1
|
Zeigler G, Harrington CA, Rosendale N, Ganos C, Roldan V, Pace A, Alick-Lindstrom S, Orozco-Poore C, Deeb W, Hansen ML, L'Erario ZP. Neurologic Care for Transgender and Gender-Diverse People: A Review of Current Evidence and Clinical Implications. Neurol Clin Pract 2024; 14:e200332. [PMID: 38919931 PMCID: PMC11195436 DOI: 10.1212/cpj.0000000000200332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/11/2024] [Indexed: 06/27/2024]
Abstract
Purpose of Review To summarize the literature on neurologic care for transgender and gender-diverse (TGD) people and provide implications for clinical practice. Recent Findings There are limited data on the frequency and management of neurologic conditions among TGD people. TGD people have a higher prevalence of various neurologic conditions compared with cisgender or general population cohorts, including migraine, subjective cognitive decline, sleep disturbances, functional disorders, and cerebrovascular disease. Gender-affirming hormone therapy interacts with commonly prescribed neurologic medications and increases stroke risk among transfeminine people. Sex hormones and sex chromosomes may play a role in neurodegeneration and disability progression in neuroimmunologic diseases. Clitoral reduction surgeries on intersex children can cause neurologic disability and sexual dysfunction in adulthood. Socioeconomic disparities among TGD people contribute to health care barriers. Summary Neurologists should consider the unique experiences and health care needs of TGD people in their clinical practice and research protocols.
Collapse
Affiliation(s)
- Gwen Zeigler
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Cole A Harrington
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Nicole Rosendale
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Christos Ganos
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Valeria Roldan
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Anna Pace
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Sasha Alick-Lindstrom
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Casey Orozco-Poore
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Wissam Deeb
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Margaret L Hansen
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| | - Z Paige L'Erario
- Department of Neurology (GZ), Albany Medical College, NY; Department of Neurology (CAH), The Ohio State University College of Medicine, Columbus; Department of Neurology and Weill Institute for Neurosciences (NR), University of California San Francisco; Movement Disorder Clinic (CG), Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Ontario, Canada; Facultad de Medicina Alberto Hurtado (VR), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Neurology (AP), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Neurology (SA-L), University of Texas Southwestern Medical Center, Dallas; Department of Pediatric Neurology (CO-P), University of California, Los Angeles; Department of Neurology (WD), UMass Memorial Medical Center and UMass Medical School, Worcester; The Ohio State University Wexner Medical Center (MLH), Columbus; Greenburgh Pride (ZPLE), Westchester, NY
| |
Collapse
|
2
|
Wheless J, Gidal B, Gong L, Lyu S, Zheng X, Li R, Chang W, Tan M. Lacosamide extended-release capsules are bioequivalent to lacosamide immediate-release tablets: Pharmacokinetic observations and simulations. Epilepsy Res 2024; 202:107350. [PMID: 38513537 DOI: 10.1016/j.eplepsyres.2024.107350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Assess the bioequivalence of lacosamide extended-release (XR) capsules and immediate-release (IR) tablets and answer real-world clinical questions regarding the use of lacosamide XR. METHODS An open-label, randomized, two-treatment, two-sequence, oral comparative bioavailability study was conducted to assess the bioequivalence of two lacosamide formulations. Participants were randomized 1:1 to receive lacosamide XR capsules (400 mg once-daily) or IR tablets (200 mg twice-daily) in 1 of 2 sequences over 7-day periods. Primary outcome was the area under the lacosamide concentration-time curve over 24 h at steady-state (AUC0-τ,ss). Secondary outcomes were maximum (Cmax,ss) and minimum concentrations at steady-state (Cmin,ss). Bioequivalence was established when 90% confidence intervals (CIs) for geometric least square means ratios (GLSMs) were between 80% and 125%. Adverse events (AEs) and other safety outcomes were also assessed. Pharmacokinetic simulations, including adherent and partially adherent dosing scenarios with XR and IR formulations, modeled the clinical use of lacosamide XR. RESULTS Thirty-five healthy adult males were enrolled in the bioequivalence study. After 7 days of study drug, mean AUC0-τ,ss, Cmax,ss, and Cmin,ss values were similar between XR and IR formulations; all 90% CIs for GLSMs were between 80% and 125%. AEs were mild and no serious AEs or other clinically significant safety findings were observed. Pharmacokinetic simulations suggested that partial adherence affected formulations similarly; and the best strategy for switching formulations was to take the morning lacosamide IR dose followed by the evening lacosamide XR dose, as this resulted in the most consistent lacosamide plasma concentrations. CONCLUSIONS Once-daily lacosamide XR capsules were bioequivalent to twice-daily lacosamide IR tablets. Pharmacokinetic simulations indicated lacosamide XR and IR formulations were similarly affected by partial adherence, though once-daily dosing with lacosamide XR may offer clinical advantages, and formulations can be easily switched. These results support the use of lacosamide XR capsules as a once-daily alternative to lacosamide IR tablets.
Collapse
Affiliation(s)
- James Wheless
- Department of Pediatrics, Division of Pediatric Neurology, University of Tennessee Health Science Center, 49 N Dunlap Ave., 3rd Floor FOB, Memphis, TN 38105, United States; Neuroscience Institute and Le Bonheur Comprehensive Epilepsy Program, Le Bonheur Children's Hospital, 49 N Dunlap Ave, 3rd Floor FOB, Memphis, TN 38105, United States
| | - Barry Gidal
- School of Pharmacy, Pharmacy Practice and Translational Research Division, University of Wisconsin, 777 Highland Ave, Madison, WI 53705, United States
| | - Lixin Gong
- Aucta Pharmaceuticals, 71 Suttons Ln., Piscataway, NJ 08854, United States
| | - Shaoqiong Lyu
- Aucta Pharmaceuticals, 71 Suttons Ln., Piscataway, NJ 08854, United States
| | - Xun Zheng
- Aucta Pharmaceuticals, 71 Suttons Ln., Piscataway, NJ 08854, United States
| | - Rong Li
- Aucta Pharmaceuticals, 71 Suttons Ln., Piscataway, NJ 08854, United States
| | - Wilson Chang
- Aucta Pharmaceuticals, 71 Suttons Ln., Piscataway, NJ 08854, United States
| | - Marie Tan
- Aucta Pharmaceuticals, 71 Suttons Ln., Piscataway, NJ 08854, United States
| |
Collapse
|
3
|
Godara K, Phakey N, Garg D, Sharma S, Das RR. Interventions to Improve Medication Adherence in Children With Epilepsy: A Systematic Review. Cureus 2024; 16:e54680. [PMID: 38523977 PMCID: PMC10960523 DOI: 10.7759/cureus.54680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Low medication adherence remains a major challenge in the treatment of epilepsy, particularly in children. In recent years, several approaches and interventions have been employed to promote medication adherence in children with epilepsy (CWE). In this study, we aimed to summarize the evidence on these interventions. In this systematic review, major medical electronic databases were searched for relevant literature from January 2005 till July 2023, including PsycINFO, Medline (via PubMed), Google Scholar, Taylor & Francis databases, and CENTRAL by the Cochrane Library. We planned to include observational studies (with a control arm) and clinical trials involving children/adolescents (<19 years) with epilepsy and/or their caregivers/families who underwent any intervention to improve adherence to anti-seizure medications. Out of 536 articles searched, eight (six randomized trials and two non-randomized intervention studies) were included in the systematic review. A total of 2,685 children/adolescents along with their caregivers participated in these studies. Six studies used educational and two used behavioral interventions to improve adherence to anti-seizure medications. Four studies showed variable levels of adherence improvement, ranging from 2-20% up to 73.9% post-intervention. To conclude, the findings suggest the potential for educational interventions to promote medication adherence in CWE. The class of evidence was II to III among the included studies, as per American Academy of Neurology guidelines.
Collapse
Affiliation(s)
- Karishma Godara
- Psychology, Jindal School of Psychology & Counselling, O.P. Jindal Global University, Sonipat, IND
| | - Nisha Phakey
- Psychology, Chitkara School of Psychology & Counselling, Chitkara University, Rajpura, IND
| | - Divyani Garg
- Neurology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Suvasini Sharma
- Pediatrics (Neurology Division), Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, IND
| | - Rashmi R Das
- Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| |
Collapse
|
4
|
Siddiqui F, Soomro BA, Badshah M, Rehman EU, Numan A, Ikram A, Khan MWA, Ali S, Hashim H, Salam JU, Akram A, Irfan Hashmat M, Iqbal S, Zeeshan Javed M, Iqbal SZ, Maqsood A, Khan A, Maheshwary N, Khan MA. Efficacy and Safety of Brivaracetam in Persons With Epilepsy in a Real-World Setting: A Prospective, Non-Interventional Study. Cureus 2023; 15:e50313. [PMID: 38205459 PMCID: PMC10777439 DOI: 10.7759/cureus.50313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND AND AIM Epilepsy stands out as one of the most prevalent neurological conditions. Brivaracetam (BRV) is a noteworthy antiseizure medication (ASM) distinguished by its pronounced and selective interaction with the synaptic vesicle protein 2A (SV2A) within the brain. Prior investigations, including regulatory trials, post-marketing assessments, and comparative meta-analyses, have consistently underscored BRV's equivalency in efficacy and superior tolerability when pitted against other antiseizure drugs. This study aimed to evaluate the effectiveness, safety, and acceptability of BRV in treating epileptic patients in the Pakistani population. METHODS This prospective observational study, conducted in Pakistan from February to December 2022, employed a non-probability consecutive sampling technique. This study included 368 adult patients diagnosed with epilepsy, with a focus on those aged 18 and above experiencing focal seizures. Demographic data, clinical history, seizure types, and epilepsy profiles were recorded. Patients were administered BRV (Brivera; manufactured by Helix Pharma Pvt Ltd., Sindh, Pakistan) monotherapy therapy under physician guidance and followed up for three months. The study assessed changes in seizure frequency, side effects, and drug resistance at baseline, 14th day, and 90th day. Safety aspects were monitored, including documenting any adverse effects associated with BRV therapy. RESULTS A total of 368 epileptic patients were included in this study, of which 287 (61.3%) were males and 181 (38.7%) were females. The mean age was 32.91±17.11 years. The mean number of seizures at the baseline visit was 5.74±6.21, at 14 days was 2.89±3.84 and at 90 days was 1.73±5.01 (p<0.001). Overall, a more than 50% reduction in seizure episodes was achieved in 178 (56.3%) patients at day 90, and less than 50% reduction in seizure episodes was achieved by 95 (26.8%) patients on Day 14, with a highly significant association between them (p<0.001). Among 316 patients, only 41 (4.4%) of all BRV-treated patients experienced adverse events; Of these 41 patients, 17 (41.7%) reported dizziness and 14(34.2%) reported behavioral issues. CONCLUSIONS Epileptic patients receiving BRV demonstrated a substantial reduction of greater than 50% seizure episodes at the end of follow-up visits. Moreover, BRV exhibited fewer adverse effects in individuals with epilepsy.
