Some epileptic patients have an increased risk of dying sooner. Poor adherence-related epilepsy control

doi:10.21203/rs.3.rs-2458364/v1

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Case Report

Some epileptic patients have an increased risk of dying sooner. Poor adherence-related epilepsy control

https://doi.org/10.21203/rs.3.rs-2458364/v1

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Background: Recurrent, spontaneous epileptic convulsions are the hallmark of epilepsy, a chronic illness. The likelihood of having an uncontrolled seizure was predicted by non-adherence to antiepileptic medicines (AEDs), the number of seizures that occurred before taking AEDs, and a head injury.

Case Presentation: On February 22, 2022, a self-employed, 26-year-old black male adult was taken to the medical ward with a seven-day history of recurring aberrant bodily movements. He had previously been treated with 100 mg of phenobarbitone for his epilepsy two years prior. On admission, he had a five-day history of anxiety, memory problems, diarrhea, sporadic fever, crying during the episode, uncontrollable jerking movements of the arms and legs, and partial loss of consciousness, in addition to a seven-day history of recurrent abnormal body movements. During his physical examination, an electroencephalogram showed that his brain was electrically active in an abnormal way. A computed tomography scan showed no lesions were present. A Glasgow Coma Scale reading of 10/15 was obtained during a neurological examination to assess his level of consciousness. When he arrived, he was given 10 mg of intravenous diazepam and three doses of 100 mg of oral phenobarbitone every eight hours.

Conclusion: Epilepsy affects people of all ages, ethnicities, sexes, levels of education, socioeconomic status, and social classes worldwide. Despite receiving the greatest care, seizure control may still be impacted by triggers or lifestyle choices.

Clinical Pharmacology

Cognitive Neuroscience

Antiepileptic drugs

Case Report

Epilepsy

Poor control

Poor adherence

The word "epilepsy" is a Greek word that means "classified into two," with "epi" meaning "upon" and "lepsis" meaning "to seize, or hold of, or experience a seizure" [1]. Epilepsy is a chronic brain illness that affects fifty million people worldwide, regardless of age, ethnicity, social class, nationality, or location. It is one of the most prevalent and serious neurological disorders [2]. An aberrant, excessive, and hypersynchronous electrical discharge of neurons in the brain is one of epilepsy's clinical presentations, including symptoms and signs. As a result, a seizure is a symptom, and epilepsy is a condition rather than a disease, as it can have a variety of etiologies [3, 4]. Unpredictable, repeated seizures or fits, which can cause loss of consciousness, impaired movement, muscle spasms, and abnormalities in autonomic and brain functioning, are the hallmarks of epilepsy [5, 6]. Uncontrolled seizures are linked to medical and psychological illness, dependent behavior, a low quality of life, and a higher risk of untimely death [7]. Noncompliance with anti-epileptic medication in epileptic patients frequently results in an increased risk of seizures, worsening of the condition, death, and increased medical costs [8]. Several factors have been linked to epilepsy medication non-adherence. These include things like gender, age at first seizure, kind of epilepsy, frequency of seizures, cause of epilepsy, length of epilepsy, abnormal electroencephalography, and the presence of comorbidities [9]. The goal of epilepsy therapy is total seizure control without too many negative effects [10]. Anti-epileptic medications differ chemically and pharmacologically, with the sole ability to stop seizures without affecting consciousness [11]. This study shows that an adult male had poorly controlled epilepsy due to poor adherence, which explains why he didn't respond to antiepileptic medications.

On February 22, 2022, a self-employed, 26-year-old black male adult was taken to the medical ward with a seven-day history of recurring aberrant bodily movements. He had no history of epilepsy in his family. He has no past history of having had a stroke, a brain tumor, a severe head injury, abusing drugs, or using alcohol. He had a history of engaging in excessive or compulsive exercise every day with his pals after leaving the office. He had previously been treated with 100 mg of phenobarbitone for his epilepsy two years prior. Five years prior, he was diagnosed with peptic ulcer disease. Three months prior, he had stopped using his anti-epileptic drug since it caused him to have excessive sleep.

On admission, he had a five-day history of anxiety, memory problems, diarrhea, sporadic fever, crying during the episode, uncontrollable jerking movements of the arms and legs, and partial loss of consciousness, in addition to a seven-day history of recurrent abnormal body movements. He had the following vital signs: a mean arterial blood pressure of 115/82 mmHg; a pulse rate of 92 beats per minute; a body temperature of 37.9 degrees Celsius; an oxygen saturation on room air of 96%; and a respiratory rate of 20 breaths per minute. His body mass index was 25.3 kg/m2, which is higher than the usual range of 18.5–24.9 kg/m².

His laboratory tests showed that he had a blood glucose level of 115 mg/dL (normal range: 70–100 mg/dL), a glycosylated hemoglobin level of 6.4% (normal range: 4-6.5%), a blood urea nitrogen level of 27 mg/dL (normal range: 6–21 mg/dL), a serum creatinine level of 1.06 mg/dL (normal range: 0.59–1.04 mg/dL), a white blood cell count of 11200 cells/mm3 (normal value: 4500–11000 cells/mm3), and cerebrospinal fluid parameters are normal.

During his physical examination, an electroencephalogram showed that his brain was electrically active in an abnormal way. A computed tomography scan showed no lesions were present. A Glasgow Coma Scale reading of 10/15 was obtained during a neurological examination to ascertain his level of awareness. An electrocardiogram revealed that the heart rate had increased slightly. A chest X-ray came back clear. Tests for Helicobacter pylori came back negative.

