How do pediatric patients perceive adverse drug events of anticonvulsant drugs? A survey

Treatment modifications of antiseizure medications in children due to adverse drug reactions: The parents' perspective

BACKGROUND

Adverse drug reactions (ADRs) occur frequently in the treatment with antiseizure medication (ASM). We investigated the influence of experienced ADRs on desired or actual treatment modifications in paediatric patients from the parents' perspective.

METHODS

We interviewed 104 parents of children with an epilepsy diagnosis in routine paediatric care at a German university hospital. The questionnaire comprised questions about current and previous experiences with ASM regarding ADRs leading to desired or actual treatment modifications.

RESULTS

Of 94 parents of children with current ASM, 11/94 (12 %) desired treatment modifications because of ADRs. Of 66 parents of children with previous ASM treatment, 51/66 (77 %) reported a total of 72 actual ADR-related modifications in the past. The most frequently mentioned ADRs leading to desired or actual treatment modifications were fatigue (current: 7/94 [7 %]; previous: 23/72 [32 %]), behavioural changes (current: 6/94 [6 %]; previous: 28/72 [39 %]), and negative changes in cognitive processes (current: 3/94 [3 %]; previous: 12/72 [17 %]). In total, parents attributed ADR-related desired or actual treatment modifications to 14 different ASMs. Behavioural changes leading to desired or actual modifications were mentioned for 10/14 (71 %) ASMs, fatigue for 9/14 (64 %) ASMs, and negative changes in cognitive processes for 8/14 (57 %) ASMs.

CONCLUSION

One-in-ten parents desired to modify current ASM treatment due to ADRs, and almost two thirds reported actual ADR-related modifications of previous ASMs. As the same ADRs were reported for different ASMs, those ADRs may not be preventable through ASM variation. Thus, coping strategies are needed, particularly for the occurrence of common neurological and psychiatric ADRs.

What extent of adverse drug reactions seems acceptable for what degree of seizure reduction in paediatric patients with epilepsy?-An exploratory study on the parents' perspective

Purpose We aimed to explore the perspectives of parents of children with epilepsy regarding the extent of adverse drug reactions (ADRs) of antiseizure medications (ASMs) they are willing to accept for a certain degree of seizure reduction. Methods We presented a table showing two levels of the likelihood of occurrence (low/high) and two levels of severity (mild/severe) for a number of ADRs including irritability, impairment of attention, and fatigue. For each combination of likelihood and severity, 98 parents were asked to indicate the degree of seizure reduction for which they were willing to accept the given ADR. Results Even in exchange for seizure-freedom, severe irritability occurring with a high likelihood was unacceptable to 53 % of parents. This applied to 51 % concerning impairment of attention, and to 40 % concerning fatigue. At 50 % seizure reduction, 2 % of parents were willing to accept a high likelihood of occurrence of severe irritability. This applied to 5 % of parents concerning impairment of attention, and 9 % of parents concerning fatigue. With regard to mild forms of ADRs very likely to occur, 16 % of parents considered impairment of attention to be unacceptable despite seizure freedom; this applied to 12 % of parents for irritability, and 6 % of parents for fatigue. Conclusion Even for seizure freedom or a major reduction in seizures, parents often refused to accept ADRs. Therefore, it is important to consider the parents' perspective when choosing an ASM, and to find the optimal balance between desired effectiveness and ADRs acceptable to parents and paediatric patients.

How do children with focal epilepsies perceive the moment they realize that they are about to have a seizure? A pilot study

PROBLEM

A seizure is a challenging situation for children with epilepsy. Little is known regarding the experience of children who perceive in advance that they are about to have a seizure.

METHODS

From September 2020 to February 2021, we invited children with focal epilepsies aged 6-18 years to participate in a semi-structured interview.

RESULTS

Of 52 children with focal epilepsies, 22 (42 %) said they perceive in advance that they are about to experience a seizure [11 with self-limited epilepsy with centro-temporal spikes (SELECTs), 11 with other focal epilepsies]. All 22/22 (100 %) children described physical symptoms such as headache or a numb feeling in one half of the body. Of those children, 17/22 (77 %) stated they try to do something about the seizure. Those strategies were perceived as helpful by 0/11 (0 %) children with SELECTs and 9/11 (86 %) children with other focal epilepsies (p < 0.001). Of the children with SELECTs 5/11 (45 %), and of those with other focal epilepsies 9/11 (86 %) stated they would like to know in the morning if they are to experience a seizure that day (n.s.).

