Quality of life, adherence and knowledge of epileptic patients and the impact of a pharmacist-led educational intervention: A review
Abstract
Around 65 million individuals suffer from epilepsy worldwide, and when it is not properly treated, it is linked to higher rates of physical harm and mortality. Due to the requirement for long-term therapy and the side effects of many medications, medication compliance is a significant issue. The purpose of this review was to summarize the findings of previous studies examining the quality of life (QOL), adherence, patient education, and medication knowledge, as well as the impact of a pharmacist-led educational intervention. Additionally, to find out if these studies benefit epileptic patients, to find the appropriate method used to help them in all aspects of their lives, and to use these in future studies. A systematic and comprehensive search was conducted using specific keywords from PubMed, Google Scholar, and Research Gate. A significantly poorer QOL was linked to prolonged antiepileptic drug use or poor adherence as well as psychiatric problems. Neglect was the most frequent reason for nonadherence. The frequency of seizures was greatly reduced, and the adherence was significantly increased by patient education and medication understanding. Patient awareness, adherence, QOL, and seizure frequency were dramatically improved following the intervention. In the absence of optimal treatment, epilepsy is associated with increased rates of bodily injuries and mortality. It is crucial to increase patient education and knowledge about disease and treatment in order to improve adherence, and QOL. Intervention by a chemist is required to achieve these results.
Abbreviations
-
- AEDs
-
- Antiepileptic drugs
-
- AEP
-
- Adverse Event Profile
-
- BAI
-
- Beck Anxiety Inventory
-
- BDI
-
- Beck's Depression Inventory
-
- CES-D
-
- Center for Epidemiologic Studies Depression Scale
-
- CWE
-
- Children with epilepsy
-
- DRIs
-
- Drug-Related Issues
-
- DRPs
-
- Drug-Related Problems
-
- ESES
-
- Electrical Status Epilepticus during Slow-wave Sleep
-
- ESMS
-
- Epilepsy Self-Management Scale
-
- ESS
-
- Epworth Sleepiness Scale
-
- GAD
-
- General Anxiety Disorder
-
- ISI
-
- Insomnia Severity Index
-
- KAP
-
- Knowledge, Attitudes, and Practices
-
- KSS
-
- Karolinska Sleepiness Scale
-
- LSSS
-
- Liverpool Seizure Severity Scale
-
- MARS
-
- Medication Adherence Report Scale
-
- MCMs
-
- Major Congenital Malformations
-
- MEMS
-
- Medication Event Monitoring System
-
- MGLS
-
- Morisky-Green-Levine Scale
-
- MMAS
-
- Morisky Medication Adherence Scale
-
- MOSES
-
- Monitoring of Side Effects Scale
-
- MPR
-
- Medication Possession Ratio
-
- MTM
-
- Medication Therapy Management
-
- NDDI-E
-
- Neurological Disorders Depression Inventory in Epilepsy
-
- OCs
-
- Oral Contraceptives
-
- PEMSQ
-
- Pediatric Epilepsy Self-Management Questionnaire
-
- PHQ
-
- Patient Health Questionnaire
-
- PLEC
-
- Pharmacist-Led Epilepsy Consultations
-
- PSPSQ
-
- Patient Satisfaction with Pharmacist Services Questionnaire
-
- PSQI
-
- Pittsburgh Sleep Quality Index
-
- PWE
-
- Patients with Epilepsy
-
- QOL
-
- Quality of life
-
- QOLCE
-
- Quality of Life in Childhood Epilepsy
-
- QOLIE
-
- QOL in Epilepsy
-
- SES
-
- Low Socioeconomic Status
-
- SF
-
- Short Form
-
- SMAQ
-
- Simplified Medication Adherence Questionnaire
-
- VPA
-
- Valproic acid
-
- WASO
-
- Wake-after-sleep onset
-
- WHOQOL-BREF
-
- World Health Organization Quality of Life Brief Version
-
- WWE
-
- Women with Epilepsy
1 INTRODUCTION
Around 65 million individuals suffer from epilepsy worldwide, and when it is not properly treated, it is linked to higher rates of physical harm and mortality [1]. Epileptic seizures frequently result in temporary impairments of awareness, putting the person at risk for physical damage and frequently interfering with their ability to learn and work. Since there is no effective prophylaxis or cure, therapy is symptomatic. This is due to the fact that the medications that are currently available inhibit seizures. Due to the requirement for long-term therapy and the side effects of many medications, medication compliance is a significant issue [2].
