Treatment response and predictors in patients with newly diagnosed epilepsy in Ethiopia: a retrospective cohort study

Gidey, Kidu; Chelkeba, Legesse; Gemechu, Tadesse Dukessa; Daba, Fekede Bekele

doi:10.1038/s41598-019-52574-y

Cited by 11 publications

(25 citation statements)

References 39 publications

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“… 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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Background: Epilepsy is characterized by two or more unprovoked recurrent seizures, which often respond to available antiseizure medications. However, seizure control among epileptic patients in the developing world is low. Factors determining seizure control among epileptic patients were not evidently explored in the study setting. Objectives: This study aimed to determine the magnitude of uncontrolled seizures and associated factors among epileptic patients at the University of Gondar hospital. Methods: This cross-sectional study was conducted at the University of Gondar hospital, Northwest Ethiopia. A convenience sampling method was used to recruit study subjects. Controlled seizure was defined as seizure freedom for the past 1 year. Logistic regression analysis was used to identify factors associated with seizure control. A p-value < 0.05 was used to declare a significant association. Results: A total of 320 study subjects were included in the study. The mean (±SD) age of patients was 27.5 ± 7.6 years. More than half (182/320, 57%) of epileptic patients had uncontrolled seizures. Five or more pretreatment seizure episodes (adjusted odds ratio = 3.98, 95% confidence interval: 1.81–8.75, p = 0.001), less than 2 years on anti-seizure medications (adjusted odds ratio = 8.64, 95% confidence interval: 3.27–22.85, p < 0.001), taking 2 or more ASMs (adjusted odds ratio = 2.48, 95% confidence interval: 1.23–5.02, p = 0.011), poor adherence to ASMs (adjusted odds ratio = 9.37, 95% confidence interval: 4.04–21.75, p < 0.001), and living at a single trip distance from hospital equaled 1 h or more (adjusted odds ratio = 4.20, 95% confidence interval: 2.11–8.41, p < 0.001) were significantly associated with uncontrolled seizures. Conclusion: The dose of a preferred anti-seizure medication should be optimized before combinations of anti-seizure medications are used. Adherence to anti-seizure medications should be reinforced for better seizure control. Epilepsy care should be integrated into primary health care services in the catchment region.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…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.…”

Section: 2mentioning

confidence: 99%

“…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].…”

Section: 2mentioning

confidence: 99%

“…In Ethiopia, there was discrepancy on the prevalence of controlled seizure among patients receiving antiepileptic drugs that ranges from 8% to 93.8% [6,7]. Poor treatment outcome can be due to nonadherence to antiepileptic drugs [8,9], and most patients rely on traditional treatments of epilepsy such as local herbs, holy water, and amulets [4]. The discrepancy of results between individual studies and the absence of systematic review on treatment outcome of epilepsy in Ethiopia warrants the need of systematic review which shows the pooled prevalence of controlled seizure among patients receiving antiepileptic drugs.…”

