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The goal of epilepsy treatment is to control seizures without drug related problems (DRPs). The evaluation of anti-seizure drugs (ASD) strategies and identification of DRPs are rarely studied. This study aimed primarily to evaluate the choice of ASD according to international guidelines and secondarily to identify and describe anti-seizure drug-related problems.A cross-sectional study was conducted during 1 year among Lebanese adults with epilepsy attending neurology clinics. The choice of ASD was compared to National Institute for Health and Care Excellence guidelines. Drug-drug interactions were evaluated by the Lexicomp database, and the DRP classification was performed using the Pharmaceutical Care Network Europe classification.A total of 404 patients with epilepsy were included. The prescription for an ASD was in accordance with the indication set in guidelines in 75.0% of population, and 1078 DRPs were identified. The main DRPs detected were adverse drug reactions (51.0%), inappropriate combinations of drugs (50.0%), and suboptimal drug regimens (46.3%). Single and divorced patients, who living in Mount Lebanon, and who took the old with the new generation had a less risk to have an inadequate prescription to guidelines. However, female gender, controlled epilepsy, multiple ASDs, and living in a rural region increased DRPs.This study showed that quarter of the population used ASDs contraindicated according to international guidelines. Since DRPs were related to the number and type of ASD prescribed, it is important to assess the case of each patient by a clinical pharmacist to prevent drug-drug interactions and iatrogenic issues.

To evaluate the effect of clinical pharmacy interventions on the unplanned rehospitalizations rates of elderly people admitted for fall to the elderly emergency medicine (EEM) unit in a teaching hospital. DESIGN AND MEASURES This was a longitudinal, comparative pilot study. Patients aged at least 75 who were admitted to the EEM unit for a fall and who had at least two chronic diseases and who were being treated with two or more medications were included from February 1, 2018 to June 30, 2018 and followed by 90 days. The main outcomes were the unplanned rehospitalizations rate at Limoges Teaching Hospital within the 90 days (primary outcome), 30 days and 72 hrs. The estimated cost-saving was also assessed. RESULTS We included 252 patients. The mean age was 88.4 ± 5.8 years and the average baseline number of medications was 8.3 ± 3.4. In total, 158 pharmaceutical interventions were performed, reflecting an acceptance rate of 94.9%. We found a significant reduction of the rate of unplanned rehospitalizations at 90-day (OR = 0.45 (0.26-0.79) p = 0.005). These results were still consistent at 30-day (p = 0.035) and 72 hours (p = 0.041). We found a cost-saving of 37,770 euros related to 21 avoided rehospitalizations. CONCLUSIONS Our results highly emphasize the positive effects of clinical pharmacy services on the prevention of unplanned rehospitalizations of old adults admitted for fall.

People with epilepsy (PWE) face a variety of psychosocial challenges. A lack of knowledge of epilepsy, a high level of depression and anxiety and a low quality of life (QoL) are among the major problems that affect most PWE. The objective of this study was to examine the association of sociodemographic characteristics, clinical factors and knowledge of epilepsy with the level of QoL, and the presence of psychiatric comorbidities.A cross-sectional study was conducted in Lebanon. The PWE were recruited from neurologists' clinics in Beirut and its suburbs. A questionnaire translated into Arabic was used and composed of four parts: sociodemographic factors, clinical characteristics, psychosocial characteristics (QoL, psychiatric disorders), and knowledge epilepsy scale. Backward logistic regression models were developed, the associations were estimated by odds ratio (OR), and the level of significance was set at p ≤ 0.05.Four hundred and four PWE were recruited in this study. About a half of PWE had controlled epilepsy (46.3 %) and 40.3 % had epilepsy for less than 5 years. The QoL was low for 38.6 % of PWE and 30.2 % had psychiatric comorbidities. More than half of PWE had a good level of knowledge (71.5 %). Controlled epilepsy (OR = 1.8; 95 %CI: 1.2-2.9), and good knowledge about epilepsy (OR = 5.5; 95 %CI: 3.4-9.1) were associated with better QoL. Patients on polytherapy with anti-seizure drugs (OR = 0.6; 95 %CI: 0.4-0.9), experienced side effects of anti-seizure drugs (OR = 0.6; 95 %CI: 0.4-0.9) and with psychiatric comorbidities (OR = 0.6; 95 %CI: 0.3-0.9) had a lower QoL. A high number of nonpsychiatric comorbidities (OR = 2.5; 95 %CI: 2.0-3.1) and a polytherapy increased the risk of having psychiatric comorbidities (OR = 1.8; 95 %CI: 1.1-2.8).Good knowledge of epilepsy and the absence of psychiatric comorbidities are important predictors of good QoL in Lebanese PWE. Educational programs are needed to reduce misconceptions about epilepsy and improve mental health of PWE.

