What is the best way to ensure people with epilepsy take the | Figure 1
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What is the best way to ensure people with epilepsy take their medication as prescribed?
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Why is this question important?
Epilepsy is a very common condition that affects the brain. People with epilepsy experience seizures ‐ or fits ‐ that can affect their daily lives. They are often prescribed medicines to control or prevent seizures. People with epilepsy can find it difficult to take their medicines as prescribed, and this is thought to be a reason for poor control of seizures. This review of studies reports on ways of improving how they take their antiepileptic medication.
What we did
We searched medical databases for clinical studies looking at ways of improving adherence to medication in people with epilepsy. We limited our search to randomised controlled trials (RCTs) involving people with a clinical diagnosis of epilepsy of any age and treated with antiepileptic drugs in a primary care (for example, doctor's surgery), outpatient or other community setting. RCTs are medical studies where people are chosen at random to receive a treatment (called the intervention group) or to receive a different treatment or no treatment (called the control group). This type of study provides the most reliable evidence about whether different approaches to health care make a difference.
The results are up to date to February 2020.
What we found
We identified 20 studies (2832 participants). The studies were conducted in different countries with the majority from the USA. The studies examined three main types of interventions:
education and counselling of participants about topics such as epilepsy and medication used to control epilepsy (4 studies);
behavioural interventions, such as asking people with epilepsy to link the intention of taking their medication with a particular time, place and other routine activity (13 studies); and
mixed interventions, which is the use of more than one intervention (4 studies).
One study is counted twice because it compared a behavioural intervention with a mixed intervention.
Studies measured adherence to medication in various ways, for example, with questionnaires, blood samples or electronic bottle tops. Studies also measured reduction in frequency or severity of seizures to see if taking medication as prescribed made a difference. The studies were all very different from each other, so we could not combine their results.
Key results and reliability of the evidence
Education and counselling interventions may improve medication adherence. Two studies showed improvement, one study showed a small improvement and one no improvement.
Behavioural and mixed interventions probably improve adherence to medication. People in the intervention groups showed improved adherence compared to the control groups.
Four studies showed that when adherence improved in the intervention groups, seizure frequency or seizure severity was decreased.
We were unable to draw firm conclusions about the results because the studies were very different from each other and did not always use the best methods. This means we are not certain about their evidence.
What should happen next?
We need carefully‐designed randomised controlled studies involving more people with longer follow‐up periods to identify the best intervention to improve adherence to antiepileptic medication.
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\ \ Background\ Alzheimer's disease is a risk factor for increased seizures in older people. Seizures of any type can be observed in Alzheimer's disease and are probably underestimated.\ Study characteristics\ We searched scientific databases for clinical trials comparing medication and non‐medication‐based treatments for epilepsy in people with Alzheimer's disease. We wanted to evaluate how well the treatment worked and if it had any side effects.\ Key results\ We included and analyzed one randomized controlled trial (a clinical study where people are randomly put into one or two (or more) treatment groups) with 95 participants. Concerning the proportion of participants with freedom from seizures, no significant differences were found between the antiepileptic drugs (levetiracetam versus lamotrigine, levetiracetam versus phenobarbital, and lamotrigine versus phenobarbital). It seemed that levetiracetam could improve cognition (thinking) and lamotrigine could relieve depression, while phenobarbital and lamotrigine could worsen cognition, and levetiracetam and phenobarbital could worsen mood.\ Certainty of the evidence\ The certainty of the evidence for all the outcomes from the study were very low. This means that we are very uncertain about the results and they should be interpreted with caution. Large randomized controlled trials are required to determine how effective and well tolerated treatments are for epilepsy in people with Alzheimer's disease.\ The evidence is current to August 2020.](https://app.figure1.com/case-detail/0039a19c-bb6c-4f62-8f53-4f5e7f9dd565)
