Management, treatment outcome and cost of epilepsy in a tertiary health care facility in northern Nigeria.
Epilepsy is the most common neurological disorder and it is one of the most common noncommunicable diseases in the world (1,2). Worldwide, it is estimated that epilepsy affects about 50 million people, among who 40 million are living in developing countries (1,3) where 80-90% of people are believed to receive inadequate/no treatment at all (4). Epilepsy affects about 2.5 million people in United States and about 200,000 new cases of epilepsy are diagnosed in the United States yearly (5). In the low-income countries, the incidence of epilepsy, may be as high as 190 per 100 000 people (3). Consequently, in the context of the large and rapidly increasing populations in developing countries, epilepsy is a significant health and socioeconomic burden requiring immediate attention (3). Provision of adequate medical care faces many constraints and difficulties in many countries. The major problems encountered by health professionals and people with epilepsy all over the world especially in developing countries include lack of drug supply due either to logistics or to economy, poor community knowledge and awareness, cultural beliefs, stigma, lack of government resources, poor economy, and lack of infrastructure (4).
Epilepsy affects the quality of life of the sufferers (6) and the condition is highly stigmatized because of the commonly held misconception that epilepsy is contagious and negative meanings are attached to its outward manifestation (seizures) (7). Epilepsy affects morbidity and mortality of patients as well as their 'quality of life', which is composed of physical, social and mental well being (8). Epilepsy has been shown to have a negative impact on social life (employment, driving, marriage, social isolation, and education opportunities) of the sufferers (4). Epilepsy has psychosocial effect on caregivers, siblings, work and other interpersonal relationships of everyone involved in the care of a member with epilepsy (9). Aside from the psychological effect, patients with epilepsy often sustain physical injury especially during status epilepticus attacks. Moreover, studies have also shown that people with epilepsy have an increased risk of premature death 2-3 times higher than the general population (10). Half of these deaths occurs at home and are sudden unexpected deaths. Suicide accounts for 7-22% of death in epilepsy and these patients are 5-10 times likely to commit suicide than the general population. Suicidal tendency has been reported to be worse with patient with temporal lobe epilepsy (11).
The choice of medication for management of epilepsy varies depending of the type of seizure. In developing countries, phenobarbitone has been reported to be the most commonly prescribed medicine not because of it efficacy but due to its availability and low cost (12,13).
Several studies have been carried out in different part of Africa on management of epilepsy with results showing that the choice of Anti Epileptic Drugs (AEDs) varied with health institutions (12,14). It is known that about 70% of people with epilepsy could live seizure-free lives if treated with AEDs (5). While there are plethora of studies on the management and cost of epilepsy worldwide (14-17) only few studies have been undertaken in Nigeria (18,19). However, studies combining detail management, treatment outcome and the cost of treatment of epilepsy are rare in the country particularly in the northern part of Nigeria. This study aimed at reviewing the management and evaluating economic burden of AEDs in Ahmadu Bello University Teaching Hospital, Kaduna.
The psychiatry clinic of Ahmadu Bello University Teaching Hospital (ABUTH), Kaduna is now relocated to Zaria where the University is sited. ABUTH is the largest teaching hospital in the northwest of Nigeria. It is also a referral centre for other secondary healthcare facilities in the region. The study is a retrospective design using selected patients' folders and medical records in the clinic.. A whole population of patients diagnosed with epilepsy who had attended clinic between January 2003 and December 2004 were enrolled for the study. The hospital's number of patients who attended clinic at least six times during this period was sorted out for the second stage of data collection. This sampling criterion was based on the fact that stable patients were usually given a minimum of sixteen weeks interval between appointments (personal communication from clinician).
Data collection procedure
The hospital unit numbers of patients diagnosed with epilepsy in ABUTH who attended clinics between January 2003 and December 2004 were collected from the out patients' clinic department register which usually held twice a week, Mondays and Thursdays. The data was analyzed using Statistical Package for the Social Sciences (SPSS) version 16.0 and the frequency of attendance was determined.
The case note/medical records of patients that had 6 or more clinic attendances were further used for data collection using structured data. Data collected included socio-demographic data, age at first registration at this healthcare facility, age of onset of epilepsy, years since registration at this healthcare facility, occupation, effect of epilepsy on marital life and education.. Others included risk factors, alternative therapy if ever used, signs and symptoms, diagnosis and laboratory investigations. The following data were also collected: other comorbid diseases or disorder, medications used, side effects of medications used, overall clinic attendance and general treatment outcome.
Patients diagnosed with epilepsy who had attended clinics for more than one year were used to determine patients who were free of seizure for at least one year. Within this group, those that attained one-year remission were compared to those who had not (as of their last clinic visit) with respect to regular clinics attendance (patients who had missed clinic appointment at least for 4 months were regarded as those not regular in clinic attendance), adherence to therapy (those who had at least one record of poor adherence between 2003 and 2004 were said to have poor adherence to therapy).
