Self-reported attitudes about medication in Lebanese people with epilepsy

Abstract

Background: Epilepsy is a common worldwide neurological disorder. For people with epilepsy, adherence and attitudes towards medication is a crucial step to improve efficacy of prescribed treatment and to prevent seizures.Objectives: The first aim of this study was to evaluate attitudes towards antiepileptic medications in Lebanese population. Secondary aims were to assess factors affecting attitudes and associated with epilepsy control.Material and Methods: A cross-sectional study was conducted in out-patients neurology clinics located in Beirut-Lebanon. Data was collected using a structured questionnaire. Self-report of medication taking behaviors were assessed using the abbreviated (4-items) Morisky Medication Adherence Scale (MMAS-4). Epilepsy was considered as controlled if the patient had no seizures in the last 6 months.Results: Among 250 people with epilepsy (PWE) recruited in this study, male-to-female ratio was 0.87 (116/134), and 50.8% were married. Mean duration of epilepsy was 13.7 ± 12.8 years. Valproate was the most common antiepileptic drug used followed by levetiracetam and carbamazepine. About 60.8% of the population presented partial epilepsy. Uncontrolled epilepsy was present in more than half of participants (55.2%), with only 32.4% had positive attitudes to their medication. Positive attitudes towards antiepileptic increased in people who found their treatment was efficacious (OR=4.9; 95%CI 1.2-20.0; p=0.03), who had controlled epilepsy (OR=3.4; 95%CI 1.6-7.1; p=0.001), and who were diagnosed as people with epilepsy between the age of 12-20 years (OR=3.1; 95%CI 1.1-8.4; p=0.03). Oppositely, these attitudes decreased in participants who felt their treatment as an economic burden (OR=0.2; 95%CI 0.1-0.4; p<0.001), and in depressive people (OR=0.4; 95%CI 0.2-0.9; p=0.04). Controlled epilepsy was higher in people who contacted a neurologist if seizure occurred, in people with positive attitudes, and after a long duration of disease, but it decreased if patient didn't follow neurologist's instructions in fasting period.Conclusions: Lebanese PWE were less likely to have positive attitudes towards medication, which may lead to poor epilepsy control. Depression and economic burden were the major factors decreased these attitudes. Identifying factors affecting attitudes to medication and leading to controlled epilepsy may help clinicians to elaborate educational programs to optimize medication adherence.

Management of epilepsy in Lebanon: Medication reviews and drug‐related problems

“…In addition, DRPs can be related to the behaviors of patients when they take less or more of the drug than prescribed or with inappropriate dosing intervals. In a previous study, positive attitudes towards ASDs in Lebanese PWE were lower, when the treatment was an economic burden, and in depressive people 14 …”

“…In some patients free of seizures, the feeling of being cured may lead to a cessation of treatment intake, leading to the occurrence of DRPs 18,43 . A previous study assessing the attitudes of Lebanese PWE towards their ASD, showed that some of them may stop their treatment in the seizure‐free period 14 …”

“…18,43 A previous study assessing the attitudes of Lebanese PWE towards their ASD, showed that some of them may stop their treatment in the seizure-free period. 14 Living in rural regions has been associated with low medication adherence in different countries. 44,45 Rural population tended to be older with more chronic diseases and multiple prescriptions in our study, which increases ASD-RPs.…”

“…In Lebanon, a study conducted among PWE found that only 32% of the patients were adherent to their treatment. 14 A study evaluated the DRPs of Lebanese patients in internal medicine, and showed that the main DRPs identified were DDIs (37%), over-dosage (28%), and nonconformity to guidelines or contra-indications (23%). 15 However, to date, an evaluation of ASD strategies and the identification of DRPs has not been perform in Lebanon.…”

“…The DRPs can be increased by a low adherence of PWE, by inappropriate choice and/or improper use of ASDs. In Lebanon, a study conducted among PWE found that only 32% of the patients were adherent to their treatment 14 . A study evaluated the DRPs of Lebanese patients in internal medicine, and showed that the main DRPs identified were DDIs (37%), over‐dosage (28%), and non‐conformity to guidelines or contra‐indications (23%) 15 .…”