Ebeveynlerin Antiepileptik İlaç Kullanımıyla İlgili Bilgi, Tutum, Davranışları ve Antiepileptik İlaçların Sık Gözlenen Yan Etkileri; Tek Merkezli Gözlemsel Deneyim

Amaç: Antiepileptik ilaçlar çocukluk çağında erişkinlere göre farmakokinetik ve farmakodinamik süreçlerinde farklılıklar gösterebilir; bu nedenle ilaçların etki ve yan etki profilleri değişebilmektedir. Çalışmamızda epilepsi tanısı konulan çocukların ebeveynlerinin antiepileptik ilaçlara karşı bilgi, tutum ve davranışları ile çocuklarda antiepileptik ilaç kullanımına bağlı sık gözlenen olası yan etkileri değerlendirmeyi amaçladık. Gereç ve Yöntemler: Çalışmamız, ebeveynlere anket uygulanarak yapıldı. Ağustos 2019-Mart 2020 tarihleri arasında Çocuk Nöroloji Polikliniği’nde epilepsi tanısı konulmuş 110 hasta ebeveyni çalışmaya dahil edildi. Bulgular: Katılımcıların çoğunluğunu anneler (n=68, %61.8) oluşturmaktaydı. Katılımcıların yaş ortalamaları 38.4±7.78 yaştı. %70 olgu monoterapi, %30 olgu politerapi kullanmaktaydı. Monoterapiden en sık kullanılan ilaçlar; levetirasetam (%22.7), valproik asit (%21.8) ve karbamazepin (%13.6)’dı. %34.5 olguda antiepileptik ilaçlara karşı yan etki gözlenmedi. En sık görülen yan etkiler; sinirlilik (%35.5), kilo alma (%18.2), yorgunluk (%14.5) ve davranış problemleri (%11.8)’di. Politerapi uygulanan hastalarda yan etki görülme oranı (%72.7), monoterapi uygulanan hastalara göre istatistiksel olarak anlamlı olmasa da daha yüksek bulundu (%62.3). Sonuç: Çalışmamızın çocuklarda antiepileptik ilaç tedavisi sırasında karşılaşılabilecek yan etki profilinin aydınlatılmasına ve ebeveynlere verilecek eğitimlere katkıda bulunacağını düşünmekteyiz.

Anahtar Kelimeler:

Epilepsi, Ebeveynler, Antiepileptik İlaçlar, Pediatri, Yan etki

Parents’ Knowledge, Attitudes, Behaviors Towards Use of Antiepileptic Drugs and Common Adverse Effects of Antiepileptic Drugs; Single Center Observational Experience

Objective: The use of antiepileptic drugs in childhood may differ in their pharmacokinetic and pharmacodynamic processes compared to adults and therefore, the effect and adverse effect profiles of drugs may change. We aimed to evaluate the knowledge, attitudes and behaviors of parents of children diagnosed with epilepsy towards antiepileptic drugs and possible adverse effects related to the use of antiepileptic drugs in children. Material and Methods: August 2019 and March 2020, 110 parents of patients who were diagnosed with epilepsy in pediatric neurology outpatient clinic were included in the study. Results: The majority of the participants were mothers (n=68, 61.8%). The mean age of the participants was 38.4±7.78 years. 70% of cases were using monotherapy, 30% of cases were using polytherapy. The most commonly used drugs from monotherapy; levetiracetam (22.7%), valproic acid (21.8%) and carbamazepine (13.6%). No side effects were observed against antiepileptic drugs in 34.5% of the cases. The most common side effects were irritability (35.5%), weight gain (18.2%), fatigue (14.5%) and behavioral problems (11.8%). The incidence of adverse effects in patients treated with polytherapy (72.7%) was found to be higher (62.3%) than in patients treated with monotherapy, although it was not statistically significant. Conclusion : We hope that our study will contribute to the enlightenment of the adverse effect profile that may be encountered during antiepileptic drug treatment in children and to the education to be given to parents.

Keywords:

