1
|
Müller IR, Grandi VT, Santos Paulino SG, Villa BD, Zembruski BM, Forcelini CM, Hahn SR, Antunes MV, Linden R. Determination of carbamazepine in fingerprints: a feasibility study to evaluate adherence in epilepsy patients. Bioanalysis 2024; 16:415-427. [PMID: 38497729 DOI: 10.4155/bio-2023-0265] [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: 12/20/2023] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Abstract
Background: Fingerprint drug concentrations can be used as a noninvasive and convenient alternative to evaluate adherence to pharmacotherapy. Methods: Fingerprints were applied over glass slides, extracted and analyzed by ultra-high performance LC-MS/MS. The assay and drug adherence questionnaires were applied to 30 epilepsy patients. Results: The assay had linearity in the range 0.05-10 ng fingerprint-1, with precision of 2.16-7.9% and accuracy of 95.0-102.8%. Carbamazepine (CBZ) levels in fingerprints were stable at 45°C for 15 days. Concentrations in patient samples were 0.06-9.28 ng fingerprint-1. A significant difference (p = 0.003) was found between CBZ concentrations in fingerprints between patient groups divided as low and medium/high adherence. Conclusion: This method can potentially be applied to the identification of epilepsy patients with low adherence to CBZ pharmacotherapy.
Collapse
Affiliation(s)
- Isadora Ritter Müller
- Analytical Toxicology Laboratory, Universidade Feevale, Rua Rubem Berta, 200, Novo Hamburgo, RS, CEP, 93525-080, Brazil
- Graduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Rua Rubem Berta, 200, Novo Hamburgo, RS, CEP, 93525-080, Brazil
| | - Valéria Tessaro Grandi
- College of Medicine, Universidade de Passo Fundo, Rua Teixeira Soares, 817, Passo Fundo, RS, CEP, 99010-080, Brazil
| | - Sarah Gondim Santos Paulino
- College of Medicine, Universidade de Passo Fundo, Rua Teixeira Soares, 817, Passo Fundo, RS, CEP, 99010-080, Brazil
| | - Bárbara De Villa
- College of Pharmacy, Universidade de Passo Fundo, Rodovia BR 285, Km 293, Passo Fundo, RS, CEP, 99052-900, Brazil
| | - Bianca Modena Zembruski
- College of Pharmacy, Universidade de Passo Fundo, Rodovia BR 285, Km 293, Passo Fundo, RS, CEP, 99052-900, Brazil
| | | | - Siomara Regina Hahn
- College of Pharmacy, Universidade de Passo Fundo, Rodovia BR 285, Km 293, Passo Fundo, RS, CEP, 99052-900, Brazil
| | - Marina Venzon Antunes
- Analytical Toxicology Laboratory, Universidade Feevale, Rua Rubem Berta, 200, Novo Hamburgo, RS, CEP, 93525-080, Brazil
- Graduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Rua Rubem Berta, 200, Novo Hamburgo, RS, CEP, 93525-080, Brazil
| | - Rafael Linden
- Analytical Toxicology Laboratory, Universidade Feevale, Rua Rubem Berta, 200, Novo Hamburgo, RS, CEP, 93525-080, Brazil
- Graduate Program on Toxicology and Analytical Toxicology, Universidade Feevale, Rua Rubem Berta, 200, Novo Hamburgo, RS, CEP, 93525-080, Brazil
| |
Collapse
|
2
|
Mamo B, Feyissa AM, Mengesha T, Ayele BA, Mamushet Yifru Y. Association between cognitive impairment and antiseizure medication adherence among people with epilepsy in Addis Ababa, Ethiopia. Epilepsy Behav 2024; 152:109651. [PMID: 38295505 DOI: 10.1016/j.yebeh.2024.109651] [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: 08/05/2023] [Revised: 12/12/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Cognitive impairment is one of the most common and most troublesome comorbidities among people with epilepsy (PWE). Adherent use of antiseizure medications (ASM) can control seizure episodes in 70% of the cases. However, the relationship between adherent use of ASMs and cognitive impairment in epilepsy is complex. OBJECTIVE To assess the association between adherence to ASMs and cognitive status among PWE. METHODS We performed a cross-sectional observational study with prospective data collection from PWE using translated and content-validated Amharic versions of the Montreal cognitive assessment tool (MOCA-B) and a four-item Morisky Medication Adherence Scale (Morski-4). Ordinal logistic regression analysis was performed to evaluate the potential risk factors for cognitive impairment, including ASM adherence, physical exercise, and level of education. RESULTS A total of 214 individuals with epilepsy were included in this study; 53.7 % were female, and the mean age was 34 years ± 12. The mean age at seizure occurrence was 19 years ± 9. The most common epilepsy type among participants was generalized epilepsy (69 %). The prevalence of poor medication adherence to ASM was 54.2 %. The prevalence of mild cognitive impairment was 65.4 %, and 18.2 % had moderate cognitive impairment, particularly affecting verbal fluency (60.8 %) and memory (43.9 %). Cognitive impairment was significantly associated with poor ASM adherence (AOR = 12.0, 95 %CI, (1.53, 93.75), lower level of physical exercise (AOR = 16.30, 95 %CI (1.24, 214.99), and poor educational attainment with both no formal education (AOR = 0.04, 95 %CI (0.02, 0.14)) and primary or secondary level education (AOR = 0.32, 95 %CI, (0.15, 0.70). CONCLUSIONS There is a high rate of cognitive impairment and non-adherence to ASMs in PWE living in Addis Ababa, Ethiopia. Poor ASM adherence is a possible risk factor for cognitive impairment. PWE can benefit from interventions to improve ASM adherence, physical exercise, and better educational attainment.
Collapse
Affiliation(s)
- Blen Mamo
- Neurologist, Department of Neurology, College of Health Sciences, Addis Ababa University, Liberia Street, Addis Ababa, Ethiopia.
| | - Anteneh M Feyissa
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32256, USA.
| | - Tariku Mengesha
- Saint Peter Specialized Hospital, Liberia Street, Addis Ababa, Ethiopia.
| | - Biniyam A Ayele
- Neurologist, Department of Neurology, College of Health Sciences, Addis Ababa University, Liberia Street, Addis Ababa, Ethiopia; Global Brain Health Institute, UCSF, USA.
| | - Yared Mamushet Yifru
- Neurologist, Department of Neurology, College of Health Sciences, Addis Ababa University, Liberia Street, Addis Ababa, Ethiopia.
| |
Collapse
|
3
|
Ghosh S, Sinha JK, Ghosh S, Sharma H, Bhaskar R, Narayanan KB. A Comprehensive Review of Emerging Trends and Innovative Therapies in Epilepsy Management. Brain Sci 2023; 13:1305. [PMID: 37759906 PMCID: PMC10527076 DOI: 10.3390/brainsci13091305] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/09/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Epilepsy is a complex neurological disorder affecting millions worldwide, with a substantial number of patients facing drug-resistant epilepsy. This comprehensive review explores innovative therapies for epilepsy management, focusing on their principles, clinical evidence, and potential applications. Traditional antiseizure medications (ASMs) form the cornerstone of epilepsy treatment, but their limitations necessitate alternative approaches. The review delves into cutting-edge therapies such as responsive neurostimulation (RNS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), highlighting their mechanisms of action and promising clinical outcomes. Additionally, the potential of gene therapies and optogenetics in epilepsy research is discussed, revealing groundbreaking findings that shed light on seizure mechanisms. Insights into cannabidiol (CBD) and the ketogenic diet as adjunctive therapies further broaden the spectrum of epilepsy management. Challenges in achieving seizure control with traditional therapies, including treatment resistance and individual variability, are addressed. The importance of staying updated with emerging trends in epilepsy management is emphasized, along with the hope for improved therapeutic options. Future research directions, such as combining therapies, AI applications, and non-invasive optogenetics, hold promise for personalized and effective epilepsy treatment. As the field advances, collaboration among researchers of natural and synthetic biochemistry, clinicians from different streams and various forms of medicine, and patients will drive progress toward better seizure control and a higher quality of life for individuals living with epilepsy.
Collapse
Affiliation(s)
- Shampa Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
- ICMR—National Institute of Nutrition, Tarnaka, Hyderabad 500007, India
| | | | - Soumya Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
| | | | - Rakesh Bhaskar
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
| | - Kannan Badri Narayanan
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
- Research Institute of Cell Culture, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
| |
Collapse
|
4
|
Samsonsen C, Mestvedthagen G, Uglem M, Brodtkorb E. Disentangling the cascade of seizure precipitants: A prospective observational study. Epilepsy Behav 2023; 145:109339. [PMID: 37413785 DOI: 10.1016/j.yebeh.2023.109339] [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: 04/24/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The management of epilepsy includes appropriate antiseizure medication (ASM) treatment and careful avoidance of seizure precipitating factors. Seizure precipitants may be multiple occurring with low intensity adding to each other, thus leaving essential elements unrecognized. The aim of this study was to reveal the patients' subjective perceptions of the most important factors and to compare them with standardized measurements. METHODS The study included 152 acute hospital admissions for seizures. The patients were asked to score the impact of various seizure precipitants as perceived by themselves on a visual analogue scale (VAS). The following items related to seizure occurrence were quantified: sleep deprivation by sleep diaries, ASM adherence by therapeutic drug monitoring, the Alcohol Use Identification Test, and the Hospital Anxiety and Depression Scale. Statistical analyses, including multiple regression, were performed to discover relationships between various parameters. RESULTS The interaction of the various factors was high. The association between lack of sleep and hazardous drinking and anxiety was highly significant. Perceived stress correlated well with anxiety and depression. Relatively low VAS scores for missed medication in patients with identified non-adherence suggest that insufficient patient awareness is common. Low VAS-scores for alcohol in patients with harmful drinking also suggest low acknowledgment of alcohol-related seizures. High alcohol scores were associated with sleep deprivation, anxiety and depression. CONCLUSION The circumstances leading to an epileptic seizure are complex. Stress, sleep loss, alcohol intake, and missed medication are among the most commonly reported seizure precipitants. They are often combined, and various facets of the same underlying cause may be at play. Their sequence and relative impact are often difficult to establish. Improved understanding of the cascade of events preceding a seizure can improve comprehensive personalized management of uncontrolled epilepsy.
Collapse
Affiliation(s)
- Christian Samsonsen
- Department of Neurology and Clinical Neurophysiology, St.Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Guro Mestvedthagen
- Faculty of Medicine and Health Sciences Norwegian University of Science and Technology, Trondheim, Norway.
| | - Martin Uglem
- Department of Neurology and Clinical Neurophysiology, St.Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology, St.Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| |
Collapse
|
5
|
Terman SW. Making Up Missed Anti-Seizure Medication Doses: Double or Nothing? Epilepsy Curr 2023; 23:220-221. [PMID: 37662469 PMCID: PMC10470109 DOI: 10.1177/15357597231169414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Handling Delayed or Missed Dose of Antiseizure Medications: A Model-Informed Individual Remedial Dosing Li ZR, Wang CY, Lin WW, Chen YT, Liu XQ, Jiao Z. Neurology . 2023;100(9):e921-e931. doi:10.1212/WNL.0000000000201604 Background and Objectives: Antiseizure medications are the major treatment modality for patients with epilepsy. Delayed or missed doses are common during long-term or lifelong anti-epilepsy treatment. This study aims to explore optimal individualized remedial dosing regimens for delayed or missed doses of 11 commonly used antiseizure medications. Methods: In order to explore remedial dosing regimens, Monte Carlo simulation was employed based on previously identified and published population pharmacokinetic models. Six remedial strategies for delayed or missed doses were investigated. The deviation time outside the individual therapeutic range was used to evaluate each remedial regimen. The influences of patients’ demographics, concomitant medication, and scheduled dosing intervals on remedial regimens were assessed. RxODE and Shiny in R were employed to perform Monte Carlo simulation and recommend individual remedial regimens. Results: The recommended remedial regimens were highly correlated to delayed time, scheduled dosing interval, and half-life of the antiseizure medication. Moreover, the optimal remedial regimens for pediatric and adult patients were different. The renal function, along with concomitant medication that affect the clearance of the antiseizure medication, may also influence the remedial regimens. A web-based dashboard was developed to provide individualized remedial regimens for the delayed or missed dose, and a user-defined module with all parameters that could be defined flexibly by the user was also built. Discussion: Monte Carlo simulation based on population pharmacokinetic models may provide a rational approach to propose remedial regimens for delayed or missed doses of antiseizure medications in pediatric and adult patients with epilepsy.
