Antiepileptic Drug Adherence and Its Associated Factors among Epilepsy Patients on Follow-ups at Emanuel Mental Specialized Hospital, Ethiopia

Medication adherence is a fundamental determinant of effective treatment. However, people with epilepsy have poor compliance with their treatment because of the chronic nature of the disease. Limited studies have been conducted to address antiepileptic medication adherence in Africa, including Ethiopia. Thus, the aim of this study was to assess antiepileptic drug adherence and its asociated factors among patients with epilepsy attending outpatient department of Amanuel Mental Specialized Hospital. METHODS: A cross-sectional study design was conducted on 439 patients with epilepsy in Amanuel Mental Specialized Hospital. Medication adherence reporting scale-5 (MARS-5) was used to assess adherence to antiepileptic drugs. The Oslo social support, Jacob perceived stigma scale, and hospital anxiety and depression scale (HADS) were the instruments used to assess associated factors. Simple and multiple linear regression analysis models were fitted. Then, the adjusted unstandardized beta (ß) coefficient at a 95% confidence level was used. RESULTS: The mean (SD) score of antiepileptic medication adherence was 16.38(±3.76) with 95%CI:(16.03, 16.72). Depressive symptoms (ß= -1.35, 95% CI: (-2.04, -0.65)), anxiety symptoms (ß=-1.12,95%CI:(-1,79, -0.44), perceived stigma (ß= -1.64, 95% CI: -2.16, -1.12), being single (ß=-0.67, 95%CI: -1.20, -0.14), presence of seizure per month (ß=-2.11,95% CI: (-2.81, -1.41) and antiepileptic drug adverse effect (ß=-0.07,95%CI: -0.11, -0.03) were factors associated with anti-epileptic medication adherence. CONCLUSION: The results suggest that the mean score of adherences to antiepileptic drugs was poor as compared to other settings. Antiepileptic medication adherence screening tool should be included in the patient's treatment protocol

Hematological consequences of antiepileptic drug therapy among children with epilepsy

Epilepsy is a chronic neurologic disease that comes third after cerebrovascular and Alzheimer's disease. Anti-epileptic drugs may affect certain hematological parameters of epileptic patients. Few researches investigated hematological adverse effects of antiepileptic drugs in Libya. Thus, the aim was to evaluate hematological parameters in epileptic children who are on antiepileptic drugs. This retrospective study included 83 pediatric patients with epilepsy recruited from Benghazi Children Hospital, Department of Neurology, from December 2017 to April 2018. Data collected included demographic characteristics, types of epilepsy, anti-epileptic drugs and serum hematological parameters. Hematological parameters recorded included: hemoglobin, hematocrit, platelet, mean cell volume, mean cell hemoglobin, mean cell hemoglobin concentration and white blood cell count. In all treated patients, regardless of the number of antiepileptic drugs therapy used, the average levels of hematological parameters were significantly lower in treated group compared to control group (11.64 gm per dl, 34.53%, 27.74 pg and 33.13 gm per dl, respectively). A significant increase (12.12109 per l) in white blood cell counts in treated group was found. Average hemoglobin, hematocrit and mean cell hemoglobin concentration levels were significantly lower in patients on poly-therapy compared to mono-therapy and control groups. Average white blood cell counts were significantly increased in patients on anti-epileptic drugs. In sodium valproate users, levels of hematological parameters were significantly decreased but significantly increased in white blood cell counts. In diazepam users, significant increases in white blood cells and platelet but no difference in other parameters observed. There were no differences in all hematological parameters among patients using carbamazepine except for platelet counts (significantly decreased). In conclusion, there is substantial effect of the anti-epileptic drugs, especially sodium valproate, on hematological parameters of children despite the effects were not critical as the changes were still in the normal range.

Prise en charge de la femme épileptique pendant la grossesse

La grossesse est envisageable chez la plupart des femmes épileptiques mais nécessite une surveillance particulière et une prise en charge multidisciplinaire impliquant le neurologue, l'obstétricien, l'anesthésiste et le pédiatre. La question de la grossesse devrait être abordée de façon systématique avec toute patiente épileptique en âge de procréer. Le projet de grossesse devrait être planifié et programmé afin d'adapter le traitement avant la conception ; le but ultime étant de réduire le risque de complications fœto-maternelles. A travers cet article, nous rapportons les données les plus récentes émanant des trois principaux registres de grossesse chez la femme épileptique : le registre européen (EURAP : The European Register of Antiepileptic Drugs ans Pregnancy), le registre nord-américain (North American Antiepileptic Drug Pregnancy Registry : NAAPR), et le registre anglo-saxon (UK and Ireland Register). En nous appuyant sur ces données, nous proposons des recommandations pour une prise en charge optimale de la femme épileptique durant la grossesse

