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To date, the burden and impact of substance use among epileptic patients were studied in a small number of studies and showed inconsistent findings, which may be attributed to the variation in age, test batteries, epilepsy subtypes, and substance use characteristics across research. The aim of the study was to determine the burden and impact of substance abuse among a sample of epileptic patients attending Alexandria University outpatient clinics. This study was conducted on 200 epileptic patients (100 male and 100 female patients). The diagnosis of epilepsy in those patients was confirmed by expert neurologists. Using the international league against epilepsy 2017 classification, they underwent a complete physical examination. EEG was done for all patients. Every patient was assessed using a semi-structured interview and a self-designed questionnaire to collect data concerning history of epilepsy, seizure type, EEG findings, as well as questions derived from the Addiction Severity Index (ASI). The Timeline between epilepsy and substance abuse, as well as the Effect of substance intake on epileptic seizures, were assessed.
Results
A total of 27 epileptic patients had a history of substance abuse; hence, the percentage of substance use among epileptic patients was 13.5%. Mean age in the male age group was (29.74 ± 11.52) years and (27.34 ± 9.35) years in females; mean seizure frequency per month was higher among males than females and this was statistically significant (P = 0.037*). More male (24%) than females (3%) had history of substance use and this was statistically significant (P < 0.001*). Regarding the Effect of substance intake on epileptic seizures, the male group (91.7%) had Seizure worsening, while in the female group, all three patients (100%) had seizures worsening with substance use. The mean Frequency of seizures was 4.48 ± 5.08 attacks per month for substance users and 2.49 ± 3.84 attacks per month for non-users; this was statistically significant. (t = 2.392) (P = 0.018*). Non-substance use patients had better compliance to treatment (79%) in comparison to 44.4%) of Substance use patients and this was statistically significant (P < 0.001*).
Conclusion
Drug abuse can have a negative impact on epilepsy in both sexes regarding seizure severity frequency, and even compliance with medication.
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ASI
Addiction severity index
SMH
Self‐medication hypothesis
PWE
Patients with epilepsy
NMC
Non-medical cannabis
CBD/THC
Cannabis/tetra hydro cannabinoids
CUD
Cannabis use disorder
Background
The association between epileptic seizure and substance use has been recognized yet to date limited studies assessed the true burden and impact of substance use among epileptic patients. Factors that make epileptic patients more susceptible to substance use include long duration of the disease, type of treatment received and the length of time it takes to control the seizures. Moreover, physical conditions like epilepsy can contribute significantly to addiction especially with coexisting psychiatric illnesses as they may play a crucial part in this process [1].
Meanwhile, the comorbidity of mental and substance use disorders, or dual diagnosis, has been a major focus of clinical work and research for more than 25 years. The self‐medication hypothesis (SMH) has been identified as a potential etiological explanation for co‐occurring disorders. In short, it entails that substance use, functions to alleviate symptoms of mental disorders or ameliorate suffering [2].
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Though more studies are required to fully understand the complex interaction between personality disorders and substance use disorders, recent research has focused on dimensional models of personality disorder, and the likely explanation of their co-occurrence [2].
Recent research also highlighted the high co-occurrence of ADHD and substance use [3].
Meanwhile, understanding the co-occurrence of ADHD and epilepsy remains a challenge. Given the reciprocal relationship between the two illnesses, this connection might not be random. Whether co-occurring symptoms of ADHD and epilepsy indicate a concomitant mental condition or are only the transient consequences of epileptic discharges, and are they associated with antiepileptic medicines (AEDs), is a debatable issue [4].
Leach and colleagues have demonstrated that some epilepsy patients have a tendency to self-treat and misuse drugs and alcohol in an attempt to manage their symptoms [1].
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The prevalence of seizures in patients with alcohol dependence is approximately 9.9% [5]. Opioids have been described as convulsant and anti-convulsant [6]. In different age groups, recent heroin use may be a risk factor for seizure development [7‐9].
There are case reports of seizures, especially during heroin withdrawal [10], and overdose of dextropropoxyphene [11]. Tramadol may induce seizures in epileptic patients and in previously healthy population [12]. Also, methamphetamine usage might have some neurologic side effects including of stroke, seizures and psychosis [13].
