Anti-epileptic drug utilization pattern and control of seizure among patients with epilepsy at two tertiary hospitals in Addis Ababa, Ethiopia: A Hospitalbased cross-sectional study

Abstract

Background: Anti-epileptic drugs (AEDs) are the primary therapeutic modes for
patients with epilepsy and have been demonstrated to control seizures, which decreases
morbidity and mortality associated with epilepsy. There is a paucity of data on treatment
outcomes among epileptic patients in resource-poor settings. The study aimed to
evaluate the AED utilization pattern and control of seizures among patients with epilepsy
on follow-up at St. Paul’s Hospital Millennium Medical College and Amanuel Specialized
Mental Hospital.
Methods: A hospital-based cross-sectional study involving direct patient interviews and
medical record reviews were conducted to collect the data. Adherence of AED was
measured using a Morisky Medication Adherence Scale-8 (MMAS-8), where patients
with MMAS-8 scores of ≥6 were considered to be adherent. Factors affecting seizure
control were determined using logistic regression analysis.
Results: From a total of 454 patients, 58.6% were men. The commonest type of seizure
was generalized tonic-clonic seizure observed in 93.3% of patients. Monotherapy was
prescribed in 83.7% of patients for the management of seizures, among which
phenobarbitone was utilized in 51.3% of patients as a single anticonvulsant drug.
Majority (61%) of patients with epilepsy had poor seizure control. About 65% of patients
were adherent to their treatment and 39 % of the patients were seizure-free for at least
one year. Only 177 (39.0%) patients had good control of seizures with no attack in the
previous six months. Duration of AED therapy ≤5 years non-adherence were found to
be independently associated with poor seizure control.
Conclusion: Based on our findings, the majority of patients with epilepsy were on
monotherapy and had poor seizure control. Phenobarbitone and phenytoin were the
frequently utilized AEDs. Duration of therapy less than 5 years and poor adherence were
independently associated with an uncontrolled seizure. The findings collectively indicate
that health care providers should focus on recently diagnosed patients and adherence
to AEDs to control seizures.