Poor adherence to antiepileptic drugs and associated factors in a sample of Cameroon epilepsy patients

Objectives:The aim of the study was to determine the prevalence and factors associated to poor adherence to antiepileptic drugs in a referral hospital of Douala, Cameroon.Method:This was a cross-sectional and descriptive study of antiepileptic drugs (AED) adherence carried out in a group of selected patients with epilepsy. Patients were recruited from January to June 2018 at the Neurology Department of the Douala Laquintinie Hospital. Non-adherence to antiepileptic drugs was measured by the 8-item Morisky Medication Adherence Scale and logistic regression was used to look for significant associations.Results:Participants (n=102) were of mean age 28.39 ± 19.74 years-old with 55% of male sex. Non-adherence was observed in 84 patients giving a prevalence rate of 82.35%. The factors associated to poor adherence to AEDs were forgetfulness (p<0.0001), lack of financial resources (p<0.0001), not having medication on hand, shortage of drugs at the pharmacy (p<0.0001) and lack of information on the disease (p<0.0001).Conclusion:Non-adherence to AEDs is common in Cameroon. Targeted management programs and communication strategies as well as health workers training are necessary to improve adherence to AED treatment in patients with epilepsy and avoid consequences such as seizure recurrence, status epilepticus and poor quality of life

An overview of analgesics - anticonvulsants, antidepressants, and other medications (Part 3)

Pain is classified by various descriptions. Chronic pain has been described as being neuropathic (due to nervous system lesions), nociceptive (due to tissue damage), or mixed (a combination of neuropathic and nociceptive). The addition of the term nociplastic pain is used to describe patients who experience chronic pain without tissue damage or nervous system lesions. Chronic pain is often difficult to manage, particularly neuropathic pain. Evidence-based pharmacological treatment options include anticonvulsants and antidepressants. The choice of medication will depend on various factors, including patient profile, type of pain, and associated conditions. Medications with the best evidence of efficacy for first-line use in neuropathic pain are the gabapentinoids, carbamazepine, the tricyclic antidepressants, and the serotonin-noradrenaline reuptake inhibitors duloxetine and venlafaxine. The cannabinoids and ketamine are being actively investigated for use in chronic pain. Currently the cannabinoids'potential benefit is outweighed by the adverse effects, and recommendations for the use of ketamine is limited by its parenteral route of administration and low evidence of efficacy in chronic pain

Management of acute seizures in children: a review with special consideration of care in resource-limited settings

Introduction:We sought to review recent evidence-based guidelines and where applicable, primary data to ex-trapolate insights into the appropriate management of acute seizures in children in resource-limited settings.Methods:PubMed and Google scholar searches were conducted with attention to publications from the last three to five years, including a focused search for acute seizure management guidelines relevant to resource limited settings. Since all guidelines to date, except the World Health Organization's, assume ready access to invasive ventilation and advanced diagnostic testing, guidelines and primary data were used to propose managementappropriate for resource-limited settings where respiratory suppression from treatment presents a major challenge in management.Results:Acute seizures are among the commonest medical emergencies encountered in the African settings.Seizure management must occur simultaneously with the diagnostic assessment, which should include addres-sing life threatening causes (e.g. hypoglycaemia, malaria) and with attention given to the most likely aetiology ina particular region or setting. For ongoing seizures, initial treatment with benzodiazepines is indicated. There is evidence of efficacy for several agents and delivery modes. Longer-acting antiepileptic drugs (AEDs) should beon hand if acute seizures fail to respond to two doses of benzodiazepines. There is little direct evidence comparing the relative efficacy of different long-acting AEDs for acute seizure management in African children.Findings suggest that generalising data from Western settings, where different aetiologies and risk factors for seizures prevail, may be inappropriate.Discussion: Though treatment options and diagnostics may be dictated by available medications andcapacity, it is possible for virtually any healthcare setting to develop a relevant and feasible local guideline for seizure management. Clear specifications on when to refer to a higher level of care should be part of the care plan

