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Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital

BACKGROUND: Epilepsy is a common health problem which carries a huge medical social psychological and economic impact for a developing country. The aim of this hospital-based study was to get an insight into the effectiveness and tolerability of low cost antiepileptic drugs (AEDs) in Bangladeshi peo...

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Autores principales: Habib, Mansur, Khan, Sharif Uddin, Hoque, Md Azhahul, Mondal, Md Badrul Alam, Hasan, ATM Hasibul, Chowdhury, Rajib Nayan, Haque, Badrul, Rahman, Kazi Mohibur, Chowdhury, Ahmed Hossain, Ghose, Swapon Kumar, Mohammad, Quazi Deen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225505/
https://www.ncbi.nlm.nih.gov/pubmed/24245810
http://dx.doi.org/10.1186/1756-0500-6-473
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author Habib, Mansur
Khan, Sharif Uddin
Hoque, Md Azhahul
Mondal, Md Badrul Alam
Hasan, ATM Hasibul
Chowdhury, Rajib Nayan
Haque, Badrul
Rahman, Kazi Mohibur
Chowdhury, Ahmed Hossain
Ghose, Swapon Kumar
Mohammad, Quazi Deen
author_facet Habib, Mansur
Khan, Sharif Uddin
Hoque, Md Azhahul
Mondal, Md Badrul Alam
Hasan, ATM Hasibul
Chowdhury, Rajib Nayan
Haque, Badrul
Rahman, Kazi Mohibur
Chowdhury, Ahmed Hossain
Ghose, Swapon Kumar
Mohammad, Quazi Deen
author_sort Habib, Mansur
collection PubMed
description BACKGROUND: Epilepsy is a common health problem which carries a huge medical social psychological and economic impact for a developing country. The aim of this hospital-based study was to get an insight into the effectiveness and tolerability of low cost antiepileptic drugs (AEDs) in Bangladeshi people with epilepsy. METHODS: This retrospective chart review was done from hospital records in weekly Epilepsy outdoor clinic of Department of Neurology, Dhaka Medical College Hospital (DMCH) from October 1998 to February 2013. A total of 854 epilepsy patients met the eligibility criteria (had a complete record of two years of follow up data) from hospital database. A checklist was used to take demographics (age and gender), epilepsy treatment and adverse event related data. At least two years of follow up data were considered for analysis. RESULTS: Out of 854 patients selected, majority of the patients attending outdoor clinic were >11-30 years age group (55.2%) with a mean age of 20.3 ± 9 years and with a male (53%) predominance. Focal epilepsy were more common (53%), among whom secondary generalized epilepsy was the most frequent diagnosis (67%) followed by complex partial seizure (21%). Among those with Idiopathic Generalized Epilepsy (46%), generalized tonic clonic seizure was encountered in 74% and absence seizure was observed in 13%. The number of patients on monotherapy and dual AED therapy were 67% and 24% respectively and polytherapy (i.e. >3 AEDs) was used only in 9%. CBZ (67%) was the most frequently prescribed AED, followed by VPA (43%), PHB (17%), and PHT (8%). CBZ was prescribed in 37% patients as monotherapy followed by VPA in 21% and PHB in 8% patients. Newer generation drugs eg lemotrigine and topiramate were used only as add on therapy in combination with CBZ and VPA in only 2% patients. The treatment retention rates over the follow up period for the AEDs in monotherapy varied between 86 and 91% and were highest for CBZ, followed by VPA. Most of the combination regimens had a treatment retention rate of 100%. The effectiveness of AED in terms of reduction of seizure frequency was highest for PHT (100%) and PHB (98%) followed by CBZ (96%) and VPA (95%). PHB and PHT were the cheapest of all AEDs (42 I$ and 56 I$/ year respectively). The costs of VPA and CBZ were two times and LTG and TOP were six to eight times higher. Adverse drug reaction (ADR) were observed among 140 (24.5%) of those with monotherapy. PHT (64%) was the most common drug to cause ADR, CBZ was at the bottom of the list to cause adverse effect (11.6%). VPA and PHB caused weight gain commonly. Adjustment of drug dose or withdrawal due to ADRs was necessary in 39% with PHT and 26% with PHB. CONCLUSION: Though PHT and PHB are cheapest and efficacious among all, CBZ and VPA are less costly, effective and well tolerated drug for seizure control in context of Bangladesh.
