Drug Therapy Problems and Contributing Factors Among Patients With Epilepsy
Yirga Legesse Niriayo, Tesfay Gebregziabher, Gebre Teklemariam Demoz, Nigusse Tesfay, Kidu Gidey
Abstract
Background
Although antiseizure medications play a crucial role in the management of epilepsy, their benefit can be compromised due to drug-related problems. Drug therapy problems can lead to poor seizure control, reduced quality of life, and increased morbidity and mortality in patients with epilepsy. However, in our setting, there is limited knowledge about drug therapy problems and the factors that contribute to them.
Objective
The aim of this study was to investigate the prevalence and contributing factors of drug-therapy problems among patients with epilepsy.
Methodology
A hospital-based prospective observational study was conducted at the neurologic clinic of Ayder Comprehensive Specialized Hospital, located in the Tigray region of Northern Ethiopia. The study included adult patients diagnosed with epilepsy who had been taking at least one antiseizure medication for a minimum of six months. Data were collected by conducting patient interviews and expert reviews of medical and medication records.
Introduction
Antiseizure medications are the mainstay of therapy in the management of epilepsy and are indicated for patients who have experienced two or more unprovoked seizures, or a single unprovoked seizure accompanied by additional factors that increase the risk of seizure recurrence [1, 2]. The ultimate goal in managing epilepsy is to achieve complete seizure control without inducing adverse effects [3].Therefore, treatment should be individualized and optimized to achieve better control of seizures while preventing or minimizing adverse drug- related harms and complications [2, 4]. The majority of people with epilepsy can become seizure-free with the optimal use of currently available antiseizure medications [2, 5]. However, seizure control remains suboptimal in the majority of patients with epilepsy in developing countries, including Ethiopia [6, 7]. Despite the availability of several evidence-based antiseizure medications, there is a huge gap in the treatment of epilepsy in resource-limited countries, including Ethiopia, due to poor healthcare system, low health literacy, insufficient supply of antiseizure medications, and poor beliefs about medication in modern medicine [8, 9]. Different cultural backgrounds influence the treatment of epilepsy by shaping beliefs, stigmas, and cultural practices, which in turn impact medical accessibility, treatment adherence, and social integration [10, 11].
Methodods
Study design and setting
A prospective observational study was conducted at the neurology clinic of Ayder Comprehensive Specialized Hospital (ACSH) in the Tigray region of Northern Ethiopia between January 2019 and April 2019. ACSH is a teaching and referral hospital that serves approximately 10 million people in the catchment area.
Study participants
The study included adult patients (aged >18 years) diagnosed with epilepsy, who had been regularly followed up for at least six months and were taking at least one antiseizre medication. Patients with intellectual disabilities or serious illnesses that prevented them from completing the interview, those who did not provide consent, and those with incomplete medical records were excluded. We calculated a sample size of 250 patients using a single population proportion formula, assuming a 50% proportion of DTPs, a 5% margin of error, a 95% confidence level, and a 10% contingency for nonresponse rate. Patients were enrolled in the study through a random selection process during their medication refilling appointments, using a simple random sampling technique.
Result
Socio-demographic related characteristics
This study included a total of 250 participants. The average age (standard deviation (SD)) was 36.6 (15.5) years. Of the total sample, 60.8% were male, 62.8% resided in urban areas, and 45.2% were married. Approximately 30.8% of participants reported using traditional medicine for their illnesses. In terms of social drug use, 8.8% were alcohol consumers, 6.0% were smokers, and 3.2% were khat chewers (Table 1).
Discussion
Epilepsy management in Ethiopia faces significant challenges due to limited healthcare resources, a shortage of trained medical professionals, and societal stigma [8, 32, 33]. Access to specialized epilepsy services, including diagnostic tools, antiseizure medications, and adequately trained healthcare professionals, is limited, especially in rural areas [11]. The availability and affordability of antiseizure medications, which are crucial for managing epilepsy, often face challenges [34]. Additionally, misconceptions and cultural beliefs contribute to stigmatizing individuals with epilepsy, which hinders their acceptance and access to healthcare services [12, 13, 35]. As a result, epilepsy management in Ethiopia is suboptimal, leading to inadequate seizure control and negatively impacting the affected individuals’ quality of life [6, 11]. To address these challenges, it is imperative to invest in healthcare infrastructure, healthcare professional training, and public awareness campaigns to enhance epilepsy care in Ethiopia [36].
Conclusion
Drug therapy problems were prevalent among patients with epilepsy. The most commonly identified DTPs included dosage too low, noncompliance with the prescribed medications, adverse drug reactions (ADRs), and unnecessary drug therapy. It was found that combining multiple medications and experiencing seizures were indicators of potential drug therapy problems. Consequently, it is imperative to prioritize patients who are on multiple medications and have uncontrolled seizures. Moreover, conducting longitudinal interventional studies would be beneficial in preventing and reducing the incidence of DTPs in epilepsy.
Acknowledgments
We would like to extend our heartfelt appreciation to the dedicated team of data collectors and hospital staff members for their exceptional commitment and cooperation throughout the project. We are also immensely grateful to the individuals participating in the study, particularly the epileptic patients, for their valuable voluntary involvement.
Citation: Niriayo YL, Gebregziabher T, Demoz GT, Tesfay N, Gidey K (2024) Drug therapy problems and contributing factors among patients with epilepsy. PLoS ONE 19(3): e0299968. https://doi.org/10.1371/journal.pone.0299968
Editor: Tai-Heng Chen, Kaohsuing Medical University Hospital, TAIWAN
Received: July 19, 2023; Accepted: February 19, 2024; Published: March 7, 2024
Copyright: © 2024 Niriayo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The author(s) received no specific funding for this work
Competing interests: The authors have declared that no competing interests exist.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0299968#sec006
