TREATMENT OUTCOME AND ASSOCIATED FACTORS AMONG EPILEPTIC PATIENTS TAKING ANTI-EPILEPTIC DRUGS AT UNIVERSITY OF GONDAR REFERRAL HOSPITAL, NORTH-WEST ETHIOPIA

Abstract

Abstract Background: Epilepsy is ubiquitous; it affects people of any age, gender, ethnicity, and social background. Its epidemiologic dimension is staggering; it is the most common chronic and serious neurologic disease. The prevalence of epilepsy in Ethiopia was reported as 5.2 per 1000 population. The incidence was 64 per 100, 000 populations. Patients with epilepsy are at increased risk of poor Quality of Life. Growing recognition of the importance of the psychosocial effects of epilepsy it has led to the need to quantify quality of life in affected individuals. The ideal goal of treatment for epilepsy is the complete elimination of seizures and no adverse drug effects related to an anti-epileptic drug with an optimal quality of life. Objective: The aim of this study was to assess treatment outcomes and associated factors among epileptic patients taking anti-epileptic drugs on follow up at University of Gondar referral Hospital. Methods: Institutional based cross-sectional study was conducted on 356 epileptic patients who were selected by systematic random sampling from epileptic patients on follow up at University of Gondar referral Hospital from January 15 to April 15, 2017. Information on socio-demographic profile and detailed history regarding seizure disorder were taken from both the patient and medical record. Quality of life in epilepsy -10 was used to measure the quality of life and Morisky medication adherence scale was used to measure adherence. Descriptive statistics were used for demographic details and inferential statistical tests like the independent t-test, analysis of variance were used to look factors associated with quality of life and frequency of seizure. Logistic regression was used to identify factors associated with adverse drug effect of anti-epileptic drugs. The level of statistical significance was declared at P- Value ? 0.05 levels. Result: A total of 354 patients were included in the analysis and mean age was 29.1years. The mean quality of life was 75.36; One hundred ninety-four (54.8%) of participants had good quality of life. During the last one year, 129(36.4%) of participants had controlled seizure. The average seizure frequency per year was 2.26(±3.96SD). Fifty-three (15%) of the study participants reported that they experienced adverse effects related to anti-epileptic drug therapy for the last three months. Being illiterate, unemployment, household income less than 500birr per month, free gaining of AEDs, adverse drug effect of AEDs, poly AED therapy, and presence of comorbid medical condition were associated with lower quality of life; while no seizure and one or two seizure for last follow up; no seizure and one up to five seizure for the last year were associat with higher quality of life than their counter parts. Unemployment, widowed marital status, adverse drug effect of AEDs, poly AED therapy, >10-year duration of epilepsy and patients perception of deteriorated epilepsy status were associated with poor seizure controlled status. The adverse drug effects of AEDs were significantly associated with illiterate educational status (AOR=4.9, 95%CI: 1.372, 17.507), monotherapy (AOR=0.375 95%CI: 0.171, 0.824), no seizure during last follow up (AOR=6.932, 95%CI: 1.152, 41.700), no seizure for at least a year (AOR=13.560 95%CI: 1.226, 150.02410), and 1-5 seizure for the last year (AOR=10.929, 95%CI: 1.061, 112.598) . Conclusion: Even though the mean quality of life of epilepsy patients of UoGRH was good, a high number of patients were below mean level. Almost two third patients had an uncontrolled seizure. Adverse anti-epileptic drug effects reported by patients were low in UoGRH. Our study assessed multiple factors that affect treatment outcomes of an epileptic patient. The findings collectively indicate that knowledge of these contributing factors can assist health-care providers when evaluating patients with epilepsy to help target interventions for improving treatment outcome. Keywords: Treatment outcome, UoGRH, Epilepsy, quality of lif