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Brett BA, Conroy M, Doshi H, Lowe MX, Kalcheff-Korn S, Jackson H. An observational time-series study on the behavioral effects of adjunctive artisanal cannabidiol use by adults with treatment resistant epilepsies. BMC Neurol 2024; 24:141. [PMID: 38671370 PMCID: PMC11046917 DOI: 10.1186/s12883-024-03646-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND For approximately 30% of people with epilepsy, seizures are not well-controlled by anti-seizure medication (ASM). This condition, called treatment resistant epilepsy (TRE), is associated with increased morbidity and mortality, and substantially impacts the quality of life of both the individual and their family. Non-responsiveness to ASMs leads many people with TRE to seek alternative therapies, such as cannabinoid-based medication, particularly cannabidiol (CBD), with or without medical or professional advice. This is due in part to widespread reporting in the media about the benefits of CBD for seizures in some forms of epilepsy. METHODS Adults with TRE, opting to add CBD to their existing treatment regime, completed this prospective, observational, longitudinal, quasi-experimental, time-series study. We hypothesized that adjunctive CBD use would positively impact participants' quality of life and psychological well-being in comparison to a baseline period without CBD use. Participants were followed for a period of approximately six months - for approximately one month of baseline prior to the initiation of CBD use and approximately five months after the initiation of CBD use. Participants provided urine samples and completed behavioral questionnaires that assessed quality of life, anxiety/depression, and adverse events during baseline and at two times during CBD use. RESULTS Complete case analyses (n = 10) showed a statistically significant improvement in quality of life, a statistically significant decrease in anxiety symptoms, and a statistically significant decrease in the experience of adverse events over time (p < 0.05). Improvements noted in the experience of depression symptoms did not reach statistical significance. Urinalysis revealed the majority of participants had no CBD/metabolites in their system at the beginning of the study, and confirmed the presence of CBD/metabolites in participants' urine after CBD was added to their treatment regime. Analysis of missing data using multiple imputation supported the findings of the complete case analysis. INTERPRETATION For a small group of individuals with TRE of varying etiologies, adjunctive use of artisanal CBD was associated with improvements in the behavioral and psychological symptoms of TRE, as well as improved medication tolerability.
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Affiliation(s)
- Barbara A Brett
- Department of Psychology, Colorado State University-Pueblo, 2200 Bonforte Blvd., Pueblo, CO, 81001, USA.
| | - Matthieu Conroy
- US Army Medical Research Institute of Chemical Defense, Aberdeen, MD, USA
| | - Hardik Doshi
- Cape Fear Valley Medical Center, Fayetteville, NC, USA
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Jarernsiripornkul N, Tiamkao S, Wongtaweepkij K, Jorns TP, Junsuaydee K, Nontasen N, Gayrash S, Kampichit S. Comparing patient reported and medical record data of adverse drug reactions to anti-seizure drugs. Int J Clin Pharm 2024; 46:101-110. [PMID: 37843693 DOI: 10.1007/s11096-023-01653-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/13/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Anti-seizure drugs (ASDs) can potentially cause serious adverse drug reactions (ADRs). Patient self-reporting can increase the rate of ADR detection, but studies examining patient self-reporting of ADRs caused by ASDs are lacking. AIM To determine the characteristics of ADRs reported by patients receiving ASDs, assess laboratory data and medical record confirmation of patient-reported ADRs, and explore factors associated with laboratory data and medical record confirmation. METHOD A self-reporting questionnaire was distributed to patients prescribed ASDs at outpatient clinics. Patients assessed the causality of suspected ADRs using Causality Assessment Tool. Naranjo's algorithm was used by researchers for causality assessment. Medical records were used to gather information on ADR symptoms, ASD medication, and abnormal laboratory data. RESULTS From 478 distributed questionnaires, 93.1% completed the questionnaire and 67.4% of respondents reported at least one ADR. The most common ADRs were drowsiness (50.7%), dizziness (9.7%), and ataxia (4.3%). For causality, suspected ADRs were classified as possible in 52.3% of cases and probable in 46.3% of cases by patients, and possible in 64.7% of cases and probable in 25.7% of cases by researchers. Only 12.7% of patients had laboratory data and/or medical record confirmation of suspected ADRs. The psychiatry clinic was less likely to confirm suspected ADRs compared to the epilepsy clinic (OR = 0.412, p = 0.022). CONCLUSION Confirmation of patient-reported ADRs with either laboratory data or medical records was uncommon. Recording patient-reported ADRs in patients' medical history and monitoring laboratory tests related to patient-reported symptoms should be promoted to increase the safety of ASD treatment.
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Affiliation(s)
- Narumol Jarernsiripornkul
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand.
| | - Somsak Tiamkao
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kamonphat Wongtaweepkij
- Division of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhon Nayok, Thailand
| | | | - Kanjana Junsuaydee
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Nattakan Nontasen
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Sasina Gayrash
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
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Zelano J, Nika O, Asztely F, Larsson D, Andersson K, Andrén K. Prevalence and nature of patient-reported antiseizure medication side effects in a Swedish regional multi-center study. Seizure 2023; 113:23-27. [PMID: 37931352 DOI: 10.1016/j.seizure.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Side effects is one of the major clinical problems in epilepsy care. We assessed the prevalence of ASM side effects in participants in a large regional multicenter observational study in western Sweden and aimed to identify risk factors and inventory the nature of side effects with different ASM regimes. METHODS Cross-sectional analysis of survey answers and clinical characteristics of 406 adult participants recruited to a regional observational study between December 2020 and March 2023. Half of the participants had been seizure free for one year. Second-generation or newer ASMs were the most common. RESULTS A total of 164 (40 %, 95 %CI: 36-45) patients reported side effects. Patients reporting side effects were younger (median 41 vs 47 years, p = 0.015), had more frequently experienced a seizure in the last year (p = 0.02), and were more often on ASM polytherapy (p < 0.01). ASM polytherapy and age were significant risk factors in regression models, but the explanatory value was low. The most common side effect was tiredness followed by cognitive symptoms. CONCLUSIONS Our findings show that side effects are still common in epilepsy care and suggests that unnecessary polypharmacy should be avoided. Apart from number or ASMs, predicting who will experience side effects is difficult and more research on individual vulnerability is needed.
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Affiliation(s)
- Johan Zelano
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden.
| | - Olha Nika
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Fredrik Asztely
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Angered hospital, SV hospital group, Gothenburg, Sweden
| | - David Larsson
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Klara Andersson
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Kerstin Andrén
- Department of clinical neuroscience, Institute of neuroscience and physiology, Sahlgrenska Academy, Gothenburg University, Blå stråket 7, 3v, Gothenburg 41345, Sweden; Angered hospital, SV hospital group, Gothenburg, Sweden
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Leonhardi J, Barthel H, Speerforck S, Dietzel J, Schroeter ML, Saur D, Tiepolt S, Rullmann M, Patt M, Claßen J, Schomerus G, Sabri O. Differential Diagnosis Between Alzheimer's Disease-Related Depression and Pseudo-Dementia in Depression: A New Indication for Amyloid-β Imaging? J Alzheimers Dis 2022; 88:1029-1035. [PMID: 35723098 DOI: 10.3233/jad-215619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alzheimer's disease and depression can start with combined cognitive and depressive symptoms [1, 2]. Accurate differential diagnosis is desired to initiate specific treatment. OBJECTIVE We investigated whether amyloid-β PET imaging can discriminate both entities. METHODS This retrospective observational study included 39 patients (20 female, age = 70±11years) with both cognitive and depressive symptoms who underwent amyloid-β PET imaging and in whom clinical follow-up data was available. Amyloid-β PET was carried out applying [18F]Florbetaben or [11C]PiB. The PET images were analyzed by standardized visual and relative-quantitative evaluation. Based on clinical follow-up (median of 2.4 years [range 0.3 to 7.0 years, IQR = 3.7 years] after amyloid PET imaging which was not considered in obtaining a definite diagnosis), discrimination ability between AD-related depression and pseudo-dementia in depression/depression with other comorbidities was determined. RESULTS Visually, all 10 patients with pseudo-dementia in depression and all 15 patients with other depression were rated as amyloid-β-negative; 2 of 14 patients with AD-related depression were rated amyloid-β-negative. ROC curve analysis of the unified composite standardized uptake value ratios (cSUVRs) was able to discriminate pseudo-dementia in depression from AD-related depression with high accuracy (AUC = 0.92). Optimal [18F]Florbetaben discrimination cSUVR threshold was 1.34. In congruence with the visual PET analysis, the resulting sensitivity of the relative-quantitative analysis was 86% with a specificity of 100% . CONCLUSION Amyloid-β PET can differentiate AD-related depression and pseudo-dementia in depression. Prospective clinical studies are warranted to confirm this result and to potentially broaden the spectrum of clinical applications for amyloid-β PET imaging.
