An evaluation of factors affecting adherence to antiepileptic drugs in patients with epilepsy: a cross-sectional study

<p><b>INTRODUCTION</b>Adherence to antiepileptic drug (AED) therapy is important for controlling seizures in patients with epilepsy (PWE). It is vital to identify the factors influencing adherence to AED therapy using validated tools. This study aimed to evaluate the pattern and extent of AED adherence among PWE and to identify the factors that influence adherence.</p><p><b>METHODS</b>This was a cross-sectional study involving PWE who had a confirmed diagnosis. Treatment adherence was assessed using the four-item Morisky Medication Adherence Scale. Univariate analysis with chi-square test was used to observe the association between different variables and AED adherence. Binary logistic regression analysis was used to identify the predictors of adherence.</p><p><b>RESULTS</b>451 PWE (mean age 27.3 ± 8.1 years) were enrolled in the study; 251 (55.7%) were male and 198 (43.9%) were from the lower socioeconomic class. 326 (72.3%) patients had high adherence to AED therapy, while 125 (27.7%) had low adherence. AED adherence was significantly associated with socioeconomic status (p = 0.043) and type of epilepsy (p = 0.033). However, no significant difference was observed between adherence and age, gender, marital status, epilepsy duration, number and type of AEDs, and occurrence of adverse drug reactions. Patients with focal epilepsy and those from the middle/lower-middle socioeconomic classes were less likely to be nonadherent. The primary reason for nonadherence was forgetfulness.</p><p><b>CONCLUSION</b>This study found that a majority of PWE have optimal rates of AED adherence and that forgetfulness is the primary reason for nonadherence among PWE.</p>

Factors influencing adherence to anti-craving medications and drinking outcomes in patients with alcohol dependence: A hospital-based study.

OBJECTIVE: To examine the factors influencing the pattern and extent of anti-craving medication adherence and drinking outcomes in alcohol-dependent patients. MATERIALS AND METHODS: Demographic data from 102 inpatients were collected at discharge from hospital. The pattern of anti-craving medication, extent of adherence, and drinking outcome was collected at 1(st), 3(rd), 8(th), and 12(th) week follow-up. Patients' self-reported adherence, medication diary, and simplified medication adherence questionnaire were used and data were analyzed using SPSS. RESULTS: Majority (99%) were male patients with a mean age of 41.17 ± 9.86 years and 70% belonged to middle socioeconomic status. There was a decrease in the number of patients coming for follow-up over time from 99.01% to 77.45% on day 90. Acamprosate was used in 74% and naltrexone and disulfiram in 7% of patients each. A significant reduction in adherence to acamprosate and naltrexone (P < 0.001) was associated with simultaneous decrease in days to alcohol abstinence and increase in relapse rate compared to adherent group (P < 0.001). Main barriers to adherence included younger age (odds ratio = 1.05 95% [1.01-1.09]; P < 0.01), self-decision, emotional factors, and adverse effects. CONCLUSIONS: The study demonstrated the need for safer therapeutic options along with suitable intervention at grass root level for sustenance of adherence to anti-craving medication among young adults to prevent relapse and achieve near-complete abstinence from alcohol dependence.

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013.

BACKGROUND: The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. METHODS: Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. RESULTS: In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. CONCLUSIONS: Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

Antiepileptic Drugs and Quality of Life in Patients with Epilepsy: A Tertiary Care Hospital-Based Study.