The cornerstone of epilepsy treatment, antiepileptic drugs (AEDs) aim to stop seizures. The non-adherence situation has a substantial impact on seizure control failure. A sickness like this could have detrimental clinical, societal, and economic implications. The patient's knowledge, the drug, the culture, the healthcare workers, and governmental health programs—which are linked to the components of therapy and instruction related to behavior that is likely to adhere—are factors that can be adjusted to encourage adherence [3].
There are more than 20 AEDs accessible, including modern and more dated models. Older AEDs, including phenytoin, carbamazepine, and valproic acid (VPA), are still frequently utilized in therapeutic settings. However, due to their nonlinear variable pharmacokinetics and restricted therapeutic indices, these medications frequently have serious side effects and drug interactions. The adverse effects of AEDs largely predict the quality of life (QOL) for epilepsy patients [4].
The information that community pharmacists provide to people with epilepsy regarding their disease and potential therapies is vital. By increasing compliance and reducing drug-drug interactions, improving patient education may also improve the patients' QOL. Pharmacists are able to spot the onset of health problems and halt the development of comorbidities. Pharmacists provided pharmaceutical counseling, pharmaco-therapeutic follow-up, systematic measurement and evaluation of findings, and increased medication adherence for Patients with epilepsy (PWE) due to the difficulty of treating epilepsy and the lack of knowledge about pharmacists' contributions to epilepsy management [5].
Pharmacists are in a unique position to help epilepsy patients perform better. Studies have shown that pharmacists are helpful in the treatment of epilepsy [4]. The purpose of this review was to summarize the findings of previous studies examining the QOL, AED adherence, and medication knowledge of epileptic patients, as well as the effect of a pharmacist-led educational intervention. Additionally, to find out if these studies benefit epileptic patients, to find the appropriate method used to help epileptic patients in all aspects of their lives, and to use these in future studies.
2 METHOD
A systematic and comprehensive search using specific keywords “epilepsy,” “Quality of life,” “adherence,” “patient education,” “Knowledge,” and “Pharmacist-led” from PubMed, Google Scholar, and research gate was conducted. Our initial search starts on the first of February and continues until the 30th of April 2023. Then, two authors evaluated the article titles and abstracts and eliminated several irrelevant studies. If we were unable to categorize the research based on titles and abstracts, we carried out a full-text verification.
2.1 Inclusion and exclusion criteria
Results of the initial search were imported into Mendeley, and publications were evaluated using the following criteria: (1) all studies examining the QOL, adherence, and knowledge of epileptic patients without regard to year of publication were included (2) Articles with sufficient data to extract.
Duplicate entries, reviews, meta-analyses, case studies, book chapters, letters to the editor, and abstracts from conferences were excluded.
2.2 Data extraction and quality assessment
The first author's name, the year of publication, the city, and the purposes, method, and conclusion of the study were all extracted in accordance with the standardized extraction process. The two authors individually extracted the data, and any inconsistencies were then settled by consensus in order to increase the accuracy of our data.
3 SUMMARY OF STUDIES
3.1 Improving the quality of life
The World Health Organization defines QOL as referring to an individual's sense of wellbeing and their perspective of their place in the world. A person's view of their QOL, happiness, and sense of fulfillment can be significantly impacted by a number of circumstances due to the complicated nature of epilepsy and its frequently chronic course. It is quite difficult to increase the QOL for those who have epilepsy [6].
Antiepileptic medications have been shown to improve PWE's QOL in a number of studies:
A study conducted in Tehran, Iran, by Hamedi-Shahraki et al. [7] considered that adherence to treatment should be monitored to improve their QOL. A longitudinal study, The Medication Adherence Report Scale (MARS-5) questionnaire, the Liverpool Seizure Severity Scale (LSSS) and the QOL in Epilepsy (QOLIE-31) questionnaires were used. The result of medication adherence significantly correlated with both seizure severity and serum AED level. QOL did not correlate with seizure severity. However, medication adherence was significantly correlated with QOL.
Another study conducted in Basrah, Iraq, by Shakir et al. [8] reported that monitoring treatment compliance would improve their QOL. The MARS-5 survey, the LSSS, and the QOLIE-31 survey were utilized in a longitudinal study. Seizure severity and serum AED levels are substantially linked with medication adherence results. Seizure severity is not connected with QOL. However, there was a substantial correlation between QOL and medication adherence.