Epilepsy, Parents, Antiepileptic Drugs, Advers Effect, Pediatrics,

PDF

___

1. Malaga I, Sanchez-Carpintero R, Roldan S, Ramos-Lizana J, Garcia-Penas JJ. New anti-epileptic drugs in Paediatrics. An Pediatr 2019; 91: 415.e1-415.e10.
2. Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kalviainen R, et al. ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2006; 47:1094–120.
3. Radhakrishnan K, Dinesh NS, Pradeep KS, Sankara SP. Profile of antiepileptic pharma-cotherapy in a tertiary referral centre in South India: A pharmacoepidemiologic and pharmaco-economic study. Epilepsia 1999; 40:179-85.
4. Saltık S. Çocukluk Epilepsilerinde Tıbbi Tedavi. Epilepsi 2014; 20(Ek 1):50-5.
5. Austin JK, Harezlak J, Dunn DW, Huster GA, Rose DF, Ambrosius WT. Behavior prob-lems in children before first recognized seizures. Pediatrics 2001; 107:115–22.
6.Aldenkamp A, Besag F, Gobbi G, Caplan R, Dunn DW, Sillanpaa M. Psychiatric and behav-ioural disorders in children with epilepsy (ILAE Task Force Report): adverse cognitive and behavioural effects of antiepileptic drugs in children. Epileptic Disord 2016; 18:55–67.
7. Brodie MJ, Besag F, Ettinger AB, Mula M, Gobbi G, Comai S, et al. Epilepsy, antiepileptic drugs, and aggression: an evidence-based review. Pharmacol Rev 2016; 68:563–602.
8. Akıcı N, Başaran NF. Rational Use of Medicine in Children. Turkiye Klinikleri J Pharmacol-Special Topics 2015; 3:50-6.
9. Bansal D, Azad C , Kaur M, Rudroju N, Vepa P, Guglani V. Adverse effects of antiepileptic drugs in North Indian pediatric outpatients. Clin Neuropharmacol 2013; 36:107-13.
10. Thijs RD, Surges R, O’Brien TJ, Sander JW. Epilepsy in adults. Lancet 2019; 393:689–701.
11. Kurt ANC. Characteristics of the knowledge and attitudes of parents about epilepsy. Epi-lepsy Behav 2018; 86:153-6.
12. Zainy LE, Atteyah DM, Aldisi WM, Abdulkarim HA, Alhelo RF, Alhelali HA, et al. Par-ents` knowledge and attitudes toward chil-dren with epilepsy. Neurosciences (Riyadh) 2013;18:345-8.
13. Anderson M, Egunsola O, Cherrill J, Millward C, Fakis A, Choonara I. A prospective study of adverse drug reactions to antiepileptic drugs in children. BMJ Open 2015;5:e008298.
14. Mistry RA, Solanki KC, Prajapati HK, Doshi TM, Trivedi HR. Drug utilization pattern of antiseizure drugs and their adverse effects in the pediatric population, in a tertiary care hospital attached to a medical college. Int J Basic Clin Pharmacol 2014; 3:336-42.
15. Kaushik S, Chopra D, Suvasini Sharma S, Aneja S. Adverse Drug Reactions of Anti-Epileptic Drugs in Children with Epilepsy: A Cross-Sectional Study. Curr Drug Saf 2019; 14:217-24.
16. Kousalya K, Swathi Cherukuri DP, Padmasani LN, Arun Prasath TS. Drug utilization pat-tern of antiepileptics and their adverse effects in pediatrics. World J Pharm Res 2014;3:504-13.
17. Junger KW, Morit D, Modi AC. The pediatric epilepsy side effects questionnaire: Establish-ing clinically meaningful change. Epilepsy Behav 2015; 45:101-4.
18. Mathur S, Sen S, Ramesh L, Kumar S. Utilization pattern of antiepileptic drugs and their adverse effects in a teaching hospital. Asian J Pharm Clin Res 2010; 3:55-60.
19. George J, Chanda K, Sharma GRK. Antiepileptic drugs and quality of life in patients with epilepsy: A Tertiary Care Hospital-based study. Value Health Reg Issues 2015; 6:1-6 .
20. Karimzadeh P, Bakrani V. Antiepileptic Drug-Related Adverse Reactions and factors influ-encing these reactions. Iran J Child Neurol 2013; 7:25-9.
21. Chen Z, Brodie MJ, Kwan P. What has been the impact of new drug treatments on epilep-sy? Curr Opin Neurol 2020; 33:185–90.
22. Cook AM, Bensalem-Owen MK. Mechanisms of action of antiepileptic drugs. Clin Pract 2011;8:307-13.
23. Asadi-Pooya AA, Sperling MR. Mechanisms of Action and Pharmacokinetic Properties of Antiepileptic Drugs. Asadi-Pooya AA, Sperling MR(eds). Antiepileptic drugs: a clinician’s manual. 2. Ed. Oxford University Press, doi:10.1093/med/9780190214968.003.0003,Feb 2016.
24. Kumar S, Sarangi SC, Tripathi M, Gupta YK. Evaluation of adverse drug reaction profile of antiepileptic drugs in persons with epilepsy: a cross-sectional study. Epilepsy Behav 2020; 105:106947.
25. Chen LC, Chen YF, Yang LL, Chou MH, Lin MF. Drug utilization pattern of antiepileptic drugs and traditional Chinese medicines in a general hospital in Taiwan - a pharmaco-epidemiologic study. J Clin Pharm Ther 2000; 25:125-9.
26. Lammers MW, Hekster YA, Keyser A, Meinardi H, Renier WO, van Lier H. Monotherapy or polytherapy for epilepsy revisited: A quantative assessment. Epilepsia 1995; 36:440-6.