Unraveling Antiseizure Medication Adherence in Paediatric Epilepsy: Implications for Clinical Practice and Patient Care

Abstract

Objective

Non adherence to antiseizure medications (ASM) is a common and modifiable risk factor for poor control of epilepsy and contributes to increased hospitalizations, bias in assessing the effectiveness of therapy and inaccurate clinical decision making.The aim of the study was to estimate proportion of nonadherence to antiseizure medications among children with epilepsy and to identify clinical and demographic factors that contribute to antiseizure medication non adherence.

Methods

Consecutive subjects ≤ 18 years with epilepsy, on antiseizure medications for atleast three months, attending Pediatric Neurology OPD, Government Medical College Thiruvananthapuram, Kerala, India were included in the study. Self reported adherence to antiseizure medications was measured using Medication Adherence Report Scale questionnaire. Perceptions towards medications were assessed using Beliefs about Medicines Questionnaire Clinicodemographic factors and medication beliefs were analysed to examine their association with non-adherence in the participating children.

Results

The rate of non-adherence in children with epilepsy was 32%. 68% of the study population had high necessity beliefs and 60% showed low concern beliefs, which indicated overall positive perception towards medications. Univariate analysis showed that the following were significantly associated with ASM non adherence: ASM side effects (OR:3.01; 95% CI:1.52–5.92; p < 0.001) and ASM Concerns (OR: 0.84; 95% CI: 0.77–0.92; p 0.0003) and Necessity-Concern Differential Score (OR: 1.19; 95% CI: 1.10–1.29; p 0.0001). Other clinic-demographic variables did not exhibit a significant association with adherence. Multivariate analysis showed that both ASM side effects and ASM beliefs, represented by NCD score remained significant.

Conclusion

Perceptions towards medications have an important and potentially modifiable association with medication non adherence. Interventions to improve adherence should be tailored to each patient, including measures to address the specific beliefs of the patient and the family, along with practical barriers such as side effects of medications.