Treatment non-adherence in pseudo-refractory epilepsy

Perampanel in routine clinical use across Europe: Pooled, multicenter, observational data

“…An alternative possibility is that failure of multiple AEDs can indicate suboptimal adherence and pseudo-refractory epilepsy. 28 Third, that use of EIAEDs was weakly associated with lower chance of seizure freedom. This is consistent with other reports 24 and is likely to be caused by lower perampanel levels due to enzyme induction.…”

“…This is consistent with other reports, and a higher number of prior AEDs are generally considered a proxy for more severe, refractory epilepsy, which is harder to treat. An alternative possibility is that failure of multiple AEDs can indicate suboptimal adherence and pseudo‐refractory epilepsy …”

Antiepileptic drug treatment of generalized tonic–clonic seizures: An evaluation of regulatory data and five criteria for drug selection

“…Reported non-adherence rates in epilepsy range from 40-60% in adults, similar to the estimated rate across all long-term conditions (50% in developed countries) [26]. It can manifest as noninitiation, poor execution (accidental or intentional) or non-persistence, and is affected by many factors related to patient (behaviours, lifestyle), prescribers, socioeconomics, healthcare barriers, and therapy-related factors [26,[87][88][89][90]. Non-adherence often occurs early after diagnosis and persists over time [91,92].…”

Real life pharmaceutical treatment patterns for adult patients with focal epilepsy in Germany: a longitudinal and cross-sectional analysis of recently approved anti-epileptic drugs

“…Secondly, AED withdrawal may be an option for patients who have been seizure free for several years [33], [35]. Thirdly, non-persistence in AED treatment may also explain why a certain percentage of patients did not receive any AED therapy in the observed follow-up years [36], [37]. Fourthly, it may be possible that an unknown number of patients were diagnosed with FE, received an initial AED therapy, but proved not to need medication, potentially due to an incorrect coding.…”

“…As an example, FE-prevalent monotherapy patients received 171–222 DDDs of supply on average in one observed year only. This may be due to non-adherence of patients to their regime [37]. Another explanation for the low prescribed AED supply may be dosage titration of AED therapy.…”