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  • View Article

    Title: Impact of Established and Newer Anti-epileptic Drugs and their Combination on the Quality of life

    Article Number: EC/2014/113

    Authors: Ahmed M.A.Y 1, TagEldin Sokrab 2, Mahmoud MA 2

    Topic: Clinical Research

    Abstract:

    Abstract:

      

    Title:

         Impact of Established and Newer Anti-epileptic Drugs and their Combination on the Quality of life in   

          People with Epilepsy

    Purpose:

    The aim was to study and compare the quality of life (QOL) in patients with epilepsy (PWE) treated with established (EAED), newer (NAED) or a combination thereof (CAED) in a developing Gulf state of a growing economy.                    

    Methods:

    The study carried on a prospective cohort of PWE attending the neurology clinic in Hamad General Hospital in Doha, Qatar between 15 October 2009 and 15 April 2011. Phenytoin, carbamazepine, sodium valproate, phenobarbitone, clobazam and clonazepam were the EAEDs and lamotrigine, topiramate and Levetiracetam were the NAEDs drugs available for prescription in our hospital.

    Epilepsy patients aged 13 year or more and on AED treatment for at least 6 months provided with a self-completing 32-item questionnaire with graded scales and checklists.

    Results:

    Fifty-three males and 47 females completed the questionnaire. 65% of the participants were below 35 years. Thirty-seven patients were on EAED, 33 on NAED and 30 on CAED. Patients on EAEDs found to have fewer drug side effects than with NAEDs. More seizure, stigmatization and birth abnormalities occurred in patients treated with CAEDs. Good control of seizures was the main determinant of a favorable perception of QOL.

    Conclusion:

    Newer AEDs linked with more side effects than the established with exception side effects of gum, hair loss and suicidal tendency, but they lesser side effects when combined with the established AEDs. The new AEDs were better on psychological wellbeing. However, good seizure control was more important than the type of AED used in rendering improvement in QOL.  

    Forum

    • SADAF TABASSUM (Viewer) 29th Jan 2015 - 5:57 PM
      The HRQOL mean score of PWEs and receiving AEDs is very low . It is evident that current management of epilepsy that focuses on only seizure control does not improve HRQOL of the patients receiving AEDs. Treatment of epilepsy should include other health dimensions in addition to seizure control and AEDs side effects. Adding clinical counseling and other interventions to address the physical, mental, psychological, social and emotional aspects for health wellbeing is likely to achieve better health outcomes for epilepsy patients.
      Reply
    • PRAJNA KUMAR (Viewer) 30th Jan 2015 - 12:41 AM
      Interesting Article, however there are several limitations in the article which needs to be addressed for scientific merit. 1) There is published scientific literature indicating that older generation antiepileptic drugs like Phenobarbital (Luminal), carbamazepine (Tegretol), phenytoin (Dilantin), and valproic acid (Depakote) have several shortcomings such as suboptimal response rates, significant adverse effects, several drug interactions, and a narrow therapeutic index. New antiepileptic drugs have been developed in the last decade to overcome some of these problems. These newer generation antiepileptics like felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), tiagabine (Gabitril), topiramate (Topamax), and zonisamide (Zonegran) have better tolerability profiles, low interaction potential, and significantly less enzyme inducing or inhibiting properties. How do you addresses this discrepancy?
      2) Which HRQoL instrument did you use? You state a validated instrument was used but there was no reference to whether this instrument was generic or epilepsy specific like below
      a) Epilepsy Surgery Inventory-55
      b) Side-Effect and Life Satisfaction (SEALS) Inventory

      3) How was confounding addressed (socio-demographic and clinical characteristics, epilepsy types, genetic, length of AED use, use of alcohol, frequency of side effects other health conditions etc)

      4) How was Internal consistency and reliability addressed?

      Good idea, however needs more in-depth analysis addressing the specific items mentioned below and other bias and issues related to self/versus interviewer lead questionnaire, sample size (too small) etc.
      Reply
      • AHMED MOHAMED ALI YOUSIF (Author) 3rd Feb 2015 - 5:12 PM
        Dear Prajna Kumar
        Realy I thank you a lot . I feel you did very intersting appraisal . The study had a number of limitations as you mentioned. Sample size was small per each arm. each group of the established and newer AEPD were compared collectively , there were no any copmarison among each group to see the impact on QOL .Bisa might be occured during the data collection as instrument for collecting data was interview.
        the tool used for collecting data was already in Liverpool for QOL in people with epilsy and it was well validated tool University Department of Neurosciences Walton Centre for Neurology and Neurosurgery .Lower Lane., Fazakerley, Liverpool, L97LJ . It contained 32 questions. the referncing might be missed in the paper.
        Reply
    • JULIUS FRU CHE (Viewer) 6th Feb 2015 - 3:38 AM
      Dear Ahmed.
      I find your article very interesting and educative.
      I also noticed that as per your work, there seem to be an association between stigmatization and the type of drug taken.
      According to your findings, is the stigmatization associated with the gum and mouth side effects associated with the established AEDs or was it due to another probably cause?
      Reply
    • AHMED MOHAMED ALI YOUSIF (Author) 7th Feb 2015 - 1:09 AM
      Dear Julius

      I thank you a lot for these encouraging l words. Stigma was experienced by epileptic patients who were taking AEDs , and there was no any other comorbidity medications were taken.
      Reply

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