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spelling pubmed-42255052014-11-11 Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital Habib, Mansur Khan, Sharif Uddin Hoque, Md Azhahul Mondal, Md Badrul Alam Hasan, ATM Hasibul Chowdhury, Rajib Nayan Haque, Badrul Rahman, Kazi Mohibur Chowdhury, Ahmed Hossain Ghose, Swapon Kumar Mohammad, Quazi Deen BMC Res Notes Research Article BACKGROUND: Epilepsy is a common health problem which carries a huge medical social psychological and economic impact for a developing country. The aim of this hospital-based study was to get an insight into the effectiveness and tolerability of low cost antiepileptic drugs (AEDs) in Bangladeshi people with epilepsy. METHODS: This retrospective chart review was done from hospital records in weekly Epilepsy outdoor clinic of Department of Neurology, Dhaka Medical College Hospital (DMCH) from October 1998 to February 2013. A total of 854 epilepsy patients met the eligibility criteria (had a complete record of two years of follow up data) from hospital database. A checklist was used to take demographics (age and gender), epilepsy treatment and adverse event related data. At least two years of follow up data were considered for analysis. RESULTS: Out of 854 patients selected, majority of the patients attending outdoor clinic were >11-30 years age group (55.2%) with a mean age of 20.3 ± 9 years and with a male (53%) predominance. Focal epilepsy were more common (53%), among whom secondary generalized epilepsy was the most frequent diagnosis (67%) followed by complex partial seizure (21%). Among those with Idiopathic Generalized Epilepsy (46%), generalized tonic clonic seizure was encountered in 74% and absence seizure was observed in 13%. The number of patients on monotherapy and dual AED therapy were 67% and 24% respectively and polytherapy (i.e. >3 AEDs) was used only in 9%. CBZ (67%) was the most frequently prescribed AED, followed by VPA (43%), PHB (17%), and PHT (8%). CBZ was prescribed in 37% patients as monotherapy followed by VPA in 21% and PHB in 8% patients. Newer generation drugs eg lemotrigine and topiramate were used only as add on therapy in combination with CBZ and VPA in only 2% patients. The treatment retention rates over the follow up period for the AEDs in monotherapy varied between 86 and 91% and were highest for CBZ, followed by VPA. Most of the combination regimens had a treatment retention rate of 100%. The effectiveness of AED in terms of reduction of seizure frequency was highest for PHT (100%) and PHB (98%) followed by CBZ (96%) and VPA (95%). PHB and PHT were the cheapest of all AEDs (42 I$ and 56 I$/ year respectively). The costs of VPA and CBZ were two times and LTG and TOP were six to eight times higher. Adverse drug reaction (ADR) were observed among 140 (24.5%) of those with monotherapy. PHT (64%) was the most common drug to cause ADR, CBZ was at the bottom of the list to cause adverse effect (11.6%). VPA and PHB caused weight gain commonly. Adjustment of drug dose or withdrawal due to ADRs was necessary in 39% with PHT and 26% with PHB. CONCLUSION: Though PHT and PHB are cheapest and efficacious among all, CBZ and VPA are less costly, effective and well tolerated drug for seizure control in context of Bangladesh. BioMed Central 2013-11-18 /pmc/articles/PMC4225505/ /pubmed/24245810 http://dx.doi.org/10.1186/1756-0500-6-473 Text en Copyright © 2013 Habib et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Habib, Mansur
Khan, Sharif Uddin
Hoque, Md Azhahul
Mondal, Md Badrul Alam
Hasan, ATM Hasibul
Chowdhury, Rajib Nayan
Haque, Badrul
Rahman, Kazi Mohibur
Chowdhury, Ahmed Hossain
Ghose, Swapon Kumar
Mohammad, Quazi Deen
Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital
title Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital
title_full Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital
title_fullStr Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital
title_full_unstemmed Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital
title_short Antiepileptic drug utilization in Bangladesh: experience from Dhaka Medical College Hospital
title_sort antiepileptic drug utilization in bangladesh: experience from dhaka medical college hospital
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225505/
https://www.ncbi.nlm.nih.gov/pubmed/24245810
http://dx.doi.org/10.1186/1756-0500-6-473
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