Antiepileptic Drug Adherence Research Articles

Retraction: Antiepileptic Drug Adherence and Psychosocial Factors in Children: Is There a Connection?

AbstractPediatric epilepsy is a neurological disorder characterized by recurrent seizures, globally affecting 15 million children. Antiepileptic drug therapy is commonly used in the treatment and control of epilepsy. Previous research has analyzed children's antiepileptic drug adherence from the perspective of parents and/or caregivers. This analysis examined the child's perspective (N = 34) regarding level of adherence to antiepileptic drug adherence and focused on psychosocial factors (e.g., child knowledge and worry) in children aged 6 to 12 years at 13 months after being diagnosed with epilepsy. The results suggested that socioeconomic status based on income may be a predictor of adherence (p = 0.00004) along with the positive correlation between child's knowledge about the disease and parent's disease-specific knowledge (p = 0.040). The findings indicate that further research on parent–child relationships is needed to improve medication adherence.

Assessment of medication management capacity in a predominantly African American and Caribbean American sample of adults with intractable epilepsy

IntroductionSuboptimal or partial adherence to antiepileptic drugs (AEDs) is an avoidable cause of seizures and deleterious outcomes in epilepsy. As self-rated adherence may be unreliable, suboptimal adherence may go undetected. This study assessed generalizability of a performance-based measure of medication management to patients with intractable epilepsy. Materials and methodsParticipants were 50 adults (age = 42 ± 14 years, 60% female, 82% Black, 20% Hispanic/Latino) with ≥2 seizures in the preceding 6 months. Antiepileptic drug adherence was electronically monitored for one month via Medication Event Monitoring Systems (MEMS) and self-rated (1 = very poor to 6 = excellent). The Medication Management Ability Assessment (MMAA) was administered at follow-up and scored by raters blind to adherence results. Spearman correlations and Poisson regressions assessed their associations. ResultsOn average, participants self-reported good-to-very good adherence. According to MEMS, participants took AEDs as prescribed 73% of the time; most participants (58%) missed ≥3 doses. The MMAA demonstrated strong internal consistency (Kuder-Richardson 20 = 0.81) and was associated with MEMS: percentage of days doses were taken correctly (rs = 0.29, p = 0.04) and frequency of missed doses (rs = −0.31, p = 0.03). The MMAA was not associated with self-rated adherence. Poisson regressions showed that self-ratings and MMAA performance accounted for unique variance in frequency of missed AED doses. ConclusionsThese findings provide evidence of the MMAA's criterion validity as a measure of capacity to manage AEDs. It may prove useful in cases where suboptimal adherence is suspected but unreported by patients. Its lack of significant association with self-rated adherence is consistent with prior reports; however, future studies should replicate these findings with larger samples.

Barriers of Drug Adherence among Patients with Epilepsy: in Tertiary Care Hospital, South India.

Introduction: Epilepsy is a treatable and curable brain disorder. However major proportion of individuals with this disease in developing countries receives no treatment because of misunderstandings of the public. Other than that, poor adherence to ordered medication is considered the primary cause of drug therapy failure in epilepsy. This study conducted to assess the adherence pattern to antiepileptic regimen, among patients with epilepsy and to identify the clinical and patient-related factors contributing as barriers. Methods: A cross sectional survey design was used in 100 epilepsy patients in an Outpatient unit of tertiary care center. A Convenient sampling technique was used to enroll the patients who meet inclusion criteria. Structured interview with pre-tested questionnaire and eight item Morisky Medication Adherence Scale was used to collect the data. Descriptive and inferential statistics were used for analysis of data. Descriptive statistics (mean, standard deviation, frequency and percentages) were used to describe the clinical and demographic variables of study participants. The determinants of medication adherence were analyzed using Chi-Square test and independent student t- test. The analysis was done with SPSS 20th version. Results: Majority (71%) of patients were not adherent to antiepileptic treatment. Severity of seizure (indicated by the presence of seizure last year), medication frequency and complexity of treatment were found to have significant association with the Anti-Epileptic Drugs (AED) adherence status. Status of adherence is significantly associated with frequency of seizure/year and positive life style. Conclusion: As Medication adherence was observed to be low, services for adherence counseling and health educational interventions in the epilepsy clinics is recommended.

