Polypharmacy for the treatment of epilepsy in public health-care: an integrative literature review

Authors

DOI:

https://doi.org/10.33448/rsd-v11i11.33621

Keywords:

Epilepsy; Polypharmacy; Unified Health System; Anticonvulsants; Aged.

Abstract

Introduction: Epilepsy is a chronic alteration with modifications in brain functions, which can lead to loss of consciousness and presents partial or focal epileptic seizures. There are different etiologies for epilepsy, characterizing a varied treatment according to the particularity of the individual, which accentuates polypharmacy. Objective: To evaluate polypharmacy related to the treatment of epilepsy in the Brazilian public network, recognizing the exacerbated or inappropriate use of medications. Methodology: This is an integrative literature review conducted between the months of April and June 2022 in the following databases: National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (Scielo), Cochrane Database of Systematic Reviews (CDSR), Google Scholar, Virtual Health Library (VHL), Virtual Health Library (VHL), and EBSCO Information Services. Results and discussion: About 50% of patients with epilepsy consume multiple medications, which increases morbidity and mortality due to the risks of adverse effects and the ability to increase seizures.  Epilepsy leads to autointoxication as a consequence of polypharmacy, especially in the elderly, due to pharmacological interactions, which must be monitored by doctors. The Brazilian Unified Health System has pharmaceutical assistance that promotes the rational use of drugs, seeking to select and standardize the drugs that are indicated and made available. Final considerations: Epileptic patients using polypharmacy tend to develop problems that hinder psychosocial performance and present a higher risk of adverse effects due to pharmacological interactions. Therefore, rational pharmacological use by balancing benefits and disadvantages becomes necessary.

References

Akerman, M., & Freitas, O. (2017). Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM): avaliação dos serviços de atenção farmacêutica primária. Rev Saude Publica, 1–5.

Anghelescu, A., Onose, G., Ciobanu, V., Mihalache, R., Spanu, A., Popescu, C., Oprea, M., Firan, C. F., & Capisizu, A. (2022). Late-Onset Epilepsy in the Elderly: Difficulties of Diagnosis and Personalized Pharmacological Management, With Particularities To Covid-19 Pandemic – Systematic Review of Literature. Farmacia, 70(2), 184–197. https://doi.org/10.31925/farmacia.2022.2.2

Assis, T., Bacellar, A., Côrtes, L., Santana, S., Costa, G., & Nascimento, O. (2021). Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center. Arquivos de Neuro-Psiquiatria, 79(1), 22–29. https://doi.org/10.1590/0004-282X-ANP-2020-0012

Baftiu, A., Feet, S. A., Larsson, P. G., Burns, M. L., Henning, O., Sætre, E., Molden, E., Granas, A. G., Johannessen, S. I., & Landmark, C. J. (2018). Utilisation and polypharmacy aspects of antiepileptic drugs in elderly versus younger patients with epilepsy: A pharmacoepidemiological study of CNS-active drugs in Norway, 2004-2015. Epilepsy Research, 139, 35–42. https://doi.org/10.1016/J.EPLEPSYRES.2017.11.001

Alexander, H. B., Broshek, D. K., & Quigg, M. (2018). Quality of life in adults with epilepsy is associated with anticonvulsant polypharmacy independent of seizure status. Epilepsy & Behavior, 78, 96-99.

Bear, M. F., Connors, B. W., Paradiso, M. A. (2017). Neurociências: desvendando o sistema nervoso. 4ª ed. Porto Alegre: Artmed.

Bjørke, A. B., Nome, C. G., Falk, R. S., Gjerstad, L., Taubøll, E., & Heuser, K. (2018). Evaluation of long-term antiepileptic drug use in patients with temporal lobe epilepsy: Assessment of risk factors for drug resistance and polypharmacy. Seizure, 61, 63–70. https://doi.org/10.1016/J.SEIZURE.2018.07.011/ATTACHMENT/4143A8FD-659B-497B-8531-7FCBACFFB004/MMC1.DOCX

Brasil (2018). Portaria no 159, de 21 de junho de 2018. Ministério da Justiça.

Jameson, J. L., Fauci, A. S., & Kasper, D. L. et al. (2021). Manual de medicina de Harrison. 20ª ed. Porto Alegre: AMGH.

Marchetti, R. L., Proença, I. C. G. F. (2019). Manual Prático de Neuropsiquiatria da Epilepsia. 1ª ed. Rio de Janeiro: Elsevier.