Collapse
Affiliation(s)
- Fowzia Siddiqui
- Neurology, The Aga Khan University Hospital (AKUH), Karachi, PAK
| | | | - Mazhar Badshah
- Neurology, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | - Ehsan U Rehman
- Neurology, Akhtar Saeed Medical and Dental College, Islamabad, PAK
| | - Ahsan Numan
- Neurology, Mayo Hospital, King Edward Medical University, Lahore, PAK
| | - Amer Ikram
- Neurology, Doctors Hospital Lahore, Lahore, PAK
| | | | - Sajjad Ali
- Neurology, Dar ul Shifa Hospital Sialkot, Sialkot, PAK
| | | | - Jawwad-Us Salam
- Medicine/Neurology, Dow International Medical College, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Shahid Iqbal
- Neurology, Rehman Medical Institute, Peshawar, PAK
| | | | - S Zafar Iqbal
- Neurology, Tahsil Head Quarter (TQH) Hospital Sadiqabad, Sadiqabad, PAK
| | - Atif Maqsood
- Neurology, Aziz Fatima Hospital, Faisalabad, PAK
| | | | | | | |
Collapse
|
5
|
Nasir M, Abebaw E, Ahmed M, Ketema DB. Clinical Characteristics, Treatment Outcome and Associated Factors of Epilepsy Among Children at Hospitals of North-West Ethiopia. Pediatric Health Med Ther 2023; 14:385-404. [PMID: 37927397 PMCID: PMC10625381 DOI: 10.2147/phmt.s436022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023] Open
Abstract
Background Epilepsy is an important cause of neurological morbidity in children and adolescents. Clinical parameters are the main diagnostic tools, especially in developing countries. Although cost-effective treatments for epilepsy are available, studies have shown that uncontrolled seizures can occur in many patients. Objective To assess clinical characteristics, treatment outcomes, and associated factors for controlled epilepsy among children with epilepsy who underwent follow-up at the Debre Markos Comprehensive Specialized Hospital, North-west Ethiopia from October 28, 2020, to April 28, 2021. Methods An institutional-based retrospective cohort study was conducted from October 28, 2020, to April 28, 2021. A total of 385 participants who fulfilled the inclusion criteria were included in the study. A pretested, structured, interviewer-administered questionnaire with a chart review was used to collect data. The data were entered into the Epi-data software version 4.4.2.1 and then exported to the Stata version 14 statistical package for analysis. Descriptive statistics were used to describe the sociodemographic and clinical characteristics, treatment profiles, and treatment outcomes of patients with epilepsy. Bivariate and multivariate analyses were used to identify factors associated with treatment outcomes. Results The most frequent type of seizure among the 385 respondents was Generalized-tonic-clonic seizures (88.1%). The proximate cause of seizures was identified in 15% of patients, of whom 45 had a perinatal history (8.8%), head injury (3.6%), and CNS infection (2.3%). One-third of patients had poor seizure control. Caregiver relationship (father AOR=0.58; 95th CI:0.35,0.97) and poor adherence (AOR=2.97; 95th CI:1.82, 4.86) were significantly associated with treatment outcome. Conclusion One-third of children with epilepsy have poor seizure control. Poor adherence to treatment is implicated in poor control. Counseling caregivers on proper treatment and adherence to anti-epileptic medication is recommended to improve treatment outcome in children.
Collapse
Affiliation(s)
- Mohammed Nasir
- Pediatrics Department, Hawassa University, Hawassa, Ethiopia
| | - Ermias Abebaw
- Pediatrics Department, ALERT Comprehensive Specialized Hospital, Addis Ababa, Ethiopia
| | - Muluken Ahmed
- Pediatrics Department, Arba Minch University, Arba Minch, Ethiopia
| | | |
Collapse
|
6
|
Tanveer M, Tahir AH, Iqbal M, Aslam F, Ahmed A. Health-related quality of life and medication adherence of people living with epilepsy in Pakistan: A cross-sectional study. Brain Behav 2023; 13:e3127. [PMID: 37515419 PMCID: PMC10498081 DOI: 10.1002/brb3.3127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/05/2023] [Accepted: 06/06/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The primary purpose of this study was to determine adherence and health-related quality of life (HRQoL) in PWE. Secondary aims were to assess association between adherence and HRQoL and determine predictors of HRQoL in PWE in Pakistan. METHODS A descriptive cross-sectional study was conducted among PWE receiving treatment from two tertiary care hospitals of Pakistan. The HRQoL and adherence were assessed with Urdu versions of Quality of Life in Epilepsy-31 (QOLIE-31), and Medication Adherence Rating Scale (MARS). Relationship between HRQoL and adherence was assessed by Pearson's product-moment correlation coefficient. Forced entry multiple linear models were used to determine relationship of independent variables with HRQoL. RESULTS 219 PWE with a mean (±standard deviation) age, 34.18 (± 13.710) years, participated in this study. The overall weighted mean HRQoL score was (51.60 ± 17.10), and mean score for adherence was 6.17 (± 2.31). There was significant association between adherence and HRQoL in PWE (Pearson's correlation = 0.820-0.930; p ≤ .0001). Multiple linear regression found adherence (B = 16.8; p ≤ .0001), male gender (B = 10.0; p = .001), employment status (employed: B = 7.50; p = .030), level of education (Tertiary: B = 0.910; p = .010), duration of epilepsy (>10 years: B = -0.700; p ≤ .0001), and age (≥46 years: B = -0.680; p ≤ .0001), and ASM therapy (polypharmacy: B = 0.430; p = .010) as independent predictors of HRQoL in PWE from Pakistan. CONCLUSIONS The findings suggest PWE from our center have suboptimal adherence which affects HRQoL. Independent factors such as male gender, employment status and duration of epilepsy are predictors of HRQoL.
Collapse
Affiliation(s)
- Maria Tanveer
- Department of PharmacyQuaid‐I‐Azam UniversityIslamabadPakistan
| | - Azhar Hussain Tahir
- Department of PharmacyQuaid‐I‐Azam UniversityIslamabadPakistan
- Primary and Secondary Healthcare DepartmentGovernment of PunjabLahorePakistan
| | - Mansoor Iqbal
- Neurology DepartmentPakistan Institute of Medical Sciences (PIMS)IslamabadPakistan
| | - Faiza Aslam
- Department of PsychiatryRawalpindi Medical UniversityRawalpindiPakistan
| | - Ali Ahmed
- Department of PharmacyQuaid‐I‐Azam UniversityIslamabadPakistan
- Riphah Institute of Pharmaceutical SciencesRiphah International UniversityIslamabadPakistan
- Monash University Health Economics Group (MUHEG)School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| |
Collapse
|
7
|
Solomon Y, Teshome Y, Ejigu S, Bezabih M. Prevalence of anti-seizure medication nonadherence and its associated factors, among people with epilepsy in North Shewa, Ethiopia, 2021. Epilepsy Behav 2023; 145:109301. [PMID: 37336134 DOI: 10.1016/j.yebeh.2023.109301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Epilepsy is a worldwide neurologic illness, characterized by recurrent unprovoked epileptic seizures and can affect people of all age groups. Patients who are receiving drug therapy for chronic diseases, such as epilepsy, must fit complex medication regimens into their everyday routines. Managing medication schedules may pose a significant burden on patients' lives. Anti-seizure medication choices should therefore be tailored to patients' factors that may limit medication use. The study aimed to determine the prevalence and Predictors of anti-seizure medication nonadherence among patients with epilepsy. METHODOLOGY An institutional-based cross-sectional study was conducted among 352 people with epilepsy who were selected by systematic random sampling method at government hospitals in North Shewa Ethiopia. Data were collected by reviewing patients' charts and interviewing people with epilepsy by using structured and pretested questionnaires. Data obtained were encoded into EPI-INFO software and exported to SPSS version 25 for analysis. Logistic regression was employed to assess independent factors associated with medication non-adherence. RESULT The prevalence of anti-seizure medication non-adherence was 40%. Being female [AOR = 3.37, 95%, CI: 1.84, 6.18], Divorced [AOR = 9.13, 95%, CI: 1.80, 46.34], Being jobless [AOR = 7.33, 95%, CI: 3.24, 16.56], Perceived poor social support [AOR = 2.73, 95%, CI: 1.28, 5.82], perceived stigma [AOR = 5.07, 95%, CI: 2.40, 10.68], polytherapy [AOR = 2.23, 95%, CI: 1.06, 4.71], drug side effects[AOR = 6.03, 95%, CI: 3.17, 11.45], buying medications [AOR = 5.81, 95%, CI: 3.63,16.79] and duration of stay on treatment [AOR = 4.31, 95%, CI: 1.863, 9.97] were significant predictors of anti-seizure medication non-adherence. CONCLUSION Non-adherence to anti-seizure medication among people with epilepsy in the study area was relatively higher as compared with study reports from different parts of the country. Health and clinical, socio-economy, and patients' psychological mindset were among the determinant factors affecting the consistency of epilepsy treatment adherence. Enhanced professional, health education for patients as well as for society and financial support, are basic pillars to reduce the constraints of effective treatment.
Collapse
Affiliation(s)
- Yerukneh Solomon
- Department of Biomedical Sciences, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia.
| | - Yonas Teshome
- Department of Biomedical Sciences, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Solomon Ejigu
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Mihret Bezabih
- Department of Public Health, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
| |
Collapse
|
8
|
Pitton Rissardo J, Fornari Caprara AL, Casares M, Skinner HJ, Hamid U. Antiseizure Medication-Induced Alopecia: A Literature Review. MEDICINES (BASEL, SWITZERLAND) 2023; 10:35. [PMID: 37367730 DOI: 10.3390/medicines10060035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
Background: Adverse effects of antiseizure medications (ASMs) remain one of the major causes of non-adherence. Cosmetic side effects (CSEs) are among the most commonly reported side effects of ASMs. In this context, alopecia is one of the CSEs that has a high intolerance rate leading to poor therapeutical compliance. Methods: We performed a literature review concerning alopecia as a secondary effect of ASMs. Results: There are 1656 individuals reported with ASM-induced alopecia. Valproate (983), lamotrigine (355), and carbamazepine (225) have been extensively reported. Other ASMs associated with alopecia were cenobamate (18), levetiracetam (14), topiramate (13), lacosamide (7), vigabatrin (6), phenobarbital (5), gabapentin (5), phenytoin (4), pregabalin (4), eslicarbazepine (3), brivaracetam (2), clobazam (2), perampanel (2), trimethadione (2), rufinamide (2), zonisamide (2), primidone (1), and tiagabine (1). There were no reports of oxcarbazepine and felbamate with drug-induced alopecia. Hair loss seen with ASMs was diffuse and non-scarring. Telogen effluvium was the most common cause of alopecia. A characteristic feature was the reversibility of alopecia after ASM dose adjustment. Conclusions: Alopecia should be considered one important adverse effect of ASMs. Patients reporting hair loss with ASM therapy should be further investigated, and specialist consultation is recommended.
Collapse
Affiliation(s)
- Jamir Pitton Rissardo
- Medicine Department, Federal University of Santa Maria, Santa Maria 97105-900, Brazil
| | | | - Maritsa Casares
- AdventHealth Orlando Neuroscience Institute, 615 E Princeton Street, Suite 540, Orlando, FL 32803, USA
| | - Holly J Skinner
- AdventHealth Epilepsy at Orlando, 615 E Princeton Street, Suite 540, Orlando, FL 32803, USA
| | - Umair Hamid
- Department of Neurology, College of Medicine, University of Illinois, Peoria, IL 61605, USA
| |
Collapse
|
9
|
Bayane YB, Senbeta BS. Pattern of anti-epileptic medications nonadherence and associated factors at ambulatory clinic of Jimma Medical Center, Southwestern Ethiopia: A prospective observational study. SAGE Open Med 2023; 11:20503121231160817. [PMID: 36969722 PMCID: PMC10031813 DOI: 10.1177/20503121231160817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/13/2023] [Indexed: 03/19/2023] Open
Abstract
Objective: This study is designed to assess the pattern of nonadherence, and associated factors among ambulatory patients with epilepsy at Jimma Medical Center, Southwestern Ethiopia, from November 2020 to April 2021. Methods: A hospital-based prospective observational study was employed. A consecutive sampling method was used to recruit study participants. Nonadherence was assessed by the Hill–Bone compliance to the high blood pressure therapy scale. A threshold of 18 scores was used to classify adherence status. Epi-Data manager version 4.6 was used for data entry and all statistical analysis was performed by Statistical Package for Social Science 25.0. Multivariable logistic regression was performed to explore associated factors. Results: A survey included 334 patients with epilepsy. One hundred twenty-two (36.52%) of the study participants were found to be non-adherent. The factors associated with nonadherence were poor involvement of the patient in the therapeutic decision (adjusted odds ratio = 1.74; 95% confidence interval: 1.04–2.90; p = 0.034), per month income of lesser than1000 Ethiopian birr (adjusted odds ratio = 2.66; 95% confidence interval: 1.03–6.84; p = 0.042), recent seizure episodes (adjusted odds ratio = 1.97; 95% confidence interval: 1.20–3.23; p = 0.007), adverse drug reaction (AOR = 2.13; 95% confidence interval: 1.31–3.47; p = 0.002), and negative medication belief (adjusted odds ratio = 1.28; 95% confidence interval: 1.53–2.25; p = 0.043). Conclusions: In our setting, the magnitude of nonadherence was substantially high. Hence, providing regular health-related information about the disease and treatment, supplying free antiepileptic drugs, routine assessment of adverse drug reactions, and a multidisciplinary approach involving patients may improve adherence.
