Unveiling the Hidden Burden: Medication-Related Problems in Epilepsy and Their Impact on Seizure Control & Quality of Life
DOI:
https://doi.org/10.52783/jns.v14.1979Keywords:
Epilepsy, Medication-Related Problems, Seizure Control, Quality of Life, Antiepileptic Drugs, Non-Adherence, Adverse Drug Reactions, Drug-Drug Interactions, Polypharmacy, Pharmacist InterventionAbstract
Background: Epilepsy is a degenerative neurological disorder marked by recurrent seizures that substantially diminish patients' quality of life (QoL). Antiepileptic medicines (AEDs), the principal treatment modality, frequently lead to various drug-related issues (MRPs) such as non-adherence, adverse drug reactions (ADRs), drug-drug interactions (DDIs), and misdosing. These MRPs adversely affect therapy efficacy by compromising seizure management and quality of life. In Iraq, there is a paucity of published research on medication-related problems in epileptic patients, indicating significant opportunities for discovery.
Objective: To ascertain the frequency and prevalence of medication-related problems (MRPs) among epileptic patients in a clinical setting in Iraq, identify the factors contributing to MRPs, and evaluate their impact on seizure management and quality of life (QoL).
Methodology: This was a cross-sectional study conducted in Dhi Qar Governorate, Iraq, from September to December 2024. This study collected data from 97 patients via formal interviews and examination of medical records. They categorized MRPs as non-adherence, adverse drug reactions (ADRs), drug-drug interactions (DDIs), and dosage mistakes. We employed descriptive statistics and logistic regression models to analyze the prevalence, contributory factors, and impacts of MRPs on seizure control and quality of life (QoL).
Results: The most prevalent medication-related problems (MRPs) were non-adherence (40.2%), adverse drug reactions (ADRs) (29.9%), drug-drug interactions (DDIs) (24.7%), and dose errors (18.6%). Polypharmacy (OR: 2.5, p < 0.001), age over 50 years (OR: 1.8, p = 0.02), and low educational attainment were all significantly correlated with medication-related problems (MRPs). Patients with MRP had much lower ratings of seizure control—only 35.1% were able to control their seizures, compared to 64.9% of people in the uncontrolled or partially controlled group. The quality of life was also diminished in individuals with persistent medication-related problems.
Conclusion: Medication-related problems (MRPs) are prevalent among individuals with epilepsy and have substantial implications for seizure treatment and overall quality of life. The efficacy of treatment depends on the prevention of MRPs via pharmacist intervention, education, and oversight. Further study is required to determine specific strategies that can reduce MRPs and enhance epilepsy care in resource-limited environments.
Downloads
Metrics
References
A. Wahab, “Difficulties in Treatment and Management of Epilepsy and Challenges in New Drug Development,” Pharmaceuticals, vol. 3, no. 7. Multidisciplinary Digital Publishing Institute, p. 2090, Jul. 05, 2010. doi: 10.3390/ph3072090.
“Global burden of epilepsy and the need for coordinated action at the country level to address its health, social and public knowledge implications.” Feb. 2023. Accessed: Dec. 16, 2024. Online. Available: https://apps.who.int/iris/handle/10665/253249
M. Podell et al., “2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs,” Feb. 22, 2016, Wiley. doi: 10.1111/jvim.13841.
C. A. Hovinga, “Levetiracetam: A Novel Antiepileptic Drug,” Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy, vol. 21, no. 11. Wiley, p. 1375, Nov. 01, 2001. doi: 10.1592/phco.21.17.1375.34432.
A. B. Ettinger, R. Manjunath, S. D. Candrilli, and K. L. Davis, “Prevalence and cost of nonadherence to antiepileptic drugs in elderly patients with epilepsy,” Nov. 26, 2008, Elsevier BV. doi: 10.1016/j.yebeh.2008.10.021.
G. L. Krauss and M. R. Sperling, “Treating patients with medically resistant epilepsy,” Dec. 01, 2011, Lippincott Williams & Wilkins. doi: 10.1212/cpj.0b013e31823d07d1.
A. V. Alexopoulos, “Pharmacoresistant epilepsy: Definition and explanation,” Mar. 01, 2013, Elsevier BV. doi: 10.1016/j.epilep.2013.01.001.
K. Schwarz, A. Allam, N. A. P. Gonzalez, and M. Krauthammer, “AttentionDDI: Siamese Attention-based Deep Learning method for drug-drug interaction predictions,” Jan. 01, 2020, Cornell University. doi: 10.48550/arXiv.2012.
D. F. Weaver and B. Pohlmann‐Eden, “Pharmacoresistant epilepsy: Unmet needs in solving the puzzles.,” Epilepsia, vol. 54. Wiley, p. 80, May 01, 2013. doi: 10.1111/epi.12191.