Cost of epilepsy involves direct medical cost of patients with "active" epilepsy (i.e. epilepsy with recurring seizures and/or under current treatment). In this study, patients (within the epilepsy patients' population) who had attended clinics regularly between November 2003 and October 2004 (1 year follow-up) and did not miss any clinic attendance and had no record of non-adherence to therapy were used. The cost item evaluated in this study was basically the cost of medications used by patients during this period.
* All patients that have been diagnosed with epilepsy in the study centre and had at least 6 clinic attendances between January 2003 and December 2004, irrespective of their age or sex.
* Patients that were not diagnosed with epilepsy
* Patients diagnosed with epilepsy in the study centre and who had less than 6 clinic attendances between January 2003 and December 2004.
* Patients newly diagnosed with epilepsy.
Data was entered into Statistical Package for the Social Sciences (SPSS) version 16 and analyzed. Frequencies of variables were determined, chi-square was used to determine levels of significance at p < 0.05 of effect years of care in this facility on attainment of remission, effect of adherence on attainment of remission among patients who had received care in the facility for more than a year and effect on seizure type on attainment of remission. Correlation analysis was use to test for relationship between cost of AEDs and clinic attendance and year since registration in the healthcare facility (p < 0.05 was considered significant).
The research protocol was approved by the local ethical committee of the hospital before the study was carried out.
Ninety-two patients were diagnosed with epilepsy and had at least 6 clinic attendances within the study period. One folder was empty (devoid of notes) and could not be used further. The results indicated below were obtained from the other 91 epilepsy patients.
Age distribution of patients diagnosed with epilepsy as seen at ABUTH
More than half of the patients were teenagers while some were in their twenties at the time of their registration with the healthcare facility. Thirty-six patients had no record of age of onset of epilepsy. Majority (74.6%) of the patients were less than 20 years of age at the time of onset of epilepsy disorder. (Figure 1 and 2)
Demographic Data of Patients
The demographical data of the patient are presented in Table 1.
Risk Factors for Epilepsy
Risk factors are factors that predispose an individual to epilepsy. Risk factor was indicated for 53 of the 91 patients. The most common risk factor for seizure disorder among the patients was febrile convulsion. It is depicted in the pie-chart below (Figure 3).
Diagnosis of Epilepsy
More than half (59.3%) of the patients were diagnosed as having generalized seizure disorder tonic-clonic seizure (53-generalized tonic clonic and 1 myoclonic seizure). While, 39.0% were diagnosed as partial seizures (20 complex, 2 simple partial and 1 partial motor seizure). (Table 2)
Effect of epilepsy on education and marital life
Out of the 91 patients used for this study, 36 patients had record of the effect of epilepsy on their education, 69.5% of them were either withdrawn from school or slow in learning or could not even go to school because of epilepsy. (Table 3)
The effect of epilepsy on marital life was also taken into consideration (18 years was considered as marriageable age). Thirty nine patients (42.9%) were below marriageable age. Two patients were divorced as a result of epilepsy while 25 (27.5%) were above the marriageable age at onset of epilepsy and one of these 25 patients was unable to marry because of epilepsy.
The most common laboratory investigations carried out on these patients included serum urea & electrolyte, full blood count (FBC) & differential (27), malaria parasite test (8), stool microscopy (26), general hematological investigations, Microscopy culture and sensitivity of urine (14), urinalysis (7), liver function test (2), serum glucose test (12), Skull X-ray (6), fundoscopy (3), Electroencephalography (EEG) (7) and Computerized Tomography (CT) scan (2). Co morbid mental or neurological disorder was not recorded for 4 patients (2 patients of both sexes), 67 patients (77.0%) had no comorbid mental disorder (38 males and 29 females). Twenty patients (23.0%) presented with comorbid mental or neurological disorders (8 males and 12 females).
Treatment of epilepsy
Medication: Carbamazepine was the most commonly prescribed medication (91.2%) for the epileptic patients in ABUTH under the period of study. (Table 4)
Non-pharmacological Management: Non pharmacological management carried out on the epileptic patients included counseling, psychotherapy and group counseling. Non-pharmacological management was not recorded for 20 patients. Counseling of patients by their doctors either to comply with treatment or follow-up is the most common form of non-pharmacological management noted in this study (84.5% of the patients). Psychotherapy was carried out on 12 (16.9%) patients. Only one patient underwent group counseling which is usually a form of counseling given to all ambulatory patients with mental disorder in the hospital. However, physiotherapy was recommended for a patient as a result of co-morbid disease (patient was experiencing weakness of flexors of his right hand for more than three days).