Section: Introductionmentioning

confidence: 99%

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

Yazie

Gelaw

Molla

2021

Behavioural Neurology

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Background. The prevalence and incidence rate of epilepsy were found to be higher in low- and middle-income countries. Uncontrolled epilepsy has a high risk of disability, stigma, discrimination, human rights violations, and premature death. The available studies of controlled seizure in Ethiopia have showed inconsistent results which calls for systematic review and meta-analysis. Therefore, this review intended to show the pooled prevalence of controlled seizure among people with epilepsy receiving antiepileptic drugs at outpatient department. Methods. A systematic literature search was conducted using PubMed/Medline, Science Direct, PsycINFO, Hinnarri databases, and Google Scholar for grey literatures. Data were extracted with structured format prepared using Microsoft Excel and exported to Stata/MP 16.0 software for analyses. The I 2 test was used to check the heterogeneity between primary studies with a corresponding 95% confidence interval (CI). Results. A total of 23 primary studies were included in the review showing the pooled prevalence of controlled seizure to be 46% (95% CI: 35, 56). A subgroup analysis of the primary studies showed a considerable variation in magnitude of seizure freedom by study regions, age groups, and seizure-free period. The highest prevalence was found in Addis Ababa 52% (95% CI: 29, 75), pediatric patients 77% (95% CI: 71, 83), and a seizure-free period of less than six months 58% (95% CI: 32, 83). On the other hand, the lowest prevalence of controlled seizure was found in Tigray 27% (95% CI: 11, 65), adult patients 43% (95% CI: 32, 54), and a seizure-free period of six or more 41% (95% CI: 32, 51). Higher frequency of seizure before treatment (2.23, 95% CI: 1.15, 3.31) and medication nonadherence (2.7, 95% CI: 1.25, 4.15) had statistically significant association with uncontrolled seizure. Conclusion. In this review, the prevalence of controlled seizure was found to be low. This warrants that clinicians should give more focus to epileptic patients regarding monitoring and evaluation of treatment outcome of epilepsy and factors that affect seizure control in routine clinical services. The use of standardized definition of controlled seizure, designing strategies to identify pharmacoresistant epilepsy and its treatment, and increasing medication adherence are recommended in Ethiopia. The review protocol has been registered with PROSPERO registration number CRD42021215302.

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“…Data published in the past few years have identified several risk factors related to the prognosis of adult epilepsy. Factors, such as the number of seizures before treatment, complex partial seizures, the etiology of abnormal brain structure, longer initial treatment time, depression, and abnormal brain imaging were related to the adverse treatment outcomes of epilepsy (3)(4)(5)(6)(7), but most of the studies were conducted in the whole or adult population. So far, few studies have explored the influencing factors of ASM on the treatment outcomes of elderly patients with new-onset epilepsy, especially in the Chinese population.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Characteristics of New-Onset Epilepsy in the Elderly and Risk Factors for Treatment Outcomes of Antiseizure Medications

Jing

Liu

et al. 2022

Front. Neurol.

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ObjectiveTo describe the clinical characteristics of elderly patients with new-onset epilepsy in a Class A tertiary comprehensive hospital in north China and evaluate the treatment outcomes of antiseizure medications (ASMs). This study focuses on investigating the factors affecting the treatment outcomes, guiding the drug treatment, and judging the prognosis of elderly epilepsy patients.MethodsWe included patients aged 60 years or older at the time of their first seizure between January 2014 and August 2020. Demographic characteristics, effects of ASM, and the proportion of 1-year and long-term seizure freedom were reported. The univariate analysis and binary logistic regression were used to identify factors potentially influencing treatment outcomes.ResultsA total of 326 patients (median age 65 years, 67.2% men) were included. Moreover, 185 (56.7%) patients who received the first ASM monotherapy achieved 1 year of seizure freedom in the early stage. Compared with structural etiology, unknown etiology was associated with a higher likelihood of early seizure freedom (odds ratio [OR] = 0.545; p < 0.05). Conversely, comorbid intracranial malignant tumors, taking carbamazepine (CBZ), and sodium valproate (VPA) were associated with a lower likelihood of seizure freedom (OR = 3.527 vs. 6.550 vs. 8.829; p < 0.05). At long-term follow-up, 263 (80.6%) patients achieved seizure freedom, with 79.8% on monotherapy.ConclusionsElderly patients with new-onset epilepsy responded well to the initial ASMs treatment. Patients with intracranial malignant tumors and prescribed VPA and CBZ were less likely to achieve early seizure freedom, while those with unknown etiology had higher probabilities of achieving early seizure freedom than those with structural etiology.

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Treatment response and predictors in patients with newly diagnosed epilepsy in Ethiopia: a retrospective cohort study

Cited by 11 publications

References 39 publications

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

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

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

The Clinical Characteristics of New-Onset Epilepsy in the Elderly and Risk Factors for Treatment Outcomes of Antiseizure Medications

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