By: Evanthia Siozios, PharmD Candidate c/o 2020
A diagnosis of epilepsy requires either two unprovoked seizures or one unprovoked seizure with the possibility of having more.1 These seizures are not usually caused by factors such as alcohol withdrawal or hypoglycemia (low blood sugar). Missing doses of seizure medication is the most common cause of breakthrough seizures making pharmacist intervention and consultation crucial in achieving proper seizure control.
A study conducted at the Cincinnati Children’s Hospital Medical Center in the Division of Behavioral Medicine and Clinical Psychology by post-doctoral fellow Ana M. Gutierrez-Colina, PhD, and colleagues, demonstrated barriers in pediatric epilepsy where pharmacist interventions can make a difference in a patient’s overall quality of life.2 Difficulty swallowing medications, forgetfulness, and refusal to take medications as prescribed has been associated with non-adherence in children with epilepsy. In order to determine the most common causes of non-adherence, descriptive statistical methods including means, standard deviations and percentages were used. Frequency of non-adherence was calculated across four age groups – preschool (2-5 years) and school-aged (6-12 years) children, adolescents (13-17 years), and young adults (18-25 years). “Dislike taste” and “caregiver forgetfulness” were found to be the two most common reasons preschool and school-aged children were non-adherent to their medications. These two barriers to adherence can be circumvented with pharmacist interventions in outpatient and inpatient settings. Pharmacists can flavor liquids to increase appeal in younger children and counsel caregivers to create reminders such as alarms on cellphones of medication administration times.
An educational intervention conducted in a specialist outpatient clinic at KK Women’s and Children’s Hospital (KKH) in Singapore by Chunliang Chen, BScPharm and colleagues, demonstrated the impact of pharmacist counseling on the caregivers of pediatric epilepsy patients.3 In this intervention, pharmacists worked with neurologists to personalize counseling for patients by educating the caregivers on epilepsy and medication administration. Patients and caregivers first consulted with the neurologist and then went to a separate room to be counseled by the pharmacist which collectively took sixty minutes. Two weeks later, the pharmacist followed up with the caregiver over the phone to inquire about patient compliance, side effects, and characteristics of the seizures, if any occurred. Overall, this study proved that educational counseling by a pharmacist is effective at improving caregiver confidence in administering antiepileptic drugs, leading to better compliance in the care of their child.
The way pharmacists provide patient care can vary but their contributions are ultimately very important when treating epileptic pediatric patients. Whether it involves flavoring a child’s medication or counseling the child’s caregiver to improve adherence, there is a strong need for pharmacists in improving health related outcomes of patients with epilepsy, a chronic disorder that can simply be provoked when medications are not taken as directed.
- What is Epilepsy? Epilepsy Foundation. https://www.epilepsy.com/learn/about-epilepsy-basics/what-epilepsy. Published 01/21/2014. Accessed 04/15/2019.
- Gutierrez-Colina AM, Smith AW, Mara CA, Modi AC. Adherence barriers in pediatric epilepsy: From toddlers to young adults. Epilepsy & Behavior: E&B. 2018;80:229-234. doi:10.1016/j.yebeh.2018.01.031.
- Chen C, Lee DSH, Hie SL. The impact of pharmacist’s counseling on pediatric patients’ caregiver’s knowledge on epilepsy and its treatment in a tertiary hospital. International Journal Of Clinical Pharmacy. 2013;35(5):829-834. doi:10.1007/s11096-013-9817-5.