\ \ Background\ Epilepsy is a common neurological disorder that appears in various forms. Many individuals with epilepsy have satisfactory seizure control with the use of antiepileptic medications. Yet, nearly a third of people with epilepsy suffer from frequent and uncontrolled seizures despite the use of medication, or are unable to tolerate the side effects of those medications. Surgery is an option for some people with uncontrolled seizures, but it is invasive and not suitable for all individuals. As a result, there remains a substantial unmet need for safe, effective therapies for these harder‐to‐treat epilepsies.\ Transcranial magnetic stimulation (TMS) is one of several newer treatments that can potentially offer people with epilepsy a safe and non‐invasive alternative to surgery. Long used as a research tool to study brain function, TMS has also been studied as a possible treatment for a number of nervous system conditions, including epilepsy. This non‐surgical and painless treatment uses induced magnetic currents to regulate brain function in order to reduce the tendency to have seizures.\ Objective\ We aimed in this review to evaluate the evidence for the use of repetitive transcranial magnetic stimulation (rTMS) in individuals with epilepsy compared with other available treatments in reducing seizure frequency, improving quality of life, reducing epileptiform discharges (abnormalities on brain electrographic testing that suggest underlying brain disturbance or seizure tendency), antiepileptic medication use, and side effects.\ Methods\ The latest search for trials was 2 June 2020. We assessed the evidence from eight randomised controlled trials (studies in which participants are assigned to one of two or more treatment groups using a random method) involving a total of 241 participants comparing rTMS to control treatments (sham treatment, antiepileptic medication, or low‐frequency rTMS).\ Results\ Some of the included trials showed that rTMS reduces the number of seizures individuals had compared to before the therapy, but other trials did not show any significant differences in seizure frequency. Four trials showed a reduction in epileptiform discharges following rTMS treatment. One study measured changes in quality of life in seven participants; although not statistically analysed they found that a greater proportion of study participants reported increased quality of life scores with active treatments compared to the sham treatment. One trial reported an increase in antiepileptic medication in a single individual but they had received the control treatment. Side effects were uncommon; the most frequently reported side effect was headache (and the majority of individuals completed the treatment with rTMS). However, one study showed an increase in seizure frequency in two individuals: one during the rTMS treatment (who discontinued the treatment early), and one weeks after the treatment.\ Certainty of the evidence\ Overall, we judged the certainty of the evidence for the main outcome of reduction in seizure frequency to be low due to unclear information in the published papers about study design and the unclear presentation of results. One included study commented on quality of life, but involved only seven participants.\ The evidence is current to June 2020.](https://app.figure1.com/case-detail/240e785d-a0ce-4655-8f0b-0afbd254319d)
\ \ The aim of this review is to provide a better understanding of what is an effective and useful intervention (treatment) for people with conversion disorders and dissociative disorders. The interventions we look at are non‐medical. Instead they concern therapy or social interventions.\ \ Background\ Conversion and dissociative disorders are conditions where people experience unusual neurological symptoms (relating to the nerves and nervous system) or changes in awareness or identity. Neurological disease or other medical conditions cannot explain these clinical signs; often a psychological (affecting or arising in the mind) stressor or trauma is present. The symptoms are real and can cause distress or problems with functioning in everyday life for the people experiencing them.\ This review seeks to help these patients, as well as the clinicians, policy makers and healthcare services working with these disorders.\ Review question\ What is the evidence for psychosocial (relating to social factors and individual thought and behaviour) intervention of conversion and dissociative disorders?\ Search date\ We searched medical databases between 16 July and 16 August 2019.\ Results of search\ We read 3048 summaries of articles, resulting in 17 studies that met our criteria for the conditions, the groups of people, the interventions and the types of studies that are the focus of this review.\ The 17 studies had 894 participants, and each study was relatively small.\ More studies are under way, and we will include them in updates of this review.