The study conducted in Boston, USA, by Pavlova et al. [9] reported that contrary to certain other AEDs, clobazam's side effects are yet unknown. Patients with epilepsy are taken into consideration if they frequently have episodes of fragmented sleep, which may lower their QOL. They looked at whether clobazam therapy could help epileptic patients sleep longer and more soundly. In the prospective study's post-treatment outcomes, there were fewer awakenings and wake-after-sleep onset (WASO) as well as fewer seizures.
In a study conducted in Atlanta, USA, by Ettinger et al. [10], they believe that in people with epilepsy, depression is frequently underdiagnosed and largely mistreated. It has been demonstrated that depression has a detrimental effect on QOL. Results from a cross-sectional survey of epileptic people revealed that sadness or the frequency or severity of seizures had a negative impact on QOL.
In another study conducted in India by Pimpalkhute et al. [11], they regarded that epilepsy can have an impact on a person's QOL and be linked to serious physical, psychological, and social implications. The kind of pharmacological therapy used is crucial. Patients receiving monotherapy had a greater QOL, primarily as a result of fewer side effects. According to a cross-sectional questionnaire survey, the carbamazepine group scored significantly higher on cognitive and medication effects than the valproate group.
In the second study, also in India, by Nagabushana et al. [12], it was considered that polytherapy, poor medication adherence, adverse effects of AEDs, hospitalization, and developmental delay were the factors most likely to affect the overall QOL in children with epilepsy (CWE). Prospective cross-sectional research was employed. Additionally, CWE who take numerous AEDs, take them for a long time, do not follow directions, or show side effects from their AEDs have much lower overall QOL.
In the study conducted in Australia by Welton et al. [13], psychiatric and self-reported memory issues are thought to be widespread and linked to the worst effects on QOL. They used cross-sectional surveys, which led to the association between “psychiatric disorders” and a decline in QOL.
However, a case–control study conducted in Northwest Greece by Siarava et al. [14] on adult PWE found that patients had a worse QOL compared with controls. It was assumed that PWE had worse physical health and psychological and socially linked QOL.
We can talk about the findings of all these research studies on QOL. We discovered that poor adherence, sleep problems, the number and intensity of seizures, physical and psychological health, and long-term polytherapy were all associated with QOL. Improving QOL requires increasing adherence and addressing other issues.
All these studies are summarized in Table 1.
Authors | Sites and year of study | Aims | Duration | Study design | Tools |
---|---|---|---|---|---|
Hamedi-Shahraki et al. [7] | Tehran, Iran (2019) | To examine the link between medication compliance and quality of life (QOL) and the mediating roles that medication compliance plays in the association between serum antiepileptic medication (AED) levels, seizure frequency, and quality of life (QOL) in elderly epileptics. | 6 months | Longitudinal study | (MARS-5), LSSS and (QOLIE-31) questionnaires |
Shakir et al. [8] | Basrah, Iraq (2012) | To determine the numerous elements influencing the quality of life (QOL) of people with epilepsy. | Not specified | Case-control study | Short form (SF-36) health survey |
Pavlova et al. [9] | Boston, USA (2020) | To assess how antiepileptic medication and quality of life affect sleep-wake patterns in patients with drug-resistant epilepsy. | Not specified | Prospective study | (PSQI), (ESS), (KSS), (ISI), and (QOLIE) |
Ettinger et al. [10] | Atlanta, USA (2014) | To evaluate how depression affects epilepsy patients' adherence to antiepileptic medication and quality of life. | Not specified | Cross-sectional study | CES-D or NDDI-E |
Pimpalkhute et al. [11] | India (2015) | To assess the health-related QOLIE-31 score of epilepsy patients. | Not specified | Cross-sectional study | QOLIE-31 |
Nagabushana et al. [12] | India (2019) | To evaluate the effects of epilepsy and antiepileptic drugs on the child's growth, health, academic achievement, and QOL and to determine the factors that influence QOL. | Not specified | Cross-sectional study | (QOLCE) questionnaire |
Welton et al. [13] | Australia (2020) | To investigate adult patients with epilepsy's quality of life (QOL) in Australia and how it relates to comorbid conditions and adverse effects from antiepileptic medicines (AEDs). | 4 months | Cross-sectional study | (QOLIE-10-P) total score |
Siarava et al. [14] | Northwest Greece (2015) | To assess potential contributing factors to depression and QOL in epilepsy patients while comparing the depression and QOL of those with the condition to that of healthy controls. | Not specified | Case-control study | (PHQ-9), WHOQOL-BREF and (AEP) questionnaire |
3.2 Adherence to antiepileptic drugs
Patients with epilepsy must adhere to their AED therapy in order to control their seizures. [15].
