TY - JOUR AB - Background: Poor adherence to antiepileptic medication is associated with increased mortality, morbidity and healthcare costs. In this review, we focus on interventions designed and tested in randomised controlled trials (RCTs) and quasi-RCTs to assist people with adherence to antiepileptic medication. This is an update of a Cochrane review first published in 2011, and last updated in 2017. Objectives: To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medication in adults and children with epilepsy. Search methods: For the latest update, we searched the following databases on 18 February 2020: Cochrane Register of Studies (CRS Web), MEDLINE, CINAHL Plus and PsycINFO. CRS Web includes RCTs or quasi-RCTs from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), CENTRAL, and the Specialized Registers of Cochrane Review Groups including Epilepsy. We also searched the reference lists of relevant articles. Selection criteria: RCTs and quasi-RCTs of adherence-enhancing interventions aimed at people with a clinical diagnosis of epilepsy (as defined in individual studies), of any age and treated with antiepileptic drugs in a primary care, outpatient or other community setting. Data collection and analysis: All review authors independently assessed lists of potentially relevant citations and abstracts. At least two review authors independently extracted data and performed a quality assessment of each study according to the Cochrane tool for assessing risk of bias. We graded the level of evidence for each outcome according to GRADE. The studies differed widely according to the type of intervention and measures of adherence; therefore combining data was not appropriate. Main results: We included 20 studies reporting data on 2832 participants. Thirteen studies targeted adults with epilepsy, one study included participants of all ages, one study included participants older than two years, one recruited pediatric patients aged between 1 month to 15 years, one study targeted caregivers of children with epilepsy, one targeted adolescents and caregivers, and two studies targeted families of children with epilepsy. We identified three ongoing studies. Follow-up time was generally short in most studies, ranging from 1 to 12 months. The studies examined three main types of interventions: educational interventions, behavioural interventions and mixed interventions. All but three studies compared treatment with usual care or 'no intervention'. Due to heterogeneity between studies in terms of interventions, methods used to measure adherence and the way the studies were reported, we did not pool the results and these findings were inappropriate to be included in a meta-analysis. Education and counselling of participants with epilepsy had mixed success (moderate-certainty evidence). Behavioural interventions such as the use of intensive reminders provided more favourable effects on adherence (moderate-certainty evidence). The effect on adherence to antiepileptic drugs described by studies of mixed interventions showed improved adherence in the intervention groups compared to the control groups (high-certainty evidence). Eleven studies described seizure frequency or seizure severity or both, with four of them, reporting improved adherence and decreased seizure frequency in the intervention groups (moderate-certainty evidence). Findings related to self-efficacy and quality of life were mixed, with no clear pattern across types of intervention. Authors' conclusions: Behavioural interventions such as intensive reminders and the use of mixed interventions demonstrate some positive results, however, we need more reliable evidence on their efficacy, derived from carefully-designed RCTs before we can draw a firm conclusion. None of the newly included studies have provided additional information that would lead to significant changes in our conclusions. AU - Al-aqeel, Sinaa AU - Gershuni, Olga AU - Al-sabhan, Jawza AU - Hiligsmann, Mickael DA - 2020/10// DO - 10.1002/14651858.CD008312.PUB4 IS - 10 KW - Adult KW - Anticonvulsants / therapeutic use* KW - Bias KW - Child KW - Cost-Benefit Analysis KW - Epilepsy / drug therapy* KW - Epilepsy / psychology KW - Humans KW - MEDLINE KW - Medication Adherence / psychology* KW - Mickael Hiligsmann KW - NCBI KW - NIH KW - NLM KW - National Center for Biotechnology Information KW - National Institutes of Health KW - National Library of Medicine KW - Non-U.S. Gov't KW - Olga Gershuni KW - PMC8092477 KW - PubMed Abstract KW - Quality of Life KW - Randomized Controlled Trials as Topic KW - Research Support KW - Self Efficacy KW - Sinaa Al-Aqeel KW - Systematic Review KW - doi:10.1002/14651858.CD008312.pub4 KW - pmid:33089492 PB - Cochrane Database Syst Rev PY - 2020 TI - Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy T2 - The Cochrane database of systematic reviews UR - https://pubmed.ncbi.nlm.nih.gov/33089492/ VL - 10 ER - TY - JOUR AB - Summary Objective To develop estimates of the direct cost of epilepsy in the United States for the general epilepsy population and sub-populations by systematically comparing similarities and differences in types of estimates and estimation methods from recently published studies. Methods Papers published since 1995 were identified by systematic literature search. Information on types of estimates, study designs, data sources, types of epilepsy, and estimation methods was extracted from each study. Annual per person cost estimates from methodologically similar studies were identified, converted to 2013 U.S. dollars, and compared. Results From 4,104 publications discovered in the literature search, 21 were selected for review. Three were added that were published after the search. Eighteen were identified that reported estimates of average annual direct costs for the general epilepsy population in the United States. For general epilepsy populations (comprising all clinically defined subgroups), total direct healthcare costs per person ranged from $10,192 to $47,862 and epilepsy-specific costs ranged from $1,022 to $19,749. Four recent studies using claims data from large general populations yielded relatively similar epilepsy-specific annual cost estimates ranging from $8,412 to $11,354. Although more difficult to compare, studies examining direct cost differences for epilepsy sub-populations indicated a consistent pattern of markedly higher costs for those with uncontrolled or refractory epilepsy, and for those with comorbidities. Significance This systematic review found that various approaches have been used to estimate the direct costs of epilepsy in the United States. However, recent studies using large claims databases and similar methods allow estimation of the direct cost burden of epilepsy for the general disease population, and show that it is greater for some patient subgroups. Additional research is needed to further understand the broader economic burden of epilepsy and how it varies across subpopulations. AU - Begley, Charles E. AU - Durgin, Tracy L. DA - 2015/9// DO - 10.1111/EPI.13084 IS - 9 KW - Burden of illness KW - Cost KW - Cost of illness KW - Costs and cost analysis KW - Economic burden KW - Economics KW - Epilepsy KW - Seizures PB - John Wiley & Sons, Ltd PY - 2015 SP - 1376 EP - 1387 TI - The direct cost of epilepsy in the United States: A systematic review of estimates T2 - Epilepsia UR - https://onlinelibrary.wiley.com/doi/full/10.1111/epi.13084 UR - https://onlinelibrary.wiley.com/doi/abs/10.1111/epi.13084 UR - https://onlinelibrary.wiley.com/doi/10.1111/epi.13084 VL - 56 ER - TY - JOUR AB - Summary Status epilepticus is a common neurological emergency with considerable associated health-care costs, morbidity, and mortality. The definition of status epilepticus as a prolonged seizure or a series of seizures with incomplete return to baseline is under reconsideration in an effort to establish a more practical definition to guide management. Clinical research has focused on early seizure termination in the prehospital setting. The approach of early escalation to anaesthetic agents for refractory generalised convulsive status epilepticus, rather than additional trials of second-line anti-epileptic drugs, to avoid neuronal injury and pharmaco-resistance associated with prolonged seizures is gaining momentum. Status epilepticus is also increasingly identified in the inpatient setting as the use of extended electroencephalography monitoring becomes more commonplace. Substantial further research to enable early identification of status epilepticus and efficacy of anti-epileptic drugs will be important to improve outcomes. AU - Betjemann, John P. AU - Lowenstein, Daniel H. DA - 2015/6// DO - 10.1016/S1474-4422(15)00042-3 IS - 6 PB - Elsevier PY - 2015 SP - 615 EP - 624 TI - Status epilepticus in adults T2 - The Lancet Neurology UR - http://www.thelancet.com/article/S1474442215000423/fulltext UR - http://www.thelancet.com/article/S1474442215000423/abstract UR - https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(15)00042-3/abstract VL - 14 ER - TY - JOUR AB - Despite the availability of numerous antiepileptic drugs (AEDs), some epilepsies remain resistant to treatment. We compared utilization and costs in patients with uncontrolled epilepsy to those with stable epilepsy. Claims data (2007-2009) were used to identify adults with epilepsy requiring additional AED therapy (having uncontrolled epilepsy) and those not requiring additional AED therapy (having stable epilepsy). The date in 2008 on which an additional AED was started was the index date for patients with uncontrolled epilepsy, and a randomly selected date was used for patients with stable epilepsy, whose AED use was unchanged in the preceding year. In the postindex year, all pharmacy and medical claims were used to estimate overall utilization and costs; claims with epilepsy in any diagnosis field were used to estimate epilepsy-related outcomes. Outcomes were adjusted using multivariate analyses. We identified 1536 patients with uncontrolled epilepsy and 8571 patients with stable epilepsy (mean age: 42.8. years; female: 48%). Patients with uncontrolled epilepsy had higher comorbidity rates (p<.02). A greater proportion of patients with uncontrolled epilepsy had ≥. 