Addressing overtreatment in patients with refractory epilepsy at a tertiary referral centre in Brazil


Autoria(s): ALEXANDRE JR., Veriano; MONTEIRO, Edna Almeida; FREITAS-LIMA, Priscila; PINTO, Kylvia Dantas; VELASCO, Tonicarlo Rodrigues; TERRA, Vera Cristina; PINHEIRO-MARTINS, Ana Paula; SOUZA, Roberto Molina; PERUCCA, Emilio; SAKAMOTO, Americo Ceiki
Contribuinte(s)

UNIVERSIDADE DE SÃO PAULO

Data(s)

19/10/2012

19/10/2012

2011

Resumo

Background. Patients with refractory epilepsy often have impaired quality of life (QOL) as a consequence of seizures and adverse effects of antiepileptic drugs. We assessed the impact of adverse effects on QOL and the utility of a structured instrument to help the physician manage adverse effects in patients with refractory epilepsy. Methods. Clinical characteristics, drug treatment and adverse effects were evaluated in 102 patients with refractory epilepsy at a single tertiary referral centre. The Adverse Events Profile (AEP) and Quality of Life in Epilepsy-31 (QOLIE-31) questionnaires were completed at baseline and after six months. At baseline, patients with a high burden of adverse effects (AEP scores >= 45) were randomized to an intervention or control group. AEP scores in the intervention group were available to the physician as an instrument to help to reduce adverse effects. Results. Ninety-five patients (93.1%) were on polytherapy. Sixty-six completed the questionnaires and, of these, 43 (65.1%) had a high AE burden and were randomized to the intervention and control group. QOLIE-31 scores were inversely correlated with AEP scores at both visits. Among randomized patients, AEP scores tended to decrease between the baseline and the final visit without significant differences between groups (intervention group: 54.1 +/- 6.1 vs 51.1 +/- 9.1; control group: 55.8 +/- 5.8 vs 50.5 +/- 12.2). QOLIE-31 scores did not change substantially between visits (intervention group: 45.9 +/- 17.4 vs 48.4 +/- 14; control group: 47.5 +/- 15.7 vs 45.2 +/- 18.9). Conclusion. A significant proportion of patients had a high toxicity burden which had an impact on their QOL. Reduction of over-treatment is a difficult challenge which cannot be addressed solely by providing a structured assessment of adverse effects, but requires a more comprehensive approach aimed at optimizing the many components of the management strategy.

CAPES Foundation, Brazil

Novartis

Bial

Pfizer

GSK

UCB Pharma

Sanofi-Aventis

Eisai

Johnson and Johnson

Identificador

EPILEPTIC DISORDERS, v.13, n.1, Special Issue 1, p.56-60, 2011

1294-9361

http://producao.usp.br/handle/BDPI/25052

10.1684/epd.2011.0411

http://dx.doi.org/10.1684/epd.2011.0411

Idioma(s)

eng

Publicador

JOHN LIBBEY EUROTEXT LTD

Relação

Epileptic Disorders

Direitos

restrictedAccess

Copyright JOHN LIBBEY EUROTEXT LTD

Palavras-Chave #epilepsy #drug resistance #antiepileptic drugs #overtreatment #adverse effects #QUALITY-OF-LIFE #Clinical Neurology
Tipo

article

original article

publishedVersion