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Affiliation(s)
- Jakob Leonhardi
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany.,Department of Radiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Jens Dietzel
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Matthias L Schroeter
- Clinic for Cognitive Neurology, University of Leipzig Medical Center, Max Planck Institute for Human Cognitive & Brain Sciences, Leipzig, Germany
| | - Dorothee Saur
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Solveig Tiepolt
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Michael Rullmann
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Marianne Patt
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Joseph Claßen
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
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Snoeren A, Majoie MH, Fasen KC, Ijff DM. Brivaracetam for the treatment of refractory epilepsy in patients with prior exposure to levetiracetam: a retrospective outcome analysis. Seizure 2022; 96:102-107. [DOI: 10.1016/j.seizure.2022.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 02/01/2023] Open
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Yadav J, Singh P, Dabla S, Gupta R. Psychiatric comorbidity and quality of life in patients with epilepsy on anti-epileptic monotherapy and polytherapy. Tzu Chi Med J 2022; 34:226-231. [PMID: 35465291 PMCID: PMC9020250 DOI: 10.4103/tcmj.tcmj_34_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/23/2021] [Accepted: 05/18/2021] [Indexed: 11/04/2022] Open
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Lim R, Ellett LK, Roughead EE, Cheah PY, Masnoon N. Patient-Reported Questionnaires to Identify Adverse Drug Reactions: A Systematic Review. Int J Environ Res Public Health 2021; 18:ijerph182211877. [PMID: 34831635 PMCID: PMC8624083 DOI: 10.3390/ijerph182211877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022]
Abstract
Background: This systematic review aims to summarise available patient-reported questionnaires to detect adverse drug reactions (ADRs) that can be utilised by healthcare professionals in clinical practice and to summarise the psychometric properties (validity, reliability, and responsiveness) of the questionnaires. Methods: A systematic literature search was conducted using Medline, Pubmed, Embase, and Emcare databases to screen for articles published between January 2000 and July 2020. Data items regarding validity, reliability, and responsiveness were extracted independently by two authors. The methodological quality was assessed using the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) checklist. Results: A total of 1563 unique article titles were identified after removing duplicates. Following shortlisting of relevant articles, 19 patient-reported ADR questionnaires were identified. Questionnaires most commonly focused on mental health medications (42.1%, n = 8), followed by general questionnaires applicable to any medication (21.1%, n = 4). Many questionnaires did not report assessing the validity and reliability of the measurement tool. For example, only 11 questionnaires (58%) mentioned assessing content validity, in addition to criterion or construct testing. Conclusion: This systematic review summarised the available patient-reported questionnaires that can be used in research and clinical practice to identify ADRs. Results of this systematic review highlight the need for more robust validity and reliability testing when developing patient-reported ADR questionnaires.
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Affiliation(s)
- Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (L.K.E.); (E.E.R.)
- Correspondence:
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (L.K.E.); (E.E.R.)
| | - Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia; (L.K.E.); (E.E.R.)
| | - Phaik Yeong Cheah
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK;
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7FZ, UK
| | - Nashwa Masnoon
- Laboratory of Ageing and Pharmacology, Kolling Institute, University of Sydney, St Leonards, NSW 2064, Australia;
- Department of Pharmacy, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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Karlov VA, Kozhokaru AB, Vlasov PN, Pushkar TN, Orlova AS. [Dynamics of epileptiform activity, efficacy and tolerability of valproic acid in adults and adolescents with newly-diagnosed epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:35-43. [PMID: 32790974 DOI: 10.17116/jnevro202012007135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the changes of epileptiform activity index (EAI) as a measure of the efficacy and tolerability of treatment with valproic acid (VA) in patients with newly-diagnosed generalized and focal epilepsy. MATERIAL AND METHODS The study included 93 patients (55 men and 38 women): 27 with focal epilepsy (FE) and 66 with idiopathic generalized epilepsy (IGE). Patients with idiopathic and age-dependent FE were not included in the study. At each visit, video-EEG monitoring with the analysis of focal, diffuse and generalized epileptiform activity during wakefulness before sleep, during sleep, after sleep and during partial awakenings with quantitative EAI assessment at baseline, after 1, 3, 6 and 12 months of therapy was performed. Therapeutic drug monitoring was performed during dose titration 1 month after the start of treatment or in case of treatment change. Treatment efficacy was assessed based on the absence of seizures, decrease of seizure episodes by more than 50% (responders) and <50% (insufficient efficacy). Adverse effects (AE) were assessed using the Assessing SIDe effects in AED treatment scale (SIDAED). RESULTS Maximal EAI was observed at baseline both in FE and IGE groups. In patients with IGE, the total EAI (52.8±7.8) was significantly higher compared to FE group (27.1±5.5 (p=0,027)). During wakefulness before sleep and during sleep EAI was significantly lower in the IGE group compared to FE patients (3.4±0. vs. 10.5±5.5 (p=0.003) and 4.3±0.8 vs. 8.9±3.7 (p=0.046), respectively). VA demonstrated the high efficacy and good tolerability in IGE and FE patients: after 12 months of treatment remission was achieved in 69 (74.2%) patients, the decrease of seizure frequency by more than 50% was observed in 22 (23,7%) patients, insufficient efficacy only in 2 (2.1%). AEs were registered only sporadically. CONCLUSIONS VA remains one of the drugs of choice in IGE and FE. EAI may become an additional objective test in cases of difficult differential diagnosis in IGE and FE, using total EAI, EAI before sleep, during sleep, during partial awakenings in the first months of treatment (1-3 months). EAI objectively reflects the dynamics of VA treatment efficacy.
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Affiliation(s)
- V A Karlov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A B Kozhokaru
- State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - P N Vlasov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - T N Pushkar
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A S Orlova
- Sechenov First Moscow State Medical Univesity, Moscow, Russia
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Abstract
Aims: Antiepileptic drugs are the main therapy for epilepsy. However, the incidence of adverse effects (AEs) results in treatment discontinuation. The aim of this study is evaluating the factors involved in discontinuation of antiepileptic drugs. Settings and Design: We studied 2797 epileptic patients who consumed levetiracetam (LEV), oxcarbazepine (OXC), topiramate (TPM), zonisamide (ZNS), rufinamide, and lacosamide to evaluate the discontinuation because of AEs. Statistical Analysis Used: Data were analyzed using descriptive statistics and Chi-square test. Results: This study showed the rate of discontinuation due to adverse reactions as follows: TPM (7.10%), OXC (4.5%), ZNS (1.8%), and LEV (1.6%) (Chi-square analysis, P < 0.0001). Our study also showed that 1.35% of the patients did not continue the therapy because of subjective experiences of the AEs. Furthermore, neurologic complications in TPM, skin rashes in OXC, and patients' subjective experiences in LEV prescription were the main reasons for nonadherence due to a AEs. Conclusions: AEs in newer antiepileptic drugs are extremely prevalent. Our observation revealed that skin rashes and paresthesia were the most probable causes of treatment discontinuation because of AEs.
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Affiliation(s)
- Mehdi Golpayegani
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Salari
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kurosh Gharagozli
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sahu J, Nair PP, Wadwekar V, Aghoram R. New-onset interictal headache in Persons with epilepsy (PWE): A case-control study. Epilepsy Behav 2018; 88:172-175. [PMID: 30290325 DOI: 10.1016/j.yebeh.2018.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/18/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE In our personal experience, headache is a frequent complaint in Persons with epilepsy (PWE) receiving antiepileptic drugs (AEDs), carbamazepine (CBZ) in particular. There is hardly any systematic study on AEDs-associated headache. We assessed the association of new-onset interictal headache in PWE with CBZ compared with other AEDs and factors associated with it. METHODS Two thousand PWE on AEDs were screened, and 165 persons having new-onset interictal headache were identified. Eight persons were excluded because of comorbid illnesses that could potentially contribute to a headache. Finally, 157 were recruited for the study. One hundred fifty-seven age- and sex-matched PWE on AEDs, without headache, were recruited as controls. Headache questionnaire based on the International Classification of Headache Disorders (ICHD-II) criteria was used. Demographic factors, seizure characteristics, type and dose of AEDs, findings on electroencephalogram (EEG), and magnetic resonance imaging (MRI)/computerized tomography (CT) were recorded. RESULTS Among PWE with headache, the majority [88 (56.1%)] were on CBZ compared with other AEDs but not significantly different from controls. In 71 (45%) persons, the headache had migrainous character. In both univariate and multivariate analyses, lower seizure frequency and fewer EEG abnormalities were found to be independent predictors of headache. CONCLUSIONS New-onset interictal headache is a significant issue in PWE; nonmigrainous headache is more common than the migrainous type. Carbamazepine was not found to have any predilection for new-onset interictal headache compared with other AEDs. A lower frequency of seizures and EEG abnormalities in PWE with headache may suggest that seizures contribute less to the development of headache and may further support the hypothesis that AEDs may be significant contributing factors for the headache.
