Enhancing medication adherence in drug-resistant epilepsy using "Epilepto": A pilot randomized controlled trial...

Drug-resistant epilepsy is a disabling, chronic condition in children. Long-term prognosis depends on the extent of seizure control. Ensuring compliance with medication can help reduce the seizure burden. Forgetfulness is a key barrier to adherence. To address this, we used a mobile application, "Epilepto," to deliver regular medication reminders aimed at improving compliance.

We enrolled children with drug-resistant epilepsy aged 3 months to 18 years with varied etiology and randomized them into two groups. The intervention group was trained to use the application to help remind them of the medications, along with the standard of care treatment given to the control group. Medication adherence was assessed using the Morisky Medication Adherence Scale-8 (MMAS-8), and seizure burden was assessed using the Early Childhood Epilepsy Severity Scale (E-Chess). All the children were assessed at 3 and 6 months after enrollment.

A total of 100 children were randomized (1:1) to either the control or intervention group. The median age of children in the intervention group was 84 months (Interquartile range, 45-144), and the control group was 96 months (48-144). Overall, 70% of the children were boys, and 52% had generalized epilepsy. The majority of the cases had a structural (70%) or a genetic (20.6%) etiology. Most of the users found daily reminders useful (42/48). 81.2% found this an acceptable intervention at the 6-month follow-up. There was a gradual improvement in the MMAS-8 scores over 6 months, with a 30% rise in high adherence in the intervention group as compared to only a 6% rise in the control group. There was no reduction in seizure burden as assessed by E-Chess at the end of the study period.

The use of medication reminders appeared to be a feasible intervention for children with drug-resistant epilepsy to improve medication adherence.