Collapse
|
6
|
Terman SW, Niznik JD, Slinger G, Otte WM, Braun KPJ, Aubert CE, Kerr WT, Boyd CM, Burke JF. Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study. BMC Neurol 2022; 22:328. [PMID: 36050646 PMCID: PMC9434838 DOI: 10.1186/s12883-022-02852-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND For the two-thirds of patients with epilepsy who achieve seizure remission on antiseizure medications (ASMs), patients and clinicians must weigh the pros and cons of long-term ASM treatment. However, little work has evaluated how often ASM discontinuation occurs in practice. We describe the incidence of and predictors for sustained ASM fill gaps to measure discontinuation in individuals potentially eligible for ASM withdrawal. METHODS This was a retrospective cohort of Medicare beneficiaries. We included patients with epilepsy by requiring International Classification of Diseases codes for epilepsy/convulsions plus at least one ASM prescription each year 2014-2016, and no acute visit for epilepsy 2014-2015 (i.e., potentially eligible for ASM discontinuation). The main outcome was the first day of a gap in ASM supply (30, 90, 180, or 360 days with no pills) in 2016-2018. We displayed cumulative incidence functions and identified predictors using Cox regressions. RESULTS Among 21,819 beneficiaries, 5191 (24%) had a 30-day gap, 1753 (8%) had a 90-day gap, 803 (4%) had a 180-day gap, and 381 (2%) had a 360-day gap. Predictors increasing the chance of a 180-day gap included number of unique medications in 2015 (hazard ratio [HR] 1.03 per medication, 95% confidence interval [CI] 1.01-1.05) and epileptologist prescribing physician (≥25% of that physician's visits for epilepsy; HR 2.37, 95% CI 1.39-4.03). Predictors decreasing the chance of a 180-day gap included Medicaid dual eligibility (HR 0.75, 95% CI 0.60-0.95), number of unique ASMs in 2015 (e.g., 2 versus 1: HR 0.37, 95% CI 0.30-0.45), and greater baseline adherence (> 80% versus ≤80% of days in 2015 with ASM pill supply: HR 0.38, 95% CI 0.32-0.44). CONCLUSIONS Sustained ASM gaps were rarer than current guidelines may suggest. Future work should further explore barriers and enablers of ASM discontinuation to understand the optimal discontinuation rate.
Collapse
Affiliation(s)
- Samuel W. Terman
- grid.214458.e0000000086837370Department of Neurology, University of Michigan, Ann Arbor, MI 48109 USA
| | - Joshua D. Niznik
- grid.10698.360000000122483208Division of Geriatric Medicine, Center for Aging and Health, School of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, NC 27599 USA ,grid.10698.360000000122483208Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina At Chapel Hill, Chapel Hill, NC 27599 USA
| | - Geertruida Slinger
- grid.5477.10000000120346234Department of Child Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Willem M. Otte
- grid.5477.10000000120346234Department of Child Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kees P. J. Braun
- grid.5477.10000000120346234Department of Child Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carole E. Aubert
- grid.5734.50000 0001 0726 5157Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Wesley T. Kerr
- grid.214458.e0000000086837370Department of Neurology, University of Michigan, Ann Arbor, MI 48109 USA
| | - Cynthia M. Boyd
- grid.21107.350000 0001 2171 9311Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD 21224 USA
| | - James F. Burke
- grid.261331.40000 0001 2285 7943Department of Neurology, the Ohio State University, Columbus, OH 43210 USA
| |
Collapse
|
7
|
Askarieh A, MacBride-Stewart S, Kirby J, Fyfe D, Hassett R, Todd J, Marshall AD, Leach JP, Heath CA. Delivery of care, seizure control and medication adherence in women with epilepsy during pregnancy. Seizure 2022; 100:24-29. [PMID: 35728343 DOI: 10.1016/j.seizure.2022.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate service access for women with epilepsy (WWE) during pregnancy; to determine seizure frequency and rates of adherence to anti-seizure medication (ASM). METHODS Between June 2019-June 2020, pregnant WWE within NHS Greater Glasgow and Clyde health-board were identified from the National Obstetric Register. A manual review of electronic patient records was undertaken to ensure diagnostic accuracy, as well as determine contact with epilepsy services and documented seizures. Medication dispensing records were obtained six months before and six months after midwifery booking and measures of ASM adherence calculated. RESULTS Between June 2019-June 2020, 4592 women were registered with a pregnancy. Eighty-five (1.9%) were identified as having active epilepsy (generalised- 40/85 (47.0%), focal- 35/85 (41.2%), unclassified- 10/85 (11.8%)). Preconceptually, 42/85 WWE (49.4%) had input from epilepsy services. Only 59/85 (69.4%) were reviewed during pregnancy (First trimester- 21/59 (35.6%), Second trimester- 25/59 (42.4%) and Third trimester- 13/59 (22.0%)). Seizure occurrence was documented in 37/85 WWE (43.5%) during the antenatal/postnatal period. 71/85 WWE (83.5%) were prescribed ASM. Poor adherence was noted in 50/85 (58.9%) and a documented seizure recorded in 26/50 (52.0%) of these women. CONCLUSION Too many WWE do not receive input from epilepsy services during pregnancy, leaving some with poor ASM adherence and continued seizures. We aim to use "near-live" obstetric and dispensing data to facilitate early identification of WWE, promoting timely access to epilepsy specialists. This will also provide an opportunity to address concerns regarding ASM safety and allow medication dose changes to be considered.
Collapse
Affiliation(s)
- Amber Askarieh
- Department of Neurology, Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Langlands Drive, Glasgow, G51 4LB, UK, United Kingdom.
| | | | - Jack Kirby
- Department of Neurology, Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Langlands Drive, Glasgow, G51 4LB, UK, United Kingdom
| | - David Fyfe
- Pharmacy Services, NHS Greater Glasgow and Clyde, United Kingdom
| | - Richard Hassett
- Pharmacy Services, NHS Greater Glasgow and Clyde, United Kingdom
| | - Jonathan Todd
- Department of Information Management, NHS Greater Glasgow and Clyde, United Kingdom
| | - Alex D Marshall
- Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - John Paul Leach
- Department of Neurology, Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Langlands Drive, Glasgow, G51 4LB, UK, United Kingdom; School of Medicine, University of Glasgow, United Kingdom
| | - Craig A Heath
- Department of Neurology, Institute of Neurological Sciences, NHS Greater Glasgow and Clyde, Langlands Drive, Glasgow, G51 4LB, UK, United Kingdom; School of Medicine, University of Glasgow, United Kingdom
| |
Collapse
|
8
|
Wang BC, Chiu HY, Luh HT, Lin CJ, Hsieh SH, Chen TJ, Wu CR, Chen PY. Comparative efficacy of prophylactic anticonvulsant drugs following traumatic brain injury: A systematic review and network meta-analysis of randomized controlled trials. PLoS One 2022; 17:e0265932. [PMID: 35358219 PMCID: PMC8970384 DOI: 10.1371/journal.pone.0265932] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022] Open
Abstract
We systematically compared the effects of prophylactic anticonvulsant drug use in patients with traumatic brain injury. We searched four electronic databases from their inception until July 13, 2021. Two researchers independently screened, appraised, and extracted the included studies. Network meta-analysis using multivariate random effects and a frequentist framework was adopted for data analysis. The risk of bias of each study was assessed using the Cochrane risk of bias tool, and confidence in evidence was assessed through confidence in network meta-analysis (CINeMA). A total of 11 randomized controlled trials involving 2,450 participants and six different treatments (i.e., placebo, carbamazepine, phenytoin, levetiracetam, valproate, and magnesium sulfate) were included. We found that anticonvulsant drugs as a whole significantly reduced early posttraumatic seizures (PTS) but not late PTS compared with placebo (odd ratios [ORs] = 0.42 and 0.82, 95% confidence intervals [CIs] = 0.21–0.82 and 0.47–1.43). For the findings of network meta-analysis, we observed that phenytoin (ORs = 0.43 and 0.71; 95% CIs = 0.18–1.01 and 0.23–2.20), levetiracetam (ORs = 0.56 and 1.58; 95% CIs = 0.12–2.55 and 0.03–84.42), and carbamazepine (ORs = 0.29 and 0.64; 95% CIs = 0.07–1.18 and 0.08–5.28) were more likely to reduce early and late PTS compared with placebo; however, the treatment effects were not significant. Sensitivity analysis, after excluding a study enrolling only children, revealed that phenytoin had a significant effect in preventing early PTS (OR = 0.33; 95% CI = 0.14–0.78). Our findings indicate that no antiepileptic drug had an effect on early or late PTS superior to that of another; however, the sensitivity analysis revealed that phenytoin might prevent early PTS. Additional studies with large sample sizes and a rigorous design are required to obtain high-quality evidence on prophylactic anticonvulsant drug use in patients with traumatic brain injury.
Collapse
Affiliation(s)
- Bo-Cyuan Wang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, New Taipei City Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hui-Tzung Luh
- Department of Neurosurgery, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Jou Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shu-Hua Hsieh
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Ting-Jhen Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chia-Rung Wu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
- * E-mail:
| |
Collapse
|
9
|
Terman SW, Kerr WT, Aubert CE, Hill CE, Marcum ZA, Burke JF. Adherence to Antiseizure vs Other Medications Among US Medicare Beneficiaries With and Without Epilepsy. Neurology 2022; 98:e427-e436. [PMID: 34893556 PMCID: PMC8793102 DOI: 10.1212/wnl.0000000000013119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/16/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The objectives of this study were to compare adherence to antiseizure medications (ASMs) vs non-ASMs among individuals with epilepsy, to assess the degree to which variation in adherence is due to differences between individuals vs between medication classes among individuals with epilepsy, and to compare adherence in individuals with vs without epilepsy. METHODS This was a retrospective cohort study using Medicare. We included beneficiaries with epilepsy (≥1 ASM, plus ICD-9-CM diagnostic codes) and a 20% random sample without epilepsy. Adherence for each medication class was measured by the proportion of days covered (PDC) in 2013 to 2015. We used Spearman correlation coefficients, Cohen κ statistics, and multilevel logistic regressions. RESULTS There were 83,819 beneficiaries with epilepsy. Spearman correlation coefficients between ASM PDCs and each of the 5 non-ASM PDCs ranged from 0.44 to 0.50; Cohen κ ranged from 0.33 to 0.38; and within-person differences between the PDC of each ASM minus the PDC of each non-ASM were all statistically significant (p < 0.01), although median differences were all very close to 0. Fifty-four percent of variation in adherence across medications was due to differences between individuals. Adjusted predicted probabilities of adherence were as follows: ASMs 74% (95% confidence interval [CI] 73%-74%), proton pump inhibitors 74% (95% CI 74%-74%), antihypertensives 77% (95% CI 77%-78%), selective serotonin reuptake inhibitors 77% (95% CI 77%-78%), statins 78% (95% CI 78%-79%), and levothyroxine 82% (95% CI 81%-82%). Adjusted predicted probabilities of adherence to non-ASMs were 80% (95% CI 80%-81%) for beneficiaries with epilepsy vs 77% (95% CI 77%-77%) for beneficiaries without epilepsy. DISCUSSION Among individuals with epilepsy, ASM adherence and non-ASM adherence were moderately correlated, half of the variation in adherence was due to between-person rather than between-medication differences, adjusted adherence was slightly lower for ASMs than several non-ASMs, and epilepsy was associated with a quite small increase in adherence to non-ASMs. Nonadherence to ASMs may provide an important cue to the clinician to inquire about adherence to other potentially life-prolonging medications as well. Although efforts should focus on improving ASM adherence, patient-level rather than purely medication-specific behaviors are also critical to consider when developing interventions to optimize adherence.
Collapse
Affiliation(s)
- Samuel W Terman
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle.
| | - Wesley T Kerr
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle
| | - Carole E Aubert
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle
| | - Chloe E Hill
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle
| | - Zachary A Marcum
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle
| | - James F Burke
- From the Department of Neurology (S.W.T., W.T.K., C.E.H., J.F.B.), and Institute for Healthcare Policy and Innovation (S.W.T., C.E.H., J.F.B.), University of Michigan, Ann Arbor; Department of Neurology (W.T.K.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of General Internal Medicine (C.E.A.), Bern University Hospital, and Institute of Primary Health Care (BIHAM) (C.E.A.), University of Bern, Switzerland; and Department of Pharmacy (Z.A.M.), School of Pharmacy, University of Washington, Seattle
| |
Collapse
|
10
|
Lee Y, Ahn Y, Cucullo L. Impact of Physical Activity and Medication Adherence on the Seizure Frequency and Quality of Life of Epileptic Patients: A Population Study in West Texas. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4193664. [PMID: 35087908 PMCID: PMC8789420 DOI: 10.1155/2022/4193664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022]
Abstract
Epilepsy is a neurological disease that affects 1-3% of the population. People with epilepsy (PWE) have poor physical and psychological health and a lower quality of life (QOL) than people without epilepsy. Moreover, PWE has more comorbid conditions (obesity, depression) than general populations. Physical activity (PA) has been reported to have various positive physical and psychological effects in PWE. Meanwhile, poor medication adherence is one of the main precipitating factors for seizure triggers. This study assessed the impact of PA and medication adherence on the seizure frequency and QOL for PWE at the Epilepsy Foundation, West Texas (EFWT). Our results indicate that PA is positively associated with the quality of life and negatively associated with the seizure frequency for PWE at EFWT, which suggests that physically active PWE tend to have fewer seizures and better QOL. Medication adherence did not affect the seizure frequency or QOL in our study. Yet, it is still crucial to encourage medication adherence for PWE since nonadherence is a known seizure promoter. Findings from this study highlight the continuous need to utilize available resources and implement programs to promote physical activity and medication adherence for better seizure control and QOL in PWE at EFWT.