Collapse
Affiliation(s)
- Yadeta Babu Bayane
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
| | | |
Collapse
|
10
|
Sheikh Hassan M, Sidow NO, Ali Adam B, GÖKGÜL A, Hassan Ahmed F, Ali IH. Epidemiology and Risk Factors of Convulsive Status Epilepticus Patients Admitted in the Emergency Department of Tertiary Hospital in Mogadishu, Somalia. Int J Gen Med 2022; 15:8567-8575. [PMID: 36540763 PMCID: PMC9760042 DOI: 10.2147/ijgm.s391090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 12/09/2022] [Indexed: 08/30/2023] Open
Abstract
INTRODUCTION Status epilepticus (SE) is one of the most common neurologic emergencies and is associated with significant morbidity and mortality. The underlying cause of SE varies between patients with epilepsy and those presenting without. The aim of this study was to evaluate the epidemiology, risk factors and outcomes of patients presenting with convulsive SE in the emergency department (ED) of a tertiary hospital in Mogadishu. METHODS This was a cross-sectional study conducted between July 2021 and June 2022. The study included both patients with epilepsy and those without epilepsy presenting to the ED with SE. Risk factors and underlying etiologies were evaluated in the patients in both the pediatric group (0-18 years) and adult group (18 years and above). Clinical history, neurologic examinations, neuroimaging, electroencephalography findings, and laboratory investigations were all evaluated. RESULTS The mean age for pediatric patients was 6 (SD±4.7), while the mean age for adult patients was 38 (SD±10.4). About 33 (36%) of the subjects had previous history of epilepsy, while 59 (64%) presented to the ED with their first seizure. About 80 (87%) had generalized seizure while 12 (13%) had focal seizure. Poor antiepileptic compliance was the most common risk factor for SE 20 (21.7%), followed by CNS infections 14 (15%), and prolonged febrile seizures 7 (7.6%). Poor antiepileptic drug compliance, cerebrovascular disorders, electrolyte imbalance, metabolic conditions, and drug abuse were the most common underlying etiologies of SE in patients older than 18 years. Prolonged febrile seizure, meningitis, encephalitis, systemic infections, and structural brain abnormalities were the most common underlying etiologies of SE in patients younger than 18 years. CONCLUSION CNS infections, CVDs, metabolic disturbances, electrolyte imbalances, and systemic infections are major etiological risk factors of SE in patients without prior history of epilepsy. Medication adherence was the major etiological risk factor for SE identified in patients with epilepsy.
Collapse
Affiliation(s)
- Mohamed Sheikh Hassan
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Nor Osman Sidow
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Bakar Ali Adam
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Alper GÖKGÜL
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Fardowsa Hassan Ahmed
- Department of Pediatrics, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ibrahim Hussein Ali
- Department of Emergency Medicine, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| |
Collapse
|
11
|
Methaneethorn J. The effect of nonadherence on phenobarbital concentrations and recommendations on the replacement dose using Monte Carlo simulation. Drug Metab Pers Ther 2022; 37:337-346. [PMID: 36476276 DOI: 10.1515/dmpt-2022-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/25/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the impacts of missed phenobarbital (PB) doses on its pharmacokinetics and to investigate the appropriate replacement dosing scheme for various PB missed dose scenarios. METHODS Monte Carlo simulations were performed using parameters from the selected population pharmacokinetic study. The impacts of missed PB dose and the proper replacement dosing scheme were assessed based on the percent deviation of simulated concentrations outside the reference range from the full adherence scenario. RESULTS The impact of missed PB dose on its concentrations depended on the daily dose. The replacement with a respective regular dose and one and a half regular dose was appropriate for the one and two missed doses scenarios for patients receiving PB monotherapy. For patients receiving PB with valproic acid or phenytoin, the same replacement scheme was still appropriate. The results also indicated that weight did not influence the proper replacement dosing scheme. CONCLUSIONS The impacts of missed PB doses on its pharmacokinetics were identified and the proper replacement dosing schemes for different missed dose scenarios were proposed. These schemes should be implemented based on the clinician's justification of the patient's seizure control.
Collapse
Affiliation(s)
- Janthima Methaneethorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Center of Excellence for Environmental Health and Toxicology, Naresuan University, Phitsanulok, Thailand
| |
Collapse
|
12
|
Shumet S, Wondie M, Ayano G, Asfaw H, Kassew T, Mesafint G. Antiepileptic Drug Adherence and Its Associated Factors among Epilepsy Patients on Follow-ups at Amanuel Mental Specialized Hospital, Ethiopia. Ethiop J Health Sci 2022; 32:913-922. [PMID: 36262706 PMCID: PMC9554767 DOI: 10.4314/ejhs.v32i5.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Medication adherence is a fundamental determinant of effective treatment. However, people with epilepsy have poor compliance with their treatment because of the chronic nature of the disease. Limited studies have been conducted to address antiepileptic medication adherence in Africa, including Ethiopia. Thus, the aim of this study was to assess antiepileptic drug adherence and its asociated factors among patients with epilepsy attending outpatient department of Amanuel Mental Specialized Hospital. METHODS A cross-sectional study design was conducted on 439 patients with epilepsy in Amanuel Mental Specialized Hospital. Medication adherence reporting scale-5 (MARS-5) was used to assess adherence to antiepileptic drugs. The Oslo social support, Jacob perceived stigma scale, and hospital anxiety and depression scale (HADS) were the instruments used to assess associated factors. Simple and multiple linear regression analysis models were fitted. Then, the adjusted unstandardized beta (β) coefficient at a 95% confidence level was used. RESULTS The mean(SD) score of antiepileptic medication adherence was 16.38(±3.76) with 95%CI:(16.03, 16.72). Depressive symptoms (β= -1.35, 95% CI: (-2.04, -0.65)), anxiety symptoms (β=-1.12,95%CI:(-1,79,-0.44), perceived stigma (β= -1.64, 95% CI:-2.16,-1.12), being single (β=-0.67, 95%CI:-1.20,-0.14), presence of seizure per month(β=-2.11,95% CI: (-2.81,-1.41) and antiepileptic drug adverse effect(β=-0.07,95%CI:-0.11,-0.03) were factors associated with anti-epileptic medication adherence. CONCLUSIONS The results suggest that the mean score of adherence to antiepileptic drugs was poor as compared to other settings. Antiepileptic medication adherence screening tool should be included in the patient's treatment protocol.
Collapse
Affiliation(s)
- Shegaye Shumet
- Department of psychiatry, University of Gondar, Gondar, Ethiopia
| | - Mesele Wondie
- Department of psychiatry, University of Gondar, Gondar, Ethiopia
| | - Getinet Ayano
- Amanuel Mental Specialized Hospital, Addis Abeba, Ethiopia
| | - Henock Asfaw
- School of nursing and midwifery, college of health and medical science, Haramaya University
| | - Tilahun Kassew
- Department of psychiatry, University of Gondar, Gondar, Ethiopia
| | - Gebremeskel Mesafint
- Department of Psychiatry, College of health science, Mizan-Tapi University, Mizan-Aman, Ethiopia
| |
Collapse
|
13
|
Mendorf S, Prell T, Schönenberg A. Detecting Reasons for Nonadherence to Medication in Adults with Epilepsy: A Review of Self-Report Measures and Key Predictors. J Clin Med 2022; 11:jcm11154308. [PMID: 35893399 PMCID: PMC9331129 DOI: 10.3390/jcm11154308] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
This review presents individual reasons for self-reported nonadherence in people with epilepsy (PWE). A literature search was performed on the PubMed/Medline and Scopus databases for studies published up to March 2022. Thirty-six studies were included using the following inclusion criteria: original studies on adults with epilepsy, use of subjective self-report adherence measurement methods, and publication in English. Data were extracted using a standardized data extraction table, including the year of publication, authors, cohort size, study design, adherence measurement method, and self-reported reasons for nonadherence. Self-reported reasons for nonadherence were grouped following the WHO model with the five dimensions of nonadherence. In addition, study characteristics and sociodemographic information are reported. Of the 36 included studies, 81% were observational. The average nonadherence rate was nearly 50%. Across all studies, patient-associated, therapy-associated, and circumstance-related factors were the most frequently reported dimensions of nonadherence. These factors include forgetfulness, presence of side-effects, and history of seizures. Regarding healthcare system factors, financial problems were the most reported reason for nonadherence. Stigmatization and quality of life were the most frequently cited factors influencing nonadherence in the disease- and circumstance-related dimensions. The results suggest that interventions for improving adherence should incorporate all dimensions of nonadherence.
Collapse
Affiliation(s)
- Sarah Mendorf
- Department of Neurology, University Hospital Jena, 07747 Jena, Germany
- Correspondence: ; Tel.: +49-3641-9323511
| | - Tino Prell
- Department of Geriatrics, University Hospital Halle, 06120 Halle, Germany; (T.P.); (A.S.)
| | - Aline Schönenberg
- Department of Geriatrics, University Hospital Halle, 06120 Halle, Germany; (T.P.); (A.S.)
| |
Collapse
|
14
|
Effect of Nonadherence on Levetiracetam Pharmacokinetics and Remedial Dose Recommendations Using Monte Carlo Simulations. Eur J Drug Metab Pharmacokinet 2022; 47:667-676. [PMID: 35761145 DOI: 10.1007/s13318-022-00774-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE Nonadherence to levetiracetam (LEV) use can result in subtherapeutic concentrations and increase the risk of the occurrence of seizures. The impact of missing LEV doses on its pharmacokinetics and evidence of the appropriate remedial dose is lacking. This study has determined the influence of missed LEV doses on its pharmacokinetics and has explored the appropriate remedial dosage regimens. METHODS Monte Carlo simulation was used to assess the impacts of different remedial dosage regimens on LEV concentrations. Simulated LEV concentrations outside the individual therapeutic range were calculated for the compliance scenario and for each of the remedial dosage regimens. The percentage of deviation from the full compliance scenario was also calculated. The regimen with the lowest percentage of deviation was considered the most appropriate. RESULTS The suitable LEV remedial dose varied across the delay times. For one missed dose, a remedial regimen with a regular dose followed by the usual dose was suitable for a delay time of less than 6 h, while a replacement with a regular dose followed by a partial dose appeared to be appropriate for a delay time of 6 h and longer. This was justified based on the concerns of LEV toxicity when the remedial dose is close to the next scheduled dose. For two consecutive missed doses, a remedial dose with one and a half of the regular dose was suitable if the gap between that and the next dose was greater than 6 h. CONCLUSIONS The appropriate remedial dosage regimen for one and two consecutive missed doses of LEV have been proposed. These remedial regimens, however, should be applied with clinicians' judgment based on the clinical status of the patients.