1 hospitalization or emergency department visit (p<.001). Patients with uncontrolled epilepsy had a greater mean length of hospital stay and more physician office visits (p<.034). After adjustment, the odds of hospitalization (OR: 1.8, any diagnosis; 2.2, epilepsy-related) and emergency department visit (OR: 1.6, any diagnosis; 1.9, epilepsy-related) were greater for patients with uncontrolled epilepsy. Annual overall ($23,238 vs. $13,839) and epilepsy-related ($12,399 vs. $5511) costs were higher in patients with uncontrolled epilepsy and remained higher after adjustment (p<.001). Patients with uncontrolled epilepsy use more services and incur higher costs compared with those with stable epilepsy. Epilepsy-related costs accounted for <. 50% of the total costs, suggesting that comorbid conditions and/or underidentification of utilization may substantially contribute to costs. © 2013 Elsevier Inc. AU - Cramer, Joyce A. AU - Wang, Zhixiao J. AU - Chang, Eunice AU - Powers, Annette AU - Copher, Ronda AU - Cherepanov, Dasha AU - Broder, Michael S. DO - 10.1016/j.yebeh.2013.09.046 KW - Antiepileptic drugs KW - Cost analysis KW - Economics KW - Epilepsy KW - Medical care KW - Seizures PB - Elsevier PY - 2014 SP - 356 EP - 362 TI - Healthcare utilization and costs in adults with stable and uncontrolled epilepsy T2 - Epilepsy and Behavior VL - 31 ER - TY - JOUR AB - Purpose: This study assessed the extent of refill nonadherence with antiepileptic drugs (AEDs) and the potential association between AED nonadherence and health care costs in an adult-managed care population. Methods: Retrospective claims from the PharMetrics database were analyzed. Inclusion criteria were: age ≥21, epilepsy diagnosis between January 01, 2000 and March 12, 2005, ≥2 AED prescriptions, and continuous health plan enrollment for ≥6 months prior to and ≥12 months following AED initiation. Adherence was evaluated using the medication possession ratio (MPR). Patients with an MPR <0.8 were classified as nonadherent. Multivariate regression was used to assess the effect of AED nonadherence on annualized cost outcomes. Regression covariates included patient demographics, Charlson Comorbidity Index (CCI), and follow-up duration. Results: Among patients meeting all inclusion criteria (N = 10,892), 58% were female, mean age was 44 years, mean CCI was 0.94, and mean follow-up was 27 months. Mean MPR was 0.78 and 39% of patients were nonadherent. AED nonadherence was associated with an increased likelihood of hospitalization (odds ratio [OR] = 1.110, p = 0.013) and emergency room (ER) admission (OR = 1.479, p < 0.0001), as well as increased inpatient and ER costs of $1,799 and $260 (both p = 0.001), respectively, per patient per year. Outpatient and other ancillary costs were not significantly affected by nonadherence. A large net positive effect of nonadherence on total annual health care costs remained (+$1,466, p = 0.034) despite an offset from reduced prescription drug intake. Discussion: Adherence with AEDs among adult epilepsy patients is suboptimal and nonadherence appears to be associated with increased health care costs. Efforts to promote AED adherence may lead to cost savings for managed care systems. © 2008 International League Against Epilepsy. AU - Davis, Keith L. AU - Candrilli, Sean D. AU - Edin, Heather M. DO - 10.1111/j.1528-1167.2007.01414.x IS - 3 KW - Antiepileptic drugs KW - Claims data KW - Costs KW - Nonadherence PB - Epilepsia PY - 2008 SP - 446 EP - 54 TI - Prevalence and cost of nonadherence with antiepileptic drugs in an adult managed care population T2 - Epilepsia VL - 49 ER - TY - GEN AB - Sudden unexpected death in epilepsy (SUDEP) can affect individuals of any age, but is most common in younger adults (aged 20–45 years). Generalised tonic-clonic seizures are the greatest risk factor for SUDEP; most often, SUDEP occurs after this type of seizure in bed during sleep hours and the person is found in a prone position. SUDEP excludes other forms of seizure-related sudden death that might be mechanistically related (eg, death after single febrile, unprovoked seizures, or status epilepticus). Typically, postictal apnoea and bradycardia progress to asystole and death. A crucial element of SUDEP is brainstem dysfunction, for which postictal generalised EEG suppression might be a biomarker. Dysfunction in serotonin and adenosine signalling systems, as well as genetic disorders affecting cardiac conduction and neuronal excitability, might also contribute. Because generalised tonic-clonic seizures precede most cases of SUDEP, patients must be better educated about prevention. The value of nocturnal monitoring to detect seizures and postictal stimulation is unproven but warrants further study. AU - Devinsky, Orrin AU - Hesdorffer, Dale C. AU - Thurman, David J. AU - Lhatoo, Samden AU - Richerson, George DO - 10.1016/S1474-4422(16)30158-2 IS - 10 KW - Dale C Hesdorffer KW - Death KW - Epilepsy / complications* KW - Extramural KW - George Richerson KW - Humans KW - MEDLINE KW - N.I.H. KW - NCBI KW - NIH KW - NLM KW - National Center for Biotechnology Information KW - National Institutes of Health KW - National Library of Medicine KW - Orrin Devinsky KW - PubMed Abstract KW - Research Support KW - Review KW - Sudden / epidemiology KW - Sudden / etiology* KW - Sudden / prevention & control KW - doi:10.1016/S1474-4422(16)30158-2 KW - pmid:27571159 PB - Lancet Publishing Group PY - 2016 SP - 1075 EP - 1088 TI - Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention T2 - The Lancet Neurology VL - 15 ER - TY - GEN AB - Patient adherence to medication continues to be a cause of concern within the medical profession. This review examines the various methods of quantifying the level of patient adherence, progress in predicting causes of non-adherence, and the implications for its management. Contributions from the medical, health belief, and psychosocial models are discussed in order to highlight how the concept of adherence has changed over time. The impact of epilepsy, seizures, and taking antiepileptic drugs (AEDs) on both adherence and quality of life are also explored. The volume and quality of previous research conducted has enabled a number of predictive factors to be identified, from which various strategies have been developed. While this review concentrates on potential strategies in managing treatment adherence within epilepsy, findings can equally be applied to other chronic conditions. © 2007 Dove Medical Press Limited. All rights reserved. AU - Eatock, Joanne AU - Baker, Gus A. DO - 10.2147/nedt.2007.3.1.117 IS - 1 KW - Adherence KW - Antiepileptic drugs KW - Compliance KW - Epilepsy KW - QOL PB - Neuropsychiatr Dis Treat PY - 2007 SP - 117 EP - 31 TI - Managing patient adherence and quality of life in epilepsy T2 - Neuropsychiatric Disease and Treatment VL - 3 ER - TY - JOUR AB - Purpose To assess the mortality related to epilepsy in Latin America. Methods We searched MEDLINE, EMBASE, and LILACS from inception to December 2013 for articles evaluating mortality in patients with epilepsy in Latin America. Studies were included if they evaluated any mortality outcome, included a population of subjects with recurrent seizures or epilepsy, and contained original data analysis. Results The search strategy yielded 177 publications in MEDLINE and EMBASE, and 59 publications in LILACS; of which 18 met inclusion criteria for our overall review of epilepsy and mortality in Latin America. Most excluded studies did not report the mortality or lacked original data. We also included two references obtained from 2 non-systematic reviews fulfilling our inclusion criteria, and able to provide data for our analyses. Five studies reported Standardized Mortality Ratio (SMR), and demonstrated that people with epilepsy had a higher risk of death than the general population. The SMRs reported in two community-based studies were 1.34 and 2.45. Conclusion The information about mortality in epilepsy in Latin America is very scarce. Comparisons cannot be made among studies due to methodological differences. More studies are needed. AU - Escalaya, Alejandro L. AU - Tellez-Zenteno, Jose F. AU - Steven, David A. AU - Burneo, Jorge G. DO - 10.1016/j.seizure.2014.09.012 KW - America KW - Epilepsy KW - Latin KW - Mortality KW - SUDEP PB - W.B. Saunders Ltd PY - 2015 SP - 99 EP - 103 TI - Epilepsy and mortality in Latin America T2 - Seizure VL - 25 ER - TY - JOUR AB - Abstract Retrospective insurance claims from the United States were analyzed to assess nonadherence to antiepileptic drugs (AEDs) and the association between AED nonadherence, seizures, and health care costs in elderly persons with epilepsy. Inclusion criteria were: age ⩾65, epilepsy diagnosis between 1 January 2000 and 31 June 2006, ⩾2 AED prescriptions, and insurance enrollment for ⩾6 months pre- and ⩾12 months post-AED initiation. Adherence was evaluated using the medication possession ratio (MPR), with MPRP=0.0212). Nonadherers had higher inpatient (+$872, P=0.001), emergency department (+$143, P=0.0008), other outpatient ancillary (+$1741, P=0.0081), and total health care (+$2674, P=0.0059) costs. AED adherence among elderly patients with epilepsy is suboptimal and associated with increased seizures and health care costs. AU - Ettinger, Alan B. AU - Manjunath, Ranjani AU - Candrilli, Sean D. AU - Davis, Keith L. DA - 2009/2// DO - 10.1016/J.YEBEH.2008.10.021 IS - 2 KW - Adherence KW - Antiepileptic drugs KW - Claims data KW - Costs KW - Elderly PB - Elsevier PY - 2009 SP - 324 EP - 329 TI - Prevalence and cost of nonadherence to antiepileptic drugs in elderly patients with epilepsy T2 - Epilepsy & Behavior UR - http://www.epilepsybehavior.com/article/S1525505008003648/fulltext UR - http://www.epilepsybehavior.com/article/S1525505008003648/abstract UR - https://www.epilepsybehavior.com/article/S1525-5050(08)00364-8/abstract VL - 14 ER - TY - JOUR AB - Purpose: To study the impact of nonadherence to antiepileptic drugs (AEDs) on health care utilization and direct medical costs in a Medicaid population. Methods: A retrospective cohort design was employed using state Medicaid claims data from Florida, Iowa, and New Jersey during the period from January 1997 to June 2006. Patients aged ≥18 years with one or more neurologist visit with an epilepsy diagnosis and two or more pharmacy claims for AEDs were included. Medication possession ratio (MPR) was used to evaluate AED adherence with MPR ≥ 0.80 considered adherent and <0.80 considered nonadherent. The association of nonadherence with utilization outcomes [hospitalizations, inpatient days, emergency department (ED), and outpatient visits] was assessed with univariate and multivariate Poisson regressions. Quarterly per-patient inpatient, outpatient, ED, and pharmacy costs were calculated across nonadherent and adherent quarters for the younger than 65 population (under-65) and cost differences were computed. Adjusted incremental costs of nonadherence were estimated with multivariate