CONCLUSION

Children who perceive in advance that they are about to have a seizure are well able to describe their experience. Most children take measures to manage their seizures. Those measures were regarded as helpful by most children with other focal epilepsies, but by no child with SELECTs. Larger studies are necessary to determine the factors contributing to the child's perception as well as the nature of the support that they require.

Survey on the management of childhood epilepsy among general practitioners in the area of Marrakech

BACKGROUND

Epilepsy is a common chronic neurological disorder in the pediatric population and its evolution can be fatal. It represents a major public health problem as well as an economic burden for the families of affected children, health systems and the overall economies of countries. This further accentuates the role that general practitioners can play in the management of childhood epilepsy in the face of the persistent lack of neurologists and neuro-pediatricians in our country.

METHODS

In order to assess the knowledge and therapeutic habits of general practitioners, we carried out a descriptive and cross-sectional study with general practitioners practicing in the two healthcare sectors: public and private, and in two settings: urban and rural, during the year 2018. The data was collected through a pre-established survey.

RESULTS

In total, 155 general practitioners responded to the survey. For 85.2% of physicians, the diagnosis of childhood epilepsy was based on interrogation, physical examination, and EEG. While brain imaging would be systematic regardless of the type of epilepsy for 45.2% of doctors. Only 6 doctors (3.9%) had knowledge of the latest classifications of the "ILAE". For treatment, the majority of physicians (65.5%) adopted first-line monotherapy with valproate in leading position. Almost half of the doctors (48.4%) found that education of parents and children was always necessary. None of the GPs interviewed in our series assessed the academic impact of epilepsy. Only 32% of doctors had received continuing education on epilepsy.

CONCLUSION

The data from our study demonstrates that continuing education on the management of childhood epilepsy and the greater involvement of general practitioners were essential elements in improving care.

The SWGEDWGEIW from Soybean Peptides Reduce Oxidative Damage-Mediated Apoptosis in PC-12 Cells by Activating SIRT3/FOXO3a Signaling Pathway

The goal of the investigation was to study the protective effects of the SWGEDWGEIW (the single peptide, TSP) from soybean peptides (SBP) on hydrogen peroxide (H2O2)-induced apoptosis together with mitochondrial dysfunction in PC-12 cells and their possible implications to protection mechanism. Meanwhile, the SBP was used as a control experiment. The results suggested that SBP and TSP significantly (p < 0.05) inhibited cellular oxidative damage and ROS-mediated apoptosis. In addition, SBP and TSP also enhanced multiple mitochondrial biological activities, decreased mitochondrial ROS levels, amplified mitochondrial respiration, increased cellular maximal respiration, spare respiration capacity, and ATP production. In addition, SBP and TSP significantly (p < 0.05) raised the SIRT3 protein expression and the downstream functional gene FOXO3a. In the above activity tests, the activity of TSP was slightly higher than that of SBP. Taken together, our findings suggested that SBP and TSP can be used as promising nutrients for oxidative damage reduction in neurons, and TSP is more effective than SBP. Therefore, TSP has the potential to replace SBP and reduce neuronal oxidative damage.

Adverse Drug Reactions at Nonelective Hospital Admission in Children and Adolescents: Comparison of 4 Causality Assessment Methods

OBJECTIVES

This study aimed to compare assessment methods to determine adverse drug reactions (ADRs) at nonelective hospital admission in pediatric patients, to investigate the interrater reliability of assessment methods in pediatric care, and to analyze symptoms related to ADRs and (suicidal) drug intoxications.

METHODS

For 1 year, the medical records of nonelective patients admitted to a university pediatric department were evaluated for potential ADRs using 4 assessments methods by 1 experienced rater. Krippendorff α was calculated from a sample of 14 patients evaluated by 4 experienced raters to determine interrater reliability.