Use of alternative therapy prior to medical intervention was not recorded for 57 (62.6%) patients. Sixteen of 34 (47.1%) who had record of use of alternative therapy had never used alternative therapy. However, seventeen (50.0%) had used traditional medicine while one (2.9%) had undergone religious intervention.
Treatment outcome and remission
Patients who had missed clinic appointments for at least 4 months were regarded as those not regular in clinic attendance. Out of 91 patients enrolled in this study, only 39 (42.9%) were not regular in clinic attendance, while 52 (57.1%) were attending regularly. (Table 5)
Six of 22 (30.0%) patients who had been on treatment for more than 4 years attained more than 2 years remission, while 10 (50.0%) of them still experienced seizures within 6 months of their last clinic visit. (Table 6)
Out of 39 patients that has been attending clinic for more than 2 year, 17 (43.6%) attained one-year remission. There is a significant difference in attainment of remission and years of care in this facility. 2 x 2 Chi-square test with rate correction for continuity is 7.96, p value = 0.005. (Table 7) Patients who had at least one record of poor adherence between 2003 and 2004 were said to have poor adherence to therapy. Eighteen (40.9%) of 44 patients that adhered to their therapy attained one-year remission, while 26 were not yet free of seizures. Adherence was also found to have a significant effect on attainment of remission among patients who had received care in the facility for more than a year. 2 x 2 Chi-square test with rate correction for continuity is 6.881, p = 0.009. (Table 8)
There were 64 patients who had more than one year since registration in the facility. 2 x2 Chi-square test with rate correction for continuity is 2.613, p value = 0.106. (Table 9)
Cost of seizure disorders
Conversion of Nigerian Naira (N) to US dollar ($) was N120 to $1, at the time of data collection. The patients whose data were tabulated in Table 10 are patients who were consistent in their clinic attendance between November 2003 and October 2004 (100.0% clinic attendance). Two patients' occupation was not recorded. Eight were either self-employed or civil servants. Majority of the patients (66.7%) were unemployed (students, children, housewives or job-applicants) who depend on their parents or husband for financial support. This implies that the cost of treatment of their illness is the sole responsibilities of their caregivers. (Table 10)
Majority of the patients were less than 20 years of age at the time of onset of epileptic disorder (Figure 2). Half of the patients were less than 20 years of age (50.6%) at first registration at this healthcare facility (Figure 1). Past studies have indicated that onset of epilepsy is common in patients less than 20 years (7,19). However, a recent study in southeastern Nigeria found that only 10% of the patients were less than 20 years of age (18). Among the patients in this study, there were more males than females (Table 1). Many studies have also shown higher incidences of epilepsy in males than in female (7,18,20,21).
About half of the patients who had record of level of education were below primary school certificate level (Table 1). This is in agreement with the patients' age and marital status which supported that most (45.1%) were children/teenagers and were single. The fact that a good number were teenagers explains why more than two-thirds of the patients were unemployed and had no income and they rely on their caregiver for their medical upkeep.
Effects of epilepsy on social life
Epilepsy negatively affected the education of patients under study (Table 3). Children with epilepsy were reported to have lower performance at school than other pupils, including those suffering from other chronic diseases that affected their attendance at school (22,23). Studies have also shown that frequent seizure has a determining effect not only on education but also on marital life (7,24-26). The effect of epilepsy on education is enormous. If a patient has to drop school or is slow in learning or could not go to school at all because of epilepsy, his or her level of productivity will be affected. Moreover the emotional and psychological effect of late marriage over these patients in this part of the country where girls marry at the very tender age of 12-14 years cannot be overemphasized.
Risk Factors of Epilepsy
The most common risk factor among the patients was febrile convulsion as seen in Figure 3. Febrile convulsions, head trauma, meningo-encephalitis, perinatal causes, cerebral palsy etc. have been reported to be major causes of seizures in Nigeria (27), Sub-Sahara Africa (7) and other parts of the world (13,29).
Diagnoses were arrived at based on history (from patients and an eyewitness of seizure attacks) and also clinical presentations by the patients coupled with clinical investigations. Most common laboratory investigations carried out (such as Electroencephalogram (EEG), Computerized Tomography (CT) scan, skull x-ray) were performed in some patients as indicated in past studies (13,30). Some of the laboratory investigations were actually carried out to identify any source of infections which could provoke seizures. For example, malaria parasite test was carried out in some patients who were found to have febrile convulsion which could later results in seizure (3). Generalized seizures accounted for 54 patients (59.3%) with generalized tonic clonic accounting for 53 patients while partial seizures accounted for 23 patients (39.0%) as seen on Table 3. Al-Zakwani et al (30) in Oman (Arabian Peninsula) also indicated high percentage of (50.6%) of generalized tonic-clonic seizures among the epileptic patients in their study. The lower percentage of partial seizures reported in this study is similar (20%) to the study of Berhanu et al (31) in Central Ethiopia. Ogunniyi et al (21) had earlier reported a high proportion of partial seizure (53.3%) in a community-based study in Nigeria.
