TY - JOUR
T1 - Medication prescribing and patient-reported outcome measures in people with epilepsy in Bhutan
AU - McKenzie, Erica D.
AU - Nirola, Damber K.
AU - Deki, Sonam
AU - Tshering, Lhab
AU - Patenaude, Bryan
AU - Clark, Sarah J.
AU - Cash, Sydney S.
AU - Thibert, Ronald
AU - Zepeda, Rodrigo
AU - Leung, Edward C.W.
AU - Lam, Alice D.
AU - Lim, Andrew S.P.
AU - Mantia, Jo
AU - Cohen, Joseph
AU - Cole, Andrew J.
AU - Mateen, Farrah J.
N1 - Funding Information:
Tali R. Sorets (Massachusetts General Hospital, Boston, USA), Chencho Dorji (formerly of the Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan), Sonam Wangda (Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan), Kate Brizzi (Massachusetts General Hospital, Boston, USA), Hannah McLane (University of Pennsylvania, Philadelphia, USA), Sarah Wahlster (University of Washington, Seattle, WA, USA), and Karma Ugyen (National Traditional Medicine Hospital, Thimphu, Bhutan) for assistance with data collection and Gretchen Birbeck (University of Rochester, Rochester, USA) for comments on earlier forms of the manuscript. This study was supported by Grand Challenges Canada and the Thrasher Research Fund .
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Objective: The aim of this study was to assess medication prescribing and patient-reported outcomes among people with epilepsy (PWE) in Bhutan and introduce criteria for evaluating unmet epilepsy care needs, particularly in resource-limited settings. Methods: People with epilepsy in Bhutan (National Referral Hospital, 2014-2015) completed a questionnaire, the Quality of Life in Epilepsy Inventory (QOLIE-31), and an electroencephalogram (EEG). Management gap was the proportion of participants meeting any of six prespecified criteria based on best practices and the National Institute for Health and Care Excellence (NICE) guidelines. Results: Among 253 participants (53% female, median: 24 years), 93% (n = 235) were treated with antiepileptic drugs (AEDs). Seventy-two percent (n = 183) had active epilepsy (≥. 1 seizure in the prior year). At least one criterion was met by 55% (n = 138) of participants, whereas the treatment gap encompassed only 5% (n = 13). The criteria were the following: 1. Among 18 participants taking no AED, 72% (n = 13) had active epilepsy. 2. Among 26 adults on subtherapeutic monotherapy, 46% (n = 12) had active epilepsy. 3. Among 48 participants reporting staring spells, 56% (n = 27) were treated with carbamazepine or phenytoin. 4. Among 101 female participants aged 14-40 years, 23% (n = 23) were treated with sodium valproate. 5. Among 67 participants reporting seizure-related injuries, 87% (n = 58) had active epilepsy. 6. Among 111 participants with a QOLIE-31 score below 50/100, 77% (n = 86) had active epilepsy. Years since first AED treatment (odds ratio: 1.07, 95% CI: 1.03, 1.12) and epileptiform discharges on EEG (odds ratio: 1.95, 95% CI: 1.15, 3.29) were significantly associated with more criteria met. Conclusions: By defining the management gap, subpopulations at greatest need for targeted interventions may be prioritized, including those already taking AEDs.
AB - Objective: The aim of this study was to assess medication prescribing and patient-reported outcomes among people with epilepsy (PWE) in Bhutan and introduce criteria for evaluating unmet epilepsy care needs, particularly in resource-limited settings. Methods: People with epilepsy in Bhutan (National Referral Hospital, 2014-2015) completed a questionnaire, the Quality of Life in Epilepsy Inventory (QOLIE-31), and an electroencephalogram (EEG). Management gap was the proportion of participants meeting any of six prespecified criteria based on best practices and the National Institute for Health and Care Excellence (NICE) guidelines. Results: Among 253 participants (53% female, median: 24 years), 93% (n = 235) were treated with antiepileptic drugs (AEDs). Seventy-two percent (n = 183) had active epilepsy (≥. 1 seizure in the prior year). At least one criterion was met by 55% (n = 138) of participants, whereas the treatment gap encompassed only 5% (n = 13). The criteria were the following: 1. Among 18 participants taking no AED, 72% (n = 13) had active epilepsy. 2. Among 26 adults on subtherapeutic monotherapy, 46% (n = 12) had active epilepsy. 3. Among 48 participants reporting staring spells, 56% (n = 27) were treated with carbamazepine or phenytoin. 4. Among 101 female participants aged 14-40 years, 23% (n = 23) were treated with sodium valproate. 5. Among 67 participants reporting seizure-related injuries, 87% (n = 58) had active epilepsy. 6. Among 111 participants with a QOLIE-31 score below 50/100, 77% (n = 86) had active epilepsy. Years since first AED treatment (odds ratio: 1.07, 95% CI: 1.03, 1.12) and epileptiform discharges on EEG (odds ratio: 1.95, 95% CI: 1.15, 3.29) were significantly associated with more criteria met. Conclusions: By defining the management gap, subpopulations at greatest need for targeted interventions may be prioritized, including those already taking AEDs.
KW - Antiepileptic drugs
KW - Electroencephalography
KW - Epilepsy
KW - Epilepsy management gap
KW - Global health
KW - Resource-limited settings
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U2 - 10.1016/j.yebeh.2016.03.035
DO - 10.1016/j.yebeh.2016.03.035
M3 - Article
C2 - 27131914
AN - SCOPUS:84964556087
SN - 1525-5050
VL - 59
SP - 122
EP - 127
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
ER -