The physician examined the patient and diagnosed poor control of epilepsy. When he arrived, he was given 10 mg of intravenous diazepam and three doses of 100 mg of oral phenobarbitone every eight hours. For three days straight, take 1000 ml of normal saline diluted to 0.9% with vitamin B complex, and 40% of dextrose. Phenobarbitone failed to control his epilepsy, so phenytoin, 100 mg orally administered once a day, was added on the seventh day. After two weeks, the patient made a partial recovery and was prescribed two anti-epileptic medications, including phenytoin 100 mg three times daily and phenobarbitone 100 mg three times daily, and discharged back to his home. He was also advised to attend follow-up appointments once a month.

He was readmitted to the hospital after 23 days with a 4-day convulsion history, repeated irregular body movements, and a 1-day loss of consciousness history. He stopped taking his antiepileptic medication four days prior to admission because he was experiencing everyday sleepiness. His vital signs upon arrival were as follows: 119/85 mmHg blood pressure, 89 beats per minute heartbeat, 20 breaths per minute respiration rate, 37.3°C body temperature, and 97% oxygen saturation on room air. The doctor started phenobarbitone 100 mg orally three times a day and diazepam 10 mg intravenously as soon as the patient arrived. The following day, the doctor switched phenytoin to valproic acid, 200 mg orally, once at bedtime. The patient was given phenobarbitone 100 mg orally, three times a day for one month, and valproic acid 200 mg orally, three times a day for one month, after spending five days in some degree of recovery from epilepsy.

Results And Follow-up

He was sent home after receiving instructions on how to take his medication consistently without skipping a dose, information on the usual side effects of prescription drugs, and a reminder to keep up with his monthly appointments.

A common neurological condition known as epilepsy is characterized by recurrent bouts of uncontrollable body movements that affect only a portion of the body (partial) or the full body (generalized), occasionally accompanied by loss of consciousness and control over bowel or bladder function [12]. The most prevalent neurological condition, epilepsy, is characterized by recurring seizures brought on by abnormally high levels of synchronized neuronal activity in the brain [13]. Epileptic seizures typically result in a temporary disturbance of awareness that puts the person at risk for physical harm and typically interferes with learning and working [14].

The symptoms that are associated with epilepsy include: autonomic symptoms like sweating, flushing, and dilated pupils; motor symptoms like tingling, numbness, lip-smacking, convulsive jerking incoordination, dystonic, chewing motions; sensory symptoms like paresthesia; aura; auditory, gustatory, olfactory, visual, and vestibular disturbances; hallucinations, dysphasia of behavior impairments in cognitive functioning, memory, and responsiveness [15].

Recurrent seizures are the first audible sign of epilepsy and are caused by ion channel dysfunction on synapses during neurotransmission [16]. Most epileptic syndromes share a common trait: a sustained rise in neuronal excitation or hyperactivity [17]. Brain injury and chemical imbalances are the two main causes of the abnormal behavior of neurons. Low blood levels of salt, calcium, sugar, and oxygen are examples of chemical imbalance [18]. Intracranial hemorrhage, brain oxygen deprivation, infection, trauma, tumor meningitis, stroke, and other neurological diseases are all examples of brain injuries [19].

Medicine non-adherence is the failure to properly fill or refill a prescription, stop taking a medication before the course of therapy is complete, follow the agreed-upon advice of a healthcare professional, take more or less of a medication than recommended, or take a dose at the wrong time [20]. All anticonvulsants have side effects, some of which may be very significant since they jump into the fantastic of life, start non-compliance, and, in rare instances, be implausibly life-threatening [21].

The ultimate goal of epilepsy treatment is to prevent seizures, eliminate side effects, and maintain a high quality of life. As a result, treatment plans should be tailored to each patient's unique needs to prevent or lessen seizures while avoiding drug interactions and side effects, preventing other complications, and achieving the highest level of quality of life feasible [22, 23]. Behavior issues, hyperactivity, sedation as a main adverse effect, dementia, loss of appetite, fatigue, vertigo, and sleepiness are all potential side effects of phenobarbital [24]. The side effects of phenytoin may include sedation, psychosis, hyperkinesias, megaloblastic anemia, decreased serum folate levels, gingival hyperplasia (overgrowth of the gums), decreased bone mineral content, liver disease, acne, hirsutism (excessive hair on the face or body/overgrowth of hair), coarseness of facial features, unsteadiness or shakiness, and ataxia [2].

Phenytoin can also cause hyperandrogenic symptoms such as hirsutism and nodular skin lesions, diplopia (cerebrovascular malfunction), exfoliative dermatitis, toxic epidermal necrosis, and lupus-like syndrome by altering the metabolism of sex steroid hormones [2]. In this study, the least frequent reason for non-adherence was complicated treatment plans, while anti-epileptic drug side effects were the most frequent.

The most prevalent neurological condition, epilepsy, is characterized by recurring seizures brought on by abnormally high levels of synchronized neuronal activity in the brain. The goal of epilepsy therapy is total seizure control without too many negative effects. All anticonvulsants have side effects, some of which may be very significant since they jump into the fantastic of life, start non-compliance, and, in rare instances, be implausibly life-threatening.

Consent for publication

Written informed consent was obtained from the patient for the publication of this case report.

Acknowledgments

The author is grateful to the study participant for his willingness to respond to all questions.

Funding

None

Competing interests

The author has no financial or proprietary interest in any of the material discussed in this article.

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Some epileptic patients have an increased risk of dying sooner. Poor adherence-related epilepsy control

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Abstract

Introduction

Case Presentation

Results And Follow-up

Discussion

Conclusion

Declarations

References

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