B. Mesraoua et al., “Novel therapies for epilepsy in the pipeline,” Epilepsy & Behavior, vol. 97. Elsevier BV, p. 282, Jul. 06, 2019. doi: 10.1016/j.yebeh.2019.04.042.
Yvonne M Hart, “Epidemiology, natural history and classification of epilepsy.” Nov. 2023. Accessed: Dec. 16, 2024. Online.. Available: https://medicinejournal.co.uk/retrieve/pii/S1357303912001296
M. Matias, A. O. Santos, S. Silvestre, and G. Alves, “Fighting Epilepsy with Nanomedicines—Is This the Right Weapon?,” Pharmaceutics, vol. 15, no. 2. Multidisciplinary Digital Publishing Institute, p. 306, Jan. 17, 2023. doi: 10.3390/pharmaceutics15020306.
S. A. Awan, I. Khawaja, M. A. Babar, and F. Khan, “Prevalence of Non-adherence to Antiepileptic Drugs in Patients With Epilepsy Presenting to Emergency With Fits,” Jul. 20, 2022, Cureus, Inc. doi: 10.7759/cureus.27072.
R. AlAjmi, S. Al-Aqeel, and S. Baz, “The impact of a pharmacist-led educational interview on medication adherence of Saudi patients with epilepsy,” May 01, 2017, Dove Medical Press. doi: 10.2147/ppa.s124028.
B. E. Gidal, P. Klein, and L. J. Hirsch, “Seizure clusters, rescue treatments, seizure action plans: Unmet needs and emerging formulations,” Epilepsy & Behavior, vol. 112. Elsevier BV, p. 107391, Sep. 06, 2020. doi: 10.1016/j.yebeh.2020.107391.
Y. Babu and B. S. Senbeta, “Pattern of anti-epileptic medications nonadherence and associated factors at ambulatory clinic of Jimma Medical Center, Southwestern Ethiopia: A prospective observational study,” Jan. 01, 2023, SAGE Publishing. doi: 10.1177/20503121231160817.
O. Henning, C. J. Landmark, K. O. Nakken, and M. I. Lossius, “Nonadherence to treatment regimens in epilepsy from the patient’s perspective and predisposing factors: Differences between intentional and unintentional lack of adherence,” Apr. 13, 2019, Wiley. doi: 10.1111/epi.14734.
C. Samsonsen, A. Reimers, G. Bråthen, G. Helde, and E. Brodtkorb, “Nonadherence to treatment causing acute hospitalizations in people with epilepsy: An observational, prospective study,” Sep. 23, 2014, Wiley. doi: 10.1111/epi.12801.
J. L. Bainbridge and C. Y. Oh, “Antiepileptic Drug Adverse Effects.” Nov. 2023. Accessed: Dec. 16, 2024. Online). Available: https://onlinelibrary.wiley.com/doi/10.1002/9781118456989.ch12
D. C. Grabowski, J. Fishman, I. Wild, and B. Lavin, “Changing the neurology policy landscape in the United States: Misconceptions and facts about epilepsy,” May 26, 2018, Elsevier BV. doi: 10.1016/j.healthpol.2018.05.012.
A. V. Dmitriev et al., “In Silico Prediction of Drug–Drug Interactions Mediated by Cytochrome P450 Isoforms,” Apr. 13, 2021, Multidisciplinary Digital Publishing Institute. doi: 10.3390/pharmaceutics13040538.
G. Zaccara, E. Gualdani, L. Policardo, P. Palumbo, and P. Francesconi, “Frequency of drug combinations between enzyme-inducing first-generation antiepileptic drugs and inducible drugs in patients with epilepsy,” Aug. 18, 2018, Elsevier BV. doi: 10.1016/j.yebeh.2018.08.004.
K. Ballaban-Gil and J. A. French, “SELECTION OF ANTIEPILEPTIC DRUGS.” Nov. 2023. Accessed: Dec. 16, 2024. Online). Available: https://journals.lww.com/00132979-200408000-00006
M. Ułamek-Kozioł, S. J. Czuczwar, S. Januszewski, and R. Pluta, “Ketogenic Diet and Epilepsy,” Nutrients, vol. 11, no. 10. Multidisciplinary Digital Publishing Institute, p. 2510, Oct. 18, 2019. doi: 10.3390/nu11102510.
R. Tariq, R. Vashisht, A. Sinha, and Y. Scherbak, “Medication Dispensing Errors And Prevention,” Jul. 25, 2021. Accessed: Dec. 2024. Online). Available: https://europepmc.org/article/MED/30085607
A. Mair, M. Wilson, and T. Dreischulte, “Addressing the Challenge of Polypharmacy,” The Annual Review of Pharmacology and Toxicology, vol. 60, no. 1. Annual Reviews, p. 661, Oct. 07, 2019. doi: 10.1146/annurev-pharmtox-010919-023508.