Antiepileptic drug therapy non-adherence can result in a number of unfavorable consequences. In order to help medical practitioners provide the best interventions to manage seizures, it is helpful to pinpoint the causes of poor adherence [16].
In a study conducted in India by Gurumurthy et al. [15], the elements that influence adherence are determined and the pattern and degree of AED adherence among PWE are examined. Antiepileptic drug adherence was found to be substantially correlated with socioeconomic status (SES) and epilepsy type; the study used a cross-sectional analysis. However, there was no correlation between adherence and any of the following variables: age, gender, marital status, duration of epilepsy, quantity and type of AEDs, or frequency of adverse medication responses. Forgetting was the leading cause of nonadherence.
In a study conducted in Malaysia by Tan et al. [16], they investigated the prevalence and variables influencing AED therapy compliance in a multiracial community of epileptic patients. Poor adherence was significantly linked to younger age, drug side effects, and confusion about the need for AEDs according to a cross-sectional study.
According to a study conducted in the USA by Smith et al. [17], over the course of a year, trends and predictors of adherence in teenagers with epilepsy were discovered. A longitudinal study also revealed that reduced family conflict, greater side effects, fewer caregiver-reported adherence hurdles, and low SES were all associated with decreased adherence.
In a study conducted in Hong Kong, China by Lin et al. [18], they found out if the MARS-5 score of self-reported medication adherence correlates with the serum level of antiepileptic medication. A longitudinal study found a negative correlation between the LSSS score and the MARS-5 score and a positive correlation between the blood antiepileptic medication level and the MARS-5 score.
A study conducted in Germany by Jacob et al. [19] utilized a cross-sectional design to examine adherence to antiepileptic medicines (AED) in children and adolescents treated in pediatric practices in Germany, discovered that children under the age of 5 had higher levels of AED adherence than those between the ages of 14 and 17. Attention-deficit hyperactivity disorder was adversely and asthma positively correlated with treatment adherence. Finally, no correlation between adherence and AED type was discovered to be statistically significant.
Another study in the UK by Chapman et al. [20] reported that a theory-based approach to evaluating patient perceptions of AEDs and adherence was evaluated for its usefulness. They used mailed validated questionnaires and discovered that nonadherence was connected to implicit attitudes against AEDs and perceptions about medications. Antiepileptic drug adherence-related views and general pharmacological beliefs were associated.
The study conducted in China by Guo et al. [21] used a cross-sectional study to examine the connection between adherence to AEDs and depression, and the results showed a significant difference in depression scores between the moderate-to-high adherence group and the low adherence group. They also found a significant difference in anxiety scores between the two groups.
Nevertheless, a study in Texas, USA, by Zeber et al. [22] examined the level of adherence to nine different AEDs in an aged clinical population from around the country. An analysis of the patients' cross-sectional data revealed that almost half of them required more adherence. Patients on phenobarbital, valproate, and gabapentin had significantly worse rates of adhering to both outcomes in multivariable models, whereas lamotrigine and levetiracetam had a favorable effect on adherence.
A study in Ethiopia by Niriayo et al. [23] examined the beliefs, medication adherence, and related factors among ambulatory epilepsy patients. A cross-sectional study revealed that forgetfulness, inability to obtain medication, and safety concerns were the most frequent reasons for nonadherence. Comorbidity, recent seizures, low medication requirement belief, high medication concern belief, and negative medication belief were all associated with medication nonadherence.
While a study in the USA by Paschal et al. [24] used a cross-sectional survey to study factors linked to adherence and offer suggestions for improvement; the findings also revealed that “forgetfulness” was the main cause.
When we look at the results of adherence studies, we can see that there are many reasons for poor adherence, including increased side effects, fewer caregivers reporting adherence challenges, older age, low knowledge, perception, and attitude, type of AEDs, and psychological health, but forgetfulness is the most common cause. As a result, improving adherence requires raising knowledge, perception, and attitude as well as boosting caregiver reporting of adherence issues and educational intervention.
All these studies are summarized in Table 2.
