Reader Response: Does Screening for Adverse Effects Improve Health Outcomes in Epilepsy? A Randomized Trial

Franco et al.1 investigated the utility of standardized methods for assessing the adverse effects (AEs) of antiepileptic drugs (AEDs). That is an important matter because it has been shown that quality of life in epilepsy is strongly correlated with AE burden from AEDs.2 The authors were inspired in a previous study from Gilliam et al.3 showing the effectiveness of systematic screening of AEs of AEDs using a self-administered standardized instrument—the Adverse Events Profile (AEP)—versus conventional clinical management. In contrast to the pioneering study of Gilliam et al., Franco and colleagues did not find a significant difference in improvement in AEP scores between patients treated by physicians who were aware of the score before the visit and those treated by physicians who were unaware of it. It is worth mentioning that—although modest—they identify an improvement in AEP scores and quality of life in both groups over time, despite a small increase in AED load by the end of the study. This finding may be explained by a rise in awareness on reporting and screening for AEs by patients and physicians, respectively, driven by their participation in a study on AEs of AEDs. In conclusion, screening for adverse events of AEDs—independently of the screening tool used—is desired. However, that is insufficient to drive a significant improvement in AE burden and quality of life. Other measures are needed to address this critical problem in patients with medication-resistant epilepsy.

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