Collapse
|
15
|
Methaneethorn J. The effect of nonadherence on phenobarbital concentrations and recommendations on the replacement dose using Monte Carlo simulation. Drug Metab Pers Ther 2022; 0:dmdi-2022-0104. [PMID: 35708353 DOI: 10.1515/dmdi-2022-0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To determine the impacts of missed phenobarbital (PB) doses on its pharmacokinetics and to investigate the appropriate replacement dosing scheme for various PB missed dose scenarios. METHODS Monte Carlo simulations were performed using parameters from the selected population pharmacokinetic study. The impacts of missed PB dose and the proper replacement dosing scheme were assessed based on the percent deviation of simulated concentrations outside the reference range from the full adherence scenario. RESULTS The impact of missed PB dose on its concentrations depended on the daily dose. The replacement with a respective regular dose and one and a half regular dose was appropriate for the one and two missed doses scenarios for patients receiving PB monotherapy. For patients receiving PB with valproic acid or phenytoin, the same replacement scheme was still appropriate. The results also indicated that weight did not influence the proper replacement dosing scheme. CONCLUSIONS The impacts of missed PB doses on its pharmacokinetics were identified and the proper replacement dosing schemes for different missed dose scenarios were proposed. These schemes should be implemented based on the clinician's justification of the patient's seizure control.
Collapse
Affiliation(s)
- Janthima Methaneethorn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- Center of Excellence for Environmental Health and Toxicology, Naresuan University, Phitsanulok, Thailand
| |
Collapse
|
16
|
Abstract
Drug-resistant epilepsy is associated with poor health outcomes and increased economic burden. In the last three decades, various new antiseizure medications have been developed, but the proportion of people with drug-resistant epilepsy remains relatively unchanged. Developing strategies to address drug-resistant epilepsy is essential. Here, we define drug-resistant epilepsy and emphasize its relationship to the conceptualization of epilepsy as a symptom complex, delineate clinical risk factors, and characterize mechanisms based on current knowledge. We address the importance of ruling out pseudoresistance and consider the impact of nonadherence on determining whether an individual has drug-resistant epilepsy. We then review the principles of epilepsy drug therapy and briefly touch upon newly approved and experimental antiseizure medications.
Collapse
|
17
|
Kumar S, Singh MB, Kumar A, Padma Srivastava MV, Goyal V. Medication Adherence in Indian Epilepsy Patients. Ann Indian Acad Neurol 2021; 24:501-505. [PMID: 34728941 PMCID: PMC8513971 DOI: 10.4103/aian.aian_925_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 08/30/2020] [Accepted: 11/18/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose: While two-thirds of epilepsy patients can become seizure free on medical treatment, poor adherence to medication is a major problem to sustained remission and functional restoration. The aim of this study was to assess the prevalence and associated factors of antiepileptic drug (AED) non-adherence. Methods: We conducted a subgroup analysis based on results that emerged from a single center, cross-sectional study. Patients who were 18 years or older were included. The 4-item Morisky Medication Adherence Scale was used to measure adherence to AED (s). Multivariable logistic regression analysis was used to predict factors associated with AED non-adherence. Results: A total of 268 patients fulfilled inclusion criteria and were included in this subgroup analysis. Among the participants, 81 (30%) were non-adherent to medication. Three factors associated with non-adherence were AED polytherapy [OR: 4.5 (2.1-9.5) P = 0.001], drug related adverse events [OR: 3.9 (2.1-7.3) P = 0.001], and treatment duration exceeding 3 years [OR: 2.6 (1.3-5.0) P = 0.003]. Conclusion: About one-third patients were not compliant with their medication. If the treatment of patients is restricted to monotherapy as far as possible and patients are educated about duration of treatment and possible adverse effects of AEDs, non-adherence may be reduced.
Collapse
Affiliation(s)
- Shrawan Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
18
|
Dayapoğlu N, Turan GB, Özer Z. Evaluation of medication adherence and medication beliefs among patients with epilepsy. Epilepsy Behav 2021; 124:108366. [PMID: 34757264 DOI: 10.1016/j.yebeh.2021.108366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 01/05/2023]
Abstract
AIM This study explored medication adherence and medication beliefs of patients with epilepsy and evaluated the relationship between these two factors. METHODS This descriptive, cross-sectional, correlational study was conducted with 174 patients with epilepsy who were referred to the neurology outpatient clinic of a university hospital in Erzurum, Turkey, between February 10, 2020 and December 30, 2020. The data were collected using the Descriptive Information Form, The eight-item Morisky Medication Adherence Scale (MMAS-8), and the Beliefs about Medicines Questionnaire (BMQ-T). RESULTS The mean age of the patients was 33.06 ± 11.94 years, and the mean duration of time since diagnosis was 12.91 ± 10.73 years. In terms of demographic information, 60.3% of the patients were single, 58% had low income or were unemployed, 53.4% had five or more seizures within the last year, 40.8% had focal onset seizures, 69% had no other chronic disease, and 76.4% used more than one medicine. The patients' mean MMAS-8 score was 3.25 ± 2.13. The mean scores for the specific concern subscale was 3.65 ± 0.85, 1.81 ± 0.75 for the specific necessity subscale, 4.19 ± 0.76 for the general overuse subscale, and 3.14 ± 1.41 for the general harm subscale. The regression analysis revealed that general overuse and general harm negatively affected the MMAS-8 total score. CONCLUSION Patients with epilepsy reported low medication adherence and were found to have concerns about the harms and side effects of the medicines they were using; they had negative perceptions of the purpose of medicines; they had high beliefs about the harms of medicines; and they had low beliefs about their personal treatment needs. The patients were generally found to have negative beliefs about medicines, which negatively affected their medication adherence.
Collapse
Affiliation(s)
| | | | - Zülfünaz Özer
- Department of Nursing, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
| |
Collapse
|
19
|
Booth S, Meller S, Packer RM, Farquhar R, Maddison JE, Volk HA. Owner compliance in canine epilepsy. Vet Rec 2021; 188:e16. [PMID: 34651709 DOI: 10.1002/vetr.16] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/15/2020] [Accepted: 10/30/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Poor medication compliance by human epilepsy patients is one of the leading causes of treatment failure and increased seizure frequency. The aim of this cross-sectional study was to analyse owner compliance in pharmacological treatment of canine idiopathic epilepsy and to identify factors associated with poor compliance. METHODS The number of antiseizure drug tablets was recorded to determine if the patient received sufficient tablets to cover the time period between prescriptions and to assess compliant prescription cycles. Additionally, compliance was assessed by an online survey of owners. RESULTS For the prescription monitoring data from 94 cases from three small animal practices in the United Kingdom revealed an overall median compliance of 56%. Thirt-three per cent of owners were >80% compliant, while 21% were 100% compliant. During a non-compliant prescription cycle, a patient missed a median of 6 days (0.11-519 days) of treatment. Patients on polytherapy had higher compliance rates than on monotherapy (p = 0.031). The survey (229 respondents from online canine epilepsy groups) showed that low daily dosing was associated with better compliance (p = 0.049). CONCLUSION Owner compliance was subpar in this study and could represent a significant issue in epilepsy management, which needs to be considered by veterinary surgeons when treating canine epilepsy.
Collapse
Affiliation(s)
- Samantha Booth
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Sebastian Meller
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Rowena Ma Packer
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | | | - Jill E Maddison
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK
| | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, UK.,Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| |
Collapse
|
20
|
von Gaudecker JR, Buelow JM, Miller WR, Tanner AL, Austin JK. Social determinants of health associated with epilepsy treatment adherence in the United States: A scoping review. Epilepsy Behav 2021; 124:108328. [PMID: 34628091 DOI: 10.1016/j.yebeh.2021.108328] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this paper is to share the results of a scoping review in which we examined the social determinants of health (SDoH) that are associated with anti-seizure medication (ASM) treatment adherence among people living with epilepsy in the United States. METHODS Our review was informed by the methods of Arksey and O'Malley for a scoping review. A total of 3,826 articles were identified for reference through a literature search, of which 17 publications were deemed relevant to our scoping review. The final articles were mapped using the Epilepsy SDoH Conceptual Framework to identify gaps. FINDINGS Our review suggests that there are multidimensional associations of SDoH in ASM adherence. The SDoH were interrelated. Race/ethnicity and socioeconomic status appeared to have major associations with ASM adherence. Several gaps in the literature were identified, including inadequately exploring the effect that each SDoH has on treatment adherence, and the methods used for assessment. CONCLUSIONS Future longitudinal research to address the identified gaps would foster interventions that promote ASM adherence among vulnerable populations living with epilepsy.
Collapse
Affiliation(s)
| | | | - Wendy R Miller
- Indiana University, 600 Barnhill Drive, Indianapolis, USA
| | | | - Joan K Austin
- Indiana University, 600 Barnhill Drive, Indianapolis, USA
| |
Collapse
|
21
|
Eslami V, Kimberley Molina D, Ákos Szabó C. Definite SUDEP population in Bexar County, Texas: A 36-year data registry. Epilepsy Behav 2021; 121:108005. [PMID: 34052632 DOI: 10.1016/j.yebeh.2021.108005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Sudden unexplained death in epilepsy (SUDEP) is one of the leading causes of mortality in epilepsy. In this study, cases of definite SUDEP are reported for Bexar County from a 36-year period. METHODS Death reports by Bexar County Medical Examiner (BCME) from 1983 to 2018 were reviewed to identify cases with definite SUDEP. The findings were based upon investigators' reports, which included medical history, medication list, sleep position, time of death, and pathology reports. In addition to these potential risk factors, body mass indices (BMI), as well as heart, lung, and brain weights were compared between SUDEP victims with therapeutic vs subtherapeutic anti-seizure medication (ASM) levels. RESULTS Definite SUDEP was identified in 286 cases. The incidence of definite SUDEP was 0.51 ± 0.26/1000 person-years among PWE and 0.56 ± 0.29 per 100,000 person-years among the general population in Bexar County. The median age was 37 years old (interquartile range 27-48), and the majority were male (65%). While 171 (60%) people were prescribed at least one ASM, ASM levels were subtherapeutic in 239 cases (83.6%). Risk factors for SUDEP did not differ between SUDEP victims with therapeutic vs subtherapeutic ASM levels. While BMIs were only slightly increased in adherent vs nonadherent SUDEP victims, they were significantly associated with subtherapeutic ASM levels. Abnormal lung, heart, and brain weights were reported in 48 (16.8%), 67 (23.4%), and 43 (15.0%) SUDEP cases, respectively. SIGNIFICANCE This study is one of the largest autopsy-based registries of definite SUDEP. Subtherapeutic ASM levels measured in post-mortem blood samples suggest that nonadherence to ASM therapy was a leading risk factor for SUDEP. As BMI was elevated in this cohort, and obesity was significantly associated with subtherapeutic ASM levels, it may also be a risk factor for SUDEP. Case-controlled studies are needed to validate the specific role of obesity and related comorbidities in this population.