Use of complementary and alternative medicine and adherence to antiepileptic drug therapy among epilepsy patients: a systematic review.

PurposeTo identify the use pattern of complementary and alternative medicine (CAM) and its impact on antiepileptic drug (AED) adherence among patients with epilepsy.MethodPotential studies were identified through a systematic search of Scopus, Science Direct, Google Scholar, and PubMed. The keywords used to identify relevant articles were “adherence,” “AED,” “epilepsy,” “non-adherence,” and “complementary and alternative medicine.” An article was included in the review if the study met the following criteria: 1) conducted in epilepsy patients, 2) conducted in patients aged 18 years and above, 3) conducted in patients prescribed AEDs, and 4) patients’ adherence to AEDs.ResultsA total of 3,330 studies were identified and 30 were included in the final analysis. The review found that the AED non-adherence rate reported in the studies was between 25% and 66%. The percentage of CAM use was found to be between 7.5% and 73.3%. The most common reason for inadequate AED therapy and higher dependence on CAM was the patients’ belief that epilepsy had a spiritual or psychological cause, rather than primarily being a disease of the brain. Other factors for AED non-adherence were forgetfulness, specific beliefs about medications, depression, uncontrolled recent seizures, and frequent medication dosage.ConclusionThe review found a high prevalence of CAM use and non-adherence to AEDs among epilepsy patients. However, a limited number of studies have investigated the association between CAM usage and AED adherence. Future studies may wish to explore the influence of CAM use on AED medication adherence.

Drowning in epilepsy: A population-based case series

ObjectivesThe risk of drowning is reported to be 15–19 times greater in people with epilepsy compared to the general population. Despite this disproportionate burden, there is limited data about the circumstances surrounding drowning deaths in people with epilepsy. This population-based case series characterizes drowning deaths in people with epilepsy. MethodsPostmortem data from coroner-ordered autopsies conducted in Ontario between 2014 and 2016 were screened for cases of drowning in people with a history of seizures. Demographic information, epilepsy characteristics, and circumstances surrounding death were extracted from post mortem reports. The incidence of drowning in people with epilepsy was calculated using government estimates of the Ontario population and the number of people with epilepsy. ResultsTwenty-five people with epilepsy drowned during the three-year study period, giving an estimated incidence of 1.5 per 10,000 epilepsy person-years (95% CI: 0.98, 2.23). Decedents were mostly young (mean age 36 years) and without physical or developmental disability. Approximately one-third had psychiatric comorbidities. Epilepsy severity ranged from well-controlled to drug refractory. Only 3 people had alcohol or illicit drugs detected on toxicological analysis. Forty-four percent of deaths were the result of an unwitnessed drowning in a bathtub. ConclusionsThis population-based case series confirms people with epilepsy drown at a rate nearly ten times greater than the general population (1.5 per 10,000 epilepsy person-years compared to the estimated provincial average of 0.13 per 10,000). Drowning deaths in people with epilepsy most often occur in the bathtub. These deaths are only rarely associated with intoxication. People with epilepsy should receive counseling on the increased risk of drowning, including information regarding the significant risk associated with bathtub use, the potential protective roles of anti-epileptic drug (AED) adherence and supervision when in or around water, and the fact that all people with epilepsy remain at an increased risk of drowning regardless of their apparent seizure control.

