Download PDF
CC BY-NC-ND 4.0 · International Journal of Epilepsy 2024; 10(01/02): 028-034
DOI: 10.1055/s-0044-1791263
Original Article

Prescribing Pattern and Medication Adherence in Patients with Epilepsy in a Tertiary Neuro-Center, Kathmandu

Poonam Pant 
1   Pharmacy Program, CiST College, New Baneshwor, Kathmandu, Nepal
,
Sarita Thapa
1   Pharmacy Program, CiST College, New Baneshwor, Kathmandu, Nepal
,
Shiba Bahadur Karkee
1   Pharmacy Program, CiST College, New Baneshwor, Kathmandu, Nepal
,
Sudip Pandey
2   Madan Bhandari University of Science and Technology, Lalitpur, Nepal
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Epilepsy is a chronic condition characterized by unusual, frequent, excessive, and self-terminating neuronal firing. Adherence to medication is crucial to achieve the intended therapeutic outcome. However, not much research has been done on drug adherence in our context. Thus, the purpose of this study is to investigate the antiseizure medication prescribing pattern, medication adherence, and associated factors.

Materials and Methods A cross-sectional, analytical research was done on randomly selected epileptic patients through interview and documentary analysis using a semi-structured interview schedule and the eight-item Morisky Medication Adherence Scale (MMAS-8). The clinical and demographic characteristics were described using descriptive statistics (median, interquartile range [IQR], frequency, and percentage). The Shapiro–Wilk and chi-squared tests were used to examine the factors influencing medication adherence and the relationships between research variables. The analysis was performed using SPSS version 16.

Results From a total of 104 patients, 77.3% were males, the median age was 29 years (IQR: 16), the majority (42.3%) had higher secondary education, 15.4% had secondary education and 5.8% were illiterate, 25% were job holders, 26% were laborers, 41.3% were from province 3, and 16.3% were from province 4. Two-thirds (63.5%) of the patients were highly adherent to antiseizure medication and 54.8% were seizure free for more than 2 years.

The most common type of epilepsy diagnosed was generalized epilepsy (54.8%). Seizures were usually treated with monotherapy (65.4%), with sodium valproate being the most often used single antiseizure medicine (26.8%), followed by carbamazepine (16.3%) and levetiracetam (15.4%). Additionally, sodium valproate was the medication most frequently used in polytherapy for epilepsy. There was a strong association established between adherence and drug therapy type, age, adverse drug reaction, and seizure control. The study revealed that adherence was not significantly associated with factors such as gender, occupation, regional distribution, or type of epilepsy.

Conclusion Low adherence was observed in 36.5% of patients. As a significant association was observed between medication adherence and seizure control, health care providers should focus on improving medication adherence. Evaluation of adherence needs to be a regular component of managing epilepsy. Further patients who do not stick to their drug regimens should receive more attention and assistance. It will support better therapy results.

Keywords

prescribing pattern - medication adherence - epilepsy - antiseizure medication

Ethical Consideration

Prior to data collection, permission was obtained from UDM-NINAS and the Institutional Review Committee at the Central Institute of Science and Technology, affiliated to Pokhara University, Nepal approved the study (Ref no.: IRC-02–076/077). Participants received a written consent form outlining all the facts in both Nepali and English. For illiterate individuals, inform consent was obtained by thumbprint after verbally giving the content provided in the form. They were informed that participation would be voluntary, and sufficient time was given to read and understand it. Any types of economic and other benefits were not provided and any influence was not used to collect the data from the patients.


Ethical Approval and Consent to Participate

Research was performed in accordance with the Declaration of Helsinki and was approved by the ethics committee Institutional Review Committee at Central Institute of Science and Technology (IRC-CiST), affiliated to Pokhara University, Nepal (Ref: IRC-02–076/077). All the patients gave written consent to participate in the study.


Authors' Contributions

S.T., P.P., and S.B.K. developed the study concept; S.T., P.P., and S.P. conducted the data mining and analysis; and P.P. and S.P. wrote the manuscript, which was reviewed and edited by all the authors.


Availability of Data and Materials

The dataset analyzed during the current study are available from the corresponding author on request.




