title: Anti-epileptic drug changes and quality of life in the community.
abstract: OBJECTIVE
  Changes in anti-epileptic drug (AED) regimens may indicate unsatisfactory treatment results such as insufficient seizure control or adverse effects. This inference underlies epilepsy management and research, yet current studies often do not account for AED changes. We assessed AED change patterns and their association with quality of life (QoL), as main outcome measure, in a community-based setting.
  
  
  METHODS
  We assessed a cohort of 248 people with epilepsy identified from community pharmacy records from whom we retrieved AED dispensing history. We assessed all changes in AED use during the 2 years prior to the index date and current QoL using the validated Dutch QOLIE-31 questionnaire.
  
  
  RESULTS
  Thirty-one per cent had at least one AED change during the study period, either in drug type or dose. People who changed showed significantly lower QoL (QOLIE score 73 vs 79), especially those who intensified their treatment. Each additional change was associated with a further reduction of 4.9 points in QoL score.
  
  
  CONCLUSIONS
  AED changes are common practice, even in people with long-standing epilepsy. Frequent changes, as objective measure of epilepsy severity, are associated with a progressively lower QoL. Changes, even in dose, should be monitored in daily clinical practice and used as a red flag that may require adjustments in epilepsy management. This may include earlier referral to a specialized centre for a more thorough evaluation or counselling. AED changes can also be used as an outcome marker in epilepsy research as a proxy of QoL for better translation of drug-efficacy results to general practice.
authors.affiliation: Stichting Epilepsie Instellingen Nederland (SEIN) Heemstede, Heemstede, Netherlands.|Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Wassenaar
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: F S S
authors.initials: FS
authors.lastname: Leijten
authors.affiliation: Stichting Epilepsie Instellingen Nederland (SEIN) Heemstede, Heemstede, Netherlands.|Biomedical Research Centre, UCL Institute of Neurology, NIHR University College London Hospitals, London, UK.|Epilepsy Society, Chalfont St Peter, UK.
authors.forename: J W
authors.initials: JW
authors.lastname: Sander
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: S G
authors.initials: SG
authors.lastname: Uijl
authors.affiliation: Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.|Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: A C G
authors.initials: AC
authors.lastname: Egberts
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012111:Residence Characteristics
chemical_list: D000927:Anticonvulsants
keywords: anti-epileptic drug; epilepsy; management; quality of life; treatment