RESULTS

In 1831 nonelective hospital admissions, 63.4% (1161 of 1831) of patients had received at least one drug before admission. We found a potential causal relationship between drugs and symptoms documented at admission and thus potential ADRs according to Naranjo in 23.3% (271 of 1161) of those patients, World Health Organization - Uppsala Monitoring Centre (WHO-UMC) in 22.5% (261 of 1161), Koh in 21.7% (252 of 1161), and Begaud in 16.5% (192 of 1161). The probability rating of the potential causal relationships varied considerably between the methods (Naranjo-Begaud, P < 0.01; Naranjo-Koh, P < 0.001; Koh-Begaud, P < 0.01; Begaud-WHO-UMC, P < 0.01). Acceptable interrater reliability (α ≥ 0.667) was only obtained for WHO-UMC (α = 0.7092). The most frequently identified definite ADR was sedation in 1.5% of all nonelective patients with medication before hospital admission. In 1.2% (22 of 1831) of all nonelective admissions, we found drug intoxications with suicidal intent.

CONCLUSIONS

The assessment methods showed a high variability in the determination of a potential causal relationship between drug and documented symptom, in the classification of the probability of ADRs, and suboptimal interrater reliability. Thus, their feasibility in pediatric patients is limited.

Physicians' perspectives on adverse drug reactions in pediatric routine care: a survey

BACKGROUND

Children and adolescents are at particular risk for adverse drug reactions (ADRs). We investigated physicians' perceptions on ADRs in pediatric routine care.

METHODS

In this exploratory study from April to November 2020, we invited physicians treating pediatric patients across Germany to complete an online questionnaire consisting mainly of closed questions.

RESULTS

Completion rate was 98% (127/129). Of all participants, 23% (29/127) stated they were not able to estimate how many of their pediatric patients experienced ADRs during drug therapy. The remaining physicians estimated that 7.5% (median; Q25/Q75 3%/20%) of their pediatric patients were affected by ADRs. Regarding counseling on ADRs, 61% (77/127) stated they do not ask regularly the extent to which parents want to be informed. In total, 26% (33/127) stated they avoid counseling on ADRs concerning commonly used approved therapies, whereas only 4% (5/127) did so concerning off-label use (P < 0.001). Altogether, 16% (20/127) stated they rather prescribe new medicines as they hope for better effectiveness; 72% (91/127) said they are cautious about doing so owing to yet unknown ADRs. Of all respondents, 46% (58/127) stated they do not report ADRs to the authorities. Concerning the black triangle symbol, a European pharmacovigilance measure, 11% (14/127) stated they knew it and 6% (7/127) stated they reported any suspected ADR for drugs with that symbol.

CONCLUSIONS

Physicians' perspectives on ADRs were ambivalent: ADRs influenced their parent counseling and drug prescribing; yet, they struggled to estimate the impact of ADRs on their patients and were not aware of specific pharmacovigilance measures.

Drug-handling problems and expectations of the ideal pediatric drug-reported by children and their parents

Experienced drug-handling problems and inadequately considered expectations for drug therapy have an unfavorable influence on therapy. We performed a questionnaire survey in (i) parents of 0-5-year-old children and (ii) 6-17-year olds and their parents. We assessed (A) experienced drug-handling problems and (B) expectations for drug therapy. (i) Forty-six parents and (ii) 103 children and their parents participated in the study. Experienced drug-handling problems were described by (i) 100% of parents and (ii) 62% of children and 70% of parents. Problems concerned with the preparation of the drug, dosing, compliance with the time interval, and acceptance. (i) Sixty-five percent of parents preferred a peroral route of drug administration, while (ii) 74% of children and 86% of parents did so. Preferred characteristics of peroral drug formulations, e.g., liquid versus solid drug formulations or flavor, were highly heterogeneous. Preferences of 6-17-year-old children and their parents matched in 43 to 66%.   Conclusion: Most children and their parents had already experienced drug-handling problems. Preferences concerning the ideal pediatric drug were highly heterogeneous and in about half of cases, preferences of children and their parents differed. Thus, the children should be approached directly. If information is solely gained from parents, the children's needs might remain unmet. What is Known: • Pediatric drug administration is complex and therefore error-prone. • Experiences and expectations of children and their parents should be considered. What is New: •Most pediatric patients and their parents have already experienced drug-handling problems. • Expectations concerning the ideal pediatric drug are highly heterogeneous. Parents are often insufficiently aware of those expectations in their children.