ABSTRACT
Although the pharmacological nature of the role of antiepileptic medication in explaining the occurrence of sudden unexpected death and epilepsy (SUDEP) is not known, it is generally accepted that noncompliance with prescribed medication is one of the possible risk factors for SUDEP. e control of seizures by anticonvulsant medication is a function of having an optimal, stable therapeutic blood level of a drug that is eectively preventing the recurrence of seizures. Factors that can aect compliance with taking eective doses are the presence of side eects and the aordability of the medication. In response to the former issue, that is, side eects, if the patient nds that the therapeutic level produces symptoms such as drowsiness, slowed thinking, depression, or balance problems, he or she may elect, without consulting a physician, to decrease the dose, resulting in seizures. Likewise, the cost of more expensive medication may result in taking fewer doses to extend the time between medication rells, thereby prolonging the interval between payments. is chapter uses an example of how odds ratio analysis can address cost, side eects, and ecacy issues that should be more systematically addressed in helping to optimize the compliance to treatment of persons with epilepsy and achieving maximal seizure
46.1 Why Is Compliance with Antiepileptic Drugs a Continuing Issue? 743 46.2 Clinical Pharmacology: Drugs as a Benet and/or Risk in Sudden Unexpected
Death in Epilepsy? 745 46.3 Odds Ratio Methods 745 46.4 Use of ORs to Examine Clinical Pharmacology of Topiramate vs. Lamotrigine
vs. Phenobarbital: Comparison of Ecacy and Side Eects Using ORs 746 46.4.1 Ecacy ORs for Topiramate vs. Lamotrigine vs. Phenobarbital 747 46.4.2 Side Eects of ORs for Topiramate vs. Lamotrigine vs. Phenobarbital 748 46.4.3 Comparison of Costs for the ree AEDs 748
46.5 Discussion 749 References 752
control, thereby helping to minimize the risk of SUDEP. is chapter and the subsequent ve chapters provide discussion that, in part, emphasizes the importance of antiepileptic drug (AED) compliance and factors that may have an adverse eect on patient compliance, such as AED side eects.
