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For many patients with epilepsy the condition does not greatly interfere
with their day-to-day life, but in others it is associated with significant
morbidity.
The National Institute for Clinical Excellence guideline on
epilepsy1 says that this may be related
to the effects of seizures, their underlying cause and/or treatment.
It comments too on the stigma that
is still attached to epilepsy.
“Epilepsy may sometimes result in
significant disability, social exclusion and stigmatisation,” says
NICE. “People with epilepsy commonly encounter problems in the
following areas: education, employment, driving, personal development,
psychiatric and psychological aspects and social and personal relationships.”
Epilepsy Action’s National
Epilepsy Week (18–24 May 2008)
is designed to increase awareness about epilepsy and to dispel myths
surrounding
the condition. The charity also runs an awareness campaign aimed at pharmacists
and GPs (see Panel 1).
Panel 1: Epilepsy Action’s “Epilepsy
Aware” campaign
Epilepsy Action is running an “Epilepsy Aware” campaign
to encourage pharmacies and GP practices to demonstrate that they
are aware of the needs of people with epilepsy.
Pharmacies (and
medical practices) that sign up to the campaign are supplied with
a window
sticker to show that they are “epilepsy-friendly” and
have committed to: • Provide their customers and patients with information about
epilepsy and their medication
• Discuss issues about antiepileptic medication with their customers,
including potential side effects, consistency of supply, and drug
interactions
• Provide their customers with contact details for Epilepsy Action’s
freephone Epilepsy Helpline (tel 0808 800 5050) and website (www.epilepsy.org.uk)
if they require further information
Further details on the campaign are available from
Gavin Barlow, Epilepsy Action Sapphire Nurse
co-ordinator (tel 0113 210 8800; e-mail gbarlow@epilepsy.org.uk). |
Drug therapy is the mainstay of epilepsy management. The aim is to
abolish seizures and keep side effects minimal so that an individual
can lead
as normal a life as possible.
Heidi Wright, head of practice at the Royal Pharmaceutical Society, says
that epilepsy tends not to be a high profile condition but that there
are many opportunities for pharmacists to help improve medicines management.
“As
with other long-term conditions, pharmacists can provide information
to improve patients’ and carers’ understanding of treatment,” she
says. “They can give self-care advice to help patients to manage
their
condition.”
Epilepsy is included in the Quality and Outcomes Framework (QOF) for
GPs, and pharmacists may have an opportunity to help GPs achieve their
targets. “During a medicines use review, pharmacists can find out
if a patient is having problems with their medicines, and this can feed
into the full medication review that is required for adults by the QOF,” says
Ms Wright.
For long-term conditions, there is increasing emphasis on empowering
patients to take control. As part of this, the NICE epilepsy guideline
comments that healthcare professionals should highlight the Expert
Patients programme to patients who want to manage
their condition more effectively.
Not taking antiepileptic drugs correctly can increase the risk of seizures,
with potentially dangerous consequences. A 2002 audit of epilepsy-related
deaths found documented problems with adherence to treatment in 14 per
cent of adults.2
Reducing the stigma associated with epilepsy is one
factor that can improve adherence to antiepileptic drug therapy, says
NICE (see Panel 2).
Panel 2: NICE advice on adherence
to therapy1
The NICE guideline says that adherence to treatment
can be optimised with the following: • Educating individuals and their families or carers in understanding
of their condition and the rationale of treatment
• Reducing the stigma associated with epilepsy
• Using simple medication regimens
• Fostering positive relationships between healthcare professionals,
individuals with epilepsy and their families or carers |
Some patients have problems remembering to take their tablets, especially
if they have drug- or epilepsy-related cognitive problems. They might
benefit from help in developing “cues” for remembering when
to take doses or from use of compliance aids.
Evelyn Frank, senior pharmacist at the National Hospital for Neurology
and Neurosurgery, London, says that patients may decide not to take their
antiepileptic drugs because of concern about side effects. Common concerns
relate to confusion and tiredness and to weight gain.
Ms Frank says: “It
is important to be honest about side effects and for pharmacists to inform
patients what sort of side effects to expect. They should always ask
patients how they are getting on — even if they have been on therapy
for a long time — and if they have problems.“ Adverse effects
might be avoided by adjustments to therapy.
Although most patients are well controlled on one drug, others have more
resistant epilepsy and may need multiple drug therapy. A balance then
has to be achieved between best quality of life and freedom from seizures,
says Ms Frank, pointing out that patients may accept a risk of occasional
seizures if this means reduced adverse effects.
Another point to be aware of is that earlier in 2008 the US Food and
Drug Administration warned that antiepileptic drugs are associated with
increased risk of suicidal thoughts and behaviour. It said that prescribers
should tell patients and carers about this so that unusual changes in
behaviour can be picked up.3 References
1. NICE. The epilepsies. Clinical guideline 20; 2004.
2. Hanna NJ, Black M, Sander JWS, Smithson WH, Appleton R, Brown S
et al. Epilepsy: Death in the shadows. National Sentinel Clinical
Audit
of Epilepsy-Related Death. London: Stationery Office; 2002.
3. US Food and Drug Administration. Information
for healthcare professionals: Suicidality and antiepileptic drugs
(accessed March 13, 2008) |
The
Pharmaceutical Journal