Profile of epileptic patients at a tertiary care centre

Background: The present study was done in a tertiary care centre of North India to know the profile of epilepsy.Methods: Total of 210 patients were selected during the period August, 2017 to July 2018 who attended outpatient clinic of the Department of Neurology, Indira Gandhi Medical College, Shimla, Himachal Pradesh. Detailed clinical history was taken, general physical examination, and routine blood examination were carried out.Results: Of all the cases, sex ratio (male:female) was 2.39:1. A high proportion of cases (43.3%) were from lower-middle socio-economic group. 76.7% patients had generalized seizures. For 38.6% patients, frequency of seizures was more than 8 in the past 6 months. 71.9% of the patients were using only one anti-epileptic drug.Conclusions: Patients with seizures comprise a significant burden in inpatient department of developing countries.

A Study on the Adverse Drug Reactions Induced by Anti Epileptic Drugs in the Epileptic Patients.

Epilepsy is a chronic disorder of the brain that affects people worldwide. The aim of this work was to study the adverse drug reactions (ADRs) induced by the antiepileptic drugs (AEDs) in epileptic patients. This prospective study was carried out for six months, from April 2014 to September 2014, in a tertiary teaching care hospital, Erode. The study included epileptic patients, both male and female of all age groups, undergoing treatment with AEDs. A total of 180 epileptic patients were monitored, 60% were male and 40% were females. Majority of the study population were adults. Majority of the epileptic patients were affected with generalized seizure (46.66%). Monotherapy was preferred more (71.1%) over combination therapy (34.44%). Sodium valproate (24.4%) was the most prescribed drug in monotherapy followed closely by Phenytoin (18.3%). Most prescribed two drug combination was of Sodium valproate and Carbamazepine (8.3%) followed by Phenytoin and Phenobarbitone (6.67%). Most common ADR was memory loss, hepatotoxicity, aggression and reduced learning. Sodium valproate was found to induce more number of ADRs followed by Carbamazepine and Phenytoin. Treatment with antiepileptic drugs was continued in all cases, except in three cases of skin rashes.

Demonstration project on epilepsy in Brazil: situation assessment

PURPOSE: To provide a situation assessment of services for people with epilepsy in the context of primary health care, as part of the Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign 'Epilepsy out of the shadows'. METHODS: We performed a door-to-door epidemiological survey in three areas to assess the prevalence of epilepsy and its treatment gap. We surveyed a sample of 598 primary health care workers from different regions of Brazil to assess their perceptions of the management of people with epilepsy in the primary care setting. RESULTS: The lifetime prevalence of epilepsy was 9.2/1,000 people [95 percent CI 8.4-10.0] and the estimated prevalence of active epilepsy was 5.4/1,000 people. Thirty-eight percent of patients with active epilepsy were on inadequate treatment, including 19 percent who were taking no medication. The survey of health workers showed that they estimated that 60 percent of patients under their care were seizure-free. They estimated that 55 percent of patients were on monotherapy and that 59 percent had been referred to neurologists. The estimated mean percentage of patients who were working or studying was 56 percent. Most of the physicians (73 percent) did not feel confident in managing people with epilepsy. DISCUSSION: The epidemiological survey in the areas of the Demonstration Project showed that the prevalence of epilepsy is similar to that in other resource-poor countries, and that the treatment gap is high. One factor contributing to the treatment gap is inadequacy of health care delivery. The situation could readily be improved in Brazil, as the primary health care system has the key elements required for epilepsy management. To make this effective and efficient requires: i) an established referral network, ii) continuous provision of AEDs, iii) close monitoring of epilepsy management via the notification system (Sistema de Informação da Atenção Básica - SIAB) and iv)...

OBJETIVO: Avaliar a situação da assistência à epilepsia no contexto da atenção primária sob o Projeto Demonstrativo em epilepsia no Brasil, parte da Campanha Global Epilepsia Fora das Sombras da WHO/ILAE/IBE. MÉTODO: Fizemos um levantamento epidemiológico para definir a prevalência e lacuna de tratamento em epilepsia. Avaliamos a percepção de 598 profissionais de saúde da atenção básica de diferentes regiões do Brasil sobre epilepsia e seu manejo na rede básica de saúde. RESULTADOS: A prevalência acumulada de epilepsia foi de 9,2/1000 pessoas (95 por centoIC= 8,4-10) e a prevalência estimada de epilepsia ativa foi de 5,4/1000 pessoas. Trinta e oito porcento dos pacientes com epilepsia ativa estavam sendo tratados inadequadamente, incluindo 19 por cento que estavam sem medicação. A enquete com os profissionais de saúde mostrou que a média estimada de pacientes livre de crises sob os cuidados dos mesmos era de 60 por cento. A média estimada de porcentagem em monoterapia era de 55 por cento. A média estimada de porcentagem de referência para neurologistas era de 59 por cento. A média estimada de porcentagem de pacientes que estavam trabalhando ou estudando era de 56 por cento. A maioria dos médicos não se sente confiante em atender uma pessoa com epilepsia. DISCUSSÃO: A análise situacional da Fase I - estudo epidemiológico nas áreas de interesse do PD mostrou que a prevalência da epilepsia é similar a outros países em desenvolvimento e a lacuna de tratamento é grande. Um dos fatores importantes para a lacuna de tratamento é a falta de adequação à assistência na atenção básica. Essa situação pode ser revertida no Brasil, pois os elementos chaves existem na rede básica para o manejo de pessoas com epilepsia. Entretanto, para torna efetivo e eficiente é preciso i) estabelecimento de um sistema de referência e contra-referência, ii) fornecimento contínuo de medicação anti-epiléptica, iii) monitorização de manejo de pessoas com epilepsia através...