OBJECTIVES: The present study evaluated patterns of the use of antiepileptic drugs (AEDs) and their impact on quality of life (QOL) in patients with epilepsy. METHODS: In this cross-sectional study, patients with epilepsy (age >18 years) receiving AEDs for at least 1 year were enrolled. Demographic, clinical, and treatment parameters were recorded. QOL was measured using the modified Quality of Life in Epilepsy Inventory-10 (QOLIE-10) questionnaire for epilepsy. RESULTS: Of 200 patients, 53.5% were males and 60% were younger than 30 years. Seizures were predominantly partial (58%) and of idiopathic origin (61%). Monotherapy to polytherapy ratio was 1:1, with 70% of the patients on one new AED. Clobazam (37%) was used most frequently followed by phenytoin (25.5%), levetiracetam (23%), oxcarbazepine (21.5%), and carbamazepine (21%). Patients on polytherapy experienced a significantly more number of adverse drug reactions than did those on monotherapy (P < 0.0001). The mean QOLIE-10 score was 74.58 ± 20.60. There was no significant difference in seizure frequency, number of adverse drug reactions, and QOLIE-10 score among patients receiving old and new AEDs. Multiple linear regression analysis identified increased seizure frequency (standardized ß -0.157; P = 0.003), more number of AEDs (standardized ß 0.107; P = 0.05) as well as adverse drug reactions (standardized ß -0.692; P = 0.0001) as significant predictors of poor QOL. CONCLUSIONS: Appropriate tools for early detection, selection of rational and safer AED treatment options, and regular monitoring for adverse effects play a crucial role in achieving seizure freedom and optimal QOL in patients with epilepsy.

The sociodemographic, clinical and pharmacotherapy characteristics influencing quality of life in patients with epilepsy: A cross-sectional study.

CONTEXT: Quality of life (QOL) assessment in patients with epilepsy (PWE) is increasingly recognized as an important component in the management of epilepsy. AIMS: The objective of the present study was to assess influence of sociodemographic, clinical and pharmacotherapy characteristics collectively on QOL in adult PWE. SETTINGS AND DESIGN: This was a cross-sectional, observational study in patients with confirmed diagnosis of epilepsy. MATERIALS AND METHODS: QOL was assessed using modified QOLIE-10 questionnaire for epilepsy. Univariate and multiple regression analysis were done to determine factors associated with poor QOL, respectively. RESULTS: There were 451 PWE, with a mean age 27.3 ± 8.15 years, 251 (56%) males and 191 (42%) had monthly income < 5000 Indian national rupees (INR)/month. The QOLIE score was 64.1 ± 15.97 (Mean ± SD). The univariate analysis showed factors such as lower monthly income, focal epilepsy, seizure frequency, antiepileptic drug (AED) polytherapy, conventional AEDs and frequent adverse drug reactions (ADRs) had significant negative influence on various domains of QOLIE-10 questionnaire. Multiple regression analysis showed seizure frequency as a significant predictor of most QOL domains and overall score, while ADRs as a significant predictor of all the domains. Seizure type was a predictive factor for domains like emotional well-being and overall score. CONCLUSION: Present findings showed patients on monotherapy had better QOL while those having lower monthly income, having focal epilepsy and who received conventional AEDs had negative influence on QOL scores. Further, higher seizure frequency and occurrence of ADRs were significant predictors of all the domains of QOL in PWE.

Modulation of haemodynamics, endogeneous antioxidant enzymes, and pathophysiological changes by selective inhibition of angiotensin II type 1 receptors in pressureoverload rats.

BACKGROUND: Constriction of the thoracic or abdominal aorta provides an experimental model of pressure-overload cardiac hypertrophy. Blockade of AT1 receptors is beneficial in preventing target-organ damage in hypertension. OBJECTIVE: To examine the effect of angiotensin II receptor antagonists on blood pressure, endogenous antioxidant enzyme and histopathological changes in pressure-overload rats. METHODS: Pressure overload was produced by abdominal aortic banding (AAB) using a blunt 22-guage needle in male rats as a model of cardiac hypertrophy. After surgery, the AAB-induced hypertension (AABIH) rats were treated with losartan 40 mg/kg/day, candesartan 10 mg/kg/day, irbesartan 10 mg/kg/day per os for 16 weeks. At 16 weeks of surgery, the rats were observed for general characteristics and mortality, and we determined non-invasive blood pressure (NIBP), endogenous antioxidant enzyme catalase and superoxide dismutase (SOD) activities, and histology of the target organs. RESULTS: In the AABIH group, significant increase in systolic blood pressure was observed from weeks 3 to 16 compared with the control group, along with reduced serum catalase and SOD activities. The treated groups showed significant reduction in systolic BP and increase in serum SOD and catalase activities. The histological changes induced in the target organs, namely heart, liver, kidneys and thoracic aorta in the AABIH rats were attenuated in the treated rats. CONCLUSION: Blockade of the AT1 receptor caused an improvement in the myocardial antioxidant reserve and decreased oxidative stress in the hypertensive rats, which was evidenced by the protection observed in the treatment groups.