Collapse
Affiliation(s)
- YoonJung Lee
- Department of Pharmaceutical Sciences, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Yeseul Ahn
- Department of Pharmaceutical Sciences, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX 79106, USA
| | - Luca Cucullo
- Department of Foundation Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA
| |
Collapse
|
11
|
Terman SW, Kerr WT, Marcum ZA, Wang L, Burke JF. Antiseizure medication adherence trajectories in Medicare beneficiaries with newly treated epilepsy. Epilepsia 2021; 62:2778-2789. [PMID: 34462911 PMCID: PMC8563423 DOI: 10.1111/epi.17051] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This study was undertaken to characterize trajectories of antiseizure medication (ASM) adherence in adults with newly treated epilepsy and to determine predictors of trajectories. METHODS This was a retrospective cohort study using Medicare. We included beneficiaries with newly treated epilepsy (one or more ASM and none in the preceding 2 years, plus International Classification of Diseases codes) in 2010-2013. We calculated the proportion of days covered (proportion of total days with any ASM pill supply) for 8 quarters or until death. Group-based trajectory models characterized and determined predictors of trajectories. RESULTS We included 24 923 beneficiaries. Models identified four groups: early adherent (60%), early nonadherent (18%), late adherent (11%), and late nonadherent (11%). Numerous predictors were associated with being in the early nonadherent versus early adherent group: non-White race (e.g., Black, odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.5-1.8), region (e.g., South vs. Northeast: OR = 1.2, 95% CI = 1.1-1.4), and once daily initial medication (OR = 1.1, 95% CI = 1.0-1.3). Predictors associated with decreased odds of being in the early nonadherent group included older age (OR = .9 per decade, 95% CI = .9-.9), female sex (OR = .9, 95% CI = .8-1.0), full Medicaid eligibility (OR = .6, 95% CI = .4-.8), neurologist visit (OR = .6, 95% CI = .6-.7), and initial older generation ASM (OR = .6, 95% CI = .6-.7). SIGNIFICANCE We identified four ASM adherence trajectories in individuals with newly treated epilepsy. Whereas risk factors for early nonadherence such as race or geographic region are nonmodifiable, our work highlighted a modifiable risk factor for early nonadherence: lacking a neurologist. These data may guide future interventions aimed at improving ASM adherence, in terms of both timing and target populations.
Collapse
Affiliation(s)
- Samuel W. Terman
- Department of Neurology, University of Michigan,, Ann Arbor, Michigan, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| | - Wesley T. Kerr
- Department of Neurology, University of Michigan,, Ann Arbor, Michigan, USA
- Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Zachary A. Marcum
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Lu Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - James F. Burke
- Department of Neurology, University of Michigan,, Ann Arbor, Michigan, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA
| |
Collapse
|
12
|
Marawar R, Faraj M, Lucas K, Burns CV, Garwood CL. Implementation of an older adult epilepsy clinic utilizing pharmacist services. J Am Pharm Assoc (2003) 2021; 61:e93-e98. [PMID: 34330650 DOI: 10.1016/j.japh.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Antiseizure medications are commonly associated with adverse effects including behavioral and cognitive issues, drug interactions, idiosyncratic reactions, and long-term complications, which can lead to non-adherence. At the same time, there are limited reports describing multidisciplinary models of epilepsy care that include pharmacists. OBJECTIVE To describe the pharmacist services in an epilepsy clinic for older adults and document the patient care delivered using this design. PRACTICE DESCRIPTION A subspecialty older adult epilepsy clinic, embedded within a neurology clinic, in an urban academic medical center. PRACTICE INNOVATION Integration of pharmacy services to document medication history, provide medication reconciliation, identify medication-related problems, and make interventions. EVALUATION METHODS Data were retrospectively evaluated for the patients seen by the pharmacist and epilepsy team between July 2019 and January 2021. Data were summarized with descriptive statistics. RESULTS Fifty-eight patients with a total of 94 encounters (70.7% of all specialty clinic visits) were seen collaboratively by the physician and the pharmacist. The majority of patients were African American (87.9%), aged 63.7 ± 8.2 years, and more frequently male (58.6%), and a high proportion had some baseline memory loss or diagnosis of dementia (53.4%). Medication reconciliation occurred in 94 (100%) encounters. More than half the encounters required reconciliation to the existing medication list by adding medication (55.3 % of encounters) or deleting mediations (53.2% of encounters). Presence of adverse effects was the most common medication-related problem identified (23.4%). Resolutions to the medication-related problems were also reported. CONCLUSION The population of older adults with epilepsy is expected to increase in prevalence. Pharmacists are able to impact medication-related problems in a vulnerable, high-risk patient population. The multidisciplinary model we describe here can be used as a template to provide care in ambulatory care practices involving other neurology specialties with a high proportion of older adult patients.
Collapse
|
13
|
Gidal BE, Ferry J, Reyderman L, Piña-Garza JE. Use of extended-release and immediate-release anti-seizure medications with a long half-life to improve adherence in epilepsy: A guide for clinicians. Epilepsy Behav 2021; 120:107993. [PMID: 33971390 DOI: 10.1016/j.yebeh.2021.107993] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/18/2022]
Abstract
Poor adherence to anti-seizure medications (ASMs) is associated with breakthrough seizures and potentially increased toxicity in patients with epilepsy. Extended-release (ER) drugs and immediate-release (IR) drugs with a long half-life (t1/2) that permit once-daily dosing (such as, perampanel, zonisamide, lamotrigine [IR, ER] and topiramate [ER]) have a number of advantages over short t1/2 ASMs that require multiple daily dosing. These advantages include simplification of dosing regimens, reduction in pill burden, and a decrease in the peak-to-trough fluctuations in serum drug concentration that may be associated with a decreased risk of adverse effects and seizures. Such properties have wider implications in improving patient adherence to treatment. This article is intended as a practical guide for clinicians that provides an overview of the features of ER ASMs and long t1/2 IR ASMs that are advantageous in the context of patient adherence and pharmacokinetic "forgiveness" (after missing a dose). In addition, we note that efforts to improve adherence should not depend solely on drug dosing regimens and drug pharmacokinetics, but should be part of a wider strategy that includes therapeutic drug monitoring, improved healthcare provider-patient dialogue, patient education, and the use of "reminder" technology.
Collapse
Affiliation(s)
- Barry E Gidal
- School of Pharmacy, University of Wisconsin, Madison, WI, USA.
| | - Jim Ferry
- Formerly: Eisai Inc., Woodcliff Lake, NJ, USA
| | | | | |
Collapse
|
14
|
Gauci J, Bloomfield J, Lawn S, Towns S, Steinbeck K. Effectiveness of self-management programmes for adolescents with a chronic illness: A systematic review. J Adv Nurs 2021; 77:3585-3599. [PMID: 33630315 DOI: 10.1111/jan.14801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/31/2020] [Accepted: 01/16/2021] [Indexed: 12/14/2022]
Abstract
AIM To assess what is known about the effectiveness of face-to-face self-management programmes designed specifically for adolescents (10-19 years) with a chronic illness. DESIGN A systematic review and synthesis without meta-analysis (SWiM). DATA SOURCES Six international web-based reference libraries were searched with a date range of 1946 to July 2020. REVIEW METHOD The PRISMA statement and SWiM guideline were used for reporting the methods and results. The PICO format was used to develop a focused clinical question and the eligibility criteria of our review. Quality assessment of the included studies was performed using the Cochrane Effective Practice Organisation of Care criteria. RESULTS Eight studies (four randomized controlled trials and four descriptive designs) met the inclusion criteria and were published between 2003 and 2017. Results of the review: Three studies demonstrated measures of illness control which showed initial improvements in adherence as a result of the interventions but failed to demonstrate sustained adherence over time. Booster sessions were identified as an effective strategy to improve adherence, but were often omitted. CONCLUSIONS There is a limited body of evidence on the effectiveness of self-management programmes specifically developed for adolescents with a chronic illness, an important but under researched area. Future research lies in the development of more rigorous studies that focus on quantitative outcome measures for evaluating the effectiveness of self-management programmes to guide the development of future programmes. IMPACT It is crucial for adolescents with a chronic illness to develop independence and the self-management skills required to effectively manage their chronic condition as they transition to adulthood. On current evidence, in planning future self-management interventions should include booster sessions. Nurses with additional training and experience have a key role in supporting adolescents with a chronic illness to develop self-management skills as they assume responsibility for their own healthcare.
Collapse
Affiliation(s)
- Jaunna Gauci
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Jacqueline Bloomfield
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Susan Towns
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Katharine Steinbeck
- Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| |
Collapse
|
15
|
Asghar MA, Rehman AA, Raza ML, Shafiq Y, Asghar MA. Analysis of treatment adherence and cost among patients with epilepsy: a four-year retrospective cohort study in Pakistan. BMC Health Serv Res 2021; 21:72. [PMID: 33468110 PMCID: PMC7816349 DOI: 10.1186/s12913-021-06085-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/13/2021] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The adherence pattern of antiepileptic drugs (AEDs) among patients with epilepsy is relatively lower in the United States and different European countries. However, adherence and cost analysis of AEDs in Asian countries have not been thoroughly studied. Therefore, the present study aimed to analyze the cost and adherence of AEDs and its associated factors in patients followed in Pakistan. METHODS Data from prescriptions collected from patients with epilepsy who have visited the Outpatient Department (OPD) of different tertiary care hospitals at the cosmopolitan city of Karachi, Pakistan from December 2015 to November 2019. The mean follow-up period for each participant was about 22 months. Pairwise comparisons from Cox regression/hazard ratios were used to assess the predictors of adherence. Direct costs of AEDs were calculated and presented as the annual cost of drugs. RESULTS A total of 11,490 patients were included in this study, 51.2 % were male and 48.8 % were female with a mean age of 45.2 ± 15.8 y. Levetiracetam was found as the most prescribing AED in all study participants (32.9 %). Of them, 49.1 % of patients continued their initial recommended treatment. However, 31.3 % of patients have discontinued the therapy, while, 19.6 % were switched to other AED. Adherence with initial treatment was more profound in male (57.4 %) patients, compared to female with a mean age of 44.2 years. Lamotrigine users (60.6 %) showed a higher tendency to retain on initially prescribed drugs. The total cost of epilepsy treatment in the entire study cohort was 153280.5 PKR ($941.9). By applying the Cox regression analysis, it can be observed that the patients with increasing age (OR, 2.04), migraine (OR, 2.21), psychiatric disorders (OR, 4.28), other comorbidities (OR, 1.52) and users of other than top five prescribing AEDs (2.35) were at higher risk of treatment discontinuation. However, levetiracetam (OR, 0.69), valproic acid (OR, 0.52), carbamazepine (OR, 0.81), lamotrigine (OR, 0.80) or lacosamide (OR, 0.65) users have more chances to continue their initial therapy. CONCLUSIONS Similar to western countries, the majority of patients with epilepsy exhibited low adherence with AEDs. Various associated factors for improving adherence were identified in this study.
Collapse
Affiliation(s)
- Muhammad Arif Asghar
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University Karachi, Karachi, Pakistan.
| | - Ahad Abdul Rehman
- Department of Pharmacology, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University Karachi, Karachi, Pakistan
| | - Muhammad Liaquat Raza
- Department of Pharmacology, Faculty of Pharmacy, Shaheed Benazir Bhutto Dewan University, Karachi, Pakistan.,Institute of Neurophysiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Yousra Shafiq
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University Karachi, Karachi, Pakistan
| | - Muhammad Asif Asghar
- Food and Feed Safety Laboratory, Food and Marine Resources Research Centre, PCSIR Laboratories Complex, Shahrah-e-Salimuzzaman Siddiqui, Off University Road, 75280, Sindh, Pakistan
| |
Collapse
|
16
|
Mohammad QD, Saha NC, Alam MB, Hoque SA, Islam A, Chowdhury RN, Hussain ME, Chowdhury YS, Hossain S, Chowdhury MA, Rahman M, Majumder BK, Salam A, Sarker A, Uddin MK, Moniruzzaman M, Hakim F, Bhuiyan R, Anwar N, Zaman MM. Prevalence of epilepsy in Bangladesh: Results from a national household survey. Epilepsia Open 2020; 5:526-536. [PMID: 33336124 PMCID: PMC7733657 DOI: 10.1002/epi4.12430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/03/2020] [Accepted: 08/10/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine the prevalence and types of epilepsy in Bangladesh. METHODS We conducted a nationwide population-based cross-sectional survey among Bangladeshi population of all ages, except children under one month. We surveyed 9839 participants (urban, 4918; rural, 4920) recruited at their households using multistage cluster sampling. Trained physicians with neurology background confirmed the diagnosis of suspected epilepsy cases identified by interviewer-administered questionnaires. We reported the overall and sex, residence, and age groups-specific prevalence of epilepsy per 1000 populations with 95% confidence interval. RESULTS The national prevalence of epilepsy per 1000 was 8.4 (95% CI 5.6-11.1), urban 8.0 (4.6-11.4), and rural 8.5 (5.60-11.5). The prevalence in adult males and females was 9.2 (5.7-12.6) and 7.7 (3.6-11.7), respectively. The prevalence in children aged <18 years (8.2, 3.4-13.0 was similar to adults (8.5 (5.4-11.4). Among all epilepsy cases, 65.1% had active epilepsy. Their (active epilepsy) prevalence was 5.8 (3.5-8.1). Of them, 63.4% were not receiving treatment. Moreover, those who received allopathy treatment, 72.5% had low adherence leading to a high treatment gap. SIGNIFICANCE Our findings out of this first-ever national survey were similar to other Asian countries. However, the prevalence of active epilepsy and treatment gap were considerably higher. This study serves useful evidence for tailoring interventions aimed to reduce the burden of epilepsy-primarily through targeted community awareness program-and access to antiepileptic treatment in health facilities in Bangladesh.
