggests that adherence to AEDs by PWE is suboptimal. Nonadherence to AEDs is associated with increased morbidity, mortality, emergency department visits, and hospitalizations, with reduced adherence also correlating to a lower quality of life, decreased productivity, and loss of employment. Furthermore, research indicates that medication errors which are widespread in chronic disease are less well studied in epilepsy but are likely also to contribute to avoidable disease morbidity and mortality. The goals of this project were to determine rates of medication adherence by self-reported questionnaire and its links to perceived medication error in a cohort of PWE attending a general epilepsy outpatient clinic. Following a plan-do-study-act cycle, it was found that the most appropriate methodology for conducting was in the form of a bespoke 9-item self-administered questionnaire. One hundred eighty-six PWE completed a nine-question questionnaire asking patients about their own medication adherence habits and their perception that they were previously exposed to medication error. This study found that 41% of respondents reported suboptimal adherence to AED therapy, while 28.5% of respondents self-reported that they unintentionally do not take their AED medication on an occasional, regular, or frequent basis. A 5.9% of respondents self-reported that they intentionally do not take their medication as prescribed. A 6% of respondents self-reported that they are both unintentionally and intentionally nonadherent to their AED therapy. No significant associations were demonstrated between age, sex, perceived effectiveness of medication, feelings of stigma/embarrassment, adverse effects or additional neurological comorbidities, and unintentional or intentional nonadherence. A 28.5% of respondents to the questionnaire reported that they perceived themselves to have been subjected to medication error. Prescribing errors were the most common form of perceived medication error, followed by dispensing errors, then administration errors. Significant associations were found between ineffective medication and feelings of stigma or embarrassment about epilepsy with perceived prescribing errors. Intentional nonadherence to medication was significantly associated with perceived dispensing errors.
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Affiliation(s)
- Jack Banks
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland; FutureNeuro SFI Research Centre, The Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
| | - Jarlath Varley
- School of Nursing and Midwifery, Trinity College, Dublin 2, Ireland
| | - Mary Fitzsimons
- FutureNeuro SFI Research Centre, The Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Colin P Doherty
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland; FutureNeuro SFI Research Centre, The Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland; Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland
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Siqueira HH, Dalbem JS, Schiavini M, Silva PE, Costa TBP, Leite PHSC, Koeche B, Diesel M, Scolari LP, Wolf P, Walz R, Lin K. Self-reported adherence among people with epilepsy in Brazil. Epilepsy Behav 2020; 103:106498. [PMID: 31653605 DOI: 10.1016/j.yebeh.2019.106498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonadherence rates among people with epilepsy (PWE) are widely variable, ranging from 26% to 95.4%. We aimed to identify nonadherence in Brazil, its determinant factors, its impact on patients' management, and to compare it with other chronic nonparoxysmal diseases. METHODS A multicenter observational case-control study was conducted between March 2015 and October 2016, and 153 subjects were included. Subjects' clinical-epidemiological data were surveyed with the Morisky-Green test (MGT), Brief Medication Questionnaire (BMQ), and the Liverpool adverse events profile (LAEP). RESULTS One hundred three PWE and 50 controls with other, nonparoxysmal chronic conditions were interviewed; both groups were matched according to age and socioeducational level. People with epilepsy were aged 36.4 ± 13.9 (range 18-67), 55% were women, mean age at epilepsy onset was 18.1 ± 15.5 years, 51.5% had pharmacoresistant epilepsy, and 48.5% were on monotherapy. 74.8% of patients and 70.0% controls were nonadherent to treatment according to MGT (p = 0.58); and barrier of recall (BMQ) was associated with nonadherence in 78% of PWE and 76% of controls (p = 0.84). Binary logistic regression analysis revealed LAEP (OR 1.05; 95%CI = 1.01-1.09; p = 0.03) and self-reported frequency of forgetfulness on the last three months (OR 19.13; 95%CI = 2.40-152.28; p < 0.01) as the main factors associated with nonadherence. Nonadherent subjects did not have more seizures and did not need emergency treatment more often than adherent ones. CONCLUSION Three of four PWE were not fully adherent to their treatment. Adherence assessment should be routine in all outpatient visits as well as interventions aimed to improving it. Adverse events are important predictors of adherence, and they should be considered when choosing the initial treatment of epilepsy.
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Affiliation(s)
- Heloise Helena Siqueira
- Medical Sciences Graduation Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Hospital Geral Universitário, Cuiabá, MT, Brazil.
| | - Juliane Salter Dalbem
- Medical Sciences Graduation Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil
| | - Marcel Schiavini
- Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil
| | - Paulo Eduardo Silva
- Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil
| | | | | | - Bruna Koeche
- Neurology Division, Hospital Geral Universitário, Cuiabá, MT, Brazil
| | - Marcelo Diesel
- Neurology Division, Hospital Geral Universitário, Cuiabá, MT, Brazil
| | | | - Peter Wolf
- Medical Sciences Graduation Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark
| | - Roger Walz
- Medical Sciences Graduation Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Center for Applied Neurosciences (CeNAp), Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil
| | - Katia Lin
- Medical Sciences Graduation Program, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil; Center for Applied Neurosciences (CeNAp), Federal University of Santa Catarina, (UFSC), Florianópolis, SC, Brazil
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Vitturi BK, Pellegrinelli A, Valerio BCO. Medication adherence in patients with myasthenia gravis in Brazil: a cross-sectional study. Acta Neurol Belg 2020; 120:83-89. [PMID: 31555980 DOI: 10.1007/s13760-019-01209-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
Advances in the treatment of MG have allowed most patients to effectively treat their disorder with oral medications. In parallel, non-adherence to medication treatment regimens is a worldwide health problem. Other chronic neurological disorders have already been associated with low adherence to treatment. However, the literature regarding adherence among patients with MG is definitely poor. The purpose of this study was to capture the prevalence and the associated factors of non-adherence to pharmacological treatment in patients with MG. We carried out a cross-sectional cohort study with 58 consecutive patients with MG from a university-affiliated referral hospital in São Paulo, Brazil. We registered clinical and sociodemographic data and patients were classified according to the MGFA classification. Clinical severity was assessed with myasthenia gravis composite (MGC) scale. Neuropsychiatric symptoms were evaluated with the Hospital Anxiety and Depression Scale (HADS) and quality of life with the 15-Item Quality Of Life Instrument for myasthenia gravis scale (MG-QOL15). Adherence to pharmacological treatment was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS-8). There were 26 (44.8%) patients adherent to treatment. Low adherence was associated with poor educational attainment, longer time of disease and greater daily number of pills (p < 0.05). Patients with poor compliance to treatment presented worse quality of life and increased neuropsychiatric symptoms (p < 0.05). Adherence can be relatively challenging in patients with MG. Medical approach should recognize that therapeutic success in the treatment of MG goes through adherence to treatment.
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