DISSCUSION
Epilepsy is a relatively common condition characterized by a tendency
for recurrent seizures, which is due to the disturbance of spread of
electrical discharge of the cortical
neurons.19Epilepsy is either: idiopathic when there is
no underlying cause or secondary if there is an underlying cause egg
brain tumors, stroke. Clinically seizures are divided into two basic
categories, generalized and focal. As many as 80% of epilepsy patients
can be controlled with anti-epileptic drugs. The type of medication
prescribed depends on the type of seizure, the underlying cause of the
epilepsy, the age of the patient, possible side effects, and the
availability of the medication. Treatment usually starts with a low dose
and then gradually increases. In most patients, the epilepsy will
subside after a few years and medications can be stopped gradually.
Phenytoin is effective for the treatment of focal and tonic clonic
seizures.Carbamazepine is effective in the treatment of focal and
generalized tonic-clonic seizures, while phenobarbital is as effective
as phenytoin and carbamazepine in clearing focal and generalized
tonic-clonic seizures. On the other hand, sodium valproate is effective
for all types of epilepsy patients. The occurrence of adverse effects
unrelated to the dose, is particularly prominent during the initiation
of therapy (especially with carbamazepine and valproic acid), but
disappear as tolerance develops. For this reason, therapy with these
drugs should be started on low doses and the dose slowly titrated up to
the recommended maintenance over several weeks. 20
Cosmetic effects of AEDs are of particular concern among women because
they can damage body image and self-esteem. Adverse effects of
antiepileptic drugs (AEDs) are common, can have a considerable impact on
quality of life and contribute to treatment failure in up to 40% of
patients. Women are more likely to experience Cosmetic side effects
(CSEs) compared with men. Like what was reported by other researchers’
worldwide cosmetic side effects (CSEs) such as weight gain
and alopecia are common among our studied group and occurred commonly
among patients taking sodium valproate.21 Current
guidelines recommend valproate (VPA) as a treatment of first choice for
patients with generalized onset seizures. Weight gain is a known
dose-related side effect of valproic acid that more commonly is seen in
women. Polycystic ovary disease and hyperandrogenism are common in women
taking valproate. Hyperandrogenism presents as hirsutism, acne, or
male-pattern alopecia. Other AEDs, such as felbamate and topiramate, are
associated with significant weight loss, occasionally requiring
discontinuation of the AEDs.Like what was mentioned in the literature
phenytoin causes excessive hair growth, particularly on the face and
arms, as well as facial acne and coarsening.21Gingival hypertrophy was reported in 13% of persons taking phenytoin.
Like what was mentioned in the literature maculopapular rashes were
noted in 3% of our patients started on carbamazepine, phenytoin,
phenobarbital, and lamotrigine.22Rarely severe
mucocutaneous reactions such as Stevens-Johnson syndrome, and toxic
epidermal necrolysis can occurred with the use of these antiepileptic
drugs. 23Patient taking phenobarbital can have many
skin reactions, including: morbilliform, urticaria, erythema multiforme,
photosensitivity, acneiform rash, and purpura. Skin eruptions are
significantly more likely if lamotrigine is given with valporic acid,
especially if the recommended dose is exceeded.Adverse effects of
Lamotrigine may include serious toxic epidermal necrolysis, in which
alopecia is a well-known phenomenon. The occurrence of
carbamazepine-induced alopecia is at or below 2%.24Hair loss is a side effect of patients taking aromatic anticonvulsants,
but it rarely occurs after such drugs are discontinued during recovery
from anticonvulsant hypersensitivity syndrome. 24
Epilepsy has diverse effects on the overall wellbeing or subjective
quality of life (QOL) of the patients.25 QOL in epilepsy is associated
with several factors. These factors include clinical variables (for
example, seizure frequency, severity, illness duration, treatment side
effects and psychiatric co- morbidities), social disadvantages (for
example, divorce, unemployment, social stigma, and illness intrusion
into social life), and family circumstances (such as family caregiver
characteristics and social support).25Adverse effects
of antiepileptic drugs have emerged as one of the strongest predictors
of impaired health-related quality of life, independent of seizure
outcome. 26