Prevalence and factors associated with adverse therapeutic outcomes of antiseizure medication therapy in people with epilepsy

Abstract

Background: Antiseizure medication (ASM) therapy has been the mainstay of the pharmacological management of epilepsy. The goal of treatment includes achieving good seizure outcomes while minimising the risk of adverse effects (AE). In developing countries, the therapeutic outcomes remain suboptimal. This study aimed to determine the prevalence of ASM therapeutic outcomes and its associated factors.

Methods: This study was conducted in a public, hospital-based specialist clinic. People with epilepsy (PWE) who were prescribed at least one ASM were screened for eligibility. The therapeutic outcomes were assessed using established tools: the Seizure Severity Questionnaire (SSQ) and Liverpool Adverse Events Profile (LAEP), respectively. The patient’s information and responses were recorded, and all relevant data was collected.

Results: Three hundred and ninety-seven PWE were included in the analysis, of which 105 were included in the face-to-face outcome assessment. It was found that 79.3% of the PWE had poor seizure control. The mean SSQ score was 1.44 (±SD:1.34), and the mean LAEP score was 24.0 (±SD:5.91). Epilepsy duration of >10 years (OR: 1.87, 95%CI:1.10- 3.17), generalised onset (OR:7.42, 95%CI:2.95-18.66), focal onset (OR:8.24, 95%CI:2.98- 22.77), non-adherence (OR:3.55, 95%CI:1.52, 8.27) and having ≥3 ASM (OR:3.29 (95%CI:1.32-8.24) were factors associated with poor seizure control. For seizure severity, younger age at onset (OR:3.29, 95%CI:1.32-8.24) and neurological deficit (OR:3.55, 95%CI:1.52-8.27) increased the tendency to have more severe seizures. The factors associated with AE occurrence were advancing age (OR:0.12, 95%CI:0.03-0.20), shorter epilepsy duration (OR:2.89, 95%CI:0.50-5.29), and PWE who had changes in their ASM regimen within the past year (OR:2.93, 95%CI:0.24-5.62).

Conclusion: Factors related to individuals’ demographic and clinical characteristics are associated with adverse outcomes of ASM therapy. Recognising PWE at risk of adverse outcomes is crucial for improving overall epilepsy management.