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Joyce Cramer

Medication Management

Joyce Cramer
President, Epilepsy Therapy Project
Associate Research Scientist, Yale University School of Medicine

Do you take your medication the way you expect your patients to take theirs?
Doctors are notoriously unreliable in following medical instructions, particularly taking medication. Healthcare professionals have the knowledge to understand the importance of preventive and symptomatic treatment; they know what health behaviors should be accomplished regularly (e.g., diet, exercise, medication); they understand the mechanisms of action and pharmacology of medications; they have the intelligence to plan and the self-regimentation to maintain a pattern of personal healthcare. True, but unrelated to actual behaviors. Of course, some healthcare professionals do follow the advice they give to patients, but not all. The Doctors’ Health Study revealed that a large proportion of doctors who volunteered for the study were not eligible for randomization because they were so poorly compliant with the dosing during the placebo run-in phase.

Kastrissios et al.1 asked medical students to take Tic Tac candy pills for two weeks, in a BID or TID regimen. They discovered that only 2/3 of “doses” were taken as agreed, 47% of doses were taken at the prescribed frequency (BID or TID), and 29% were taken at the prescribed intervals (hours apart). The Physicians’ Health Study II was designed to assess the efficacy of vitamin C, vitamin E, beta-carotene, and a multivitamin in reducing cardiovascular risk. Doctors who enrolled were sent calendar packs containing placebos of all four of the study drugs. Of the 11,128 willing to participate, only 7,001 (63%) took the pills regularly during the baseline (placebo run-in phase) and said they wanted to continue with the study2.

I wrote an article for www.epilepsy.com geared toward patients called: "The Titanic Impact of Medication Compliance on Epilepsy"3 to explain that seizures may be related to missed doses, inadequate scheduling, and other remediable factors. Forgetfulness remains the main reason people report for missed doses, not unexpected for people commonly having memory difficulties. Rather than expecting patients to accommodate to know how to take their medication, or to use dosing schedules that are not convenient, try to adjust the medication to what the patient will be able to accomplish.

Of course, it’s difficult to counsel patients on medication management unless you know a few methods to impart to patients. Watch for a new CME program next month with tips on how to teach patients approaches to taking their (essential) antiepileptic drugs.

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Joseph I. Sirven, M.D.Epilepsy.com/Professionals Announcements from Joseph I. Sirven, MD, Editor-in-Chief

First of all we want to acknowledge and Congratulate the Epilepsy Research Foundation New Therapy Grant Awardees. These Grants are what the Epilepsy Therapy Project are all about.

July 2009: Epilepsy Research Foundation New Therapy Grant Awards

Grant: Safety Profile of the Subdural Hybrid Neuroprosthesis for Focal Epilepsy
New York University School of Medicine
New York, NY
Ludvig Nandor, MD, PhD, Associate professor at the New York University School of Medicine received a grant to determine the safety of a new medical device, the subdural Hybrid Neuroprosthesis, for the treatment of drug resistant, surgically untreatable focal epilepsies. The device will deliver muscimol or other seizure-controlling drugs directly into the cortical seizure focus via the subdural space to prevent seizures without side-effects. The safety of this emerging epilepsy therapy will be tested in monkeys so that the device can be implanted in the same way as in humans, and generated data can be relevant to human conditions.

Grant: Clinical EEG Acquisition Systems with Online Fast Ripple Detection
Columbia University Medical Center
New York, NY
Catherine Schevon, MD, Assistant Professor at Columbia University Medical Center received a grant to develop a practical intracranial EEG recording system that will bring the additional information that can be gained from evaluation of high frequencies into clinical practice, thus increasing the efficacy of the current surgical treatment of medically refractory partial epilepsy. By increasing the specificity of the identification of the epileptogenic region, seizure outcomes can be improved while the area of brain that must be removed is minimized. In addition, a biomarker that is reliably present in interictal recordings could obviate the need for prolonged implantation. This technology may even make possible single-stage surgical procedures for neocortical epilepsy syndromes, a therapy which currently is not available to most patients with medically refractory epilepsy.

Check out this month's featured online roundtable: Cognition Across the Lifespan: Antiepileptic Drugs, Epilepsy, or Both? with guests Dr. Bruce Hermann, Dr. Kimford Meador and Dr. William Gaillard, and hosted by Joyce Cramer, President, Epilepsy Therapy Project.

tolerability roundtable drs

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Please Join us for our September offerings on Epilepsy.Com/Professionals. During this month, we begin a special series of Hallway Conversations relating to the 22nd Annual Arizona Epilepsy Update which is scheduled for November 6, 2009. As part of the symposium, we will be highlighting the various talks by speakers at the conference. This month, Dr. Hemant Kudrimoti from the University of Arizona will be discussing Generic antiseizure medications and Dr. Steven Chung from the Barrow Neurological Institute will be talking about New Antiseizure medications and how to choose between them? Lastly, Dr. Katherine Noe will be discussing Women’s Issues and Epilepsy. We hope that you join us for these Hallway Conversations and take full advantage of all of our offerings.

Joseph Sirven, MD

1 Kastrissios H, Flowers NT, Blaschke T0046. Introducing medical students to medication noncompliance. Clin Pharmacol Therap,1996: 59, 577–582.
2 http://phs.bwh.harvard.edu/phs2.htm
3 http://www.epilepsy.com/epilepsy/compliance/titanic

Reviewed by Joseph I. Sirven, M.D., Editor-in-Chief
Submitted August 31, 2009

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