M. Molokhia and A. Majeed, “Current and future perspectives on the management of polypharmacy,” Jun. 06, 2017, Springer Science+Business Media. doi: 10.1186/s12875-017-0642-0.
N. Masnoon, S. Shakib, L. M. K. Ellett, and G. E. Caughey, “What is polypharmacy? A systematic review of definitions,” BMC Geriatrics, vol. 17, no. 1. BioMed Central, Oct. 10, 2017. doi: 10.1186/s12877-017-0621-2.
C. Gallagher et al., “Polypharmacy and health outcomes in atrial fibrillation: a systematic review and meta-analysis,” Open Heart, vol. 7, no. 1. BMJ, Apr. 01, 2020. doi: 10.1136/openhrt-2020-001257.
D. Keine, M. C. Zelek, J. Q. Walker, and M. N. Sabbagh, “Polypharmacy in an Elderly Population: Enhancing Medication Management Through the Use of Clinical Decision Support Software Platforms,” Mar. 21, 2019, Adis, Springer Healthcare. doi: 10.1007/s40120-019-0131-6.
K. W. K. Tang, B. C. Millar, and J. E. Moore, “Antimicrobial Resistance AMR),” British Journal of Biomedical Science, vol. 80. Taylor & Francis, Jun. 28, 2023. doi: 10.3389/bjbs.2023.11387.
F. Bekele and W. Gezimu, “Treatment outcome and associated factors among epileptic patients at ambulatory clinic of Mettu Karl Comprehensive Specialized Hospital: A cross-sectional study,” Jan. 01, 2022, SAGE Publishing. doi: 10.1177/20503121221125149.
J. Engel, “Approaches to refractory epilepsy,” Jan. 01, 2014, Medknow. doi: 10.4103/0972-2327.128644.
W. Boling, M. Means, and A. Fletcher, “Quality of Life and Stigma in Epilepsy, Perspectives from Selected Regions of Asia and Sub-Saharan Africa,” Brain Sciences, vol. 8, no. 4. Multidisciplinary Digital Publishing Institute, p. 59, Apr. 01, 2018. doi: 10.3390/brainsci8040059.
F. Tang, A. M. S. Hartz, and B. Bauer, “Drug-Resistant Epilepsy: Multiple Hypotheses, Few Answers,” Frontiers in Neurology, vol. 8. Frontiers Media, Jul. 06, 2017. doi: 10.3389/fneur.2017.00301.
S. Healy, T. A. Fantaneanu, and S. Whiting, “The importance of mental health in improving quality of life in transition-aged patients with epilepsy,” Jul. 25, 2020, Elsevier BV. doi: 10.1016/j.yebeh.2020.107324.
A. W. Martin, A. P. Heberle, and J. M. Knight, “Interventions associated with implementation of a pharmacist‐led neurology pharmacotherapy clinic in an ambulatory care setting,” Sep. 19, 2018, Wiley. doi: 10.1002/jac5.1039.
P. S. Flanagan and A. Barns, “Current perspectives on pharmacist home visits: do we keep reinventing the wheel?,” Integrated Pharmacy Research and Practice. Dove Medical Press, p. 141, Sep. 30, 2018. doi: 10.2147/iprp.s148266.
D. T. Gold and B. McClung, “Approaches to Patient Education: Emphasizing the Long-Term Value of Compliance and Persistence,” The American Journal of Medicine, vol. 119, no. 4. Elsevier BV, Mar. 25, 2006. doi: 10.1016/j.amjmed.2005.12.021.
K. Santo, S. Richtering, J. Chalmers, A. Thiagalingam, C. K. Chow, and J. Redfern, “Mobile Phone Apps to Improve Medication Adherence: A Systematic Stepwise Process to Identify High-Quality Apps,” Dec. 02, 2016, JMIR Publications. doi: 10.2196/mhealth.6742.
R. S. Mickelson and R. J. Holden, “Medication adherence: staying within the boundaries of safety,” Apr. 10, 2017, Taylor & Francis. doi: 10.1080/00140139.2017.1301574.
E. Faught, J. Weiner, A. Guérin, M. Cunnington, and M. S. Duh, “Impact of nonadherence to antiepileptic drugs on health care utilization and costs: Findings from the RANSOM study,” Oct. 06, 2008, Wiley. doi: 10.1111/j.1528-1167.2008.01794.x.
P. Ryvlin, E. Perucca, and S. Rheims, “Pregabalin for the management of partial epilepsy,” Nov. 01, 2008, Dove Medical Press. doi: 10.2147/ndt.s4716.