Some drugs share the ability to generate dose-related excitation of the central nervous system leading to convulsions. The stimulation may be at cortical, brainstem, or spinal levels. The cortical stimulants analyzed were cocaine, amphetamines and related agents, caffeine, cannabinoids, and psychedelic drugs [14]. The most common complications of stimulant use that resulted in visits to emergency rooms and hospital admissions are referred to psychiatric, cardiopulmonary, and neurologic symptoms. Neurological complications most commonly included seizures and stroke, but relative to the prevalence of stimulant abuse, the incidence of stroke and seizures is small [15].
Cocaine raised the possibility of a seizure development,by preventing the dopamine transporter from reabsorbing. Cocaine increases the effects of catecholamine neurotransmitters by increasing dopaminergic stimulation at important brain locations. Nevertheless, cocaine also prevents the reuptake of serotonin (5-HT) and norepinephrine (NE), which is linked to the "kindling" phenomenon. In brain-imaging studies, it has been shown to be associated with altered brain metabolism, especially in the temporal lobes [16].
Cavalcante and colleagues in 2024 proposed that cocaine inhalation increased seizure susceptibility by reducing acetylcholinesterase activity [17].
The role of amphetamines in causing seizures appears to be weaker than that of cocaine. It has an intrinsic convulsant activity because of its adenosine receptor antagonizing properties [18].
Cannabinoids: Marijuana is the most commonly used illegal drug. The smoke formed during burning cannabis contains many chemicals, 61 different cannabinoids have been identified. When used with antiepileptic medications, smoking marijuana may help manage seizures, according to a number of non-interventional trials [19, 20]. A survey on the medical use of cannabis products in Germany showed that epilepsy (3.6%) was among the most frequently mentioned indications [21].
Oral cannabis extracts have also been studied in a number of pediatric epilepsy patients. Study showed that administering CBD-enriched cannabis extracts orally as an adjunctive treatment reduced the frequency of seizures in 84% of patients. Additionally, there was an improvement in conduct, sleep, and concentration [20].
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Depression along with epilepsy have a significant negative impact on the patient's life, causing a deterioration in day-to-day functioning and an aggravation of symptoms [22]. Further more Mochrie and colleagues demonstrated a correlation between ADHD, substance use and depression [3].
A review of Egypt research revealed that the state of epileptic patients with substance use has received little consideration. The aim of this research was to explore the impact of drug usage on individuals with epilepsy.
Methods
This study was a cross-sectional study conducted in an epilepsy outpatient clinic at a university hospital.
This study was conducted on a convenient sample of 200 subjects with epileptic seizures (100 males and 100 females) visiting the university hospital (epilepsy clinic). Inclusion criteria were age group between 18 and 60 years old with epileptic seizures history. Exclusion criteria were patients with epileptic seizures due to organic causes such as cerebral palsy or brain tumor, psychogenic seizures, syncope.
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A written informed consent was obtained from all subjects prior to recruitment to the study. The diagnosis of epilepsy in those patients was confirmed by expert neurologists, diagnosis was done in accordance with the International League against Epilepsy (ILAE) 2017 [23].
All participants underwent a complete physical examination then all patients were asked about history of epilepsy, using a semi-structured–self-designed questionnaire which also included questions derived from the Addiction Severity Index (ASI). Data concerning history of epilepsy Age of onset of the disease, duration of the epilepsy,frequency of seizures, type of seizures, treatment of epilepsy, compliance with antiseizure medication. Other medical condition, family history of epilepsy.
EEG was done for all patients using the device brand name Natus neurology SN: v32-15250024, Nicolet REF:515-0-19000, model number 0086, year of manufacture (2015) country of origin united states of America.
A standard EEG was acquired using cup electrodes and the 10–20 system. EEGs were recorded for 20–30 min and reviewed in a longitudinal bipolar montage.
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Data concerning type of substance use was collected using Addiction Severity Index (ASI) [24].