Self-reported medication adherence to antiepileptic drugs and treatment satisfaction among paediatric patients having epilepsy: A cross sectional study from the Indian subcontinent

Introduction: Non adherence to antiepileptic drugs (AEDs) can vary the course of epilepsy. There is a dearth of data regarding adherence status among paediatric epilepsy patients. Objectives: To determine the level of AED adherence among paediatric patients having epilepsy and to assess the relationship between AED adherence and treatment satisfaction among paediatric epileptics. Method: A cross sectional study was conducted at a tertiary level referral hospital in northern India from July 2015 to June 2016 on children aged 2 to 13 years of age, diagnosed with epilepsy and treatment initiated with at least 1 AED for the past 6 months. Data collection was done using a questionnaire which was divided into three parts. The first part comprised demographical information about patients and their caregivers along with clinical details of epilepsy. The second part gathered information about medication adherence profile with the help of the Morisky Medication Adherence Scale-8 (MMAS-8). The third part gathered data on treatment satisfaction profile about these patients with the help of Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). The estimated sample size was at least 61 patients. Data was analysed using Graph Pad InStat 6.0. Ethical approval was obtained from the institutional ethics committee. Results: A convenient sample of 112 patients with their respective immediate caregivers was enrolled in this study. The mean age of children was 9.82±2.17 years and male to female sex ratio was 1.24. Fifty (44.6%) patients had low adherence, 29 (25.9%) medium adherence and 33 (29.5%) high adherence to AEDs as per MMAS-8 questionnaire. Altogether 79 (70.5%) children were non adherent when dichotomised MMAS scores were considered. Age of children, duration of epilepsy, mean number of family members, frequency of drug ingestion by patient, employment status of caregiver were significantly associated with non-adherence in epileptic children. Children adhering to medication prescription had significantly higher satisfaction in the effectiveness, convenience and global satisfaction domains of TSQM. Conclusions: Twenty nine percent of epileptic children showed medication adherence to AEDs in the present study. Increasing age of children, increased duration of epilepsy, increasing mean number of family members, patients taking medications more than once per day and employed caregiver status were significantly associated with non-adherence in epileptic children. Satisfaction scores were higher in medication adherent children, particularly in the effectiveness, convenience and global satisfaction domains but not in the side effects domain. Sri Lanka Journal of Child Health , 2018; 47 (2): 129-136

AD1 - The Association Between Anti-Epileptic Drug Adherence to Sodium Channel Blockers and Health-Related Quality of Life: Analysis of US Survey Data from Patients with Epilepsy

AD1 - The Association Between Anti-Epileptic Drug Adherence to Sodium Channel Blockers and Health-Related Quality of Life: Analysis of US Survey Data from Patients with Epilepsy

The prevalence rates of medication adherence and factors influencing adherence to antiepileptic drugs in children with epilepsy: A systematic review and meta analysis

ObjectiveWe conducted a systematic review to assess antiepileptic drug (AED) adherence rates, and to identify the characteristics associated with nonadherence in children. MethodsWe searched PubMed, EMBASE, and the Cochrane Library from inception to June 2017. Observational studies addressing medication adherence or examining factors influencing AED adherence were included. ResultsWe included 22 studies, involving 3955 participants. The general quality of included studies were rated as high quality. Adherence rates were reported in 18 studies, varying between 22.1% and 96.5%. Meta analysis of 13 studies (n = 2051) revealed a pooled adherence rate assessed by objective methods of 58% (95% CI [0.46, 0.74]). Meta analysis of nine studies (n = 1217) revealed a pooled adherence rate assessed by subjective Methods of 73%, (95% CI [0.63, 0.85]). Family support, smaller family size, stable parental marriage status, support from healthcare providers and higher family socioeconomic status were associated with better medication adherence. However, contradictory results were found regarding the effects of age, the frequency of seizure, type of seizures, type of medication and the number of administered drugs. ConclusionsAdherence to AEDs is challenging for pediatric patients with epilepsy. Few factors which influence adherence can be drawn because of differing variables and results. Future prospective research should be designed with longer study periods and larger samples in naturalistic settings.

Allocation of Treatment Responsibility in Adolescents With Epilepsy: Associations With Cognitive Skills and Medication Adherence.