Tobit regression models. Results: A total of 33,658 patients were included (28,470 under-65), together contributing 388,564 treated quarters (26% nonadherent). In multivariate analyses, AED nonadherence was associated with significantly higher incidence of hospitalizations [incident rate ratio (IRR) = 1.39, 95% confidence interval (CI) = 1.37-1.41], inpatient days (IRR = 1.76, 95% CI = 1.75-1.78), and ED visits (IRR = 1.19, 95% CI = 1.18-1.21). Nonadherence was associated with cost increases related to serious outcomes, including inpatient ($4,320 additional cost per quarter, 95% CI = $4,077-$4,564) and ED services ($303 additional cost per quarter, 95% CI = $273-$334), but lower costs for outpatient and pharmacy services, likely because of nonadherent behavior. Discussion: Nonadherence to AEDs appears to be associated with serious outcomes, as evidenced by increased utilization and costs of inpatient and ED services. © 2008 International League Against Epilepsy. AU - Faught, R. Edward AU - Weiner, Jennifer R. AU - Guérin, Annie AU - Cunnington, Marianne C. AU - Duh, Mei Sheng DA - 2009/3// DO - 10.1111/j.1528-1167.2008.01794.x IS - 3 KW - Adherence KW - Antiepileptic drugs KW - Costs KW - Health care utilization PB - John Wiley & Sons, Ltd PY - 2009 SP - 501 EP - 509 TI - Impact of nonadherence to antiepileptic drugs on health care utilization and costs: Findings from the RANSOM study T2 - Epilepsia VL - 50 ER - TY - JOUR AB - Objectives: The primary objective was to investigate whether nonadherence to antiepileptic drugs (AEDs) is associated with increased mortality and the secondary objective to examine whether nonadherence increases the risk of serious clinical events, including emergency department (ED) visits, hospitalizations, motor vehicle accident (MVA) injuries, fractures, and head injuries. Methods: A retrospective open-cohort design was employed using Medicaid claims data from Florida, Iowa, and New Jersey from January 1997 through June 2006. Patients aged ≥18 years with ≥1 diagnosis of epilepsy by a neurologist and ≥2 AED pharmacy dispensings were selected. Medication possession ratio (MPR) was used to evaluate AED adherence on a quarterly basis with MPR ≥0.80 considered adherent and <0.80 nonadherent. The association of nonadherence with mortality was assessed using a time-varying Cox regression model adjusting for demographic and clinical confounders. Incidence rates for serious clinical events were compared between adherent and nonadherent quarters using incidence rate ratios (IRRs) with 95% CIs calculated based on the Poisson distribution. Results: The 33,658 study patients contributed 388,564 AED-treated quarters (26% nonadherent). Nonadherence was associated with an over threefold increased risk of mortality compared to adherence (hazard ratio = 3.32, 95% CI = 3.11-3.54) after multivariate adjustments. Time periods of nonadherence were also associated with a significantly higher incidence of ED visits (IRR = 1.50, 95% CI = 1.49-1.52), hospital admissions (IRR = 1.86, 95% CI = 1.84-1.88), MVA injuries (IRR = 2.08, 95% CI = 1.81-2.39), and fractures (IRR = 1.21, 95% CI = 1.18-1.23) than periods of adherence. conclusion: These findings suggest that nonadherence to antiepileptic drugs can have serious or fatal consequences for patients with epilepsy. © 2008 by AAN Enterprises, Inc. AU - Faught, E. AU - Duh, M. S. AU - Weiner, J. R. AU - Guérin, A. AU - Cunnington, M. C. DO - 10.1212/01.wnl.0000319693.10338.b9 IS - 20 KW - Adolescent KW - Adult KW - Aged KW - Anticonvulsants / therapeutic use* KW - Cohort Studies KW - E Faught KW - Epilepsy / drug therapy* KW - Female KW - Health KW - Humans KW - Incidence KW - Insurance KW - M C Cunnington KW - M S Duh KW - MEDLINE KW - Male KW - Middle Aged KW - Mortality* KW - Multivariate Analysis KW - NCBI KW - NIH KW - NLM KW - National Center for Biotechnology Information KW - National Institutes of Health KW - National Library of Medicine KW - Non-U.S. Gov't KW - PubMed Abstract KW - Regression Analysis KW - Reimbursement / statistics & numerical data* KW - Research Support KW - Retrospective Studies KW - Risk KW - Treatment Refusal / statistics & numerical data* KW - United States KW - Young Adult KW - doi:10.1212/01.wnl.0000319693.10338.b9 KW - pmid:18565827 PB - Lippincott Williams and Wilkins PY - 2008 SP - 1572 EP - 8 TI - Nonadherence to antiepileptic drugs and increased mortality: findings from the RANSOM Study T2 - Neurology VL - 71 ER - TY - JOUR AB - The International League Against Epilepsy (ILAE) presents a revised operational classification of seizure types. The purpose of such a revision is to recognize that some seizure types can have either a focal or generalized onset, to allow classification when the onset is unobserved, to include some missing seizure types, and to adopt more transparent names. Because current knowledge is insufficient to form a scientifically based classification, the 2017 Classification is operational (practical) and based on the 1981 Classification, extended in 2010. Changes include the following: (1) “partial” becomes “focal”; (2) awareness is used as a classifier of focal seizures; (3) the terms dyscognitive, simple partial, complex partial, psychic, and secondarily generalized are eliminated; (4) new focal seizure types include automatisms, behavior arrest, hyperkinetic, autonomic, cognitive, and emotional; (5) atonic, clonic, epileptic spasms, myoclonic, and tonic seizures can be of either focal or generalized onset; (6) focal to bilateral tonic–clonic seizure replaces secondarily generalized seizure; (7) new generalized seizure types are absence with eyelid myoclonia, myoclonic absence, myoclonic–atonic, myoclonic–tonic–clonic; and (8) seizures of unknown onset may have features that can still be classified. The new classification does not represent a fundamental change, but allows greater flexibility and transparency in naming seizure types. AU - Fisher, Robert S. AU - Cross, J. Helen AU - French, Jacqueline A. AU - Higurashi, Norimichi AU - Hirsch, Edouard AU - Jansen, Floor E. AU - Lagae, Lieven AU - Moshé, Solomon L. AU - Peltola, Jukka AU - Roulet Perez, Eliane AU - Scheffer, Ingrid E. AU - Zuberi, Sameer M. DO - 10.1111/epi.13670 IS - 4 KW - Classification KW - Epilepsy KW - Focal KW - Generalized KW - Seizures KW - Taxonomy PB - Blackwell Publishing Inc. PY - 2017 SP - 522 EP - 530 TI - Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology T2 - Epilepsia VL - 58 ER - TY - JOUR AB - Epilepsy was defined conceptually in 2005 as a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. This definition is usually practically applied as having two unprovoked seizures >24 h apart. The International League Against Epilepsy (ILAE) accepted recommendations of a task force altering the practical definition for special circumstances that do not meet the two unprovoked seizures criteria. The task force proposed that epilepsy be considered to be a disease of the brain defined by any of the following conditions: (1) At least two unprovoked (or reflex) seizures occurring >24 h apart; (2) one unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years; (3) diagnosis of an epilepsy syndrome. Epilepsy is considered to be resolved for individuals who either had an age-dependent epilepsy syndrome but are now past the applicable age or who have remained seizure-free for the last 10 years and off antiseizure medicines for at least the last 5 years. "Resolved" is not necessarily identical to the conventional view of "remission or "cure." Different practical definitions may be formed and used for various specific purposes. This revised definition of epilepsy brings the term in concordance with common use. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here. © 2014 International League Against Epilepsy. AU - Fisher, Robert S. AU - Acevedo, Carlos AU - Arzimanoglou, Alexis AU - Bogacz, Alicia AU - Cross, J. Helen AU - Elger, Christian E. AU - Engel, Jerome AU - Forsgren, Lars AU - French, Jacqueline A. AU - Glynn, Mike AU - Hesdorffer, Dale C. AU - Lee, B. I. AU - Mathern, Gary W. AU - Moshé, Solomon L. AU - Perucca, Emilio AU - Scheffer, Ingrid E. AU - Tomson, Torbjörn AU - Watanabe, Masako AU - Wiebe, Samuel DO - 10.1111/epi.12550 IS - 4 KW - Definition KW - Epilepsy KW - Recurrence KW - Seizure KW - Unprovoked PB - Blackwell Publishing Inc. PY - 2014 SP - 475 EP - 482 TI - ILAE Official Report: A practical clinical definition of epilepsy T2 - Epilepsia VL - 55 ER - TY - JOUR AB - Introduction. Antiepileptic drugs are effective in the treatment of epilepsy to the extent that about 70% of people with epilepsy can be seizure-free, but poor adherence to medication is major problem to sustained remission and functional restoration. The aim of this study was to assess the prevalence and associated factors of antiepileptic drug nonadherence. Methods. Cross-sectional study was conducted on 450 individuals who were selected by systematic random sampling method. Antiepileptic drug nonadherence was measured by Morisky Medication Adherence Scale (MMAS) and logistic regression was used to look for significant associations. Result. The prevalence of AEDs nonadherence was 37.8%. Being on treatment for 6 years and above [AOR = 3.47, 95% CI: 1.88, 6.40], payment for AEDs [AOR = 2.76, 95% CI: 1.73, 4.42], lack of health information [AOR = 2.20, 95% CI: 1.41,3.43], poor social support [AOR = 1.88, 95%, CI: 1.01, 3.50], perceived stigma [AOR = 2.27, 95% CI: 1.45, 3.56], and experience side effect [AOR = 1.70, 95% CI: 1.06, 2.72] were significantly associated with antiepileptic drug nonadherence. Conclusion. More than one-third of people with epilepsy were not compliant with their AEDs. Giving health information about epilepsy and its management and consequent reduction in stigma will help for medication adherence. AU - Getnet, Asmamaw AU - Woldeyohannes, Solomon Meseret AU - Bekana, Lulu AU - Mekonen, Tesfa AU - Fekadu, Wubalem AU - Menberu, Melak AU - Yimer, Solomon AU - Assaye, Adisu AU - Belete, Amsalu AU - Belete, Habte DO - 10.1155/2016/3189108 PB - Hindawi Limited PY - 2016 TI - Antiepileptic Drug Nonadherence and Its Predictors among People with Epilepsy T2 - Behavioural Neurology VL - 2016 ER - TY - JOUR AB - Objective: To assess the effect of patient and drug characteristics on medication adherence in people with epilepsy (PWE) in a large cohort representative of the German population. Methods: Information was obtained from the Disease Analyzer database that collects anonymous demographic and medical data from practice computer systems throughout Germany. From 2010 to 2013, adult PWE were retrospectively