The ASI is a 45–60-min semi-structured interview administered by a trained clinician, one of the important new features of the ASI was that it broadened the perspective of treatment and treatment research to cover alcohol and drug related problems in various areas of life in addition to narrowly defined patterns of drinking and drug-taking. Another important idea was to combine objective and subjective measures in treatment planning. The ASI has been shown to be reliable and valid, when correctly administered, in a wide variety of clinical populations and treatment settings [25].
Mode of intake, duration and frequency of usage, timeline relation between epilepsy and substance abuse were assessed as well as the effect of substance intake on epileptic seizures. Epilepsy patients were asked if their condition became worse or if they had more frequent or severe episodes.
Descriptive statistics were used to assess distribution and frequencies. Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. (Armonk, NY: IBM Corp). Qualitative data were described using numbers and percentages. The Kolmogorov–Smirnov test was used to verify the normality of distribution. Quantitative data were described using range (minimum and maximum), mean, standard deviation, median and interquartile range (IQR).
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Results
A total of 200 patients were included, characteristics of the total studied groups are demonstrated in Table 1 which shows their sociodemographic data. Mean age in the male age group was 29.74 ± 11.52 while mean age among females was 27.34 ± 9.35. 45%of male patients received higher education compared to only 35% in female group.
Table 1
The socio demographic characteristics of the studied group
Socio demographic characteristics
Males (N = 100)
Females (N = 100)
Test of sig
p
n
%
n
%
Age:
t = 1.617
0.107
Min–Max
18–60
18–60
Mean ± SD
29.74 ± 11.52
27.34 ± 9.35
Median
27.00
24.00
Education:
X2 = 3.674
0.452
Illiterate
5
5
6
6
Does not complete his education
32
32
32
32
In school
6
6
12
12
High education
45
45
35
35
Collage education
12
12
15
15
Work:
X2 = 49.508
MCp < 0.001*
Employed
71
71
27
27
Non-employed
24
24
73
73
Retired
5
5
0
0
Marital status:
X2 = 5.009
MCp = 0.179
Single
53
53
53
53
Married
43
43
38
38
Divorced
1
1
7
7
Widow
3
3
2
2
* statistically significant difference
Regarding the seizure type, Table 2 shows 32% in the male group had Generalized Myoclonic, 30% had multiple type of seizures and 5% had absence seizures while in female group they were 19%, 29% and 14%, respectively.There was no statistically significant difference between the two studied groups regarding the type of seizure (P = 0.082).
Table 2
Type of seizure
Type of seizure
Males (N = 100)
Females (N = 100)
X2
MCp
n
%
n
%
Absence seizure
5
5
14
14
11.210
0.082
Generalized myoclonic
32
32
19
19
Generalized tonic clonic
21
21
21
21
Partial seizure simple
4
4
3
3
Partial seizure complex
8
8
11
11
Psychomotor seizures
0
0
3
3
Combination
30
30
29
29
X2 chi square test, MC Monte Carlo
P: p value for comparing between males and females
Regarding history of seizures, Table 3 shows that the mean seizure frequency was higher among males (3.36 ± 4.41 attacks per month) compared to females (2.16 ± 3.61 attacks per month) and this was statistically significant (p 0.037*).
Table 3
History of epilepsy
Epilepsy characteristics
Males (N = 100)
Females (N = 100)
t
p
n
%
n
%
Age of onset:
1.110
0.268
Min–Max
2–50
4–50
Mean ± SD
20.23 ± 10.74
18.75 ± 7.91
Median
18.00
18.00
Duration of epilepsy:
0.620
0.536
Min–Max
1 month–31 years
1 month–32 years
Mean ± SD
9.27 ± 6.40
8.67 ± 7.26
Median
9.00
6.00
Frequency:
2.104
0.037*
Min–Max
0–25
0–30
Mean ± SD
3.36 ± 4.41
2.16 ± 3.61
Median
2.00
1.00
t = student t test P: p value for comparing between males and females
* statistically significant difference
Table 4 shows the distribution of the studied sample according to EEG findings, 38% of male group showed generalized epileptiform activity and 15% showed focal epileptiform activities, while it was 32% and 17% in female group. On the other hand, only 3% of the male group showed no epileptiform activity compared to 19% in the female group. This was statistically significant (X2 = 17.214) (P = 0.015*).
