Examining the Relationship Between Missed-Dose Antiseizure Medications as a Seizure Precipitant and Adherence Among Veterans with Focal Onset Epilepsy
Abstract number :
1.307
Submission category :
7. Anti-seizure Medications / 7E. Other
Year :
2021
Submission ID :
1826660
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:55 AM
Authors :
Sriprasad Vikram, Pre-Med/BSc Biomedical Sciences student - VA Greater Los Angeles Healthcare System; Alexander Crossley, MPH - Research Assistant, Research, VA Greater Los Angeles Healthcare System; Riley Johnson, PharmD - PGY2 Neurology Specialty Pharmacy Resident, Pharmacy, VA Greater Los Angeles Healthcare System; Jennifer Nguyen, PharmD - PGY2 Neurology Specialty Pharmacy Resident, Pharmacy, VA Greater Los Angeles Healthcare System; Neha Gautam, BS - Research Assistant, Research, VA Greater Los Angeles Healthcare System; Brian Toh - Research Assistant, Research, VA Greater Los Angeles Healthcare System and UCLA; Hyojin Suh, PharmD - Clinical Pharmacy Specialist in Neurology and Neurosurgery, Pharmacy, VA Greater Los Angeles Healthcare System; Sunita Dergalust, PharmD - Clinical Pharmacy Specialist in Neurology, Pharmacy, VA Greater Los Angeles Healthcare System
Rationale: Adherence to anti-seizure medications (ASMs) leads to improved seizure control and a lower mortality rate for two-thirds of people with epilepsy (PWE). However, of those who are not intractable, 20%-40% do not adhere to ASM therapy leading to a potentially higher risk of status epilepticus, breakthrough seizures, other complications, and a higher financial burden to the healthcare system. For patients with drug-resistant epilepsy (DRE), consequences of non-adherence to ASM therapy may be more critical. It is well known that missing doses of ASMs is a major precipitant for seizures. We explored the relationship between DRE status, adherence to ASMs, and missed doses of ASMs as a precipitant for seizures.
Methods: We conducted a retrospective chart review of all veterans seen in Seizure Clinic at the Veterans Affairs West Los Angeles Healthcare Center from 7/1/2008 to 6/30/2017. DRE status was determined based on ILAE criteria. Seizure precipitants were recorded for missed medication, sleep, illness, stress, substance use, among others. Quartiles of medication possession ratios (MPRs) were categorized from VA pharmacy refill history. Adherence to ASMs was defined as MPR >75%. Additional data points collected included baseline characteristics, duration of epilepsy, and duration of intractability. Patients with psychogenic non-epileptic seizures, generalized onset epilepsy, or those with missing refill history were excluded from the analysis. Descriptive statistics and baseline characteristics of the sample were calculated. We ran bivariate analyses (nonparametric t-test, chi2, fisher exact) to test whether there was a relationship between person-level missed medication precipitant rates and patient-level factors described above.
Results: Of 500 veterans enrolled in our Seizure Clinic, we have reviewed 257 patient charts of which 176 (68%) met inclusion criteria. Sixty-six (38%) had a diagnosis of DRE with a mean duration of intractability of 10 years. The mean duration of epilepsy was 21 years. The missed medication precipitant rate was 59% for DRE patient’s vs 41% for non-DRE patients (p=0.02). However, when controlling for DRE status, we did not observe a difference in the relationship between missed medication as a seizure precipitant and adherence.
Conclusions: In our study, missed medication as a precipitant was not associated with improved adherence. However, those in the DRE group were more likely to have missed medication as a seizure precipitant than those in the non-DRE group.
Funding: Please list any funding that was received in support of this abstract.: None.
Anti-seizure Medications