Barriers of Drug Adherence among Patients with Epilepsy: in Tertiary Care Hospital, South India

Introduction: Epilepsy is a treatable and curable brain disorder. However major proportion of individuals with this disease in developing countries receives no treatment because of misunderstandings of the public. Other than that, poor adherence to ordered medication is considered the primary cause of drug therapy failure in epilepsy. This study conducted to assess the adherence pattern to antiepileptic regimen, among patients with epilepsy and to identify the clinical and patient-related factors contributing as barriers. Methods: A cross sectional survey design was used in 100 epilepsy patients in an Outpatient unit of tertiary care center. A Convenient sampling technique was used to enroll the patients who meet inclusion criteria. Structured interview with pre-tested questionnaire and eight item Morisky Medication Adherence Scale was used to collect the data. Descriptive and inferential statistics were used for analysis of data. Descriptive statistics (mean, standard deviation, frequency and percentages) were used to describe the clinical and demographic variables of study participants. The determinants of medication adherence were analyzed using Chi-Square test and independent student t- test. The analysis was done with SPSS 20th version. Results: Majority (71%) of patients were not adherent to antiepileptic treatment. Severity of seizure (indicated by the presence of seizure last year), medication frequency and complexity of treatment were found to have significant association with the Anti-Epileptic Drugs (AED) adherence status. Status of adherence is significantly associated with frequency of seizure/year and positive life style. Conclusion: As Medication adherence was observed to be low, services for adherence counseling and health educational interventions in the epilepsy clinics is recommended

Does the chronic inflammatory demyelinating polyradiculoneuropathy due to secondary cause differ from primary?

Background: The clinical presentation, neurophysiological findings, and outcome may vary between primary and secondary chronic inflammatory demyelinating polyradiculopathy (CIDP). Objective: To compare clinical and electrodiagnostic features of primary and secondary CIDP. Setting: Tertiary care teaching referral hospital. Materials and Methods: The CIDP patients who were diagnosed as per European Federation of Neurological Societies/Peripheral Nerve Society criteria were included and subjected to detailed history and examinations. The clinical disability was graded on a 0-10 scale. Neurophysiology included motor and sensory nerve conductions and F wave studies of all four limbs. Based on investigations for underlying diseases, the patients were categorized into primary or secondary CIDP. Prednisolone was prescribed in all and azathioprine added in resistant cases. The secondary CIDP group received specific treatment in addition. The outcome was assessed at 3 months, 6 months, and last follow-up. Results: A total of 65 patients aged 17 to 72 years were included and 20 were females. Twenty-five patients had secondary CIDP and include diabetes mellitus (16), POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) (4), monoclonal gammopathy of undetermined significance (2), myeloma (1), lymphoma (1), and malignancy (1). The secondary CIDP patients were older (48.35 vs 41.0 years), had less relapsing remitting (0 vs 6) and more frequent dysautonomia (7 vs 1). The demyelinating features were more marked in primary CIDP group and had better outcome compared with secondary CIDP. Conclusions: Of the total patients with CIDP, 38.5% of patients had secondary CIDP which was associated with progressive course, less demyelinating features, and worse prognosis

High Frequency of Depressive Symptoms among Adults with Epilepsy: Results from a Hospital-based Study

Context: Assessment of comorbid burden of depression and associated factors among adult people living with epilepsy (PWE) has the potential to inform clinical evaluation and management to improve outcomes. Aim: The aim of this study is to determine frequency of depressive symptoms and factors associated with it among PWE attending a tertiary care hospital. Setting and Design: This was a cross-sectional observational study conducted in the outpatient clinic of a tertiary care center. Subjects and Methods: One hundred and fifty patients with epilepsy were recruited between May 2016 and August 2016. For assessing depression, Tamil validated version of Patient Health Questionnaire-12 was used. Frequency of depression and its association with various sociodemographic and clinical factors were assessed. Statistical Analysis Used: Student t-test and Chi-square test for univariate analysis and logistic regression for multivariate analysis were used for statistical analysis. Results: Of the 150 subjects, 89 (59.3%) were males. Generalized tonic–clonic seizures were present in 131 people (87.3%). Genetic and unknown epilepsies contributed higher proportion (44.7%) as compared to structural epilepsies (37.3%). Majority (88%) were on one or two antiepileptic drugs. Thirty-one people (20.3%) had less than one seizure per year. Depressive symptoms were present in 95 patients (63.3%). In multivariate regression analysis, secondary generalized seizures and seizure frequency >1/month emerged as significant predictors of depression ([OR]: 5.48 [95% (CI): 1.35–22.28] and OR: 2.53 [95% CI: 1.11–5.75], respectively). Conclusion: Depression is prevalent in a majority of adult PWE. Hence, a routine screening for depression as part of comprehensive epilepsy care is advisable for PWE attending the outpatient clinic