Collapse
Affiliation(s)
- Vahid Eslami
- Department of Neurology, University of Health Science Center at San Antonio, TX, United States
| | - D Kimberley Molina
- Bexar County's Medical Examiner's Office, San Antonio, TX, United States
| | - Charles Ákos Szabó
- Department of Neurology, University of Health Science Center at San Antonio, TX, United States; South Texas Comprehensive Epilepsy Center, San Antonio, TX, United States.
| |
Collapse
|
22
|
Abebaw N, Girma N, Yasin M. Non-Adherence to Anti-Epileptic Drugs and Associated Factors among Epileptic Patients in Dessie Town Public Hospitals, Northeast Ethiopia. J Epilepsy Res 2021; 11:39-48. [PMID: 34395222 PMCID: PMC8357546 DOI: 10.14581/jer.21006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Patients who are non-adherent to their medication are frequently hospitalized with prolonged lengths of stay and make repeated emergency department visits. They are also more likely to miss work or school due to the seizure effects. In Ethiopia, although there is little evidence concerning anti-epileptic drug adherence, some studies were conducted with some controversy with studies done in another country. This study was therefore conducted to assess non-adherence to antiepileptic drugs and associated factors among adult epileptic patients attending in Dessie town public hospitals, northeast Ethiopia. Methods Hospital-based cross-sectional study design was employed on 368 patients from January 16, 2018 to March 16, 2018. A systematic random sampling technique was employed to recruit study participants. The collected data were entered into EpiData 3.1 and exported to SPSS version 22.0 for analysis. All covariates that were significant at p-value <0.25 in the bivariate logistic regression analysis were considered for further multivariable logistic regression analysis level of statistical significance at p-value <0.05. Results Among the respondents, 37.5% (95% confidence interval [CI], 32.1–42.9) of them were non-adhered to antiepileptic drugs. Patients who were unable to write and read (adjusted odds ratio [aOR], 22.30; 95% CI, 5.84–85.21), primary education level (aOR, 5.63; 95% CI, 1.90–16.69), being male (aOR, 2.37; 95% CI, 1.33–4.23), experience adverse effect (aOR, 13.68; 95% CI, 3.27–56.97), patients got medication by payment (aOR, 2.06; 95% CI, 1.04–4.11) were statistically associated with non-adherence. Conclusions This study revealed that over one-third of participants were non-adherent to antiepileptic drugs. Sex, educational level, adverse effect, and medication source were independent factors for non-adherence to antiepileptic drugs. Therefore, educations and instructions about the importance of recommended drug use can improve antiepileptic drug adherence in patients with epilepsy.
Collapse
Affiliation(s)
- Nigusie Abebaw
- Department of Midwifery, Samara University School of Medical and Health Sciences, Samara, Ethiopia
| | - Natnaiel Girma
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Miftah Yasin
- Department of Midwifery, Samara University School of Medical and Health Sciences, Samara, Ethiopia
| |
Collapse
|
23
|
Mirpuri P, Chandra PP, Samala R, Agarwal M, Doddamani R, Kaur K, Ramanujan B, Chandra PS, Tripathi M. The development and efficacy of a mobile phone application to improve medication adherence for persons with epilepsy in limited resource settings: A preliminary study. Epilepsy Behav 2021; 116:107794. [PMID: 33578224 DOI: 10.1016/j.yebeh.2021.107794] [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: 10/14/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Persons with epilepsy (PWE), especially those with limited education backgrounds from developing countries, are challenged by complicated medication regimens, debilitating seizures, and stigmatization in their daily life. Consequently, it is difficult for physicians to ensure medication adherence. This study validates a novel mobile application which was hypothesized to increase medication adherence and self-management skills in PWE. Created by medical professionals, the application included behavioral and educational components and was built to be easy-to-understand for those of socio-economically disadvantaged backgrounds. METHODS This was a parallel, two-armed randomized controlled trial in which a total of 96 participants were enrolled from a Neurology Outpatient Department into a control standard care group and a mobile application group that used the smartphone application (app) in addition to the standard medical treatment. The app was intuitive and easy to understand for those coming from a socio-economically disadvantaged background. Medication adherence and self-efficacy were assessed with the Morisky Green and Levine Scale (MGLS) and the Epilepsy Self Efficacy Scale (ESES). Patients were reassessed 12 weeks later. Change in seizure frequency following administration of the application was a secondary outcome. RESULTS In an intent-to-treat analysis, the mobile application interventional group showed over a 60% increase in the proportion of medication adherence (P < 0.0001). The mean self-efficacy score for the mobile application group was increased from 269.5 to 289.75 (P < 0.0001). The control group showed no statistically significant increases in either the proportion adherent or mean self-efficacy scores. SIGNIFICANCE This study demonstrated the statistically significant performance of a mobile application in improving medication adherence and self-management skills in Indian persons with epilepsy.
Collapse
Affiliation(s)
- Pranav Mirpuri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mohit Agarwal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kirandeep Kaur
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India; MEG Facility, National Brain Research Centre, Manesar, Haryana, India
| | - Bhargavi Ramanujan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| |
Collapse
|
24
|
Biset G, Woday A. Epilepsy treatment outcomes in the referral hospitals of northeast Ethiopia. Epilepsy Res 2021; 171:106584. [PMID: 33611143 DOI: 10.1016/j.eplepsyres.2021.106584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Globally, more than half of the epileptic patients have uncontrolled seizures despite treatment with the appropriate antiepileptic drugs. However, the problem has been remained under-reported especially in developing countries. Therefore, this study was designed to assess the treatment outcomes of epileptic patients in the referral hospitals of the Amhara region. METHODS An institutional-based cross-sectional study was conducted among 420 epileptic patients in the referral hospitals of Amhara region. The study participants were selected by a systematic random sampling method using the patient registration logbook as a sampling frame. An interviewer-administered questionnaire and abstraction checklist were used to collect data. The data was entered into Epi-Data software version 3.1 and analyzed using the Statistical Package for Social Science) version 24.0. The Descriptive statistics were done and presented using the descriptive summaries and frequency tables. Bivariate and Multivariate Binary Logistic Regression Models with a Backward Elimination Method were done to identify the factors associated with the treatment outcome of epilepsy. The odds ratio with a 95 % confidence interval was used to determine the significance level of association. RESULT In this study, the magnitude of uncontrolled seizure was 44 % (95 % CI: 39%-48.6%). Being male [AOR = 0.39: 95 % CI 0.25,0.62], high medication necessity beliefs [AOR = 0.34: 95 %CI 0.2,0.57], positive medication beliefs [AOR = 0.23: 95 % CI: 0.13-0.4], and good medication adherence [AOR = 0.21: 95 % CI: 0.1-0.46] were the preventive factors of uncontrolled seizure. In contrast, the presence of co-morbidities [AOR = 2.22, 95 %CI:1.38-3.57] and poor social support [AOR = 1.7: 95 %CI:1.07-2.69] were a risk factors of uncontrolled seizures. CONCLUSION Uncontrolled seizure was found to be higher than the expected seizure frequency, which is preferably zero after one year of treatment. The clinical and treatment related factors were the factors associated with uncontrolled seizure. Emphasis should be given to the treatment strategies of epileptic patients. The health extension packages should integrate community-based counseling to enhance social support and early detection of comorbidities, increase medication adherence, and medication belief among epileptic patients.
Collapse
Affiliation(s)
- Gebeyaw Biset
- Departments of Paediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Abay Woday
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Afar Region, Ethiopia.
| |
Collapse
|
25
|
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
|
26
|
Abd Wahab ES, Al Omar M, Altabakha MMAM. Adherence to Antiepileptic Drugs among Patients Attending the Neuro Spinal Hospital in the United Arab Emirates. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2020; 12:499-507. [PMID: 33679099 PMCID: PMC7909063 DOI: 10.4103/jpbs.jpbs_367_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/20/2020] [Accepted: 05/29/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Adherence to antiepileptic drugs (AEDs) is an integral component of epilepsy management. There are no previous data in the United Arab Emirates (UAE). Objectives: The aim of this study was to assess the prevalence of AED adherence among patients attending the Neuro Spinal Hospital in UAE and to identify the predictors of nonadherence. Materials and Methods: A cross-sectional study was conducted between April 2018 and May 2019, and included consecutive patients with epileptic who were receiving AEDs for at least 6 months. A validated interviewer-administered questionnaire was used. Adherence was assessed by four-item Morisky’s Medication Adherence Scale with a score between 0 and 4. Patients were considered adherent or nonadherent for a score of zero, or 1 and more, respectively. Chi-square test, binary, and multiple logistic regression analysis were used. Results: The study included 315 respondents, 70.8% (n = 223) were adherent, the rest were nonadherent. The most common factor affecting adherence was forgetfulness. Lower education level and having a seizure within the last 6 months were significant risk of nonadherence (odds ratio [OR] 95% confidence interval [CI] = 2.6 (1.2–5.8) and 2.5 (1.3–5.2), respectively), whereas levetiracetam intake reduces the risk of nonadherence (OR: 0.5 [0.2–0.9]). Conclusions: The prevalence of AED adherence was 70.8%. Education level and having a seizure in the last 6 months were significant predictors of nonadherence, whereas levetiracetam intake reduces the risk of nonadherence.
Collapse
Affiliation(s)
- Enas S Abd Wahab
- Department of Pharmacy, Neuro Spinal Hospital, Dubai, United Arab Emirates
| | - Muaed Al Omar
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Moawia M A M Altabakha
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| |
Collapse
|
27
|
Teh KX, Henien NPB, Wong LS, Wong ZKH, Raja Ismail RZ, Achok HN, Mariapun J, Yunos NM. A cross-sectional study on the rate of non-adherence to anti-seizure medications and factors associated with non-adherence among patients with epilepsy. PLoS One 2020; 15:e0235674. [PMID: 32649723 PMCID: PMC7351198 DOI: 10.1371/journal.pone.0235674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background Non-adherence to anti-seizure medication (ASM) therapy is an important contributing factor to the higher mortality rate and treatment failure of epilepsy. This study aimed to determine the rate and factors associated with non-adherence to ASM therapy through the WHO five dimensions of medication adherence framework. Methods We conducted a cross-sectional study at an outpatient Neurology Clinic of a tertiary government hospital in Malaysia. Between March and July 2019, we identified 217 patients with a confirmed diagnosis of epilepsy, receiving oral ASM therapy and able to administer their medications. We performed a semi-structured interview to gather information on sociodemographic background, clinical and medication history, and perceptions on healthcare services. Adherence to ASM therapy was evaluated using the Medication Compliance Questionnaire (MCQ). Patient’s illness perception was assessed by the Brief Illness Perception Questionnaire (B-IPQ). Results 208 patients participated in this study. The median age of the study participants was 35 years (IQR 26–44). 58.2% were females and majority, 55.8%, were from the Malay ethnic group. Based on the MCQ scoring, 89 patients (42.8%) were non-adherent. Multiple logistic regression demonstrated that being employed or students (adjusted odds ratio [aOR] 2.26, 95%CI: 1.19–4.29 p = 0.012) and having an average or below average perceived access to pharmacy services (aOR 2.94, 95%CI: 1.38–6.24, p = 0.005) were significant contributors to non-adherence. Conclusion Being employed or students and having an average or below average perceived access to pharmacy services were associated with ASM non-adherence Efforts to improve ASM adherence should adopt a comprehensive approach considering the success of adherence is contingent on the interrelationship of multiple dimensions.