Medication prescribed for treatment of epilepsy
Among all the medications prescribed, carbamazepine was the most commonly prescribed medication (Table 4). Phenobarbitone is generally regarded as the most commonly prescribed antiepileptic medication (AED) in developing countries (15,16,20) on accounts of its being 5, 15 and 20 times cheaper than phenytoin, carbamazepine and sodium valproate respectively (13). The studies of Ezeala-Adikaibe et al (18) conducted in eastern part of Nigeria and Sanya and Musa (17) conducted in Ilorin middle belt of Nigeria showed that carbamazepine was also the most commonly prescribed drug for epilepsy in those areas. In the study of Al-Zakwani et al (30) in Oman (Arabian peninsula), the most common AED refill was sodium valproate (35.4%) followed by carbamazepine (30.8%) and lamotrigine (9.7%). However, none of the newer AEDs such as gabapentin, lamotrigine, levetiracetam, tiagabine, topiramate and zonisamide were used in these patients in our study probably because of the cost and their unavailability in developing countries as noted by Krishnan et al (14).
There was good rationale of drug use among the patients as medication prescribed was either first line or second line medication for the seizure type presented by each patient. For example, carbamazepine, used for majority of the patients is the medication of choice in both generalized and partial seizures except in myoclonic seizures. The benzodiazepines used in 49.4% are also generally effective in both classes of seizures in addition to myoclonic seizures. The latter medications are also preferred to the barbiturates on account of their greater efficacy and lesser side effects. Phenytoin and sodium valproate were rarely prescribed possibly on account of their relatively high cost. Ethosuximide, indicated specifically for absence seizures, again was hardly used in these patients, probably because absence seizure was not diagnosed in any of the patients.
Non- pharmacological management
Counseling of patients by their doctors either to comply with treatment or follow-up is the most common form of non-pharmacological management noted in this study being carried out among some patients. Group counseling is a counseling method in which patients with similar psychological problems were brought together by the health care team and the psychologist to discuss their problems and how such can be tackled. This method is beneficial to the patients as they shared experiences.
Half of the patients with a record of use of alternative therapy had used traditional medicine before visiting the hospital. There have been reports of patients with epilepsy in Africa visiting traditional healers first before visiting hospitals (13,31). However, this study did not ascertain whether the use of these alternative therapies continued after commencement of treatment at ABUTH.
Treatment outcome and remission
Clinic attendance and general treatment outcome is depicted in Tables 5 and 6 respectively. Patients who had less than 2 years of registration in the hospital had the highest percentage among patients who were not regular in their clinic attendance; this could probably explain the low remission rate among this group of patients (Table 6). Generally, majority of the patients were not regular in their clinic attendance. But this was more common among patients who were <2 years since registration at this healthcare facility. It is worthy to know that this group also tended to have a poorer treatment outcome with 90.1% having seizures within the last year of their clinic attendance (Table 7). Adherence to therapy and attainment of one-year remission from seizure is depicted in Table 8. Adherence to therapy is paramount to seizure management as poor adherence with antiepileptic drugs (AEDs) usually leads to higher rates of seizure recurrence which in turn results in increase in medical resource utilization and costs (32). The difference in the two groups' attainment of remission is statistically significant [X.sup.2] test p = 0.009 (p < 0.05) (Table 8). Therefore, failure to adhere to therapy has a significant effect on attainment of remission in these patients. Patients that failed to adhere to therapy experienced increase in number and severity of seizures (13,33). Poor adherence to prescribed medications is considered to be the main cause of unsuccessful medication treatment for epilepsy (34,35). Seizure type (either generalized or partial) has no significant ([X.sup.2] test p < 0.05) effect in the attainment of at least one-year remission after controlling for adherence level (Table 9). This suggests that patients with any type of seizure can attain remission provided the patient adhered to therapy. Other past studies in Ethiopia (23) and the United Kingdom showed that seizure type had no significant effect on the chances of achieving remission (36). Although Sirdharam (37) has a contrary view, he reported that partial seizure had lower rate of remission compared to generalized seizure.
Cost of epilepsy treatment in ABUTH Kaduna
The mean annual cost for AEDs is N30, 986.67 ($258.2) (Table 10). The mean cost of total medications (both for epilepsy and other comorbid diseases) taken by these patients was N33, 697.10 ($280.8). In India, Krishnan et al (14), estimated cost of $47 per outpatient. According to UNDP (38), more than 60% of people in the developing world are living on less than $1 per day. The added burden of cost of epilepsy on the meager family budget is immense bearing in mind that majority of the patients (66.7%) were unemployed (students, children, housewives or job-applicants) who depend on their parents or husband for financial support. This implies that the cost of treatment of their illness is solely the responsibility of their caregivers.