Authors | Sites and year of study | Aims | Duration | Study design | Tools |
---|---|---|---|---|---|
Gurumurthy et al. [15] | India (2017) | To assess the degree and pattern of AED adherence among PWE and to pinpoint the driving variables. | Not specified | Cross-sectional study | Morisky medication adherence scale |
Tan et al. [16] | Malaysia (2015) | To determine the prevalence and elements influencing AED therapy compliance in a multiracial group of epileptics. | Not specified | Cross-sectional study | Modified Morisky adherence Scale-8 |
Smith et al. [17] | USA (2018) | As well as patterns and determinants of adherence, this study will examine the effects of adherence over the course of a year on seizures and health-related quality of life (HRQOL) in adolescents with epilepsy. | 12 months | Longitudinal study | MEMS TrackCaps |
Lin et al. [18] | Hong Kong, China (2016) | To determine whether the medication adherence report scale (MARS-5) score can be used to predict a patient's quality of life (QOL) in people with epilepsy and whether it correlates with the serum level of antiepileptic medication. | 18 months | Longitudinal study | MARS-5, LSSS and (QOLIE-31) questionnaire |
Jacob et al. [19] | Germany (2017) | To examine the use of antiepileptic medications (AED) by children and teenagers in German pediatric practices. | 10 years | Cross-sectional study | The medication possession ratio (MPR) |
Chapman et al. [20] | UK (2014) | To determine the effectiveness of a theory-based method for gaining insight into patient views on AEDs and adherence. | Not specified | Mailed validated questionnaires | Self-report and medication possession ratio and PSM scale |
Guo et al. [21] | China (2015) | To research the relationship between antiepileptic drug (AED) adherence and depression and anxiety. | Not specified | Cross-sectional study | (BDI), (BAI), and (MMAS-8) |
Zeber et al. [22] | Texas, USA (2010) | To examine the use of 9 different AEDs by older individuals with new-onset epilepsy in a national clinical population. | 3 months | Cross-sectional study | The medication possession ratio (MPR) |
Niriayo et al. [23] | Ethiopia (2019) | To research medication adherence, belief, and related factors in ambulatory epilepsy patients. | Not specified | Cross-sectional study | Self-reported questionnaires |
Paschal et al. [24] | USA (2014) | To look at issues that affect adherence and to offer suggestions for improvement. | Not specified | Cross-sectional study | Self-reported missed/skipped medication doses and seizures and mailed surveys |
3.3 Patient education
In order to control recurrent seizure occurrences in epilepsy, good medication adherence and follow-up treatment are required. Nonadherence to antiepileptic medications is one of the most frequent causes of “breakthrough” seizures. Patients are urged to participate in epilepsy self-management in addition to standard therapeutic therapy by learning about the condition's causes and effective preventative actions. [25].
Health education is an effective technique that helps improve PWE's self-management abilities and medicine adherence. In PWE with a moderate to high level of education, structured health education programs increase seizure control and boost therapy satisfaction [26].
In a study conducted in India by Dash et al. [26], a randomized control trial investigation was utilized to examine the impact of a structured training program on medication adherence and self-care management in epilepsy patients in a developing nation. The group receiving epilepsy health education showed a significant change in the findings.
Another study in Thailand by Saengow et al. [27] discovered that an inadequate understanding of epilepsy causes poor drug compliance and seizure control. Accordingly, the leading authors produced an educational video animation that gives crucial details on pediatric epilepsy patients' diagnosis, treatment, and medication usage for epilepsy patients. The effect of the 8.52-min video animation was evaluated using a randomized controlled trial study. Indeed, drug adherence significantly improved following the video intervention.
A study in China by Hu et al. [28] examined the effect of a rigorous self-management education program on seizure frequency. The study used a randomized controlled design investigation, leading to a considerably decreased seizure frequency compared with the baseline.
A study was also conducted in China by Ma et al. [4] that compared the percentage of VPA samples that fell within the therapeutic reference range and the effect of pharmacist education on patient medication adherence and employing a retrospective randomized controlled trial analysis. It was found that the proportion of therapeutic VPA samples that achieved the therapeutic range changed significantly after the pharmacist's intervention.
Another study in China by Tang et al. [29] examined the results of behavioral intervention and medication education in Chinese epilepsy patients. The study used a randomized control trial study, which had the additional benefit of causing a significant rise in AED adherence and understanding among all patients following the intervention and a drop in the proportion of patients who skipped or had seizures.
A study conducted in Egypt by El-Shiekh et al. [30] also examined how educational training initiatives affected how well epilepsy teenagers stayed on their medication regimens. The study used a randomized control experiment and found that following the intervention, epileptic teenagers' adherence to AED therapy and awareness of medication both considerably improved.
Another study in Iran by Bahiraei et al. [31] also evaluated the impact of educational initiatives on the self-management of epilepsy patients. Regarding demographic factors and disease characteristics, a randomized control trial study found no significant differences between the two groups. However, the experimental group showed a significant difference in the areas of medication self-management, information, safety, lifestyle, and seizure before and after the intervention.
