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

Veriano Alexandre, Edna Almeida Monteiro, Priscila Freitas-Lima, Kylvia Dantas Pinto, Tonicarlo Rodrigues Velasco, Vera Cristina Terra, Ana Paula Pinheiro-Martins, Roberto Molina Souza, Emilio Perucca, Americo Ceiki Sakamoto

Research output: Contribution to journalArticle

Abstract

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

Original languageEnglish
Pages (from-to)56-60
Number of pages5
JournalEpileptic Disorders
Volume13
Issue number1
DOIs
Publication statusPublished - Mar 2011

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Tertiary Care Centers
Brazil
Epilepsy
Quality of Life
Control Groups
Physicians
Medical Overuse
Anticonvulsants
Seizures
Pharmaceutical Preparations

Keywords

  • adverse effects
  • antiepileptic drugs
  • drug resistance
  • epilepsy
  • overtreatment

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Alexandre, V., Monteiro, E. A., Freitas-Lima, P., Pinto, K. D., Velasco, T. R., Terra, V. C., ... Sakamoto, A. C. (2011). Addressing overtreatment in patients with refractory epilepsy at a tertiary referral centre in Brazil. Epileptic Disorders, 13(1), 56-60. https://doi.org/10.1684/epd.2011.0411

Addressing overtreatment in patients with refractory epilepsy at a tertiary referral centre in Brazil. / Alexandre, Veriano; Monteiro, Edna Almeida; Freitas-Lima, Priscila; Pinto, Kylvia Dantas; Velasco, Tonicarlo Rodrigues; Terra, Vera Cristina; Pinheiro-Martins, Ana Paula; Souza, Roberto Molina; Perucca, Emilio; Sakamoto, Americo Ceiki.

In: Epileptic Disorders, Vol. 13, No. 1, 03.2011, p. 56-60.

Research output: Contribution to journalArticle

Alexandre, V, Monteiro, EA, Freitas-Lima, P, Pinto, KD, Velasco, TR, Terra, VC, Pinheiro-Martins, AP, Souza, RM, Perucca, E & Sakamoto, AC 2011, 'Addressing overtreatment in patients with refractory epilepsy at a tertiary referral centre in Brazil', Epileptic Disorders, vol. 13, no. 1, pp. 56-60. https://doi.org/10.1684/epd.2011.0411
Alexandre V, Monteiro EA, Freitas-Lima P, Pinto KD, Velasco TR, Terra VC et al. Addressing overtreatment in patients with refractory epilepsy at a tertiary referral centre in Brazil. Epileptic Disorders. 2011 Mar;13(1):56-60. https://doi.org/10.1684/epd.2011.0411
Alexandre, Veriano ; Monteiro, Edna Almeida ; Freitas-Lima, Priscila ; Pinto, Kylvia Dantas ; Velasco, Tonicarlo Rodrigues ; Terra, Vera Cristina ; Pinheiro-Martins, Ana Paula ; Souza, Roberto Molina ; Perucca, Emilio ; Sakamoto, Americo Ceiki. / Addressing overtreatment in patients with refractory epilepsy at a tertiary referral centre in Brazil. In: Epileptic Disorders. 2011 ; Vol. 13, No. 1. pp. 56-60.
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AU - Velasco, Tonicarlo Rodrigues

AU - Terra, Vera Cristina

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