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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: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Hendriksen RGF, Lionarons JM, Hendriksen JGM, Vles JSH, McAdam LC, Biggar WD. Development of a New Self-Reporting Instrument Measuring Benefits and Side Effects of Corticosteroids in Duchenne Muscular Dystrophy: Report from a Pilot Study. J Neuromuscul Dis 2018; 4:217-236. [PMID: 28800336 DOI: 10.3233/jnd-170223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is no cure for Duchenne Muscular Dystrophy (DMD); treatment is symptomatic and corticosteroids slow the progression. Side effects of corticosteroids - especially the physical effects - have been described, however patients' and caregivers perception on chronic corticosteroid treatment and their side effects is less well known, in particular with regards to cognition, behaviour, and emotional functioning. OBJECTIVE The primary aim of this pilot study was to (i) construct a self-report questionnaire to assess the perceived benefits and side effects of corticosteroids for patients with DMD and their parents. Furthermore we aimed to (ii) investigate the psychometric qualities of this questionnaire, (iii) whether there was a difference between parents' and patient's perceptions, and finally (iv) to what extent reported side effects may alter over time. METHODS A 23-item questionnaire (SIDECORT: side effect of corticosteroids) was constructed to assess the perception of these benefits and side effects in a systematic manner. RESULTS In total, 86 patients (aged 5 - 28 years) and 125 of their parents completed the questionnaire. Internal consistency was good. Using factor analyses on the side effect items as reported by parents, two underlying factors were found, with the first factor describing cognitive, behavioural and emotional functioning, and the second factor describing physical functioning. The potential benefits of corticosteroids were highly rated among both parents and patients, although parents rated the importance of the benefits higher than their sons (p = 0.002). Similarly, parents rated the severity of the side effects generally higher than their sons (p = 0.011), especially with regards to the physical side effects (p = 0.014). Based on the parent's perception, the neurodevelopmental side effects generally appeared to decline the longer corticosteroids were used. CONCLUSIONS To our knowledge, this is the first explicit study on perceived cognitive-, behavioural-, and emotional side effects and the allocation of benefits to corticosteroids in DMD. On the basis of our research we suggest a short form questionnaire, which proves to be reliable and valid for research- and clinical practice. This questionnaire could provide useful insights for the care of boys and men with DMD.
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Affiliation(s)
- Ruben G F Hendriksen
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Judith M Lionarons
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jos G M Hendriksen
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,Center for Neurological Learning Disabilities, Kempenhaeghe, Heeze, The Netherlands
| | - Johan S H Vles
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Laura C McAdam
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - W Douglas Biggar
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Hospital for Sick Children, Toronto, Canada
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13
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Feldman L, Lapin B, Busch RM, Bautista JF. Evaluating subjective cognitive impairment in the adult epilepsy clinic: Effects of depression, number of antiepileptic medications, and seizure frequency. Epilepsy Behav 2018; 81:18-24. [PMID: 29455082 DOI: 10.1016/j.yebeh.2017.10.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/22/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Subjective cognitive complaints are a frequent concern of patients with epilepsy. The Aldenkamp-Baker Neuropsychological Assessment Schedule (ABNAS) is a patient-reported scale validated to measure adverse cognitive effects of antiepileptic drugs (AEDs). The goals of this study were to identify predictors of patient-reported cognitive dysfunction and to assess the relationship between subjective and objective cognitive impairment. METHODS The Cleveland Clinic Knowledge Program Data Registry was used to identify adult patients seen in outpatient epilepsy clinic from January to May 2015 and who completed the following scales: ABNAS for subjective cognitive impairment, Patient Health Questionnaire (PHQ-9) for depression, Generalized Anxiety Disorder 7-item (GAD-7) scale, Quality of Life in Epilepsy (QOLIE-10), and EuroQOL five dimensions questionnaire (EQ-5D) for health-related quality of life. Topiramate (TPM) was considered a high-risk medication for cognitive impairment. Patients were categorized into groups based on total ABNAS score: subjective cognitive impairment (ABNAS>15; N=270) and no subjective cognitive impairment (ABNAS≤15; N=400). Multivariable logistic regression models were constructed to identify independent predictors of subjective cognitive impairment. In a subset of patients who had neuropsychological testing within 6months of completing the ABNAS (N=60), Pearson correlations and multivariable logistic regression models, controlling for number of AEDs, depression, and anxiety, assessed the relationship between subjective cognitive impairment and objective cognitive performance on measures of intelligence, attention/working memory, verbal fluency, naming, processing speed, manual dexterity, visuomotor processing, and verbal memory. RESULTS Forty percent of patients in the overall sample (N=270/670) reported cognitive impairment. The variables most strongly associated with subjective cognitive impairment were PHQ-9 score, number of AEDs, and seizure frequency. In the subset of patients with neuropsychological testing, ABNAS score was correlated with anxiety (r=0.44), depression (r=0.38), and attention/working memory (r=-0.31). After adjusting for depression and anxiety, patients who endorsed subjective cognitive impairment scored significantly lower on measures of nonverbal intelligence and attention/working memory, but not on other cognitive measures. CONCLUSIONS Subjective cognitive impairment as reported on the ABNAS is most strongly associated with depressive symptomatology, number of AEDs, and seizure frequency, but not with most objective cognitive measures. Identifying these three predictors provides a clear framework to understand and address subjective cognitive complaints in adult patients with epilepsy.
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Affiliation(s)
- Lauren Feldman
- Department of Neurology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robyn M Busch
- Department of Psychiatry and Psychology, Cleveland Clinic, 2070 East 90th Street, Cleveland, OH 44195, United States; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue S51, Cleveland, OH 44195, United States
| | - Jocelyn F Bautista
- Department of Neurology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue S51, Cleveland, OH 44195, United States.
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14
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Leenen LAM, Wijnen BFM, Kessels AGH, Chan H, de Kinderen RJA, Evers SMAA, van Heugten CM, Majoie MHJM. Effectiveness of a multicomponent self-management intervention for adults with epilepsy (ZMILE study): A randomized controlled trial. Epilepsy Behav 2018; 80:259-265. [PMID: 29449140 DOI: 10.1016/j.yebeh.2018.01.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of the ZMILE study was to compare the effectiveness of a multicomponent self-management intervention (MCI) with care as usual (CAU) in adult patients with epilepsy (PWE) over a six-month period. METHODS Participants (PWE & relative) were randomized into intervention or CAU groups. Self-report questionnaires were used to measure disease-specific self-efficacy as the primary outcome measure and general self-efficacy, adherence, seizure severity, emotional functioning, quality of life, proactive coping, and side-effects of antiepileptic drugs (AED) as secondary outcome measures. Instruments used at baseline and during a six-month follow-up period were the following: disease-specific self-efficacy (Epilepsy Self-Efficacy Scale [ESES], General Self-Efficacy Scale [GSES]); adherence (Medication Adherence Scale [MARS] and Medication Event Monitoring System [MEMS]); seizure severity (National Hospital Seizure Severity Scale [NHS3]); emotional well-being (Hospital Anxiety and Depression Scale [HADS]); quality of life (Quality of Life in Epilepsy [QOLIE-31P]); proactive coping (Utrecht Proactive Coping Competence [UPCC]); and side-effects of antiepileptic drugs [SIDAED]. Multilevel analyses were performed, and baseline differences were corrected by inclusion of covariates in the analyses. RESULTS In total, 102 PWE were included in the study, 52 of whom were in the intervention group. On the SIDAED and on three of the quality of life subscales QOLIE-31P, a significant difference was found (p<0.05) in the intervention group. Self-efficacy, however, showed no significant differences between the MCI and the CAU groups. None of the other outcome measures showed any significant difference between the two groups. SIGNIFICANCE Although we found no statistically significant difference in the primary outcome measure, disease-specific self-efficacy, this MCI could prove promising, since we found improvement in some domains of quality of life in epilepsy scale and a decrease in AED side-effects in the MCI group compared with the CAU group.
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Affiliation(s)
- Loes A M Leenen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; Department of Neurology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands.
| | - Ben F M Wijnen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands.
| | - Alfons G H Kessels
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands.
| | - HoiYau Chan
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands.
| | - Reina J A de Kinderen
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Silvia M A A Evers
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology and Neurosciences: Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands.
| | - Marian H J M Majoie
- Department of Research & Development, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; Department of Neurology, Academic Centre for Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands; School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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15
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Affiliation(s)
- Dorien van Blooijs
- Brain Center Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geertjan J M Huiskamp
- Brain Center Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frans S S Leijten
- Brain Center Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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16
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Elafros MA, Birbeck GL, Gardiner JC, Siddiqi OK, Sikazwe I, Paneth N, Bositis CM, Okulicz JF. Patient-Reported Adverse Effects Associated with Combination Antiretroviral Therapy and Coadministered Enzyme-Inducing Antiepileptic Drugs. Am J Trop Med Hyg 2017; 96:1505-1511. [PMID: 28719255 DOI: 10.4269/ajtmh.16-0107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AbstractConcurrent treatment with combination antiretroviral therapy (cART) and an enzyme-inducing antiepileptic drug (EI-AED) is common in resource-limited settings; however, the incidence and impact of adverse effects in cotreated patients is largely unknown. Symptoms of adverse effects were assessed by both spontaneous report and checklist for 145 human immunodeficiency virus (HIV)-infected Zambian adults initiating various treatment combinations, such as cART with an EI-AED (N = 20), cART only (N = 43), or neither drug (untreated; N = 82). At study baseline, the cART + EI-AED group reported more headache, generalized fatigue, problems with concentration, and depression than the untreated group (P < 0.01 for all). At 2 weeks, a greater proportion of cART + EI-AED participants reported increased nausea or vomiting compared with baseline (P < 0.05). Adverse effects did not appear to impact self-reported adherence at 2 weeks as 100% cART adherence was reported in 19 of 20 (95%) and 42 of 43 (98%) cART + EI-AED and cART-only participants, respectively; 100% EI-AED adherence was reported in 19 of 20 (95%) participants. However, adherence at 6 months was suboptimal in both groups with 18 of 33 (56%) participants on cART experiencing greater than 1-week lapse in pharmacy-reported medication supply. Our results highlight the need to educate patients about the increased potential for nausea and vomiting with cART + EI-AED cotreatment. Although adherence was high early during treatment, adherence should be reinforced overtime to minimize the potential for HIV and/or epilepsy treatment failure.