Another study in Iran by Aliasgharpour et al. [32] assessed how an educational program affected epilepsy patients' ability to control their condition on their own. The results indicated a significant difference before and after the intervention using a randomized control study design.
All of these studies revealed that adherence improves following education or intervention programs; hence, it is critical to promote improved education through awareness workshops, educational leaflets, or brochures.
All these studies are summarized in Table 3.
Authors | Sites and year of study | Aims | Duration | Study design | Tools |
---|---|---|---|---|---|
Dash et al. [26] | India (2015) | To investigate how a formal education program influences self-care management and medication compliance in epilepsy patients in a developing country. | 6 months | Randomized controlled trial study | (MMAS) and (ESES) |
Saengow et al. [27] | Thailand (2018) | To produce an educational video animation for epilepsy patients and carers and assess the video's value. | 3 months | Randomized controlled trial study | Ten-item questionnaires and drug adherence (Morisky et al. (MMAS-8)) |
Hu et al. [28] | China (2020) | To research how a comprehensive self-management education program affects patients who experience epileptic seizures with prodromes or triggering events in terms of their quality of life and frequency of seizures. | 1 year | Randomized controlled trial study | QOLIE 31 and MMAS |
Ma et al. [4] | China (2019) | To assess how much valproic acid (VPA) samples approach the therapeutic reference range and the effect of pharmacist education on patient medication adherence. | 2 years | Randomized controlled trial study | (SMAQ) |
Tang et al. [29] | China (2014) | To assess and contrast the various impacts of behavioral intervention and medication education on Chinese patients with epilepsy. | 6 months | Randomized controlled trial study | (MMAS-4) |
El-Shiekh et al. [30] | Egypt (2021) | To determine whether an educational training program has a positive impact on teen patients' drug compliance. | Not specified | Randomized controlled trial study | Structured interview questionnaire, epilepsy knowledge questionnaire, and (MMAS-8) |
Bahiraei et al. [31] | Iran (2019) | To assess how educational programs affect epilepsy patients' ability to care for themselves. | 6 months | Randomized controlled trial study | Self-management scale |
Aliasgharpour et al. [32] | Iran (2013) | To assess how an educational program affects epilepsy patients' ability to manage their condition on their own. | 1 month | Randomized controlled trial study | Self-management scale |
3.4 Knowledge of patient about epilepsy
Knowing more about epilepsy can help lessen the dread of seizures, avoid risky self-management techniques, and lessen the emotional toll of both seizures and treatment. It has been argued that education is essential to enhancing one's capacity to manage epilepsy successfully by reducing the condition's negative effects on social and psychological functioning [33].
Studies in European countries by Doughty et al. [33] described the extent of epilepsy knowledge among affected individuals and their families. Self-completion questionnaires were used to collect data for a cross-sectional study, and all factors were shown to differ significantly between countries. There were, however, certain knowledge gaps, particularly when it came to matters involving drugs and the origin of epilepsy.
In another study in Croatia by Friedrich et al. [34], it was thought that educational and counseling programs could improve AED tolerance, increase AED compliance, and result in fewer side effects. In particular, when conducted prior to conception, these programs could aid women with epilepsy (WWE) in making an educated choice about becoming mothers and lower the incidence of fetal abnormalities. WWEs of reproductive age are still largely misinformed about various pregnancy-related difficulties, according to a cross-sectional survey.
Another study in New York, USA, by Pack et al. [35] also took into account the knowledge of WWE regarding oral contraceptives (OCs), antiepileptic medicines (AEDs), and the potential teratogenicity of AEDs. It used a cross-sectional questionnaire-based study and discovered that WWE knew little about the teratogenic consequences of AEDs and their potential interactions with OCs.
A Study in Italy by Cassina et al. [36] performed a prospective cohort study to find that there was no statistically significant difference between the rates of major congenital malformations (MCMs) in the epileptic and non-epileptic groups. They took into account the increased risk of MCMs in children born to epileptic women receiving antiepileptic medicines (AEDs). The rate in the group of epileptic patients was higher than that in the control group.
A study in Kerala, India, by Shaju et al. [37] analyzed the parents' attitudes, practices, and knowledge (knowledge, attitude, and practice) on the treatment of epilepsy in children. The study used a randomized control design and discovered that while parents had a reasonable understanding of epilepsy, they knew less about its traits, causes, and prognosis.