To describe allocation of treatment responsibility (ATR) in adolescents with epilepsy, investigate associations between cognitive skills and ATR, and examine whether ATR for antiepileptic drugs (AEDs) predicted electronically monitored adherence. Sixty adolescents with epilepsy and their caregivers completed the Allocation of Treatment Responsibility Scale and a battery of self-report measures. Medical chart review data and electronically monitored AED adherence were collected for 1 year. Descriptive data assessed ATR for caregivers and adolescents; multivariate hierarchical regressions tested associations between variables. ATR for labs and clinic appointments was greatest for caregivers, while ATR for AEDs was more likely to be shared between caregiver and adolescent. Poorer attention was associated with greater caregiver responsibility for AEDs. Greater caregiver responsibility for AEDs was associated with higher electronically monitored adherence over 12 months. In adolescents with epilepsy, caregivers are responsible for most treatment tasks, although responsibility for taking medication was shared with the adolescent. Greater caregiver responsibility for medication results in better long-term AED adherence. ATR is an important construct that warrants further attention in research and clinical practice, especially in the context of transition and health outcomes in pediatric epilepsy.

Prevalence of Depression and its Associated Factors among Adult Epileptic Patients Following Treatment at Selected Public Health Facilities of Bench Maji Zone, South West Ethiopia, 2017

Background: Depression among epileptic patients has multiple effects: poor quality of life, increased seizure frequency, risk of suicide, increased health care cost and worsened side effects of anti-epileptic medications. It is often under recognized and untreated among these patients.Objective: To assess the prevalence of depression and associated factors among epileptic patient on treatment follow up at selected public health facilities of Bench Maji zone, south west Ethiopia, 2017.Methods: Cross-sectional study was conducted in selected public health facilities of Bench Maji zone from March 3- April 3/2017. Simple random sampling was used. Data was collected through face to face interview and analyzed using frequency, percentage and binary logistic.Result: In this study a total of 244 participants were involved, and the response rate was 98.8%. The overall prevalence of depression was 51.2%. Of these, 60%, 36%, and 4% of the patients were found to have mild, moderate and severe depression respectively. Low educational status (AOR=2.5, CI (1.32, 4.78)), Seizure frequencies ≥ 3 per month (AOR=3.06, CI (1.412, 6.65)), Age onset of epilepsy ≤ 11 years (AOR=4.58, CI (1.94, 10.82)), low anti-epileptic drug adherence (AOR=4.81, CI (2.32, 9.97)) and poor knowledge about epilepsy (AOR=2.77, CI (1.5,5.12)) were found to be independent predictors of depression among epileptic patients.Conclusion and recommendation: Considerable amount of epileptic patients had depression that may predispose them to different health related problems. Low educational status, seizure frequencies, age at onset of the epilepsy, low antiepileptic drug adherence and poor knowledge about epilepsy were found to be contributing factor to the depression.

The association of psychosocial variables with adherence to antiepileptic drugs in patients with temporal lobe epilepsy

ObjectiveThe aim of this study was to explore the association between psychosocial factors and adherence to antiepileptic drugs (AEDs) in patients with temporal lobe epilepsy (TLE). MethodsThis cross-sectional study was conducted with 123 individuals with TLE, admitted to our epilepsy center from December 2015 to May 2017. The participants completed standardized self-report questionnaires measuring medication adherence, anxiety, depression, and family and social support. Adherence was measured by the 8-item Morisky Medication Adherence Scale (MMAS), and logistic regression was used to examine statistically significant associations of different variables with adherence. ResultsWe found a 33.3% rate of poor AED adherence. Moderate-to-severe anxiety (odds ratio (OR)=2.851, 95% confidence interval (CI)=1.138–7.144, P=0.025) and the presence of hippocampal sclerosis (OR=3.098, 95% CI=1.259–7.620, P=0.014) were positively associated with poor adherence to antiepileptic drugs. Social support (OR=0.925, 95% CI=0.863–0.990, P=0.025) was negatively associated with poor adherence. Neither depression nor family support was associated with adherence. ConclusionOne-third of patients with TLE were prone to poor AED adherence, especially individuals with hippocampal sclerosis. Intervention approaches designed to improve AED adherence in patients with TLE should focus on psychosocial factors.

Factors limiting adherence to antiepileptic treatment: A French online patient survey.

