Adjustment of treatment increases quality of life in patients with epilepsy: a randomized controlled pragmatic trial.
OBJECTIVE
Complaints about side-effects of antiepileptic drugs (AEDs) may be overlooked in clinical practice. We assessed the value and risks of an active intervention policy for reported complaints in a randomized controlled pragmatic trial.


METHODS
This randomized controlled pragmatic trial included 111 adults treated for epilepsy in seven general hospitals. They were considered well-managed by their treating physician, but reported moderate to severe complaints on a questionnaire (SIDAED, assessing SIDe effects in AED treatment). The intervention was adjustment of AED treatment (53 patients), either reduction of dose or switch of AED, versus continuation of treatment unchanged (58 control patients) during 7 months. Primary outcomes were quality of life (Qolie-10) and complaints score. Secondary outcome measures were the occurrence of seizures or adverse events.


RESULTS
After 7 months, the relative risk (RR) for improvement in quality of life was 1.80 (1.04-3.12) for the intervention group compared to control and the RR of decrease in complaints was 1.34 (0.88-2.05). In 58% of patients randomized to adjustment, the medication had indeed been changed.


CONCLUSIONS
In conclusion, despite a possible risk of seizure recurrence, adjustment of drug treatment in well-managed patients with epilepsy, who report considerable complaints, improves the quality of life.
Uijl
S G
SG
University Medical Center Utrecht, the Netherlands. s.g.uijl@umcutrecht.nl
Uiterwaal
C S P M
CS
Aldenkamp
A P
AP
Carpay
J A
JA
Doelman
J C
JC
Keizer
K
K
Vecht
C J
CJ
de Krom
M C T F M
MC
van Donselaar
C A
CA
D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects*; D004334:Drug Administration Schedule; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012640:Seizures / Q000188:drug therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000927:Anticonvulsants