Non-adherence and epileptic emergency—reasons and solutions

Abstract Background One important cause of epileptic treatment failure and emergency department visits is due to non-adherence. Medication adherence is a complex behavior that describes the association between recommended and actual medicine use. Numerous modifiable and unmodifiable factors may affect medication adherence in patients with epilepsy. Other factors, such as pharmacogenetics, need to be considered and may provide opportunities in the future treatment of epilepsy. Method We present the case of a patient with newly diagnosed epilepsy and sub-therapeutic levels for antiseizure medication due to suspected non-adherence. We delineate the main challenges while elucidating the reasons for unmet seizure control, and suggest interventions for adherence management. Results In the case of unmet therapeutic goals, distinguishing non-response, pharmacoresistance, and non-adherence remains a challenge. We suggest first double-checking therapy-related factors (interaction, contra-indication) and adapting them. Then, behavior-related reasons should be elucidated depending on the treatment phase (initiation, implementation, persistence). Improving adherence through modifiable factors targets forgetfulness, medication management, beliefs/concerns, and costs. The intervention should be tailored to the modifiable factors. Pharmacogenetic tests can be used to predict how an individual may respond to a specific pharmacotherapy, but only in specific situations and in combination with other information. Conclusion Non-adherence should be considered as a common cause of epileptic treatment failure. We recommend elucidating the modifiable reasons systematically alongside therapeutic and behavioral factors.