analyzed regarding demographic characteristics, comorbidities, and treatment with antiepileptic drugs (AED). Adherence was measured using the medication possession ratio (MPR). Individuals with an MPR <80% were classified as nonadherent. Multivariate regression models were applied to assess the association of different factors with adherence by calculating adjusted odds ratios (OR) with 95% confidence intervals. Results: A total of 31,317 PWE were included. The mean MPR was 81.1% (SD 25.7%) with 64.7% of patients showing good adherence (MPR >80%). Patient-related factors associated with good adherence to AED treatment were West German residence (OR 1.23, p < 0.0001) and learning disability (OR 1.80, p < 0.0001). Adherence was higher in patients treated with new than old (OR 1.52, p < 0.0001) and branded than generic AED (OR 1.44, p < 0.0001). Among the most common AED, levetiracetam achieved best adherence (OR 2.85, p < 0.0001), valproate lowest. Two or more daily dosages reduced adherence (TID vs QD: OR 0.84, p 0.005; BID vs QD: OR 0.86, p 0.011). Conclusions: One third of PWE treated with AED in Germany showed poor adherence, which was related to demographic characteristics and drug properties. Administration of new, well-tolerated drugs in simple dosage regimens improved AED compliance. AU - Gollwitzer, Stephanie AU - Kostev, Karel AU - Hagge, Mareike AU - Lang, Johannes AU - Graf, Wolfgang AU - Hamer, Hajo M. DA - 2016/8// DO - 10.1212/WNL.0000000000002791 IS - 5 KW - Adult KW - Anticonvulsants / therapeutic use* KW - Comorbidity KW - Databases KW - Epilepsy / drug therapy KW - Factual KW - Female KW - Germany KW - Hajo M Hamer KW - Humans KW - Karel Kostev KW - MEDLINE KW - Male KW - Medication Adherence / statistics & numerical data* KW - Middle Aged KW - NCBI KW - NIH KW - NLM KW - National Center for Biotechnology Information KW - National Institutes of Health KW - National Library of Medicine KW - PubMed Abstract KW - Retrospective Studies KW - Stephanie Gollwitzer KW - Young Adult KW - doi:10.1212/WNL.0000000000002791 KW - pmid:27371490 PB - Neurology PY - 2016 SP - 466 EP - 472 TI - Nonadherence to antiepileptic drugs in Germany: A retrospective, population-based study T2 - Neurology UR - https://pubmed.ncbi.nlm.nih.gov/27371490/ VL - 87 ER - TY - JOUR AB - Background: The aim was to determine predictors of hospital and 1-year mortality in patients with intensive care unit (ICU)-treated refractory status epilepticus (RSE) in a population-based study. Methods: This was a retrospective study of the Finnish Intensive Care Consortium (FICC) database of adult patients (16 years of age or older) with ICU-treated RSE in Finland during a 3-year period (2010-2012). The database consists of admissions to all 20 Finnish hospitals treating RSE in the ICU. All five university hospitals and 11 out of 15 central hospitals participated in the present study. The total adult referral population in the study hospitals was 3.92 million, representing 91% of the adult population of Finland. Patients whose condition had a post-anoxic aetiological basis were excluded. Results: We identified 395 patients with ICU-treated RSE, corresponding to an annual incidence of 3.4/100,000 (95% confidence interval (CI) 3.04-3.71). Hospital mortality was 7.4% (95% CI 0-16.9%), and 1-year mortality was 25.4% (95% CI 21.2-29.8%). Mortality at hospital discharge was associated with severity of organ dysfunction. Mortality at 1 year was associated with older age (adjusted odds ratio (aOR) 1.033, 95% CI 1.104-1.051, p = 0.001), sequential organ failure assessment (SOFA) score (aOR 1.156, CI 1.051-1.271, p = 0.003), super-refractory status epilepticus (SRSE) (aOR 2.215, 95% CI 1.20-3.84, p = 0.010) and dependence in activities of daily living (ADL) (aOR 2.553, 95% CI 1.537-4.243, p < 0.0001). Conclusions: Despite low hospital mortality, 25% of ICU-treated RSE patients die within a year. Super-refractoriness, dependence in ADL functions, severity of organ dysfunction at ICU admission and older age predict long-term mortality. Trial registration: Retrospective registry study; no interventions on human participants. AU - Kantanen, Anne Mari AU - Kälviäinen, Reetta AU - Parviainen, Ilkka AU - Ala-Peijari, Marika AU - Bäcklund, Tom AU - Koskenkari, Juha AU - Laitio, Ruut AU - Reinikainen, Matti DA - 2017/3// DO - 10.1186/S13054-017-1661-X/TABLES/2 IS - 71 KW - ICU treatment KW - Incidence KW - Mortality KW - Outcome KW - Refractory status epilepticus KW - Status epilepticus KW - Super-refractory status epilepticus PB - BioMed Central Ltd. PY - 2017 SP - 1 EP - 7 TI - Predictors of hospital and one-year mortality in intensive care patients with refractory status epilepticus: A population-based study T2 - Critical Care UR - https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1661-x VL - 21 ER - TY - JOUR AB - Seizures in some 30% to 40% of patients with epilepsy fail to respond to antiepileptic drugs or other treatments. While much has been made of the risks of new drug therapies, not enough attention has been given to the risks of uncontrolled and progressive epilepsy. This critical review summarizes known risks associated with refractory epilepsy, provides practical clinical recommendations, and indicates areas for future research. Eight international epilepsy experts from Europe, the United States, and South America met on May 4, 2013, to present, review, and discuss relevant concepts, data, and literature on the consequences of refractory epilepsy. While patients with refractory epilepsy represent the minority of the population with epilepsy, they require the overwhelming majority of time, effort, and focus from treating physicians. They also represent the greatest economic and psychosocial burdens. Diagnostic procedures and medical/surgical treatments are not without risks. Overlooked, however, is that these risks are usually smaller than the risks of long-term, uncontrolled seizures. Refractory epilepsy may be progressive, carrying risks of structural damage to the brain and nervous system, comorbidities (osteoporosis, fractures), and increased mortality (from suicide, accidents, sudden unexpected death in epilepsy, pneumonia, vascular disease), as well as psychological (depression, anxiety), educational, social (stigma, driving), and vocational consequences. Adding to this burden is neuropsychiatric impairment caused by underlying epileptogenic processes ("essential comorbidities"), which appears to be independent of the effects of ongoing seizures themselves. Tolerating persistent seizures or chronic medicinal adverse effects has risks and consequences that often outweigh risks of seemingly "more aggressive" treatments. Future research should focus not only on controlling seizures but also on preventing these consequences. © 2014. AU - Laxer, Kenneth D. AU - Trinka, Eugen AU - Hirsch, Lawrence J. AU - Cendes, Fernando AU - Langfitt, John AU - Delanty, Norman AU - Resnick, Trevor AU - Benbadis, Selim R. DA - 2014/8// DO - 10.1016/j.yebeh.2014.05.031 KW - Antiepileptic treatment KW - Comorbidities KW - Epilepsy KW - Mortality KW - Safety KW - Sudden unexpected death in epilepsy PB - Academic Press Inc. PY - 2014 SP - 59 EP - 70 TI - The consequences of refractory epilepsy and its treatment T2 - Epilepsy and Behavior VL - 37 ER - TY - JOUR AB - Background: Although self-management is recommended for persons with epilepsy, its optimal strategies and effects are uncertain. Purpose: To evaluate the components and efficacy of selfmanagement interventions in the treatment of epilepsy in community-dwelling persons. Data Sources: English-language searches of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL in April 2018; the MEDLINE search was updated in March 2019. Study Selection: Randomized and nonrandomized comparative studies of self-management interventions for adults with epilepsy. Data Extraction: An investigator assessed study characteristics; intervention details, including 6 components of selfmanagement; and outcomes, which were verified by a second reviewer. Risk of bias (ROB) was assessed independently by 2 investigators. Data Synthesis: 13 randomized and 2 nonrandomized studies (2514 patients) evaluated self-management interventions. Interventions were delivered primarily in group settings, used a median of 4 components, and followed 2 general strategies: 1 based on education and the other on psychosocial therapy. Education-based approaches improved self-management behaviors (standardized mean difference, 0.52 [95% CI, 0.0 to 1.04]), and psychosocial therapy–based approaches improved quality of life (mean difference, 6.64 [CI, 2.51 to 10.77]). Overall, self-management interventions did not reduce seizure rates, but 1 educational intervention decreased a composite of seizures, emergency department visits, and hospitalizations. Limitation: High ROB in most studies, incomplete intervention descriptions, and studies limited to English-language publications. Conclusion: There is limited evidence that self-management strategies modestly improve some patient outcomes that are important to persons with epilepsy. Overall, self-management research in epilepsy is limited by the range of interventions tested, the small number of studies using self-monitoring technology, and uncertainty about components and strategies associated with benefit. AU - Luedke, Matthew W. AU - Blalock, Dan V. AU - Goldstein, Karen M. AU - Kosinski, Andrzej S. AU - Sinha, Saurabh R. AU - Drake, Connor AU - Lewis, Jeffrey D. AU - Husain, Aatif M. AU - Lewinski, Allison A. AU - Shapiro, Abigail AU - Gierisch, Jennifer M. AU - Tran, Tung T. AU - Gordon, Adelaide M. AU - Van Noord, Megan G. AU - Bosworth, Hayden B. AU - Williams, John W. DA - 2019/7// DO - 10.7326/M19-0458 IS - 2 PB - American College of Physicians PY - 2019 SP - 117 EP - 126 TI - Self-management of Epilepsy A Systematic Review T2 - Annals of Internal Medicine VL - 171 ER - TY - JOUR AB - People with epilepsy (PWE) have a higher risk of mortality in comparison with the general population. This in part reflects intrinsic factors or associated comorbidities, but poor adherence to anti-epileptic drugs (AED) has also been shown to contribute to increased risk of death and increased utilization of unscheduled care. The aim of this review was to determine the prevalence of non-adherence to AED in PWE, evaluate whether specific clinical and demographic features can allow clinicians to identify those at highest risk and identify the methods and techniques that can be used to improve adherence in clinical settings. We identified relevant studies for the prevalence of