Bilateral acute angle-closure glaucoma following treatment with topiramate for headache.

INTRODUCTION: This case report adds supportive evidence to the development of acute angle-closure glaucoma (AACG), a rare but serious adverse effect following the use of topiramate (TPM) for a severe headache. CASE REPORT: A 25-year-old female reported with severe headache, suspected to be migraine, and was started on TPM 25 mg/day on the first day. However, she presented at the emergency clinic of a hospital with sudden blurring of vision and colored halos 5 days after stopping the drug, i.e., day 8. She was subjected to ophthalmic examination and was diagnosed with AACG. The intraocular pressure (IOP) was found to be elevated and she was hence started on acetazolamide 500 mg instantly, maintained on tablet acetazolamide 250 mg four times a day (QID), pilocarpine 2% eye drops QID, travoprost 0.004% once a day (OD), and dorzolamide 2% eye drops three times a day (TID). After a week's treatment, there was rapid improvement with return of IOP to normal. CONCLUSION: TPM-induced AACG is a rare serious adverse event leading to blindness but is preventable, when diagnosed early and by instituting appropriate treatment.

Patterns of poisoning and drug overdosage and their outcome among in-patients admitted to the emergency medicine department of a tertiary care hospital.

BACKGROUND: Poisoning and drug overdose (DO) are important health problems in developing countries. These emergencies are associated with high mortality and morbidity. Different factors affect the final outcome of patients. This study aims to review the pattern of poisoning and DO in an urban tertiary care hospital and also the determinants and final outcome of patients with poisoning and DO. MATERIALS AND METHODS: Observational, retrospective hospital records-based study at a tertiary care hospital (15 months). Data on demography, hospitalization, complications, type of poison/drug and outcome of patients with poisoning and DO were collected. Data were analyzed using descriptive statistics, Chi square test and ANOVA. P < 0.05 was considered significant. RESULTS: Of the total of 296 records, 213 were included (122 poisoning, 91 DO). Organophosphates (OP) (32.5%), pyrethroids (17.2%) and organocarbamates (12.2%) were the commonly used poisons. Sedatives and antiepileptics (21% each) were the common DOs. Poisoning among men was greater than that among women (P < 0.001). Outcome parameters of hospital stay and ventilator requirement were significant (P < 0.001). The overall case fatality rate was 2.4%. CONCLUSIONS: OP compounds were the most common among poisons, while sedatives were frequently consumed drugs. Young adults from urban areas were the common victims with suicidal intention. Regulations, educational awareness and poison information centers will help to reduce the growth of this public health problem.

A randomized comparative study of safety and efficacy of immediate release glucosamine HCL and glucosamine HCL sustained release formulation in the treatment of knee osteoarthritis: A proof of concept study.

OBJECTIVES: To compare the safety and efficacy of glucosamine HCl- sustained release (GLU-SR) with that of Glucosamine HCl- immediate release (GLU-IR) in patients with knee osteoarthritis (OA). MATERIALS AND METHODS: This study involved 59 patients with knee OA, randomised to receive single oral dose of 1,500 mg, GLU-SR and GLU-IR for 60 days with 31 and 28 patients, respectively. The primary efficacy (pain and function) was assessed using visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Intention-to-treat principle, repeated measure of ANOVA and mixed model analysis were used. RESULTS: The patients baseline, demographic and clinical characteristics were comparable between groups with female preponderance (71.20%). There was a significant reduction in algofunctional indices as primary outcome measure in both the groups across time (P < 0.001) and 29% lesser adverse events (AEs) in GLU-SR group, with no difference in the use of rescue medications. CONCLUSIONS: The study showed equal efficacy of the glucosamine formulations on algofunctional indices in reducing pain in patients with knee OA with less number of AEs in GLU-SR.

