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.