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Does Missing Medication Acutely Change Seizure Risk? A Prospective Study
Daniel M Goldenholz1,2, Joshua C Cheng1,2, Chi-Yuan Chang1,2
1Department of Neurology, Harvard Medical School, Boston, MA.
Annals of Neurology
|January 5, 2026
Summary
Occasional missed anti-seizure medication (ASM) doses did not increase short-term seizure risk in people with drug-resistant epilepsy. Sustained nonadherence remains a concern, but brief lapses are unlikely to trigger acute seizures.
Area of Science:
- Neurology
- Pharmacology
Background:
- Drug-resistant epilepsy affects many individuals, necessitating effective management strategies.
- Adherence to anti-seizure medications (ASMs) is crucial for seizure control.
- The impact of occasional missed ASM doses on short-term seizure risk is not well-established.
Purpose of the Study:
- To investigate whether missing individual doses of ASMs increases short-term seizure risk in patients with drug-resistant epilepsy.
Main Methods:
- A prospective, community-based cohort study involving adults with drug-resistant epilepsy.
- Participants recorded seizures and ASM intake via smartphone applications for 10 months.
- Analysis included individual-level modeling and group-level mixed-effects modeling using a 90-day moving average ('Napkin method').
Main Results:
- Twenty-seven participants contributed 7,853 person-days of data.
- Individual analysis revealed a weak relationship between ASM adherence and seizure occurrence in most participants.
- Group-level analysis indicated seizure occurrence was strongly linked to the 'Napkin method' forecast, not ASM adherence.
Conclusions:
- Occasional missed ASM doses did not significantly elevate immediate seizure risk in individuals with frequent, drug-resistant epilepsy.
- Clinicians can reassure patients that infrequent lapses in ASM adherence are unlikely to cause acute seizures.
- Emphasis on overall adherence remains important for long-term seizure control in epilepsy management.
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