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Epilepsy Research in Mali: A Pilot Pharmacokinetics Study on First-Line Antiepileptic Drug Treatment

Journal of Epilepsy Research 2020년 10권 1호 p.31 ~ 39
Sangare Modibo, Doumbia Fatoumata, Sidibe Oumar, Oumar Aboucacar Alassane, Bah Sekou, Kouyate Modibo, Diakite Seidina S., Traore Karim, Karembe Adama, Haidara Mohamed S.,
소속 상세정보
 ( Sangare Modibo ) - University of Sciences, Techniques and Technologies of Bamako Faculty of Medicine and Odontostomatology
 ( Doumbia Fatoumata ) - University of Sciences, Techniques and Technologies of Bamako Faculty of Medicine and Odontostomatology
 ( Sidibe Oumar ) - University of Sciences, Techniques and Technologies of Bamako Faculty of Pharmacy
 ( Oumar Aboucacar Alassane ) - University of Sciences, Techniques and Technologies of Bamako Faculty of Pharmacy
 ( Bah Sekou ) - University of Sciences, Techniques and Technologies of Bamako Faculty of Pharmacy
 ( Kouyate Modibo ) - University of Sciences, Techniques and Technologies of Bamako African Center of Excellence in Bio-informatics
 ( Diakite Seidina S. ) - University of Sciences, Techniques and Technologies of Bamako Faculty of Medicine and Odontostomatology
 ( Traore Karim ) - University of Sciences, Techniques and Technologies of Bamako Faculty of Pharmacy
 ( Karembe Adama ) - University of Sciences, Techniques and Technologies of Bamako Faculty of Medicine and Odontostomatology
 ( Haidara Mohamed S. ) - University of Sciences, Techniques and Technologies of Bamako Faculty of Medicine and Odontostomatology

Abstract


Background and Purpose: The indication and benefit of plasma level of antiepileptic (AEDs) has been debating in the monitoring of people living with epilepsy and the epilepsy treatment gap has largely been documented in developed countries. This study was aimed to highlight the epilepsy treatment gap between rural and urban Mali.

Methods: We conducted a pilot study on AEDs treatment from September 2016 to May 2019. For 6 months, 120 children and young adults living with epilepsy (rural site, 90; urban site, 30) received phenobarbital, valproic acid and/or carbamazepine. At our rural study site, we determined the AED plasma levels, monitored the frequency, severity and the duration of seizure, and administered monthly the McGill quality of life questionnaire. At our urban study site, each patient underwent an electroencephalogram and brain computed tomography scan without close monitoring.

Results: At the rural study site, patients were mostly on monotherapy; AED levels at 1 month (M1) (n=90) and at 3 months (M3) (n=27) after inclusion were normal in 50% at M1 versus 55.6% at M3, low in 42.2% at M1 versus 33.3% at M3 and high in 7.8% at M1 versus 11.1% at M3. AED levels at M1 and at M3 were significantly different p<0.0001. By M3, seizures (n=90) were <1/month in 26.7%, and lasted less than 1 minute in 16.7%. After a yearlong follow up, all 90 patients reported a good or excellent quality of life. At our urban study site, patients (n=30) were on carbamazepine and valproid acid in 66.67% and monotherapy (carbamazepine) in 33.33%. By November 2018, only six out 30 patients (on bi-therapy) were still taking their medications.

Conclusions: Epilepsy diagnostic and treatment are a real concern in Mali. Our data showed appropriate AED treatment with close follow up resulted in a better quality of life of patients in rural Mali. We will promote the approach of personalized medicine in AED treatment in Mali.

키워드

Epilepsy; Carbamazepine; Quality of life; Phenobarbital; Valproic acid; Mali

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