\ Study characteristics\ The studies took place in nine different countries worldwide, with adults aged 18 to 80 years, who had a diagnosis of conversion or dissociative disorder for any length of time. Some studies were conducted in either psychiatric or neurological settings. Some included people already in hospital, some included people attending outpatient clinics.\ The interventions were all psychosocial, meaning that they focused on psychological or social interventions such as therapy, hypnosis or simply teaching people about their illness. The number of sessions varied.\ The included studies all compared the intervention to a control group to see if the interventions made any difference. The control groups received a different psychosocial intervention, medication or the care that people would normally get if they had the same condition but were not part of a research study.\ The primary outcome we looked for was a reduction in physical signs.\ Key results\ We investigated the effect of different types of psychosocial interventions, ranging from hypnosis to behavioural therapy. None of the studies were conducted to a high enough standard to be able to say anything conclusive about the evidence of the results.\ There was a reduction in physical signs at the end of treatment for three interventions.\ Hypnosis reduced the severity of impairment compared to people on a wait list for treatment; behavioural therapy, given on top of routine care to inpatients, reduced the number of weekly seizures (fits) and symptom severity compared with people receiving routine care alone; and psychotherapy preceded by motivational interviewing (a talking therapy that attempts to move an person away from a state of indecision or uncertainty to positivity) compared with psychotherapy alone reduced seizure frequency.\ Quality of the evidence\ Most of the included studies had methodological flaws and the quality of evidence used to assess the effectiveness of the different treatments was judged as low or very low. Due to this low‐quality evidence, we cannot say how reliable the results are.\ Conclusion\ The results of the meta‐analysis and reporting of single studies suggest that there is lack of evidence regarding the effects of any psychosocial intervention of conversion and dissociative disorders in adults. Therefore, it is not possible to draw any conclusions about potential benefits or harms from the included studies.\ However, the review shows that research in this area is possible.](https://app.figure1.com/case-detail/4c4d1d0d-eb04-4bd7-840d-aad2990f5501)
\ \ Background\ Epilepsy is a neurological disorder which causes people to have seizures. Most people can control their epilepsy with a single antiepileptic drug. Some people, however, require multiple antiepileptic drugs to control their epilepsy, and are said to have drug‐resistant epilepsy. Oxcarbazepine is an antiepileptic drug and is similar to an older antiepileptic drug, carbamazepine. Oxcarbazepine can be taken as an add‐on treatment, alongside other antiepileptic medication, to treat drug‐resistant epilepsy.\ Aim of the review\ This review examined whether oxcarbazepine is tolerable and effective when used alongside other antiepileptic medication by people with drug‐resistant focal epilepsy (epilepsy that originates from one area of the brain).\ Results\ We included six clinical trials that investigated oxcarbazepine as an add‐on treatment for people with drug‐resistant focal epilepsy. There were 1593 people across the studies and they were aged from 1 month to 65 years.\ People who received oxcarbazepine in addition to their normal antiepileptic medication were more likely to have a 50% or greater reduction in the frequency of their seizures compared to people who were on a control treatment, which is believed to have little or no effect. They were also nearly three times more likely to be free from all seizures than those receiving control treatment. Both of these findings suggest that oxcarbazepine is effective at treating drug‐resistant focal epilepsy. These findings are, however, based on evidence that was of low certainty. This means that we are not confident that the findings that we have reported are accurate.\ People who received oxcarbazepine add‐on treatment were also more likely to withdraw from the studies and were more likely to experience side effects, including dizziness and drowsiness, than people receiving control add‐on treatment. The evidence for treatment withdrawal was of moderate certainty, and this means that we can be fairly confident that this is a true effect.\ Authors' conclusions\ As a result of the low‐certainty evidence, we cannot be sure that oxcarbazepine is an effective add‐on treatment for people with drug‐resistant focal epilepsy. Instead, we have concerns about the tolerability of oxcarbazepine because of the increased number of people who withdrew from treatment and who experienced side effects.\ The evidence is current to September 2018.](https://app.figure1.com/case-detail/658ac7c2-7da7-446f-9835-d52d25ea0a1b)
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