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Affiliation(s)
- Melissa A Elafros
- Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Gretchen L Birbeck
- Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia.,Department of Neurology, University of Rochester, Rochester, New York
| | - Joseph C Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Omar K Siddiqi
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.,Global Neurology Program, Division of Neuroimmunology, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | | | - Jason F Okulicz
- Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas
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17
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Wijnen BF, de Kinderen RJ, Lambrechts DA, Postulart D, Aldenkamp AP, Majoie MH, Evers SM. Long-term clinical outcomes and economic evaluation of the ketogenic diet versus care as usual in children and adolescents with intractable epilepsy. Epilepsy Res 2017; 132:91-99. [DOI: 10.1016/j.eplepsyres.2017.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/14/2017] [Accepted: 03/12/2017] [Indexed: 11/30/2022]
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18
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Lambrechts DAJE, de Kinderen RJA, Vles JSH, de Louw AJA, Aldenkamp AP, Majoie HJM. A randomized controlled trial of the ketogenic diet in refractory childhood epilepsy. Acta Neurol Scand 2017; 135:231-239. [PMID: 27027847 DOI: 10.1111/ane.12592] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the efficacy and tolerability of the ketogenic diet (KD) during the first 4 months of a randomized controlled trial (RCT) in refractory epilepsy patients aged 1-18 years. METHODS Children and adolescents with refractory epilepsy, not eligible for epilepsy surgery, were included. Following 1 month at baseline, patients were randomized to either the KD or to care as usual (CAU).Primary outcome is the proportion of patients with at least 50% reduction in seizure frequency at 4 months. Secondary outcomes are mean percentage of baseline seizures, seizure severity, and side effects. RESULTS Fifty-seven patients were randomized; nine dropped out, leaving 48 for analysis (i.e., 26 KD, 22 CAU). In an intention-to-treat analysis, 13 patients (50%) treated with the KD and four patients (18.2%) of the CAU group were responders.Mean seizure frequency at 4 months compared to baseline, after removal of two outliers in the KD group, was significantly lower (P = 0.024) in the KD group (56%) (95% CI: 36-76) than in the CAU group (99%) (95% CI: 65-133%).Twice as many patients in the KD group had a relevant decrease in seizure severity score (P = 0.070).Patients treated with the KD had a significantly higher score for gastrointestinal symptoms (P = 0.021) without an increase in the total score of side effects. CONCLUSIONS This trial provides class I evidence that the KD is an effective therapy in children and adolescents with refractory epilepsy compared with CAU. Most often reported side effects are gastrointestinal symptoms.The study has been registered with the Netherlands Trial Registry (NTR2498).
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Affiliation(s)
- D. A. J. E. Lambrechts
- Department of Neurology; Academic Center for Epileptology Kempenhaeghe & Maastricht UMC+; Heeze The Netherlands
| | - R. J. A. de Kinderen
- Research School of Mental Health & Neuroscience; Maastricht University; Maastricht The Netherlands
- Department of Health Services Research; CAPHRI School for Public Health & Primary Care; Maastricht University; Maastricht The Netherlands
- Department of Research & Development; Academic Center for Epileptology Kempenhaeghe & Maastricht UMC+; Heeze The Netherlands
| | - J. S. H. Vles
- Department of Neurology; Academic Center for Epileptology Kempenhaeghe & Maastricht UMC+; Heeze The Netherlands
- Research School of Mental Health & Neuroscience; Maastricht University; Maastricht The Netherlands
- Department of Neurology; Maastricht University Medical Center; Maastricht The Netherlands
| | - A. J. A. de Louw
- Department of Neurology; Academic Center for Epileptology Kempenhaeghe & Maastricht UMC+; Heeze The Netherlands
- Faculty of Electrical Engineering; University of Technology; Eindhoven The Netherlands
| | - A. P. Aldenkamp
- Research School of Mental Health & Neuroscience; Maastricht University; Maastricht The Netherlands
- Department of Neurology; Maastricht University Medical Center; Maastricht The Netherlands
- Faculty of Electrical Engineering; University of Technology; Eindhoven The Netherlands
- Department of Behavioral Sciences; Academic Center for Epileptology Kempenhaeghe & Maastricht UMC+; Heeze The Netherlands
| | - H. J. M. Majoie
- Department of Neurology; Academic Center for Epileptology Kempenhaeghe & Maastricht UMC+; Heeze The Netherlands
- Research School of Mental Health & Neuroscience; Maastricht University; Maastricht The Netherlands
- Department of Neurology; Maastricht University Medical Center; Maastricht The Netherlands
- Faculty of Health, Medicine and Life Sciences; School of Health Professions Education; Maastricht UMC+; Maastricht The Netherlands
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Liu JM, Xu RX, Hu YS, Ren LK, Qiao H, Ding H, Liu ZL. Chinese Internet Searches Provide Inaccurate and Misleading Information to Epilepsy Patients. Chin Med J (Engl) 2016; 128:3324-8. [PMID: 26668147 PMCID: PMC4797508 DOI: 10.4103/0366-6999.171425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Most patients with epilepsy want to learn as much as possible about the disease, and many have turned to the internet for information. Patients are likely to use information obtained from the internet to control their epilepsy, but little is known about the accuracy of this information. In this survey, we have assessed the feasibility and usability of internet-based interventions for the treatment of epilepsy. Methods: Data were collected from an internet search. Different search terms were used to obtain general information on epilepsy together with information about medication, types of epilepsy, treatment, women's health, and other information. The accuracy of the information was evaluated by a group of experts. Results: A total of 1320 web pages were assessed. The majority were websites related to health. A large number (80.2%) of web pages contained content related to the search term. A significant number of web pages 450/1058 (42.5%) claimed to provide information from a credible source; however, only 206/1058 (19.5%) of the information was accurate and complete; 326/1058 (30.8%) was accurate but incomplete; 328/1058 (31.0%) was correct but nonstandard, and 198/1058 (18.8%) was inaccurate. The authenticity of the information was not significantly different between the two search engines (χ2 = 0.009, P = 0.924). No significant difference was observed in the information obtained from a specialist or nonspecialist source (χ2 = 7.538, P = 0.057). There was also no correlation between the quality of the information and the priority (χ2 = 6.880, P = 0.076). Conclusions: Searching for information about epilepsy on the internet is convenient, but the information provided is not reliable. Too much information is inaccurate or for advertisement purposes, and it is difficult for patients to find the useful information. Turning to the internet for medical knowledge may be harmful. Physicians should be aware that their patients may search for information on the internet and guide them to safe, reputable websites.
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Affiliation(s)
| | - Ru-Xiang Xu
- Affiliated Bayi Brain Hospital, Bayi Clinical College, Southern Medical University, Beijing 100700, China
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20
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de la Loge C, Dimova S, Mueller K, Phillips G, Durgin TL, Wicks P, Borghs S. PatientsLikeMe® Online Epilepsy Community: Patient characteristics and predictors of poor health-related quality of life. Epilepsy Behav 2016; 63:20-8. [PMID: 27544877 DOI: 10.1016/j.yebeh.2016.07.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/06/2016] [Accepted: 07/24/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The online PatientsLikeMe® Epilepsy Community allows patients with epilepsy to record, monitor, and share their demographic, disease, and treatment characteristics, providing valuable insights into patient perceptions and understanding of epilepsy. The objective of this retrospective analysis was to characterize the profile of users and their disease and identify factors predictive of poor health-related quality of life (HRQoL), while assessing the platform's potential in providing patient-reported data for research purposes. METHODS Data recorded (January 2010-November 2011) by Epilepsy Community members, with an epilepsy diagnosis and who reported >1 seizure, included the following: sociodemographic and disease characteristics, treatments, symptoms, side effects perceived as medication-related, seizure occurrence, and standardized questionnaires (Quality of Life in Epilepsy Inventory [QOLIE-31/P], EuroQoL 5-Dimensions Scale, 3 Levels [EQ-5D-3L], and Hospital Anxiety and Depression Scale [HADS]). Univariate and multivariate logistic regressions were conducted to identify predictors of poor HRQoL. RESULTS During the study period, the Epilepsy Community comprised 3073 patients, of whom 71.5% were female, had a mean age of 37.8years, and had a mean epilepsy duration of 17.7years. The most frequently reported moderate/severe symptoms (n=2135) included memory problems (60.2%), problems concentrating (53.8%), and fatigue (50.0%). Medication-related side effects (n=639) included somnolence (23.2%), fatigue (17.2%), and memory impairment (13.8%). The QOLIE-31/P scores (n=1121) were significantly worse in patients who experienced a recent seizure. For QOLIE-31/P, highly predictive factors for poor HRQoL included the following: mild/moderate problems concentrating, depression, memory problems, treatment side effects, occurrence of tonic-clonic seizures, and epilepsy duration ≤1year. For EQ-5D-3L, highly predictive factors for poor HRQoL included the following: pain, depression, and comorbidities. Patients on newer AEDs were less likely to report poor HRQoL (QOLIE-31/P). SIGNIFICANCE These findings move further towards supporting the feasibility and usefulness of collecting real-world, anonymized data recorded by patients online. The data provide insights into factors impacting HRQoL, suggesting that a holistic treatment approach beyond seizure control should be considered in epilepsy.