medication non-adherence in PWE by searching MEDLINE (1946–7 Dec 2015), EMBASE (1947–7 Dec 2015) and Cochrane Library (1946–7 Dec 2015) as per predefined inclusion and exclusion criteria. We included 17 research studies from our review of the medical literature to determine the prevalence of medication non-adherence in epilepsy. The prevalence of significant medication non-adherence in epilepsy has been reported to vary between 26% and 79%. This variation partly reflects the differences in defining what clinically significant medication adherence is, the methods used to estimate the scale of the problem and the underlying population heterogeneity. A number of clinical and demographic features have been associated with poor adherence allowing clinicians to identify those at greatest risk. Educating patients and their carers about the risks associated with poor adherence, certain behavioural interventions and simplifying their drug regimens have been shown to improve adherence. AU - Malek, N. AU - Heath, C. A. AU - Greene, J. DO - 10.1111/ane.12703 IS - 5 KW - adherence KW - compliance KW - epilepsy PB - Blackwell Publishing Ltd PY - 2017 SP - 507 EP - 515 TI - A review of medication adherence in people with epilepsy T2 - Acta Neurologica Scandinavica VL - 135 ER - TY - JOUR AB - This study evaluated the potential effect of antiepileptic drug (AED) nonadherence on the risk of subsequent seizure. Retrospective insurance claims from the United States were analyzed. Inclusion criteria were: age 21-64 years, diagnosis of epilepsy or nonfebrile convulsions, ≥2 AED prescriptions, and insurance enrollment for ≥6 months pre- and ≥60 days post-AED initiation. Seizure was defined as a hospital or emergency admission associated with epilepsy or nonfebrile convulsions. Observation began 7 days post-drug initiation, ending with the first of the following: seizure, insurance disenrollment, or 365 days post-drug initiation. Adherence was measured using the medication possession ratio (MPR), with MPR <0.8 defining nonadherence. Seizure risk was assessed using an extended Cox proportional hazards model. Of 18,073 subjects identified, 2467 (14%) had ≥1 seizure. Mean follow-up was 133 days among subjects with event and 305 days for patients without event. Seizure risk was 21% higher among nonadherers (hazard ratio = 1.205, P = 0.0002) than adherers. © 2008 Elsevier Inc. All rights reserved. AU - Manjunath, Ranjani AU - Davis, Keith L. AU - Candrilli, Sean D. AU - Ettinger, Alan B. DO - doi: 10.1016/j.yebeh.2008.12.006. IS - 2 KW - Antiepileptic drugs KW - Claims data KW - Nonadherence KW - Seizure risk PB - Epilepsy Behav PY - 2009 SP - 372 EP - 8 TI - Association of antiepileptic drug nonadherence with risk of seizures in adults with epilepsy T2 - Epilepsy and Behavior VL - 14 ER - TY - JOUR AB - Background: Epilepsy lays an important burden on healthcare systems and society in general. Disability adjusted life years (DALYs) have been developed to compare the burden of this disease both between conditions and between geographical boundaries. With improving data on disease incidence and prevalence in Colombia, we can refine our DALYs-based estimates. Methods: Using different strategies, including the official healthcare provision database and death certificates, as well as extrapolation from published neuroepidemiologic studies, we estimated the incidence and prevalence by age groups, disease duration and attributable mortality. With this information we calculated DALYs for the year 2012. Results: Overall, it was found that epilepsy was responsible for 0.88% of all deaths in Colombia. A total of 5.25 DALYs per 1,000 person-years are lost due to epilepsy in Colombia, 75% of which (3.91 DALYs) are due to premature mortality, with a higher burden in men (6.12 DALYs) than in women (4.41 DALYs). Conclusions: We reported new estimations on epilepsy incidence and prevalence by age groups in Colombia and conclude that DALYs lost due to epilepsy in Colombia are almost double the previous figure, mostly because of the underestimation of attributable mortality. With this figure, epilepsy ranks 12th instead of 19th in the list of the most important causes of DALYs lost. AU - Méndez-Ayala, Alejandro AU - Nariño, Daniel AU - Rosselli, Diego DO - doi: 10.1159/000381424 IS - 3 KW - Administrative data KW - Burden of disease KW - Colombia KW - Developing countries KW - Epilepsy KW - Incidence KW - Mortality KW - Mortality rate KW - Prevalence PB - S. Karger AG PY - 2015 SP - 144 EP - 8 TI - Burden of epilepsy in Colombia T2 - Neuroepidemiology VL - 44 ER - TY - JOUR AB - Purpose of Review: This review discusses the definition, evaluation, and management of patients with drug-resistant epilepsy. Recent Findings: Drug-resistant epilepsy is defined as a failure of two or more appropriately selected and adequately tried anticonvulsant medications to achieve seizure freedom for a sustained period of time in either monotherapy or polytherapy. Once this definition has been met, the likelihood that further medication trials will lead to seizure freedom is in the range of 5% to 10%. Reasons for pseudoresistance to anticonvulsant therapy include wrong diagnosis, wrong drug, wrong dose, or poor compliance. Patients with epilepsy who are drug resistant should be referred to an epilepsy center for a surgical evaluation or more specialized care. The odds of being seizure free following epilepsy surgery versus continued medications are around 4 to 3. Currently, surgical referrals occur late in the disease. Summary: Determination of drug-resistant epilepsy and referral to an epilepsy surgical center can be expedited to avoid exposing patients to continued seizures and the resultant morbidity. AU - Nair, Dileep R. DA - 2016/2// DO - 10.1212/CON.0000000000000297 IS - 1 PB - Lippincott Williams and Wilkins PY - 2016 SP - 157 EP - 172 TI - Management of drug-resistant epilepsy T2 - CONTINUUM Lifelong Learning in Neurology UR - https://journals.lww.com/continuum/Fulltext/2016/02000/Management_of_Drug_Resistant_Epilepsy.13.aspx VL - 22 ER - TY - JOUR AB - Purpose of Review: Status epilepticus, refractory status epilepticus, and super-refractory status epilepticus can be life-threatening conditions. This article presents an overview of the three conditions and discusses their management and outcomes. Recent Findings: Status epilepticus was previously defined as lasting for 30 minutes or longer but now is more often defined as lasting 5 minutes or longer. A variety of potential causes exist for status epilepticus, refractory status epilepticus, and super-refractory status epilepticus, but all three ultimately involve changes at the cellular and molecular level. Management of patients with status epilepticus generally requires several studies, with EEG of utmost importance given the pathophysiologic changes that can occur during the course of status epilepticus. Status epilepticus is treated with benzodiazepines as first-line antiepileptic drugs, followed by phenytoin, valproic acid, or levetiracetam. If status epilepticus does not resolve, these are followed by an IV anesthetic and then alternative therapies based on limited data/evidence, such as repetitive transcranial magnetic stimulation, therapeutic hypothermia, immunomodulatory agents, and the ketogenic diet. Scores have been developed to help predict the outcome of status epilepticus. Neurologic injury and outcome seem to worsen as the duration of status epilepticus increases, with outcomes generally worse in super-refractory status epilepticus compared to status epilepticus and sometimes also to refractory status epilepticus. Summary: Status epilepticus can be a life-threatening condition associated with multiple complications, including death, and can progress to refractory status epilepticus and super-refractory status epilepticus. More studies are needed to delineate the best management of these three entities. AU - Nelson, Sarah E. AU - Varelas, Panayiotis N. DA - 2018/12// DO - 10.1212/CON.0000000000000668 IS - 6 PB - Lippincott Williams and Wilkins PY - 2018 SP - 1683 EP - 1707 TI - Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus T2 - CONTINUUM Lifelong Learning in Neurology UR - https://journals.lww.com/continuum/Fulltext/2018/12000/Status_Epilepticus,_Refractory_Status_Epilepticus,.8.aspx VL - 24 ER - TY - JOUR AB - Purpose To identify the barriers to antiepileptic drug (AED) adherence among adults with epilepsy (AWE). The impact of AED non-adherence on quality of life (QoL) was also examined. Method Systematic design (SR) study. A search strategy was undertaken with no time limits, for articles published in English, in MEDLINE, CINANL, PsycINFO, EMBASE, Cochrane databases and grey literature sources. Eligibility criteria included participants with epilepsy over 18 years, who were prescribed AEDs. Adherence had to be defined and adherence assessment measurements identified. A screening process was undertaken to select eligible studies. Eight studies met the inclusion criteria and were included in a quantitative synthesis. Quality of evidence was conducted using the EBL critical appraisal checklist and assessing risk of bias within individual studies. Results Across the included studies a high prevalence of non-adherence was identified. AED non-adherence was associated with specific beliefs about medications, being depressed or anxious, poor medication self-administration management, uncontrolled recent seizures, frequent medication dosage times, poor physician-patient relationship and perceived social support. Additionally, AED non-adherence impacted negatively on QoL as a result of poor seizure control. Conclusion Although included studies were of good quality, risk of biases reduced the generalisability of results. Findings suggested that comprehensive adherence assessments should routinely be performed. Recommendations for future research include the use of longitudinal research designs and a follow up SR to include the 16–18-year-old population. AU - O’ Rourke, Geraldine AU - O’ Brien, Julie Jordan DO - 10.1016/j.seizure.2016.12.006 KW - Adherence KW - Adults with epilepsy KW - Antiepileptic drug KW - Barriers PB - W.B. Saunders Ltd PY - 2017 SP - 160 EP - 168 TI - Identifying the barriers to antiepileptic drug adherence among adults with epilepsy T2 - Seizure VL - 45 ER - TY - JOUR AB - Abstract Although it is one of the most common neurological disorders, epilepsy continues to be a highly stigmatized and disabling chronic condition. Healthy People 2020 aims for improvement in the health-related quality of life and well-being of Americans, including these medically