Translation, cross-cultural adaptation, and validation of the Bulgarian version of the Liverpool Adverse Event Profile

Tolerability of antiseizure medicines using Lithuanian version of the Liverpool Adverse Events Profile

OBJECTIVES

To develop and validate a Lithuanian version of the Liverpool Adverse Events Profile (LT-LAEP), and to evaluate the main demographic, clinical, and pharmacological determinants of its score.

MATERIALS AND METHODS

We developed the LT-LAEP and examined its psychometric properties. People with epilepsy (PWE) were asked to fill in the LT-LAEP, the Generalized Anxiety Disorder scale-7 (GAD-7), the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and a questionnaire addressing key demographic and clinical information. Antiseizure medicine (ASM) burden was expressed as a number of ASM and total drug load. Multiple linear regression analysis was used to determine the influence of various variables on LAEP results.

RESULTS

The data of 157 participants with the established diagnosis of epilepsy and stable ASM regimen were included in the final analysis. The mean LT-LAEP score was 48.72 ± 13.65. High internal consistency (Cronbach's α = 0.912) and test-retest reliability (ICC = 0.801) were demonstrated. The most common adverse effects (AEs) were tiredness (24.8%) and memory problems (23.6%). Lithuanian version of the Liverpool Adverse Events Profile score significantly correlated with NDDI-E (r = 0.635, p < 0.001) and GAD-7 (r = 0.640, p < 0.001) scores. The correlation between LT-LAEP score and total drug load was weak (r = 0.243, p = 0.002). The significant predictors of higher LT-LAEP score were female sex (β = -4.768, p = 0.003), higher seizure frequency (β = 4.757, p < 0.001), and higher NDDI-E (β = 1.457, p < 0.001) and GAD-7 scores (β = 0.610, p = 0.007) (F(4,152) = 43.975, R2 = 0.536, p < 0.001).

CONCLUSIONS

The LT-LAEP is a reliable and valid instrument for the evaluation of the AEs of ASM. A higher score of LT-LAEP is predicted by female sex, seizure frequency, and anxiety and depression levels rather than total drug load.

Validation of the Serbian version of the Liverpool Adverse Events Profile of antiseizure therapy in patients with epilepsy

The Liverpool Adverse Event Profile (LAEP) is a useful instrument in assessing the consequences of adverse events in patients using antiseizure medication. The LAEP scale has been validated in several languages to date. The aim of our study was to validate the LAEP scale in the Serbian language (SVLAEP). Validation of the SVLAEP scale was conducted by translating the original English version into the Serbian language and backtranslated into the English language. The translation was accepted when the two versions of the text were compatible. The questionnaire is then given to a group of patients with epilepsy treated with a stable dose of antiseizure medication. For the assessment of the quality of life and depression, we used the Serbian version of the Quality of Life in Epilepsy Inventory-31 (SVQOLIE-31) and the Serbian version of the Neurological Disorders Depression Inventory for Epilepsy (SVNDDI-E). From a total of 166 patients, 118 patients were included, and the remaining 48 were excluded because of other comorbidities and using other psychotropic drugs. Internal consistency (Cronbach's α = 0.87) and test-retest reliability (intraclass correlation coefficient (ICC) = 0.80) were satisfactory. The SVLAEP and SVQOLIE-31 had a strong negative statistical correlation (r_s = -0.73; p < 0.001). The SVLAEP and SVNDDI-E final scores had a positive moderate correlation (r_s = 0.52; p < 0.001). A moderate negative statistical correlation was found between SVNDDI-E and SVQOLIE-31 (r_s = -0.56; p < 0.001). Our study showed that the LAEP scale is a useful indicator for the frequency of the adverse events in antiepileptic drug (AED) usage, despite a minor overlap with the symptoms of depression.

Self-reported attitudes about medication in Lebanese people with epilepsy

BACKGROUND

Epilepsy is a common worldwide neurological disorder. For people with epilepsy (PWE), adherence and attitudes towards medication is a crucial step to improve efficacy of prescribed treatment and to prevent seizures.

OBJECTIVES

The first aim of this study was to evaluate attitudes towards antiepileptic medications in Lebanese population. Secondary aims were to assess factors affecting attitudes and associated with epilepsy control.

MATERIAL AND METHODS

A cross-sectional study was conducted in outpatient neurology clinics located in Beirut-Lebanon. Data were collected using a structured questionnaire. Self-report of medication taking behaviors were assessed using the abbreviated (4 items) Morisky Medication Adherence Scale (MMAS-4). Epilepsy was considered as controlled if the patient had no seizures in the last 6 months.

