Mastura AHMAD
(Hospital Tengku Ampuan Afzan, Department of Pharmacy, Pahang, Malaysia)
(Universiti Sultan Zainal Abidin School of Pharmacy, Terengganu, Malaysia)
(Jalan Hospital, Hospital Sungai Buloh, Department of Medical, Selangor, Malaysia)
Yıl: 2020Cilt: 52Sayı: 1ISSN: 1308-8734 / 1308-8742Sayfa Aralığı: 41 - 46İngilizce

13 0
Factors Associated with Good Seizure Control in Patients on Valproic Acid
Objective: This study aims to generate a reference range for valproic acid (VPA) in this cohort and determine the factors associated with good seizure control in patients taking this drug. Materials and Methods: We conducted a prospective, cohort, observational study among patients with epilepsy who received VPA treatment at Hospital Kuala Lumpur. The patients were considered to have good control if they had a 50% or higher seizure reduction in the one-year study period compared with the previous year. The VPA reference range was generated from those patients who had good control and whose drug concentration values were available. Multiple logistic regression analysis with a backward likelihood ratio method was applied to assess the predicting factors for good seizure control. Results: A total of 242 patients were recruited and followed up for one year. The VPA reference range was determined to be 40-85 mg/L. After multivariate analysis, significant predictive variables for good control were monotherapy [adjusted OR 4.74, 95% CI: 2.258, 9.947, p<0.001], non-smoking [adjusted OR 3.23, 95% CI: 1.099, 9.473, p=0.033], normal brain imaging results [adjusted OR 5.83, 95% CI: 2.507, 13.552, p<0.001], and the absence of stress [adjusted OR 19.98, 95% CI: 9.255, 42.764, p<0.001]. Conclusion: Monotherapy, non-smoking, normal brain imaging results, and the absence of stress are predictive of good seizure control in patients on VPA. However, a serum concentration of VPA in the reference range failed to predict good seizure control.
DergiAraştırma MakalesiErişime Açık
  • 1. Schoenenberger RA, Tanasijevic MJ, Jha A, Bates DW. Appropriateness of Antiepileptic Drug Level Monitoring. JAMA 1995; 274: 1622-6. [CrossRef]
  • 2. Thapar A, Richens A, Roland M, et al. Are serum anticonvulsant levels in people with epilepsy appropriately monitored? J Eval Clin Pract 2001; 7: 335-8. [CrossRef]
  • 3. Wing DS, Duff HJ. The impact of therapeutic drug monitoring program for phenytoin. Ther Drug Monit 1989; 11: 32-7. [CrossRef]
  • 4. Bates DW, Soldin SJ, Rainey PM, Micelli JN. Strategies for physician education in therapeutic drug monitoring. Clin Chem 1998; 44: 401-7. [CrossRef]
  • 5. Warner A. Setting Standards of Practice in Therapeutic Drug Monitoring and Clinical Toxicology: A North American View. Ther Drug Monit 2000; 22: 93-7. [CrossRef]
  • 6. Tomson T, Dahl ML, Kimland E. Therapeutic monitoring of antiepileptic drugs for epilepsy. Cochrane Database Syst Rev 2007; CD002216.[CrossRef]
  • 7. Patsalos PN, Berry DJ, Bourgeois BD, et al. Antiepileptic drugs--best practice guidelines for therapeutic drug monitoring: a position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia 2008; 49: 1239-76. [CrossRef]
  • 8. National Institute for Health and Care Excellence. Epilepsies: Diagnosis and Management. Clinical Guideline; 2012.
  • 9. Minshall I, Berry D, Smith D. The impact of an educational intervention, the New GP Contract and NICE guidelines on anti-epilepsy therapeutic drug monitoring. Seizure 2011; 20: 126-30. [CrossRef]
  • 10. Ab Rahman AF, Ahmed Abdelrahim HE, Mohamed Ibrahim MI. A survey of therapeutic drug monitoring services in Malaysia. Saudi Pharm J 2013; 21: 19-24. [CrossRef]
  • 11. Epilepsy Council. Consensus Guidelines on the Management of Epilepsy. Malaysian Society of Neurosciences, Kuala Lumpur 2010.
  • 12. Okuma T, Kumashiro H. Natural history and prognosis of epilepsy: report of a multi-institutional study in Japan. The group for the study of prognosis of epilepsy in Japan. Epiepsia 1981; 22: 35-53. [CrossRef]
  • 13. Eadie MJ. Plasma antiepileptic drug monitoring in a neurological practice: a 25-year experience. Ther Drug Monit 1994; 16: 458-68. [CrossRef]
  • 14. Naing L, Than W, Rusli B. Practical issues in calculating the sample size for prevalence studies. Arch Orofacial Sci 2006; 1: 9-14.
  • 15. Bachok N. Multivariate Analyses Regressions, School of Medical Sciences, Malaysia, 2011.