vulnerable patients. Efforts to research and improve medication adherence in this population and others with chronic conditions are an important step towards this end. The purpose of this study was to investigate factors associated with adherence and to provide recommendations for improvement. A cross-sectional survey research design was used in a convenience sample of patients receiving treatment at a tertiary epilepsy center. Adherence was measured by self-reported missed/skipped medication doses and seizure frequencies and by the presence of intractable seizures as indicated in patients' medical charts. Analysis was conducted with SPSS 21.0 on the data collected from the returned mailed surveys. Among the sample of 180 patients, most had some education beyond high school, household incomes of varying amounts, and health insurance coverage. Most of the participants were unemployed. Clinical records showed that 46% had intractable seizures. About 66% missed taking their medication on a monthly basis, with "forgetfulness" being the primary reason. Adherence (seizure frequency) was associated with being employed (P=.028). Adherence (complying with medication treatment plan) was also associated with "medication reminders" (P=.002) and educational attainment (P=.008). The findings indicate a continued need to explore the complex issue of adherence. The findings also highlight the need for health education and other public health and medical professionals to design effective strategies to connect patients with employment opportunities and other resources. Efforts are also needed to help provide information and build skills among patients with epilepsy that would lead to improved medication adherence and management. AU - Paschal, Angelia M. AU - Rush, Sarah E. AU - Sadler, Toni DO - 10.1016/J.YEBEH.2013.10.002 KW - Adherence KW - Compliance KW - Education KW - Employment KW - Epilepsy KW - Medication KW - Reminders KW - Seizures KW - Tertiary KW - Treatment PB - Elsevier PY - 2014 SP - 346 EP - 350 TI - Factors associated with medication adherence in patients with epilepsy and recommendations for improvement T2 - Epilepsy & Behavior VL - 31 ER - TY - JOUR AB - Purpose: Based on available epidemiologic, health economic, and international population statistics literature, the cost of epilepsy in Europe was estimated. Methods: Europe was defined as the 25 European Union member countries, Iceland, Norway, and Switzerland. Guidelines for epidemiological studies on epilepsy were used for a case definition. A bottom-up prevalence-based cost-of-illness approach, the societal perspective for including the cost items, and the human capital approach as valuation principle for indirect costs were used. The cost estimates were based on selected studies with common methodology and valuation principles. Results: The estimated prevalence of epilepsy in Europe in 2004 was 4.3-7.8 per 1,000. The estimated total cost of the disease in Europe was €15.5 billion in 2004, indirect cost being the single most dominant cost category (€8.6 billion). Direct health care costs were €2.8 billion, outpatient care comprising the largest part (€1.3 billion). Direct nonmedical cost was €4.2 billion. That of antiepileptic drugs was €400 million. The total cost per case was €2,000-11,500 and the estimated cost per European inhabitant was €33. Conclusions: Epilepsy is a relevant socioeconomic burden at individual, family, health services, and societal level in Europe. The greater proportion of such burden is outside the formal health care sector, antiepileptic drugs representing a smaller proportion. Lack of economic data from several European countries and other methodological limitations make this report an initial estimate of the cost of epilepsy in Europe. Prospective incidence cost-of-illness studies from well-defined populations and common methodology are encouraged. © 2007 International League Against Epilepsy. AU - Pugliatti, Maura AU - Beghi, Ettore AU - Forsgren, Lars AU - Ekman, Mattias AU - Sobocki, Patrik DO - 10.1111/j.1528-1167.2007.01251.x IS - 12 KW - Cost-of-illness KW - Epilepsy KW - Europe KW - Prevalence PB - Epilepsia PY - 2007 SP - 2224 EP - 33 TI - Estimating the cost of epilepsy in Europe: a review with economic modeling T2 - Epilepsia VL - 48 ER - TY - JOUR AB - The EEG is an invaluable tool in the diagnosis of epilepsy which guides clinical management. It helps to determine if attacks are of epileptic origin, allows the estimation of the recurrence risk a... AU - Rosenow, Felix AU - Klein, Karl Martin AU - Hamer, Hajo M. DA - 2015/4// DO - 10.1586/14737175.2015.1025382 IS - 4 KW - EEG KW - epilepsy KW - focal KW - generalized KW - hyperventilation KW - medication KW - photic stimulation KW - sleep deprivation PB - Informa Healthcare PY - 2015 SP - 425 EP - 444 TI - Non-invasive EEG evaluation in epilepsy diagnosis T2 - Expert Rev Neurother UR - https://www.tandfonline.com/doi/abs/10.1586/14737175.2015.1025382 VL - 15 ER - TY - JOUR AB - Falta de adherencia terapéutica es uno de los factores principales que modifican la efectividad farmacológica de los antiepilépticos. Para determinar los factores de riesgo asociados a incumplimiento terapéutico en pacientes con epilepsias, realizamos un estudio de casos y controles incluido dentro de una cohorte. Analizamos trece factores que incluyeron las características del paciente, de la enfermedad y de la relación médico-paciente. El seguimiento fue de seis meses; como indicadores se determinaron niveles séricos de antiepilépticos y el registro por conteo directo de los medicamentos. De 150 pacientes que concluyeron el estudio, 66 fueron incumplidores y 84 cumplidores. Siete factores mostraron asociación con una razón de momios mayor de 3 (p < 0.05); luego del análisis de regresión logística, sólo el número total de tabletas y el nivel intelectual demostraron una asociación significativa con el incumplimiento terapéutico. La presencia simultánea de estos factores incrementa en 3.66 veces el riesgo de incumplimiento terapéutico. Concluimos que los pacientes con un coeficiente intelectual inferior, y que requieren más de tres tabletas de uno o más antiepilépticos, tienen un riesgo de 3.66 veces mayor de no adherirse al tratamiento antiepiléptico. Palabras clave: Incumplimiento terapéutico, epilepsia, factores de riesgo, coeficiente intelectual AU - Santiago-Rodríguez, E AU - Sales-Carmona, V AU - Ramos-Ramírez, R. IS - 3 KW - Ciencias de la salud KW - Ciencias de la salud. Generalidades PB - Academia Nacional de Medicina de México PY - 2002 SP - 241 EP - 246 TI - Factores de riesgo para incumplimiento terapéutico en pacientes con epilepsias T2 - Gaceta médica de México UR - https://dialnet.unirioja.es/servlet/articulo?codigo=4363119&info=resumen&idioma=SPA UR - https://dialnet.unirioja.es/servlet/articulo?codigo=4363119 VL - 138 ER - TY - JOUR AB - The International League Against Epilepsy (ILAE) Classification of the Epilepsies has been updated to reflect our gain in understanding of the epilepsies and their underlying mechanisms following the major scientific advances that have taken place since the last ratified classification in 1989. As a critical tool for the practicing clinician, epilepsy classification must be relevant and dynamic to changes in thinking, yet robust and translatable to all areas of the globe. Its primary purpose is for diagnosis of patients, but it is also critical for epilepsy research, development of antiepileptic therapies, and communication around the world. The new classification originates from a draft document submitted for public comments in 2013, which was revised to incorporate extensive feedback from the international epilepsy community over several rounds of consultation. It presents three levels, starting with seizure type, where it assumes that the patient is having epileptic seizures as defined by the new 2017 ILAE Seizure Classification. After diagnosis of the seizure type, the next step is diagnosis of epilepsy type, including focal epilepsy, generalized epilepsy, combined generalized, and focal epilepsy, and also an unknown epilepsy group. The third level is that of epilepsy syndrome, where a specific syndromic diagnosis can be made. The new classification incorporates etiology along each stage, emphasizing the need to consider etiology at each step of diagnosis, as it often carries significant treatment implications. Etiology is broken into six subgroups, selected because of their potential therapeutic consequences. New terminology is introduced such as developmental and epileptic encephalopathy. The term benign is replaced by the terms self-limited and pharmacoresponsive, to be used where appropriate. It is hoped that this new framework will assist in improving epilepsy care and research in the 21st century. AU - Scheffer, Ingrid E. AU - Berkovic, Samuel AU - Capovilla, Giuseppe AU - Connolly, Mary B. AU - French, Jacqueline AU - Guilhoto, Laura AU - Hirsch, Edouard AU - Jain, Satish AU - Mathern, Gary W. AU - Moshé, Solomon L. AU - Nordli, Douglas R. AU - Perucca, Emilio AU - Tomson, Torbjörn AU - Wiebe, Samuel AU - Zhang, Yue Hua AU - Zuberi, Sameer M. DA - 2017/4// DO - 10.1111/EPI.13709 IS - 4 KW - Classification KW - Epilepsy syndromes KW - Etiology KW - Terminology PB - John Wiley & Sons, Ltd PY - 2017 SP - 512 EP - 521 TI - ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology T2 - Epilepsia UR - https://onlinelibrary.wiley.com/doi/full/10.1111/epi.13709 UR - https://onlinelibrary.wiley.com/doi/abs/10.1111/epi.13709 UR - https://onlinelibrary.wiley.com/doi/10.1111/epi.13709 VL - 58 ER - TY - JOUR AB - The International League Against Epilepsy defines epilepsy as at least 2 unprovoked seizures more than 24 hours apart. It is a wide-reaching and complex illness affecting more than 70 million people worldwide and can take on a variety of forms, patterns, and severities. Geographic differences in the illness are often related to its etiology. A host of endemic illnesses and parasitic infections can lead to epilepsy syndromes. Management varies by region due to the availability of diagnostic modalities and medications. Treatment gaps in epilepsy care often are related to social and cultural factors that must also be understood. AU - Singh, Anuradha AU - Trevick, Stephen DO - 10.1016/j.ncl.2016.06.015 IS - 4 KW - CNS infections KW - Epidemiology KW - Epilepsy KW - Seizures KW - Taboos KW - Treatment gap PY - 2016 SP - 837 EP - 847 TI - The Epidemiology of Global Epilepsy T2 - Neurologic Clinics VL - 34 ER - TY - JOUR AB - The consequences of epilepsy can be quite severe and include shortened lifespan, excessive