4.0 DISCUSSION
We reported a significant
association between medication adherence, duration of epilepsy, duration
of AED use, Epileptiform pattern with mean LAEP score. Furthermore, the
mean LAEP from this study was higher compared to values previous
studies. The mean age of our participant is 39.19±8.80, with higher
values in male compared to female participants. The female preponderance
among participants was like findings from previous studies among PWE.
Furthermore, the mean (SD) between ages 13-20, 21-35, 36-50,
>50 respectively is 175(18.6), 298(31.7), 201±21.4, and
266(28.3), respectively. Paul et al found that the prevalence of active
epilepsy was very similar for 0-39 age group but higher among women in
the age group of 40-50 years. When the prevalence trend of lifetime
epilepsy was analyzed by sex, the peak in the 20-39 age group is higher
for men, but the second peak in the 50-59 age group is seen only in
women.(Paul et al., 2012)The mean LAEP score among cohorts from this
study is higher than reported values from previous studies conducted in
Nigeria, Italy, and India.(Du et al., 2019; Fadare et al., 2018; Lee et
al., 2014) This difference might be due to pharmacogenomics, drug
interaction, inter and intra racial disparity, under reporting of ADR,
varied doses of AEDs, different number of participants and duration of
treatment but more importantly different methodological approach. For
instance, Fadare and his colleagues in a Nigeria study aimed at
determining medication adherence and adverse effect profile of AEDs
among Nigerian cohorts, reported a lower mean LAEP score with highest
value of those on phenobarbital.(Fadare et al., 2018)This finding which
is similar to that of this study, is not unexpected as Phenobarbitone
has been associated with several significant adverse effect profile
ranging cognitive dysfunction, enzyme inductions, drowsiness, headache,
dizziness and psychomotor disturbance.(Abou-Khalil, 2016; Goodman et
al., 2015; Roy et al., 2016)In a study to access the extent of ADR of
CBZ and its potential associated factors, memory, headache,
restlessness, tiredness and depression were most frequently reported ADR
and identified female gender, lower level of formal education has
factors associated with ADR.(Olusanya et al., 2017) Nasopharyngitis,
agitation, hyperkinetic muscle activity, outburst of anger, agitation
has been associated with ADR of LVC.(Bates et al., 1995; Belcastro et
al., 2008; Joshi et al., 2017)In a review recently published by Cochrane
evaluated the effectiveness of LVC, six most common ADR in a decreasing
order: somnolence, headache, asthenia, accidental injury, dizziness and
infection were reported. Only somnolence and infection were
significantly associated with LVC.(Kaushik et al.,
2019) Routine evaluation for
known ADR that is specific for AEDs should be incorporated to management
of PWE by physician and Health Care Providers (HCP) to improve their
quality of life. In previous studies, age, gender, multiple drugs,
disease state, allergy, genetic factors, and large doses of drugs were
identified as determinants of ADR in PWE. In this study, adherence,
duration of epilepsy, duration AEDs use, presence of Epileptiform
pattern, drug adherence and duration of seizures were identified as
significant factors associated with high mean LEAP which increase the
possibility of the occurrence of high ADRs in PWE. In-tandem with
previous studies,(Du et al., 2019; Fadare et al., 2018; Kaushik et al.,
2019)the present study reported higher mean LAEP score for patients on
polytherapy compared to those on monotherapy, though not statistically
significant. This is not unexpected as polypharmacy or use of more than
one medication for epilepsy has been linked to increase ADR.(Adedapo et
al., 2021; St. Louis, 2009)This is the reason why PWE, therapy should be
started with a single AEDs and then titrate as appropriate after due
consideration of other factors that govern choice of AEDs. Combination
therapy should be considered only when monotherapy fails.(Assadeck et
al., 2019; Joshi et al., 2017; Stephen & Brodie, 2012)It is recommended
that AED can be gradually withdrawn after 2 years of seizure freedom,
and this must be carried out under the guidance of a physician.(Assadeck
et al., 2019; Brodie & Sills, 2011; St. Louis, 2009)
Using the MMAS-8, 4(0.43%), 571(61.7%), and 351(37.9%) respectively,
of the participants were identified as highly adherent, medium adherent
and no adherent to AEDs, respectively. This shows that, majority of PWE
in this study had reduced number of highly adherence patients compared
to findings in previous studies.(Du et al., 2019)This underscores the
importance of compliance for better seizure controls and extent of TG.
The use of alternatives to medicine such as healing homes, herbalists,
and other spiritual mission houses, have been ascribed for low adherence
in previous studies which account for the high rate of treatment gap in
observed low- and middle-income countries.(Assadeck et al., 2019; Nwani
et al., 2013; Owolabi et al., 2020) There is a dramatic global disparity
in the care for epilepsy between high- and low-income countries, and
between rural and urban settings. The reported size of the epilepsy
treatment gap in Sub Sahara African varies widely, ranging from 23% in
Senegal to 100% in Uganda, Tanzania, Gambia, and Togo.(Adeloye, 2014;
Ding et al., 2021; Owolabi et al., 2020) A similar study in eastern
Nigeria, reported overall treatment gap of 76%, diagnosed gap in 38%
(n=11/29) and those who were diagnosed but discontinued AED treatment of
their own volition accounting for a therapeutic gap of 38%
(n=11/29).(Nwani et al., 2013) An online survey among 408 adults with
epilepsy and 175 neurologists who treat epilepsy revealed that 29% of
patients self-reported non-adherent to medications in a one-month
period. Surprisingly from this study, there was no significant
association between medication adherence and age, gender, marital
status, level of education, seizure remission, seizures, and type of
seizure in this study. However, there was a significant association
between adherence and mean LAEP score. Nervousness, aggression, and
memory problems were the most common ADRs previously reported in PWE.
This finding is similar to findings from this study which revealed
nervousness, aggression, weight gain, unsteadiness, restlessness and
tiredness are the most common ADR. Furthermore, we reported that
Carbamazepine (68%) was the most frequently prescribed monotherapy AEDs
used, followed by Levetiracetam (9%) in this study, like other
published studies in India and Nigeria.