title: Medication prescribing and patient-reported outcome measures in people with epilepsy in Bhutan.
abstract: The aim of this study was to assess medication prescribing and patient-reported outcomes among people with epilepsy (PWE) in Bhutan and introduce criteria for evaluating unmet epilepsy care needs, particularly in resource-limited settings.
  
  
  
  People with epilepsy in Bhutan (National Referral Hospital, 2014-2015) completed a questionnaire, the Quality of Life in Epilepsy Inventory (QOLIE-31), and an electroencephalogram (EEG). Management gap was the proportion of participants meeting any of six prespecified criteria based on best practices and the National Institute for Health and Care Excellence (NICE) guidelines.
  
  
  
  Among 253 participants (53% female, median: 24years), 93% (n=235) were treated with antiepileptic drugs (AEDs). Seventy-two percent (n=183) had active epilepsy (≥1 seizure in the prior year). At least one criterion was met by 55% (n=138) of participants, whereas the treatment gap encompassed only 5% (n=13). The criteria were the following: 1. Among 18 participants taking no AED, 72% (n=13) had active epilepsy. 2. Among 26 adults on subtherapeutic monotherapy, 46% (n=12) had active epilepsy. 3. Among 48 participants reporting staring spells, 56% (n=27) were treated with carbamazepine or phenytoin. 4. Among 101 female participants aged 14-40years, 23% (n=23) were treated with sodium valproate. 5. Among 67 participants reporting seizure-related injuries, 87% (n=58) had active epilepsy. 6. Among 111 participants with a QOLIE-31 score below 50/100, 77% (n=86) had active epilepsy. Years since first AED treatment (odds ratio: 1.07, 95% CI: 1.03, 1.12) and epileptiform discharges on EEG (odds ratio: 1.95, 95% CI: 1.15, 3.29) were significantly associated with more criteria met.
  
  
  
  By defining the management gap, subpopulations at greatest need for targeted interventions may be prioritized, including those already taking AEDs.
authors.affiliation: Massachusetts General Hospital, Boston, USA.
authors.forename: Erica D
authors.initials: ED
authors.lastname: McKenzie
authors.affiliation: Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
authors.forename: Damber K
authors.initials: DK
authors.lastname: Nirola
authors.affiliation: Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
authors.forename: Sonam
authors.initials: S
authors.lastname: Deki
authors.affiliation: Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
authors.forename: Lhab
authors.initials: L
authors.lastname: Tshering
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Patenaude
authors.affiliation: Massachusetts General Hospital, Boston, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
authors.affiliation: Massachusetts General Hospital, Boston, USA.
authors.forename: Sydney S
authors.initials: SS
authors.lastname: Cash
authors.affiliation: Massachusetts General Hospital, Boston, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Thibert
authors.affiliation: Massachusetts General Hospital, Boston, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Zepeda
authors.affiliation: Health Sciences Centre, Winnipeg, Canada.
authors.forename: Edward C W
authors.initials: EC
authors.lastname: Leung
authors.affiliation: Massachusetts General Hospital, Boston, USA.
authors.forename: Alice D
authors.initials: AD
authors.lastname: Lam
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Andrew S P
authors.initials: AS
authors.lastname: Lim
authors.affiliation: Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Jo
authors.initials: J
authors.lastname: Mantia
authors.affiliation: Massachusetts General Hospital, Boston, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Massachusetts General Hospital, Boston, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cole
authors.affiliation: Massachusetts General Hospital, Boston, USA. Electronic address: fmateen@mgh.harvard.edu.
authors.forename: Farrah J
authors.initials: FJ
authors.lastname: Mateen
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D001631:Bhutan / Q000453:epidemiology; D002220:Carbamazepine / Q000627:therapeutic use; D011307:Drug Prescriptions; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D010672:Phenytoin / Q000627:therapeutic use; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D002220:Carbamazepine; D014635:Valproic Acid; D010672:Phenytoin
keywords: Antiepileptic drugs; Electroencephalography; Epilepsy; Epilepsy management gap; Global health; Resource-limited settings