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21
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Bermeo-Ovalle A. Do We Know What We Think We Know? Reconciling Subjective Complaints and Objective Cognitive Testing in Older Adults With Epilepsy. Epilepsy Curr 2016; 16:230-1. [PMID: 27582656 DOI: 10.5698/1535-7511-16.4.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Epilepsy impairs quality of life in physical, psychological, cognitive, social, and occupational domains. In people who are not seizure free, depression and adverse medication effects have a predominant role in determining quality of life. The assessment of these factors and other comorbidities is essential for maximizing quality of life in epilepsy. There are multiple tools available to assess medication effects and quality of life in a structured format. Such tools can provide superior assessments and allow clinicians to have a greater impact on their patients' quality of life.
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Affiliation(s)
- Benjamin N Blond
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA
| | - Kamil Detyniecki
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA
| | - Lawrence J Hirsch
- Department of Neurology, Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA.
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23
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Nijsse B, van Heugten CM, van Mierlo ML, Post MWM, de Kort PLM, Visser-Meily JMA. Psychological factors are associated with subjective cognitive complaints 2 months post-stroke. Neuropsychol Rehabil 2015. [PMID: 26207868 DOI: 10.1080/09602011.2015.1065280] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate which psychological factors are related to post-stroke subjective cognitive complaints, taking into account the influence of demographic and stroke-related characteristics, cognitive deficits and emotional problems. In this cross-sectional study, 350 patients were assessed at 2 months post-stroke, using the Checklist for Cognitive and Emotional consequences following stroke (CLCE-24) to identify cognitive complaints. Psychological factors were: proactive coping, passive coping, self-efficacy, optimism, pessimism, extraversion, and neuroticism. Associations between CLCE-24 cognition score and psychological factors, emotional problems (depressive symptoms and anxiety), cognitive deficits, and demographic and stroke characteristics were examined using Spearman correlations and multiple regression analyses. Results showed that 2 months post-stroke, 270 patients (68.4%) reported at least one cognitive complaint. Age, sex, presence of recurrent stroke(s), comorbidity, cognitive deficits, depressive symptoms, anxiety, and all psychological factors were significantly associated with the CLCE-24 cognition score in bivariate analyses. Multiple regression analysis showed that psychological factors explained 34.7% of the variance of cognitive complaints independently, and 8.5% (p < .001) after taking all other factors into account. Of all psychological factors, proactive coping was independently associated with cognitive complaints (p < .001), showing that more proactive coping related to less cognitive complaints. Because cognitive complaints are common after stroke and are associated with psychological factors, it is important to focus on these factors in rehabilitation programmes.
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Affiliation(s)
- Britta Nijsse
- a Department of Neurology , St Elisabeth Hospital , Tilburg , The Netherlands
| | - Caroline M van Heugten
- b Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience , Maastricht University , Maastricht , The Netherlands.,c Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience , Maastricht University , Maastricht , The Netherlands
| | - Marloes L van Mierlo
- d Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine , University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands
| | - Marcel W M Post
- d Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine , University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands
| | - Paul L M de Kort
- a Department of Neurology , St Elisabeth Hospital , Tilburg , The Netherlands
| | - Johanna M A Visser-Meily
- d Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine , University Medical Center Utrecht and De Hoogstraat Rehabilitation , Utrecht , The Netherlands
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24
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IJff DM, van Veenendaal TM, Majoie HJM, de Louw AJA, Jansen JFA, Aldenkamp AP. Cognitive effects of lacosamide as adjunctive therapy in refractory epilepsy. Acta Neurol Scand 2015; 131:347-54. [PMID: 25630655 DOI: 10.1111/ane.12372] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lacosamide (LCM) is a novel antiepileptic drug (AED) with potential benefit as adjunctive treatment in patients with partial-onset seizures. As yet, limited information on cognitive effects of LCM is available, especially in real-life settings. AIMS In this open clinical prospective study, the cognitive effects of LCM were evaluated when used as adjunctive antiepileptic therapy in patients with refractory epilepsy. METHODS We included 33 patients aged between 16 and 74 years (mean: 37 years). All patients had a localization-related epilepsy. Patients were assessed at baseline before starting LCM treatment and during follow-up when the optimal clinical dose was achieved. MATERIALS Subjective complaints were evaluated using the SIDAED; effects on cognition were evaluated using the computerized visual searching task (CVST). RESULTS The CVST showed significant faster information processing reaction times at the second evaluation (P = 0.013), which was not correlated with seizure control, type of epilepsy, age, gender, drug load, number of concomitant drugs, dose or duration of LCM treatment. On the SIDAED, patients complained more about their cognitive function at the second evaluation (P = 0.005). For the SIDAED, a positive correlation at follow-up was found between the total severity score and higher age (r = 0.375, P = 0.031), but not with epilepsy factors or treatment characteristics. DISCUSSION/CONLUSION Screening of the cognitive effects of LCM showed that LCM does not have negative effects on information processing speed. As this is the most sensitive function for cognitive side effects of AEDs, LCM does not seem to induce the common negative cognitive effects. Remarkably, patients complained more, especially about their cognitive function, which is possible the 'doing better, feeling worse phenomenon'.
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Affiliation(s)
- D. M. IJff
- Departments of Neurology and Neuropsychology Epilepsy Centre Kempenhaeghe; Heeze The Netherlands
- School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
| | - T. M. van Veenendaal
- School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - H. J. M. Majoie
- Departments of Neurology and Neuropsychology Epilepsy Centre Kempenhaeghe; Heeze The Netherlands
- School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
| | - A. J. A. de Louw
- Departments of Neurology and Neuropsychology Epilepsy Centre Kempenhaeghe; Heeze The Netherlands
| | - J. F. A. Jansen
- School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
- Department of Radiology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - A. P. Aldenkamp
- Departments of Neurology and Neuropsychology Epilepsy Centre Kempenhaeghe; Heeze The Netherlands
- School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
- Department of Neurology; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Neurology; Gent University Hospital; Gent Belgium
- Faculty of Electrical Engineering; University of Technology; Eindhoven The Netherlands
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Karkoska A, Hallmeyer-Elgner S, Berth H, Reichmann H, Schmitz-Peiffer H. Improving the assessment of everyday cognitive functioning in patients with epilepsy by means of proxy reports. Epilepsy Behav 2015; 44:55-8. [PMID: 25622023 DOI: 10.1016/j.yebeh.2014.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The self-report of cognitive deficits by of patients with epilepsy is often poorly correlated with objective test performances but highly related to mood and personality. The aim of this study was to evaluate whether information obtained by close relatives of the patient shows higher correlations with the patients' objective test scores and thereby can be a complementary measure for ensuring a reliable basis for diagnostic decision-making. METHODS Thirty-four patients and 29 relatives were asked to fill in a questionnaire about everyday cognitive deficits of the patient. All patients completed a neuropsychological test battery comprising measures of memory, attention, and executive functioning and questionnaires on anxiety, depression, and the personality trait neuroticism. RESULTS Correlations between relatives' reports and patients' test performances were highly significant across all examined domains. By contrast, self-reports of the patients significantly correlated with none of the neuropsychological measures of memory and with only a subset of the objective measures of attention and executive functioning. Regression analyses additionally revealed a strong dependency of the patients' self-assessment on depression, anxiety, and neuroticism (R(2)=0.42). CONCLUSIONS These results point out the risk of self-reports distorting reality and additionally recommend consulting a close relative of the patient to ensure reliable information about the patient's everyday cognitive functioning.
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Affiliation(s)
- Anne Karkoska
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
| | - Susanne Hallmeyer-Elgner
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
| | - Hendrik Berth
- Department of Medical Psychology and Medical Sociology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
| | - Henning Schmitz-Peiffer
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany.
