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

Abstract

INTRODUCTIONEpilepsy affects 70 million people worldwide.(1) Long-term antiepileptic drug (AED) administration remains the mainstay of epilepsy treatment. In up to 67% of patients with epilepsy (PWE), AEDs effectively eliminate or reduce the frequency of seizures.(2) Medication adherence refers to the extent to which a patient's behaviour corresponds with the recommendations of a health professional. Medication adherence is usually better when there is greater patient involvement in the treatment choice, as well as cooperation and mutual agreement between the health provider and the patient.(2) Nonadherence rates among PWE are reported to be 30%-50%.(3) It is well established that patients with suboptimal adherence levels are more likely to have seizures that are associated with increased number of hospital admissions and healthcare costs.(4) Factors influencing adherence to AEDs have been described; these include patient-, treatment-and health system-related factors.(5) The promotion of medication adherence is considered to be an important component of pharmaceutical care practice. Several methods have been used to measure therapeutic adherence, including self-report, pill count, appointment attendance, medication refill history, blood or urine drug levels and drug diary.(6) Indirect methods, such as self-reports and patient interviews, are the simplest and most common methods used for measuring medication adherence. (7,8) To date, most of the studies conducted to evaluate AED adherence among PWE did not account for the influence of a wide range of variables (e.g. demographic, disease and treatment patterns). There are not many studies in the Indian literature that examine the factors that influence AED adherence. Identifying the factors associated with AED adherence would allow the development of strategies to improve adherence. Thus, the present study aimed to evaluate the pattern and extent of AED adherence among PWE and to identify the factors that influence adherence. METHODSThis cross-sectional study was conducted by the Division of Clinical Pharmacology at the outpatient and inpatient clinics of the Department of Neurology, St John's Medical College and Hospital, Bangalore, India, over a period of 1.5 years (January 2012 to July 2013). Ethical approval was obtained from the institution's Ethical Review Board. Patients aged ≥ 18 years who were receiving AED treatment were eligible for inclusion in the study. Only those who gave their consent for participation were enrolled. Pregnant or lactating women and patients with comorbidities were excluded from the study.Data was collected using a specially designed case record form that included items on demographic/family history, seizure history, duration of epilepsy, AEDs prescribed and occurrence of

Adherence to Antiepileptic Therapy in Adults

“…This study highlights pertinent factors affecting adherence to treatment in patients living with epilepsy in a rural background in India. About seventy percent of patients showed moderate-high adherence to therapy which was similar to other studies conducted in Asia[78] but comparatively higher than those conducted in other continents, where moderate to low adherence was predominant. [910] Males, literates, and employed patients were found to be highly adherent as compared to their other counterparts, signifying that these sociodemographic parameters allowed them to gain better access to treatment and provided greater motivation to continue therapy.…”

A prospective observational study to assess compliance and factors influencing compliance with antiepileptic drugs among patients with epilepsy

“…In a cross-sectional study conducted by Gurumurthy et al, 318 (70.5%) patients were between 18-30 year of age group. 9 Among 105 patients studied; males patients (n=64, 61%) were predominant as compared to females in this study, which is in concordance with another study by Kalyani et al, where 65% patients were males and 35% were female. 10 The higher prevalence in males could be because in some population, the symptoms and diagnosis of epilepsy in women is concealed from public because the exposure of epilepsy may become a hurdle in their marriage.…”

Epilepsy Treatment Outcome and Its Predictors among Ambulatory Patients with Epilepsy at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia

“…e most commonly used AEDs as polytherapy were the combination of phenobarbitone with phenytoin (11.9%) followed by the combination of the phenobarbitone and carbamazepine (6.3%). In contrast to this, studies done in different parts of India revealed that either phenytoin or carbamazepine was the most prescribed AED as monotherapy [20,21].…”