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Medicineworld.org: Adverse drug effects in epileptic patients

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Adverse drug effects in epileptic patients




Scientists have observed that polytherapy with multiple anti-epileptic drugs (AEDs) did not result in greater adverse effects than monotherapy for patients with refractory epilepsy. This observational study also found AED load was not a factor in causing adverse effects, but suggests that individual susceptibility, type of AEDs used, and physicians' skills determine which patients suffer adverse effects. Results of this study are available today in Epilepsia, a journal published by Wiley-Blackwell on behalf of the International League Against Epilepsy.



Adverse drug effects in epileptic patients

There are more than 20 different AEDs used to treat epilepsy. However, only about one-half of patients become seizure-free with the first prescribed AED; an additional 20% of patients may find complete relief from seizures through a polytherapy AED regimen. The medical community has extensively debated the value of monotherapy versus polytherapy, not only for relative efficacy in reducing frequency of seizures, but also for impact on health-related quality of life (HRQOL). Past studies have indicated that polypharmacy therapy provides only modest advantages in controlling seizures, with the added burden of potentially increasing adverse effects. In contrast, other studies suggest AED toxicity appears to be better correlated with 'drug load' (the sum of ratios between actual prescribed daily doses and the average therapeutic dose of each drug) than with the number of AEDs administered.

In the current study, 809 epileptic patients were enrolled at 11 tertiary referral centers with 709 participants (344 men and 465 women) having localization-related epilepsy. Mean duration of epilepsy in the study group was over 20 years and the median seizure frequency was 2.5 seizures per month. The most common AEDs prescribed for single AED treatment were carbamazepine, oxcarbazepine, or lamotrigine; one-fourth of participants were treated with monotherapy. In the 627 subjects (77.7%) subjects on polytherapy, levetiracetam was the most usually co-prescribed drug.

Adverse effects were assessed using the Adverse Event Profile (AEP) questionnaire and through unstructured interviews with participants. Nervousness and/or agitation, tiredness, sleepiness, and memory problems were the most usually reported adverse effects in the AEP questionnaire. At the unstructured interviews, about one-third of participants reported at least one adverse effect, and 13.6% reported two or more adverse effects.

"There was no major difference in frequency of the recorded adverse effects between patients on monotherapy and patients on polytherapy," confirmed Emilio Perucca, M.D., of the University of Pavia and main author of the SOPHIE (Study of Outcome of PHarmacoresistance In Epilepsy) study. This finding differs from previous studies that suggest poorer HRQOL is linked to polytherapy and improved HRQOL after conversion from multi-AED therapy to monotherapy.

Results also showed that polytherapy patients had higher drug loads than monotherapy patients. However, scientists did not find a connection between the AED drug load and the number of adverse effects in individual patients. "Our findings suggest that adverse effects can be attributed to individual reaction to the therapy regimen, the type of AED or combination prescribed, and the physicians' skills at therapy," concluded Dr. Perucca. "Further studies of AED therapies and associated adverse effects are needed to uncover fundamental factors such as gender, mood status, therapy duration, and other co-morbidities that influence HRQOL".


Posted by: Daniel    Source




Did you know?
Scientists have observed that polytherapy with multiple anti-epileptic drugs (AEDs) did not result in greater adverse effects than monotherapy for patients with refractory epilepsy. This observational study also found AED load was not a factor in causing adverse effects, but suggests that individual susceptibility, type of AEDs used, and physicians' skills determine which patients suffer adverse effects. Results of this study are available today in Epilepsia, a journal published by Wiley-Blackwell on behalf of the International League Against Epilepsy.

Medicineworld.org: Adverse drug effects in epileptic patients

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