Too much of a good thing: Overtreatment in epilepsy
de Souza, S.M. 2018
Presented by Dr. Pyae Phyo Aung
2:46 - Presentation on Overtreatment in Epilepsy:Â The rationale for maintaining certain conditions over complete seizure elimination was discussed from both patient and neurologic perspectives.
4:27 - Definitions and Patient Perspectives:Â Illness and overtreatment were defined, with an emphasis on how benefits and harms vary among individuals. It was highlighted that some patients with temporal epilepsy prefer to maintain their condition due to the unique and enjoyable experiences of auras.
10:16 - Patient Experiences and Objections:Â Patient experiences were shared, and potential objections to maintaining auras were addressed. It was argued that the preferences of temporal epilepsy patients are valid and not merely adaptive or in denial, and that their cognitive and judgment abilities are maintained.
14:26 - Overcoming Overtreatment:Â Ways to overcome overtreatment were suggested, including clearly outlining treatment options, validating patient experiences, avoiding pressure during consultations, and ensuring that patients are not overwhelmed, especially when newly diagnosed.
Discussion
1:37 - Patient Experiences with Epilepsy:Â It was noted that while some patients prefer to stay on lower doses of medication to avoid side effects, their seizures are not experienced as pleasant. It was also mentioned that some patients with minimal seizures prefer not to increase their medication unless there is a risk of injury.
3:53 - Balancing Treatment and Seizure Freedom:Â The importance of balancing treatment to avoid overtreatment and ensure seizure freedom was emphasized. The need to consider the potential harmfulness of seizures and the adverse effects of treatment was highlighted.
4:46 - Patient-Doctor Communication:Â The importance of building trust and confidence between patients and doctors was stressed. It was noted that patients are more likely to adhere to treatment plans when they feel heard and understood. The need to discuss all treatment options and potential side effects with patients was emphasized.
7:27 - Declining Treatment:Â The issue of patients who decline treatment for epilepsy was discussed by participants. It was agreed that explaining the risks and benefits of not taking medication is essential, and ensuring that patients have the capacity to make informed decisions is crucial. It was also noted that some patients may refuse treatment because they do not believe they have epilepsy or need more proof.
11:18 - Challenges with Elderly Patients:Â The challenges of treating elderly patients with temporal lobe epilepsy were highlighted. These patients often do not accept the diagnosis or treatment and may require multiple visits before agreeing to take medication. The importance of patience and thorough explanation of the pros and cons of treatment was emphasized.
Addressing overtreatment in patients with refractory epilepsy at a tertiary referral centre in Brazil
Alexandre V. et al. 2011
Presented by Dr. Leena Kämppi
1:42 - Overtreatment in Refractory Epilepsy:Â The study aimed to assess the impact of adverse effects on quality of life and the utility of a structured instrument to help physicians manage these effects.
3:12 - Study Design and Methodology:Â It was explained that the study was prospective and observational, including adults with pharmacoresistant epilepsy treated at one clinic in Brussels. The study included both observational and interventional parts, with data collected at baseline and six months.
5:42 - Interventional Part of the Study:Â In the interventional part, patients with high adverse event profile scores were randomized into intervention and control groups. The intervention group had their adverse event profile scores available to physicians at each visit. However, no significant differences in adverse effects or quality of life between the groups were observed.
10:56 - Study Results and Conclusions:Â It was concluded that overtreatment is substantial in patients with refractory epilepsy, and adverse effects significantly impact quality of life. The use of structured evaluation methods alone is not sufficient; a more comprehensive approach, including patient discussions and educational programs, is needed to improve clinical outcomes.
Discussion
0:00 - Paper Structure and Methodology:Â It was noted that the definition of drug-resistant epilepsy and the medications used at that time differ significantly from today's standards. The importance of considering these differences when evaluating the paper's conclusions was highlighted.
2:51 - Dose Reduction and Medication Management:Â The low percentage of patients who experienced dose reduction or withdrawal of anti-seizure medication in the study was discussed, along with the challenges of using scales like adverse event profiles and quality of life in a busy clinical setting.
5:10 - Refractory Epilepsy and Medication Management:Â The challenges of managing refractory epilepsy cases were discussed, including the impact of adding new medications on drug interactions, side effects, and quality of life. The importance of reducing old medications and discussing the effectiveness of different medications with patients was emphasized.
7:47 - Mental Illness and Anti-Seizure Medications:Â The challenges of managing patients with epilepsy and mental illness were addressed by participants, noting that some anti-seizure medications can cause psychotic problems. The importance of considering the patient's quality of life and working with psychiatrists to manage medication regimens effectively was discussed.
10:21 - Overtreatment and Undertreatment:Â The issue of overtreatment and undertreatment in epilepsy management was discussed, sharing a case study of a patient who experienced significant improvement after being prescribed a new medication. The importance of presenting new treatment options to patients and staying informed about the latest anti-seizure medications was emphasized.