Collapse
Affiliation(s)
- Kai Xuan Teh
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Nevein Philip Botross Henien
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
- * E-mail:
| | - Lyang Shenz Wong
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Zoe Kee Hui Wong
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Raja Zarina Raja Ismail
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Hamdi Najman Achok
- Department of Medicine, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Jeevitha Mariapun
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| | - Nor’azim Mohd Yunos
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru, Johor, Malaysia
| |
Collapse
|
28
|
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
|
29
|
Schmidt SJ, Wurmbach VS, Lampert A, Bernard S, Haefeli WE, Seidling HM, Thürmann PA. Individual factors increasing complexity of drug treatment-a narrative review. Eur J Clin Pharmacol 2020; 76:745-754. [PMID: 32239242 PMCID: PMC7239823 DOI: 10.1007/s00228-019-02818-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 12/08/2019] [Indexed: 12/11/2022]
Abstract
Purpose Complexity of drug treatment is known to be a risk factor for administration errors and nonadherence promoting higher healthcare costs, hospital admissions and increased mortality. Number of drugs and dose frequency are parameters often used to assess complexity related to the medication regimen. However, factors resulting from complex processes of care or arising from patient characteristics are only sporadically analyzed. Hence, the objective of this review is to give a comprehensive overview of relevant, patient-centered factors influencing complexity of drug treatment. Methods A purposeful literature search was performed in MEDLINE to identify potential complexity factors relating to the prescribed drug (i.e. dosage forms or other product characteristics), the specific medication regimen (i.e. dosage schemes or additional instructions), specific patient characteristics and process characteristics. Factors were included if they were associated to administration errors, nonadherence and related adverse drug events detected in community dwelling adult patients. Results Ninety-one influencing factors were identified: fourteen in “dosage forms”, five in “product characteristics”, twelve in “dosage schemes”, nine in “additional instructions”, thirty-one in “patient characteristics” and twenty in “process characteristics”. Conclusions Although the findings are limited by the non-systematic search process and the heterogeneous results, the search shows the influence of many factors on the complexity of drug treatment. However, to evaluate their relevance for individual patients, prospective studies are necessary. Electronic supplementary material The online version of this article (10.1007/s00228-019-02818-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Steffen J Schmidt
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Viktoria S Wurmbach
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Anette Lampert
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Simone Bernard
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | | | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Petra A Thürmann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.,Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Heusnerstraße 40, 42283, Wuppertal, Germany
| |
Collapse
|
30
|
Kumar S, Sarangi SC, Tripathi M, Gupta YK. Evaluation of adverse drug reaction profile of antiepileptic drugs in persons with epilepsy: A cross-sectional study. Epilepsy Behav 2020; 105:106947. [PMID: 32109858 DOI: 10.1016/j.yebeh.2020.106947] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/12/2020] [Accepted: 01/24/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Newer antiepileptic drugs (AEDs) are preferred over conventional AEDs with the perception of better safety profile and efficacy though there is a lack of confirmatory evidence. The present study assessed the adverse drug reactions' (ADRs) profile of AEDs prescribed in persons with epilepsy (PWE) as per the System Organ Class (SOC) and compared them on the basis of demographics and treatment pattern. MATERIAL AND METHODS This prospective, cross-sectional, and observational study was conducted in PWE attending Neurology Outpatient-Department from February 2016 to April 2019 who were presented with any ADR. World Health Organization-Uppsala Monitoring Centre (WHO-UMC) scale was used for the causality assessment of suspected ADRs. RESULTS Among the 1011 PWE on AEDs, male:female ratio was 622:389, adult:pediatric ratio 736:275, and conventional:newer AEDs ratio 624:387. Among monotherapy PWE (47.1%), commonly used AEDs were levetiracetam (34.4%), valproic acid (22.9%), carbamazepine (18.3%), phenytoin (11.9%), and other AEDs (12.5%). A total of 1990 ADRs (1.96 ADRs per PWE) were reported as per SOC; among them, newer vs. conventional AEDs did not reveal any significant difference; however, monotherapy vs. polytherapy showed differences in nervous system disorders (p = 0.01) and skin and subcutaneous tissue disorders (p = 0.005). Causality assessment revealed 0.3% certain, 27.3% probable, 61.3% possible, and 11.1% unlikely association of ADRs with AEDs. Depending on the ADRs, there was either withdrawal of AED (0.9%), reduction in dose (48.4%), or continuation in the same dose as before (50.7%). CONCLUSION The ADR analysis showed that newer AEDs were associated with a similar trend of ADRs as that of conventional AEDs. Thus, the choice among newer and conventional AEDs should preferably focus on the experience of better efficacy in addition to safety data.
Collapse
Affiliation(s)
- Sachin Kumar
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
31
|
Holbein CE, Smith AW, Peugh J, Modi AC. Allocation of Treatment Responsibility in Adolescents With Epilepsy: Associations With Cognitive Skills and Medication Adherence. J Pediatr Psychol 2020; 44:72-83. [PMID: 29447360 DOI: 10.1093/jpepsy/jsy006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/20/2018] [Indexed: 01/09/2023] Open
Abstract
Objectives To describe allocation of treatment responsibility (ATR) in adolescents with epilepsy, investigate associations between cognitive skills and ATR, and examine whether ATR for antiepileptic drugs (AEDs) predicted electronically monitored adherence. Method Sixty adolescents with epilepsy and their caregivers completed the Allocation of Treatment Responsibility Scale and a battery of self-report measures. Medical chart review data and electronically monitored AED adherence were collected for 1 year. Descriptive data assessed ATR for caregivers and adolescents; multivariate hierarchical regressions tested associations between variables. Results ATR for labs and clinic appointments was greatest for caregivers, while ATR for AEDs was more likely to be shared between caregiver and adolescent. Poorer attention was associated with greater caregiver responsibility for AEDs. Greater caregiver responsibility for AEDs was associated with higher electronically monitored adherence over 12 months. Conclusions In adolescents with epilepsy, caregivers are responsible for most treatment tasks, although responsibility for taking medication was shared with the adolescent. Greater caregiver responsibility for medication results in better long-term AED adherence. ATR is an important construct that warrants further attention in research and clinical practice, especially in the context of transition and health outcomes in pediatric epilepsy.
Collapse
Affiliation(s)
| | - Aimee W Smith
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - James Peugh
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Avani C Modi
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| |
Collapse
|
32
|
Assessment of Quality of Life of Epileptic Patients in Ethiopia. Int J Chronic Dis 2020; 2020:8714768. [PMID: 31976314 PMCID: PMC6961609 DOI: 10.1155/2020/8714768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/26/2019] [Accepted: 10/10/2019] [Indexed: 01/26/2023] Open
Abstract
Background Patients with epilepsy are at an increased risk of poor quality of life. Purpose We aimed at assessing the quality of life and its determinants among epileptic patients at University of Gondar Referral Hospital (UoGRH), Ethiopia. Methods Institution based cross-sectional study was conducted on epileptic patients on follow up at UoGRH from January 15 to April 15, 2017. Information including socio-demographic profile and diagnosis was extracted from medical records and patients. Quality Of Life In Epilepsy-10 (QOLIE-10) tool was used to measure the quality of life. Independent t-test and one-way analysis of variance were used to look for factors associated with quality of life. The level of statistical significance was declared at P-value ≤ 0.05. Results A total of 354 patients were included in the study and mean age was 29.1 ± 11.7 years. The mean QOLIE-10 score was 19.85. One hundred ninety-four (54.8%) of participants had a good quality of life. Being illiterate, unemployment, and presence of co-morbid medical condition were associated with poorer quality of life. Conclusion Nearly half of the participants had a poor quality of life. Patients with co-morbidity, illiteracy, and unemployment should be given special emphasis in order to improve their quality of life.
Collapse
|
33
|
Khalyfa A, Sanz-Rubio D. Genetics and Extracellular Vesicles of Pediatrics Sleep Disordered Breathing and Epilepsy. Int J Mol Sci 2019; 20:ijms20215483. [PMID: 31689970 PMCID: PMC6862182 DOI: 10.3390/ijms20215483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/14/2019] [Accepted: 10/28/2019] [Indexed: 12/27/2022] Open
Abstract
Sleep remains one of the least understood phenomena in biology, and sleep disturbances are one of the most common behavioral problems in childhood. The etiology of sleep disorders is complex and involves both genetic and environmental factors. Epilepsy is the most popular childhood neurological condition and is characterized by an enduring predisposition to generate epileptic seizures, and the neurobiological, cognitive, psychological, and social consequences of this condition. Sleep and epilepsy are interrelated, and the importance of sleep in epilepsy is less known. The state of sleep also influences whether a seizure will occur at a given time, and this differs considerably for various epilepsy syndromes. The development of epilepsy has been associated with single or multiple gene variants. The genetics of epilepsy is complex and disorders exhibit significant genetic heterogeneity and variability in the expressivity of seizures. Phenobarbital (PhB) is the most widely used antiepileptic drug. With its principal mechanism of action to prolong the opening time of the γ-aminobutyric acid (GABA)-A receptor-associated chloride channel, it enhances chloride anion influx into neurons, with subsequent hyperpolarization, thereby reducing excitability. Enzymes that metabolize pharmaceuticals including PhB are well known for having genetic polymorphisms that contribute to adverse drug–drug interactions. PhB metabolism is highly dependent upon the cytochrome P450 (CYP450) and genetic polymorphisms can lead to variability in active drug levels. The highly polymorphic CYP2C19 isozymes are responsible for metabolizing a large portion of routinely prescribed drugs and variants contribute significantly to adverse drug reactions and therapeutic failures. A limited number of CYP2C19 single nucleotide polymorphisms (SNPs) are involved in drug metabolism. Extracellular vesicles (EVs) are circular membrane fragments released from the endosomal compartment as exosomes are shed from the surfaces of the membranes of most cell types. Increasing evidence indicated that EVs play a pivotal role in cell-to-cell communication. Theses EVs may play an important role between sleep, epilepsy, and treatments. The discovery of exosomes provides potential strategies for the diagnosis and treatment of many diseases including neurocognitive deficit. The aim of this study is to better understand and provide further knowledge about the metabolism and interactions between phenobarbital and CYP2C19 polymorphisms in children with epilepsy, interplay between sleep, and EVs. Understanding this interplay between epilepsy and sleep is helpful in the optimal treatment of all patients with epileptic seizures. The use of genetics and extracellular vesicles as precision medicine for the diagnosis and treatment of children with sleep disorder will improve the prognosis and the quality of life in patients with epilepsy.
Collapse
Affiliation(s)
- Abdelnaby Khalyfa
- Department of Pediatrics, Section of Sleep Medicine, The University of Chicago, Chicago, IL 60637, USA.
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA.
| | - David Sanz-Rubio
- Department of Child Health and the Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA.
| |
Collapse
|
34
|
Mamo Y, Dukessa T, Mortimore A, Dee D, Luintel A, Fordham I, Phillips DIW, Parry EHO, Levene D. Non-communicable disease clinics in rural Ethiopia: why patients are lost to follow-up. Public Health Action 2019; 9:102-106. [PMID: 31803581 DOI: 10.5588/pha.18.0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Providing medical care for non-communicable diseases (NCDs) in rural sub-Saharan Africa has proved to be difficult because of poor treatment adherence and frequent loss to follow-up (LTFU). The reasons for this are poorly understood. Objective To investigate LTFU among patients with two different but common NCDs who attended rural Ethiopian health centres. Method The study was based in five health centres in southern Ethiopia with established NCD clinics run by nurses and health officers. Patients with epilepsy or hypertension who were lost to follow-up and non-LTFU comparison patients were identified and traced; a questionnaire was administered enquiring about the reasons for LTFU. Results Of the 147 LTFU patients successfully located, 62 had died, moved away or were attending other medical facilities. The remaining 85 patients were compared with 211 non-LFTU patients. The major factors associated with LTFU were distance from the clinic, associated costs and a preference for traditional treatments, together with a misunderstanding of the nature of NCD management. Conclusions The delivery of affordable care closer to the patients' homes has the greatest potential to address the problem of LTFU. Also needed are increased levels of patient education and interaction with traditional healers to explain the nature of NCDs and the need for life-long management.
Collapse
Affiliation(s)
- Y Mamo
- Jimma University Chronic Disease Project, Jimma, Ethiopia
| | - T Dukessa
- Jimma University Chronic Disease Project, Jimma, Ethiopia
| | - A Mortimore
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - D Dee
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - A Luintel
- Hospital for Tropical Diseases, University College, London, UK
| | - I Fordham
- Queen Elizabeth Hospital, Woolwich, London, UK
| | - D I W Phillips
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E H O Parry
- London School of Hygiene & Tropical Medicine, London, UK
| | - D Levene
- School of Humanities, University of Southampton, Southampton, UK
| |
Collapse
|
35
|
Mroueh L, Boumediene F, Jost J, Ratsimbazafy V, Preux PM, Salameh P, Al-Hajje A. Self-reported attitudes about medication in Lebanese people with epilepsy. Epilepsy Behav 2019; 98:80-87. [PMID: 31301454 DOI: 10.1016/j.yebeh.2019.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 11/20/2022]
Abstract
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.
