Addressing overtreatment in patients with refractory epilepsy at a tertiary referral centre in Brazil

Abstract

Background. Patients with refractory epilepsy often have impaired quality of life (QOL) as a consequence of seizures and adverse effects of antiepileptic drugs. We assessed the impact of adverse effects on QOL and the utility of a structured instrument to help the physician manage adverse effects in patients with refractory epilepsy. Methods. Clinical characteristics, drug treatment and adverse effects were evaluated in 102 patients with refractory epilepsy at a single tertiary referral centre. The Adverse Events Profile (AEP) and Quality of Life in Epilepsy-31 (QOLIE-31) questionnaires were completed at baseline and after six months. At baseline, patients with a high burden of adverse effects (AEP scores ≥45) were randomized to an intervention or control group. AEP scores in the intervention group were available to the physician as an instrument to help to reduce adverse effects. Results. Ninety-five patients (93.1%) were on polytherapy. Sixty-six completed the questionnaires and, of these, 43 (65.1%) had a high AE burden and were randomized to the intervention and control group. QOLIE-31 scores were inversely correlated with AEP scores at both visits. Among randomized patients, AEP scores tended to decrease between the baseline and the final visit without significant differences between groups (intervention group: 54.1 ± 6.1 vs 51.1 ± 9.1; control group: 55.8 ± 5.8 vs 50.5 ± 12.2). QOLIE-31 scores did not change substantially between visits (intervention group: 45.9 ± 17.4 vs 48.4 ± 14; control group: 47.5 ± 15.7 vs 45.2 ± 18.9). Conclusion. A significant proportion of patients had a high toxicity burden which had an impact on their QOL. Reduction of overtreatment is a difficult challenge which cannot be addressed solely by providing a structured assessment of adverse effects, but requires a more comprehensive approach aimed at optimizing the many components of the management strategy.

Drug‐resistant epilepsy and topiramate: Plasma concentration and frequency of epileptic seizures

“…The prevalence of patients in combination therapy found in this study is in agreement with other studies conducted with patients with drug‐resistant epilepsy, since one of the main strategies for the control of seizures in drug‐resistant epilepsy is the association of AEDs.…”

Efficacy and Tolerability of Antiepileptic Drugs in Patients with Focal Epilepsy: Systematic Review and Network Meta-analyses

“…In addition, this study did not evaluate the impact of AEDs on the quality of life of patients with epilepsy because there are few studies and they use different methodologies. It is noteworthy that the literature data showed that the higher the incidence of ARs due to AEDs, the lower is the quality of life of patients with epilepsy, thus emphasizing the importance of our presented data on the ranking of probability on the tolerability of AEDs (Figure ).…”

Epilepsy Care in the Time of COVID-19 Pandemic in Italy: Risk Factors for Seizure Worsening

“…With the aim of developing an efficient telemedicine program, the number of ASMs is a more objective parameter assess compared to seizure frequency [which is sometimes difficult to assess objectively and accurately by patients and caregivers (9)]. In addition, the number of ASMs may represent the expression of an overtreatment condition, where patients are taking unnecessary high doses of combination therapy (polypharmacy), and polytherapy-itself may increase side effects and lower adherence, inducing seizure worsening in a vicious circle (10,11). The analysis we conducted on sleep quality demonstrated that the reduction of sleep time and, generally, insomnia-related issues were the factors most influencing the reported sleep concerns.…”