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Leenen LA, Wijnen BF, de Kinderen RJ, Majoie MH, van Heugten CM, Evers SM. (Cost)-effectiveness of a multi-component intervention for adults with epilepsy: study protocol of a Dutch randomized controlled trial (ZMILE study). BMC Neurol 2014; 14:255. [PMID: 25540089 PMCID: PMC4301056 DOI: 10.1186/s12883-014-0255-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/17/2014] [Indexed: 11/23/2022] Open
Abstract
Background In patients with epilepsy, poor adherence to anti-epileptic drugs has been shown to be the most important cause of poorly controlled epilepsy. Furthermore, it has been noted that the quality of life among patients with epilepsy can be improved by counseling and treatments aimed at increasing their self-efficacy and concordance, thus stimulating self-management skills. However, there is a need for evidence on the effectiveness of such programs, especially within epilepsy care. Therefore, we have developed a multi-component intervention (MCI) which combines a self-management/education program with e-Health interventions. Accordingly, the overall objective of this study is to assess the (cost)-effectiveness and feasibility of the MCI, aiming to improve self-efficacy and concordance in patients with epilepsy. Methods A RCT in two parallel groups will be conducted to compare the MCI with a control condition in epilepsy patients. One hundred eligible epilepsy patients will be recruited and allocated to either the intervention or control group. The intervention group will receive the MCI consisting of a self-management/education program of six meetings, including e-Health interventions, and will be followed for 12 months. The control group will receive care as usual and will be followed for 6 months, after which patients will be offered the possibility of participating in the MCI. The study will consist of three parts: 1) a clinical effectiveness study, 2) a cost-effectiveness study, and 3) process evaluation. The primary outcome will be self-efficacy. Secondary outcomes include adherence, side effects, change in seizure severity & frequency, improved quality of life, proactive coping, and societal costs. Outcome assessments will be done using questionnaires at baseline and after 3, 6, 9, and 12 months (last two applicable only for intervention group). Discussion In times of budget constraints, MCI could be a valuable addition to the current healthcare provision for epilepsy, as it is expected that higher concordance and self-efficacy will result in reduced use of healthcare resources and an increased QOL. Accordingly, this study is aimed helping patients to be their own provider of health care, shifting epilepsy management from professionals to self-care by patients equipped with appropriate skills and tools. Trial registration number NTR4484.
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Affiliation(s)
- Loes Am Leenen
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands.
| | - Ben Fm Wijnen
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands.
| | - Reina Ja de Kinderen
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands.
| | - Marian Hjm Majoie
- Department of Research & Development, Epilepsy Centre Kempenhaeghe, Heeze, the Netherlands. .,Department of Neurology, Academic Centre for Epileptology, Epilepsy Centre Kempenhaeghe & Maastricht University Medical Centre, Maastricht, The Netherlands. .,MHENS, School for Mental Health and Neuroscience, department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Caroline M van Heugten
- MHENS, School for Mental Health and Neuroscience, department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands. .,Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands.
| | - Silvia Maa Evers
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Department of Health Services Research, Maastricht University, Duboisdomein 30, 6229 GT, Maastricht, the Netherlands. .,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
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de Kinderen RJ, Evers SM, Rinkens R, Postulart D, Vader CI, Majoie MH, Aldenkamp AP. Side-effects of antiepileptic drugs: The economic burden. Seizure 2014; 23:184-90. [DOI: 10.1016/j.seizure.2013.11.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 01/02/2023] Open
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Jordan S, Gabe M, Newson L, Snelgrove S, Panes G, Picek A, Russell IT, Dennis M. Medication monitoring for people with dementia in care homes: the feasibility and clinical impact of nurse-led monitoring. ScientificWorldJournal 2014; 2014:843621. [PMID: 24707218 PMCID: PMC3951004 DOI: 10.1155/2014/843621] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/06/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring. DESIGN Feasibility "before-and-after" intervention study. SETTING Three care homes in Wales. PARTICIPANTS Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine. INTERVENTION West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines. OUTCOME MEASURES (1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants' records before and after introduction of the profile, and one month later. RESULTS Nurses recruited and retained 11 of 29 eligible service users. The profile took 20-25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation. CONCLUSIONS Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.
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Affiliation(s)
- Sue Jordan
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Marie Gabe
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Louise Newson
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Sherrill Snelgrove
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Gerwyn Panes
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Aldo Picek
- Fieldbay Ltd., Chestnut House, Tawe Business Village, Swansea Enterprise Park, Swansea SA7 9LA, UK
| | - Ian T. Russell
- The College of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Michael Dennis
- The College of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK
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Liu J, Liu Z, Zhang Z, Dong S, Zhen Z, Man L, Xu R. Internet usage for health information by patients with epilepsy in China. Seizure 2013; 22:787-90. [DOI: 10.1016/j.seizure.2013.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 06/14/2013] [Accepted: 06/15/2013] [Indexed: 10/26/2022] Open
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Chmielewska B, Lis K, Rejdak K, Balcerzak M, Steinborn B. Pattern of adverse events of antiepileptic drugs: results of the aESCAPE study in Poland. Arch Med Sci 2013; 9:858-64. [PMID: 24273570 PMCID: PMC3832831 DOI: 10.5114/aoms.2013.38679] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 07/24/2011] [Accepted: 09/04/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Adverse Event Scale in Patients With Epilepsy (aESCAPE) European study (NCT00394927) explored and analyzed adverse events (AEs) and reasons for modifying treatment in patients treated with newer and older antiepileptic drugs (AEDs) used in monotherapy or polytherapy. The present analysis concerns the results of patients recruited in Poland. MATERIAL AND METHODS Multicentre, international, observational, cross-sectional study investigating AEs in patients with epilepsy (aged ≥ 4 years), on stable AED treatment with one or two AED(s) for ≥ 3 months, using standardized questionnaires completed by a physician during a single study visit. RESULTS Out of 309 patients, 24.6% were treated exclusively with newer AED(s) in monotherapy or in combination, while 75.4% were treated with older AED(s) or a combination of older and newer AED(s). 60.8% were on monotherapy, and 39.9% on polytherapy. In general, 73.8% of patients reported ≥ 1 AE(s). There were no significant differences in the frequency of reported AEs in compared groups. The most common were disturbances in cognitive function (40.5%), psychological problems (36.2%), and sedation (32.7%). Some AEs were found to be more specific for particular types and treatment regimens. Changes in treatment or dose during the study visit occurred in 22.3% of the patients, mainly due to lack of efficacy (10.7%), AEs (5.2%) or absence of seizures (4.5%). CONCLUSIONS A detailed structured interview revealed high frequency of AEs in patients treated with AEDs. The main reasons for treatment modifications at the study visit were lack of efficacy, adverse events and absence of seizures.
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Affiliation(s)
| | | | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, Lublin, Poland
| | | | - Barbara Steinborn
- Department of Developmental Neurology, Poznan University of Medical Sciences, Poznan, Poland
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Wassenaar M, Heijl I, Leijten FSS, Linden P, Uijl SG, Egberts ACG, Carpay JA. Treatment of epilepsy in daily clinical practice: have outcomes improved over the past 10 years? J Neurol 2013; 260:2736-43. [DOI: 10.1007/s00415-013-7058-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/03/2013] [Accepted: 07/18/2013] [Indexed: 12/31/2022]
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Abstract
Antiepileptic drugs (AEDs) are used by millions of people worldwide for the treatment of epilepsy, as well as in many other neurological and psychiatric conditions. They are frequently associated with adverse effects (AEs), which have an impact on the tolerability and success of treatment. Half the people who develop intolerable AEs discontinue treatment early on after initiation, while the majority of people will continue to be exposed to their effects for long periods of time. The long-term safety of AEDs reflects their potential for chronic, cumulative dose effects; rare, but potentially serious late idiosyncratic effects; late, dose-related effects; and delayed, teratogenic or neurodevelopmental effects. These AEs can affect every body system and are usually insidious. With the exception of delayed effects, most other late or chronic AEs are reversible. To date, there is no clear evidence of a carcinogenic effect of AEDs in humans. While physicians are aware of the long-term AEs of old AEDs (the traditional liver enzyme-inducing AEDs and valproate), information about AEs of new AEDs (such as lamotrigine, levetiracetam, oxcarbazepine, topiramate or zonisamide), particularly of their teratogenic effects, has emerged over the years. Sporadic publications have raised issues about AEs of the newer AEDs eslicarbazepine, retigabine, rufinamide, lacosamide and perampanel but their long-term safety profiles may take years to be fully appreciated. Physicians should not only be aware of the late and chronic AEs of AEDs but should systematically enquire and screen for these according to the individual AED AE profile. Care should be taken for individuals with comorbid conditions that may render them more susceptible to specific AEs. Prevention and appropriate management of long-term AED AEs is expected to improve adherence to treatment, quality of life and control of epilepsy.
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Nixon A, Kerr C, Breheny K, Wild D. Patient Reported Outcome (PRO) assessment in epilepsy: a review of epilepsy-specific PROs according to the Food and Drug Administration (FDA) regulatory requirements. Health Qual Life Outcomes 2013; 11:38. [PMID: 23497117 PMCID: PMC3606363 DOI: 10.1186/1477-7525-11-38] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022] Open
Abstract
Despite collection of patient reported outcome (PRO) data in clinical trials of antiepileptic drugs (AEDs), PRO results are not being routinely reported on European Medicines Agency (EMA) and Food and Drug Administration (FDA) product labels. This review aimed to evaluate epilepsy-specific PRO instruments against FDA regulatory standards for supporting label claims. Structured literature searches were conducted in Embase and Medline databases to identify epilepsy-specific PRO instruments. Only instruments that could potentially be impacted by pharmacological treatment, were completed by adults and had evidence of some validation work were selected for review. A total of 26 PROs were reviewed based on criteria developed from the FDA regulatory standards. The ability to meet these criteria was classified as either full, partial or no evidence, whereby partial reflected some evidence but not enough to comprehensively address the FDA regulatory standards. Most instruments provided partial evidence of content validity. Input from clinicians and literature was common although few involved patients in both item generation and cognitive debriefing. Construct validity was predominantly compromised by no evidence of a-priori hypotheses of expected relationships. Evidence for test-retest reliability and internal consistency was available for most PROs although few included complete results regarding all subscales and some failed to reach recommended thresholds. The ability to detect change and interpretation of change were not investigated in most instruments and no PROs had published evidence of a conceptual framework. The study concludes that none of the 26 have the full evidence required by the FDA to support a label claim, and all require further research to support their use as an endpoint. The Subjective Handicap of Epilepsy (SHE) and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) have the fewest gaps that would need to be addressed through additional research prior to any FDA regulatory submission, although the NDDI-E was designed as a screening tool and is therefore unlikely to be suitable as an instrument for capturing change in a clinical trial and the SHE lacks the conceptual focus on signs and symptoms favoured by the FDA.