Correlation analysis of clinic attendance and cost of AEDs showed that cost increased with increase clinic attendance (r = 0.454, p = 0.006). This could be due to the fact that medication(s) doses and frequencies of patients attending clinic frequently (less stable patients) may have been increased, therefore resulting in increase in their medication cost. Medication cost decreased with decrease in clinic attendance. These could be a result of good treatment outcome and therefore decrease in frequencies and doses of medication(s) prescribed for such patients. There is a positive correlation (p < 0.05, r = 0.358) between years since registration at this healthcare facility and cost of AEDs. This result indicates that cost of AEDs used by the patients reduced with increase in years since registration at this healthcare facility. This finding is similar to that of Berto et al (39) and Forsgren et al (40), who showed that direct cost (which includes cost of medication) reduces with increase in year of clinic attendance/commencement of AEDs. Berto et al (39) also indicated that, direct cost accounted for 87.6% of total cost in which medication cost is 10.5%. This implies that medication cost (which was calculated in this study) accounted for a small percentage of the cost of illness. This therefore means the cost of illness of epilepsy in Nigeria (if other cost items were included) will be substantially high and the economic burden on the patients, caregivers and the country as a whole cannot be overemphasized.
From this study, it is seen that epilepsy affects marital life and education of the patients in ABUTH, Kaduna, as it does in other parts of the world. Half of the patients were 20 years old at first registration at this healthcare facility, larger proportions were less than that age at the onset of epilepsy. The most common risk factor identified for epilepsy in this study was febrile convulsion. Diagnosis was made based on information from eyewitnesses of attacks, patients and clinical examinations, EEG and CT scan in a few patients. Generalized tonic-clonic seizure was most commonly reported in this hospital and carbamazepine was the most commonly prescribed medication in this study centre.
In general, patients that had less than 2 years since registration at this healthcare facility were not as regular in their clinic attendance when compared with those who had more than 2 years since registration. This study revealed that the longer patients stay on therapy, the better their outcome. Non-adherence to follow-up and therapy has a significant effect on the outcome of treatment in terms of attaining one-year remission while type of seizure (Generalized or Partial) does not have a significant effect on attainment of one-year remission of seizures. The cost of AEDs used by the patients per year was high considering the fact that majority of these patients were unemployed. Cost increased with increase in clinic attendance, but decreased with increase in years since registration at this healthcare facility. There was no significant difference in cost of medications (either total medications or AEDs) as regards the type of seizure.
DOI: http://dx.doi.org/ 10.4314/iimu.v10i2.5
(Received 17 December 2014 and accepted 12 June 2015)
This research was self-funded. My profound appreciation goes to Prof. H. Kwanashie for her mentorship and guidance. I want to appreciate Mr Kehinde Aimola for his support and also the staff of ABUTH medical record departmental for their assistance.
(1.) Nuhu FT, Fawole JO, Babalola OJ, Ayilara OO, et al. Social consequences of epilepsy: a study of 231 Nigerian patients. Ann Afr Med. 2010; 9(3):170-5.
(2.) Olubunmi AO. Epilepsy in Nigeria - a review of etiology, epidemiology and management. Benin J Postgrad Med. 2006; 8(1):27-50.
(3.) Scott RA, Lhatoo SD, Sander JW. The treatment of epilepsy in developing countries: where do we go from here? Bull World Health Organ. 2001; 79:344-51.
(4.) Dua T, deBoer HM, Prilipko LL, Saxena S. Epilepsy care in the world: results of an ILAE/IBE/WHO Global Campaign against epilepsy survey. Epilepsia. 2006; 47(7):1225-31.
(5.) http://www.cdc.gov/nccdphp/publications/AA G/pdf/epilepsy.pdf 15/05/2015
(6.) Viteva E. Impact of stigma on the quality of life of patients with refractory epilepsy. Seizure. 2012; 12:S1059-1311.
(7.) Paul A, Adeloye D, George-Carey R, Kolcic I, et al. An estimate of the prevalence of epilepsy in Sub-Saharan Africa: A systematic analysis. Journal of Global Health. 2012; 2(2):020405
(8.) Lachhwani D. Quality of life after epilepsy surgery. Retrived from: https://my.clevelandclinic.org/ccf/media/files/ Epilepsy_Center/Lachhwani_Handout.pdf
(9.) Wood LJ, Sherman E, Hamiwka LD, Blackman M, et al. Depression, anxiety, and quality of life in siblings of children with intractable epilepsy. Epilepsy Behav. 200S; 13(1):144-8.