  • 16. Karlovassitou-Koniari A, Alexiou D, Angelopoulos P, et al. Low dose sodium valproate in the treatment of juvenile myoclonic epilepsy. J Neurol 2002; 249: 396-9. [CrossRef]
  • 17. Holland KD, Monahan S, Morita D, Vartzelis G, Glauser TA. Valproate in children with newly diagnosed idiopathic generalized epilepsy. Acta Neurol Scand 2010; 121: 149-53. [CrossRef]
  • 18. Miro J, Aiguabella M, Veciana M, et al. Low-dose sodium valproate in the treatment of idiopathic generalized epilepsies. Acta Neuro Scand 2014; 129: e20-3. [CrossRef]
  • 19. Hernandez-Vanegas LE, Jara-Prado A, Ochoa A, Rodriguez NR, Duron RM, Crail-Melendez D. Highdose versus low-dose valproate for the treatment of juvenile myoclonic epilepsy: Going from low to high. Epilepsy Behav 2016; 61: 34-40. [CrossRef]
  • 20. Jannuzzi G, Cian P, Fattore C, et al. A multicenter randomized controlled trial on the clinical impact of therapeutic drug monitoring in patients with newly diagnosed epilepsy. The Italian TDM Study Group in Epilepsy. Epilepsia 2000; 41: 222-30. [CrossRef]
  • 21. Arts WF, Brouwer OF, Peters AC, et al. Course and prognosis of childhood epilepsy: 5-year follow-up of the Dutch study of epilepsy in childhood. Brain 2004; 127: 1774-84. [CrossRef]
  • 22. Kharkar S, Pillai J, Rochestie D, Haneef Z. Sociodemographic influences on epilepsy outcomes in an inner-city population. Seizure 2014; 23: 290-4. [CrossRef]
  • 23. Poudel P, Chitlangia M, Pokharel R. Predictors of Poor Seizure Control in Children Managed at a Tertiary Care Hospital of Eastern Nepal. Iran J Child Neurol 2016; 10: 48-56.
  • 24. Cassano PA, Koepsell TD, Farwell JR. Risk of febrile seizures in childhood in relation to prenatal maternal cigarette smoking and alcohol intake. Am J Epidemiol 1990; 132: 462-73. [CrossRef]
  • 25. Sidenvall R, Heijbel J, Blomquist HK, Nyström L, Forsgren L. An incident case-control study of first unprovoked afebrile seizures in children: a population-based study of pre- and perinatal risk factors. Epilepsia 2001; 42: 1261-5. [CrossRef]
  • 26. Dworetzky BA, Bromfield EB, Townsend MK, Kang JH. A prospective study of smoking, caffeine, and alcohol as risk factors for seizures or epilepsy in young adult women: data from the Nurses' Health Study II. Epilepsia 2010; 51: 198- 205. [CrossRef]
  • 27. Czuczwar M, Kiś J, Czuczwar P, Wielosz M, Turski W. Nicotine diminishes anticonvulsant activity of antiepileptic drugs in mice. Pol J Pharmacol 2003; 55: 799-802.
  • 28. Krumholz A, Shinnar S, French J, Gronseth G, Wiebe S. Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2015; 85: 1526-7. [CrossRef]
  • 29. Tripathi M, Padhy UP, Vibha D, et al. Predictors of refractory epilepsy in north India: a case-control study. Seizure 2011; 20: 779-83. [CrossRef]
  • 30. Seker Yilmaz B, Okuyaz C, Komur M. Predictors of intractable childhood epilepsy. Pediatr Neurol 2013; 48: 52-5. [CrossRef]
  • 31. Saygi S, Erol İ, Alehan F. Early clinical predictors of intractable epilepsy in childhood. Turk J Med Sci 2014; 44: 490-5. [CrossRef]
  • 32. Frucht MM, Quigg M, Schwaner C, Fountain NB. Distribution of seizure precipitants among epilepsy syndromes. Epilepsia 2000; 41: 1534-9 [CrossRef]
  • 33. Nakken KO, Solaas MH, Kjeldsen MJ, Friis ML, Pellock JM, Corey LA. Which seizure-precipitating factors do patients with epilepsy most frequently report? Epilepsy Behav 2005; 6: 85-9. [CrossRef]
  • 34. Sperling MR, Schilling CA, Glosser D, Tracy JI, Asadi-Pooya AA. Self-perception of seizure precipitants and their relation to anxiety level, depression, and health locus of control in epilepsy. Seizure 2008; 17: 302-7. [CrossRef]
  • 35. Thapar A, Kerr M, Harold G. Stress, anxiety, depression, and epilepsy: investigating the relationship between psychological factors and seizures. Epilepsy Behav 2009; 14: 134-40. [CrossRef]
  • 36. van Campen JS, Jansen FE, Steinbusch LC, Joëls M, Braun KP. Stress sensitivity of childhood epilepsy is related to experienced negative life events. Epilepsia 2012; 53: 1554-62. [CrossRef]
  • 37. Moshe S, Shilo M, Chodick G, et al. Occurrence of seizures in association with work-related stress in young male army recruits. Epilepsia 2008; 49: 1451-6. [CrossRef]

TÜBİTAK ULAKBİM Ulusal Akademik Ağ ve Bilgi Merkezi Cahit Arf Bilgi Merkezi © 2019 Tüm Hakları Saklıdır.