Another study in Australia by Ahmad et al. [38] discovered that individuals with epilepsy who used AEDs had a greater incidence of fractures, with the risk being highest in those who had longer-term AED use. Patients with epilepsy were not generally aware of the dangers of fractures and falls. A cross-sectional investigation revealed that the risk of fractures for both general fractures and fractures associated with seizures increases with each year of AED use. Few patients were aware that using an AED increased their risk of fractures, decreased their bone mineral density, and/or fell.
According to studies, there is a knowledge gap, and many studies on pregnant women reveal insufficient information on numerous pregnancy-related difficulties caused by AEDs and their interaction with oral contraception. To avoid any complications, it is necessary to enhance awareness to bridge this gap, particularly for women taking OCs who have opted to become pregnant.
All these studies are summarized in Table 4.
Authors | Sites and year of study | Aims | Duration | Study design | Tools |
---|---|---|---|---|---|
Doughty et al. [33] | European countries (2003) | To describe the levels of epilepsy knowledge held by individuals with the condition and their families in Europe and to spot any knowledge gaps. | Not specified | Cross-sectional study | Self-completion questionnaires and the epilepsy knowledge questionnaire |
Friedrich et al. [34] | Croatia (2018) | To carry out a thorough investigation on a group of WWE women who are of childbearing age in order to respond to the following questions: | 2 months | Cross-sectional study | Online questionnaire |
1) How well-informed are they about PRIE, and what factors are associated with better knowledge? | |||||
2) Their use of and requirements for PRIE's information sources. | |||||
3) Their current AED use and how it relates to their clinical and demographic characteristics, as well as their desire for children. | |||||
Pack et al. [35] | New York, USA (2009) | To determine how much US WWE are aware of how AEDs may affect OC effectiveness and their potential teratogenicity. | Not specified | Cross-sectional study | Questionnaire |
Cassina et al. [36] | Italy (2013) | To establish the function of maternal epilepsy. | 8 years | Prospective cohort study | – |
Shaju et al. [37] | Kerala, India (2014) | To assess the parents' knowledge, attitude, and practice (KAP) on the administration of antiepileptic drugs to children. | 10 months | Randomized-control trail | The authors prepared the questionnaire and pediatric epilepsy self-management questionnaire (PEMSQ) |
Ahmad et al. [38] | Australia (2012) | Analyze the risk of fractures and falls in epilepsy patients receiving antiepileptic medicines (AED) and gauge their knowledge of these issues. | Not specified | Cross-sectional study | – |
3.5 Pharmacist-led intervention
Pharmacist-led educational activities to promote medication adherence may be helpful in the management of epilepsy. To keep seizures under control and prevent treatment failure, maintaining drug adherence is crucial [39].
A study in Turkey by Özdağ et al. [39] applied pharmacist-led education. The results showed PWE can improve medication adherence, identify and manage drug-related problems, and see a reduction in seizures. A prospective and interventional study design was used to demonstrate that the number of patients with high levels of medication adherence increased dramatically as a result of pharmacist-led instruction. Seizures diminished during the course of 2 months. All patients reported feeling satisfied with their care.
Another study in Nigeria by Eshiet et al. [40] examined the effectiveness of a treatment program that a pharmacist implemented for epilepsy knowledge and perception improvement in patients. The study used a randomized controlled design, and it was discovered that there was a substantial difference between the control and intervention groups over time in terms of their knowledge and perception of epilepsy as a result of the intervention group's patients' significantly higher knowledge and perception of the condition.
In a study in Singapore by Chen et al. [41] determined whether an improved understanding of epilepsy and its treatment is connected to the education of carers provided by outpatient pharmacists. A cross-sectional pre- and post-intervention study revealed that average knowledge levels after counseling were significantly higher than pre-counseling scores.
The study in the Kingdom of Saudi Arabia by Alajmi et al. [42] evaluated the effectiveness of a pharmacist-led educational interview in terms of adult epilepsy patients' compliance with the use of antiepileptic medications. The results showed that the intervention group demonstrated improved compliance following the pharmacist-led educational interview.
Also, Chandrasekhar et al. [43] conducted a study in India to assess the medication adherence habits and knowledge of epilepsy patients prior to patient counseling. The effectiveness of patient counseling provided by a clinical pharmacist was also monitored and evaluated using this approach. The study used a prospective interventional experiment; it was found that after the intervention, patient comprehension and medication adherence had significantly improved overall.
