Measurement Of Selected Antiepileptic Drugs Level And Quality Of Life Among Studied Population At Sultan Abdul Halim Hospital
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Date
2017-09
Authors
Nicholas, Dayana
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
In spite of well-established therapeutic drug monitoring (TDM) services in
most of the major hospitals, the TDM for anti-epileptic drugs (AEDs) is still very
challenging. Thus, the main aim of this research was to explore the provision of
TDM services in the management of seizures and also to determine the clinical
characteristics of responders and non-responders in relation to the attainment of
therapeutic levels and appropriate Quality of Life (QoL) among children, adults and
geriatrics who had different type of seizures. This study has provided the estimation
of seizure prevalence, characteristics of seizures; serum drug concentrations (SDCs)
of AEDs recorded by executing a hospital based prospective study. In phase-I study,
series of results as sub grouped patients in A, B, C and D to response to AEDs verses
therapeutic ranges were observed with significant variables using binary logistic
regression analysis and was found that age group is the predictive variable that
affected the response to AEDs among adult and geriatrics whose B exponential value
shown -0.064. Patients who did not respond to the AEDs from the study population
were children [77 (68.7 %)], adults [67 (37.1 %)] and geriatric patients [12 (44.4 %)].
The one-way ANOVA test has identified with significant factors such as gender,
duration of the frequency, family history of epilepsy; co-morbidities and adherence
are more likely to cause non response to AEDs in children. Remarkable predictors’
namely female gender, co-morbidity, mono-therapy and breakthrough seizures were
identified among adults. Predictors such as male gender, co-morbidity and break
through seizures are identified in children. Sodium valproate was commonly
prescribed mono-therapy and well utilized in children. Patients who gain weight
were possibly on carbamazepine and sodium valproate therapy. Most of the patients
in adult group between the age of 19-64 years and children between the age group
of 1-18 years are at risk of receiving recurrent epilepsy strikes where these subjects
shown with non-target ranges and not responded to AEDs. By phase-II study, the
impact of seizures on quality of life (QoL) was evaluated using completely
answered QOLIE-31 questionnaire in which males had the least score with regard to
the medication effects domain (48.90±23.47) and cognitive functioning was the
highest score (74.00±23.72). This research study helps the pharmacists to involve in
effective counselling for patients as well as create more awareness on monitoring
the SDCs and do safe recommendation on dose. Through this study, the clinicians
can make safe drug prescriptions by understanding the precipitating factors that
could affect the patient’s response to AEDs, therapeutic levels and medication
effects that affect quality of life in adults. This study strongly recommends the
effective treatment strategies and clinical decision support for appropriate
monitoring for better clinical outcome and quality of life in patients and this study
suggests more future research to support health care team.
Description
Keywords
The attainment of therapeutic levels , and appropriate Quality of Life