Evaluation of efficacy and safety of gabapentin, duloxetine, and pregabalin in patients with painful diabetic peripheral neuropathy.

AIM: To compare the efficacy and safety of gabapentin (GBP), duloxetine (DLX), and pregabalin (PGB) in patients with painful diabetic peripheral neuropathy (DPNP). METHODS: A prospective, randomized, open label, 12-week study was conducted. A total of 152 patients with history of pain attributed to DPNP with a minimum 40-mm score on visual analogue scale (VAS) were randomized to receive GBP, DLX, or PGB. The primary efficacy measure was pain severity as measured on 11 point VAS. Secondary efficacy measures included sleep interference score, Patient Global Impression of Change (PGIC), and Clinical Global Impression of Change (CGIC). Assessment of safety was done by recording the occurrence of adverse drug reactions. Data was analyzed using descriptive statistics, Chi square test, analysis of variance (ANOVA), and repeated measures ANOVA. RESULTS: Of total 152 patients, 50 patients received GBP, DLX each while 52 received PGB. A significant reduction in pain score (VAS), sleep interference score, PGIC, and CGIC was seen in all the three treatment groups across time (P<0.05) with no statistically significant difference between the groups. There was a significant interaction between the time and treatment groups (P<0.001) for pain score (VAS), sleep interference score, and PGIC. The improvement in pain scores (VAS) and sleep interference score was higher with PGB compared to DLX and GBP. Adverse drug reactions were mild and occurred in 9.2% of all cases. CONCLUSIONS: Monotherapy with GBP, DLX, or PGB Produced a clinically and subjectively meaningful pain relief in patients with DPNP with onset of pain relief being faster and superior with PGB.

Modulation of hemodynamics, endogenous antioxidant enzymes, and pathophysiological changes by Angiotensin-converting enzyme inhibitors in pressure-overload rats.

INTRODUCTION: We sought to assess the role of angiotensin-converting enzyme (ACE) inhibitors on systolic blood pressure (BP), endogenous antioxidant enzymes and histopathological changes in pressure-overload rats. METHODS: Pressure overload was produced in male rats by abdominal aortic banding (AAB) using a blunt 22-gauge needle, as a model of cardiac hypertrophy. After surgery, AAB-induced hypertensive (AABIH) groups were treated with captopril 4 mg and ramipril 10 mg/kg per day p.o. for 16 weeks. At 16 weeks, rats were observed for general characteristics and mortality, non-invasive blood pressure (NIBP) and endogenous antioxidant enzyme catalase and superoxide dismutase (SOD) activity and histological evaluation of target organs. RESULTS: In the AABIH group a significant increase in systolic BP was observed in week 3 (149.3 ± 0.821) and persisted until week 16, along with lower levels of serum catalase (144.7 ± 2.204) and SOD (12.92 ± 0.4601) activity compared to the control group. Captopril and ramipril treated groups showed a significantly smaller increase in systolic BP (25.47 ± 3.685, 20.21 ± 3.306) and greater serum SOD (27.33 ± 2.338, 28.95 ± 1.143) and catalase (181.7 ± 8.407, 187.9 ± 8.497) activity, respectively, than the hypertensive rats. The histological changes induced in target organs (heart, liver, kidneys and thoracic aorta) in AABIH rats were attenuated in treated rats. CONCLUSIONS: ACE-inhibition causes an improvement in myocardial antioxidant reserve, reduces oxidative stress, and prevents pathophysiological alterations, while showing a trend for potential target organ protection in hypertensive rats.

Pattern of adverse drug reactions to anti-epileptic drugs: a cross-sectional one-year survey at a tertiary care hospital.

