https://orcid.org/0000-0002-9931-6421
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Abstract
Objective
Anti-epileptic drugs (AEDs) are the primary therapeutic modalities for epilepsy management. However, one-third of epileptic patients continue to experience seizure even with appropriate AED use. Patients with epilepsy are at increased risk for seizure-related injury and they have higher incidences of home, street and work accidents. There is a paucity of data on AED use pattern and treatment outcomes among patients with epilepsy in the tertiary hospitals of Ethiopia. Therefore, the aim of this study was to assess AED use pattern, treatment outcome, and prevalence of seizure-related injury among patients with epilepsy in Tikur Anbessa specialized Hospital (TASH), Ethiopia.
Patients and Methods
An institution-based cross-sectional study was carried out on 291 patients with epilepsy attending the neurology clinic of TASH. A semi-structured questionnaire and data abstraction format were used to collect data through patient interview and medical chart review. Binary logistic regression was utilized to identify the associated factors of treatment outcome.
Results
About 172 (59%) of the patients were taking a single AED, in which phenobarbital, 195 (67%), and phenytoin, 97 (33.3%), were the most frequently prescribed AEDs as monotherapy and combination therapy. Headache, depressed mood and epigastric pain were frequently reported as adverse drug reactions. Seizure-related injury was reported among 78 (26.8%) patients and head injury 15 (5.2%), desntal injury 15 (5.2%), soft tissue injury 14 (4.8%) and burns 10 (3.4%) were the commonest. About two-thirds (191, 65.6%) of the study participants had uncontrolled seizure. Medication adherence and multiple AEDs were significantly associated with treatment outcome.
Conclusion
All the study participants were put on old generation AEDs with phenobarbital being the most frequently used. About two-thirds of the patients had uncontrolled seizure and seizure-related injury is still a serious concern among patients with epilepsy.
Abbreviations
ADR, adverse drug reaction; AEDs, anti-epileptic drugs; AOR, adjusted odds ratio; CBZ, carbamazepine; CLZ, clonazepam; COR, crude odds ratio; GTCS, generalized tonic clonic seizure; ILAE, international league against epilepsy; LTG, lamotrigine; PHB, phenobarbital; PHT, phenytoin; TASH, Tikur Anbessa Specialized Hospital, VPA, valproic acid.
Data Sharing Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Ethics and Consent Statement
The study complied with the Declaration of Helsinki. A letter of ethical clearance was obtained from Addis Ababa University, College of Health Sciences, Institutional Review Board (AAU, CHS, IRB, protocol number = 002/17/SPharma). Written informed consent was obtained from each patient or parents/guardians for patients who were under 18 years to participate in the interview and to extract data from their medical charts. Privacy and confidentiality were ensured during patient interview and medical chart review.
Acknowledgments
The authors would like to thank all the study participants for their time and willingness to participate in the study. We would also like to extend our sincere gratitude to the data collectors, physicians, pharmacists and nurses working in the neurology department of TASH for their support throughout the study period.
Author Contributions
All authors made substantial contributions to conception and design, analysis and interpretation of data, took part in revising the article critically for important intellectual content, gave final approval of the version to be published and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.