INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Beirut, Lebanon.
INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France.
Epilepsy Behav. 2019 Sep;98(Pt A):80-87. doi: 10.1016/j.yebeh.2019.06.028. Epub 2019 Jul 10.
Epilepsy is a common worldwide neurological disorder. For people with epilepsy (PWE), adherence and attitudes towards medication is a crucial step to improve efficacy of prescribed treatment and to prevent seizures.
The first aim of this study was to evaluate attitudes towards antiepileptic medications in Lebanese population. Secondary aims were to assess factors affecting attitudes and associated with epilepsy control.
A cross-sectional study was conducted in outpatient neurology clinics located in Beirut-Lebanon. Data were collected using a structured questionnaire. Self-report of medication taking behaviors were assessed using the abbreviated (4 items) Morisky Medication Adherence Scale (MMAS-4). Epilepsy was considered as controlled if the patient had no seizures in the last 6 months.
Among 250 PWE recruited in this study, male-to-female ratio was 0.87 (116/134), and 50.8% were married. Mean duration of epilepsy was 13.7 ± 12.8 years. Valproate was the most common antiepileptic drug (AED) used followed by levetiracetam and carbamazepine. About 60.8% of the population presented partial epilepsy. Uncontrolled epilepsy was present in more than half of participants (55.2%), with only 32.4% had positive attitudes to their medication. Positive attitudes towards antiepileptic increased in people who found that their treatment was efficacious (odds ratio (OR) = 4.9; 95% confidence interval (CI): 1.2-20.0; p = 0.03), who had controlled epilepsy (OR = 3.4; 95%CI 1.6-7.1; p = 0.001), and who were diagnosed as PWE between the age of 12-20 years (OR = 3.1; 95%CI 1.1-8.4; p = 0.03). Oppositely, these attitudes decreased in participants who felt their treatment as an economic burden (OR = 0.2; 95%CI 0.1-0.4; p ≪ 0.001), and in people with depression (OR = 0.4; 95%CI 0.2-0.9; p = 0.04). Controlled epilepsy was higher in people who contacted a neurologist if seizure occurred, in people with positive attitudes, and after a long duration of disease, but it decreased if patient did not follow neurologist's instructions in fasting period.
Lebanese PWE were less likely to have positive attitudes towards medication, which may lead to poor epilepsy control. Depression and economic burden were the major factors that decreased these attitudes. Identifying factors affecting attitudes to medication and leading to controlled epilepsy may help clinicians to elaborate educational programs to optimize medication adherence.
癫痫是一种常见的全球性神经系统疾病。对于癫痫患者 (PWE) 来说，坚持和对药物的态度是提高规定治疗效果和预防癫痫发作的关键步骤。
本研究的首要目的是评估黎巴嫩人群对抗癫痫药物的态度。次要目的是评估影响态度和与癫痫控制相关的因素。
这是一项在贝鲁特-黎巴嫩的门诊神经科诊所进行的横断面研究。使用结构化问卷收集数据。使用简化的（4 项）Morisky 药物依从性量表 (MMAS-4) 评估药物服用行为的自我报告。如果患者在过去 6 个月内没有癫痫发作，则认为癫痫得到控制。
在这项研究中招募的 250 名 PWE 中，男女性别比为 0.87（116/134），50.8%已婚。癫痫的平均病程为 13.7±12.8 年。最常用的抗癫痫药物 (AED) 是丙戊酸钠，其次是左乙拉西坦和卡马西平。约 60.8%的人群患有部分性癫痫。超过一半的参与者（55.2%）癫痫未得到控制，只有 32.4%的人对其药物治疗持积极态度。在那些认为治疗有效的人（优势比 (OR) = 4.9；95%置信区间 (CI)：1.2-20.0；p = 0.03）、癫痫得到控制的人（OR = 3.4；95%CI 1.6-7.1；p = 0.001）和 12-20 岁之间被诊断为 PWE 的人（OR = 3.1；95%CI 1.1-8.4；p = 0.03）中，对癫痫药物的积极态度会增加。相反，在那些认为治疗带来经济负担的参与者（OR = 0.2；95%CI 0.1-0.4；p ≪ 0.001）和有抑郁的参与者（OR = 0.4；95%CI 0.2-0.9；p = 0.04）中，这种态度会降低。如果癫痫发作时联系了神经科医生、如果患者持积极态度、疾病持续时间较长，那么癫痫控制会更好，但如果患者不遵守神经科医生禁食期的医嘱，癫痫控制则会下降。
黎巴嫩 PWE 对药物治疗的态度不太可能积极，这可能导致癫痫控制不佳。抑郁和经济负担是降低这些态度的主要因素。确定影响药物治疗态度和导致癫痫控制的因素可能有助于临床医生制定教育计划，以优化药物依从性。
