Multiple anti-epileptic drug use in children with epilepsy in Mulago hospital, Uganda: a cross sectional study
Rita Atugonza,Angelina Kakooza-Mwesige,Samden D. Lhatoo,Mark Kaddumukasa,Levicatus Mugenyi,Levicatus Mugenyi,Martha Sajatovic,Elly Katabira,Richard Idro,Richard Idro +9 more
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TLDR
Multiple AED use is most frequent in symptomatic focal epilepsies but doses are frequently sub-optimal and there is urgent need to improve clinical monitoring in patients.Abstract:
Seizures in up to one third of children with epilepsy may not be controlled by the first anti-epileptic drug (AED). In this study, we describe multiple AED usage in children attending a referral clinic in Uganda, the factors associated with multiple AED use and seizure control in affected patients. One hundred thirty nine patients attending Mulago hospital paediatric neurology clinic with epilepsy and who had been on AEDs for ≥6 months were consecutively enrolled from July to December 2013 to reach the calculated sample size. With consent, the history and physical examination were repeated and the neurophysiologic and imaging features obtained from records. Venous blood was also drawn to determine AED drug levels. We determined the proportion of children on multiple AEDs and performed regression analyses to determine factors independently associated with multiple AED use. Forty five out of 139 (32.4 %) children; 46.7 % female, median age 6 (IQR = 3–9) years were on multiple AEDs. The most common combination was sodium valproate and carbamazepine. We found that 59.7 % of children had sub-therapeutic drug levels including 42.2 % of those on multi-therapy. Sub-optimal seizure control (adjusted odds ratio [ORa] 3.93, 95 % CI 1.66–9.31, p = 0.002) and presence of focal neurological deficits (ORa 3.86, 95 % CI 1.31–11.48, p = 0.014) were independently associated with multiple AED use but not age of seizure onset, duration of epilepsy symptoms, seizure type or history of status epilepticus. One third of children with epilepsy in Mulago receive multiple AEDs. Multiple AED use is most frequent in symptomatic focal epilepsies but doses are frequently sub-optimal. There is urgent need to improve clinical monitoring in our patients.read more
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Volumetric absorptive microsampling as an alternative tool for therapeutic drug monitoring of first-generation anti-epileptic drugs
Sofie Velghe,Christophe P. Stove +1 more
TL;DR: The aim of this study was to develop and validate an LC-MS/MS method for the determination and quantification of four anti-epileptic drugs and one active metabolite in samples collected by VAMS and demonstrate the validity and applicability of the developed procedure.
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Stakeholder views of the practical and cultural barriers to epilepsy care in Uganda.
Nadine Sanchez,Mayanja Kajumba,Juma Kalyegira,Drishti D. Sinha,Samuel Bobholz,Alex Gualtieri,Payal Chakraborty,Erica Onuoha,Anthony T. Fuller,Dirk E. Teuwen,Michael M. Haglund,Deborah C. Koltai +11 more
TL;DR: There are four critical interventions that should be considered for improving epilepsy care in Uganda: the creation of dedicated epilepsy clinics, infrastructure strengthening to address medication stock-outs, community outreach programs for sensitization, and collaboration between biomedical providers and traditional healers.
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Medication adherence and adverse effect profile of antiepileptic drugs in Nigerian patients with epilepsy.
TL;DR: Medication adherence to AED was poor among patients in this study and the most common reported adverse effects among respondents were tiredness and headache.
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Biomedical drugs and traditional treatment in care seeking pathways for adults with epilepsy in Masindi district, Western Uganda: A household survey
TL;DR: Engaging the private sector and community health workers, conducting community outreaches and community sensitization with messages tailored for audiences including the young, older epileptics, traditional healers as stakeholders, and traders could increase access to appropriate treatment for epilepsy.
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Healthcare provider perspectives regarding epilepsy care in Uganda.
Deborah C. Koltai,Caleigh E. Smith,Grace Y. Cai,Olivia Ratliff,Angelina Kakooza-Mwesige,Josephine N. Najjuma,Rose Muhindo,Godfrey Zari Rukundo,Dirk E. Teuwen,Adrian Kayanja,Peter Kalubi,Michael M. Haglund,Anthony T. Fuller +12 more
TL;DR: The findings delineate the perspectives of providers caring for PWE, with consistent recognition of challenges centering around resource augmentation, infrastructure strengthening, and education.
References
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Journal ArticleDOI
Early Identification of Refractory Epilepsy
TL;DR: Patients who have many seizures before therapy or who have an inadequate response to initial treatment with antiepileptic drugs are likely to have refractory epilepsy.
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Revised Terminology and Concepts for Organization of Seizures and Epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005-2009
Anne T. Berg,Anne T. Berg,Samuel F. Berkovic,Martin J. Brodie,Jeffrey Buchhalter,J. Helen Cross,Walter van Emde Boas,Jerome Engel,Jacqueline A. French,Tracy A. Glauser,Gary W. Mathern,Solomon L. Moshé,Douglas R. Nordli,Perrine Plouin,Ingrid E. Scheffer +14 more
TL;DR: The International League Against Epilepsy (ILAE) Commission on Classification and Terminology has revised concepts, terminology, and approaches for classifying seizures and forms of epilepsy.
Journal ArticleDOI
Antiepileptic drugs—best practice guidelines for therapeutic drug monitoring: A position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies
Philip N. Patsalos,David J. Berry,Blaise F. D. Bourgeois,James C. Cloyd,Tracy A. Glauser,Svein I. Johannessen,Ilo E. Leppik,Torbjörn Tomson,Emilio Perucca +8 more
TL;DR: Evidence from nonrandomized studies and everyday clinical experience does indicate that measuring serum concentrations of old and new generation antiepileptic drugs (AEDs) can have a valuable role in guiding patient management provided that concentrations are measured with a clear indication and are interpreted critically, taking into account the whole clinical context.
Journal ArticleDOI
Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries.
Aluísio J D Barros,Carine Ronsmans,Henrik Axelson,Edilberto Loaiza,Andréa Dâmaso Bertoldi,Giovanny Vinícius Araújo de França,Jennifer Bryce,J. Ties Boerma,Cesar G. Victora +8 more
TL;DR: Skilled birth attendant coverage was the least equitable intervention, according to all four summary indices, followed by four or more antenatal care visits, and the most equitable intervention was early initation of breastfeeding.
Journal ArticleDOI
Early development of intractable epilepsy in children: a prospective study.
Anne T. Berg,Shlomo Shinnar,Susan R. Levy,Francine M. Testa,Susan Smith-Rapaport,Barbara Beckerman +5 more
TL;DR: Initial seizure frequency is highly predictive of intractable epilepsy in children, and age at onset between 5 and 9 years was associated with a lowered risk of IE, and absolute number of seizures and unprovoked or febrile status epilepticus are not.