Collapse
Affiliation(s)
| | - Narayan Chandra Saha
- Department of Pediatric NeurologyNational Institute of Neurosciences and HospitalDhakaBangladesh
| | - Md Badrul Alam
- Department of Clinical NeurologyNational Institute of Neurosciences and HospitalDhakaBangladesh
| | - Seikh Azimul Hoque
- Department of Paediatric NeurologyNational Institute of Neurosciences and HospitalDhakaBangladesh
| | - Ariful Islam
- Department of Paediatric NeurologyNational Institute of Neurosciences and HospitalDhakaBangladesh
| | - Rajib Nayan Chowdhury
- Department of NeurophysiologyNational Institute of Neurosciences and HospitalDhakaBangladesh
| | - Mohammad Enayet Hussain
- Department of NeurophysiologyNational Institute of Neurosciences and HospitalDhakaBangladesh
| | - Yamin Shahriar Chowdhury
- Department of Paediatric NeurologyNational Institute of Neurosciences and HospitalDhakaBangladesh
| | | | - Mahmood Ahmed Chowdhury
- Autism & Child Development CenterChattogram Maa O Shishu Hospital Medical CollegeAgrabad, ChattogramBangladesh
| | | | | | - Abdus Salam
- NeurologyShaheed Sheikh Abu Naser Specialized HospitalKhulnaBangladesh
| | - Amitabh Sarker
- NeurologySher‐E‐Bangla Medical CollegeBarishalBangladesh
| | - Md Kafil Uddin
- National Institute of Neurosciences and HospitalDhakaBangladesh
- NeurologyRajshahi Medical CollegeRajshahiBangladesh
| | - Mohammad Moniruzzaman
- Center for Epidemiologic Research in AsiaShiga University of Medical ScienceOtsuJapan
| | - Ferdous Hakim
- Mental and Neurology Study TeamNational Institute of Neurosciences and HospitalDhakaBangladesh
| | - Rijwan Bhuiyan
- Mental and Neurology Study TeamNational Institute of Neurosciences and HospitalDhakaBangladesh
| | - Nazneen Anwar
- World Health Organization Regional Office for South‐ East AsiaNew DelhiIndia
| | | |
Collapse
|
17
|
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.
Collapse
|
18
|
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].
Collapse
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
| |
Collapse
|
19
|
Yang C, Yu D, Li J, Zhang L. Prevalence of medication adherence and factors influencing adherence to antiepileptic drugs in children with epilepsy from western China: A cross-sectional survey. Epilepsy Behav 2020; 104:106662. [PMID: 31935645 DOI: 10.1016/j.yebeh.2019.106662] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/20/2019] [Accepted: 10/20/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the study was to evaluate adherence to prescribed antiepileptic drugs (AEDs) and influencing factors in children with epilepsy from western China. METHODS In this cross-sectional study, children with epilepsy were recruited from Western China Second Hospital. Questionnaires were used to collect baseline patient data and medication adherence, which was assessed using the Morisky scale. An ordinal logistic regression model was used to examine the factors affecting medication adherence. RESULTS In total, 399 children were included. The age of participants ranged from 0.3 to 17.8 years, with a male-to-female ratio of 1.36:1. Overall, 57.1% (228/399) had generalized seizures. Further, 21.3% (85/399) patients showed good adherence, 51.4% (205/399) moderate adherence, and 27.3% (109/399) poor adherence. Ordered multiclassification logistic regression analysis showed that the age of patient, type of epilepsy, total household income, and source of drug information were associated with adherence. CONCLUSIONS Medication adherence is not high in children with epilepsy from western China. Medication adherence is affected by many factors, and we suggest that efforts are focused on tailored approaches to epilepsy education and behavioral interventions for better adherence.
Collapse
Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China; Department of Epidemiology, West China School of Public Health, and West China Fourth Hospital, Sichuan University, China
| | - Dan Yu
- Department of Pediatric Neurology, West China Second Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Jiayuan Li
- Department of Epidemiology, West China School of Public Health, and West China Fourth Hospital, Sichuan University, China.
| | - Lingli Zhang
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
| |
Collapse
|
20
|
Rassart J, Luyckx K, Verdyck L, Mijnster T, Mark RE. Personality functioning in adults with refractory epilepsy and community adults: Implications for health-related quality of life. Epilepsy Res 2019; 159:106251. [PMID: 31862480 DOI: 10.1016/j.eplepsyres.2019.106251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/14/2019] [Accepted: 12/06/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Prior research has shown that people with epilepsy are at risk for a poorer health-related quality of life (HRQOL). However, patients differ greatly in how well they adjust to their epilepsy. To better understand these differences, the present study examined the role of personality. More specifically, we examined mean-level differences in Big Five personality traits between adults with refractory epilepsy and a community sample and related these traits to patients' HRQOL. METHODS A total of 121 adults with refractory epilepsy (18-40 years old, 56% women) completed questionnaires on the Big Five personality traits, HRQOL, and seizure frequency and severity. Patients' Big Five scores were compared to those of a community sample matched on sex and age using paired samples t-tests. We conducted hierarchical regression analyses to examine associations between personality and HRQOL, while controlling for the effects of sex, age, age at diagnosis, seizure frequency, and seizure severity. RESULTS Patients reported higher levels of neuroticism and lower levels of openness as compared to controls. In patients, seizure severity was positively related to neuroticism and negatively related to agreeableness. Finally, patients high in neuroticism and low in conscientiousness generally reported a poorer HRQOL. CONCLUSION In the present study, small personality differences were observed between adults with refractory epilepsy and a community sample. Patients' personality was found to play an important role in adjusting to epilepsy, even after controlling for seizure frequency and severity. Personality assessment may help healthcare professionals in identifying patients at risk for poor HRQOL later in life.
Collapse
Affiliation(s)
| | - Koen Luyckx
- KU Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Ludo Verdyck
- Kempenhaeghe Expertise Center Epilepsy, Oosterhout, the Netherlands
| | - Teus Mijnster
- Kempenhaeghe Expertise Center Epilepsy, Oosterhout, the Netherlands
| | - Ruth E Mark
- Tilburg University, Tilburg, the Netherlands
| |
Collapse
|
21
|
Zheng Y, Ding X, Guo Y, Chen Q, Wang W, Zheng Y, Wang S, Ding Y, Ding M. Multidisciplinary management improves anxiety, depression, medication adherence, and quality of life among patients with epilepsy in eastern China: A prospective study. Epilepsy Behav 2019; 100:106400. [PMID: 31634729 DOI: 10.1016/j.yebeh.2019.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of a multidisciplinary program on anxiety, depression, medication adherence, and quality of life in patients with epilepsy in eastern China. METHODS A cohort of 184 patients with epilepsy from the epilepsy clinic of a tertiary hospital in eastern China completed this program, out of which 92 were randomized into the intervention group and 92 the control group. Patients in both groups received standard antiepileptic drugs (AEDs), while those of the intervention group received an additional 12-month multidisciplinary program developed by a group of the epileptologist, pharmacist, psychiatrist, and epilepsy specialist nurse. Patients were assessed both before and after the 12-month period. The Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the eight-item Morisky Medication Adherence Scale (MMAS-8) were used to assess the severity of depression, anxiety, and medication adherence, respectively, along with Quality of life in Epilepsy-31 (QOLIE-31) and self-reported seizure frequency for life quality and seizure severity. RESULTS The 12-month multidisciplinary program significantly reduced the number of patients with severe depression (p = 0.013) and anxiety (p = 0.002), increased the number of patients with moderate-to-high AED adherence (p = 0.006) and the overall QOLIE-31 score (p < 0.001) in the intervention group. Both groups demonstrated a significant increase in the number of patients with a low seizure frequency after the 12-month period (p < 0.001). CONCLUSION The 12-month multidisciplinary program offers an effective management strategy in improving psychiatric comorbidities, medication adherence, and quality of life in patients with epilepsy in eastern China.
Collapse
Affiliation(s)
- Yang Zheng
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Xiaoyan Ding
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Yi Guo
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China.
| | - Qiaozhen Chen
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Weijun Wang
- Department of Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Yuanyuan Zheng
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Shan Wang
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Yao Ding
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| | - Meiping Ding
- Department of Neurology, Epilepsy Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, Zhejiang Province 310009, China
| |
Collapse
|
22
|
Costs and cost-drivers of a diagnosis of depression among adults with epilepsy in the United States. Epilepsy Behav 2019; 98:96-100. [PMID: 31301456 DOI: 10.1016/j.yebeh.2019.04.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the amount of direct costs associated with occurrence of depression in people with epilepsy. METHODS The Medical Expenditure Panel Survey Household Components (MEPS-HC) served as data source to identify adults (≥18 years) with epilepsy from 2003 to 2014, using the Clinical Classification Code CCC-83. Annual unadjusted per person total healthcare expenditures and individual cost components (inpatient, outpatient, prescription, emergency room, and home health) were compared between people with epilepsy and depression vs. without depression. A two-part model estimated the adjusted incremental direct cost of depression (total and individual cost components) among adults with epilepsy. The model was adjusted for sex, race/ethnicity, education, marital status, insurance status, census region, income, Charlson Comorbidities index (CCI), and year trend. RESULTS Out of a weighted 1,942,413 US adults with epilepsy, 675,037 (34.7%) had a diagnosis of depression. Annual total unadjusted per person direct cost of depression was $5290 higher in people with epilepsy vs. without [$18,776 (95% confidence interval [CI]: 16,241-21,311) vs. $13,486 (95%CI: 9780-17,191)]. Costs for outpatient and prescriptions were higher among people with epilepsy plus depression vs. without depression, but no differences were observed for inpatient, emergency room, and home health costs. In the adjusted model, total costs [$2523 (95%CI: 62-4984)], incremental annual direct costs per person for outpatient [$1940 (95%CI: 1266-2613)], prescriptions [$1285 (95%CI: 772-1798)], and emergency room [$191 (95%CI: 20-361)] were significantly higher for people with epilepsy plus depression. Unadjusted and adjusted incremental total aggregate annual direct costs of depression for people with epilepsy were $3.5 billion and $1.7 billion respectively. CONCLUSION Costs of epilepsy with presence of depression in the US are high, and primarily driven by outpatient, prescriptions, and emergency room costs.
Collapse
|
23
|
Javor A, Ciumas C, Ibarrola D, Ryvlin P, Rheims S. Social cognition, behaviour and therapy adherence in frontal lobe epilepsy: a study combining neuroeconomic and neuropsychological methods. ROYAL SOCIETY OPEN SCIENCE 2019; 6:180850. [PMID: 31598216 PMCID: PMC6731699 DOI: 10.1098/rsos.180850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/23/2019] [Indexed: 05/30/2023]
Abstract
Social behaviour of healthy humans and its neural correlates have been extensively studied in social neuroscience and neuroeconomics. Whereas it is well established that several types of epilepsies, such as frontal lobe epilepsy, lead to social cognitive impairments, experimental evidence on how these translate into behavioural symptoms is scarce. Furthermore, it is unclear whether social cognitive or behavioural disturbances have an impact on therapy adherence, which is critical for effective disease management, but generally low in these patients. In order to investigate the relationship between social cognition, social behaviour, and therapy adherence in patients with frontal lobe epilepsies (FLE), we designed a study combining conventional neuropsychological with behavioural economic and functional magnetic resonance imaging (fMRI) methodology. Fifteen patients and 15 healthy controls played a prisoners' dilemma game (an established game to operationalize social behaviour) while undergoing fMRI. Additionally, social cognitive, basic neuropsychological variables, and therapy adherence were assessed. Our results implicate that social behaviour is indeed affected and can be quantified using neuroeconomic methods in patients with FLE. Impaired social behaviour in these patients might be a consequence of altered brain activation in the medial prefrontal cortex and play a role in low therapy adherence. Finally, this study serves as an example of how to integrate neuroeconomic methods in neurology.
