Poor AED Compliance May Lead to Seizures and Dosage Increases in Children With Epilepsy

PHILADELPHIA—Among children with new-onset epilepsy, imperfect adherence to antiepileptic drug (AED) therapy was associated with recurrent seizures and subsequent avoidable dosage increases, according to findings reported by Julie E. Koumoutsos, and colleagues at the 61st Annual Meeting of the American Epilepsy Society.

Ms. Koumoutsos, a research assistant at the Cincinnati Children’s Hospital Medical Center, and coauthors included 25 children ages 2 to 12 (mean age, 6.9; 76% males; 72% white; 72% with partial epilepsy) and their parents in the study. Sixty-eight percent of the children were taking carbamazepine, and 32% were taking valproic acid.

Treatment adherence was measured with the use of the Medication Event Monitoring System (MEMS) TrackCap (Aardex Ltd, Union City, California), an electronic device containing a microchip that registers the dates and times that a medication bottle is opened. Increases in AED dosage, the number of seizures prior to the increase, and adherence prior to dosage increase were analyzed. Clinicians were blinded to the adherence data and made drug or dosage changes based on a detailed clinical history.

“Results indicated that 56% of the 25 participants had an increase in their AED after reaching the maintenance dose,” stated Ms. Koumoutsos’ group. “Patients with partial epilepsy had more dosage increases than those with generalized epilepsy. Of the 25 participants, 71% of those with a dosage increase had imperfect adherence. Adherence in the week prior to the AED dosage increase was 82.6%, and the mean number of seizures in the week prior was 0.38. In the week prior to the AED dosage increase, one-week adherence was inversely related to the number of seizures that occurred that week.”

The researchers concluded that “identifying poor adherence to AED regimens is important to help clinicians better decide when a behavioral intervention to improve adherence rather than an AED dosage increase is warranted.”

ONE-MONTH ADHERENCE RATES

In a related study, Avani C. Modi, PhD, Assistant Professor in the Division of Behavioral Medicine and Clinical Psychology at the Cincinnati Children’s Hospital Medical Center, and colleagues analyzed one-month treatment adherence in children with new-onset epilepsy and sought to determine whether demographic variables or proximity to a clinic affected adherence. The researchers included 35 children ages 2 to 12 (mean age, 7.2) and their caregivers. Among the participants, 66% were males, 66% were white, and 60% had partial epilepsy. Treatment adherence information was obtained for one month and for one, three, and five days prior to and three days after the clinic appointment using data collected from the MEMS TrackCap. Demographic data were also analyzed.

The investigators found that mean adherence for the first month of treatment was 79.4%. Children with a higher socioeconomic status and those with married parents had higher one-month adherence rates than did the other children, according to the researchers, who noted that adherence was not affected by gender, age, epilepsy type, or prescribed medication. In addition, patients did not have higher adherence rates prior to a clinic visit compared to their one-month adherence rate, suggesting that “white coat compliance” does not exist in this population.

NR