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Unraveling Antiseizure Medication Adherence in Paediatric Epilepsy: Implications for Clinical Practice and Patient
Anchu Anna Cherian1, Mini Sreedharan1, Priya Sreenivasan2
1Department of Pediatric Neurology, Government Medical College Thiruvananthapuram, India.
Insights
In children with epilepsy, 32% showed non-adherence to antiseizure medications. Addressing medication side effects and patient beliefs is crucial for improving adherence in pediatric epilepsy management.
Area of Science:
- Pediatric Neurology
- Epilepsy Management
- Medication Adherence Research
Background:
- Non-adherence to antiseizure medications (ASM) is a significant, modifiable risk factor for poor epilepsy control in children.
- It contributes to increased hospitalizations, biased treatment effectiveness assessments, and flawed clinical decision-making.
Purpose of the Study:
- To determine the proportion of non-adherence to ASM among children with epilepsy.
- To identify clinical and demographic factors associated with ASM non-adherence in this population.
Main Methods:
- A study involving children (≤18 years) with epilepsy on ASM for at least three months was conducted.
- Self-reported adherence was measured using the Medication Adherence Report Scale, and beliefs about medications were assessed.
- Clinicodemographic factors and medication beliefs were analyzed for their association with non-adherence.
Main Results:
- The rate of non-adherence to ASM in children with epilepsy was found to be 32%.
- Significant associations with non-adherence included ASM side effects (OR: 3.01) and ASM Concerns (OR: 0.84), as well as the Necessity-Concern Differential Score (OR: 1.19).
- Multivariate analysis confirmed the significance of both ASM side effects and ASM beliefs (NCD score) in relation to adherence.
Conclusions:
- Medication perceptions significantly and modifiably influence non-adherence in pediatric epilepsy.
- Interventions should be individualized, addressing patient/family beliefs and practical barriers like medication side effects to enhance adherence.
Objective:
Non adherence to antiseizure medications (ASM) is a common and modifiable risk factor for poor control of epilepsy and contributes to increased hospitalizations, bias in assessing the effectiveness of therapy and inaccurate clinical decision making.The aim of the study was to estimate proportion of nonadherence to antiseizure medications among children with epilepsy and to identify clinical and demographic factors that contribute to antiseizure medication non adherence.
Methods:
Consecutive subjects ≤ 18 years with epilepsy, on antiseizure medications for atleast three months, attending Pediatric Neurology OPD, Government Medical College Thiruvananthapuram, Kerala, India were included in the study. Self reported adherence to antiseizure medications was measured using Medication Adherence Report Scale questionnaire. Perceptions towards medications were assessed using Beliefs about Medicines Questionnaire Clinicodemographic factors and medication beliefs were analysed to examine their association with non-adherence in the participating children.
Results:
The rate of non-adherence in children with epilepsy was 32%. 68% of the study population had high necessity beliefs and 60% showed low concern beliefs, which indicated overall positive perception towards medications. Univariate analysis showed that the following were significantly associated with ASM non adherence: ASM side effects (OR:3.01; 95% CI:1.52-5.92; p < 0.001) and ASM Concerns (OR: 0.84; 95% CI: 0.77-0.92; p 0.0003) and Necessity-Concern Differential Score (OR: 1.19; 95% CI: 1.10-1.29; p 0.0001). Other clinic-demographic variables did not exhibit a significant association with adherence. Multivariate analysis showed that both ASM side effects and ASM beliefs, represented by NCD score remained significant.
Conclusion:
Perceptions towards medications have an important and potentially modifiable association with medication non adherence. Interventions to improve adherence should be tailored to each patient, including measures to address the specific beliefs of the patient and the family, along with practical barriers such as side effects of medications.
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