There are various reasons why antiepileptic treatment can fail. One is drug-resistant epilepsies, but non-adherence, or poor adherence, to treatment may make some patients' treatment ineffective. The consequences of poor adherence include treatment failure or introduction of more complex treatments involving greater toxicity with uncertain prognosis. This study contributes to a critical research area focused on antiepileptic drug adherence and aims to assess the main factors limiting adherence, as well as psychosocial factors influencing on risk of non-adherence. An opinion survey was conducted among patients and parents of children treated for epilepsy and members of a French online support group. A total of 263 questionnaires were collected. Of the patients, 79% said they never forget their medication, whereas 21% admitted occasional or frequent omissions. The main treatment-related factors that can limit adherence were adverse effects (limiting factors reported for 70% of patients) and number of tablets or number of intake per day (limiting factors reported for 32% of patients). Galenic (liquid) formulation (18%), drug taste (18%), tablet size (14%) and concern about the perception of others (17%) were cited in roughly equivalent terms as limiting adherence to treatment. Among the 55 patients who were genuinely non-adherent to their treatment, the occupational difficulties induced by following the treatment were a main cause of non-adherence. Improving adherence in patients with epilepsy is a difficult and complex problem. Community pharmacists could play a major role in the determination of patients' adherence and should be aware of the risk of non-adherence.

The Stability and Influence of Barriers to Medication Adherence on Seizure Outcomes and Adherence in Children With Epilepsy Over 2 Years.

To determine the stability and influence of adherence barriers on medication adherence and seizure control in pediatric epilepsy. Caregivers of 118 children aged 2-12 years old with epilepsy completed the Pediatric Epilepsy Medication Self-Management Questionnaire at nine time points over 2 years post diagnosis. Electronically monitored antiepileptic drug adherence and seizure outcome data were collected. Hierarchical linear modeling results for overall barriers remained stable over 2 years. Specific item-level barriers were also generally stable over time, with the exception of running out of medication becoming more of a barrier over time. No specific barriers were related to seizure control; however, difficulties swallowing medication, forgetting, and medication refusal were related to electronically monitored adherence over time. Assessing for specific adherence barriers over time may lead to identification of interventions that result in improved adherence and care.

The impact of a pharmacist-led educational interview on medication adherence of Saudi patients with epilepsy.

PurposeTo evaluate the effectiveness of a pharmacist-led educational interview in terms of adherence to antiepileptic drug administration among adult patients with epilepsy.MethodSixty adult patients with epilepsy who fulfilled the inclusion criteria were recruited. A pharmacist-led educational interview was conducted with the intervention group (n=30). Patients in the control group (n=30) were interviewed and contacted 6 weeks after the initial visit without receiving any intervention. Antiepileptic drug adherence was measured during clinic visits, and 6 weeks afterwards using the 8-item Morisky Medication Adherence Scale. This prospective interventional study was conducted between September and December 2013.ResultsOnly 29 control patients and 27 intervention patients completed the 6 weeks post-intervention adherence measurement. The adherence score average in the intervention group was 5.26±0.98 at baseline and improved to 6.7±0.823 (P<0.0001) after intervention. In the control group, the adherence score average was 5.76±1.806 at baseline and 5.83±1.627 at 6 weeks (P=0.792). While there was no statistically significant difference in adherence score between intervention and control groups at baseline, the post-intervention difference was significant (P=0.024).ConclusionOur study suggests that pharmacist-led educational interviews had a positive impact on medication adherence in patients with epilepsy.

An evaluation of factors affecting adherence to antiepileptic drugs in patients with epilepsy: a cross-sectional study.