People with psychogenic non-epileptic seizures: a South African perspective

Background: Psychogenic non-epileptic seizures (PNES) is a disabling disorder which has a negative effect on the quality of life of individuals with PNES. A clear understanding of the disorder is necessary; however, to date, research about PNES in South Africa is limited. Objectives: The aims of this study were to explore the demographic variables of individuals with PNES in South Africa, to review the available body of research on PNES, and to compare it with our results. Method: Twenty-two people with PNES, with confirmed video EEG, were recruited by means of convenience sampling from two hospitals. Descriptive statistics were used to describe the demographic variables of the participants. Results: Internationally comparable results revealed misdiagnoses and low treatment delivery amongst a primarily female population.Conclusion: This study provided greater insight into individuals with PNES in South Africa, highlighting the need for more information, support, effective treatment and accurate diagnosis of PNES

Women and epilepsy: Sudanese experience

Epilepsy is equally prevalent in men and women. However; for women there are unique concerns related to hormone effects on seizures and the effects of seizures and antiepileptic drugs (AEDs) on reproductive health. Some AEDs reduce the efficacy of oral contraceptive agents; increasing the probability of unplanned pregnancies. Seizure frequency may change during pregnancy; seizures may cause pregnancy complications; and the treatment of a woman with epilepsy must consider all these issues. Objective: To study the clinical presentation of epilepsy among adult Sudanese females and to verify aspects of epilepsy specific to women. Methods: This is a cross sectional descriptive non intervention clinical based study; it was carried out in Elshaab Teaching Hospital and El-shiekh Mohamed Kheir charity clinic; from February-2008 to June- 2008. 630 female patients with epilepsy were included in the study. Results: The study showed that 72of the patients had generalized epilepsy and 28had partial epilepsy; primary epilepsy is more common than secondary epilepsy; 54of our patients had warning symptoms and 39.7had triggering factors; irregular menstrual cycle was observed in 28; 22of our patients had catamenial seizures; 7.1had increased frequency of seizures during pregnancy. Obstetric complications were common among our studied group. The incidence of infertility increased among our studied group. Conclusion: Women had differences in presentation and control of epilepsy that must be understood and considered when treating women with epilepsy

Epilepsie et vie de la femme : specificite de la prise en charge : revue de la litterature

Huit personnes sur 1000 soufrent d'epilepsie dans le monde et 80se trouvent dans les pays en developpement [1]. L'Afrique sub-saharienne et l'Amerique latine ont des prevalences medianes elevees avec respectivement 15;4et 12;4; par comparaison aux prevalences observees en Europe (5;4) 0 et a 5 a 100 en Amerique du nord [2]. Sur cette inegalite epidemiologique se superpose une disparite considerable dans la qualite des soins dispenses aux epileptiques; entre les pays a revenu faible et eleve et entre le milieu urbain et rural. Dans ce contexte; l'un des sujets les plus controverses dans le domaine de l'epileptologie est la prise en charge des femmes epileptiques; de surcroit enceintes et de leur progeniture. En effet; etre une femme epileptique n'est pas comme etre un homme. Les preoccupations specifiques aux femmes epileptiques concernent essentiellement la sexualite; la contraception; la reproduction; la fertilite et la teratogenicite anatomique et cognitive des medicaments anti-epileptiques. La sensibilisation des femmes epileptiques commence depuis la puberte jusqu'a la menopause. Environ un tiers des femmes epileptiques subissent des variations de leur maladie liees au cycle menstruel; probablement du fait d'une neurotoxicite des oestrogenes (non contrebalancee par les progestatifs). Le probleme de la teratogenicite des medicaments antiepileptiques (MAE) n'est pas resolu malgre la mise sur le marche des nouvelles molecules. Une collaboration etroite entre sages femmes; obstetriciens et neurologues et une sensibilisation des professionnels de sante sont essentielles pour une prise en charge globale des femmes epileptiques enceintes ou en age de procreer

Anticonvulsant Activity of Carissa carandas Linn. Root Extract in Experimental Mice

Purpose: The aim of the present study was to investigate anticonvulsant effect of the ethanolic extract of the roots of Carissa carandas (ERCC) on electrically and chemically induced seizures. Methods: The ethanolic extract of the roots of C. carandas (100, 200 and 400 mg/kg, i.p.) was studied for its anticonvulsant effect on maximal electroshock-induced seizures and pentylenetetrazole-, picrotoxin-, bicuculline- and N-methyl-dl-aspartic acid-induced seizures in mice. The latency of tonic convulsions and the number of animals protected from tonic convulsions were noted. Results: ERCC (100-400 mg/kg) significantly reduced the duration of seizures induced by maximal electroshock (MES). However, only 200 and 400mg/kg of the extract conferred protection (25 and 50%, respectively) on the mice. The same doses also protected animals from pentylenetetrazole-induced tonic seizures and significantly delayed the onset of tonic seizures produced by picrotoxin and N-methyl-dl-aspartic acid. The extract had no effect on bicuculline-induced seizures. Conclusion: The data suggest that the ethanolic root extract of C. carandas may produce its anticonvulsant effects via non-specific mechanisms since it reduced the duration of seizures produced by maximal electroshock as well as delayed the latency of seizures produced by pentylenetetrazole and picrotoxin

