Ingrid Anne Lie1, Ingvild Hoggen2, Christian Samsonsen3, Eylert Brodtkorb4. 1. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: ingridanne.lie@gmail.com. 2. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: ingvildhoggen@gmail.com. 3. Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway. Electronic address: christian.samsonsen@stolav.no. 4. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway. Electronic address: eylert.brodtkorb@ntnu.no.
Abstract
PURPOSE: To investigate the role of non-adherence to antiepileptic drug treatment as a trigger for status epilepticus (SE). METHODS: 124 consecutive admissions for SE in patients with established epilepsy were studied. Those who had had therapeutic drug monitoring at admission were identified. Non-adherence was defined as a serum concentration/dose ratio at admission of <75% of the patient's own trough control value. RESULTS: In 64 cases serum concentration/dose ratios at admission were available for comparison with morning trough values. Treatment non-adherence was identified in a total of 24 (38%), 50% in children, 32% in patients 16-59 years and in 44% above 60. Missed medication had been reported in only two of these patients. No cases with confirmed non-adherence had a fatal outcome (p=0.05). No significant differences between non-adherent and adherent admissions concerning demographic factors or epilepsy and SE characteristics were found. CONCLUSION: Antiepileptic drug non-adherence is a common cause of SE across all ages, but is not always identified due to the first history-based information often being elusive. Prompt and reliable recognition of non-adherence is imperative for correct management. This is the first study to demonstrate the extent of non-adherence by therapeutic drug monitoring in SE.
PURPOSE: To investigate the role of non-adherence to antiepileptic drug treatment as a trigger for status epilepticus (SE). METHODS: 124 consecutive admissions for SE in patients with established epilepsy were studied. Those who had had therapeutic drug monitoring at admission were identified. Non-adherence was defined as a serum concentration/dose ratio at admission of <75% of the patient's own trough control value. RESULTS: In 64 cases serum concentration/dose ratios at admission were available for comparison with morning trough values. Treatment non-adherence was identified in a total of 24 (38%), 50% in children, 32% in patients 16-59 years and in 44% above 60. Missed medication had been reported in only two of these patients. No cases with confirmed non-adherence had a fatal outcome (p=0.05). No significant differences between non-adherent and adherent admissions concerning demographic factors or epilepsy and SE characteristics were found. CONCLUSION: Antiepileptic drug non-adherence is a common cause of SE across all ages, but is not always identified due to the first history-based information often being elusive. Prompt and reliable recognition of non-adherence is imperative for correct management. This is the first study to demonstrate the extent of non-adherence by therapeutic drug monitoring in SE.
Authors: Lidia Mvr Moura; Eli L Schwamm; Valdery Moura Junior; Michael P Seitz; Daniel B Hoch; John Hsu; Lee H Schwamm Journal: Clinicoecon Outcomes Res Date: 2016-11-17
Authors: Rafael Wabl; Samuel W Terman; Maria Kwok; Jordan Elm; James Chamberlain; Robert Silbergleit; Chloe E Hill Journal: Neurology Date: 2021-06-29 Impact factor: 11.800