PURPOSE: To investigate pattern and extent of adverse drug reactions (ADRs) associated with AEDs and to identify safer options for treatment of epilepsy. METHOD: Study was a retrospective, cross-sectional survey. Data from patients with epilepsy at the out-patient and in-patient of Neurology Department was collected in a specially designed proforma. Causality and severity of ADRs was categorized as per WHO guidelines. RESULTS: Among 788 patients with epilepsy, 80 (10.27%) had ADRs. ADRs with AED monotherapy were 9.18% and with polytherapy were 11.56%. ADRs with conventional and newer AED monotherapy was 10.24% and 6.84%, respectively, and were maximum with phenytoin and clobazam (14.28% and 12.5%). ADRs were mild in 4.16%, moderate in 70.83% and severe in 25% patients. Causality was probable in 65.62%, possible in 13.54% and definite in 20.83%. Patients (15/80) were hospitalized due to ADRs. Age and gender distribution showed statistically significant difference in occurrence of ADRs (p < 0.05). Chi-square test for poly versus monotherapy and conventional versus newer AEDs did not show any significant difference. CONCLUSIONS: Study showed maximum ADRs with AED polytherapy with no significant difference in frequency and severity of ADRs between conventional versus newer AEDs. This finding needs further investigation in larger number of patients to identify safer treatment options for epilepsy.

Steroid sparing effect of a herbal preparation in steroid-dependent nephrotic syndrome.

Investigations on plants are revealing the potential therapeutic benefits of medicinal herbs in treating immunological disorders. Nephrotic syndrome has emerged as an immunological disorder. Steroid dependence poses a therapeutic challenge in the management of nephrotic syndrome. Our pilot study compares the efficacy of an ayurvedic polyherbal preparation 'Shathavaryadi Yoga (NS001)' with oral cyclophosphamide in maintaining remission in steroid-dependent nephrotic syndrome.

Individual and combined effects of N6-cyclopentyladenosine, flunarizine and diazepam on aminophylline-induced recurrent generalized seizures in mice.

Protective effects of anticovulsant agents, N6-cyclopentyladenosine (CPA) and flunarizine (FLN) against aminophylline (AMPH) (280 mg/kg)-induced convulsions were tested in different groups of mice. All drugs were administered by intraperitoneal route. CPA (2 mg/kg and 4 mg/kg) delayed the time to onset of clonic convulsions (p < 0.05). The standard drug diazepam (DZP, 2.5 mg/kg) increased the time to onset of clonic and tonic convulsions to a statistically significant extent (p < 0.05 and p < 0.01, respectively). The AMPH-induced mortality (90.9%) was significantly reduced (p < 0.02) following the test anticonvulsants--CPA (2 mg/kg and 4 mg/kg), FLN (10 mg/kg) and the combination of CPA with FLN (though not to a significant extent), indicating partial involvement of adenosinergic and calcium related mechanisms, while DZP afforded maximum protection. However, none prevented the mortality in mice over 24 h. The results show the lethal effects of AMPH-induced seizures and involvement of multiple and complex neurotransmitter systems in this process which requires further investigation.

Prescribing pattern of anti-seizure medications (ASMs): an evaluation of extent of xanthine co-medication.

This study was conducted to evaluate the prescribing pattern of anti-seizure medications (ASMs) at a tertiary care hospital. The extent and pattern of concurrently used medications for co-exiting illnesses was also studied. Attention was focussed in particular on co-existence of bronchial asthma with epilepsy and co-medication of ASMs with xanthines. The study was carried out at the Central Pharmacy and at the Medical Records Department. Data analysis at the central pharmacy showed 3.98% prescriptions for ASMs, with maximum number for males. More drugs were prescribed during the second decade of life and there were 2.17 drugs per prescription. The data for pattern and extent of use of ASMs along with polytherapy and concurrently used medications revealed the highest number of prescriptions for phenytoin, maximum number with single ASM, and phenytoin with phenobarbitone as most frequently prescribed combination. Co-administration of ASMs with respiratory medications was found in 2.47%, with 38.8% prescriptions having xanthines prescribed in them. Xanthines, the well known CNS stimulants, a property attributed to their adenosine receptor antagonistic activity, are considered potential seizurogenic agents. The results of the present preliminary survey show an indirect evidence for co-existence of epilepsy with asthma along with the extent of co-medication of ASMs with xanthines. Results indicate the need for further studies to evaluate the consequences of co-medication of ASMs with xanthines.