Collapse
Affiliation(s)
- Andrija Javor
- Department of Neurology 2, Kepler University Clinic, Linz, Austria
| | - Carolina Ciumas
- Translational and Integrative Group in Epilepsy Research (TIGER), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, University Lyon 1, Lyon, France
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
- Epilepsy Institute (IDEE), Lyon, France
| | - Danielle Ibarrola
- CERMEP - Imagerie du vivant, MRI department and CNRS UMS3453, Lyon, France
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland
- Epilepsy Institute (IDEE), Lyon, France
| | - Sylvain Rheims
- Translational and Integrative Group in Epilepsy Research (TIGER), INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, University Lyon 1, Lyon, France
- Epilepsy Institute (IDEE), Lyon, France
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon and University of Lyon, Lyon, France
| |
Collapse
|
24
|
Villanueva V, Bermejo P, Montoya J, Massot-Tarrús A, Galiano ML, Toledo M, Rodriguez-Uranga JJ, Bertol V, Mauri JÁ, Poza JJ, Bonet M, Castro-Vilanova MD, Ruiz-Giménez J, López-González FJ, Rodríguez-Osorio X, Tortosa-Conesa D, Ojeda J, Giner P, Garcés M, Alvarez BM, Quiroga-Subirana P, Esteve P, Baiges JJ, Hampel K. MONOZEB: Long-term observational study of eslicarbazepine acetate monotherapy. Epilepsy Behav 2019; 97:51-59. [PMID: 31181429 DOI: 10.1016/j.yebeh.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
AIM The aim of the study was to evaluate the effectiveness and tolerability of eslicarbazepine acetate (ESL) when used as monotherapy for 1 year or more in routine clinical use in patients with focal seizures in epilepsy clinics in Spain. METHODS This is a retrospective, observational, noninterventional study. Eligible patients were aged ≥18 years, had focal seizures, and started on ESL ≥1 year before database closure. Primary endpoint was the following: proportion seizure-free for ≥6 months at 1 and 2 years. Secondary endpoints included retention on ESL monotherapy at 1 and 2 years, seizure frequency change, seizure worsening, and side effects. Other analyses included seizure freedom from baseline to 1 and 2 years and outcomes in special populations. RESULTS Four hundred thirty-five patients were included (127 on first-line monotherapy and 308 converting to ESL monotherapy): median daily dose was 800 mg at all time points; 63.2% were seizure-free at 1 year, 65.1% at 2 years, and 50.3% for the entire follow-up. Mean duration of ESL monotherapy was 66.7 months; retention was 88.0% at 1 year and 81.9% at 2 years. Mean reduction in seizure frequency was 75.5% at last visit. Over the entire follow-up, seizure worsening was seen in 22 patients (5.1%), side effects in 28.0%, considered severe in 1.8%, and leading to discontinuation in 5.7%. Dizziness, hyponatremia (sodium <135 mEq/l), and somnolence were the most frequent side effects. Outcomes in special populations (patients aged ≥65 years and those with psychiatric history or learning difficulty) were consistent with the overall population. CONCLUSIONS Patients with focal seizures taking ESL monotherapy had excellent retention, high seizure-free rates, and good tolerability up to 2 years.
Collapse
Affiliation(s)
| | - Pedro Bermejo
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | | | | | - Manuel Toledo
- Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | - Pau Giner
- Hospital Universitario Doctor Peset, Valencia, Spain
| | | | | | | | | | | | - Kevin Hampel
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| |
Collapse
|
25
|
Terman SW, Guterman EL, Hill CE, Betjemann JP, Burke JF. Factors associated with 30-day readmission for patients hospitalized for seizures. Neurol Clin Pract 2019; 10:122-130. [PMID: 32309030 DOI: 10.1212/cpj.0000000000000688] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/25/2019] [Indexed: 11/15/2022]
Abstract
Background We sought to determine the cumulative incidence of readmissions after a seizure-related hospitalization and identify risk factors and readmission diagnoses. Methods We performed a retrospective cohort study of adult patients hospitalized with a primary discharge diagnosis of seizure (International Classification of Diseases, Ninth Edition, Clinical Modification codes 345.xx and 780.3x) using the State Inpatient Databases across 11 states from 2009 to 2012. Hospital and community characteristics were obtained from the American Hospital Association and Robert Wood Johnson Foundation. We performed logistic regressions to explore effects of patient, hospital, and community factors on readmissions within 30 days of discharge. Results Of 98,712 patients, 13,929 (14%) were readmitted within 30 days. Reasons for readmission included epilepsy/convulsions (30% of readmitted patients), mood disorders (5%), schizophrenia (4%), and septicemia (4%). The strongest predictors of readmission were diagnoses of CNS tumor (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.9-2.4) or psychosis (OR 1.8, 95% CI 1.7-1.8), urgent index admission (OR 2.0, 95% CI 1.8-2.2), transfer to nonacute facilities (OR 1.7, 95% CI 1.6-1.8), long length of stay (OR 1.7, 95% CI 1.6-1.8), and for-profit hospitals (OR 1.7, 95% CI 1.6-1.8). Our main model's c-statistic was 0.66. Predictors of readmission for status epilepticus included index admission for status epilepticus (OR 3.5, 95% CI 2.6-4.7), low hospital epilepsy volume (OR 0.4, 95% CI 0.3-0.7), and rural hospitals (OR 4.8, 95% CI 2.1-10.9). Conclusion Readmission is common after hospitalization for seizures. Prevention strategies should focus on recurrent seizures, the most common readmission diagnosis. Many factors were associated with readmission, although readmissions remain challenging to predict.
Collapse
Affiliation(s)
- Samuel W Terman
- University of Michigan (SWT, CEH), Department of Neurology, Ann Arbor, MI; University of California San Francisco (ELG, JPB), Department of Neurology, San Francisco, CA; Department of Neurology and Stroke Program (JFB), University of Michigan; and Department of Veterans Affairs (JFB), VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI
| | - Elan L Guterman
- University of Michigan (SWT, CEH), Department of Neurology, Ann Arbor, MI; University of California San Francisco (ELG, JPB), Department of Neurology, San Francisco, CA; Department of Neurology and Stroke Program (JFB), University of Michigan; and Department of Veterans Affairs (JFB), VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI
| | - Chloe E Hill
- University of Michigan (SWT, CEH), Department of Neurology, Ann Arbor, MI; University of California San Francisco (ELG, JPB), Department of Neurology, San Francisco, CA; Department of Neurology and Stroke Program (JFB), University of Michigan; and Department of Veterans Affairs (JFB), VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI
| | - John P Betjemann
- University of Michigan (SWT, CEH), Department of Neurology, Ann Arbor, MI; University of California San Francisco (ELG, JPB), Department of Neurology, San Francisco, CA; Department of Neurology and Stroke Program (JFB), University of Michigan; and Department of Veterans Affairs (JFB), VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI
| | - James F Burke
- University of Michigan (SWT, CEH), Department of Neurology, Ann Arbor, MI; University of California San Francisco (ELG, JPB), Department of Neurology, San Francisco, CA; Department of Neurology and Stroke Program (JFB), University of Michigan; and Department of Veterans Affairs (JFB), VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI
| |
Collapse
|
26
|
Gray SL, Marcum ZA, Schmader KE, Hanlon JT. Update on Medication Use Quality and Safety in Older Adults, 2017. J Am Geriatr Soc 2018; 66:2254-2258. [PMID: 30423194 DOI: 10.1111/jgs.15665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 01/10/2023]
Abstract
Improving the quality of medication use and medication safety in older adults is an important public health priority and is of paramount importance for clinicians who care for them. We selected four important articles from 2017 that address these issues to annotate and critique, and we discuss the broader implications for optimizing medication use. A longer list of articles is given in an online appendix. The first study provides national data on the prevalence of central nervous system-active medication polypharmacy in older adults and how this has changed over a 9-year period (2004-2013). The second study characterizes prevalence of and factors associated with nonadherence to antiepileptic drugs in 36,912 older adults with epilepsy, with an emphasis on minorities. The third study describes the extent of antibiotic use in residents of 381 long-term care facilities (LTCF) in British Columbia, Canada, from 2007 to 2014. Finally, we discuss a meta-analysis of 42 studies that evaluated the prevalence of hospital admissions caused by adverse drug reactions in older adults. This article is intended to provide a narrative review of important publications on medication use quality and safety for clinicians and researchers committed to optimizing medication use in older adults. J Am Geriatr Soc 66:2254-2258, 2018.
Collapse
Affiliation(s)
- Shelly L Gray
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington
| | - Zachary A Marcum
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington
| | - Kenneth E Schmader
- Division of Geriatrics, Department of Medicine, School of Medicine, Duke University Medical Center, Durham, North Carolina.,Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Joseph T Hanlon
- Division of Geriatrics, Department of Medicine, School of Medicine, Pittsburgh, Pennsylvania.,Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,Geriatric Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| |
Collapse
|
27
|
Alsous M, Hamdan I, Saleh M, McElnay J, Horne R, Masri A. Predictors of nonadherence in children and adolescents with epilepsy: A multimethod assessment approach. Epilepsy Behav 2018; 85:205-211. [PMID: 30032809 DOI: 10.1016/j.yebeh.2018.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a lack of a standardized tool for adherence measurement in patients with epilepsy. Studies in children with epilepsy have reported adherence in 50-96.5%. The primary objective of this study was to identify predictors of nonadherence to antiepileptic drugs (AEDs) using two different methods in Jordanian children and adolescents with epilepsy. METHODS Participants included 63 children and adolescents with epilepsy and their primary caregivers. Adherence measures included a subjective approach (using parent and child self-reports via Medication Adherence Report Scale (MARS)) and an objective method (measuring plasma levels of AEDs coupled with the application of population pharmacokinetic models to predict AED concentrations in the children). The Beliefs about Medicines Questionnaire (BMQ) was used to examine the association beliefs about medicines with nonadherence in the participating patients. RESULTS Measuring AEDs in plasma samples captured the highest percentage of nonadherence (36.2%). No significant agreement was found between the AED plasma level method and both the MARS (parent) and MARS (child). The overall nonadherence (combined methods) to AED therapy in children with epilepsy was 44.4%. Logistic regression analysis indicated that children with longer duration of disease were more likely (odds ratio [OR]: 1.54, 95% confidence interval [CI]: 1.16-2.04) to be classified as nonadherent as were children whose parents have lower AED Necessity scores (OR: 0.68, 95% CI: 0.53-0.87) and higher AED Concerns (OR: 1.6, 95% CI: 1.26-2.04) as measured by the BMQ. CONCLUSION The use of a multimethod approach for assessing adherence increases sensitivity for detection of nonadherence to AEDs. Disease duration and parental necessity beliefs and concerns assessed by the BMQ-specific questionnaire were significant predictors of nonadherence to the AED therapy. The need for the development and implementation of interventions that can be employed to improve adherence within this pediatric population has been highlighted by the high levels of nonadherence identified.
Collapse
Affiliation(s)
- Mervat Alsous
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan.
| | - Imad Hamdan
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, the University of Jordan, Amman, Jordan
| | - Mohammad Saleh
- Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, the University of Jordan, Amman, Jordan
| | - James McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Robert Horne
- Behavioural Medicine, Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, UK
| | - Amira Masri
- Children Neurology, Faculty of Medicine, the University of Jordan, Amman, Jordan
| |
Collapse
|
28
|
Lekoubou A, Bishu KG, Ovbiagele B. Health care expenditures among elderly patients with epilepsy in the United States. Epilepsia 2018; 59:1433-1443. [DOI: 10.1111/epi.14455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Alain Lekoubou
- Department of Neurology; Medical University of South Carolina; Charleston SC USA
| | - Kinfe G. Bishu
- Department of Medicine; Medical University of South Carolina; Charleston SC USA
- Section of Health Systems Research and Policy; Medical University of South Carolina; Charleston SC USA
| | - Bruce Ovbiagele
- Department of Neurology; Medical University of South Carolina; Charleston SC USA
| |
Collapse
|
29
|
EPICON consensus: Recommendations for proper management of switching to eslicarbazepine acetate in epilepsy. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
30
|
Jóźwiak S, Veggiotti P, Moreira J, Gama H, Rocha F, Soares-da-Silva P. Effects of adjunctive eslicarbazepine acetate on neurocognitive functioning in children with refractory focal-onset seizures. Epilepsy Behav 2018; 81:1-11. [PMID: 29454255 DOI: 10.1016/j.yebeh.2018.01.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/07/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE This was a phase-II, randomized, double-blind (DB), placebo-controlled study aimed to evaluate neurocognitive effects of eslicarbazepine acetate (ESL) as adjunctive therapy in pediatric patients with refractory focal-onset seizures (FOS). METHODS Children (6-16years old) with FOS were randomized (2:1) to ESL or placebo. Treatment started at 10mg/kg/day, was up-titrated up to 30mg/kg/day (target dose), and maintained for 8weeks, followed by one-year open-label follow-up. The primary endpoint was change from baseline to the end of maintenance period in the composite Power of Attention assessed with the Cognitive Drug Research (CDR) system. Behavioral and emotional functioning and quality of life (QOL), secondary endpoints, were assessed with Child Health Questionnaire-Parent Form 50 (CHQ-PF50), Child Behavior Checklist (CBCL), and Raven's Standard Progressive Matrices (SPM). Efficacy was evaluated through changes in standardized seizure frequency (SF), responder rate, and proportion of seizure-free patients. Safety was evaluated by the incidence of treatment-emergent adverse events (TEAEs). RESULTS One hundred and twenty-three patients were randomized. A noninferiority analysis failed to reject the null hypothesis that the change from baseline in the Power of Attention score in the ESL group was at least 121ms inferior to the placebo group for all age groups. The CDR scores showed no differences between placebo and ESL in Power of Attention (1868.0 vs 1759.5), Continuity of Attention (1.136 vs -1.786), Quality of Working Memory (-0.023 vs -0.024), and Speed of Memory (-263.4 vs -249.6). Nonsignificant differences between placebo and ESL were seen for CHQ-PF50, CBCL scores, and Raven's SPM. Episodic Memory Index showed significant negative effect on ESL. Efficacy results favored the ESL group (SF least square [LS] means 1.98 vs 4.29). The TEAEs had a similar incidence between treatment groups (41.0% vs 47.5%). CONCLUSIONS Overall ESL did not produce statistically significant effects on neurocognitive and behavioral functioning in patients with epilepsy aged 6 to 16years. Additionally, ESL was effective in reducing seizure frequency and was well-tolerated.