Demonstration project on epilepsy in Brazil: outcome assessment

PURPOSE: To assess the outcome of patients with epilepsy treated at primary care health units under the framework of the demonstration project on epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy. METHOD: We assessed the outcome of patients treated at four primary health units. The staff of the health units underwent information training in epilepsy. The outcome assessment was based on: 1) reduction of seizure frequency, 2) subjective perception from the patients and the physicians point of view, 3) reduction of absenteeism, 4) social integration (school and work), and 5) sense of independence. RESULTS: A total of 181 patients (93 women - 51 percent) with a mean age of 38 (range from 2 to 86) years were studied. The mean follow-up was 26 months (range from 1 to 38 months, 11 patients had follow-up of less than 12 months). Seizure frequency was assessed based on a score system, ranging from 0 (no seizure in the previous 24 months) to 7 (>10 seizure/day). The baseline median seizure-frequency score was 3 (one to three seizures per month). At the end of the study the median seizure-frequency score was 1 (one to three seizures per year). The patients and relatives opinions were that in the majority (59 percent) the health status had improved a lot, some (19 percent) had improved a little, 20 percent experienced no change and in 2 percent the health status was worse. With regard to absenteeism, social integration and sense of independence, there were some modest improvements only. DISCUSSION: The development of a model of epilepsy treatment at primary health level based on the existing health system, with strategic measures centred on the health care providers and the community, has proved to be effective providing important reductions in seizure frequency, as well as in general well being. This model can be applied nationwide, as the key elements already exist provided that strategic measures are put forward...

OBJETIVO: Avaliar o resultado do tratamento de pacientes com epilepsia na atenção básica sob o modelo proposto pelo Projeto Demonstrativo no Brasil, como parte da Campanha Global Contra a Epilepsia da WHO/ILAE/IBE. MÉTODO: Avaliamos o resultado do tratamento nos pacientes acompanhados em quatro unidades básicas de saúde. As equipes de saúde fizeram um treinamento padrão. O resultado do tratamento foi baseado em cinco aspectos: 1) redução da freqüência das crises, 2) percepção subjetiva dos pacientes e dos médicos, 3) redução de absenteísmo, 4) integração social (escola, trabalho), e 5) senso de independência. RESULTADOS: Um total de 181 pacientes (93 mulheres - 51 por cento), com uma média de 38 anos (variando de 2 a 86 anos) entraram nesta análise. O tempo médio de seguimento foi de 26 meses (variou de 1 a 38 meses, 11 pacientes tinham seguimento menos de 12 meses). A freqüência das crises foi categorizada variando de 0 (sem nenhuma crise nos últimos 24 meses) a 7 (>10 crises/dia). O escore mediano da freqüência de crises no começo era de 3 (uma a três crises por mês). O escore mediano da freqüência de crises no final era de 1 (uma a três crises por ano). A opinião dos pacientes e familiares é que a maioria (106 casos) houve uma melhora importante na saúde, 34 tiveram pouca melhora, 37 não tiveram mudanças e em quatro houve piora. Em relação ao absenteísmo, integração social e senso de independência houve pouca melhora. DISCUSSÃO: O modelo desenvolvido de tratamento de epilepsia na atenção primária com base na estrutura de saúde existente, com estratégias centradas nos profissionais de saúde e na comunidade, provou ser efetivo com redução importante na freqüência das crises bem como na melhora em geral da saúde. Esse modelo pode ser aplicado em âmbito nacional, pois os elementos chaves já existem, desde que essas estratégias sejam pactuadas com os organismos locais de saúde.