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Affiliation(s)
- Annabel Nixon
- Oxford Outcomes, an ICON Plc. Company, Seacourt Tower, West Way, Oxford, OX2 0JJ, UK
| | - Cicely Kerr
- Oxford Outcomes, an ICON Plc. Company, Seacourt Tower, West Way, Oxford, OX2 0JJ, UK
| | - Katie Breheny
- Oxford Outcomes, an ICON Plc. Company, Seacourt Tower, West Way, Oxford, OX2 0JJ, UK
| | - Diane Wild
- Oxford Outcomes, an ICON Plc. Company, Seacourt Tower, West Way, Oxford, OX2 0JJ, UK
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Koo YS, Yang KS, Seok HY, Lee SK, Lee IK, Cho YW, Lee JH, Hwang H, Kim KJ, Jung KY. Characteristics of patients with epilepsy who use a website providing healthcare information about epilepsy in South Korea. Epilepsy Behav 2012; 25:156-61. [PMID: 23032122 DOI: 10.1016/j.yebeh.2012.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/01/2012] [Accepted: 06/03/2012] [Indexed: 11/22/2022]
Abstract
We studied characteristics of epilepsy patients who use 'Epilia', a healthcare website for epilepsy patients, and the impact of 'Epilia' on patient satisfaction and attitude about epilepsy. A total of 153 epilepsy patients from 'Epilia' (online group) and 367 patients from epilepsy clinics (offline group) were recruited. A survey was done to investigate their socio-demographic, epilepsy-related, and psychological characteristics, as well as attitude alterations after beginning to use 'Epilia'. Factors affecting attitude were also identified in the online group. Online group had more severe and more frequent seizures, more adverse effects, more anxiety and depression, and worse quality of life than offline group. Online group patients who are more satisfied, who take two or more antiepileptic drugs, who visit to 'Epilia' more and longer had a greater positive attitude change than those without these characteristics. A healthcare website can contribute to self-management by providing useful information and education for epilepsy patients.
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Abstract
More than 150 years after bromide was introduced as the first antiepileptic drug, adverse effects remain a leading cause of treatment failure and a major determinant of impaired health-related quality of life in people with epilepsy. Adverse effects can develop acutely or many years after starting treatment and can affect any organ or structure. In the past two decades, many efforts have been made to reduce the burden of antiepileptic drug toxicity. Several methods to screen and quantify adverse effects have been developed. Patient profiles associated with increased risk of specific adverse effects have been uncovered through advances in the areas of epidemiology and pharmacogenomics. Several new-generation antiepileptic drugs with improved tolerability profiles and reduced potential for drug interaction have been added to the therapeutic armamentarium. Overall, these advances have expanded the opportunities to tailor treatment with antiepileptic drugs, to enhance effectiveness and minimise the risk of toxic effects.
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Affiliation(s)
- Piero Perucca
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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Jarernsiripornkul N, Senacom P, Uchaipichat V, Chaipichit N, Krska J. Patient reporting of suspected adverse drug reactions to antiepileptic drugs: factors affecting attribution accuracy. Epilepsy Behav 2012; 24:102-6. [PMID: 22520583 DOI: 10.1016/j.yebeh.2012.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 03/16/2012] [Accepted: 03/16/2012] [Indexed: 11/16/2022]
Abstract
This study was aimed to assess the frequency and number of suspected ADRs reported by patients taking antiepileptic drugs (AEDs) and to explore the factors that may affect patients' symptom attribution accuracy. A validated questionnaire containing an extensively checklist of symptoms was distributed to outpatients prescribed one or more AEDs. Data on concomitant drugs and diseases were obtained from outpatient records. All symptoms identified were assessed for causality. Of 1388 questionnaires distributed to 1214 patients, 830 completed questionnaires were returned (59.8%) from 727 patients. In total, 7815 symptoms were identified on 757 questionnaires (91.2%). Symptom severity ratings were positively related to the number of symptoms reported (p=0.003). Causality assessment found that 71.9% of the symptoms were 'true' ADRs and 28.1% were 'false' ADRs. Attribution accuracy was primarily influenced by the number of symptoms identified and indication for AED therapy, fewer symptoms and use for non-epilepsy indications being associated with greater attribution accuracy.
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Affiliation(s)
- Narumol Jarernsiripornkul
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand.
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Cramer JA. Tolerability of antiepileptic drugs: can we determine differences? Epilepsy Behav 2012; 23:187-92. [PMID: 22366050 DOI: 10.1016/j.yebeh.2011.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 11/25/2011] [Accepted: 11/27/2011] [Indexed: 11/21/2022]
Abstract
Patient tolerability of adverse effects is integral to successful treatment. Although standard antiepileptic drugs (AEDs) are well tolerated by many patients, the promise of newer AEDs has been the potential for diminished burden of problems with similar seizure control. This report reviews the prevalence of systemic and neurological adverse effects reported in clinical trials of AED monotherapy. A central finding in this report was the unidirectional higher prevalence of selected adverse effects from standard compared with newer AEDs. A system of questioning every patient at every visit to elicit information may be helpful when balancing benefit-to-risk ratio of individualized therapy during everyday practice.
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Gauffin H, Flensner G, Landtblom AM. Living with epilepsy accompanied by cognitive difficulties: young adults' experiences. Epilepsy Behav 2011; 22:750-8. [PMID: 22019020 DOI: 10.1016/j.yebeh.2011.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/05/2011] [Accepted: 09/06/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Epilepsy can sometimes be followed by memory impairment. This can result from the underlying cause of epilepsy or from recurrent seizures, or can be a side effect of antiepileptic drugs or a symptom of another disease such as depression. The aim of the study described here was to explore the experience of living with epilepsy and subjective cognitive decline. METHOD To better understand the deeper meaning of the phenomenon, a qualitative design was chosen. Fourteen adults aged 18-35 took part in focus group interviews. The participants were divided into four groups, two groups of women and two groups of men, and the interviews were conducted according to a semistructured protocol. Transcripts were analyzed in accordance with the content analysis guidelines. RESULTS Four themes emerged: "affecting the whole person," "influencing daily life," "affecting relationships," and "meeting ignorance in society." CONCLUSIONS Cognitive decline has a heavy impact on young adults with intractable epilepsy. In contrast to seizures, the cognitive decline is persistent. The themes reflected different hardships faced by the participants. The consequences of living with epilepsy and cognitive impairment concerned education, employment, social life, self-esteem, and hope for the future. The participants were already using strategies to cope with their cognitive decline, but may benefit from help in developing new strategies to better adjust to their memory problems. Development of more educational programs for both people with epilepsy and their relatives could improve their difficult situations. With help, people can learn to adjust their goals in life and live a fulfilling life despite the disease.
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Affiliation(s)
- Helena Gauffin
- Division of Neurology, Medical Faculty/IKE, Linköping University, Sweden.
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Martins HH, Alonso NB, Vidal-Dourado M, Carbonel TD, de Araújo Filho GM, Caboclo LO, Yacubian EM, Guilhoto LM. Are adverse effects of antiepileptic drugs different in symptomatic partial and idiopathic generalized epilepsies? The Portuguese-Brazilian validation of the Liverpool Adverse Events Profile. Epilepsy Behav 2011; 22:511-7. [PMID: 21907625 DOI: 10.1016/j.yebeh.2011.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 08/03/2011] [Indexed: 11/28/2022]
Abstract
We report the results of administration of the Portuguese-Brazilian translation of the Liverpool Adverse Events Profile (LAEP) to 100 patients (mean age=34.5, SD=12.12; 56 females), 61 with symptomatic partial epilepsy (SPE) and 39 with idiopathic generalized epilepsy (IGE) (ILAE, 1989) who were on a stable antiepileptic drug (AED) regimen and being treated in a Brazilian tertiary epilepsy center. Carbamazepine was the most commonly used AED (43.0%), followed by valproic acid (32.0%). Two or more AEDs were used by 69.0% of patients. The mean LAEP score (19 questions) was 37.6 (SD=13.35). The most common adverse effects were sleepiness (35.0%), memory problems (35.0%), and difficulty in concentrating (25.0%). Higher LAEP scores were associated with polytherapy with three or more AEDs (P=0.005), female gender (P<0.001), older age (P<0.001), and uncontrolled seizures (P=0.045). The intraclass coefficient (test-retest reliability) for LAEP overall score was 0.848 (95% CI=0.782-0.895), with a range from 0.370 (unsteadiness) to 0.750 (memory problems). Cronbach's α coefficient (internal consistency) was 0.903. The LAEP was highly correlated with Quality of Life in Epilepsy-31 inventory (r=-0.804, P>0.001) and Hospital Anxiety and Depression Scale (Depression: r=0.637, P<0.001; Anxiety: r=0.621, P<0.001) dimensions. LAEP overall scores were similar in people with SPE and IGE and were not helpful in differentiating adverse effects in these two groups. Clinical variables that influenced global LAEP were seizure frequency (P=0.050) and generalized tonic-clonic seizures in the last month (P=0.031) in the IGE group, and polytherapy with three or more AEDs (P=0.003 and P=0.003) in both IGE and SPE groups.
