Bangalore, India – Epilepsy is the second most common chronic neurological disorder characterized by episodes of convulsions due to excessive abnormal discharge from neuronal cells in the brain and afflicts approximately 8-10 per 1,000 persons in India. Any medical illness that is known to interfere with the daily routine of an individual and epilepsy is no exception. Epilepsy is an eminently treatable condition using anti-epileptic drugs [AEDs] with treatment duration lasting for at least two years. A good control over convulsions, having least unwanted effects with improved quality of life (QOL) is considered key to efficient management of epilepsy.
With recent increase in availability of large numbers of AEDs for treatment, it was considered important to examine appropriateness of their selection for chronic condition like epilepsy as well as their impact on QOL in people with epilepsy [PWE].
The investigating team consisting clinical pharmacologists and neurologist enrolled patients with epilepsy receiving AED treatment who reported at the St John’s Medical College & Hospital Neurology Out-patient Department. They were assessed clinically for efficacy of AED treatment on seizure control and for QOL using a validated QOLIE – 10 questionnaire.
As described in the article, “Antiepileptic Drugs and Quality of Life in Patients with Epilepsy: A Tertiary Care Hospital-Based Study,“ published in Value in Health Regional Issues Volume 6 focusing on Asia, the study examined influence of AEDs on QOL of 200 PWE. The results showed more number of male patients in the age group of 18 to 30 years. The monotherapy to polytherapy ratio was 1:1, and majority had a prescription of newly available AEDs. It was found increase in seizure frequency, AED polytherapy and adverse drug reactions [ADRs] correlated well with poor QOL. Also the number of ADRs was more with use of combination of AED use. The increase in number of seizures, use of combination AED treatment and more number of ADRs were predictors of poor QOL.
“Epilepsy by itself is strongly associated with psychosocial stigma due to its dramatic and episodic presentation and hence well known to have a negative impact on QOL of PWE. The key findings of our study indicate “need for early detection and treatment initiation with appropriate AED monotherapy to avoid use of combination AED, to achieve early control of seizures and minimize ADRs. Therefore, educational intervention not only of PWE but their care takers and community at large is important” said the study’s corresponding author, Dr. Chanda Kulkarni, MBBS, MD, PhD, FSASMS, Cert. Clin. Epilepsy, formerly Professor and Head, Clinical Pharmacology, St. John’s Medical College, Bangalore, India, along with co-authors Dr. Jesso John and Dr. G. R. K. Sarma, emphasizing the need for appropriate tools for early detection and safer AED treatment options with careful monitoring, recognition, and assessment of ADRs of AEDs, that are essential to achieving the ultimate goal of seizure freedom and optimal QOL in PWE.