(10.) Hargreaves S. "Shortcomings in care" to blame for avoidable epilepsy deaths. BMJ. 2002; 324(7348):1237.
(11.) Moore PM, Baker G.A. The neuropsychological and emotional consequences of living with intractable temporal lobe epilepsy: implications for clinical management. Seizure. 2002; 11:224-30.
(12.) Ngoungou EB, Quet F, Minso M, Assengone-Zeh Y, et a. First population-based survey of epilepsy in Gabon, Central Africa. Neuroepidemiology. 2009; 33:68-78.
(13.) WHO. Epilepsy in the WHO African region: Bridging the gap. The Global campaign against epilepsy "Out of the shadow'. 2004:1-24.
(14.) Krishnan A, Saharah AS, Kapoor SK. Cost of epilepsy in patients attending secondary-level hospital in India. Epilepsia. 2004; 45 (3):289-91.
(15.) Yemadje LP1, Houinato D, Boumediene F, Ngoungou EB, et al. Prevalence of epilepsy in the 15 years and older in Benin: a door-to-door nationwide survey. Epilepsy Res. 2012; 99:31-826.
(16.) Quet F, Guerchet M, Pion SD, Ngoungou EB, et al. Meta-analysis of the association between cysticercosis and epilepsy in Africa. Epilepsia. 2006; 51:830-7.
(17.) Sanya EO, Musa TO. Attitude and management of epilepsy: Perspective of private practitioners. Niger Med Pract. 2005; 48:130-3.
(18.) Ezeala-Adikaibe B, Onwuekwe I, Ekenze S, Achor J, et al. Estimated direct cost of treating epilepsy per month in Southeast Nigeria. The Internet J Neurology. 2009; 13(1). https://ispub.com/UN/13/1Z9661
(19.) Osuntokun BO, Adeuja AO, Nottidge VA, Bademosi O, et al. Prevalence of the epilepsies in Nigerian Africans: a community-based study. Epilepsia. 1987; 28(3):272-9.
(20.) Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia. Epilepsia. 1981; 22(4):489-501.
(21.) Heaney DC1, MacDonald BK, Everitt A, Stevenson S, et al. Socioeconomic variation in incidence of epilepsy: prospective community based study in South East England. BMJ. 2002; 325:1013-6.
(22.) Adewuya AO, Oseni SB, Okeniyi JA. School performance of Nigerian adolescents with epilepsy. Epilepsia. 2006; 47:415-20.
(23.) Robert SA, Lhatoo SD, Sander JW. The treatment of Epilepsy in developing countries: where do we go from here? Bull World Health Organ. 2001; 79:344-51.
(24.) Tsuji S. Social aspects of epilepsy: marriage, pregnancy, driving, antiepileptic drug withdrawal and against social stigma. Rinsho Shinkeigaku. 2004 Nov; 44(11):865-7.
(25.) Berhanu S, Prevett, M. Treatment of epilepsy in rural Ethiopia: 2-year follow-up. Ethiopia J Health Dev. 2004; 18(1):31-4.
(26.) Wada K, Iwasa H, Okada M, Kwata T, et al. Marital status of patients with epilepsy with special reference to the influence of epileptic seizures on the patient's marital life. Epilepsia. 2004; 45(8): 33-6.
(27.) Ogunniyi A, Oluwole OS, Osuntokun BO. Two-year remission in Nigerian epileptics. East Afr Med Journal. 1998; 75(7):392-5.
(28.) de Boer HM, Mula M, Sander JW. The global burden and stigma of epilepsy. Epilepsy Behav. 2008; 12:540-546.
(29.) Cavazos JE, Lum F, Spitz M. Seizures and epilepsy: overview and classification. E Medicine [online]. Available at: http: //www.emedicine.com/neuro/topic415.ht m
(30.) Al-Zakwani I, Hanssensy Deleu, D, Cohen A, Mcghan W, et al. Annual direct medical cost and contributing factors to total cost of epilepsy in Oman. Seizure. 2003; 12:555-60.
(31.) Berhanu S, Alemu S, Asmara J, Prevett M. Primary care treatment of epilepsy in rural Ethiopia. Ethiopia J Health Dev. 2002; 16(3):235-40.
(32.) Davis KL, Candrilli SD, Edin HM. Prevalence and cost impact of non- adherence with antiepilepsy drugs among adults in a managed care population. Epilepsia. 2008; 49:446-54.
(33.) Hargrave R, Remler MP. Non-adherence. J Natl Med Assoc. 1996; 56:708-13.
(34.) Gilliam F, Hecimovic H, Shelinea Y. Psychiatric comorbidity, health and function in epilepsy. Epilepsy Behav. Epilepsy Behav. 2003; 4 Suppl 4:S26-30.
