Abstracts

Rationale:
The International League Against Epilepsy defines epilepsy as one of the following: at least two unprovoked seizures more than 24 hours apart, one unprovoked seizure with a high probability of reoccurrence during the next 10 years, or diagnosis of an electroclinical syndrome.Effective management of epilepsy heavily relies on strict adherence to anti-seizure medications (ASM) to control seizures and prevent adverse outcomes. Nonadherence is associated with increased seizure occurrence, sudden unexpected death due to epilepsy (SUDEP), low Quality of Life (QOL), increased healthcare utilization and costs. Despite the critical importance of medication adherence in epilepsy management, the factors influencing adherence and the consequences of non-adherence are not fully understood. Existing studies have explored various aspects of this issue, but there remains a need for a comprehensive synthesis of the available evidence to identify key factors affecting adherence and to quantify the impact of non-adherence on clinical outcomes. Despite the simplicity of epilepsy treatment regimens (e.g., taking one to




two AEDs once or twice per day), the measurement of adherence is complex, limited by low reliability and validity, and lack of a gold standard for clinical and research use.This study aims to fill this gap by conducting a systematic review and meta-analysis of the literature on adherence to anti-seizure medications among patients with epilepsy. By reviewing studies published from 1990 to 2020, we seek to provide a detailed understanding of the effects of non-adherence on seizure control, emergency room visits, and SUDEP.









Methods:
A study protocol based on PRISMA guidelines was developed, reviewing studies from 1990 to 2020 on PUBMED, COCHRANE, CINHAL PLUS, EMBASE, and LILAC using keywords related to adherence and epilepsy. The search was restricted to human studies in English. Our systematic search utilized combinations of keywords such as "adherence," "non-adherence," "compliance," "epilepsy," "seizures," and "epilepsies."





Articles that did not mention adherence/compliance to ASM or were limited to non-epileptic cases were excluded. Further articles were pulled out based on the references of shortlisted articles from the databases searched. Duplicates were removed.




Data entry was conducted independently by each author and reliability cross checked.




Results: The findings indicate that non-adherence is associated with a 39% rate of recurrent seizures leading to emergency room visits, a high non-adherence rate of 78% among patients experiencing breakthrough seizures, and a substantial 62% of SUDEP cases involved patients with sub-therapeutic drug levels due to non-adherence. These results underscore the critical need for interventions to improve adherence to anti-seizure medications to reduce adverse outcomes in epilepsy management.







Conclusions:
Non-adherence to antiseizure medication (ASM) significantly impacts epilepsy management, contributing to increased ER visits, breakthrough seizures, and SUDEP. The high prevalence of non-adherence underscores the need for targeted interventions to improve medication adherence and reduce adverse outcomes in epilepsy patients.




Funding: none