Relevance More than 70 million people suffer epilepsy worldwide. Low availability of anti-epileptic drugs, side-effects and drug-resistant epilepsy affect the quality of life of persons with epilepsy in countries with a poorly developed health system. Herbal medicine is frequently used for this neurological condition. Objectives The main objective was to provide a detailed analysis of Herbal Medicine used for neurological conditions related with epilepsy in Asia, Africa and Latin America. More broadly, this study aims to highlight species with assessed efficacy (cross-cultural use, pharmacological effects on models of epileptic seizures) and safety (toxicological data in laboratory) information, in order to point out species of interest for further studies. A critical assessment of models used in pharmacological evaluations was done. Materials and methods The systematic search for Herbal Medicine treatments for epilepsy was performed considering all the articles published until February 2017 through three scientific databases. It was made with MeSH terms and free text defining the epilepsy seizures and plant species. We included studies carried out in Asia, Africa and Latin America. All articles reporting the use of Herbal Medicine to treat epilepsy seizures and/or their pharmacological evaluation were retained for further analysis. Results The search yielded 1886 articles, from 30 countries. Hundred and six articles published between 1982 and 2017 were included, corresponding to a total of 497 use reports for 351 plant species belonging to 106 families. Three hundred and seventy seven use reports corresponding to 264 species in ethnopharmacological surveys and 120 evaluation reports corresponding to 107 species were noted. Twenty-nine reports, for 29 species, combined both ethnopharmacological and pharmacological evaluation. Fifty eight studies originated from Africa, 35 studies from Asia and 18 from Latin America. Highest use report was noted for rhizomes of Acorus calamus L. (12 use report in 1 country) and leaves of Bacopa monnieri (L.) Wettst. (8 use report in 2 countries). Therefore these species display the highest use convergence. Regarding pharmacological evaluation most studied species were: Leonotis leonurus (L.) R.Br. (4 evaluation reports in 1 country), Uncaria rhynchophylla (Miq.) Miq. ex Havil. (3 evaluation reports in 2 countries) and Calotropis gigantea (L.) Dryand. (3 evaluation reports in 1 country). In vivo models of chronic epilepsy were more relevant than in vitro models or chemical models inducing acute seizures for pharmacological assessment. Conclusion Species with the highest use report were not those with pharmacological evaluation. It will be pertinent to assess the pharmacological effects and safety of medicinal plants used mostly by traditional healers on predictive models of seizures.

International audience; Background: Epilepsy is among the more stigmatising diseases, leading to a negative impact on the quality of life (QoL) of people with epilepsy (PWE). Assessment of the QoL and stigma in PWE reflects the outcome of their disease, and the findings can be used to improve the management of epilepsy. To fill a gap in the literature, our primary aim is to evaluate the QoL and stigma in Lebanese PWE, and our secondary aim is to identify factors affecting these parameters.Material and methods: A cross-sectional study was conducted for 1 year in Greater Beirut. PWE were interviewed by using a standardised questionnaire. QoL was evaluated by the QoL in Epilepsy Inventory-10 (QOLIE-10), and the stigma was evaluated by the Jacoby scale. Multivariate analyses were used to identify the factors associated with QoL and stigma.Results: The sample was 404 PWE. More than half of the PWE (61.4 %) had a better QoL than the other PWE (mean QOLIE-10 score of 26.9 ± 11.3), and 47.8 % of PWE felt stigmatised. Linear regression showed that presence of psychiatric comorbidities (p = 0.03), stigma (p < 0.001), experiencing side effects (p = 0.001), polytherapy (p = 0.002), living in a northern area (p = 0.003), and older age (p = 0.004) were the major factorsassociated with a poor QoL. Logistic regression showed that a low level of QoL (p = 0.005) and experiencing side effects (p = 0.045) were associated with a high level of stigma.Conclusions: An appropriate treatment based on a monotherapy can reduce the risk of side effects, improving QoL of PWE, and decreasing stigma. Furthermore, the management of depression by specialists is an essential step to improve the QoL of Lebanese PWE. Education programmes and information on epilepsy and treatment also play a major role in reducing stigma.