(35.) French J. Long-term therapeutic management of epilepsy. Ann Intern Med. 1994; 120:411-22.
(36.) Cockerell OC, Johnson AL, Sander JW, Hart, YM, et al. Remission of epilepsy: results from national general practice studies of epilepsy. Lancet.1995; 346:140-4.
(37.) Sridharam R. Epidemiology of Epilepsy. Current Sci. 2002; 82(6):664-70.
(38.) UNDP (UNITED NATIONS DEVELOPMENT PROGRAMME). The real wealth of nations. Washington DC; 2010.
(39.) Berto P, Tinuper P, Viaggi S. Cost of illness of epilepsy in Italy. Data from a multicentre observational study. Pharmacoeconomic. 2000; 17(2):197-208.
(40.) Forsgren E, Beghil, Ekman M. Cost of epilepsy in Europe. Eur J Neurol. 2005; 12(1):54-8.
Aduke E Ipingbemi ([PSI])
Department of Clinical Pharmacy and Pharmacy Administration, University of Ibadan, Ibadan, Nigeria
([PSI]) Correspondence at: Department of Clinical Pharmacy and Pharmacy Administration, University of Ibadan, Ibadan, Nigeria; Phone: +2348057371986; Email: firstname.lastname@example.org
Table 1: Demographic data of patients Demographic Factors Option Frequency Percentages Sex Male 48 52.7 Female 43 47.3 Total 91 100 Marital status Single 66 72.5 Married 23 25.3 Divorced 2 2.2 Total 91 100 Educational level No formal education 5 12.8 Koranic education 3 7.7 Nursery school 4 10.2 Primary school 14 35.9 Secondary school 9 23.1 Tertiary 4 10.2 Not recorded 52 57.1 Total 91 100 Occupation Child 36 39.6 Student 18 19.8 Housewife 11 12.1 Privately Employed 11 12.1 Applicants 4 4.4 Civil Servant 5 5.5 Not recorded 6 6.6 Total 91 100 Table 2: Specific diagnosis of epilepsy Class of seizure Specific Diagnosis Patients Patients Number Percentage Generalized Tonic-clonic 53 58.3 Generalized Myoclonic seizure 1 1.1 Partial Partial motor seizure 1 1.1 Partial Simple partial 2 2.2 Mixed seizure Mixed seizure 2 2.2 Status epilepticus Status epilepticus 1 1.1 Total 91 100 Table 3: Effect of epilepsy on education Effect of Epilepsy on Education Number of Percentage Patients (%) Dropped out because of embarrassment 1 2.8 Cannot go to school 4 11.1 Slow learning 3 8.3 Withdrawn from nursery school 2 5.6 Withdrawn from primary school 6 16.7 Withdrawn from secondary school 7 19.4 Withdrawn from tertiary 2 5.6 Doing well in school 11 30.6 Total 36 100 Table 4: Anti-epileptic medications prescribed for epileptic patients in ABUTH, Kaduna between 2003 and 2004 Medication Class/Subclass Number of % of patients prescribed patients using using medication medication Carbamazepine Iminostilbenes 83 91.2 Diazepam Benzodiazepines 31 34.1 Phenobarbitone Barbiturate 18 19.8 Clonazepam Benzodiazepines 14 15.4 Phenytoin Hydantoin 7 7.7 Primidone Deoxybarbiturate 4 4.4 Sodium Valproate Valproic acid 4 4.4 Ethosuximide Succinimides 1 1.1 Nitrazepam Benzodiazepine 1 1.1 Table 5: Cross tabulation of years since contact with orthodox facilities and clinic attendance Years since Clinic Attendance contact with orthodox Not regular in Regular in Total facilities clinic attendance clinic attendance <2 years 18 (35.3%) 33 (64.7%) 51(100.0%) 2-4 years 9 (45.0%) 11 (55.0%) 20 (100.0%) >4years 12 (60.0%) 8 (40.0%) 20 (100.0%) Total 39 (42.9%) 52 (57.1%) 91 (100%) Table 6: Cross tabulation of general treatment outcome and years since registration at this healthcare facility Years since General Treatment outcome registration at this healthcare Free of Seizure Free of Seizure facility in > 2years between 1-2 years <2 years -- 5 (9.8%) 2-4 years 4 (20.0%) 5 (25.0%) >4years 6 (30.0%) 2 (10.0%) Total 10 12 Years since General Treatment outcome registration at this healthcare Seizure between