Collapse
Affiliation(s)
- Sergiusz Jóźwiak
- Department of Child Neurology, Warsaw Medical University, Warsaw, Poland; Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - P Veggiotti
- Child Neurology Department, V. Buzzi Hospital, Milan, Italy; L. Sacco Department, University of Milan, Milan, Italy
| | - J Moreira
- BIAL - Portela & Cª. S.A., Coronado (S. Romão e S. Mamede), Portugal
| | - H Gama
- BIAL - Portela & Cª. S.A., Coronado (S. Romão e S. Mamede), Portugal
| | - F Rocha
- BIAL - Portela & Cª. S.A., Coronado (S. Romão e S. Mamede), Portugal
| | - P Soares-da-Silva
- BIAL - Portela & Cª. S.A., Coronado (S. Romão e S. Mamede), Portugal; Department of Biomedicine, Pharmacology and Therapeutics Unit, Faculty of Medicine, University Porto, Porto, Portugal; MedInUP - Center for Drug Discovery and Innovative Medicines, University Porto, Porto, Portugal.
| |
Collapse
|
31
|
Illness identity in young adults with refractory epilepsy. Epilepsy Behav 2018; 80:48-55. [PMID: 29414558 DOI: 10.1016/j.yebeh.2017.12.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/30/2017] [Accepted: 12/30/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Refractory epilepsy is an intrusive condition with important implications for daily functioning in emerging and young adulthood. The present study examined the degree to which refractory epilepsy is integrated in one's identity, and examined how such a sense of illness identity was related to health-related quality of life (HRQOL). METHODS A total of 121 18- to 40-year-old patients with refractory epilepsy (56.2% women) completed self-report questionnaires assessing the four illness identity states of acceptance, enrichment, engulfment, and rejection (Illness Identity Questionnaire (IIQ)); HRQOL (Quality of Life in Epilepsy Inventory - 31); and seizure frequency and severity (Liverpool Seizure Severity Scale (LSSS)). Illness identity scores were compared with a sample of 191 patients with a nonneurological chronic disease (congenital heart disease). Hierarchical regression analyses were conducted to assess the predictive value of illness identity for HRQOL when simultaneously controlling for demographic and clinical features. RESULTS Patients with refractory epilepsy scored higher on rejection and engulfment and lower on acceptance when compared with patients with congenital heart disease. Further, seizure severity and number of medication side-effects were positively related to engulfment and negatively to acceptance. Finally, when simultaneously controlling for various demographic and clinical variables, illness identity significantly predicted HRQOL (with engulfment being the strongest and most consistent predictor). CONCLUSION The extent to which patients with refractory epilepsy succeed in integrating their illness into their identity may have important implications for HRQOL. Clinicians should be especially attentive for signs that patients feel engulfed by their epilepsy.
Collapse
|
32
|
Sundelin HEK, Chang Z, Larsson H, Lichtenstein P, Almqvist C, Tomson T, Ludvigsson JF. Epilepsy, antiepileptic drugs, and serious transport accidents: A nationwide cohort study. Neurology 2018; 90:e1111-e1118. [PMID: 29490912 DOI: 10.1212/wnl.0000000000005210] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/13/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the association between epilepsy and antiepileptic drugs and serious transport accidents requiring emergency care or resulting in death. METHODS We identified 29,220 individuals 18 years or older with epilepsy without cerebral palsy or intellectual disability and 267,637 matched controls using Swedish registers. This nationwide cohort was followed from 2006 to 2013 for serious transport accidents. We used Cox regression to analyze the risk of serious transport accidents between individuals with epilepsy and matched controls, and then stratified Cox regression to compare the risk during periods of medication with the risk during nonmedication period within the same individual with epilepsy. We adjusted for civil status, employment, education, living area, psychiatric disorders prior to the start of follow-up, and psychotropic medication. RESULTS Compared to matched controls, individuals with epilepsy were at increased risk of serious transport accidents (hazard ratio [HR] 1.37; 95% confidence interval [CI] 1.29-1.46). There were increased risks of pedestrian accidents (HR 2.24, 95% CI 1.69-2.97), bicycle accidents (HR 1.68, 95% CI 1.49-1.89) and car accidents (HR 1.31, 95% CI 1.19-1.44). However, among patients with a diagnosis of epilepsy, use of antiepileptic drugs did not influence the risk of serious transport accidents in population-level comparisons (HR 0.97; 95% CI 0.85-1.11) or within-individual comparisons (HR 0.99; 95% CI 0.69-1.42). CONCLUSION Serious transportation accidents were more common in individuals with epilepsy, but this risk was independent of use of antiepileptic drugs.
Collapse
Affiliation(s)
- Heléne E K Sundelin
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY.
| | - Zheng Chang
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Henrik Larsson
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Paul Lichtenstein
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Catarina Almqvist
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Torbjörn Tomson
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| | - Jonas F Ludvigsson
- From the Department of Pediatrics (H.E.K.S.), Linköping University Hospital; Departments of Medical Epidemiology and Biostatistics (Z.C., H.L., P.L., C.A., J.F.L.) and Clinical Neuroscience (T.T.), Karolinska Institutet; Astrid Lindgren Children's Hospital (C.A.), Karolinska University Hospital, Stockholm; Department of Pediatrics (J.F.L.), Örebro University Hospital, Sweden; Division of Epidemiology and Public Health, School of Medicine (J.F.L.), University of Nottingham, UK; and Department of Medicine (J.F.L.), Columbia University, New York, NY
| |
Collapse
|
33
|
Trimboli M, Russo E, Mumoli L, Tripepi G, Fortunato F, Mastroianni G, Abate F, De Sarro G, Gambardella A, Labate A. Brand-to-generic levetiracetam switching: a 4-year prospective observational real-life study. Eur J Neurol 2018; 25:666-671. [DOI: 10.1111/ene.13568] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M. Trimboli
- Department of Medical Sciences; Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - E. Russo
- Science of Health Department; School of Medicine; University Magna Graecia; Catanzaro Italy
| | - L. Mumoli
- Department of Medical Sciences; Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - G. Tripepi
- Institute of Clinical Physiology; Research Unit of Reggio Calabria; National Research Council (IFC-CNR); Reggio Calabria Italy
| | - F. Fortunato
- Department of Medical Sciences; Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - G. Mastroianni
- Department of Medical Sciences; Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - F. Abate
- Department of Medical Sciences; Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - G. De Sarro
- Science of Health Department; School of Medicine; University Magna Graecia; Catanzaro Italy
| | - A. Gambardella
- Department of Medical Sciences; Institute of Neurology; University Magna Graecia; Catanzaro Italy
| | - A. Labate
- Department of Medical Sciences; Institute of Neurology; University Magna Graecia; Catanzaro Italy
| |
Collapse
|
34
|
Alsaadi T, Kassie S, El Hammasi K, Shahrour TM, Shakra M, Turkawi L, Nasreddine W, Raoof M. Potential factors impacting health-related quality of life among patients with epilepsy: Results from the United Arab Emirates. Seizure 2017; 53:13-17. [PMID: 29096164 DOI: 10.1016/j.seizure.2017.10.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE to investigate potential factors impacting HRQOL among PWE at a medical facility in the UAE. METHODS Depression, anxiety, and health-related quality of life were assessed in 160 adult patients with epilepsy from September 2014 to January 2015 at Sheikh Khalifa Medical City (SKMC). The World Health Organization Quality of Life abbreviated scale (WHOQOL-BREF), the Patient Health Questionnaire nine-item (PHQ-9) depression scale, and Generalized Anxiety Disorder seven-item (GAD-7) scale were administered. Demographic details including psychosocial factors were also obtained. Clinical details including seizure freedom, epilepsy type, epilepsy duration, and magnetic resonance imaging (MRI) results were recorded. Multivariate analysis was used to look at significant variables associated with HRQOL. RESULTS Depression, anxiety, seizure freedom, and the use of anti-depressants had significant positive correlation with HRQOL in univariate analysis. However, depression, followed by seizure freedom, had the strongest association with HRQOL in a multivariate regression analysis. CONCLUSION Depression and seizure freedom, followed by anxiety and anti-depressants use, were significantly correlated with HRQOL. These results underscore the importance of screening for psychiatric comorbidities in patients with epilepsy. IMPLICATIONS Screening for comorbid psychiatric disorders should be an essential component of the standard of care, and incorporated in the treatment plan for all patients with epilepsy. Factors contributing to psychiatric symptoms among PWE, such as maladaptive illness perceptions, non-adherence to anti-epileptic drugs (AED), and social stigma should be carefully addressed to achieve an optimal health-care plan.
Collapse
Affiliation(s)
- Taoufik Alsaadi
- American Center for Psychiatry & Neurology, Abu Dhabi, United Arab Emirates.
| | - Seada Kassie
- American Center for Psychiatry & Neurology, Abu Dhabi, United Arab Emirates
| | - Khadija El Hammasi
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Tarek M Shahrour
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Mustafa Shakra
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Lamya Turkawi
- Department of Neurology, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Wassim Nasreddine
- Department of Neurology, American University of Beirut-Medical center 7, Lebanon, Lebanon
| | - Mufeed Raoof
- Department of Psychiatry, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| |
Collapse
|
35
|
Efficacy and safety of eslicarbazepine acetate monotherapy for partial-onset seizures: Experience from a multicenter, observational study. Epilepsy Behav 2017. [PMID: 28641170 DOI: 10.1016/j.yebeh.2017.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Eslicarbazepine acetate (ESL, Aptiom™) is a once-daily anticonvulsant, approved as adjunctive treatment of partial-onset seizures (POS). Historical-controlled trials investigating the use of ESL as monotherapy have demonstrated a favorable efficacy and tolerability profile in patients with POS. This prospective, non-interventional study recruited POS patients in 17 hospitals in Spain. After a 3-month baseline period, ESL therapy was initiated as 400mg QD and up-titrated to an optimal maintenance dose based on clinical response and tolerance. The incidence of seizures was assessed via seizure calendars and the nature and severity of adverse events (AEs) were also recorded. A total of 117 patients (aged 9-87years) enrolled in the study and were treated with ESL at either 400mg/day (3.4% patients), 800mg/day (61% patients), 1200mg/day (27.1% patients) or 1600mg/day (8.5% patients). At 3months, 82.0% (n=72) of patients achieved a ≥50% reduction in seizure frequency, compared to 79.7% (n=67) of patients at 6months and 83.0% (n=49) at 12months. Patients who suffered secondary generalized tonic-clonic (SGTC) seizures had seizure-free rates of 71% (n=27), 69.6% (n=29), and 72.7% (n=16) at 3, 6, and 12months, respectively. Overall, 18 patients (15.3%) reported AEs of instability and dizziness (n=9), somnolence (n=3), mild hyponatremia (n=3), headache (n=1), hypertriglyceridemia (n=1), and allergic reaction (n=1), which caused ESL discontinuation of ESL treatment. ESL is effective and well tolerated as monotherapy for patients with POS, which supports previous findings. Early use is supported by its frequent use as monotherapy in this study and lack of severe side effects.
Collapse
|
36
|
Constantinescu I, Korff CM, Vulliemoz S, Picard F, Seeck M. Drug-Level Monitoring on Admission for Presurgical Epilepsy Evaluation. Eur Neurol 2017; 78:105-110. [PMID: 28738370 DOI: 10.1159/000479003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/27/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Evaluation for surgical treatment is offered to patients who do not respond to antiepileptic drugs. Pseudo-pharmacoresistance (PPR) has been described in the context of impaired compliance, incorrect diagnosis of epilepsy or pharmacological interference resulting in too low blood levels. We were interested to determine the frequency and causes of PPR in patients admitted for presurgical evaluation. METHODS We reviewed 553 drug levels in 199 patients and analyzed the relative frequency of drugs below reference range (10 and 20% below the range). RESULTS Patients who had at least one serum level below the 10% cut-off amounted to 33% and 9% of patients had at least one serum level below the 20% cut-off. Only in 2 patients (1%), this was due to poor compliance. Low levels were equally frequent in mono- or polytherapy. Drugs that were most frequently found out of range were phenytoin, valproate, and topiramate. In monotherapy, lamotrigine was often prescribed in too low dosages. CONCLUSION Low drug levels are frequently observed in surgical candidates due to pharmacological interference or insufficient dosing. Poor compliance or incorrect diagnosis does not appear to be a significant concern in this patient group. Our data strengthen the need for regular drug monitoring even in advanced chronic epilepsy to avoid unnecessary health costs by too low and ineffective dosages.