Moran, S., Peterson, C., Blackberry, I., Cook, M., Walker, C., Furler, J., Shears, G., Piccenna, L., & Richards Centre, J. (2020). Antiepileptic Drugs, Polypharmacy, and Quality of Life in People Living with Epilepsy Managed in General Practice. International Journal of Epilepsy, 6(1), 24–29. https://doi.org/10.1055/s-0040-1712074

Nascimento, R. C. R. M., Álvares, J., Guerra Junior, A. A., Gomes, I. C., Silveira, M. R., Costa, E. A., Leite, S. N., Costa, K. S., Soeiro, O. M., Guibu, I. A., Karnikowski, M. G. de O., & Acurcio, F. de A. (2017). Polifarmácia: uma realidade na atenção primária do Sistema Único de Saúde. Revista de Saúde Pública, 1–12. https://doi.org/10.11606/S1518-8787.2017051007136

Nevitt, S. J., Sudell, M., Cividini, S., Marson, A. G., & Tudur Smith, C. (2022). Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data. Cochrane Database of Systematic Reviews, 2022(4). https://doi.org/10.1002/14651858.CD011412.PUB4/FULL/PT

Perucca, P., & Gilliam, F. G. (2012). Adverse effects of antiepileptic drugs. The Lancet Neurology, 11(9), 792–802. https://doi.org/10.1016/S1474-4422(12)70153-9

Ramos, L. R., Tavares, N. U. L., Bertoldi, A. D., Farias, M. R., Oliveira, M. A., Lucia Luiza, V., Pizzol, T.S. D., Arrais, P. S. D., & Mengue, S. S. (2016). Polifarmácia e polimorbidade em idosos no Brasil: um desafio em saúde pública. Revista Pública de Saúde, 50(2), 1–13. https://doi.org/10.1590/S1518-8787.2016050006145

Rani, R. A., Razali, R., Hod, R., Mohamad, K., Rani, S. A. M., Yahya, W. N. N. W., Sahathevan, R., Remli, R., Law, Z. K., Ibrahim, N. M., & Tan, H. J. (2014). Suicidal ideation amongst epilepsy patients in a tertiary centre. Neurology Asia, 19(2), 129–136. https://doi.org/10.13140/2.1.1443.2968

Terman, S. W., Aubert, C. E., Hill, C. E., Maust, D. T., Betjemann, J. P., Boyd, C. M., & Burke, J. F. (2020). Polypharmacy in patients with epilepsy: A nationally representative cross-sectional study. Epilepsy & Behavior : E&B, 111. https://doi.org/10.1016/J.YEBEH.2020.107261

Terman, S. W., Aubert, C. E., Maust, D. T., Hill, C. E., Lin, C. C., & Burke, J. F. (2022). Polypharmacy composition and patient - and provider -related variation in patients with epilepsy. Epilepsy and Behavior, 126, 1–8. https://doi.org/10.1016/J.YEBEH.2021.108428

Trindade, G. V. de M., Sousa, D. A. G., Duarte, A. E. S., Silveira, J. L. F. da, Oliveira, R. L. de, Ferreira, L. de C., Peixoto, P. P. L., & Melo, A. C. de. (2021). Non-psychiatrist prescriptions within the Brazilian National Health System represents a risk to patients in the use of psychotropic pharmacotherapies. Research, Society and Development, 10(15), e455101522971–e455101522971. https://doi.org/10.33448/RSD-V10I15.22971

Valova, V., Kochan, A., Werry, B., John, R., Prager, C., Schneider, J., & Kaindl, A. M. (2020). Early Onset, Long Illness Duration, Epilepsy Type, and Polypharmacy Have an Adverse Effect on Psychosocial Outcome in Children with Epilepsy. Neuropediatrics, 51(2), 164–169. https://doi.org/10.1055/S-0039-3399529

World Health Organization. (2019). Medication Without Harm – Global Patient Safety Challenge on Medication Safety. Geneva: World Health Organization, 2019.

Published

26/08/2022

How to Cite

PEREIRA, A. K. A. .; NOGUEIRA, E. C. .; BRITO , E. N. D. .; ALMEIDA , M. G. de .; NASCIMENTO, S. C. da S. .; SANTOS, S. C. dos . Polypharmacy for the treatment of epilepsy in public health-care: an integrative literature review. Research, Society and Development, [S. l.], v. 11, n. 11, p. e398111133621, 2022. DOI: 10.33448/rsd-v11i11.33621. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/33621. Acesso em: 24 dec. 2024.

Issue

Section

Health Sciences