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Affiliation(s)
- H H Martins
- Department of Neurology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Stern JM, Labiner DM, Gilliam FG, Penovich PE, Onofrey M, Eagan CA, Holmes GL. More effective assessment of adverse effects and comorbidities in epilepsy: results of a Phase II communication study. Epilepsy Behav 2011; 22:552-6. [PMID: 21967731 DOI: 10.1016/j.yebeh.2011.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/31/2011] [Accepted: 06/05/2011] [Indexed: 11/27/2022]
Abstract
Research was conducted to evaluate conversations about epilepsy between community-based neurologists and patients. Adverse effects of antiepileptic drugs and mood/behavioral issues were infrequently discussed, and neurologists and patients disagreed about these issues postvisit. Follow-up research was conducted to assess the impact of a previsit assessment tool on discussions of epilepsy. Twenty neurologists reviewed a tool incorporating questions from validated instruments (Adverse Events Profile [AEP] and Neurological Disorders Depression Inventory for Epilepsy [NDDI-E]). Naturally occurring interactions between neurologists and 60 patients were recorded. Neurologists and patients were interviewed separately. All components were transcribed and analyzed using sociolinguistics. Using the previsit assessment tool increased the number of discussions about adverse effects and mood/behavioral issues and increased neurologist-patient agreement about issues postvisit. Visit length did not increase significantly when the tool was used. Ten months after follow-up research, 50% of neurologists reported continuing to use the tool in everyday practice with patients with epilepsy.
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Affiliation(s)
- John M Stern
- Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Cramer JA, Steinborn B, Striano P, Hlinkova L, Bergmann A, Bacos I, Baukens C, Buyle S. Non-interventional surveillance study of adverse events in patients with epilepsy. Acta Neurol Scand 2011; 124:13-21. [PMID: 21039365 DOI: 10.1111/j.1600-0404.2010.01440.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Compare adverse events (AEs) in patients with epilepsy taking different antiepileptic drugs (AEDs) using standardized physician-completed questionnaires. MATERIALS AND METHODS Multicenter, observational, cross-sectional study in epilepsy patients aged ≥4 , stable on 1-2 AED(s) for ≥3 months. RESULTS One thousand and nineteen patients were evaluated: 28.7% took newer, 71.3% older (or older + newer) AED(s); 56.9% monotherapy; 43.1% polytherapy. Overall, 68.3% reported ≥1 AE (61.3% newer; 71.1% older AEDs), most commonly: cognitive function disturbances, sedation, psychological problems. Patients taking newer AEDs were significantly less likely to report ≥1 AE (OR [95% CI]: 0.64 [0.46-0.89], P = 0.008). Treatment/dose changed at study visit: 22.8% (17.5% newer; 24.9% older AEDs) because of (newer/older); lack of efficacy (6.2%/7.8%); AEs (4.1/8.4%); absence of seizures (3.8/4.0%). Patients receiving levetiracetam or lamotrigine were significantly less likely to report AEs/modify treatment. CONCLUSION Patients taking newer AEDs were significantly less likely to report AEs, although the non-randomized study design does not allow the lower rate of AEs to be attributed with certainty to the use of newer AEDs. A standardized AE questionnaire appeared useful for monitoring AEs/optimizing AED therapy.
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Affiliation(s)
- J A Cramer
- Yale University, Epilepsy Therapy Project, Houston, TX 77027-9310, USA.
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van Tuijl J, van Raak E, de Krom M, Lodder J, Aldenkamp A. Early treatment after stroke for the prevention of late epileptic seizures: A report on the problems performing a randomised placebo-controlled double-blind trial aimed at anti-epileptogenesis. Seizure 2011; 20:285-91. [DOI: 10.1016/j.seizure.2010.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 11/22/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022] Open
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Namazi S, Borhani-haghighi A, Karimzadeh I. Adverse Reactions to Antiepileptic Drugs in Epileptic Outpatients: A Cross-Sectional Study in Iran. Clin Neuropharmacol 2011; 34:79-83. [DOI: 10.1097/wnf.0b013e318210ece0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Weijenberg A, Offringa M, Brouwer OF, Callenbach PM. RCTs with new antiepileptic drugs in children: A systematic review of monotherapy studies and their methodology. Epilepsy Res 2010; 91:1-9. [DOI: 10.1016/j.eplepsyres.2010.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 06/17/2010] [Accepted: 07/04/2010] [Indexed: 12/18/2022]
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Lee JW, Dworetzky B. Rational Polytherapy with Antiepileptic Drugs. Pharmaceuticals (Basel) 2010; 3:2362-79. [PMID: 27713357 DOI: 10.3390/ph3082362] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 07/21/2010] [Accepted: 07/22/2010] [Indexed: 11/16/2022] Open
Abstract
Approximately 30-40% of patients do not achieve seizure control with a single antiepileptic drug (AED). With the advent of multiple AEDs in the past 15 years, rational polytherapy, the goal of finding combinations of AEDs that have favorable characteristics, has become of greater importance. We review the theoretical considerations based on AED mechanism of action, animal models, human studies in this field, and the challenges in finding such optimal combinations. Several case scenarios are presented, illustrating examples of rational polytherapy.
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Ben-Menachem E, Sander JW, Privitera M, Gilliam F. Measuring outcomes of treatment with antiepileptic drugs in clinical trials. Epilepsy Behav 2010; 18:24-30. [PMID: 20462803 DOI: 10.1016/j.yebeh.2010.04.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 03/31/2010] [Accepted: 04/04/2010] [Indexed: 11/30/2022]
Abstract
Epilepsy often requires life-long treatment with antiepileptic drugs (AEDs). For clinicians to meet the challenges of patient management, data on AED performance based on clearly defined and consistently applied outcome measures are needed. Ideally, the design of AED clinical trials should be relevant to real-world settings, providing reliable, valid, and comprehensive information on efficacy, tolerability, and quality of life (QOL). Several types of outcome parameters have been employed: percent seizure reduction, responder rate based on > or =50% seizure reduction, seizure-free rate, time to first seizure, time to Nth seizure, adverse events, QOL, retention, and compliance. Each provides important information about a drug's performance. Here we define and review endpoints for measuring AED treatment success and explore the concepts of efficacy, tolerability, QOL, retention, and compliance as well as their usefulness as clinical trial endpoints.
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Affiliation(s)
- Elinor Ben-Menachem
- Department of Clinical Neuroscience, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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Uijl SG, Uiterwaal CSPM, Aldenkamp AP, Carpay JA, Doelman JC, Keizer K, Vecht CJ, de Krom MCTFM, van Donselaar CA. Adjustment of treatment increases quality of life in patients with epilepsy: a randomized controlled pragmatic trial. Eur J Neurol 2009; 16:1173-7. [DOI: 10.1111/j.1468-1331.2009.02713.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gilliam F, Penovich PE, Eagan CA, Stern JM, Labiner DM, Onofrey M, Holmes GL, Mathis E, Cramer J. Conversations between community-based neurologists and patients with epilepsy: results of an observational linguistic study. Epilepsy Behav 2009; 16:315-20. [PMID: 19720567 DOI: 10.1016/j.yebeh.2009.07.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 07/24/2009] [Accepted: 07/26/2009] [Indexed: 01/01/2023]
Abstract
An in-office linguistic study was conducted to assess neurologist-patient discussions of epilepsy. Naturally occurring interactions among 20 neurologists and 60 of their patients with epilepsy were recorded. Participants were interviewed separately postvisit. Transcripts were analyzed using sociolinguistic techniques. Of 59 patients taking antiepileptic drugs previsit, 44 (75%) discussed side effects with their neurologist. Side effect discussions were most often neurologist initiated. Postvisit, patients and neurologists often disagreed about which side effects were experienced. The presence of a caregiver (e.g., spouse) usually resulted in lengthier, more detailed discussions of side effects, without drastically increasing overall visit length. Discussions of mood- and behavior-related comorbidities occurred infrequently (14 of 60 visits); postvisit, neurologists stated that they felt that management of these conditions was outside their area of expertise. Communication gaps observed in discussions of epilepsy and its treatment warrant further exploration. Additional research is currently underway to assess the efficacy of a previsit assessment tool.
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Affiliation(s)
- Frank Gilliam
- Comprehensive Epilepsy Center, Cornell University, New York, NY, USA
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Brodie MJ, Rosenfeld WE, Vazquez B, Sachdeo R, Perdomo C, Mann A, Arroyo S. Rufinamide for the adjunctive treatment of partial seizures in adults and adolescents: A randomized placebo-controlled trial. Epilepsia 2009; 50:1899-909. [DOI: 10.1111/j.1528-1167.2009.02160.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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