Epilepsy was 33 years and was highest among middle

Epilepsy is a chronic and serious
neurological disorder with multifarious
un-certainties and stigmatization which have significant negative role in the
QOL of those PLWE, in which lack of medication adherence plays a major role.
The main objective of the study was to determine the impact of pharmacist
assisted patient counseling for improving medication adherence and QOL in
epileptic patients.

In our study, we saw that incidence of
epilepsy can occur at any age, in this study the mean age of population was 33
years and was highest among middle adulthood. This is comparable with study
done by Emanuela BB et al30 who reported that the median of age of
the study population was 33 years without significant differences in patient
age based on gender.

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Incidence noticed that the most affected
gender were males (60%) and females (40%). This result is correspondent with
Hiwot G et al58, the study shows that 59.4% were males and 40.6%
females. The results of our study indicated that mostly males were showing non
adherence to AEDs than female.

Marital status and education are major
concerns in epilepsy patients. In our study 71% of study population were
married. More than half of the population were literate and only 2% were
illiterate. However many other studies reveal that high percentage of patients
were illiterate.

Among all the type of epilepsy Generalized
tonic clonic seizure (GTCS) was found to be pre-dominant in our study.81% of
the patients had generalized type of epilepsy. Study conducted by Shakirullah
et al18, shows that GTCS type of epilepsy is common among other type
of epilepsy.

During our study we observed that control
of seizure attack is the main objective in management of epilepsy. There was a
variation in the number of seizure attacks in enrolled study patients. The
majority of patients reported 1-3 attacks per year.  Based on our data seizure can be triggered by
various factors which includes stress 33% , missed medication 27%, lack of
sleep 7%, alcohol consumption 7%, special time 7% , poor follow-up 7% and
unknown factors 12% , a  study conducted
by E. Balamurugan et al.10 supports our data.

In our study we observed the pattern of
AED treatment given to PLWE.Monotherapy which is the gold standard of managing
epilepsy, 53% of patients were administered antiepileptic monotherapy. However
patients who do not respond to monotherapy were prescribed poly therapy (two or
more drugs ) with the aim of controlling seizure. In this study 47% of PLWE
were given poly-therapy. Nuruluni A et al2 got similar result. In
monotherapy most widely used drugs were Phenytoin 63%, Levetiracetam 15% ,
Divalproex sodium 6%, Phenobarbital 5%, Carbamazepine 5% ,Valproic acid 5% and
Lamotrigine 1% .In poly-therapy most commonly prescribed combination was
phenytoin with phenobarbital. This is supported by study conducted by Sanjeev
V.T et al42.  Major side
effects related to therapy reported by the subjects include weakness, headache
gastric irritation, joint pain, hypersensitivity reaction, rashes, weight gain,
memory deficit and nystagmus. Out of this weakness was the major side effect
experienced by the patients. Martin H.H et al60 observed drowsiness
as the major side effect related to AED therapy.

In our study we used validated structured
questionnaire and QOLIE-31 for measuring medication adherence and QOL in
epilepsy patients respectively. During our research, we were able to see that
medication adherence is the major factor influencing the QOL of epileptic
patients, high medication adherence results in seizure control which in turn
positively affect patient QOL. In our study a significant correlation
(p<0.05) between QOL and medication adherence was obtained which is in agreement with the study conducted by Ayswarya P. et al35.  QOL and medication adherence are important parameters in epilepsy management which can be improved by proper education given to the patients about the disease, treatment duration, side effects and need of adherence. Identifying the adherence intension is important in patients with epilepsy. Medication adherence plays a significant role in managing epilepsy, in our study 91.05% patients were non-adherent to AED. On the other hand Temesgen Y.H et al37 found that adherence to AED was 32%. Assessment of Medication Adherence was done using validated structured questionnaire .91.5% patients were found to be non- adherent to AEDs during baseline measurement. After providing educational intervention as per methodology the non adherence of AED taking patients were found to be 54.47% during first follow up and 25.20% during second follow up. Statistical analysis of medication adherence from baseline value to second follow up value shows significant result p<0.05.In case of QOL the overall T score mean of sample population was found to be 34.04±7.40 before counseling and after counseling the first follow up overall T score mean was found to be 49.67±11.459,second follow up overall T score mean was found to be 55.70±9.87. Statistical analysis of QOL reveals a significant result (p<0.05) from baseline to second follow up. The study conducted by Kanitpong P et al. shows similar significance (p<0.05). Thus through our study we were able to see that patient counseling had a significant impact on medication adherence and QOL. Also the study shows that medication adherence improves the QOL45. Most of the epilepsy study was concentrated on QOL which is a multi-factorial construction that describe an individual perceptions of their physical, psychological, social functioning and wellbeing. The QOLIE-31 scale consists of 7 domains (seizure worry, overall QOL, energy/fatigue, emotional well-being, medication effects, cognitive function and social function) and allows to assess QOL in epilepsy patients based on these domains. In this study the overall baseline T score is found to be 34.04± 7.40.Low T scores are obtained for subscales overall QOL 32.20±10.66, emotional wellbeing 35.15±7.81, seizure worry 35.42±7.17, social function 7.32±7.12,energy/fatigue 39.20±7.38, medication effects 44.42±7.58, and cognitive function 45.42±9.59. Ayswarya P et al35. reported that social function, emotional wellbeing, were the most affected domains of QOL in people with epilepsy. QOLIE-31 includes 7 domains among which overall QOL was more affected. There was a statistically significant improvement in overall QOL after the counseling (p<0.0001). This study highlights the importance of medication adherence directly correlating in improving QOL in epilepsy patients. The study concluded that epilepsy patients had poor QOL and medication adherence. Significant association was found between medication adherence and QOL. Thus, when medication adherence increased, it leads to improved QOL. Patient counseling plays an important role in improving medication adherence and QOL in epilepsy patients. The measurement of QOL in epilepsy patients is essential to have an in-depth understanding of the effect of disease on various dimensions of health. Therefore, adherence intention should be monitored to provide appropriate support in improving quality of life in epilepsy patients. Adherence to medication, assessing QOL and providing patient education should be a routine part of the epilepsy management.