4.1 Efficacy
Previous studies on education effect on efficacy measured by the number
of seizure free patients showed controversial results. Ibinda et
al. (2014) had similar findings to ours, but education was provided by
a nurse or clinical officer, it was found that there was no significant
difference in number of seizure free patients between the intervention
and the control groups, (50.8% vs. 46.8%), even after a follow up
period of one year, a longer follow-up time than ours (22). Moreover,
Tang et al . (2014) studied the effect of education by pharmacist
in 59 patients with epilepsy. It showed a significant improvement in
seizure control after a follow up period of six months, as the
percentage of seizure free patients were increased from 5.7% to 50.9%,
but it lacked a control group (i.e. with no education), thus, results
from this study should be interpreted with caution (9). On the other
hand, the effect of an educational program called MOSES showed
significant improvement in seizure frequency in the intervention group
compared to the control group over a period of six months, 19% improved
in the intervention group vs. 7.2% in the control (P -value 0.04)
(23).
As we provided education to all patients receiving AEDs regardless of
their type, we did not perform a blood sampling for TDM as a measure of
treatment efficacy as in Ma et al . (2019) study because not all
AEDs have an established therapeutic drug concentration to monitor, and
the researchers in the above study provided education only to patients
who received the AED Valproic acid which makes their results only
applicable to this specific type of patients (24). Chen et al(2013) evaluated the effect of education by pharmacist on caregiver’s
knowledge about epilepsy, and it was found to increase the caregivers’
knowledge significantly, but it did not correlate the effect of this
increase in knowledge with the efficacy of treatment as this study did,
and it had a sample size of 27 caregivers only (8). A significant direct
correlation was found in our study between the number of seizures and
the number of AEDs prescribed to the patient and this is expected as
when the patient is experiencing more seizures, he will be prescribed
more AEDs to control them.