Table 4
Electroencephalogram findings
Traditional medicine
Males (N = 100)
Females (N = 100)
X2
MCp
n
%
n
%
Generalized epileptiform activities
38
38
32
32
17.214
0.015*
Focal epileptiform activities
15
15
17
17
Rt. Temporal epileptiform activities
13
13
11
11
Lt. Temporal epileptiform activities
11
11
9
9
Bitemporal epileptiform activities
5
5
5
5
Frontal epileptiform activities
11
11
3
3
Background slowness
4
4
4
4
No epileptiform activity
3
3
19
19
X2 chi square test, MC Monte Carlo P: p value for comparing between males and females
* statistically significant difference
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Regarding history of drug/alcohol consumption, a total of 27epileptic patients had a history of substance abuse, 24% of male patients had history of substance use, while in female group, there were only 3%; this was statistically significant (X2 = 18.882) (P < 0.001*).
Regarding type of drug consumed, Table 5 shows the drug consumption among the studied groups, 75% of males used opiates followed by 66.7% used cannabis, while in females, both cannabis and cocaine was present in 67.7%.
Table 5
Drug consumption among the studied group
Alcohol/drug consumption
Males (n = 24)
Females (n = 3)
n
%
N
%
Alcohol (any use at all)
Never
23
93.75
2
67.7
In past 30 days
0
0
0
0.0
Years of regular use
1
6.25
1
33.3
Heroin
Never
22
91.7
2
67.7
In past 30 days
2
8.3
0
0.0
Years of regular use
2
8.3
1
33.3
Other opiates/analgesics
Never
6
25
1
33.3
In past 30 days
7
29.2
1
33.3
Years of regular use
18
75
2
67.7
Sedatives/hypnotics/tranquilizers
Never
22
91.7
3
100
In past 30 days
0
0
0
0.0
Years of regular use
2
8.3
0
0.0
Cocaine
Never
22
91.7
3
100
In past 30 days
0
0
0
0.0
Years of regular use
2
8.3
0
0.0
Amphetamine
Never
24
100
2
67.7
In past 30 days
0
0.0
1
33.3
Years of regular use
0
0.0
1
33.3
Cannabis
Never
7
29.2
1
33.3
In past 30 days
13
54.2
2
67.7
Years of regular use
16
66.7
2
67.7
Considered the response was not mutually exclusive and every patient was able to choose more than one answer
Regarding the timeline relationship between drug consumption and appearance of epilepsy, Table 6 shows the relation between seizures and substance use. 12.5% of male patients reported seizures before substance use, 20.8% during and 66.7% after substance use, while 67.7% of the female group were before and 33.3% after substance with no statistically significant difference (P = 0.154).
Table 6
Timeline relationship between substance use and epilepsy
Relation between substance abuse and epilepsy
Males (n = 24)
Females (n = 3)
X2
p
n
%
n
%
Timeline relation between substance abuse and epilepsy
5.321
MCp = 0.154
Seizures appeared before the start of use
3
12.5
2
67.7
Seizures appeared with usage
5
20.8
0
0.0
Seizures appeared after usage
16
66.7
1
33.3
Effect of substance intake on epileptic seizures
0.270
FEp = 1.000
Worsen
22
91.7
3
100
No effect on seizures
2
8.3
0
0
χ2 chi square test, FE Fisher Exact, MC Monte Carlo p: p value for comparing between males and females
Regarding the effect of substance intake on epileptic seizures, Table 6 shows that in the male group, 22 patients’ (91.7%) seizures worsened and 2 patients’ (8.3%) seizures were not affected with substance use, while in the female group, all 3 patients’ (100%) seizures worsened with no statistically significant difference between both groups (P = 1.000).
Table 7 shows the degree of seizure worsening with different illicit drugs, 76%reported seizure worsening with opiates, 72% reported seizure worsening with cannabis,while among females, it was 50% worsening with both drugs.