Blood Concentration Monitoring of Anti-epileptic Drugs in Our Hospital from 2001 to 2006:Analysis of Monitoring Data / 中国药房

OBJECTIVE:To discuss the significance of therapeutic drug monitoring(TDM)for rational administration of anti-epileptic drugs and to probe into the cognition of clinic staff on TDM.METHODS:Access database of antiepileptic drugs was established to analyze the TDM data of antiepileptic drugs used from 2001 to 2006.RESULTS:The TDM cases of anti-epileptic drugs increased year by year.The proportions of effective concentration,high blood drug concentration and low blood drug concentration derived from TDM data showed that it is quite necessary to conduct blood drug concentration monitoring.But the lack of individual medication information has hindered the development of patients' individualized medication of anti-epileptic drugs.CONCLUSION:The application of TDM is increasingly widespread;however,the joint efforts of physicians and pharmacists are still needed to ensure individualized medication of anti-epileptic drugs.

Clinical and Electroencephalography Features of Childhood Frontal Lobe Epilepsy / 实用儿科临床杂志

Objective To explore the clinical and electroencephalography features of children's frontal lobe epilepsy(FLE)and improve the diagnosis and therapy.Methods Medical records were reviewed and neuropsychological evaluations of patients with FLE diagnosed from 2000 to 2006.Children were examined by 24 h EEG and imaging examinations.Their charts for family medical history,seizure,aura,simultaneous phenomenon and anti-epilepic drug therapeutic effects were reviewed.Results Seizures were clonus in 24 cases,tonic in 4 cases,adversive,atonic,vomit in 2 cases,respectively,paresthesia,cephalic,visul,sensory in 1 case,Imaging finding were in 9 of 40.All the 40 cases were bought into 1 to 6 years' follow-up.Long-term control was achieved in 35 of 40.Partial control was achieved in 3 of 40.The left 2 cases had no response to the anti-epileptic drugs.Conclusions The common features of FLE included high seizure frequency,short duration and nocturnal preponderance.There is high positive rate of active EEG in detecting epileptic discharges,and active EEG shoud be necessary.Carbamazepine is recommended to be the first choice to FLE.

The Efficacy of Routine Liver Function Test Follow Up in Epileptic Children

PURPOSE: Routine liver function test follow up is done in epileptic children receiving antiepileptic drugs to prevent hepatotoxicity induced by these drugs. But rarely seen are the abnormalities of liver function test, and seldomly are these abnormalities accompanied by the clinical manifestation. This study is carried out to assess the efficacy of routine liver function test follow up in epileptic children. METHODS: We determined the changes of the serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, direct bilirubin, total protein, albumin, gamma-glutamyltransferase (gamma-GT) and alkaline phosphatase before and 3, 6, 12 months and 2 years after antiepileptic drug medication in 59 epileptic children who had been receiving carbamazepine (n=16), phenobarbital (n=14), valproic acid (n=10) and combination of these (n=19) for 2 to 5 years. RESULTS: 1) The difference in liver function test follow up according to the age and sex was not found and there was no statistical correlationship between drug medication time and the serum drug level. 2) AST and ALT had been within normal range for all the study period in any group. 3) Total bilirubin had been within normal range for all the study period in any group. Direct bilirubin had decreased for the first 6 months in valproic acid group, but the changes had been within normal range for all the study period. 4) Total protein and albumin had been within normal range for all the study period in any group. 5) gamma-GT had the increasing tendency for all the study period in valproic acid group, but the values had been within normal range for all the study period. 6) Alkaline phosphatase had decreased for the first 6 months in valproic acid group, but the changes had been within normal range for all the study period. 7) No clinically significant hepatic manifestation had developed during study period in any group. CONCLUSIONS: Our data suggest that routine liver function test follow up itself can not be the indicator of hepatotoxicity and that liver function test in need when accompanied by the development of clinical hepatic manifestation is more efficacious than routine liver function test follow up.

Analysis of the Results of Blood Concentrations of Anti-epileptic Drugs in 733 Epilepsy Patients / 中国药房

OBJECTIVE:To guide the rational use of anti-epileptic drugs(AEDs)in clinical practice.METHODS:In a retrospective review,there were733patients in Xuanwu hospital who suffered from poor curative effect or intoxication of AEDs from March2000to March2001.The results of blood concentration of anti-epileptic drugs(AEDs Css)were ana?lyzed.RESULTS:The Css of37.6%of the patients were within the normal Css range,and6.4%were higher and55.9%were lower than the normal.In combined use of AEDs and other drugs,79.1%of the patients had higher or lower Css than nor?mal.In addition,chemosynthetic components were detected in90%of the patients who took Chinese medicine.Among them,86%of the patients had abnormal Css.CONCLUSION:Css monitoring should be done when AEDs were administrated.It is advisable to use only one or two kinds of AEDs,and to pay attention of the chemosynthetic components in Chinese medicine.