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Don't Stop: The Importance of Epilepsy Treatment

Posted Aug 24 2008 1:49pm

TRACY GLAUSER, MD: Seizures are electrical storms on the surface of the brain. Epilepsy is the condition of chronic, recurrent, unprovoked seizures.

Seizures occur in 10 percent of the population over the course of one's life. Epilepsy occurs in 1 percent of the general population, approximately three million people in the United States.

ANNOUNCER: Although a large number of anti-seizure drugs have been developed that can effectively treat epilepsy, it has been estimated that over 50 percent of patients with epilepsy fail to take their medications as directed. Patient non-compliance to their prescribed drug regimen can lead to sub-optimal results and breakthrough seizures.

ELINOR BEN-MENACHEM: Why don't people take their drugs? They maybe find that the pills are too big. There's too many of them. They have to take them too often. They forget. Many of my patients just simply forget to take their medication.

TRACY GLAUSER, MD: At the beginning of therapy, it may occur because patients don't understand the need to take their medicine, or they may be rebelling against having a diagnosis of epilepsy and not wanting to feel different.

Non-compliance may occur later in the treatment regimen because a patient may no longer feel that they need to take the medicine. They may feel that they've outgrown it and they try to wean themselves off of it.

It can be as simple as missing a few doses, all the way to the other extreme of a person purposely not taking their medicine out of fear of the disease or desire not to feel different.

ANNOUNCER: Other contributing factors to patient non-compliance are the side effects that can be associated with anti-epileptic medications.

BLANCA VAZQUEZ, MD: You don't want to take a medicine if you don't feel well when you take it. Antiepileptic drugs are always characterized by having side effects that are related to the central nervous system. For instance: dizziness, tiredness, behavioral toxicity, lack of interest, decrease in cognition.

TRACY GLAUSER, MD: In addition to the side effects that can affect the brain, there are also common side effects that are seen affecting the gut. For example: nausea, vomiting, decreased appetite. Some people can gain weight, and some people can lose weight.

BLANCA VAZQUEZ, MD: There are some drugs that are less likely to produce those side effects, and those are more favorable for the patients.

ANNOUNCER: The common practice of using more than one medication to treat epilepsy, known as polytherapy, can also make it difficult for a patient to stick to his or her regimen.

TRACY GLAUSER, MD: A good number of patients, approximately 30 percent of patients, need polytherapy. In patients on polytherapy there is a higher risk of drug-drug interactions, a higher risk of compliance problems, because people have to remember two types of dosing regimens. So polytherapy at times is necessary, but at times carries with it more difficulties for the patient.

BLANCA VAZQUEZ, MD: It's very important to reassess the need for taking more than one or two antiepileptic drugs to try to prevent this problem.

ANNOUNCER: Patient non-compliance can cause an array of problems for both the patient and the physician.

TRACY GLAUSER, MD: At the initiation of therapy, non-compliance can lead to the idea on the physician's side that the medicine is not working, or it may reinforce on the patient's side that they're different somehow with their epilepsy and that they view taking the medicine as losing a battle.

Non-compliance later in therapy can result in breakthrough seizures, some of which may be long and potentially life-threatening. Non-compliance can take the form as not only breakthrough seizures, but disrupting the doctor-patient relationship, because the doctor is acting upon the idea the patient is taking the medicine and feels the medicine is not working, and the patient is feeling that the medicine is not needed and doesn't truly understand how the doctor's trying to help them.

ANNOUNCER: But the main risks of not controlling epilepsy effectively are the threat of more seizures and an increased risk of damage to the brain.

BLANCA VAZQUEZ, MD: The risk of having recurrent seizures is that patients could have other seizures that otherwise they did not have to have. Seizures will bring other seizures. The brain becomes very epileptogenic, and you create highways to have other seizures.

TRACY GLAUSER, MD: Seizures that are prolonged, lasting 30 minutes or more, raise the risk of brain injury substantially. Seizures that last greater than 30 minutes are what are called status epilepticus, and constitute a life-threatening emergency.

BLANCA VAZQUEZ, MD: There is a cognitive and functional decline in patients after they have recurrent seizures. They can accumulate not only more psychomotor slowing, but eventually also cognitive decline in IQ points.

ANNOUNCER: Uncontrolled seizures can hurt the patient in other ways as well.

TRACY GLAUSER, MD: Adults with uncontrolled seizures have a lower rate of employment compared to adults who are seizure-free. Secondly, adults who have uncontrolled seizures have much higher rates of dental injuries, head injuries and visits to the emergency room for serious injuries compared to adults whose seizures are well controlled. Lastly, there's a higher rate of death among adults and kids with uncontrolled seizures compared to adults and children with controlled seizures.

ANNOUNCER: There are several things that physicians and patients can do to increase patient compliance.

TRACY GLAUSER, MD: Education of the patient and their family as to the dangers of seizures and the importance of taking their medicine will help limit non-compliance.

Other methods of minimizing non-compliance include getting a treatment regimen which is easy to follow. Medicines that are taken three and four times a day are often harder to follow on a regular basis than if a medicine is given once or twice a day.

The physician, nurse and health care team need to work with the patient to develop a routine so that the patient will always remember their medicine. Whether that's a routine where the patient takes it when they wake up in the morning and then in bed at night, or with breakfast and dinner, a routine needs to be developed such that the patient can seamlessly and easily incorporate taking their medications into their daily routine.

ELINOR BEN-MENACHEM: One of the best things they can do is get the pillbox for everyday use and then fill up a pillbox for a whole week and then take them and control that they've really taken it. Then the patient can make sure they take the drugs at times that they will remember.

TRACY GLAUSER, MD: If a patient feels that they're experiencing side effects, they need to communicate that to their health care professional and to have a serious discussion about whether a change in medicine might be helpful, or whether the side effect is due to something that's unrelated.

ANNOUNCER: If anti-seizure medication regimens are followed closely and accurately, a patient with epilepsy has a much greater chance of living seizure-free.

ELINOR BEN-MENACHEM: It is very important, when starting out on the treatment of epilepsy, that a patient really understands all of these factors, and it is a duty of the doctor to try to spend the time, especially at the beginning, to tell the patients how important it is to be compliant, to come forth with their side effects, to be honest and that, probably, they might increase the chances of being seizure-free, if they would continue on their medications and make sure that they don't miss any.

TRACY GLAUSER, MD: In general, over 90 percent of people with epilepsy have normal intelligence. In general, people with epilepsy should strive to lead normal lives. In general, people with epilepsy should expect that they can participate fully in life and to work with their health care professional to try and achieve this goal.

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