Table 7
Effect of each substance use on the epileptic seizures
Variable
Worsen seizure (n = 25)
No effect on seizure (n = 2)
OR
95% CI (lower–upper)
Chi- square
FEp
N
%
n
%
Alcohol
1.087
0.968–1.220
0.173
1.000
Yes
2
8
0
0
No
23
92
2
100
Heroin
1.091
0.967–1.231
0.270
1.000
Yes
3
12
0
0
No
22
88
2
100
Other opiates
3.167
0.171–58.703
0.652
0.459
Yes
19
76
1
50
No
6
24
1
50
Sedatives
1.087
0.968–1.220
0.173
1.000
Yes
2
8
0
0
No
23
92
2
100
Cocaine
1.087
0.968–1.220
0.173
1.000
Yes
2
8
0
0
No
23
92
2
100
Amphetamine
1.083
0.970–1.210
0.083
1.000
Yesilli
1
4
0
0
No
24
96
2
100
Cannabis
2.571
0.141–47.017
0.430
0.513
Yes
18
72
1
50
No
7
28
1
50
χ2 chi square test, FE Fisher Exact, MC Monte Carlo
Table 8 shows the median of the money spent on drugs in the male group from 0 to 1500 Egyptian pounds was 450 (0–775), while the female group from 480 to 2000 pounds was 500 (480–). There was no statistically significant difference between the two studied groups regarding the money spent on drugs (U = 23.000) (P = 0.308).
Table 8
Money spent on substance use
Money spent on drugs
Males (n = 24)
Females (n = 3)
U
p
Min–Max
0–1500
480–2000
23.000
0.308
Mean ± SD
458.33 ± 450.04
993.33 ± 871.86
Median (IQR)
450 (0–775)
500 (480–)
U Mann–Whitney test p: p value for comparing between males and females
Regarding psychiatric status Table 9, shows the distribution of the substance use cases regarding treatment for any psychological or emotional problems, more females (33.3% two times, 33.3% more than twice) than males (8.3% one time) were treated for any psychological or emotional problems in private this was statistically significant (X2 = 17.315) (P = 0.016*).
Table 9
Psychiatric status
Psychiatric status
Males (n = 24)
Females (n = 3)
X2
p
n
%
n
%
Treated for any psychological or emotional problems in hospital
8.308
FEp = 0.111
Never
24
100
2
67.7
Two times
0
0
1
33.3
Treated for any psychological or emotional problems in private
17.315
MCp = 0.016*
Never
22
91.7
1
33.3
One time
2
8.3
0
0.0
Two times
0
0.0
1
33.3
More than two times
0
0/0
1
33.3
Received pension for a psychiatric disability
Yes
0
0
0
0
No
24
100
3
100
χ2 chi square test, FE Fisher Exact, MC Monte Carlo p: p value for comparing between males and females
* statistically significant difference
Figure 1 shows that there was no statistically significant difference between male and female studied groups regarding being charged with disorderly conduct, vagrancy, public intoxication (X2 = 8.775) (P = 0.122).
Fig. 1
Charged with disorderly conduct, vagrancy, public intoxication
Figure 2 shows that there was no statistically significant difference between the two studied groups regarding being charged with major driving violations (X2 = 1.985) (P = 0.815).
Regarding the mean duration of seizures between users and non-users Table 10, shows that mean duration of epilepsy among users was shorter than non-users; 5.78 ± 5.10 years for substance use and 9.47 ± 6.94 years for the non-substance use patients and this was statistically significant (P = 0.009*).
Table 10
Duration and frequency of seizures among substance use and non-substance use epileptic patients
Users (n = 27)
Non-users (n = 173)
t
p
Duration of seizure
−2.649
0.009*
Min.–Max
0.08–19.0
0.08–32.0
Mean ± SD
5.78 ± 5.10
9.47 ± 6.94
Median (IQR)
4.0 (2.0–10.0)
8.0 (4.0–14.0)
Frequency of seizure
2.392
0.018*
Min.–Max
0.0–20.0
0.0–30.0
Mean ± SD
4.48 ± 5.08
2.49 ± 3.84
Median (IQR)
3.0 (2.0–5.0)
2.0 (0.0–3.0)
χ2 chi square test, FE Fisher Exact, MC Monte Carlo
* statistically significant difference
Regarding the mean frequency of seizures Table 10, shows higher mean frequency was among substance users with a mean of 4.48 ± 5.08 attacks per month compared to a mean of 2.49 ± 3.84 attacks per month among non-users; this was statistically significant (P = 0.018*).