RESULTS

Among 250 PWE recruited in this study, male-to-female ratio was 0.87 (116/134), and 50.8% were married. Mean duration of epilepsy was 13.7 ± 12.8 years. Valproate was the most common antiepileptic drug (AED) used followed by levetiracetam and carbamazepine. About 60.8% of the population presented partial epilepsy. Uncontrolled epilepsy was present in more than half of participants (55.2%), with only 32.4% had positive attitudes to their medication. Positive attitudes towards antiepileptic increased in people who found that their treatment was efficacious (odds ratio (OR) = 4.9; 95% confidence interval (CI): 1.2-20.0; p = 0.03), who had controlled epilepsy (OR = 3.4; 95%CI 1.6-7.1; p = 0.001), and who were diagnosed as PWE between the age of 12-20 years (OR = 3.1; 95%CI 1.1-8.4; p = 0.03). Oppositely, these attitudes decreased in participants who felt their treatment as an economic burden (OR = 0.2; 95%CI 0.1-0.4; p ≪ 0.001), and in people with depression (OR = 0.4; 95%CI 0.2-0.9; p = 0.04). Controlled epilepsy was higher in people who contacted a neurologist if seizure occurred, in people with positive attitudes, and after a long duration of disease, but it decreased if patient did not follow neurologist's instructions in fasting period.

CONCLUSIONS

Lebanese PWE were less likely to have positive attitudes towards medication, which may lead to poor epilepsy control. Depression and economic burden were the major factors that decreased these attitudes. Identifying factors affecting attitudes to medication and leading to controlled epilepsy may help clinicians to elaborate educational programs to optimize medication adherence.

Adverse Events of Antiepileptic Drugs Using Indonesian Version of Liverpool Adverse Events Profile

Introduction

Adverse events (AEs) associated with antiepileptic drugs (AEDs) affect people with epilepsy's (PWE) quality of life. A study conducted in 15 European countries showed that the AEs prevalence of AEDs in PWE was up to 80%. To date, there are no validated screening instruments to detect AEs of AEDs in Indonesian PWE. Therefore its epidemiology is currently unknown. This study aimed to validate the Indonesian version of Liverpool Adverse Events Profile (LAEP), consequently increasing physicians' awareness toward the probability of AEs and its necessary evaluation. Furthermore, this study was intended to determine the AEs prevalence of AEDs in Indonesian PWE.

Methods

The questionnaire was translated from English into Indonesian version. The validity and reliability were tested using Spearman correlation and Cronbach's alpha measurement. An observational cross-sectional study was carried out on consecutive PWE in outpatient clinic, Cipto Mangunkusumo Hospital. We analyzed duration of epilepsy, onset of epilepsy, seizure frequency, type of epilepsy, etiology and epilepsy syndrome, number of AEDs, duration of AED use, and comorbidity.

Results

All of the 19 items in the questionnaire were valid, with correlation coefficient ranging from 0.465 to 0.690 (moderate-strong correlation). Cronbach's alpha value was 0.846 (good consistency). The total of 90 subjects were enrolled with 91% screened as having AEs using LAEP questionnaire. The most common AEs were tiredness (67.8%), sleepiness (66.7%), memory problems (62.2%), and difficulty in concentrating (56.7%). The only clinical variable that influenced AEs was polytherapy.

Conclusion

The Indonesian version of LAEP was a valid and reliable instrument to screen AE of AEDs in PWE. Almost all the subjects in this study were suspected having AEs. Polytherapy was the independent factor of AE.

Liverpool Adverse Events Profile: Italian validation and predictive value for dropout from antiepileptic treatment in people with epilepsy

INTRODUCTION

Adverse events (AEs) of antiepileptic drugs (AEDs) affect patient compliance and dropout. No questionnaire measuring AEs of AEDs is available for Italian-speaking people with epilepsy. Moreover, no questionnaire has been shown to predict patient dropout.

OBJECTIVE

The aim of this study was to provide a validated Italian version of the Liverpool Adverse Events Profile (iLAEP) and to define iLAEP reliability in AE monitoring and dropout risk prediction.

METHODS

The original LAEP was translated and tested for internal consistency and reliability. Patients with epilepsy who are on stable AED regimen completed the questionnaire as well as a 3-month follow-up to assess dropouts.

RESULTS

Overall, 204 patients with epilepsy were enrolled (mean age: 47.1±21.5). High internal consistency (Cronbach's α=0.88) was demonstrated, and very quick completion time was registered (mean=9min). A 3-month follow-up was performed to assess treatment discontinuation and potential predictive value of the iLAEP score. Treatment was discontinued in 33.3% of the cohort. Moreover, iLAEP scores (mean=30.71) significantly differed between patients interrupting (39.15±5.66) and those prosecuting treatment (29.4±6.54, p<.001). A cutoff of 36.5 had an 85% accuracy in predicting treatment discontinuation (85% sensitivity, 79% specificity). Scores >36.5 were associated with a 20.27-fold increase in dropout relative risk (RR), with a 66% positive predictive value.

CONCLUSIONS

The iLAEP represents a reliable, quick, and inexpensive assessment tool for patient-reported AEs of AEDs. An iLAEP cutoff of 36.5 differentiates patients unlikely to interrupt treatment from those more prone to stop AEDs in the following 3months. The iLAEP might help clinicians in weighting the risk of dropout and better tailor treatment to patients.

