Adherence barriers in pediatric epilepsy: From toddlers to young adults
Ana M Gutierrez-Colina1, Aimee W Smith1, Constance A Mara1
1Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, United States.
Insights
Adherence barriers in pediatric epilepsy change with age, impacting treatment, seizures, and quality of life. Targeted interventions are crucial for different developmental stages.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Clinical Pharmacy
Background:
- Adherence to antiepileptic drugs (AEDs) is critical for managing pediatric epilepsy.
- Understanding how adherence barriers evolve across development is essential for effective treatment.
- Previous research has not fully explored the continuity and impact of these barriers from childhood to young adulthood.
Purpose of the Study:
- To examine the continuity of adherence barriers throughout developmental stages in pediatric epilepsy.
- To assess the differential influence of these barriers on adherence, seizure control, and health-related quality of life (HRQOL).
Main Methods:
- Combined data from five studies for a developmentally representative sample (ages 2-25).
- Included 269 caregivers and 77 adolescents/young adults.
- Assessed adherence barriers and HRQOL via questionnaires and electronic monitoring of AED adherence over 30 days.
Main Results:
- Adherence barriers showed both continuity and discontinuity across development.
- Specific barriers like medication taste, parent forgetfulness, and refusal were more prominent in certain periods.
- Barriers differentially predicted adherence, seizure control, and HRQOL based on developmental stage.
Conclusions:
- Routine assessment of adherence barriers is vital from toddlerhood to young adulthood.
- Intervention strategies must be developmentally tailored and target barriers most predictive of poor outcomes.
Objective:
The objectives of this study were to examine the continuity of adherence barriers across stages of development in pediatric epilepsy and to assess the differential influence of barriers on several important clinical outcomes from early childhood to young adulthood, including adherence, seizures, and health-related quality of life (HRQOL).
Method:
A developmentally representative sample of youth 2-25years with epilepsy was obtained by combining data from five different studies. A total of 269 caregivers and 77 adolescents and young adults were included in this investigation. Participants completed measures of adherence barriers and HRQOL. An electronic monitoring system was used to assess adherence to the primary antiepileptic drug over 30days. The prevalence of individual barriers across development and their relative importance as predictors of clinical outcomes were examined.
Results:
Adherence barriers are characterized by both continuity and discontinuity from early childhood to early adulthood. Barriers such as disliking the taste of medication, parent forgetfulness, and refusal to take medications were significantly more salient during certain developmental periods. No significant differences across age groups were found for other barriers, including difficulty getting to the pharmacy and embarrassment. Certain adherence barriers, such as running out of medications, were more important to particular clinical outcomes despite being low prevalence. Adherence barriers differentially predicted adherence, seizure control, and HRQOL based on developmental stage.
Conclusion:
Routine assessment of adherence barriers is imperative from toddlerhood to young adulthood given that the prevalence of barriers and their relative influence on important health outcomes vary by developmental stage. Adherence intervention efforts should be targeted, developmentally tailored, and focused on those barriers that are most predictive of poor outcomes for a given developmental period.
Related Concept Videos
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:25Physiological Barriers
The blood endothelial barrier is the most porous of these. It allows all small ionized, un-ionized, and lipophilic molecules to pass through the endothelial lining into the interstitial space...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:25Mucosal Barrier of the Stomach
Within parietal cells, carbonic acid is first formed through the reaction of water and carbon dioxide. The dissociation of carbonic acid releases bicarbonate and hydrogen ions. The bicarbonate...
01:21Barriers to Effective Communication II
Cultural barriers:
Differences in values, beliefs, religion, knowledge, and tradition can significantly impact communication. Awareness of nonverbal cues is critical, especially when conversing with a patient from a different culture. What appears appropriate in one culture may be inappropriate in another.
Semantic barriers:
As a result of their tendency to use...
01:18Surface Membrane Barriers
The outer layer of the skin, the epidermis, is a robust barrier comprising layers of closely packed keratinized cells. This dense arrangement prevents microbes from penetrating the body. The periodic shedding of epidermal cells...