Background Epilepsy is a common worldwide neurological disorder. For people with epilepsy (PWE), adherence and attitudes towards medication is a crucial step to improve efficacy of prescribed treatment and to prevent seizures. Objectives The first aim of this study was to evaluate attitudes towards antiepileptic medications in Lebanese population. Secondary aims were to assess factors affecting attitudes and associated with epilepsy control. Material and methods A cross-sectional study was conducted in outpatient neurology clinics located in Beirut-Lebanon. Data were collected using a structured questionnaire. Self-report of medication taking behaviors were assessed using the abbreviated (4 items) Morisky Medication Adherence Scale (MMAS-4). Epilepsy was considered as controlled if the patient had no seizures in the last 6 months. Results Among 250 PWE recruited in this study, male-to-female ratio was 0.87 (116/134), and 50.8% were married. Mean duration of epilepsy was 13.7 ± 12.8 years. Valproate was the most common antiepileptic drug (AED) used followed by levetiracetam and carbamazepine. About 60.8% of the population presented partial epilepsy. Uncontrolled epilepsy was present in more than half of participants (55.2%), with only 32.4% had positive attitudes to their medication. Positive attitudes towards antiepileptic increased in people who found that their treatment was efficacious (odds ratio (OR) = 4.9; 95% confidence interval (CI): 1.2–20.0; p = 0.03), who had controlled epilepsy (OR = 3.4; 95%CI 1.6–7.1; p = 0.001), and who were diagnosed as PWE between the age of 12–20 years (OR = 3.1; 95%CI 1.1–8.4; p = 0.03). Oppositely, these attitudes decreased in participants who felt their treatment as an economic burden (OR = 0.2; 95%CI 0.1–0.4; p ≪ 0.001), and in people with depression (OR = 0.4; 95%CI 0.2–0.9; p = 0.04). Controlled epilepsy was higher in people who contacted a neurologist if seizure occurred, in people with positive attitudes, and after a long duration of disease, but it decreased if patient did not follow neurologist's instructions in fasting period. Conclusions Lebanese PWE were less likely to have positive attitudes towards medication, which may lead to poor epilepsy control. Depression and economic burden were the major factors that decreased these attitudes. Identifying factors affecting attitudes to medication and leading to controlled epilepsy may help clinicians to elaborate educational programs to optimize medication adherence.

The purpose of this paper is to highlight the difficulties of applying neuroepidemiological methods in low income countries or developing countries, which are mostly tropical countries, taking advantage of the experience of the Institute of Neuroepidemiology and Tropical Neurology, which was created in Limoges in 1982. These difficulties could be related to several aspects: methodological, logistical, political or economical, linked to ethical issues, even difficulties to publish the studies. However, concept and neuroepidemiological methods should stay the same worldwide, even if their translation into practice could sometimes raise some problems in developing countries. Study protocol should be more detailed. Some specific epidemiological methods could be useful. Collection of data should be standardized. True cooperation at every level is needed for these researches to be valid.

Dans le cadre d’une prevention primaire du risque cardiovasculaire, l’evaluation du risque global permet de fixer le niveau-cible du LDL-cholesterol puis de mettre en oeuvre la prise en charge adequate. Elle comprend des mesures hygieno-dietetiques, a mettre en oeuvre pendant au moins 3 mois, avant d’envisager un traitement medicamenteux, qui se fonde en premiere intention selon les dyslipidemies sur les statines et les fibrates. En 2 nde intention, et le plus souvent en association, d’autres hypolipemiants sont envisageables.

Le fentanyl administre via les muqueuses buccales ou nasales permet de limiter les effets de 1er passage hepatique et intestinal. Il devient alors possible d’obtenir rapidement des concentrations efficaces pour traiter les acces douloureux paroxystiques des cancers, chez les patients adultes. Les effets indesirables, dont la depression respiratoire, devraient pouvoir etre evites grâce au respect du plan de gestion des risques assortissant les AMM et a une education therapeutique adaptee.

Apres la mise en place d’une unite de dispensation journaliere (UDJ) des medicaments, en 2003, a l’hopital Dupuytren de Limoges, la prescription informatisee a ete deployee dans le service de rhumatologie en octobre 2007, puis dans le service de chirurgie viscerale et transplantations en mars 2008. Afin de valider l’interet de ce nouvel outil informatique, une enquete de satisfaction a ete initiee par une interne en pharmacie aupres des chirurgiens et des infirmieres de ce service.

A partir des principes de la formation medicale continue (FMC) et de l’evaluation des pratiques professionnelles (EPP) en vigueur, les rapporteurs de l’Inspection generale des affaires sociales (Pierre-Louis Bras et Gilles Duhamel) proposent un nouveau concept : le developpement professionnel continu.