Significance of noncompliance when treating patients with epilepsy

INTRODUCTION

The absence of patient's cooperation when it comes to his/her treatment ("noncompliance") is typical to chronic diseases and it is significant problem in medical practice. The term "compliance" means patient's capability of strictly adhering to the recommendations concerning the prescribed treatment. The noncompliance with drug regime is frequent case in patients with epilepsy, it is related to increased risk of epileptic seizures' occurrence and other undesired consequences, including increased costs in the healthcare area.

OBJECTIVE

The objective of our research is assessing the interconnection between compliance with the treatment and social-demographic and clinical factors in patients with epilepsy.

CONTINGENT AND METHODS

The research covers 131 consecutively included patients with epilepsy of various social-demographic and clinical characteristics. We have utilized analysis of the medical documentation, anamnesis, study of the somatic and neurological status, self-assessment scales and statistical methods.

RESULTS

We established statistically significant positive correlations between the number of patients with poor compliance and the absence of professional/educational occupation, frequency of epileptic seizures, number of the antiepileptic drugs taken during the present and past treatment, the simultaneous presence of poor control of epileptic seizures and adverse drug events being the reason behind the modification of the previous treatment.

CONCLUSION

Patient's poor compliance, the great frequency of seizures, the higher number of antiepileptic drugs and the adverse drug reactions have negative impact on the course of the epileptic disease. The improved compliance results in optimizing the antiepileptic treatment, improving patients' condition and significantly cutting down costs incurred in the healthcare area.

Evaluating quality of life in epilepsy: The role of screening for adverse drug effects, depression, and anxiety

OBJECTIVE

The objective of this study was to evaluate the contribution of validated screening tools for antiepileptic drug (AED) adverse effects, depression, and anxiety to measure the quality of life (QoL) in people with epilepsy (PWE).

METHODS

Patients in a tertiary epilepsy service were screened for quality of life (using QOLIE-31), major depressive disorder (MDD) (NDDI-E), generalized anxiety disorder (GAD) (GAD-7), and AED effects (AEP). Mini International Neuropsychiatric Interview (MINI) generalized anxiety disorder module was also performed. For AEP validation in French, the internal structural validity was analyzed. Dimensional (NDDI-E and GAD-7 scores) and categorical (MDD and GAD) analyses were performed to investigate interactions between QoL and AEP.

RESULTS

A total of 132 (87 females) subjects were included. The French version of the AEP demonstrated satisfactory psychometric properties (Cronbach's α 0.87). Correlations between NDDI-E, GAD-7, AEP, and QOLIE-31 scores were high, and significant for all subscales of QOLIE-31; no effect of seizure-related variables was seen. Some sex differences in QOLIE-31 subscales were found, and mean AEP score was higher in females. Age, sex, NDDI-E, GAD-7, and AEP scores accounted for 61% of variance of QOLIE-31 scores. Differential effects were seen on QOLIE-31 subscales: AEP strongly correlated with all subscales; GAD-7 scores more strongly correlated with "Seizure Worry"; NDDI-E with "Energy-Fatigue"; and both NDDI-E and GAD-7 scores strongly correlated with "Emotional Well-Being". Categorical analysis of groups with MDD alone, GAD alone, MDD+GAD, and neither MDD nor GAD showed significant differences in AEP and QOLIE-31 scores, with MDD+GAD showing the most AED effects and the poorest QoL.

SIGNIFICANCE

The combination of screening tools for depression (NDDI-E), anxiety (GAD-7), and AED effects (AEP) has a strong power for evaluating QoL in PWE. Coexisting MMD and GAD were associated with the poorest quality of life and the highest AEP scores.

Relation of Perceived Stigma to Adverse Events of Medications in Patients with Epilepsy

Purpose. We aimed to assess the influence of adverse events (AEs) of antiepileptic drugs (AEDs) on perceived stigma of Bulgarian patients with epilepsy. Methods. Our study was based on questionnaires (Liverpool Adverse Events Profile (LAEP) and stigma scale), information from medical documentation, and an interview on clinical factors of 153 consecutive patients with epilepsy. Results. Perceived stigma was observed in 64.71% of the study participants. There was a significant association between perceived stigma and the total LAEP score (p < 0.05, F = 13.71). Patients who reported AEs had an increased risk of perceiving stigma compared to those who did not experience AEs. A significant correlation between perceived stigma and the presence of neurological and psychiatric AEs (p < 0.001, r = +0.60) and a mild correlation between perceived stigma and the presence of nonneurological AEs (p < 0.01, r = +0.20) were verified. In a multivariate regression analysis the only predictors of perceived stigma were AED polytherapy and the presence of neurological and psychiatric AEs. Conclusions. AEs of AEDs in patients with epilepsy significantly correlate with perceived stigma. Our study results will be useful in the campaign to overcome stigma predictors.