INTRODUCTIONEpilepsy affects 70 million people worldwide.(1) Long-term antiepileptic drug (AED) administration remains the mainstay of epilepsy treatment. In up to 67% of patients with epilepsy (PWE), AEDs effectively eliminate or reduce the frequency of seizures.(2) Medication adherence refers to the extent to which a patient's behaviour corresponds with the recommendations of a health professional. Medication adherence is usually better when there is greater patient involvement in the treatment choice, as well as cooperation and mutual agreement between the health provider and the patient.(2) Nonadherence rates among PWE are reported to be 30%-50%.(3) It is well established that patients with suboptimal adherence levels are more likely to have seizures that are associated with increased number of hospital admissions and healthcare costs.(4) Factors influencing adherence to AEDs have been described; these include patient-, treatment-and health system-related factors.(5) The promotion of medication adherence is considered to be an important component of pharmaceutical care practice. Several methods have been used to measure therapeutic adherence, including self-report, pill count, appointment attendance, medication refill history, blood or urine drug levels and drug diary.(6) Indirect methods, such as self-reports and patient interviews, are the simplest and most common methods used for measuring medication adherence. (7,8) To date, most of the studies conducted to evaluate AED adherence among PWE did not account for the influence of a wide range of variables (e.g. demographic, disease and treatment patterns). There are not many studies in the Indian literature that examine the factors that influence AED adherence. Identifying the factors associated with AED adherence would allow the development of strategies to improve adherence. Thus, the present study aimed to evaluate the pattern and extent of AED adherence among PWE and to identify the factors that influence adherence. METHODSThis cross-sectional study was conducted by the Division of Clinical Pharmacology at the outpatient and inpatient clinics of the Department of Neurology, St John's Medical College and Hospital, Bangalore, India, over a period of 1.5 years (January 2012 to July 2013). Ethical approval was obtained from the institution's Ethical Review Board. Patients aged ≥ 18 years who were receiving AED treatment were eligible for inclusion in the study. Only those who gave their consent for participation were enrolled. Pregnant or lactating women and patients with comorbidities were excluded from the study.Data was collected using a specially designed case record form that included items on demographic/family history, seizure history, duration of epilepsy, AEDs prescribed and occurrence of
Context:Quality of life (QOL) assessment in patients with epilepsy (PWE) is increasingly recognized as an important component in the management of epilepsy.Aims:The objective of the present study was to assess influence of sociodemographic, clinical and pharmacotherapy characteristics collectively on QOL in adult PWE.Settings and Design:This was a cross-sectional, observational study in patients with confirmed diagnosis of epilepsy.Materials and Methods:QOL was assessed using modified QOLIE-10 questionnaire for epilepsy. Univariate and multiple regression analysis were done to determine factors associated with poor QOL, respectively.Results:There were 451 PWE, with a mean age 27.3 ± 8.15 years, 251 (56%) males and 191 (42%) had monthly income < 5000 Indian national rupees (INR)/month. The QOLIE score was 64.1 ± 15.97 (Mean ± SD). The univariate analysis showed factors such as lower monthly income, focal epilepsy, seizure frequency, antiepileptic drug (AED) polytherapy, conventional AEDs and frequent adverse drug reactions (ADRs) had significant negative influence on various domains of QOLIE-10 questionnaire. Multiple regression analysis showed seizure frequency as a significant predictor of most QOL domains and overall score, while ADRs as a significant predictor of all the domains. Seizure type was a predictive factor for domains like emotional well-being and overall score.Conclusion:Present findings showed patients on monotherapy had better QOL while those having lower monthly income, having focal epilepsy and who received conventional AEDs had negative influence on QOL scores. Further, higher seizure frequency and occurrence of ADRs were significant predictors of all the domains of QOL in PWE.
Study showed maximum ADRs with AED polytherapy with no significant difference in frequency and severity of ADRs between conventional versus newer AEDs. This finding needs further investigation in larger number of patients to identify safer treatment options for epilepsy.
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