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Nonadherence to Antiepileptic Medications in Children

More than half of children with newly diagnosed epilepsy were nonadherent to medication dosing during the first 6 months of treatment.



Investigators prospectively examined the pattern and determinants of antiepileptic medication adherence in 124 consecutive children (age range, 2–12 years) with newly diagnosed seizures. Adherence during the first 6 months of therapy (carbamazine or valproic acid twice daily) was measured using an electronic medication monitoring system.

The authors identified five patterns of adherence. Severe early nonadherence described the 13% of children who took 25%–50% of prescribed doses during the first month and become totally nonadherent within 6 months. Severe delayed nonadherence described the 7% of children whose high adherence declined over time to only 20% of doses at 6 months. Moderate nonadherence described the 13% of children who averaged 70% of medications. Mild nonadherence referred to children who averaged 85% of doses. Only 42% of children had near-perfect adherence. The only variable that predicted adherence trajectory was socioeconomic status (SES); lower SES was associated with poorer adherence. Seizure type and severity, frequency of adverse events, and whether a parent witnessed the first seizure did not predict adherence.

Comment: Nearly 60% of children with newly diagnosed seizures do not adhere to their seizure medication dosing schedule during the first 6 months of therapy. Unfortunately, the only predictor of adherence — SES — is beyond the therapeutic power of providers, but it can help identify children at risk for nonadherence. Providers can suggest ways to improve adherence to dosing schedules (e.g., use of calendars or alarms). Visiting nurses might be considered to periodically monitor medication compliance for some patients.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine May 18, 2011

Citation(s):

Modi AC et al. Patterns of nonadherence to antiepileptic drug therapy in children with newly diagnosed epilepsy. JAMA 2011 Apr 27; 305:1669.