Collapse
Affiliation(s)
- Irina Constantinescu
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland.,Department of Neurology, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Christian M Korff
- Neuropediatrics Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Serge Vulliemoz
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
| | - Fabienne Picard
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
| | - Margitta Seeck
- EEG and Epilepsy Unit, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
| |
Collapse
|
37
|
Bellon ML, Barton C, McCaffrey N, Parker D, Hutchinson C. Seizure-related hospital admissions, readmissions and costs: Comparisons with asthma and diabetes in South Australia. Seizure 2017. [PMID: 28624716 DOI: 10.1016/j.seizure.2017.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Seizures are listed as an Ambulatory Care Sensitive Condition (ACSC), where, in some cases, hospitalisation may be avoided with appropriate preventative and early management in primary care. We examined the frequencies, trends and financial costs of first and subsequent seizure-related hospital admissions in the adult and paediatric populations, with comparisons to bronchitis/asthma and diabetes admissions in South Australia between 2012 and 2014. METHODS De-identified hospital separation data from five major public hospitals in metropolitan South Australia were analysed to determine the number of children and adults admitted for the following Australian Refined Diagnosis Related Groups: seizure related conditions; bronchitis/asthma; and diabetes. Additional data included length of hospital stay and type of admission. Demographic data were analysed to identify whether social determinants influence admission, and a macro costing approach was then applied to calculate the financial costs to the Health Care System. RESULTS The rate of total seizure hospitalizations was 649 per 100,000; lower than bronchitis/asthma (751/100,000), yet higher than diabetes (500/100,000). The highest proportions of subsequent separations were recorded by children with seizures regardless of complexity (47% +CSCC; 17% -CSCC) compared with asthma (11% +CSCC; 14% -CSCC) or diabetes (14% +CSCC; 13% -CSCC), and by adults with seizures with catastrophic or severe complications/comorbidity (25%), compared with diabetes (22%) or asthma (14%). The mean cost per separation in both children and adults was highest for diabetes (AU$4438/$7656), followed by seizures (AU$2408/$5691) and asthma (AU$2084/$3295). CONCLUSIONS Following the lead of well-developed and resourced health promotion initiatives in asthma and diabetes, appropriate primary care, community education and seizure management services (including seizure clinics) should be targeted in an effort to reduce seizure related hospitalisations which may be avoidable, minimise costs to the health budget, and maximise health care quality.
Collapse
Affiliation(s)
- Michelle L Bellon
- School of Health Sciences, Flinders University, Adelaide, Australia.
| | | | - Nikki McCaffrey
- School of Health & Social Development, Deakin University, Victoria, Australia.
| | - Denise Parker
- School of Health Sciences, Flinders University, Adelaide, Australia.
| | - Claire Hutchinson
- School of Health Sciences, Flinders University, Adelaide, Australia.
| |
Collapse
|
38
|
La Neve A, Boero G, Francavilla T, Striano P. Switching to eslicarbazepine acetate in patients with epilepsy: a field-practice observation. FUTURE NEUROLOGY 2017. [DOI: 10.2217/fnl-2016-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To provide field-practice information on the safety and efficacy of eslicarbazepine. Patients & methods: Patients who switched from carbamazepine or oxcarbazepine to eslicarbazepine were consecutively and retrospectively identified in two Italian reference centers for the treatment of epilepsy. Results: Eighteen patients with a mean age of 39 ± 16 years were recruited. Mean monthly seizure frequency was 18 ± 22 (range: 2–59) before switching to eslicarbazepine, and decreased to 11 ± 18 (0–56) after switching (p = 0.03). The monthly number of seizures decreased in 16/18 patients (89%) and it remained unchanged in one. Six patients became seizure-free after switching, five of whom had underwent overnight switch. The mean score of the adverse event profile questionnaire before switching was 42.5 ± 9.5 and it decreased to 35.0 ± 6.4 with eslicarbazepine therapy; 8/11 patients (73%) reported improved scores. Conclusion: Although the limited number of patients should be taken into account, switching to eslicarbazepine allowed a reduction of monthly number of seizures in about 55% of patients. Furthermore, eslicarbazepine showed a good safety profile with a potential lower impact on quality of life of patients.
Collapse
Affiliation(s)
- Angela La Neve
- Clinic of Nervous System Diseases “Amaducci”, University of Bari, Bari, Italy
| | - Giovanni Boero
- Complex Structure of Neurology, “SS Annunziata” Hospital, Taranto, Italy
| | - Teresa Francavilla
- Clinic of Nervous System Diseases “Amaducci”, University of Bari, Bari, Italy
| | - Pasquale Striano
- Pediatric Neurology & Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal & Child Health, University of Genoa, “G Gaslini” Institute, Genova, Italy
| |
Collapse
|
39
|
Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare. Epilepsy Behav 2017; 66:68-73. [PMID: 28038389 PMCID: PMC5297256 DOI: 10.1016/j.yebeh.2016.10.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Older minority groups are more likely to have poor AED adherence. We describe adherence to antiepileptic drugs (AEDs) among older Americans with epilepsy. METHODS In retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries augmented by minority representation, epilepsy cases in 2009 were those with ≥1 claim with ICD-9345.x or ≥2 with 780.3x, and ≥1 AED. New-onset cases had no such claims or AEDs in the year before the 2009 index event. We calculated the Proportion of Days Covered (PDC) (days with ≥1 AED over total follow-up days) and used logistic regression to estimate associations of non-adherence (PDC <0.8) with minority group adjusting for covariates. RESULTS Of 36,912 epilepsy cases (19.2% White, 62.5% African American (AA), 11.3% Hispanic, 5.0% Asian and 2% American Indian/Alaskan Native), 31.8% were non-adherent (range: 24.1% Whites to 34.3% AAs). Of 3706 new-onset cases, 37% were non-adherent (range: 28.7% Whites to 40.5% AAs). In adjusted analyses, associations with minority group were significant among prevalent cases, and for AA and Asians vs. Whites among new cases. Among other findings, beneficiaries from high-poverty ZIP codes were more likely to be non-adherent than their counterparts, and those in cost-sharing drug benefit phases were less likely to be non-adherent than those in deductible phases. CONCLUSION About a third of older adults with epilepsy have poor AED adherence; minorities are more likely than Whites. Investigations of reasons for non-adherence, and interventions to promote adherence, are needed with particular attention to the effect of cost-sharing and poverty.
Collapse
|
40
|
O' Rourke G, O' Brien JJ. Identifying the barriers to antiepileptic drug adherence among adults with epilepsy. Seizure 2016; 45:160-168. [PMID: 28063375 DOI: 10.1016/j.seizure.2016.12.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To identify the barriers to antiepileptic drug (AED) adherence among adults with epilepsy (AWE). The impact of AED non-adherence on quality of life (QoL) was also examined. METHOD Systematic design (SR) study. A search strategy was undertaken with no time limits, for articles published in English, in MEDLINE, CINANL, PsycINFO, EMBASE, Cochrane databases and grey literature sources. Eligibility criteria included participants with epilepsy over 18 years, who were prescribed AEDs. Adherence had to be defined and adherence assessment measurements identified. A screening process was undertaken to select eligible studies. Eight studies met the inclusion criteria and were included in a quantitative synthesis. Quality of evidence was conducted using the EBL critical appraisal checklist and assessing risk of bias within individual studies. RESULTS Across the included studies a high prevalence of non-adherence was identified. AED non-adherence was associated with specific beliefs about medications, being depressed or anxious, poor medication self-administration management, uncontrolled recent seizures, frequent medication dosage times, poor physician-patient relationship and perceived social support. Additionally, AED non-adherence impacted negatively on QoL as a result of poor seizure control. CONCLUSION Although included studies were of good quality, risk of biases reduced the generalisability of results. Findings suggested that comprehensive adherence assessments should routinely be performed. Recommendations for future research include the use of longitudinal research designs and a follow up SR to include the 16-18-year-old population.
Collapse
|
41
|
Ernst LDL, Harden CL, Pennell PB, Llewellyn N, Lau C, Barnard S, Bartfeld E, French JA. Medication adherence in women with epilepsy who are planning pregnancy. Epilepsia 2016; 57:2039-2044. [PMID: 27778312 DOI: 10.1111/epi.13586] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study examines medication adherence among women with epilepsy via use of an electronic diary, as part of a prospective multicenter observational study designed to evaluate fertility in women with epilepsy (WWE) versus age-matched controls. METHODS WWE and healthy age-matched controls, seeking pregnancy, were given an iPod Touch using a customized mobile application (the WEPOD App) for daily data tracking. Eighty-six WWE tracked seizures and antiepileptic drugs (AEDs). Tracking of nonepilepsy medications was optional. Diary data were counted from enrollment date until date of delivery, or up to 12 months if pregnancy was not achieved. Each day that subjects reported missing one or more AED was counted as nonadherence. Because adherence can only be determined in women who track consistently, we elected to include adherence data only for women who tracked >80% of days in the study. RESULTS Approximately 75% of WWE tracked >80% of days and were included in medication adherence data analysis. In this group, medication adherence rate was 97.71%; 44% of women admitted to missing an AED on at least 1 day. Among the subgroup of WWE who recorded nonepilepsy medications, AED adherence rate was 98.56%, versus 93.91% for non-AEDs. SIGNIFICANCE The 75% compliance rate with an electronic diary suggests that it may be useful to track medication adherence in future studies and in the clinical setting. In those who tracked, the observed medication adherence rate was considerably higher than the 75% adherence rate seen in previous epilepsy studies. This might be explained in part by selection bias, but may also result from properties of the diary itself (daily reminders, real time feedback given to the provider). Women reported a higher rate of adherence to AEDs than to other prescribed medications and supplements, suggesting that perceived importance of medications likely influences medication adherence, and warrants future study.
Collapse
Affiliation(s)
- Lia de Leon Ernst
- Neurology, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Cynthia L Harden
- Neurology, Mount Sinai School of Medicine, New York, New York, U.S.A
| | - Page B Pennell
- Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Nichelle Llewellyn
- Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Connie Lau
- Neurology, Hofstra Northwell School of Medicine, Great Neck, New York, U.S.A
| | - Sarah Barnard
- Neurology, New York University School of Medicine, New York, New York, U.S.A
| | | | - Jacqueline A French
- Neurology, New York University School of Medicine, New York, New York, U.S.A
| |
Collapse
|
42
|
van Dijkman SC, Alvarez-Jimenez R, Danhof M, Della Pasqua O. Pharmacotherapy in pediatric epilepsy: from trial and error to rational drug and dose selection - a long way to go. Expert Opin Drug Metab Toxicol 2016; 12:1143-56. [PMID: 27434782 DOI: 10.1080/17425255.2016.1203900] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Whereas ongoing efforts in epilepsy research focus on the underlying disease processes, the lack of a physiologically based rationale for drug and dose selection contributes to inadequate treatment response in children. In fact, limited information on the interindividual variation in pharmacokinetics and pharmacodynamics of anti-epileptic drugs (AEDs) in children drive prescription practice, which relies primarily on dose regimens according to a mg/kg basis. Such practice has evolved despite advancements in pediatric pharmacology showing that growth and maturation processes do not correlate linearly with changes in body size. AREAS COVERED In this review we aim to provide 1) a comprehensive overview of the sources of variability in the response to AEDs, 2) insight into novel methodologies to characterise such variation and 3) recommendations for treatment personalisation. EXPERT OPINION The use of pharmacokinetic-pharmacodynamic principles in clinical practice is hindered by the lack of biomarkers and by practical constraints in the evaluation of polytherapy. The identification of biomarkers and their validation as tools for drug development and therapeutics will require some time. Meanwhile, one should not miss the opportunity to integrate the available pharmacokinetic data with modeling and simulation concepts to prevent further delays in the development of personalised treatments for pediatric patients.