Publication History

Article published online:
07 October 2024

© 2024. Indian Epilepsy Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Falco-Walter JJ, Scheffer IE, Fisher RS. The new definition and classification of seizures and epilepsy. Epilepsy Res 2018; 139: 73-79
    CrossrefPubMedSearch in Google Scholar
  • 2 Janežič A, Locatelli I, Kos M. Criterion validity of 8-item Morisky Medication Adherence Scale in patients with asthma. PLoS One 2017; 12 (11) e0187835
    CrossrefPubMedSearch in Google Scholar
  • 3 International League Against Epilepsy (ILAE). 2017 . Available at: https://www.ilae.org/guidelines/definition-and-classification/ilae-classification-of-the-epilepsies-2017
    PubMed
  • 4 Baumann RJ, Ryan M, Yelowitz A. Physician preference for antiepileptic drug concentration testing. Pediatr Neurol 2004; 30 (01) 29-32
    CrossrefPubMedSearch in Google Scholar
  • 5 Martins HH, Alonso NB, Guilhoto LMFF, Guaranha MSB, Yacubian EMT. Adherence to treatment in patients with juvenile myoclonic epilepsy: correlation with quality of life and adverse effects of medication. J Epilepsy Clin Neurophysiol 2009; 15: 192-196
    CrossrefPubMedSearch in Google Scholar
  • 6 Ramsey RR, Zhang N, Modi AC. The stability and influence of barriers to medication adherence on seizure outcomes and adherence in children with epilepsy over 2 years. J Pediatr Psychol 2018; 43 (02) 122-132
    CrossrefPubMedSearch in Google Scholar
  • 7 Trinka E, Kwan P, Lee B, Dash A. Epilepsy in Asia: disease burden, management barriers, and challenges. Epilepsia 2019; 60 (Suppl. 01) 7-21
    CrossrefPubMedSearch in Google Scholar
  • 8 Ghimire P, Pant P, Khatiwada S, Ranjit S, Malla S, Pandey S. Self-medication practice in Kathmandu metropolitan city: a cross-sectional study. SAGE Open Med 2023; 11: 20 503121231158966
    CrossrefPubMedSearch in Google Scholar
  • 9 Davis KL, Candrilli SD, Edin HM. Prevalence and cost of nonadherence with antiepileptic drugs in an adult managed care population. Epilepsia 2008; 49 (03) 446-454
    CrossrefPubMedSearch in Google Scholar
  • 10 Buck D, Jacoby A, Baker GA, Chadwick DW. Factors influencing compliance with antiepileptic drug regimes. Seizure 1997; 6 (02) 87-93
    CrossrefPubMedSearch in Google Scholar
  • 11 Farrukh MJ, Makmor-Bakry M, Hatah E, Tan HJ. Use of complementary and alternative medicine and adherence to antiepileptic drug therapy among epilepsy patients: a systematic review. Patient Prefer Adherence 2018; 12: 2111-2121
    CrossrefPubMedSearch in Google Scholar
  • 12 Meyer A, Dua T, Ma J, Saxena S, Birbeck G. Global disparities in the epilepsy treatment gap: a systematic review. Bull World Health Organ 2010; 88 (04) 260-266
    CrossrefPubMedSearch in Google Scholar
  • 13 Kassahun G, Moges G, Demessie Y. Assessment of patients' adherence to antiepileptic medications at Dessie Referral Hospital, chronic follow-up, South Wollo, Amhara region, north east Ethiopia. Neurol Res Int 2018; 2018: 1-6
    CrossrefPubMedSearch in Google Scholar
  • 14 Niriayo YL, Mamo A, Gidey K, Demoz GT. Medication belief and adherence among patients with epilepsy. Behav Neurol 2019; 2019: 2806341
    CrossrefPubMedSearch in Google Scholar
  • 15 Tan X, Makmor-Bakry M, Lau CL, Tajarudin FW, Raymond AA. Factors affecting adherence to antiepileptic drugs therapy in Malaysia. Neurol Asia 2015; 20: 235-241
    PubMedSearch in Google Scholar
  • 16 Gurumurthy R, Chanda K, Sarma G. An evaluation of factors affecting adherence to antiepileptic drugs in patients with epilepsy: a cross-sectional study. Singapore Med J 2017; 58 (02) 98-102
    CrossrefPubMedSearch in Google Scholar
  • 17 Elsayed MA, El-Sayed NM, Badi S, Ahmed MH. Factors affecting adherence to antiepileptic medications among Sudanese individuals with epilepsy: a cross-sectional survey. J Family Med Prim Care 2019; 8 (07) 2312-2317
    CrossrefPubMedSearch in Google Scholar
  • 18 Hasiso TY, Desse TA. Adherence to treatment and factors affecting adherence of epileptic patients at Yirgalem General Hospital, Southern Ethiopia: a prospective cross-sectional study. PLoS One 2016; 11 (09) e0163040
