Pattern of diagnostic and therapeutic care of childhood epilepsy in Alexandria, Egypt

Bassili, Amal; Omar, Tarek; Zaki, Ahmad; Abd-ELfattah, Mohamed; Tognoni, Gloria

doi:10.1093/intqhc/14.4.277

Cited by 22 publications

(28 citation statements)

References 24 publications

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“…The association between lower SES and epilepsy in developing countries was reported in several studies (Bassili et al, 2002), this was explained by poor hygienic conditions of labour in addition to a cumulative effect arising from other risk factors, such as infectious-contagious and parasitic diseases in the lower SES (Hesdorffer et al, 2005).…”

Section: Discussionmentioning

confidence: 87%

Epilepsy prevalence in Al-Manial Island, Egypt. A door-to-door survey

et al. 2015

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Section: Discussionmentioning

confidence: 87%

Epilepsy prevalence in Al-Manial Island, Egypt. A door-to-door survey

et al. 2015

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“…In adults with epilepsy, nonadherence has been associated with increased morbidity (eg, continued seizures), 4 elevated mortality, 5–8 and higher health care costs. 9 It remains unclear whether nonadherence in children has similar consequences since it is fundamentally different, including involvement of parents, siblings, and peers as well as developmental processes (eg, tantrums, puberty).…”

mentioning

confidence: 99%

Patterns of Nonadherence to Antiepileptic Drug Therapy in Children With Newly Diagnosed Epilepsy

Modi¹

2011

JAMA

218

220

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Context Because of epilepsy’s common occurrence, the narrow therapeutic and safety margins of antiepileptic medications, and the recognized complications of medication nonadherence in adults with epilepsy, identifying the rates, patterns, and predictors of nonadherence in children with epilepsy is imperative. The onset and evolution of antiepileptic drug nonadherence in children with newly diagnosed epilepsy remains unknown. Objectives To identify and characterize trajectories of adherence in children with newly diagnosed epilepsy over the first 6 months of therapy and to determine sociodemographic and epilepsy-specific predictors of adherence trajectories. Design, Setting, and Patients Prospective, longitudinal observational study of antiepileptic drug adherence in a consecutive cohort of 124 children (2–12 years old) with newly diagnosed epilepsy at Cincinnati Children’s Hospital Medical Center. Patients were recruited from April 2006 through March 2009, and final data collection occurred in September 2009. Main Outcome Measure Objective adherence measured using electronic monitors. Results Fifty-eight percent of children with newly diagnosed epilepsy demonstrated persistent nonadherence during the first 6 months of therapy. Group-based trajectory models identified 5 differential adherence patterns (Bayesian information criterion=−23611.8): severe early nonadherence (13%; 95% confidence interval [CI], 8%–20%), severe delayed nonadherence (7%; 95% CI, 3%–12%), moderate nonadherence (13%; 95% CI, 8%–20%), mild nonadherence (26%; 95% CI, 19%–34%), and near-perfect adherence (42%; 95% CI, 33%–50%). The adherence pattern of most patients was established by the first month of therapy. Socioeconomic status was the sole predictor of adherence trajectory group status (χ42=19.3 [n = 115]; P < .001; partial r2 = 0.25), with lower socioeconomic status associated with higher nonadherence. Conclusion Five trajectory patterns were identified that captured the spectrum of nonadherence to antiepileptic drugs among children with newly diagnosed epilepsy; the patterns were significantly associated with socioeconomic status.

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“…The over-reliance on clinical assessments as the sole diagnostic instrument for epileptic disorders observed in this study suggests that our practice lags way behind international recommendations. Although, clinical approaches can suffice in the diagnosis of epilepsy, the judicious use of EEG and neuro-imaging techniques can help improve the quality of epilepsy care [13] [18] [20] and facilitate the detection of those conditions that could be surgically corrected [32] [33]. The use of EEG in the diagnosis of seizures gives valuable information that may create value with respect to clinical diagnostic specification, classification of the epilepsy type, choice of future AED and recognition of structural brain lesions [34].…”

Section: Seizure Management Strategymentioning

confidence: 99%

“…Even when the seizures cannot be controlled completely, a reduction in their frequency and severity can contribute immensely to enhancing the patient's quality of life and general wellbeing [10] [11] [12]. The rational use of antiepileptic drugs in settings with limited resources necessitate the evaluation and audit of their prescribing patterns in relation to efficacy in seizure control and patient wellbeing enhancement [11] [13]. The assessment and monitoring of care quality is necessary for health system capacity-building, decision-making and policy actions [13] [14].…”

Section: Introductionmentioning

confidence: 99%

“…The rational use of antiepileptic drugs in settings with limited resources necessitate the evaluation and audit of their prescribing patterns in relation to efficacy in seizure control and patient wellbeing enhancement [11] [13]. The assessment and monitoring of care quality is necessary for health system capacity-building, decision-making and policy actions [13] [14]. The drug prescription patterns are related to drug availability, accessibility, and clinician preferences within a given locality.…”

Section: Introductionmentioning

confidence: 99%

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Anti-Epileptic Drug Prescription in a Psychiatric Hospital Outpatient Clinic in Southeast Nigeria

Achor¹,

Nwefoh²,

Ezeala-Adikaibe³

et al. 2017

OJPsych

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The optimum control of seizures requires adequate dosing of appropriately selected anti-epileptic medications. The availability of AEDs in Nigeria is limited and this constrains the prescription latitude of clinicians. This study was conducted to describe the prescribing pattern of anti-epileptic drugs in the outpatient service of a psychiatric facility in southeast Nigeria. The case records of the epileptic patients attending the outpatient clinic of a psychiatric hospital were retrieved, reviewed and data abstracted with a prepared proforma. The information extracted include age, sex, marital status, residence, type of seizure and anti-seizure medications prescribed, frequency of administration and dosage among other variables. Of the 178 patients whose prescriptions and case records were assessed, males constituted 62.9% and females 37.1%. Most of the patients were single (78.1%) and the group had a mean age of 25.6 ± 10.9 years. Generalized tonic-clonic seizures predominated (61.2%) among the seizure types, whilst complex partial seizure type was identified in 35.4% of the patients. Patient diagnosis relied heavily on the use of clinical description alone. About 92.7% of the patients were treated with monotherapy, whereas 7.3% received two anti-epileptic drug combinations. Carbamazepine was the most frequently prescribed drug, and was utilized in the treatment of 87.9% of patients receiving monotherapy and 92.3% of individuals receiving two drug combinations. Adjunctive medications like benzodiazepines were rarely utilised to improve the effect of the AEDs. The patients that received polytherapy could only be distinguished from those that received 295 Open Journal of Psychiatry monotherapy by higher frequency of epileptic auras and higher mean dose of AEDs per day. The predominant use of monotherapy is in accordance with the treatment recommendations and needs to be encouraged. The greater use of carbamazepine is probably related to its perceived benefits in the control of behavioural symptoms.

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Pattern of diagnostic and therapeutic care of childhood epilepsy in Alexandria, Egypt

Cited by 22 publications

References 24 publications

Epilepsy prevalence in Al-Manial Island, Egypt. A door-to-door survey

Epilepsy prevalence in Al-Manial Island, Egypt. A door-to-door survey

Patterns of Nonadherence to Antiepileptic Drug Therapy in Children With Newly Diagnosed Epilepsy

Anti-Epileptic Drug Prescription in a Psychiatric Hospital Outpatient Clinic in Southeast Nigeria

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