Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes

Abstract

Objective: The aim of the study was to determine sociodemographic, biological epilepsy-specific, and adherence predictors of long-term pediatric seizure outcomes.Methods: This study is a prospective, longitudinal, observational study of antiepileptic drug (AED) adherence and seizure outcomes in children with newly diagnosed epilepsy. Patients were recruited from April 2006 to March 2009 and followed for 2 years. Objective, electronic monitors were used to assess AED adherence. Medical chart reviews assessed medical variables and seizure outcomes.Results: Participants (n 5 109) were 7.3 6 2.9 years of age, and 62% male. Four adherence trajectory groups were identified: severe early nonadherence (n 5 10), variable nonadherence (n 5 16), moderate nonadherence (n 5 40), and high adherence (n 5 43). Two seizure probability trajectory groups were identified: high seizure (n 5 28) and low seizure probability (n 5 81). Participants with recognizable syndromes were less likely to be a member of the high seizure probability group (b 5 22.372; odds ratio [OR] 5 0.093; 95% confidence interval [CI] OR 5 0.015, 0.595); those with the presence of epileptiform discharges on EEG were more likely to be in the high seizure probability group (b 5 1.649; OR 5 5.203; 95% CI OR 5 1.422, 19.037). Adherence trajectory group status was a significant predictor of seizure trajectory group status (partial maxrescaled R 2 5 0.13). Despite the introduction of multiple new efficacious antiepileptic drugs (AEDs), 20% to 35% of children with newly diagnosed epilepsy continue to have seizures. 1-3 Several biologically based factors have been examined to understand this disease course, including underlying brain disorders and structural abnormalities, seizure type/etiology, and genetics. Conclusions:4,5 However, these biological factors, which are nonmodifiable, do not fully explain the variability in seizure outcomes. In contrast, behavioral factors, such as AED nonadherence, are modifiable and may affect long-term seizure outcome. While discrete trajectories of AED nonadherence in children with newly diagnosed epilepsy have been identified, 6 similar trajectories of long-term seizure outcomes have not been examined. Our prior work also indicates that children who are nonadherent to their AEDs within the first 6 months of therapy are 3.24 times more likely to have seizures 4 years after diagnosis. 7 In adults, AED nonadherence increases short-term risk of seizures. 8,9 However, what remains unknown is the relationship between long-term nonadherence and seizure outcome in both adults and children. We conducted a prospective, longitudinal, observational study to

Predictors of trajectories of epilepsy-specific quality of life among children newly diagnosed with epilepsy

“…Internal consistency reliability in this sample was 0.99. Seizure probability trajectory groups indicating the likelihood of patients having a seizure over the two year study were previously identified and used a marker of seizure course in this study [18]. …”

“…Data were downloaded from the TrackCap at each study visit and those data were previously used to identify trajectories of AED adherence over the first two years. Four long-term adherence trajectory groups were identified including Severe Early Non-adherence, Variable Non-adherence, Moderate Non-adherence, and High Adherence[18] and were utilized in the current paper.…”

“… a Seizure probability trajectory groups indicating the likelihood of patients having a seizure over the two year study were previously identified and used a marker of seizure course in this study [18] *** OR (95% CI) for the Early Severe Nonadherence Group vs High Adherence Group: 26.52 (1.82, 387.54), Variable Nonadherence Group vs High Adherence Group: 0.98 (0.14, 6.84), Moderate Nonadherence Group vs High Adherence Group: 0.51 (0.12, 2.07), Severe Early Nonadherence Group vs Moderate Nonadherence Group: 52.49 (3.72, 741.23), Variable Nonadherence Group vs Moderate Nonadherence Group: 1.94 (0.35, 10.64), Group Severe Early Nonadherence vs Variable Nonadherence: 27.06 (1.66, 440.83). …”

Caveat medicus: medication non‐adherence in children and adolescents with epilepsy

“…2 Critical analysis of the literature to assess the true prevalence of this condition, the range of underlying etiologies, prognosis, and associated complications is challenging due to variations in neuroanatomical definition and patient cohort selection between studies and the complexity of corpus callosum development. An excellent review article 3 highlights that the formation of the corpus callosum involves multiple neurodevelopmental processes, each orchestrated by a large number of interacting genes.…”

“…3 Prior research suggests multiple patterns of non-adherence which are identifiable early on in the disease course with some variation over time. 1 Barriers to adherence that have been identified include a non-modifiable barrier of socio-economic status and modifiable barriers including epilepsy knowledge, family problem-solving, family communication, parent fears and concerns, and parent life stress.…”