Epilepsy Treatment Outcome and Its Predictors among Ambulatory Patients with Epilepsy at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia

Abstract

Background. Epilepsy is among the most common neurological disorders which is highly treatable with currently available antiepileptic drugs at a reasonable price. In Ethiopia, despite a number of studies revealed high prevalence of epilepsy, little is known on predictors of poorly controlled seizures. us, the aim of this study was to assess epilepsy treatment outcome and its predictors among patients with epilepsy on follow-up at the ambulatory care unit of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia. Methods. A hospital-based cross-sectional study involving patient interview and chart review was conducted from March 10 to April 10, 2018. Drug use patterns and sociodemographic data of the study participants were accustomed to descriptive statistics. Backward logistic regression analysis was done to identify predictors of poor seizure control. Statistical significance was considered at p value <0.05. Results. From a total of 143 studied patients with epilepsy, 60.8% had uncontrolled seizures. Monotherapy (79%) was commonly used for the treatment of seizures, of which phenobarbital was the most commonly utilized single anticonvulsant drug (62.9%). e majority (72.7%) of the patients had developed one or more antiepileptic-related adverse effects. Medium medication adherence (adjusted odds ratio (AOR) � 5.4; 95% CI � 1.52-19.23; p � 0.009), poor medication adherence (AOR � 8.16; 95% CI � 3.04-21.90; p � 0.001), head injury before seizure occurrence (AOR � 4.9; 95% CI � 1. 25-19.27; p � 0.02), and seizure attacks ≥4 episodes/week before AEDs initiation (AOR � 8.52; % CI � 2.41-13.45; p � 0.001) were the predictors of uncontrolled seizure. Conclusions. Based on our findings, more than half of the patients with epilepsy had poorly controlled seizures. Nonadherence to antiepileptic drugs, high frequency of seizure attack before AEDs initiation, and history of a head injury before the occurrence of seizure were predictors of uncontrolled seizure. Patient medication adherence should be increased by the free access of antiepileptic drugs and attention should be given for the patients with a history of head injury and high frequency of seizure attacks before AEDs initiation.

Treatment Outcome of Epileptic Patients Receiving Antiepileptic Drugs in Ethiopia: A Systematic Review and Meta-Analysis

“…This may be explained in part by the fact that patients with higher 7 Behavioural Neurology seizure frequency can have a risk of head injury due to convulsion that triggers seizure [17]. It is ascertained that medication nonadherence was responsible for uncontrolled seizure [29,30,37]. The result of this meta-analysis also confirmed this conclusion by revealing that nonadherent participants were 2.23 times more likely to have uncontrolled Behavioural Neurology seizure compared to participants which adhered to their medication.…”

“…Twentythree primary studies were included in the present systematic review and meta-analysis. These studies were conducted in different parts of Ethiopia (from Amhara seven primary articles [7,[13][14][15][16][17][18], Oromiya eight [8,9,[19][20][21][22][23][24], Addis Ababa four [25][26][27][28], Tigray two [9,29], and Southern Nation, Nationalities, and People two articles) [30,31]. The sample size of the included primary studies was considerably variable ranging from 121 to 415 participants.…”

“…Regarding the seizurefree period, two studies assessed seizure freedom over one month [6,21], one study over two months [17], two studies over three months [7,14,25], and the remaining studies assessed seizure freedom over at least six months. Concerning the age groups, one study included only pediatric patients [7], two studies included all age group patients [13,19], and the remaining studies included only adult patients [6,8,9,[14][15][16][17][18][20][21][22][23][24][25][26][27][28][29][30][31]. Regarding the antiepileptic drugs, most of the patients were treated with monotherapy and the commonly used drugs were phenobarbitone, phenytoin, carbamazepine, and valproic acid [6-8, 17, 20, 26].…”

Seizure control and its associated factors among epileptic patients at Neurology Clinic, University of Gondar hospital, Northwest Ethiopia

“… 17 , 40 Two-thirds of patients with controlled seizure achieved seizure control with single ASM use, which was congruent with reports from other sub-Saharan African countries. 16 – 18 , 21 – 23 Several Western studies have shown that the response to the first ASM is the best predictor of long-term outcome. Seizures that continued despite adequate doses of an appropriate had a lower chance of subsequent seizure remission.…”

Experimental Therapeutic Strategies in Epilepsies Using Anti-Seizure Medications

“… 1 Despite significant therapeutic advances in the control of epileptic seizures, in 20–30% of patients, epileptic seizures are not well controlled, and patients who are controlled with medication(s) are not free from unwanted adverse effects and its various problems. 2 The symptoms of epilepsy fall in a wide range, of which some people with absence epilepsy stare for a few seconds during a seizure, while others with generalized epilepsies may experience tonic-clonic seizures. 3 Epilepsy is diagnosed based on history, physical examination, and paraclinical tests, in particular, electroencephalography (EEG).…”