<p>Antiepileptic Drug Treatment Outcomes and Seizure-Related Injuries Among Adult Patients with Epilepsy in a Tertiary Care Hospital in Ethiopia</p>

Abstract

Objective: Anti-epileptic drugs (AEDs) are the primary therapeutic modalities for epilepsy management. However, one-third of epileptic patients continue to experience seizure even with appropriate AED use. Patients with epilepsy are at increased risk for seizure-related injury and they have higher incidences of home, street and work accidents. There is a paucity of data on AED use pattern and treatment outcomes among patients with epilepsy in the tertiary hospitals of Ethiopia. Therefore, the aim of this study was to assess AED use pattern, treatment outcome, and prevalence of seizure-related injury among patients with epilepsy in Tikur Anbessa specialized Hospital (TASH), Ethiopia. Patients and Methods: An institution-based cross-sectional study was carried out on 291 patients with epilepsy attending the neurology clinic of TASH. A semi-structured questionnaire and data abstraction format were used to collect data through patient interview and medical chart review. Binary logistic regression was utilized to identify the associated factors of treatment outcome. Results: About 172 (59%) of the patients were taking a single AED, in which phenobarbital, 195 (67%), and phenytoin, 97 (33.3%), were the most frequently prescribed AEDs as monotherapy and combination therapy. Headache, depressed mood and epigastric pain were frequently reported as adverse drug reactions. Seizure-related injury was reported among 78 (26.8%) patients and head injury 15 (5.2%), desntal injury 15 (5.2%), soft tissue injury 14 (4.8%) and burns 10 (3.4%) were the commonest. About two-thirds (191, 65.6%) of the study participants had uncontrolled seizure. Medication adherence and multiple AEDs were significantly associated with treatment outcome. Conclusion: All the study participants were put on old generation AEDs with phenobarbital being the most frequently used. About two-thirds of the patients had uncontrolled seizure and seizure-related injury is still a serious concern among patients with epilepsy.

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

“…e probable explanation might be due to the difference in study design (retrospective cohort study design was used in USA), but the current study employed the crosssectional study design and newer AEMs (gabapentin, lamotrigine, levetiracetam, and topiramate) which were commonly used in USA and France [10,31,32]; since newer medications have a lower side effect, the adherence rate could be higher. In Ethiopia, cheap and old generation antiepileptic drugs like phenobarbitone are highly used, and these might increase the nonadherence rate [33].…”

Role of clinical pharmacists in epilepsy management at a general hospital in Vietnam: a before-and-after study

“…Many guidelines now recommend the use of monotherapy with AED for most patients because of similar efficacy and better tolerability compared to polytherapy [ 11 ]. As reported in some prior studies, the proportion of monotherapy is pretty high and can be up to 71% [ 12 , 13 ]. This study’s result also showed a preference for monotherapy in over 70% of the patients.…”

Treatment Outcome of Epileptic Patients Receiving Antiepileptic Drugs in Ethiopia: A Systematic Review and Meta-Analysis

“…Twentythree primary studies were included in the present systematic review and meta-analysis. These studies were conducted in different parts of Ethiopia (from Amhara seven primary articles [7,[13][14][15][16][17][18], Oromiya eight [8,9,[19][20][21][22][23][24], Addis Ababa four [25][26][27][28], Tigray two [9,29], and Southern Nation, Nationalities, and People two articles) [30,31]. The sample size of the included primary studies was considerably variable ranging from 121 to 415 participants.…”

“…Regarding the seizurefree period, two studies assessed seizure freedom over one month [6,21], one study over two months [17], two studies over three months [7,14,25], and the remaining studies assessed seizure freedom over at least six months. Concerning the age groups, one study included only pediatric patients [7], two studies included all age group patients [13,19], and the remaining studies included only adult patients [6,8,9,[14][15][16][17][18][20][21][22][23][24][25][26][27][28][29][30][31]. Regarding the antiepileptic drugs, most of the patients were treated with monotherapy and the commonly used drugs were phenobarbitone, phenytoin, carbamazepine, and valproic acid [6-8, 17, 20, 26].…”

“…The pooled prevalence of seizure freedom varied by the duration of seizure-free period, and the higher pooled prevalence of seizure freedom (58%) was found in seizure-free period of less than 6 months (Figure 5). [13], male gender [7], monotherapy [28], alcohol consumption, negative belief towards medication, presence of comorbidity ( 29), head injury, sleep deprivation, and exposure to noise and light [17] were reported to be associated with uncontrolled seizure. Although a number of factors were reported as determinant of uncontrolled seizure, variables reported as predictors of uncontrolled seizure among at least two primary studies were considered for this meta-analysis.…”