Adherence to antiepileptic drug (AED) therapy is important for controlling seizures in patients with epilepsy (PWE). It is vital to identify the factors influencing adherence to AED therapy using validated tools. This study aimed to evaluate the pattern and extent of AED adherence among PWE and to identify the factors that influence adherence. This was a cross-sectional study involving PWE who had a confirmed diagnosis. Treatment adherence was assessed using the four-item Morisky Medication Adherence Scale. Univariate analysis with chi-square test was used to observe the association between different variables and AED adherence. Binary logistic regression analysis was used to identify the predictors of adherence. 451 PWE (mean age 27.3 ± 8.1 years) were enrolled in the study; 251 (55.7%) were male and 198 (43.9%) were from the lower socioeconomic class. 326 (72.3%) patients had high adherence to AED therapy, while 125 (27.7%) had low adherence. AED adherence was significantly associated with socioeconomic status (p = 0.043) and type of epilepsy (p = 0.033). However, no significant difference was observed between adherence and age, gender, marital status, epilepsy duration, number and type of AEDs, and occurrence of adverse drug reactions. Patients with focal epilepsy and those from the middle/lower-middle socioeconomic classes were less likely to be nonadherent. The primary reason for nonadherence was forgetfulness. This study found that a majority of PWE have optimal rates of AED adherence and that forgetfulness is the primary reason for nonadherence among PWE.

Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare.

Older minority groups are more likely to have poor AED adherence. We describe adherence to antiepileptic drugs (AEDs) among older Americans with epilepsy. In retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries augmented by minority representation, epilepsy cases in 2009 were those with ≥1 claim with ICD-9345.x or ≥2 with 780.3x, and ≥1 AED. New-onset cases had no such claims or AEDs in the year before the 2009 index event. We calculated the Proportion of Days Covered (PDC) (days with ≥1 AED over total follow-up days) and used logistic regression to estimate associations of non-adherence (PDC <0.8) with minority group adjusting for covariates. Of 36,912 epilepsy cases (19.2% White, 62.5% African American (AA), 11.3% Hispanic, 5.0% Asian and 2% American Indian/Alaskan Native), 31.8% were non-adherent (range: 24.1% Whites to 34.3% AAs). Of 3706 new-onset cases, 37% were non-adherent (range: 28.7% Whites to 40.5% AAs). In adjusted analyses, associations with minority group were significant among prevalent cases, and for AA and Asians vs. Whites among new cases. Among other findings, beneficiaries from high-poverty ZIP codes were more likely to be non-adherent than their counterparts, and those in cost-sharing drug benefit phases were less likely to be non-adherent than those in deductible phases. About a third of older adults with epilepsy have poor AED adherence; minorities are more likely than Whites. Investigations of reasons for non-adherence, and interventions to promote adherence, are needed with particular attention to the effect of cost-sharing and poverty.

Antiepileptic drug adherence and persistence in children with epilepsy attending a large tertiary care children's hospital.

We aimed to evaluate antiepileptic drug treatment persistence and adherence in paediatric epilepsy patients and investigate the association between medication-taking behaviours and clinical outcome. Medical and prescription records of newly treated paediatric epilepsy patients, aged 1-18 years who initiated antiepileptic drug monotherapy in a tertiary teaching hospital, were retrospectively reviewed. The rates of overall treatment, non-persistence, a treatment gap >60 days, and adherence, as measured by a medication possession ratio ≥0.8, were assessed. The relationship between non-adherence and clinical outcome, defined as an emergency department visit or hospitalisation due to seizure-related reasons, was analysed. A total of 1,172 patients met the inclusion criteria. The proportion of patients who were both persistent and adherent at one year was 70.14% and decreased to 56.83% at two years. Patients who started an antiepileptic drug at one year of age, took older generation antiepileptic drugs as the initial treatment, and those diagnosed with localized seizures were less likely to be adherent to and persistent with overall antiepileptic drug treatment. Patients who were non-adherent to antiepileptic drug treatment were at an increased risk of hospitalisation or emergency department visits for seizure-related reasons (adjusted HR 2.10, 95% CI 1.25-3.55). This large population study shows that 70% of paediatric epilepsy patients were persistent with and adherent to antiepileptic drugs after one year of treatment and confirms that non-adherence to antiepileptic drug treatment is an important factor in seizure-related clinical outcome.

Medication adherence in women with epilepsy who are planning pregnancy.