Depuis pres d’une decennie, l’Agence francaise de securite sanitaire des produits de sante mene diverses actions, la premiere en 1999, pour le bon usage des AVK. La Haute Autorite de sante, quant a elle, a diligente un groupe de travail sur la prise en charge des hemorragies, du risque hemorragique et du surdosage en antivitamine K qui ont fait l’objet de recommandations afin d’eviter les accidents thromboemboliques encore frequents.

International audience; Epilepsy is a chronic neurological disease affecting more than 69 million people worldwide, nearly 90% of them in low and middle-income countries (LMICs). In those countries, only four major antiepileptic drugs are commonly used: phenobarbital, carbamazepine, sodium valproate and phenytoin. There are also problems with the accessibility, availability and quality of drugs. The main objective was to review the literature concerning "long" sustained-release formulations of AEDs that have the potential to reduce the number of administrations and help overcome problems of compliance, accessibility and the treatment gap. The main endpoint was a releasing of the active ingredient over more than 24h. We also assessed the feasibility and acceptability in resource-limited settings. Two drugs were found in unconventional release formulations: carbamazepine and sodium valproate; but they were not "long" sustained release because they required administration once a day. Several techniques were available, including: esterification, transdermal devices, liposomes and polymeric devices preformed or formed in situ. In situ methods for the preparation of injectable biodegradable microparticles or implants for controlled delivery seemed best suited to the objective. Furthermore, they appear to fulfil the requirements of feasibility and cost. Sodium valproate appeared as well to be a relevant candidate for a "long" sustained release formulation that would improve access to medicines for people with epilepsy in resource-limited settings. .

OBJECTIVES: To contribute to a better knowledge of how epilepsy is perceived by traditional healers in Burkina Faso; what means they use to treat it, and how they think about modern treatment. MATERIAL AND METHODS: Individual interviews with 65 traditional healers chosen at random from members of the Reelwende Association. RESULTS: All traditional practitioners were of male gender. Most of them were above 50 years of age, and 75% had more than 10 years' experience. Epilepsy was considered to be contagious by 44% of the traditional practitioners, and hereditary according to 40% of them. Roughly, 15% of the healers think that the problem is localized in the head of a person and 7.8% think that they have worms in their head. Thirty-one per cent of them diagnose epilepsy if there is a combination of 'convulsions, sudden fall, dribbling and amnesia'. Another 15% require a combination of 'convulsions, amnesia and dribbling', the remaining 54% make the diagnosis based on one symptom or various combinations of two symptoms of 'grand mal' (generalized tonic clonic) seizures and most claim they have a treatment for it. For a quarter of them, therapeutic-means include concoctions of herbs or roots, baths and infusions. During the fit, 31% of the traditional practitioners think that nothing should be performed. According to 75% of them, traditional and modern treatments are complementary. CONCLUSION: Notwithstanding important differences in culture and religions (Muslim, Christian and Original), there is great similarity between the knowledge and beliefs about epilepsy reported from other parts of Africa and those presented by our study-group, suggesting an ancient origin of the concepts. Further study is needed to find out how other facets of epilepsy (e.g. complex partial seizures, absences) are perceived and how these are being treated. Ways need to be found to raise awareness about epilepsy without interfering with religious and cultural beliefs.

International audience

International audience; Background: The World Health Organization estimates that 50 million people worldwide have epilepsy and nearly 80% of them are found in developing countries. Although epilepsy responds to treatment in 70-80% of individuals, a major problem is the lack of access to appropriate treatment. Furthermore, we know that the treatment of epilepsy is limited by several factors: the difficulty of tracking the different stages of treatment, lack of qualified staff, the tools for securing the diagnosis, non-compliance with the therapeutic dosing because of beliefs, and the high cost of antiepileptic drugs (AEDs).Objective: The main objective of this study was to determine the most important actions necessary to improve the accessibility of anti-epileptic drugs (AEDs) in rural and urban areas in Ecuador.Patients and methods: An observational epidemiological study is underway in Quito and the province of Napo in Ecuador from January 2015, to September 2016. Different surveys will assess all the AED circuits including the Ministry of Health and national services, components of the medical circuit (wholesalers, drug manufacturers and retailers) prescribers and healthcare facilities and the people with epilepsy. We are going to use three sources of information (medical records, key informants and door-to-door surveys) to find patients with epilepsy in these study areas.Expected results: The goal is to identify the barriers and facilitators to access of care and especially of AEDs, one of the first steps needed to improve health access for patients with epilepsy in Ecuador.

International audience; Using an indirect assessment technique we assessed the epilepsy treatment gap (ETG) in Madagascar. We estimate the ETG in Madagascar to be 92%. However, given the sociological, economic and sanitary conditions of the country, it is likely that the true ETG is even higher than our estimate. Our study also documents the lack of access to treatment for patients in this developing country. The indirect method could be used to assess the treatment gaps of other chronic medical conditions.