bodily injury, neuropsychological and psychiatric impairment, and social disability. There is evidence that seizures cause brain injury, including neuronal death and physiological dysfunction. Mortality rates are 4-7 times higher in people with medically refractory seizures, and injury rates are substantial, ranging from one per 20 person-years to as much as one per 3 person-years. Quality of life is impaired in epilepsy, and relates to seizure control. Psychosocial disabilities, including lower social interaction with reduced marriage rates and reduced employment levels, are more common in people with refractory seizures. Complete seizure control is desirable, since seizures potentially constitute a serious threat to health and well-being. Therefore, satisfactory seizure control should be defined as having no seizures. Treatment should be directed to preventing seizures whenever possible and achieving control early in the course of illness. The risks of uncontrolled seizures outweigh the risks of aggressive medical or surgical therapy. AU - Sperling, Michael R. DO - doi: 10.1017/s1092852900008464. IS - 2 KW - Activities of Daily Living / classification KW - Activities of Daily Living / psychology KW - Brain Damage KW - Cause of Death KW - Chronic / etiology KW - Chronic / mortality KW - Chronic / psychology KW - Epilepsy / complications* KW - Epilepsy / mortality KW - Epilepsy / psychology KW - Epilepsy / therapy KW - Humans KW - MEDLINE KW - Michael R Sperling KW - NCBI KW - NIH KW - NLM KW - National Center for Biotechnology Information KW - National Institutes of Health KW - National Library of Medicine KW - P.H.S. KW - PubMed Abstract KW - Quality of Life / psychology KW - Research Support KW - Review KW - Risk KW - Survival Analysis KW - U.S. Gov't KW - doi:10.1017/s1092852900008464 KW - pmid:14999166 PB - Cambridge University Press PY - 2004 SP - 98 EP - 9 TI - The consequences of uncontrolled epilepsy T2 - CNS Spectrums VL - 9 ER - TY - JOUR AB - Epilepsy is one of the most common and disabling neurologic conditions, yet we have an incomplete understanding of the detailed pathophysiology and, thus, treatment rationale for much of epilepsy. This article reviews the clinical aspects of seizures and epilepsy with the goal of providing neuroscientists an introduction to aspects that might be amenable to scientific investigation. Seizures and epilepsy are defined, diagnostic methods are reviewed, various clinical syndromes are discussed, and aspects of differential diagnosis, treatment, and prognosis are considered to enable neuroscientists to formulate basic and translational research questions. AU - Stafstrom, Carl E. AU - Carmant, Lionel DO - 10.1101/CSHPERSPECT.A022426 IS - 6 PB - Cold Spring Harbor Laboratory Press PY - 2015 SP - 1 EP - 19 TI - Seizures and Epilepsy: An Overview for Neuroscientists T2 - Cold Spring Harbor Perspectives in Medicine UR - /pmc/articles/PMC4448698/ UR - /pmc/articles/PMC4448698/?report=abstract UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4448698/ VL - 5 ER - TY - JOUR AB - Summary Epilepsy is one of the most common serious brain conditions, affecting over 70 million people worldwide. Its incidence has a bimodal distribution with the highest risk in infants and older age groups. Progress in genomic technology is exposing the complex genetic architecture of the common types of epilepsy, and is driving a paradigm shift. Epilepsy is a symptom complex with multiple risk factors and a strong genetic predisposition rather than a condition with a single expression and cause. These advances have resulted in the new classification of epileptic seizures and epilepsies. A detailed clinical history and a reliable eyewitness account of a seizure are the cornerstones of the diagnosis. Ancillary investigations can help to determine cause and prognosis. Advances in brain imaging are helping to identify the structural and functional causes and consequences of the epilepsies. Comorbidities are increasingly recognised as important aetiological and prognostic markers. Antiseizure medication might suppress seizures in up to two-thirds of all individuals but do not alter long-term prognosis. Epilepsy surgery is the most effective way to achieve long-term seizure freedom in selected individuals with drug-resistant focal epilepsy, but it is probably not used enough. With improved understanding of the gradual development of epilepsy, epigenetic determinants, and pharmacogenomics comes the hope for better, disease-modifying, or even curative, pharmacological and non-pharmacological treatment strategies. Other developments are clinical implementation of seizure detection devices and new neuromodulation techniques, including responsive neural stimulation. AU - Thijs, Roland D. AU - Surges, Rainer AU - O'Brien, Terence J. AU - Sander, Josemir W. DA - 2019/2// DO - 10.1016/S0140-6736(18)32596-0 IS - 10172 PB - Elsevier PY - 2019 SP - 689 EP - 701 TI - Epilepsy in adults T2 - The Lancet UR - http://www.thelancet.com/article/S0140673618325960/fulltext UR - http://www.thelancet.com/article/S0140673618325960/abstract UR - https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32596-0/abstract VL - 393 ER - TY - JOUR AB - Summary Objective There is not yet a clear consensus on the incidence of sudden unexpected death in epilepsy (SUDEP) or the extent of its burden on public health. In this systematic review, we seek to summarize the incidence of SUDEP and its age distribution, as well as the years of potential life lost and cumulative risks of SUDEP for persons with epilepsy. Methods We conducted a systematic search for epidemiologic studies of sudden death in epilepsy and rated their quality of evidence. We pooled data from comparable higher quality population-based studies of SUDEP incidence across all age groups, calculating the overall incidence of SUDEP per 100,000 population, and per 1,000 people with epilepsy. Using standard formulas, we also calculated the years of potential life lost and cumulative risks associated with SUDEP. Results SUDEP has an estimated overall crude annual incidence rate of 0.81 cases per 100,000 population, or 1.16 cases per 1,000 patients with epilepsy. Comparing years of potential life lost from SUDEP with selected other neurologic diseases, SUDEP ranks second only to stroke. Significance Despite limitations to the data on which our analysis is based, we conclude that the public health burden of SUDEP, which has previously been underappreciated, is substantial and deserves much more attention from clinicians, researchers, and the public health community. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here. AU - Thurman, David J. AU - Hesdorffer, Dale C. AU - French, Jacqueline A. DA - 2014/10// DO - 10.1111/EPI.12666/SUPPINFO IS - 10 KW - Epilepsy KW - Incidence KW - Sudden death KW - Systematic review PB - John Wiley & Sons, Ltd PY - 2014 SP - 1479 EP - 1485 TI - Sudden unexpected death in epilepsy: Assessing the public health burden T2 - Epilepsia UR - https://onlinelibrary.wiley.com/doi/full/10.1111/epi.12666 UR - https://onlinelibrary.wiley.com/doi/abs/10.1111/epi.12666 UR - https://onlinelibrary.wiley.com/doi/10.1111/epi.12666 VL - 55 ER - TY - JOUR AB - The Commission on Classification and Terminology and the Commission on Epidemiology of the International League Against Epilepsy (ILAE) have charged a Task Force to revise concepts, definition, and classification of status epilepticus (SE). The proposed new definition of SE is as follows: Status epilepticus is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t1). It is a condition, which can have long-term consequences (after time point t2), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures. This definition is conceptual, with two operational dimensions: the first is the length of the seizure and the time point (t1) beyond which the seizure should be regarded as "continuous seizure activity." The second time point (t2) is the time of ongoing seizure activity after which there is a risk of long-term consequences. In the case of convulsive (tonic-clonic) SE, both time points (t1 at 5 min and t2 at 30 min) are based on animal experiments and clinical research. This evidence is incomplete, and there is furthermore considerable variation, so these time points should be considered as the best estimates currently available. Data are not yet available for other forms of SE, but as knowledge and understanding increase, time points can be defined for specific forms of SE based on scientific evidence and incorporated into the definition, without changing the underlying concepts. A new diagnostic classification system of SE is proposed, which will provide a framework for clinical diagnosis, investigation, and therapeutic approaches for each patient. There are four axes: (1) semiology; (2) etiology; (3) electroencephalography (EEG) correlates; and (4) age. Axis 1 (semiology) lists different forms of SE divided into those with prominent motor systems, those without prominent motor systems, and currently indeterminate conditions (such as acute confusional states with epileptiform EEG patterns). Axis 2 (etiology) is divided into subcategories of known and unknown causes. Axis 3 (EEG correlates) adopts the latest recommendations by consensus panels to use the following descriptors for the EEG: name of pattern, morphology, location, time-related features, modulation, and effect of intervention. Finally, axis 4 divides age groups into neonatal, infancy, childhood, adolescent and adulthood, and elderly. AU - Trinka, Eugen AU - Cock, Hannah AU - Hesdorffer, Dale AU - Rossetti, Andrea O. AU - Scheffer, Ingrid E. AU - Shinnar, Shlomo AU - Shorvon, Simon AU - Lowenstein, Daniel H. DA - 2015/10// DO - 10.1111/epi.13121 IS - 10 KW - Classification KW - Definition KW - Seizure KW - Seizure duration KW - Status epilepticus PB - Blackwell Publishing Inc. PY - 2015 SP - 1515 EP - 1523 TI - A definition and classification of status epilepticus - Report of the ILAE Task Force on Classification of Status Epilepticus T2 - Epilepsia UR - http://doi.wiley.com/10.1111/epi.13121 VL - 56 ER - TY - JOUR AU - Vergara, Jean Paul AU - Ladino, Lady AU - Castro, Carlos Alberto AU - Gómez, Bety AU - Forero, Edwin AU - Vargas, Juliana AU - Gaona, Iván AU - Lizcano, Angélica AU - Mayor, Carlos AU - Nariño, Daniel AU - Ramírez, Sergio AU - Suárez, Fabio AU - Benjumea, Vanessa AU - Espinosa, Camilo AU - Martínez, Adriana AU - Moreno, Julio AU - Tolosa, Carlos AU - Martínez, Paula AU - Guio, Laura DO - 10.22379/24224022237 IS - 2 PB - Carlos Tolosa PY - 2019 SP - 74 EP - 88 TI - Tratamiento del estado