4.0 DISCUSSION
We reported a significant association between medication adherence, duration of epilepsy, duration of AED use, Epileptiform pattern with mean LAEP score. Furthermore, the mean LAEP from this study was higher compared to values previous studies. The mean age of our participant is 39.19±8.80, with higher values in male compared to female participants. The female preponderance among participants was like findings from previous studies among PWE. Furthermore, the mean (SD) between ages 13-20, 21-35, 36-50, >50 respectively is 175(18.6), 298(31.7), 201±21.4, and 266(28.3), respectively. Paul et al found that the prevalence of active epilepsy was very similar for 0-39 age group but higher among women in the age group of 40-50 years. When the prevalence trend of lifetime epilepsy was analyzed by sex, the peak in the 20-39 age group is higher for men, but the second peak in the 50-59 age group is seen only in women.(Paul et al., 2012)The mean LAEP score among cohorts from this study is higher than reported values from previous studies conducted in Nigeria, Italy, and India.(Du et al., 2019; Fadare et al., 2018; Lee et al., 2014) This difference might be due to pharmacogenomics, drug interaction, inter and intra racial disparity, under reporting of ADR, varied doses of AEDs, different number of participants and duration of treatment but more importantly different methodological approach. For instance, Fadare and his colleagues in a Nigeria study aimed at determining medication adherence and adverse effect profile of AEDs among Nigerian cohorts, reported a lower mean LAEP score with highest value of those on phenobarbital.(Fadare et al., 2018)This finding which is similar to that of this study, is not unexpected as Phenobarbitone has been associated with several significant adverse effect profile ranging cognitive dysfunction, enzyme inductions, drowsiness, headache, dizziness and psychomotor disturbance.(Abou-Khalil, 2016; Goodman et al., 2015; Roy et al., 2016)In a study to access the extent of ADR of CBZ and its potential associated factors, memory, headache, restlessness, tiredness and depression were most frequently reported ADR and identified female gender, lower level of formal education has factors associated with ADR.(Olusanya et al., 2017) Nasopharyngitis, agitation, hyperkinetic muscle activity, outburst of anger, agitation has been associated with ADR of LVC.(Bates et al., 1995; Belcastro et al., 2008; Joshi et al., 2017)In a review recently published by Cochrane evaluated the effectiveness of LVC, six most common ADR in a decreasing order: somnolence, headache, asthenia, accidental injury, dizziness and infection were reported. Only somnolence and infection were significantly associated with LVC.(Kaushik et al., 2019) Routine evaluation for known ADR that is specific for AEDs should be incorporated to management of PWE by physician and Health Care Providers (HCP) to improve their quality of life. In previous studies, age, gender, multiple drugs, disease state, allergy, genetic factors, and large doses of drugs were identified as determinants of ADR in PWE. In this study, adherence, duration of epilepsy, duration AEDs use, presence of Epileptiform pattern, drug adherence and duration of seizures were identified as significant factors associated with high mean LEAP which increase the possibility of the occurrence of high ADRs in PWE. In-tandem with previous studies,(Du et al., 2019; Fadare et al., 2018; Kaushik et al., 2019)the present study reported higher mean LAEP score for patients on polytherapy compared to those on monotherapy, though not statistically significant. This is not unexpected as polypharmacy or use of more than one medication for epilepsy has been linked to increase ADR.(Adedapo et al., 2021; St. Louis, 2009)This is the reason why PWE, therapy should be started with a single AEDs and then titrate as appropriate after due consideration of other factors that govern choice of AEDs. Combination therapy should be considered only when monotherapy fails.(Assadeck et al., 2019; Joshi et al., 2017; Stephen & Brodie, 2012)It is recommended that AED can be gradually withdrawn after 2 years of seizure freedom, and this must be carried out under the guidance of a physician.(Assadeck et al., 2019; Brodie & Sills, 2011; St. Louis, 2009)
Using the MMAS-8, 4(0.43%), 571(61.7%), and 351(37.9%) respectively, of the participants were identified as highly adherent, medium adherent and no adherent to AEDs, respectively. This shows that, majority of PWE in this study had reduced number of highly adherence patients compared to findings in previous studies.(Du et al., 2019)This underscores the importance of compliance for better seizure controls and extent of TG. The use of alternatives to medicine such as healing homes, herbalists, and other spiritual mission houses, have been ascribed for low adherence in previous studies which account for the high rate of treatment gap in observed low- and middle-income countries.(Assadeck et al., 2019; Nwani et al., 2013; Owolabi et al., 2020) There is a dramatic global disparity in the care for epilepsy between high- and low-income countries, and between rural and urban settings. The reported size of the epilepsy treatment gap in Sub Sahara African varies widely, ranging from 23% in Senegal to 100% in Uganda, Tanzania, Gambia, and Togo.(Adeloye, 2014; Ding et al., 2021; Owolabi et al., 2020) A similar study in eastern Nigeria, reported overall treatment gap of 76%, diagnosed gap in 38% (n=11/29) and those who were diagnosed but discontinued AED treatment of their own volition accounting for a therapeutic gap of 38% (n=11/29).(Nwani et al., 2013) An online survey among 408 adults with epilepsy and 175 neurologists who treat epilepsy revealed that 29% of patients self-reported non-adherent to medications in a one-month period. Surprisingly from this study, there was no significant association between medication adherence and age, gender, marital status, level of education, seizure remission, seizures, and type of seizure in this study. However, there was a significant association between adherence and mean LAEP score. Nervousness, aggression, and memory problems were the most common ADRs previously reported in PWE. This finding is similar to findings from this study which revealed nervousness, aggression, weight gain, unsteadiness, restlessness and tiredness are the most common ADR. Furthermore, we reported that Carbamazepine (68%) was the most frequently prescribed monotherapy AEDs used, followed by Levetiracetam (9%) in this study, like other published studies in India and Nigeria.