Regarding compliance to antiepileptics, non-substance users showed higher compliance (79%) than in substance users (44.4%); this was statistically significant (P < 0.001*) as shown in Table 11.
Table 11
Compliance to treatment among substance use and non-substance use epileptic patients
Compliance
Users
Non-users
OR
95% CI (LL–UL)
X2
p
n
%
n
%
Yes
12
44.4
137
79.2
0.210
0.090–0.488
14.842
< 0.001*
No
15
55.6
36
20.8
Total
27
100
173
100
χ2 chi square test, FE Fisher Exact, MC Monte Carlo
* statistically significant difference
Discussion
The relationship between substance abuse and epilepsy is complicated because of both the psychological impacts of the condition and the fact that different medications and substances can exacerbate epileptic fits and result in seizures.
Regarding gender difference among epileptic patients in a door-to-door survey in Egypt, Hashem and colleagues in 2015 demonstrated no gender differences [26]; this was also supported by kishk and colleagues in 2019 [27].
Regarding employment, similar findings were supported by Kishk and colleagues reporting that the unemployment among males was 35.2% and among females was 64.71% [27]; also, this was explained by Francis and colleagues, their study showed that people with epilepsy may face a number of complex and interacting problems in finding and maintaining employment [28].
Concerning burden of substance use in Egypt, a community-based study in Egypt in 2013 by Hamdi and colleagues showed the lifetime prevalence of any substance use in Egyptian community varies between 7.25 and 14.5%. Prevalence of substance use in males was 13.2%, while in females, it was 1.1%. Comparing this study to a study in 1996 [29], the prevalence of drug use in general population was higher yet lower than in Western nations. The true prevalence is greater presumably because of inadequate reporting. The distribution pattern of substance use across populations reflects drug accessibility and availability [30].
Khan and colleagues also highlighted important gender differences in cannabis use disorder with CUD Compared to women with CUD, males with CUD fulfilled more criteria for cannabis abuse, experienced longer episodes of the disorder, smoked more and were older when they were in remission [31].
According to research conducted in Egypt by Al-khateeb and colleagues, the study showed that the chronic illness of epilepsy imposed several psychosocial stressors on patients and influenced their health-related behaviors. Patients with epilepsy required substantial behavioral and psychosocial adjustments. The influence of psychosocial stressors exerted by epilepsy on a Person's self-efficacy is not well documented, especially among the Egyptian patients. Patients with epilepsy had intermediate psychosocial stressors (75%) as well as intermediate self-efficacy (72%) [32].
The percentage of substance use among epileptic patients in the present study was higher than the percentage reported in general population in a recent cross-sectional, community-based survey in almost all Egyptian governorates [33], which reported that about 6.7% of the Egyptians were dealing regularly with substance(s), though this was consistent with kishk and colleagues [27] and Najafi and colleagues [34].
Taalab and colleagues found that drug abuse was more frequent in epileptic patients compared to the general population, with the most frequent substance abused being tramadol, an even higher percentage (37.5%) was reported on cannabis [35] which was also consistent with the current study findings.
Szaflarski and colleagues stated that 50–60% of patients who took different cannabis extracts for TRE, including those who received treatment with pure cannabidiol (CBD), showed improvement, according to anecdotal evidence [36].
In a systemic review in USA, jimmy and colleagues highlighted that the median number of PWE using cannabis was 24.5, range was 1–37,945 which was very low more over the use of cannabis in patients with epilepsy was often linked to male sex, younger adult age, and poorer levels of education. Non-medical cannabis (NMC) was exclusively given orally to epileptic children with high CBD/THC ratios for the primary purpose of controlling seizures. Adults with epilepsy used NMC for a variety of purposes, mostly by smoking, as well as for recreational purposes and with varying CBD/THC ratios. In every study, the majority of PWE thought that NMC helped with seizure management. There were few and sometimes contradictory reports about other features of NMC usage in PWE [37].
