Global patterns and predictors of anti-seizure medication adherence in pediatric epilepsy: A systematic review and
Molalign Aligaz Adisu1, Alemu Birara Zemariam1, Yabibal Asfaw Derso2
1Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia.
Insights
Medication adherence in children with epilepsy is suboptimal, with only 63.96% adhering to anti-seizure drugs. Factors like maternal education and diagnosis duration influence adherence, highlighting the need for targeted interventions.
Area of Science:
- Neurology
- Public Health
- Pharmacology
Background:
- Epilepsy affects 50 million worldwide, primarily children and young adults.
- Anti-seizure medication (ASM) adherence is crucial but challenging.
- Limited evidence exists on global ASM adherence in pediatric populations.
Purpose of the Study:
- To estimate global adherence prevalence to ASMs in children and adolescents.
- To identify regional variations and determinants of ASM adherence.
- To provide evidence-based suggestions for improving ASM adherence.
Main Methods:
- Systematic review and meta-analysis following PRISMA guidelines.
- Searched major databases (PubMed, Embase, Scopus, Web of Science, Cochrane).
- Employed random-effects model for pooled estimates; performed heterogeneity, bias, and sensitivity analyses.
Main Results:
- Analyzed 41 studies with 13,747 participants.
- Pooled adherence prevalence to ASMs was 63.96% (95% CI: 59.36%-68.57%).
- Predictors included higher maternal education, recent diagnosis, lower healthcare costs, and monotherapy.
Conclusions:
- Adherence to ASMs in pediatric epilepsy is suboptimal.
- Key predictors identified: maternal education, time since diagnosis, cost, and polypharmacy.
- Interventions addressing socioeconomic factors and treatment complexity are necessary to improve adherence.
Background:
Epilepsy is a chronic neurologic disorder that affects around 50 million individuals worldwide, disproportionately affecting children and young adults. Anti-seizure medication is vital to control seizures, yet adherence remains a key public health concern. While there are scattered individual studies addressing these issues, there is no summary of evidence. This systematic review and meta-analysis will give an estimate of global adherence prevalence, regional variations and determinants, and offer suggestions on improving medication adherence in this vulnerable population.
Methods:
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews for studies reporting on the adherence of anti-seizure medication among children and adolescents. We employed random-effects model to calculate pooled estimates. Additionally, heterogeneity, publication bias and sensitivity analysis was performed.
Results:
The final analysis consisted of 41 studies on a sample of 13,747. The pooled prevalence of adherence to anti-seizure medication in children and adolescents with epilepsy was estimated to be 63.96% (95% CI: 59.36%-68.57%). Independent predictors of medication adherence in the study were: children and adolescents of mothers with highest educational levels (AOR: 2.07, 95% CI: 1.01-3.14), recently diagnosed children and adolescents with epilepsy (AOR: 2.20, 95% CI: 1.25-3.16), parents with annual healthcare costs of over $7,000 (AOR: 0.53, 95% CI: 0.30-0.76), and patients on monotherapy (AOR: 3.03, 95% CI: 2.47-3.60).
Conclusion:
This meta-analysis found that there was a suboptimal rate of adherence to anti-seizure medication in children and adolescents. Predictors were maternal education, time since diagnosis, cost, and polypharmacy. The findings confirm the necessity of intervention into socioeconomic status and treatment complexity to improve adherence.
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