A study in Jordon by Jarad et al. [44] examined the impact of clinical pharmacist-led education on AED (AED) adherence in young epilepsy patients; the efficacy and safety of AEDs, caregiver satisfaction with the information supplied to them regarding AEDs, and patients' QOL are examples of secondary outcomes. The study used an interventional randomized controlled study, which led to an increase in mean adherence in the intervention group but no discernible improvement in the control group. At the follow-up, there was no discernible difference between the groups in terms of effectiveness or safety, while the intervention group showed greater levels of QOL and information satisfaction.
A study in the UK by Fogg et al. [45] investigated whether a study on pharmacist-led epilepsy consultations (PLEC) was feasible and acceptable. This included determining the eligibility and consent rates for PLEC studies as well as the acceptability of prospective intervention outcome metrics and their expected effects. The results of the prospective interventional trial showed that more participants reported adhering behavior following the pharmacists' interventions.
In another study in the USA by Siodlak et al. [46], pharmacist-driven Medication Therapy Management was used to increase adherence, self-efficacy, and disease morbidity in PWE. The introduction of pharmacist-led epilepsy education via telephone consultations is implementable, especially if administrative scheduling tasks are transferred to support personnel according to the findings of prospective cohort studies.
All pharmacist intervention trials improve all areas of the review; pharmacist intervention leads to increased knowledge, adherence, and better QOL. To improve the lives of epileptic patients, more interventional research should be conducted as well as the previously indicated teaching strategies.
All these studies are summarized in Table 5.
Authors | Sites and year of study | Aims | Duration | Study design | Tools |
---|---|---|---|---|---|
Özdağ et al. [39] | Turkey (2023) | To increase medication adherence, identify and treat drug-related issues (DRIs), and reduce the frequency of seizures in epilepsy patients through pharmacist-led education. | 2 months | Prospective interventional study | Morisky-Green-Levine scale (MGLS) and (PSPSQ) |
Eshiet et al. [40] | Nigeria (2019) | To assess the success of a pharmacist-implemented educational treatment program in changing how epilepsy is perceived and understood by those who have it. | Not specified | randomized controlled study | Epilepsy knowledge scale and the brief illness perception questionnaire and MOSES |
Chen et al. [41] | Singapore (2013) | To ascertain whether the education of caregivers given by outpatient pharmacists is related to a better understanding of epilepsy and its management. | 9 months | Cross-sectional pre- to post-intervention study | Questionnaire |
Alajmi et al. [42] | Kingdom of Saudi Arabia (2017) | To assess the success of a pharmacist-led educational interview in promoting antiepileptic drug administration compliance among adult epilepsy patients. | 4 months | Randomized controlled study | Morisky medication adherence scale |
Chandrasekhar et al. [43] | India (2020) | To examine the medication adherence patterns and understanding of epilepsy patients prior to patient counseling, as well as to track and assess the outcomes of clinical pharmacist-mediated patient counseling. | 1 year | Prospective interventional study | Medication adherence scale (MMAS-4) |
Jarad et al. [44] | Jordon (2022) | To examine the impact of clinical pharmacist-led education on pediatric epilepsy patients' adherence to antiepileptic medications (AEDs). | 2 months | Randomized controlled study | Questionnaire |
Fogg et al. [45] | UK (2012) | To assess the acceptability and viability of a pharmacist-led epilepsy consultation (PLEC) study. This included determining the eligibility and consent rates for PLEC studies as well as the acceptability of prospective intervention outcome metrics and their expected effects. | 2 months | Prospective interventional study | Questionnaire |
Siodlak et al. [46] | USA (2020) | To assess the viability and effects of providing patients with epilepsy with a pharmacist-driven medication therapy management (MTM) service in order to increase adherence, self-efficacy, and disease morbidity. | 3 months | Prospective interventional study | (ESES), (ESMS), (QOLIE-10-P), (GAD-7), and (NDDI-E) |
4 CONCLUSION
Epilepsy is a disease associated with increased rates of bodily injuries and mortality when not optimally treated. It is important to increase patient education and knowledge about the disease and its treatment to increase adherence, satisfaction, and QOL and reduce the number and severity of seizures. Pharmacist-led educational interventions may play a crucial role in obtaining these results.
AUTHOR CONTRIBUTIONS
Zahraa Abbas Munaf: Research, collect studies, write, revise, and publish and Samer Imad Mohammed: Supervising and making adjustments to all sections.
ACKNOWLEDGMENTS
None.
CONFLICT OF INTEREST STATEMENT
Not present for all authors.
ETHICS STATEMENT
Not applicable.
INFORMED CONSENT
Not applicable.
Open Research
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no new data were created or analyzed in this study.