In a study by Lekoubou and colleagues demonstrated that 3.2% of adult patients with epilepsy who were hospitalized had cannabis use disorder (CUD), and that the prevalence of CUD increased by more than twice between 2006 and 2014 [38].
Those with other mental illnesses showed the largest increase in CUD prevalence [39].
In concordance with the current study findings, a study by Naz and colleagues in turkey it showed that patients with epilepsy had low frequency of alcohol use in comparison to general population as well as low rate of smoking in patients with epilepsy duration of < 5 year [40].
Najafi and colleagues investigated prevalence of drugs of abuse in epileptic patients, mean epilepsy duration was 4.66 ± 0.98 years and the most frequent substance which was abused was Tramadol (25 patients 41.7%), they also concluded that compared to the general population, drug misuse appears to be more common patients with epilepsy. It appears that people with epilepsy were more vulnerable to these drugs. Conversely, a significant side effect of several of these drugs, such as Tramadol, one of the most prescribed analgesics worldwide, was seizures [34].
Time line relation between epilepsy and substance use was not thoroughly investigated in literature, in the current study, 5% of male patients reported seizures before substance use, 20.8% during and 66.7% after substance use, while 67.7% of the female group were before and 33.3% after substance use with no statistically significant difference between the both genders; also, epileptic seizures worsened with substance use in 91.7% male patients and 100% of the female patients with no statistically significant difference; this was consistent with a study in 2010 which showed that substance users with epilepsy experienced seizure worsening seizures with time [41].
In a study carried out in Canada with 136 epileptic participants, 68% of current cannabis users reported having less severe seizures, and 54% reported having fewer seizures [42].
Hamerle and colleagues aimed to assess the prevalence of illicit drug use among epilepsy patients and its effects on the disease the study included 310 subjects, 63 (20.3%) reported consuming cannabis after epilepsy was diagnosed, and 16 (5.2%) used other illicit drugs. Seven participants stated that using cannabis worsened their epilepsy and they had to stop using it as a result. However, the majority of participants (84.1%) showed no effect at all of cannabis use on epilepsy [19]. Other studies confirmed this result, through reporting that cannabis consumption has little to no effect on epilepsy [43].
Meanwhile, our current study demonstrated little evidence regarding psychiatric illness and illicit drugs in male epileptic patients other studies demonstrated a substantial correlation between the intensity of seizures and the reported stress experienced by epileptic patients who consume drugs [44, 45].
In concordance with our study, Gordon and colleagues emphasized the poor compliance among epileptic patients with concomitant substance use [46].
In a systemic review in Ethiopia by Belayneh and colleagues showed that substance use was one of the contributing factors for lack of compliance with anti-seizure medication [47].
Conclusion
Drug abuse can have a negative impact on epilepsy in both sexes regarding severity, frequency of seizers and even compliance with medication.
Limitation
One of the study's shortcomings was that the assessment of seizure frequency and frequency was subjective rather than objective because it was based on a history. Future studies are needed to compare the substance use of people with epilepsy with the general population to adequately address and assess the quality of life among these individuals.
Acknowledgements
Not applicable.
Declarations
Ethics approval and consent to participate
Ethical approval was obtained from the Ethics Committee (EC) of Faculty of Medicine which is constituted and operates according to the International Conference on Harmonisation-Good Clinical Practice ICH GCP guidelines (Food and Drug Administration guideline) and applicable local and institutional regulations and guidelines which govern EC operation. Ethical approval number 0305074 date of meeting was 19-3-2021.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
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Ashraf Moustafa Abdou
Professor of Neurology, Department of Neurology and Psychiatry, Alexandria University Faculty of Medicine, Egypt.
Ahmed Mohamed Abdel Karim
lecturer of psychiatry, Department of Neurology and Psychiatry, Alexandria University Faculty of Medicine, Egypt.
Reham Mahmoud Abozaid
master candidate Department of Neurology and Psychiatry, Alexandria University Faculty of Medicine, Egypt.
Dina El Sayed Gaber
PhD., Lecturer of Neurology, Department of Neurology and Psychiatry, Alexandria University Faculty of Medicine, Egypt.
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