Seizure in Total facility 6month-1year <6months <2 years 14 (27.4%) 32 (62.7%) 51 2-4 years 5 (25.0%) 6 (30.0%) 20 >4years 2 (10.0%) 10 (50.0%) 20 Total 21 48 91 Table 7: Cross tabulation of years since contact with orthodox facilities and remission of epileptic patients as seen at ABUTH Years since Remission contact with orthodox 1 year Not in facilities remission remission Total >1-2 years 5 (13.9%) 31 (86.1%) 36 (100.0%) > 2years 17 (43.6%) 22 (56.4%) 39 (100.0%) Total 22 53 75 Table 8: Cross tabulation of adherence and remission of epileptic patients as seen at ABUTH Adherence Remission One-year Not seizure Total remission free Good 18 (40.9%) 26 (59.1%) 44 (100.0%) Poor 4 (12.9%) 27 (87.1%) 31(100.0%) Total 22 53 75 Table 9: Cross tabulation of type of seizure and remission of epileptic patients as seen at ABUTH Remission Type of seizure One-year Not seizure Total remission free Generalized 10 (22.2%) 35 (77.8%) 45 (100.0%) Partial 8 (42.1%) 11 (57.9%) 19 (100.0%) Total 18 46 64 Table 10: Diagnosis and cost of medications of patient who had 100% clinic attendance between November 2003 and October 2004 S/N Diagnosis Age Occupation Number of Clinics Attended 1 G. Tonic-clonic 20 Student 6 2 G. Tonic-clonic 11.5 Child 10 3 G. Tonic-clonic 17 Student 10 4 Seizure disorder 48 Petty trader 6 5 T.L.E 26 Petty trader 7 6 T.L.E 26 Housewife 11 7 Myoclonic 25 Housewife 13 8 G. Tonic-clonic 40 Farmer 12 9 Seizure disorder 8 Student 8 10 G. Tonic-clonic 50 Policeman 6 11 G. Tonic-clonic 12 Student 6 12 Mixed seizure 18 Student 9 13 Complex partial 39 Not recorded 7 14 G. Tonic-clonic 15 Student 4 15 G. Tonic-clonic 11 Child 9 16 G. Tonic-clonic 12 Student 8 17 G. Tonic-clonic 23 Not recorded 11 18 T.L.E 26 Student 6 19 G. Tonic-clonic 22 Unemployed 5 20 Complex partial 8 Child 5 21 T.L.E 25 Tailor 6 22 G. Tonic-clonic 4 Child 16 23 G. Tonic-clonic 9 Student 5 24 Complex partial 12 Child 16 25 G. Tonic-clonic 21 Student 3 26 T.L.E 26 Unemployed 12 27 Status epilepticus 39 Teacher 5 28 G. Tonic-clonic 24 Farmer 6 29 G. Tonic-clonic 26 Civil servant 12 30 T.L.E 28 Student 10 S/N Years Since first Total Cost Total Cost contact with of Drugs of AEDS orthodox facilities used (N) used (N) 1 1.19 24,200($201.7) 18,270($152.3) 2 1.20 14,016($116.8) 13,300($110.8) 3 1.27 33,484($279.0) 33,033($275.3) 4 1.28 28,835($240.3) 25,550($212.9) 5 1.31 34,733($289.4) 34,569($288.1) 6 1.38 37,971($316.4) 37,501($312.5) 7 1.46 43,300($360.8) 41,274($344.0) 8 1.54 57,105($475.9) 50,454($420.5) 9 1.98 35,788($298.2) 33,705($280.9) 10 2.17 25,550($212.9) 25,550($212.9) 11 2.32 12,775($106.4) 12,775($106.4) 12 2.37 45,690($380.8) 39,239($327.0) 13 2.39 40,643($338.7) 37,960($316.3) 14 2.58 15,890($132.4) 15,890($132.4) 15 2.58 27,515($229.3) 25,550($212.9) 16 2.60 27,736($231.1) 25,500($212.5) 17 2.71 59,331($494.4) 55,172($459.8) 18 3.27 41,809($348.4) 37,960($316.3) 19 3.31 39,428($328.6) 38,115($317.6) 20 3.62 27,160($226.3) 25,500($212.5) 21 6.53 7,317($61.0) 5,390($44.9) 22 7.11 47,696($397.5) 45,958($383.0) 23 7.15 11,335($94.5) 9,415 ($78.5) 24 7.71 31,493($262.4) 29,402($245.0) 25 7.92 37,960($316.3) 37,960($316.3) 26 8.21 42,834($356.95) 32,096($267.5) 27 8.96 40,880($340.7) 25,550($212.9) 28 11.51 2,256($18.8) 2,160($18.0) 29 16.95 40,673($338.9) 39,900($332.5) 30 29.83 75,510($629.3) 74,902($624.2) TLE: Temporal Lobe Epilepsy
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|Title Annotation:||Original Work|
|Author:||Ipingbemi, Aduke E.|
|Publication:||Internet Journal of Medical Update|
|Date:||Jul 1, 2015|
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