Aqueous stem bark extract of Stereospermum kunthianum (cham, Sandrine Petit) protects against generalized seizures in pentylenetetrazole and electro-convulsive models in Rodents

Abstract: Stereospermum kunthianum, Cham Sandrine Petit (Bignoniaceae) known in English as pink jacaranda is used in traditional medicine to treat an array of ailments including febrile convulsions in infants and young children by the rural dwellers in Nigeria. This study examined the anticonvulsant activity of its aqueous stem bark extract (100 ­ 400mg/kg) against maximal electroshock and pentylenetetrazole-induced seizures in rodents. Phenobarbitone and ethosuximide were used as reference anticonvulsant drugs for comparison. Stereospermum kunthianum extract (200 ­ 400mg/kg, i.p.) remarkably protected (76.9% and 84.6 % respectively) the rats against electroshock-induced seizures. However, the extract (200- 400mg/kg) when administered orally showed a comparatively less effect (33.3% and 55.6% respectively) to the intraperitoneally administered extract in the maximal electroshock test. The extract (100-400mg/kg, i.p.) significantly delayed (p<0.05) the onset of pentylenetetrazole-induced clonic seizures but only slightly prolonged the time of death of the mice. Although the findings in the present study do not provide conclusive evidence, it appears that the aqueous stem bark extract of Stereospermum kunthianum produces its antiseizure effect by enhancing GABAergic neurotransmission and/or action in the brain. The results indicate that the aqueous extract possesses anticonvulsant activity in rodents and therefore tend to suggest that the shrub may be used as a natural supplementary remedy in the management, control and/or treatment of childhood convulsions. It can be concluded that the aqueous stem bark extract possesses anticonvulsant activity and therefore lend pharmacological credence to the traditionally claimed use in the treatment of childhood convulsions

Aqueous stem bark extract of Stereospermum kunthianum (cham, sandrine petit) protects against generalized seizures in pentylenetetrazole and electro-convulsive models in rodents

Stereospermum kunthianum; Cham Sandrine Petit (Bignoniaceae) known in eng as pink jacaranda is used in traditional medicine to treat an array of ailments including febrile convulsions in infants and young children by the rural dwellers in Nigeria. This study examined the anticonvulsant activity of its aqueous stem bark extract (100 - 400mg/kg) against maximal electroshock and pentylenetetrazole-induced seizures in rodents. Phenobarbitone and ethosuximide were used as reference anticonvulsant drugs for comparison. Stereospermum kunthianum extract (200 - 400mg/kg; i.p.) remarkably protected (76.9and 84.6respectively) the rats against electroshock-induced seizures. However; the extract (200- 400mg/kg) when administered orally showed a comparatively less effect (33.3and 55.6respectively) to the intraperitoneally administered extract in the maximal electroshock test. The extract (100-400mg/kg; i.p.) significantly delayed (p0.05) the onset of pentylenetetrazole-induced clonic seizures but only slightly prolonged the time of death of the mice. Although the findings in the present study do not provide conclusive evidence; it appears that the aqueous stem bark extract of Stereospermum kunthianum produces its antiseizure effect by enhancing GABAergic neurotransmission and/or action in the brain. The results indicate that the aqueous extract possesses anticonvulsant activity in rodents and therefore tend to suggest that the shrub may be used as a natural supplementary remedy in the management; control and/or treatment of childhood convulsions. It can be concluded that the aqueous stem bark extract possesses anticonvulsant activity and therefore lend pharmacological credence to the traditionally claimed use in the treatment of childhood convulsions

The anticonvulsant and sedative properties of stems of Cissus quadrangularis in mice

Cissus quadrangularis Linn grows in Savannah areas in Africa (Cameroon; Mali; Mauritania; Senegal; etc). In traditional medicine; the plant is used to treat anorexia; asthma; sickle cells; colds; pains; malaria; asthma and as an analgesic. In vivo animal models of epilepsy (maximal electroshock; n-methyl -d-aspartate; pentylenetetrazol; isonicotinic hydrazid acid and strychnine -induced convulsions or turning behavior) and insomnia (diazepam -induced sleep) were used. The aqueous extract of the stems of C. quadrangularis strongly increased the total sleep time induced by diazepam (50 mg/kg i.p.). It also protected mice against maximal electroshock; pentylenetetrazol; strychnine and n-methyl-d-aspartate-induced seizures or turning behavior and delayed the onset time of seizures induced by isonicotinic hydrazid acid. The results lead to the conclusion that the extract of C. quadrangularis possesses anticonvulsant and sedative properties in mice and could explain its use in traditional medicine in Africa; in the treatment of insomnia and epilepsy