Les medicaments sont variables selon le type de dyslipidemie, mais ils sont toujours accompagnes des mesures hygieno-dietetiques. Le regime alimentaire instaure, adapte au patient et a l’objectif therapeutique (correction d’une hypercholesterolemie, d’une hypertriglyceridemie et des hyperlipidemies), vise a modifier le comportement nutritionnel.

Introduction L’epilepsie touche 50 millions de personnes dans le monde. Plus de 80 % de ces patients vivent dans les PED dont 80% ne recevraient pas un traitement adapte. Dans ces pays, 70% de la population vivent en zone rurale. Objectifs Etudier la litterature relative a la prise en charge therapeutique de l’epilepsie dans les pays en voie de developpement, en zone rurale ou vivent de nombreux patients souffrant d’epilepsie. Methodes Il s’agit d’une recherche bibliographique croisant sur Medline les mots –– cles suivants : prise en charge ; epilepsie ; antiepileptiques ; zone rurale et pays en voie de developpement. Resultats 17 articles (1989 a 2005) sur plus de 1 500 patients concernaient l’Afrique, 56 %, l’Asie, 33 %, l’Amerique, 11 %. 77 % des etudes (duree : 2-60 mois) utilisaient : carbamazepine, phenobarbital, phenytoine et/ou valproate. 65 % incluaient du phenobarbital. 76 % exploraient l’efficacite ; 29 %, les effets indesirables et 58 %, l’observance. La reponse etait « satisfaisante » (30,7 %) et, dans 30,7 %, les crises, reduites d’au moins 50 % pour 18 % des patients, tendant vers leur disparition chez 64 %. Discussion Lorsque le traitement est encadre par une etude, il s’avere efficace, quel que soit le medicament. C’est le phenobarbital qui a offert la meilleure tolerance. Il est, par ailleurs, le moins couteux. Des que l’encadrement s’arrete, la mauvaise observance s’installe, compromettant l’efficacite therapeutique. Conclusion Ces travaux montrent le benefice des antiepileptiques. Pour que ce benefice soit perenne, il faut ameliorer l’accessibilite aux traitements (possible avec le phenobarbital) et organiser une education therapeutique efficace.

Pour 2009–2010, les innovations medicamenteuses ayant obtenu une autorisation de mise sur le marche (AMM) traitees dans ce dossier annuel concernent dix disciplines. Quinze specialites pharmaceutiques sont ainsi passees en revue, avec les resultats des essais cliniques menes et ce que la Commission de la transparence a evalue comme niveau d’amelioration du service medical rendu. Une vingtaine de medicaments ont recu entre le 1er janvier et le 30 juin 2010 une autorisation temporaire d’utilisation (ATU) nominative ou de cohorte. Concernant les dispositifs medicaux, deux techniques innovantes sont etudiees dans le domaine de la neurochirurgie et de la chirurgie orthopedique.

De nombreuses etudes montrent l’interet des immunoglobulines (Ig) dans le traitement des polyneuropathies inflammatoires demyelinisantes chroniques (PIDC) et certains auteurs se sont interesses a leur administration par voie sous cutanee (SC) pour l’interet qu’elles peuvent avoir en terme de qualite de vie.L’objectif de ce travail est d’evaluer l’impact economique de la prise en charge de patients atteints de PIDC traites par IgSC par rapport a la strategie traditionnelle faisant appel aux IgIV. Il compare donc les couts de la prise en charge d’une PIDC dans le but de savoir quelle therapeutique represente le cout le moins eleve. Cette etude retrospective de 24 mois sur 487 sejours de patients atteints de PIDC montre que le cout du sejour des patients traites par IgIV est statistiquement different de ceux traites par IgSC (p

Selon les recommandations de l’Afssaps, emises en 2005, la prise en charge du patient dyslipidemique releve de la prevention du risque cardiovasculaire. Elle comprend des mesures hygieno-dietetiques, a mettre en oeuvre pendant au moins 3 mois, avant d’envisager un traitement medicamenteux. Le changement de regime alimentaire constitue un traitement au long cours, avec diminution des graisses saturees, introduction des graisses insaturees, controle du poids, eviction de l’alcool. Il s’accompagne de la pratique reguliere d’exercice physique. Lorsque la prise de medicaments s’impose, le schema s’appuie en premiere intention selon le type de dyslipidemie sur les statines et les fibrates. En 2 nde intention, et le plus souvent en association avec les premiers, d’autres hypolipemiants sont envisageables.