    CrossrefPubMedSearch in Google Scholar
  • 19 Lamichhnae A, Pant P, Khadka S, Shrestha R, Pey S. Prevalence and associated risk factors of hypothyroidism in patients with diabetes mellitus. Diabetes Res 2024; 1: 1-11
    CrossrefPubMedSearch in Google Scholar
  • 20 Tefera G, Woldehaimanot T, Angamo M. Poor treatment outcomes and associated factors among epileptic patients at Ambo Hospital, Ethiopia. Gaziantep Med J. 2015; 21: 9
    CrossrefPubMedSearch in Google Scholar
  • 21 Kandel A, Pant P, Todi S, KC S, Pandey S. Effect of exercise and pharmacotherapy on non-alcoholic fatty liver disease. SAGE Open Med 2024; 12: 20 503121241227090
    CrossrefPubMedSearch in Google Scholar
  • 22 Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24 (01) 67-74
    CrossrefPubMedSearch in Google Scholar
  • 23 Gurshaw M, Agalu A, Chanie T. Anti-epileptic drug utilization and treatment outcome among epileptic patients on follow-up in a resource poor setting. J Young Pharm 2014; 6: 47-52
    CrossrefPubMedSearch in Google Scholar
  • 24 Habib M, Khan SU, Hoque A. et al. Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital. BMC Res Notes 2013; 6: 473
    CrossrefPubMedSearch in Google Scholar
  • 25 Liu J, Xu R, Liu Z, You Y, Meng F. Factors influencing medication adherence after epilepsy surgery. Epileptic Disord 2015; 17 (01) 47-51 , quiz 51
    CrossrefPubMedSearch in Google Scholar
  • 26 Mazhar F, Shamim S, Malhi SM. Drug utilization evaluation of antiepileptics in three selected multidisciplinary teaching hospitals of Pakistan. Int J Pharm Pharm Sci 2014; 6: 59-66
    PubMedSearch in Google Scholar
  • 27 Gabr WM, Shams MEE. Adherence to medication among outpatient adolescents with epilepsy. Saudi Pharm J 2015; 23 (01) 33-40
    CrossrefPubMedSearch in Google Scholar
  • 28 Getnet A, Woldeyohannes SM, Bekana L. et al. Antiepileptic drug nonadherence and its predictors among people with epilepsy. Behav Neurol 2016; 2016: 3189108
    CrossrefPubMedSearch in Google Scholar
  • 29 Niriayo YL, Mamo A, Gidey K, Demoz GT. Medication belief and adherence among patients with epilepsy. Behav Neurol 2019; 2019: 2806341
    CrossrefPubMedSearch in Google Scholar
  • 30 Conrad P. The meaning of medications: another look at compliance. Soc Sci Med 1985; 20 (01) 29-37
    CrossrefPubMedSearch in Google Scholar
  • 31 Tan WW, Kong ST, Chan DWS, Ho PC. A retrospective study on the usage of antiepileptic drugs in Asian children from 2000 to 2009 in the largest pediatric hospital in Singapore. Pharmacoepidemiol Drug Saf 2012; 21 (10) 1074-1080
    CrossrefPubMedSearch in Google Scholar
  • 32 Liu J, Liu Z, Ding H, Yang X. Adherence to treatment and influencing factors in a sample of Chinese epilepsy patients. Epileptic Disord 2013; 15 (03) 289-294
    CrossrefPubMedSearch in Google Scholar
  • 33 Gollwitzer S, Kostev K, Hagge M, Lang J, Graf W, Hamer HM. Nonadherence to antiepileptic drugs in Germany: a retrospective, population-based study. Neurology 2016; 87 (05) 466-472
    CrossrefPubMedSearch in Google Scholar
  • 34 Abd Wahab ES, Al Omar M, Altabakha MMAM. Adherence to antiepileptic drugs among patients attending the neuro spinal hospital in the United Arab Emirates. J Pharm Bioallied Sci 2020; 12 (04) 499-507
    CrossrefPubMedSearch in Google Scholar
  • 35 Laville F, Montana M, Roux N, Rathelot P, Giorgi R, Vanelle P. Factors limiting adherence to antiepileptic treatment: a French online patient survey. J Clin Pharm Ther 2018; 43 (01) 73-79
    CrossrefPubMedSearch in Google Scholar
  • 36 Govil N, Chahal S, Gupta N, Kaloti AS, Nadda A, Singh P. Factors associated with poor antiepileptic drugs adherence in below poverty line persons with epilepsy: a cross-sectional study. J Neurosci Rural Pract 2021; 12 (01) 95-101
    Thieme ConnectPubMedSearch in Google Scholar
  • 37 Jones RM, Butler JA, Thomas VA, Peveler RC, Prevett M. Adherence to treatment in patients with epilepsy: associations with seizure control and illness beliefs. Seizure 2006; 15 (07) 504-508
    CrossrefPubMedSearch in Google Scholar