Strategies for improving adherence to antiepileptic drug treatment in patients with epilepsy

Abstract

Poor adherence to antiepileptic medications is associated with increased mortality and morbidity. In this review we focus on interventions designed to assist patients with adherence to antiepileptic medications. To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medications in adults and children with epilepsy. We searched the Epilepsy Group's Specialised Register (24 June 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2) and electronic databases: MEDLINE (OVID) (1950 to June 2010); EMBASE (OVID) (1980 to 2010 Week 24); CINAHL (1982 to June 2010) and PsycINFO (22 June 2010), and the reference lists of relevant articles. Randomised or quasi-randomised controlled trials of adherence-enhancing interventions aimed at patients with clinical diagnosis of epilepsy (as defined in individual studies), of any age and of either gender, treated with antiepileptic drugs in a primary care, outpatient or other community setting. We screened titles and abstracts for eligibility. Two review authors independently extracted data and assessed each study according to the Cochrane criteria. The studies differed widely according to intervention and measures of adherence, therefore combining data was not appropriate. Six trials met our inclusion criteria: five targeted adult epileptic patients with a combined patient number of 222 and one targeted parents of children with epilepsy (n = 51). Follow-up time was generally short: from one to six months. Two main types of intervention were examined: educational and behavioural modification. Each study compared treatment with no intervention 'usual care'. None compared one intervention with another. Due to heterogeneity between studies in terms of interventions and the methods used to measure adherence, we did not pool the results. Education and counselling of patients with epilepsy have shown mixed success. Behavioural interventions such as the use of intensive reminders and 'implementation intention' interventions provided more positive effects on adherence. Intensive remindersand 'implementation intention' interventions appear promising in enhancing adherence to antiepileptic mediations, however we need more reliable evidence on their efficacy from carefully designed randomised controlled trials before a firm conclusion can be reached.