Paul C Ho
National University of Singapore, Singapore
Title: Prevalence of drug resistant epilepsy (DRE) and the value of therapeutic drug monitoring (TDM) and utilization of dried blood spots for TDM in epilepsy
Biography
Biography: Paul C Ho
Abstract
The objective of study is to determine the proportion of population of adult people with epilepsy (PWE) in Singapore to have drug resistant epilepsy (DRE). 557 adult PWE who have attended the neurology specialist clinic of a tertiary referral hospital in Singapore were profiled for drug responses according to the definition for DRE as specified by the International League against Epilepsy (ILAE) 2010 consensus. This is a retrospective cohort study. Data collected included demographics, characteristics of seizure and epilepsy, blood biochemistry levels, electroencephalogram and brain imaging findings, and medication histories. The types and dosages of antiepileptic drugs (AEDs) used were retrieved from case notes and checked against pharmacy records. Each patient was counselled upon the diagnosis of epilepsy and taught to maintain a seizure diary. The dates and number of seizures were retrieved from these diaries at each visit. Treatment-related adverse effects were routinely assessed and hence, patients were assumed not to have treatment-related adverse effects when no relevant documentation was encountered. The prevalence rate of DRE in this clinic was 21.5%. From multivariate analysis, patients with structural-metabolic etiology, mental retardation, psychiatric illnesses and pre-treatment seizure frequency of more than once monthly were found to be more likely to have DRE (p≤0.05). Although the influence of Indian ethnicity on the risk of DRE was only found in the univariate analysis, it warrants investigation in a larger cohort.