Collapse
Affiliation(s)
- Lara Mroueh
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Beirut, Lebanon.
| | - Farid Boumediene
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France
| | - Jeremy Jost
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France; CHU Limoges, Department of Pharmacy, 87000 Limoges, France
| | - Voa Ratsimbazafy
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France; CHU Limoges, Department of Pharmacy, 87000 Limoges, France
| | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France
| | - Pascale Salameh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Beirut, Lebanon
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Beirut, Lebanon
| |
Collapse
|
36
|
Kusznir Vitturi B, Barreto Cabral F, Mella Cukiert C. Outcomes of pregnant women with refractory epilepsy. Seizure 2019; 69:251-257. [DOI: 10.1016/j.seizure.2019.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/05/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022] Open
|
37
|
Cistulli PA, Armitstead J, Pepin JL, Woehrle H, Nunez CM, Benjafield A, Malhotra A. Short-term CPAP adherence in obstructive sleep apnea: a big data analysis using real world data. Sleep Med 2019; 59:114-116. [PMID: 30799254 PMCID: PMC6589354 DOI: 10.1016/j.sleep.2019.01.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/02/2018] [Accepted: 01/04/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Peter A Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Royal North Shore Hospital, Sydney, Australia; MedXcloud Group, USA.
| | - Jeff Armitstead
- ResMed Science Center, Sydney, Australia; MedXcloud Group, USA
| | - Jean-Louis Pepin
- HP2 Laboratory, Inserm U1042 Unit, University Grenoble Alps, Grenoble and EFCR, Thorax and Vessels, Grenoble Alps University Hospital, Grenoble, France; MedXcloud Group, USA
| | - Holger Woehrle
- Sleep & Ventilation Center Blaubeuren, Lung Center Ulm, Ulm, Germany; MedXcloud Group, USA
| | - Carlos M Nunez
- ResMed Science Center, ResMed Corp., San Diego, CA, USA; MedXcloud Group, USA
| | - Adam Benjafield
- ResMed Science Center, ResMed Corp., San Diego, CA, USA; MedXcloud Group, USA
| | - Atul Malhotra
- University of California San Diego, La Jolla, CA, USA; MedXcloud Group, USA
| |
Collapse
|
38
|
Van Steenkiste F, Fidèle S, Nsanzabaganwa W, Uwacu B, Dedeken P, Teuwen DE, Boon P. An ambispective cohort study on treatment outcomes of patients with epilepsy in a tertiary epilepsy center in Rwanda and recommendations for improved epilepsy care. Epilepsia Open 2019; 4:123-132. [PMID: 30868122 PMCID: PMC6398151 DOI: 10.1002/epi4.12304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Because outcome data inform and drive healthcare decisions and improvement of patient care, this study aimed to gain a deep understanding of sociodemographic profiles and treatment outcomes of newly presenting and recently diagnosed persons living with epilepsy (PwE) at a tertiary epilepsy center in Rwanda. METHODS In June 2016 (T1), as a first stage of this single-center cohort study, an ambispective chart review was conducted on baseline sociodemographic and disease characteristics of PwE using a structured questionnaire. Missing data were obtained by phone interview. In 2017, follow-up data were collected by phone interview on treatment outcomes after 15-months (T2). RESULTS Of 406 PwE screened, 235 were included at T1 and outcomes on 166 PwE were obtained at T2. More than 70% were <20 years of age, with a male preponderance. A high number of patients were aged ≥20 years, were single (67.4%), unemployed (41.5%), and had no formal education or primary level education (53.9%), possibly reflecting stigma. A mean delay in diagnosis since first seizure increased with age at first seizure, amounting to 3 years for patients aged ≥20 years. At T2, 69.6% of 166 patients who could be contacted reported no seizures in the previous month. Valproate monotherapy was the most frequently prescribed treatment. At T2, 47% had discontinued treatment, which was often not recommended by a physician, despite medical insurance coverage in >90% of patients. Only 19% reported an adverse event. Marked and partial improvement in quality of life (QoL) was reported by, respectively, 50.9% and 32.7% of patients. SIGNIFICANCE Encouraging results on improved seizure control and QoL were observed at follow-up. The treatment gap remains high due to loss to follow-up and treatment discontinuation. In this article, we discuss needs and recommendations for improving patient care, requiring concerted efforts of stakeholders at all levels of the healthcare system.
Collapse
Affiliation(s)
| | | | | | - Beni Uwacu
- CARAES Neuro‐Psychiatric HospitalKigaliRwanda
| | | | | | - Paul Boon
- Reference Center for Refractory EpilepsyGhent University HospitalGhentBelgium
| |
Collapse
|
39
|
A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Med 2019; 17:17. [PMID: 30764819 PMCID: PMC6376728 DOI: 10.1186/s12916-019-1250-8] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/02/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions. METHODS We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations. RESULTS Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes. CONCLUSIONS Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.
Collapse
|
40
|
The neurology-psychiatry interface in epilepsy. Ir J Psychol Med 2018; 38:9-15. [PMID: 33715646 DOI: 10.1017/ipm.2018.49] [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] [Indexed: 11/05/2022]
Abstract
Epilepsy and mental illness have a bidirectional association. Psychiatrists are likely to encounter epilepsy as comorbidity. Seizures may present as mental illness. Equally, the management of psychiatric conditions has the potential to destabilise epilepsy. There is a need for structured epilepsy awareness and training amongst psychiatrists. This paper outlines key considerations around diagnosis, treatment and risk while suggesting practical recommendations.
Collapse
|
41
|
Sequeira AJ, Buchman S, Lewis A, Karceski S. Future development of a depot antiepileptic drug: What are the ethical implications? Epilepsy Behav 2018; 85:183-187. [PMID: 30032805 DOI: 10.1016/j.yebeh.2018.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 12/13/2022]
Abstract
Depot medications have been used for long-term treatment of many different medical conditions (schizophrenia, opioid addiction) and for prevention of pregnancy (birth control). In addition, proposals for depot medication for antidepressants have been made as a possible treatment for chronic depression. For the treatment of chronic epilepsy, there are currently no depot antiepileptic drugs (AEDs). However, there may be a role for them. Depot AEDs could improve medication adherence rates, thereby reducing the morbidity and mortality that are associated with ongoing seizures. This could help to reduce hospital costs for people with epilepsy. Potential patient populations that could benefit from a depot AED include patients with forgetfulness, socioeconomic barriers to access of daily oral medications, impaired gastric absorption or dysphagia, comorbid epilepsy and psychiatric disease, and personal preference to avoid the inconvenience of taking a medication daily or even multiple times per day. In this article, we review reasons to create a depot AED and the outcomes of doing so in the context of the pillars of bioethics: beneficence (to act in a patient's best interest), autonomy (to respect a patient as an individual and honor their preferences), nonmaleficence (to do no harm), and justice (to treat all persons fairly and equally).
Collapse
Affiliation(s)
- Alexandra J Sequeira
- Weill Cornell New York Presbyterian Epilepsy Center, Department of Neurology, United States.
| | - Stephanie Buchman
- Weill Cornell New York Presbyterian Epilepsy Center, Department of Neurology, United States
| | - Ariane Lewis
- NYU Langone Medical Center, Departments of Neurology and Neurosurgery, United States
| | - Steven Karceski
- Weill Cornell New York Presbyterian Epilepsy Center, Department of Neurology, United States
| |
Collapse
|
42
|
Ernawati I, Islamiyah WR, Sumarno. How to Improve Clinical Outcome of Epileptic Seizure Control Based on Medication Adherence? A Literature Review. Open Access Maced J Med Sci 2018; 6:1174-1179. [PMID: 29983823 PMCID: PMC6026415 DOI: 10.3889/oamjms.2018.235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/11/2018] [Accepted: 05/19/2018] [Indexed: 11/09/2022] Open
Abstract
Anti-Epileptic Drugs (AEDs) are the main therapy for epilepsy to prevent seizures. Non-adherence situation plays an important factor in the failure of seizure control. Such a condition may generate several impacts on clinical, social, and economic aspect. Several methods are used to measure adherence in epilepsy patients, including direct and indirect measurement. The direct measure involves measurement of drug levels in hair or body fluids such as blood and saliva. Whereas, indirect measure involves the non-biological tools, for example, a self-report measure, pill counts, appointment attendance, medication refills, and seizure frequency. Numerous factors may affect adherence in epilepsy patients, such as age, sex, and seizure aetiology, seizure sites, which are categorised as irreversible factors and hardly to be improved. However, there are factors that can be influenced to improve adherence such as patient knowledge, medication, cultural, health care professionals, and national health policies, which are related to treatment and education factor which is associated with behaviour to be likely adherence.
Collapse
Affiliation(s)
- Iin Ernawati
- Faculty of Pharmacy, Airlangga University, Gubeng, Surabaya, East Java, Indonesia
| | | | - Sumarno
- Department of Clinical Pharmacy, Faculty of Pharmacy, Airlangga University, Gubeng, Surabaya, East Java, Indonesia
| |
Collapse
|
43
|
Ayalew MB, Muche EA. Patient reported adverse events among epileptic patients taking antiepileptic drugs. SAGE Open Med 2018; 6:2050312118772471. [PMID: 29760918 PMCID: PMC5946606 DOI: 10.1177/2050312118772471] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/28/2018] [Indexed: 11/23/2022] Open
Abstract
Objective: The aim of this study was to assess patient reported adverse events and associated factors among epileptic patients taking antiepileptic drugs on follow-up at University of Gondar Referral Hospital. Methods: Cross-sectional study was done on 354 adult epileptic patients. Patients who were on antiepileptic drugs for epilepsy treatment for less than a year, those who were below 18 years old, patients with incomplete information on the chart and those who were involuntary or uncooperative were excluded from the study. Data were entered in to SPSS version 20.0 for analysis. Bivariate and multivariate binary logistic regression analysis was done to see factors associated with antiepileptic drugs adverse effect. Level of statistical significance was declared at p ≤ 0.05. Result: Generalized tonic clonic seizure was the most common (86.2%) type of epilepsy. A total of 79 adverse events were reported. The most frequently encountered adverse events were fatigue (5.08%), gastrointestinal disturbance (4.24%) and sedation/depression (4.24%). Adverse drug effect of antiepileptic drugs was significantly associated with illiterate educational status, increased number of antiepileptic drugs, no seizure during last follow-up and last year, and 1–5 seizures for the last year. Conclusion: About one-sixth of epileptic patients reported adverse drug effects. Adverse drug effects were more commonly seen in patients with low educational status, increased number of antiepileptic drugs, absence of seizure during last follow-up and last year, and 1–5 seizures for the last year. So clinicians should give emphasis for patients with these characteristics to counsel on how to minimize or prevent adverse drug events from antiepileptic drugs or giving reassurance about it if it is minor.
Collapse
Affiliation(s)
- Mohammed Biset Ayalew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Esileman Abdela Muche
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
44
|
Yang C, Hao Z, Yu D, Xu Q, Zhang L. The prevalence rates of medication adherence and factors influencing adherence to antiepileptic drugs in children with epilepsy: A systematic review and meta analysis. Epilepsy Res 2018; 142:88-99. [PMID: 29609075 DOI: 10.1016/j.eplepsyres.2018.03.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/13/2018] [Accepted: 03/25/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We conducted a systematic review to assess antiepileptic drug (AED) adherence rates, and to identify the characteristics associated with nonadherence in children. METHODS We searched PubMed, EMBASE, and the Cochrane Library from inception to June 2017. Observational studies addressing medication adherence or examining factors influencing AED adherence were included. RESULTS We included 22 studies, involving 3955 participants. The general quality of included studies were rated as high quality. Adherence rates were reported in 18 studies, varying between 22.1% and 96.5%. Meta analysis of 13 studies (n = 2051) revealed a pooled adherence rate assessed by objective methods of 58% (95% CI [0.46, 0.74]). Meta analysis of nine studies (n = 1217) revealed a pooled adherence rate assessed by subjective Methods of 73%, (95% CI [0.63, 0.85]). Family support, smaller family size, stable parental marriage status, support from healthcare providers and higher family socioeconomic status were associated with better medication adherence. However, contradictory results were found regarding the effects of age, the frequency of seizure, type of seizures, type of medication and the number of administered drugs. CONCLUSIONS Adherence to AEDs is challenging for pediatric patients with epilepsy. Few factors which influence adherence can be drawn because of differing variables and results. Future prospective research should be designed with longer study periods and larger samples in naturalistic settings.
