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13 June 2006
Everyone who reads detective stories knows
that you can analyse a person's hair to
find whether they have been poisoned. In
the real world the same technique can also
be used for finding out whether a person's
been taking a prescribed drug. The longer
a hair, the older the end of it, so hair
analysis can indicate both the period a
drug was taken for and the dosage it was
taken at. It is therefore a neat way of
measuring how consistently people with epilepsy
take their medication.
Variability in taking medication (also
called variable compliance) has been suggested
as a possible cause of Sudden Unexpected
Death in Epilepsy (SUDEP). If so, it might
be a preventable cause. Analysis of anti-epileptic
drug (AED) concentrations in hair samples
taken at autopsy can therefore be used to
discover whether this might have contributed
to someone's death.
In their study
reported in the June edition of the Journal
of
Neurology, Neurosurgery and Psychiatry,
researchers from the University Hospital
of Wales in Cardiff compared AED concentrations
in sections of hair 1 cm long from 16 patients
who had died of SUDEP, 9 patients with epilepsy
who had died of causes other than SUDEP,
31 patients with epilepsy being treated
in the community, and 38 patients with epilepsy
being treated in hospital. After analysis
the results were corrected to take account
of the effect of washing the hair on the
concentrations of AEDs in each section.
Researchers then used statistical methods
to measure how much the AED concentrations
varied between pieces of hair from each
individual.
The researchers found that AED concentrations
varied by an average of 20.5% in the SUDEP
group, compared with 15.0% in the non-SUDEP
death group, 9.6% in the outpatients and
6.2% in the inpatients. This implies that
the patients who had died of SUDEP had been
significantly more variable in taking their
medication than patients in the other groups.
The researchers concluded that these findings
suggest that at least a proportion of deaths
from SUDEP may be preventable with more
regular medicine-taking.
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