Collapse
Affiliation(s)
- Sven C van Dijkman
- a Division of Pharmacology , Leiden Academic Centre for Drug Research , Leiden , The Netherlands
| | - Ricardo Alvarez-Jimenez
- a Division of Pharmacology , Leiden Academic Centre for Drug Research , Leiden , The Netherlands
| | - Meindert Danhof
- a Division of Pharmacology , Leiden Academic Centre for Drug Research , Leiden , The Netherlands
| | - Oscar Della Pasqua
- b Clinical Pharmacology and Discovery Medicine , GlaxoSmithKline , Stockley Park , UK.,c Clinical Pharmacology and Therapeutics , University College London , London , UK
| |
Collapse
|
43
|
Mendizabal A, Thibault DP, Willis AW. Patient safety events in hospital care of individuals with epilepsy. Epilepsia 2016; 57:1301-9. [DOI: 10.1111/epi.13440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Adys Mendizabal
- Temple University School of Medicine; Philadelphia Pennsylvania U.S.A
| | - Dylan P. Thibault
- Department of Neurology; University of Pennsylvania School of Medicine; Philadelphia Pennsylvania U.S.A
- Department of Biostatistics and Epidemiology; University of Pennsylvania School of Medicine; Philadelphia Pennsylvania U.S.A
| | - Allison W. Willis
- Department of Neurology; University of Pennsylvania School of Medicine; Philadelphia Pennsylvania U.S.A
- Department of Biostatistics and Epidemiology; University of Pennsylvania School of Medicine; Philadelphia Pennsylvania U.S.A
- Leonard Davis Institute of Health Economics; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
- Center for Clinical Epidemiology and Biostatistics; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| |
Collapse
|
44
|
EPICON consensus: recommendations for proper management of switching to eslicarbazepine acetate in epilepsy. Neurologia 2016; 33:290-300. [PMID: 27349151 DOI: 10.1016/j.nrl.2016.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/05/2016] [Accepted: 04/10/2016] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The objective of the EPICON Project is to develop a set of recommendations on how to adequately switch from carbamazepine (CBZ) and oxcarbazepine (OXC) to eslicarbazepine acetate (ESL) in some patients with epilepsy. METHODS A steering committee drafted a questionnaire of 56 questions regarding the transition from CBZ or OXC to ESL in clinical practice (methodology and change situation). The questionnaire was then distributed to 54 epilepsy experts in 2 rounds using the Delphi method. An agreement/disagreement consensus was defined when a median ≥ 7 points or ≤ 3 was achieved, respectively, and a relative interquartile range ≤ 0.40. We analysed the results obtained to reach our conclusions. RESULTS Our main recommendations were the following: switching from CBZ to ESL must be carried out over a period of 1 to 3 weeks with a CBZ:ESL dose ratio of 1:1.3 and is recommended for patients who frequently forget to take their medication, those who work rotating shifts, polymedicated patients, subjects with cognitive problems, severe osteoporosis-osteopaenia, dyslipidaemia, or liver disease other than acute liver failure, as well as for men with erectile dysfunction caused by CBZ. The transition from OXC to ESL can take place overnight with an OXC:ESL dose ratio of 1:1 and it is recommended for patients who frequently forget to take their medication, those who work rotating shifts, polymedicated patients, or those with cognitive problems. The transition was not recommended for patients with prior rash due to CBZ or OXC use. CONCLUSION The EPICON Project offers a set of recommendations about the clinical management of switching from CBZ or OXC to ESL, using the Delphi method.
Collapse
|
45
|
Asadi-Pooya AA, Tavana B, Tavana B, Emami M. Drug adherence of patients with epilepsy in Iran: the effects of the international economic sanctions. Acta Neurol Belg 2016; 116:151-5. [PMID: 26442685 DOI: 10.1007/s13760-015-0545-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
Drug adherence of patients with epilepsy was investigated to determine the reasons behind poor adherence. In this retrospective chart review study, all patients with a clinical diagnosis of epilepsy were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences. We routinely asked about the patient's drug adherence and reasons behind poor drug adherence in every office visit. We defined drug adherence adequate if the patient reported less than or equal to one missed dose per month. Patients' drug adherences were investigated during two time periods: March 2010-2011 (before intensification of the international economic sanctions against Iran), and September 2012-2013 (during intensified international economic sanctions). One hundred and ninety-nine patients were studied. Drug adherence was satisfactory in 139 patients (69.8 %) during the first time period. Drug adherence was satisfactory in 146 patients (73.4 %) during the second time period. The most common reasons for poor drug adherence was carelessness, followed by cost and lack of drug availability (1.5 % in the first time period and 4 % in the second time period; P = 0.07). About one-third of patients with epilepsy had poor drug adherence. To overcome the problem, it is important to find the reasons behind poor drug adherence in each patient and try to overcome the cause. Purely from a clinical and patient care perspective, it seems necessary that politicians should facilitate decisions that make the health and well-being of ordinary people more affordable and without hardship.
Collapse
|
46
|
Treatment non-adherence in pseudo-refractory epilepsy. Epilepsy Res 2016; 122:1-6. [DOI: 10.1016/j.eplepsyres.2016.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/10/2015] [Accepted: 02/02/2016] [Indexed: 01/16/2023]
|
47
|
Tambucci R, Basti C, Maresca M, Coppola G, Verrotti A. Update on the role of eslicarbazepine acetate in the treatment of partial-onset epilepsy. Neuropsychiatr Dis Treat 2016; 12:1251-60. [PMID: 27307737 PMCID: PMC4889089 DOI: 10.2147/ndt.s86765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Eslicarbazepine acetate (ESL) is a once daily new third generation antiepileptic drug that shares the basic chemical structure of carbamazepine and oxcarbazepine - a dibenzazepine nucleus with the 5-carboxamide substituent, but is structurally different at the 10,11-position. ESL is a pro-drug metabolized to its major active metabolite eslicarbazepine. Despite the fact that the exact mechanism of action has not been fully elucidated, it is thought to involve inhibition of voltage-gated sodium channels (VGSC). ESL inhibits sodium currents in a voltage-dependent way by an interaction predominantly with the inactivated state of the VGSC, thus selectively reducing the activity of rapidly firing (epileptic) neurons. ESL reduces VGSC availability through enhancement of slow inactivation. In Phase III studies, adjunctive therapy with ESL 800 or 1,200 mg/day leads to a significant decrease in the seizure frequency in adults with refractory partial onset epilepsy. Based on these results, ESL has been approved in Europe (by the European Medicines Agency) and in the United States (by the US Food and Drug Administration) as add-on therapy. Data on efficacy and safety have been confirmed by 1-year extension and real life observational studies. Recently, based on results from two randomized, double-blind, historical control Phase III trials, ESL received US Food and Drug Administration approval also as a monotherapy for patients with partial onset epilepsy. In the pediatric setting, encouraging results have been obtained suggesting its potential role in the management of epileptic children. Overall ESL was generally well tolerated. The most common adverse events were dizziness, somnolence, headache, nausea, diplopia, and vomiting. Adverse events can be minimized by appropriate titration. In conclusion, ESL seems to overcome some drawbacks of the previous antiepileptic drugs, suggesting a major role of ESL in the management of focal onset epilepsy for both new onset and refractory cases, either as monotherapy or as adjunctive treatment.
Collapse
Affiliation(s)
- Renato Tambucci
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Claudia Basti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Maria Maresca
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Giangennaro Coppola
- Child and Adolescent Neuropsychiatry Unit, University of Salerno, Salerno, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
48
|
Guo Y, Ding XY, Lu RY, Shen CH, Ding Y, Wang S, Tang YL, Ding MP. Depression and anxiety are associated with reduced antiepileptic drug adherence in Chinese patients. Epilepsy Behav 2015. [PMID: 26209942 DOI: 10.1016/j.yebeh.2015.06.042] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association of depression and anxiety with adherence to antiepileptic drugs (AEDs) in Chinese patients with epilepsy. METHODS A total of 184 Chinese patients with epilepsy, and without cognitive impairment, underwent psychometric tests: the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Adherence to antiepileptic drugs was measured by the eight-item Morisky Medication Adherence Scale (MMAS-8). Data on patients' demographic characteristics, disease characteristics, and treatment characteristics were also collected. RESULTS The MMAS-8 indicated that 39.7% of the patients had low adherence, 34.2% had moderate adherence, and 26.1% had high adherence. Demographic, disease, and treatment characteristics were not significantly different between the low adherence group and the moderate-to-high adherence group. Thirty-six (19.6%) patients had moderate-to-severe depression according to the BDI, and 47 (25.5%) patients were considered anxious according to the BAI. A significant difference in depression scores was found between the low adherence group and the moderate-to-high adherence group (χ(2)=13.625, P<0.001). We also found a significant difference in anxiety scores between the two groups (χ(2)=8.331, P=0.004). Pearson's correlations indicated that depression scores (r=-0.281, P<0.001) and anxiety scores (r=-0.255, P<0.001) were negatively correlated with adherence. Negative correlations were found between BDI scores and items 2, 7, and 8 of the MMAS-8 (P<0.05); negative correlations were also found between BAI scores and items 3 and 6-8 (P<0.05). CONCLUSION Depression and anxiety were associated with reduced antiepileptic drug adherence in Chinese patients. Addressing depression and anxiety among patients with epilepsy may help improve adherence to AEDs.
Collapse
Affiliation(s)
- Yi Guo
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao-Yan Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ru-Yi Lu
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chun-Hong Shen
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yao Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ye-Lei Tang
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mei-Ping Ding
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| |
Collapse
|
49
|
Chapman SCE, Horne R, Eade R, Balestrini S, Rush J, Sisodiya SM. Applying a perceptions and practicalities approach to understanding nonadherence to antiepileptic drugs. Epilepsia 2015. [PMID: 26215092 DOI: 10.1111/epi.13097] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Nonadherence to antiepileptic drugs (AEDs) is a common cause of poor seizure control. This study examines whether reported adherence to AEDs is related to variables identified in the National Institute for Health and Clinical Excellence (NICE) Medicines Adherence Guidelines as being important to adherence: perceptual factors (AED necessity beliefs and concerns), practical factors (limitations in capability and resources), and perceptions of involvement in treatment decisions. METHODS This was a cross-sectional study of people with epilepsy receiving AEDs. Participants completed an online survey hosted by the Epilepsy Society (n = 1,010), or as an audit during inpatient admission (n = 118). Validated questionnaires, adapted for epilepsy, assessed reported adherence to AEDs (Medication Adherence Report Scale [MARS]), perceptions of AEDs (Beliefs about Medicines Questionnaire [BMQ]), and patient perceptions of involvement in treatment decisions (Treatment Empowerment Scale [TES]). RESULTS Low adherence was related to AED beliefs (doubts about necessity: t(577) = 3.90, p < 0.001; and concerns: t(995) = 3.45, p = 0.001), reported limitations in capability and resources (t(589) = 7.78, p < 0.001), and to perceptions of a lack of involvement in treatment decisions (t(623) = 4.48, p < 0.001). In multiple logistic regression analyses, these factors significantly (p < 0.001) increased variance in reported adherence, above that which could be explained by age and clinical variables (seizure frequency, type, epilepsy duration, number of AEDs prescribed). SIGNIFICANCE Variables identified in the NICE Medicines Adherence Guidelines as potentially important factors for adherence were found to be related to adherence to AEDs. These factors are potentially modifiable. Interventions to support optimal adherence to AEDs should be tailored to address doubts about AED necessity and concerns about harm, and to overcome practical difficulties, while engaging patients in treatment decisions.
Collapse
Affiliation(s)
- Sarah C E Chapman
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, United Kingdom
| | - Rob Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, United Kingdom
| | - Rona Eade
- Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom
| | - Simona Balestrini
- Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom.,Neuroscience Department, Polytechnic University of Marche, Ancona, Italy
| | - Jennifer Rush
- Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom
| | - Sanjay M Sisodiya
- Epilepsy Society, Chalfont St. Peter, Bucks, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom
| |
Collapse
|
50
|
Redmayne N, Robertson S, Kockler J, Llewelyn V, Haywood A, Glass B. Repackaged sodium valproate tablets--Meeting quality and adherence to ensure seizure control. Seizure 2015; 31:108-11. [PMID: 26362386 DOI: 10.1016/j.seizure.2015.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/13/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Sodium valproate, which is commonly repacked to assist with adherence to ensure seizure control, is hygroscopic and therefore sensitive to moisture. The aim of this study was thus to determine the stability implications of removing the enteric coated tablets from their original packaging and repackaging into a Dose Administration Aid (DAA) with storage under various environmental conditions. METHODS Physicochemical stability of enteric coated sodium valproate tablets repackaged into a DAA and stored at controlled room temperature, accelerated and refrigerated conditions was evaluated for 28 days. A validated high performance liquid chromatography method was used for the quantitation of the drug content. RESULTS Although the chemical stability (sodium valproate between 95 and 105% of labelled content) was maintained for 28 days for all storage conditions, for those tablets stored under accelerated conditions the integrity of the enteric coat was compromised after only 8 days. CONCLUSIONS Repackaging of enteric coated sodium valproate should be undertaken with caution and be informed by storage climate. This is particularly relevant for those patients living in hot, humid environments where they should be advised to store their DAA in a refrigerator.
Collapse
Affiliation(s)
| | - Sherryl Robertson
- Pharmacy, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Jutta Kockler
- Pharmacy, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Victoria Llewelyn
- Pharmacy, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Alison Haywood
- School of Pharmacy, Griffith University, Gold Coast, QLD 4222, Australia
| | - Beverley Glass
- Pharmacy, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia.
| |
Collapse
|