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
| | - Zilong Hao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 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
| | - Qunfen Xu
- 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.
| | - 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
|
45
|
Tareke M, Tesfaye S, Amare D, Belete T, Abate A. Antipsychotic medication non-adherence among schizophrenia patients in Central Ethiopia. S Afr J Psychiatr 2018; 24:1124. [PMID: 30263211 PMCID: PMC6138084 DOI: 10.4102/sajpsychiatry.v24i0.1124] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 11/22/2017] [Indexed: 01/10/2023] Open
Abstract
Background Despite the fact that adherence to antipsychotic medications is the cornerstone in the treatment and prevention of relapse of the disease, non-adherence is a major problem among schizophrenia patients. The purpose of this study was to assess the magnitude and factors associated with antipsychotic medication non-adherence among schizophrenia patients in Amanuel Mental Specialized Hospital. Method An institution-based cross-sectional study was conducted among 412 people with schizophrenia at Amanuel Mental Specialized Hospital from April to May 2014. Non-adherence was assessed using the questionnaire of Morisky medication adherence rating scale and semi-structured questions for assessment of associated factors. Logistic regression analysis was used to assess predictors of non-adherence. Results Prevalence of non-adherence was 41.0% among schizophrenia patients. Living in rural areas (adjusted odds ratio [AOR] = 2.07; 95% confidence interval [CI]: 1.31, 3.28), current substance use (AOR = 1.67; 95% CI: 1.09, 2.56), long duration of treatment (AOR = 2.07; 95% CI: 1.22, 3.50) and polypharmacy (AOR = 2.13; 95% CI: 1.34, 3.40) were found to be significantly associated with non-adherence. Conclusion The results indicate that non-adherence to antipsychotic medication was a major problem among patients with schizophrenia. Reducing the number of antipsychotic medications and availing drugs in rural areas may decrease the level of non-adherence.
Collapse
Affiliation(s)
- Minale Tareke
- College of Medicine and Health Science, Bahir Dar University, Ethiopia
| | - Siranesh Tesfaye
- Department of Psychiatry, Felege Hiwot Referral Hospital, Ethiopia
| | - Desalegn Amare
- College of Medicine and Health Science, Bahir Dar University, Ethiopia
| | - Tilahun Belete
- College of Health Science, Psychiatry Unit, Department of Nursing, Mekelle University, Ethiopia
| | - Andargie Abate
- College of Medicine and Health Science, Bahir Dar University, Ethiopia
| |
Collapse
|
46
|
Introna A, D'Errico E, Modugno B, Scarafino A, Fraddosio A, Distaso E, Tempesta I, Mastronardi A, Simone IL. Adherence to riluzole in patients with amyotrophic lateral sclerosis: an observational study. Neuropsychiatr Dis Treat 2018; 14:193-203. [PMID: 29379292 PMCID: PMC5757977 DOI: 10.2147/ndt.s150550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Riluzole is the first drug approved to treat amyotrophic lateral sclerosis (ALS). Recently, an oral suspension (OS) of riluzole was made available. Thus, the aim of our study was to evaluate the adherence to 2 formulations of riluzole in patients with ALS. PATIENTS AND METHODS We enrolled 45 consecutive patients with ALS. At disease diagnosis, riluzole was prescribed in 2 different formulations depending on the severity of dysphagia (27/45 patients received tablets and 18/45 patients received OS). Side effects (SEs) and treatment adherence were investigated using a clinical questionnaire including the ©Morisky 8-item Medication Adherence Questionnaire. RESULTS Gastroenteric complaints were the most frequent SEs (58% in the tablet group and 48% in the OS group), followed by those at the nervous system (29% and 40%, respectively). No serious SEs related to treatment were reported. The rate of adherence to riluzole was independent of the formulation of the drug and consistent with other medications assumed for comorbidities (p=0.004). In the tablet group, low adherence was caused by SEs in 55.6% and by dysphagia in 44.4% of patients. In the OS group, SEs caused low adherence in 75% of patients. Independently of the drug formulation, patients with high or medium adherence to riluzole had a higher progression rate (p=0.002 and p=0.009, respectively) and a shorter time to generalization (TTG; p=0.01), compared to those with low adherence. CONCLUSION Gastroenteric symptoms were the most frequent SE related to tablet as well as OS. The rate of adherence was independent of the formulation of riluzole and the number of medications assumed for comorbidities, and it was consistent with the severity of the disease. The low adherence was caused by dysphagia and SEs in the tablet group, whereas it was caused prevalently by SEs in the OS group.
Collapse
Affiliation(s)
- Alessandro Introna
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Eustachio D'Errico
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Boris Modugno
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Antonio Scarafino
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Angela Fraddosio
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Eugenio Distaso
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Irene Tempesta
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Antonella Mastronardi
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| | - Isabella Laura Simone
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro," Bari, Italy
| |
Collapse
|
47
|
Wang S, Chen C, Jin B, Yang L, Ding Y, Guo Y, Chen Y, Wang S, Ding M. The association of psychosocial variables with adherence to antiepileptic drugs in patients with temporal lobe epilepsy. Epilepsy Behav 2017; 77:39-43. [PMID: 29107200 DOI: 10.1016/j.yebeh.2017.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of this study was to explore the association between psychosocial factors and adherence to antiepileptic drugs (AEDs) in patients with temporal lobe epilepsy (TLE). METHODS This cross-sectional study was conducted with 123 individuals with TLE, admitted to our epilepsy center from December 2015 to May 2017. The participants completed standardized self-report questionnaires measuring medication adherence, anxiety, depression, and family and social support. Adherence was measured by the 8-item Morisky Medication Adherence Scale (MMAS), and logistic regression was used to examine statistically significant associations of different variables with adherence. RESULTS We found a 33.3% rate of poor AED adherence. Moderate-to-severe anxiety (odds ratio (OR)=2.851, 95% confidence interval (CI)=1.138-7.144, P=0.025) and the presence of hippocampal sclerosis (OR=3.098, 95% CI=1.259-7.620, P=0.014) were positively associated with poor adherence to antiepileptic drugs. Social support (OR=0.925, 95% CI=0.863-0.990, P=0.025) was negatively associated with poor adherence. Neither depression nor family support was associated with adherence. CONCLUSION One-third of patients with TLE were prone to poor AED adherence, especially individuals with hippocampal sclerosis. Intervention approaches designed to improve AED adherence in patients with TLE should focus on psychosocial factors.
Collapse
Affiliation(s)
- Shan Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Cong Chen
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bo Jin
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Linglin Yang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yao Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Guo
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Chen
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ding
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
| |
Collapse
|
48
|
Kaufman KR, Coluccio M, Sivaraaman K, Campeas M. Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review. BJPsych Open 2017; 3:249-253. [PMID: 29034101 PMCID: PMC5627137 DOI: 10.1192/bjpo.bp.117.005538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/07/2017] [Accepted: 08/23/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Optimal anti-epileptic drug (AED) treatment maximises therapeutic response and minimises adverse effects (AEs). Key to therapeutic AED treatment is adherence. Non-adherence is often related to severity of AEs. Frequently, patients do not spontaneously report, and clinicians do not specifically query, critical AEs that lead to non-adherence, including sexual dysfunction. Sexual dysfunction prevalence in patients with epilepsy ranges from 40 to 70%, often related to AEDs, epilepsy or mood states. This case reports lamotrigine-induced sexual dysfunction leading to periodic non-adherence. AIMS To report lamotrigine-induced sexual dysfunction leading to periodic lamotrigine non-adherence in the context of multiple comorbidities and concurrent antidepressant and antihypertensive pharmacotherapy. METHOD Case analysis with PubMed literature review. RESULTS A 56-year-old male patient with major depression, panic disorder without agoraphobia and post-traumatic stress disorder was well-controlled with escitalopram 20 mg bid, mirtazapine 22.5 mg qhs and alprazolam 1 mg tid prn. Comorbid conditions included complex partial seizures, psychogenic non-epileptic seizures (PNES), hypertension, gastroesophageal reflux disease and hydrocephalus with patent ventriculoperitoneal shunt that were effectively treated with lamotrigine 100 mg tid, enalapril 20 mg qam and lansoprazole 30 mg qam. He acknowledged non-adherence with lamotrigine secondary to sexual dysfunction. With lamotrigine 300 mg total daily dose, he described no libido with impotence/anejaculation/anorgasmia. When off lamotrigine for 48 h, he described becoming libidinous with decreased erectile dysfunction but persistent anejaculation/anorgasmia. When off lamotrigine for 72 h to maximise sexual functioning, he developed auras. Family confirmed patient's consistent monthly non-adherence for 2-3 days during the past year. CONCLUSIONS Sexual dysfunction is a key AE leading to AED non-adherence. This case describes dose-dependent lamotrigine-induced sexual dysfunction with episodic non-adherence for 12 months. Patient/clinician education regarding AED-induced sexual dysfunction is warranted as are routine sexual histories to ensure adherence. DECLARATION OF INTEREST No financial interests. K.R.K. is Editor of BJPsych Open; he took no part in the peer-review of this work. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
Collapse
Affiliation(s)
- Kenneth R Kaufman
- , MD, FRCPsych, DLFAPA, FAES, Departments of Psychiatry, Neurology and Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Melissa Coluccio
- , BS, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kartik Sivaraaman
- , MD, Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Miriam Campeas
- , BA, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| |
Collapse
|
49
|
Reimers A, Olsson P, Nilsson J, Hoff E, Reis M, Strandberg M, Lundgren A, Källén K. Impact of generic substitution on levetiracetam serum concentration—A prospective study in an outpatient setting. Epilepsy Res 2017; 134:54-61. [DOI: 10.1016/j.eplepsyres.2017.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/22/2017] [Accepted: 04/22/2017] [Indexed: 10/19/2022]
|
50
|
Shon YM, Joung WJ. [Illness Experience of Married Korean Women with Epilepsy]. J Korean Acad Nurs 2017; 47:289-304. [PMID: 28706165 DOI: 10.4040/jkan.2017.47.3.289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to understand and describe the illness experience of married Korean women with epilepsy. METHODS Data were collected during 2015~2016 through individual in-depth interviews with 12 married women with epilepsy. Verbatim transcripts were analyzed using Giorgi's phenomenological analysis to uncover the meaning of the illness experience of the participants. RESULTS The study results showed that the illness experience of married Korean women with epilepsy was clustered into a specific description of situated structure and a general description of situated structure. Six themes from 20 meaning units were identified: 1) Undermined self-esteem with stigma of being epileptic; 2) Limited social interaction; 3) Suffering sorrow as a 'disqualified being'; 4) Shuttling back and forth across the boundary between healthy and epileptic; 5) Desperate struggle to meet the expectation of given role; 6) Self-empowering through self-restriction and realization. CONCLUSION The findings from this study show that both the enacted and felt stigma of epilepsy impact on the life of married Korean women with epilepsy. Although the participants face social and interpersonal restriction and prejudices, they try their best to fulfill their role rather than to be cared for as patients. As the stigma and hardships of the participants are related to lack of knowledge, health professionals should focus not just on clinical intervention but also on providing targeted educational programs and counseling for these women to dispel the stigma of the disease and to increase their quality of life.
Collapse
Affiliation(s)
- Young Min Shon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Joung Joung
- Research Institute of Nursing Science, Seoul National University, Seoul, Korea.
| |
Collapse
|