This study examines medication adherence among women with epilepsy via use of an electronic diary, as part of a prospective multicenter observational study designed to evaluate fertility in women with epilepsy (WWE) versus age-matched controls. WWE and healthy age-matched controls, seeking pregnancy, were given an iPod Touch using a customized mobile application (the WEPOD App) for daily data tracking. Eighty-six WWE tracked seizures and antiepileptic drugs (AEDs). Tracking of nonepilepsy medications was optional. Diary data were counted from enrollment date until date of delivery, or up to 12 months if pregnancy was not achieved. Each day that subjects reported missing one or more AED was counted as nonadherence. Because adherence can only be determined in women who track consistently, we elected to include adherence data only for women who tracked >80% of days in the study. Approximately 75% of WWE tracked >80% of days and were included in medication adherence data analysis. In this group, medication adherence rate was 97.71%; 44% of women admitted to missing an AED on at least 1 day. Among the subgroup of WWE who recorded nonepilepsy medications, AED adherence rate was 98.56%, versus 93.91% for non-AEDs. The 75% compliance rate with an electronic diary suggests that it may be useful to track medication adherence in future studies and in the clinical setting. In those who tracked, the observed medication adherence rate was considerably higher than the 75% adherence rate seen in previous epilepsy studies. This might be explained in part by selection bias, but may also result from properties of the diary itself (daily reminders, real time feedback given to the provider). Women reported a higher rate of adherence to AEDs than to other prescribed medications and supplements, suggesting that perceived importance of medications likely influences medication adherence, and warrants future study.

Increasing adherence to treatment in epilepsy: what do the strongest trials show?

Patient non-adherence to prescribed anti-epileptic drugs (AEDs) remains a challenge to successful treatment of patients with epilepsy. However, the literature on epilepsy does not document a comprehensive review of interventions to improve adherence as a means to improve clinical outcomes. This study systematically reviews existing literature on interventions to enhance AED adherence and clinical outcomes, and the measures of adherence included in these studies. We selected randomized controlled trials (RCTs) of interventions to enhance adherence with AEDs, which also measured clinical outcomes, with at least 80% follow-up of participants for at least 6months, from a comprehensive Cochrane review of adherence interventions for medications, complete to January 2013, and updated searches for additional AED studies in multiple bibliographic databases to January 2016. Two review authors independently extracted all data and a third author resolved disagreements. The present update included one trial from the Cochrane review and three RCTs published since, bringing the total number of RCTs on this topic to four. Two types of intervention were tested: educational (e.g., providing information to the patient or carer about treatment characteristics, duration, dosage regime, and how to use the AED) and behavioral (activity in order to remind the patient to take a medicine). Methods of measuring adherence included a combination of direct (plasma AED levels) and indirect measures (prescription refill frequency and appointment keeping) or use alone of self-report adherence on standardized scales. Despite the importance of the problem, evidence is limited concerning enhancement of adherence among people with epilepsy. However, the trials available to date show that medication adherence in epilepsy can be improved, leading to better seizure control.

Preliminary feasibility and efficacy of text messaging and application-based adherence interventions in adolescents with epilepsy.

Few interventions have been developed to improve treatment adherence in adolescents with epilepsy. The purpose of this study was to test the feasibility and acceptability of text messaging and application-based interventions to improve adolescent antiepileptic drug adherence. It was hypothesized that these interventions would improve adherence and would be feasible and acceptable to adolescents and their caregivers. Twenty-five adolescents (mean age=15.7; 52% males) and caregivers were randomized to one of five interventions for one month: 1) adolescent text only, 2) adolescent and caregiver text plus communication, 3) adolescent application only, 4) adolescent and caregiver application plus communication, and 5) epilepsy application for adolescents only. Questionnaires were completed at baseline, posttreatment, and 1-month follow-up. The primary outcome measure was electronically monitored adherence. Results indicated high levels of baseline adherence that contributed to minimal adherence improvements. Adolescents and caregivers reported that text messaging and application-based interventions were feasible and acceptable. These data highlight that technology-focused adherence interventions are feasible but should likely be targeted to those with demonstrated nonadherence in future clinical trials.