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Published on: September 1, 2023
Treatment non-adherence as a trigger for status epilepticus: An observational, retrospective study based on
Ingrid Anne Lie1, Ingvild Hoggen1, Christian Samsonsen2
1Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
Purpose:
To investigate the role of non-adherence to antiepileptic drug treatment as a trigger for status epilepticus (SE).
Methods:
124 consecutive admissions for SE in patients with established epilepsy were studied. Those who had had therapeutic drug monitoring at admission were identified. Non-adherence was defined as a serum concentration/dose ratio at admission of <75% of the patient's own trough control value.
Results:
In 64 cases serum concentration/dose ratios at admission were available for comparison with morning trough values. Treatment non-adherence was identified in a total of 24 (38%), 50% in children, 32% in patients 16-59 years and in 44% above 60. Missed medication had been reported in only two of these patients. No cases with confirmed non-adherence had a fatal outcome (p=0.05). No significant differences between non-adherent and adherent admissions concerning demographic factors or epilepsy and SE characteristics were found.
Conclusion:
Antiepileptic drug non-adherence is a common cause of SE across all ages, but is not always identified due to the first history-based information often being elusive. Prompt and reliable recognition of non-adherence is imperative for correct management. This is the first study to demonstrate the extent of non-adherence by therapeutic drug monitoring in SE.
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