P. N. Patsalos and E. Perucca, “Clinically important drug interactions in epilepsy: general features and interactions between antiepileptic drugs,” The Lancet Neurology, vol. 2, no. 6. Elsevier BV, p. 347, May 28, 2003. doi: 10.1016/s1474-442203)00409-5.
S. K. Ramasubbu, S. K. Mahato, A. Agnihotri, R. Pasricha, U. K. Nath, and B. Das, “Prevalence, severity, and nature of risk factors associated with drug-drug interactions in geriatric patients receiving cancer chemotherapy: A prospective study in a tertiary care teaching hospital,” Dec. 12, 2020, Elsevier BV. doi: 10.1016/j.ctarc.2020.100277.
J. A. Cramer, S. Mintzer, J. W. Wheless, and R. H. Mattson, “Adverse effects of antiepileptic drugs: a brief overview of important issues,” Expert Review of Neurotherapeutics, vol. 10, no. 6. Taylor & Francis, p. 885, Jun. 01, 2010. doi: 10.1586/ern.10.71.
T. S. Lesar, “Tenfold Medication Dose Prescribing Errors,” Dec. 01, 2002, SAGE Publishing. doi: 10.1345/aph.1c032.
S. W. Terman et al., “Polypharmacy in patients with epilepsy: A nationally representative cross-sectional study,” Jul. 03, 2020, Elsevier BV. doi: 10.1016/j.yebeh.2020.107261.
A. K. Sharma, E. Rani, A. Waheed, and S. K. Rajput, “Pharmacoresistant Epilepsy: A Current Update on Non-Conventional Pharmacological and Non-Pharmacological Interventions,” Journal of Epilepsy Research, vol. 5, no. 1. p. 1, Jun. 29, 2015. doi: 10.14581/jer.15001.
R. Manjunath, K. L. Davis, S. D. Candrilli, and A. B. Ettinger, “Association of antiepileptic drug nonadherence with risk of seizures in adults with epilepsy,” Jan. 05, 2009, Elsevier BV. doi: 10.1016/j.yebeh.2008.12.006.
N. Buchanan, “Noncompliance with medication amongst persons attending a tertiary referral epilepsy clinic: implications, management and outcome,” Mar. 01, 1993, Elsevier BV. doi: 10.1016/s1059-131105)80107-4.
S. Kumar, S. C. Sarangi, M. Tripathi, and Y. K. Gupta, “Evaluation of adverse drug reaction profile of antiepileptic drugs in persons with epilepsy: A cross-sectional study,” Feb. 25, 2020, Elsevier BV. doi: 10.1016/j.yebeh.2020.106947.
E. K. St. Louis, “Minimizing AED Adverse Effects: Improving Quality of Life in the Interictal State in Epilepsy Care,” Jun. 01, 2009, Bentham Science Publishers. doi: 10.2174/157015909788848857.
S. Sarkar, “Psychiatric Polypharmacy, Etiology and Potential Consequences,” Dec. 08, 2016, Bentham Science Publishers. doi: 10.2174/2211556005666160916124719.
A.-H. R. Seiam, H. Dhaliwal, and S. Wiebe, “Determinants of quality of life after epilepsy surgery: Systematic review and evidence summary,” Epilepsy & Behavior, vol. 21, no. 4. Elsevier BV, p. 441, Jun. 27, 2011. doi: 10.1016/j.yebeh.2011.05.005.
P. Ioannou et al., “The burden of epilepsy and unmet need in people with focal seizures,” Brain and Behavior, vol. 12, no. 9. Wiley, Aug. 26, 2022. doi: 10.1002/brb3.2589.
A. Corsonello, C. Pedone, and R. A. Incalzi, “Age-Related Pharmacokinetic and Pharmacodynamic Changes and Related Risk of Adverse Drug Reactions,” Current Medicinal Chemistry, vol. 17, no. 6. Bentham Science Publishers, p. 571, Jan. 18, 2010. doi: 10.2174/092986710790416326.
G. Paolella, A. Boyd, S. Wirth, S. Cuéllar, N. K. Venepalli, and S. Y. Crawford, “Adherence to Oral Anticancer Medications: Evolving Interprofessional Roles and Pharmacist Workforce Considerations,” Mar. 08, 2018, Multidisciplinary Digital Publishing Institute. doi: 10.3390/pharmacy6010023.
W. R. Garnett, “Antiepileptic Drug Treatment: Outcomes and Adherence,” Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy, vol. 20, no. 8. Wiley, Aug. 01, 2000. doi: 10.1592/phco.20.12.191s.35250.
R. O. Day, L. R. Snowden, and A. J. McLachlan, “Life‐threatening drug interactions: what the physician needs to know,” Internal Medicine Journal, vol. 47, no. 5. Wiley, p. 501, May 01, 2017. doi: 10.1111/imj.13404.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