epiléptico, consenso de expertos. Asociación Colombiana de Neurología, Comité de Epilepsia T2 - Acta Neurol Colomb UR - https://doi.org/10.22379/24224022237 VL - 35 ER - TY - JOUR AB - SUMMARY It is estimated that approximately 70 million people live in the world with epilepsy, of which 80 °% live in low-or middle-income countries such as Colombia. Despite this, people with epilepsy live with unmet needs as, eventhough epilepsy is a prevalent disease, it is not reflected in the priorities of health services. This is why there are important challenges in the comprehensive treatment of epilepsy. Epilepsy is a stigmatized disease that, beyond pharmacological expenses, has a psychological and social impact that results in a very varied spectrum of disability, suffering from notable depressions such as depression and anxiety. Likewise, people with epilepsy have a lower employment rate than people without epilepsy even up to 8 years after starting pharmacological therapy. The crisis-free state, which is one of the main objectives in the therapy of epilepsy, is difficult to achieve in some patients and although the amount of anticonvulsant drugs has increased markedly since 1990, the crises can be generated from multiple mechanisms, which translates into a challenge when looking for therapeutic targets for medications since several etiologies can be translated clinically into similar types of crisis. Although monotherapy is the ideal treatment in epilepsy, the priority is to achieve a reduction in ictal frequency or a crisis-free state, so if it is not achieved with the first medication, the option of adding a second medication is fully accepted. . There is a great concern about the use of generic drugs, copy or multi-source and originals since the concentration and absorption is very important for their effectiveness and safety and it is known that they should not vary more than 5-10 % to avoid Changes in the ictal pattern of patients. It has been considered that the change to generic or multi-source drugs is associated with changes in the safety profile and changes in the ictal pattern, in addition to an increase in the use of health services and a high rate of change to brand-name drugs, which could increase health costs. For all of the above, it is considered that optimal care for patients with epilepsy refers to an interdisciplinary management in which access and follow-up are guaranteed, for which challenges such as training of personnel in primary care and health care should be accepted. continuity of management to avoid changes in bioavaila-bility, safety profile and drug toxicity. con epilepsia, de las cuales 80 % viven en países de ingreso bajo o medio como Colombia. Las personas con epilepsia viven con necesidades insatisfechas. Esta enfermedad, a pesar de ser prevalente, no se ve reflejada en las prioridades de los servicios de salud. Por lo anterior, existen importantes retos en el tratamiento integral de esta enfermedad. La epilepsia, enfermedad estigmatizada, más allá de los gastos farmacológicos tiene un impacto psicológico y social que resulta en un espectro de discapacidad muy variado, el cual cursa con dolencias notables como la depresión y la ansiedad. Asimismo, las personas con epilepsia tienen una menor tasa de empleo que las personas sin epilepsia, incluso ocho años después de haber comenzado la terapia farmacológica. El estado libre de crisis, uno de los objetivos principales en la terapia de epilepsia, es difícil de alcanzar en algunos pacientes y, si bien la cantidad de medicamentos anticonvulsivantes ha aumentado notablemente desde 1990, las crisis pueden ser generadas a partir de múltiples mecanismos, lo que se traduce en un reto a la hora de buscar blancos terapéuticos para los medicamentos ya que varias etiologías se pueden traducir clínicamente en tipos de crisis similares. Aunque la monoterapia sea el ideal del tratamiento en epilepsia, la prioridad es alcanzar una reducción en la frecuencia ictal o un estado libre de crisis, por lo que si no se alcanza con el primer medicamento, la opción de añadir un segundo medicamento es aceptada plenamente. Existe una gran preocupación alrededor del uso de los medicamentos genéricos, los copia o multifuente y los riginales, ya que la concentración y la absorción son muy importantes para su eficacia y seguridad, y es conocido que no deben variar más del 5-10 % para evitar cambios del patrón ictal de los pacientes. Se ha considerado que el cambio a medicamentos genéricos o multifuente está asociado con cambios en perfil de seguridad y en el patrón ictal, además de un aumento del uso de los servicios de salud y una alta tasa de cambio a medicamentos de marca, lo que podría aumentar los costos en salud. Por todo lo anterior, se considera que una atención óptima a los pacientes con epilepsia hace referencia a un manejo interdisciplinario en el cual se garantice el acceso y el seguimiento, para lo cual se deben aceptar retos como el entrenamiento del personal en atención primaria y la continuidad del manejo para evitar cambios en la biodisponibilidad, el perfil de seguridad y la toxicidad de los medicamentos. AU - Vergara Aguilar, Jean Paul AU - Nariño González, Daniel AU - Gómez Calzada, Ubier Eduardo AU - Gómez Arias, Betty AU - Martínez Micolta, Paula AU - Rosselli, Diego AU - Pantoja, Camila DO - 10.22379/24224022238 IS - 2 PB - Asociacion Colombiana de Neurologia PY - 2019 SP - 89 EP - 98 TI - Reunión de expertos en epilepsia T2 - Acta Neurológica Colombiana VL - 35 ER - TY - JOUR AB - Background: Diagnosing epilepsy can be lengthy and stressful, potentially leading to increased use of healthcare resources and a reduction in quality of life. Aim: This study aims to determine cost and quality of life before and after an optimized diagnostic procedure for people suspected of having epilepsy from a societal perspective with a follow-up of 12 months. In addition, this study aims to differentiate between people diagnosed with epilepsy during the follow-up of the study and the people who are diagnosed as not having epilepsy or for whom diagnosis is still uncertain. Methods: A questionnaire regarding the use of healthcare resources was used accompanied by the EQ-5D-3 L. Multiple imputations by chained equations with predictive mean matching was used to account for missing data. To investigate the uncertainty of the results, non-parametric bootstrapped (1000 times) was used. Results: In total, 116 people were included in the study. Total average costs per patient made in the previous 3 months had decreased from €4594 before the optimized diagnostic trajectory to €2609 in the 12 months after the optimized diagnostic trajectory. Healthcare costs were the largest expense group (52–66%) and had decreased significantly from baseline measurement to 12 months after baseline (€2395 vs €1581). Productivity costs had decreased from €1367 to €442 per 3 months. Total annual costs were similar between people diagnosed with epilepsy during the follow-up of the study and the people who are diagnosed as not having epilepsy or for whom diagnosis is still uncertain. Quality of Life had significantly increased over the course of 12 months from 0.80 to 0.84 (Dutch tariff). Discussion: This study indicates that an optimized diagnostic trajectory has positively influenced the use of healthcare resources and the quality of life in people with epilepsy. As chronic care patients make diverse costs, future research should identify the long-term costs after an optimized diagnostic trajectory for patients with epilepsy, possibly identifying patients who are at high risk of becoming high-cost users in the future for early intervention. AU - Wijnen, Ben F.M. AU - Schat, Scarlett L. AU - de Kinderen, Reina J.A. AU - Colon, Albert J. AU - Ossenblok, Pauly P.W. AU - Evers, Silvia M.A.A. DO - 10.1016/j.eplepsyres.2018.07.024 KW - Cost of illness KW - Diagnosis KW - EEG KW - Epilepsy KW - MEG KW - Quality of life PB - Elsevier B.V. PY - 2018 SP - 87 EP - 93 TI - Burden of disease of people with epilepsy during an optimized diagnostic trajectory: costs and quality of life T2 - Epilepsy Research VL - 146 ER - TY - JOUR AB - BACKGROUND: Medication adherence among patients with epilepsy remains a significant challenge, even for patients prescribed newer antiepileptic drugs (AEDs), leading to increased risks of seizures, hospitalizations, and higher treatment costs. Despite substantial research identifying numerous risk factors, the role of specific medications has been neglected. OBJECTIVE: To analyze adherence to 9 different AEDs in a national clinical sample of elderly patients with new-onset epilepsy. METHODS: Patients over age 66 receiving care in the Veterans Health Administration were eligible if they met criteria for new-onset epilepsy with AED monotherapy of at least 3 months. A cross-sectional study design was used to assess adherence as defined by the medication possession ratio (MPR) and a 90-day or longer medication gap. Multivariable logistic regression modeled each dichotomous adherence outcome as a function of clinical and demographic measures. RESULTS: The sample (N = 6373) was primarily male (98%), white (79%), and exempt from medication copayments due to disability status; nearly 40% had a prior psychiatric or dementia diagnosis. Nearly half of the patients were poorly adherent, with rates ranging from 42% to 63% across AEDs. In multivariable models, patients on phenobarbital, valproate, and gabapentin were significantly less likely to be adherent on both outcomes, while lamotrigine and levetiracetam were positively associated with adherence per the MPR. CONCLUSIONS: Adherence difficulty in this elderly cohort is attributable to several factors, yet specific AEDs substantially increased this risk. Drugs that produce adverse effects such as cognitive difficulty or weight gain may prove detrimental to maintaining appropriate adherence early in the treatment course. Given comparable efficacy among AEDs, providers should be aware that certain medications impart differential risks of poor adherence in older patients with epilepsy. AU - Zeber, John E. AU - Copeland, Laurel A. AU - Pugh, Mary Jo V. DA - 2010/12// DO - 10.1345/aph.1P385 IS - 12 KW - Antiepileptic drugs KW - Elderly KW - Epilepsy KW - Medication adherence KW - Veterans PB - SAGE PublicationsSage CA: Los Angeles, CA PY - 2010 SP - 1896 EP - 1904 TI - Variation in antiepileptic drug adherence among older patients with new-onset epilepsy T2 - Annals of Pharmacotherapy UR - https://journals.sagepub.com/doi/10.1345/aph.1P385?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed VL - 44 ER -