Anticonvulsant effect of the aqueous extract of Xeromphis nilotica in mice

Xeromphis nilotica is used traditionally to treat epilepsy. The freeze dried aqueous extract of the plants' rootbark was tested for anticonvulsant activity against pentylenetetrazol (PTZ) induced seizures and pentobarbital induced sleep in mice. Results showed that the extract significantly (p 0.05) reduced the onset and severity of the PTZ-induced seizure and prolonged the duration of sleep induced by pentobarbital dose dependently. The results show that the extract has depressant effect; supporting the claimed ethno- medical usage in controlling seizure

Anticonvulsant Activity of Extracts of Epilepsy Fscheri Stem Bark

Evaluation of extracts of Diospyros fischeri Gurke (Ebenaceae); which is used traditionally for the treatment of epilepsy shows that the aqueous extract of the tem bark has no effect against picrotoxin induced convulsions in mice. However; an 80ethanol extract of the bark caused dose-dependent suppression of convulsions induced by 10 mg/kg body wt picrotoxin; at doses between 100-3200 mg/kg body wt. Petroleum ether; 1:1 dichloromethane:methanol; and methanol extracts also suppressed picrotoxin-induced convulsions; but had a slightly lower inhibitory effect. The petroleum ether extract was the most active; but all were less active than the ethanol extract. Unlike phenobarbitone; which at 50 mg/kg body wt completely suppressed convulsions induced by 10 mg/kg body wt picrotoxin; none of the plant extracts completely suppressed convulsions in the mice. These results support the traditional uses of D.fischeri for the treatment of epilepsy. Given the seemingly innocuous nature of the extracts more work is suggested to ascertain their clinical application

Antidepressants and Antiepileptic Drugs for Chronic Non-Cancer Pain

The development of newer classes of antidepressants and second-generation antiepileptic drugs has created unprecedented opportunities for the treatment of chronic pain. These drugs modulate pain transmission by interacting with specific neurotransmitters and ion channels. The actions of antidepressants and antiepileptic drugs differ in neuropathic and non-neuropathic pain; and agents within each medication class have varying degrees of efficacy. Tricyclic antidepressants (e.g.; amitriptyline; nortriptyline; desipramine) and certain novel antidepressants (i.e.; bupropion; venlafaxine; duloxetine) are effective in the treatment of neuropathic pain. The analgesic effect of these drugs is independent of their antidepressant effect and appears strongest in agents with mixed-receptor or predominantly noradrenergic activity; rather than serotoninergic activity. First-generation antiepileptic drugs (i.e.; carbamazepine; phenytoin) and second-generation antiepileptic drugs (e.g.; gabapentin; pregabalin) are effective in the treatment of neuropathic pain. The efficacy of antidepressants and antiepileptic drugs in the treatment of neuropathic pain is comparable; tolerability also is comparable; but safety and side effect profiles differ. Tricyclic antidepressants are the most cost-effective agents; but second-generation antiepileptic drugs are associated with fewer safety concerns in elderly patients. Tricyclic antidepressants have documented (although limited) efficacy in the treatment of fibromyalgia and chronic low back pain. Recent evidence suggests that duloxetine and pregabalin have modest efficacy in patients with fibromyalgia

Contribution a l'etude des convulsions chez l'enfant : aspect [sic] epidemiologiques et cliniques : a propos de 275 observations (CMS Elf-Congo; Pointe-Noire

La crise convulsive; symptome tres frequent en pediatrie represente le type meme d'urgence parce qu'elle peut reveler une maladie necessitant un traitement immediat. Il est question ici d'une etude; realisee dans le CMS de Elf-Congo a Pointe-Noire; portant sur 275 cas de convulsions colliges dans le service du 1er novembre 1988 au 31 decembre 1990. Il ressort de cette etude que la frequence globale de ce symptome est de 3;2 pour cent des admissions pediatriques pendant cette periode; les nourrissons sont les plus touches (78;20 pour cent) et la manifestation clinique la plus frequente est la crise tonique. Ces resultats constituent donc un cri d'alarme pour une prevention du paludisme par une prophylaxie bien codifiee et correctement suivie; seule arme pour reduire les consequences de cette endemie tres meurtriere sous les tropiques