Adjustment of treatment increases quality of life in patients with epilepsy: a randomized controlled pragmatic trial

Abstract

Background and purpose: Complaints about side-effects of antiepileptic drugs (AEDs) may be overlooked in clinical practice. We assessed the value and risks of an active intervention policy for reported complaints in a randomized controlled pragmatic trial. Methods: This randomized controlled pragmatic trial included 111 adults treated for epilepsy in seven general hospitals. They were considered well-managed by their treating physician, but reported moderate to severe complaints on a questionnaire (SIDAED, assessing SIDe effects in AED treatment). The intervention was adjustment of AED treatment (53 patients), either reduction of dose or switch of AED, versus continuation of treatment unchanged (58 control patients) during 7 months. Primary outcomes were quality of life (Qolie-10) and complaints score. Secondary outcome measures were the occurrence of seizures or adverse events. Results: After 7 months, the relative risk (RR) for improvement in quality of life was 1.80 (1.04-3.12) for the intervention group compared to control and the RR of decrease in complaints was 1.34 (0.88-2.05). In 58% of patients randomized to adjustment, the medication had indeed been changed. Discussion: In conclusion, despite a possible risk of seizure recurrence, adjustment of drug treatment in well-managed patients with epilepsy, who report considerable complaints, improves the quality of life.

Cognitive effects of lacosamide as adjunctive therapy in refractory epilepsy

“…Patients were tested with two measurements: a standardized inventory to evaluate subjectively perceived cognitive side effects and a neuropsychological test to assess possible effects independent of subjective complaints. Complaints were assessed using a list of 46 items with possible AED‐related complaints, the SIDAED . A complete overview of the SIDAED is provided in the Appendix A.…”

“…This questionnaire can be analyzed in different ways: regarding the total reported complaints, the different categories and the different items. The SIDAED is chosen because the psychometric properties have been established and cognitive complaints can be measured relative to other domains.…”

Mood, anxiety, and incomplete seizure control affect quality of life after epilepsy surgery

“…27 While the adverse side effects of AEDs negatively affect QOL 28 and decreasing AED-related adverse side effects improves QOL, 29 we were only able to accurately obtain number of AEDs used at each of the follow-up intervals. Depression and anxiety are aspects of mental health, and thus measures of depression and anxiety are expected to be associated with the mental health domain of the QOLIE-89.…”

Subjectively Perceived Side-Effects of Anti-Epileptic Drugs in Chronic Refractory Epilepsy

“…In addition to the community-based studies from our group [1,2,21], we attempted to investigate the impact of subjective complaints in a hospital-based study, in patients with chronic refractory epilepsy. In the community based studies most patients were in remission or they had only infrequent seizures and most were on low dose monotherapy.…”