Use of complementary and alternative medicine and adherence to antiepileptic drug therapy among epilepsy patients: a systematic review

Abstract

PurposeTo identify the use pattern of complementary and alternative medicine (CAM) and its impact on antiepileptic drug (AED) adherence among patients with epilepsy.MethodPotential studies were identified through a systematic search of Scopus, Science Direct, Google Scholar, and PubMed. The keywords used to identify relevant articles were “adherence,” “AED,” “epilepsy,” “non-adherence,” and “complementary and alternative medicine.” An article was included in the review if the study met the following criteria: 1) conducted in epilepsy patients, 2) conducted in patients aged 18 years and above, 3) conducted in patients prescribed AEDs, and 4) patients’ adherence to AEDs.ResultsA total of 3,330 studies were identified and 30 were included in the final analysis. The review found that the AED non-adherence rate reported in the studies was between 25% and 66%. The percentage of CAM use was found to be between 7.5% and 73.3%. The most common reason for inadequate AED therapy and higher dependence on CAM was the patients’ belief that epilepsy had a spiritual or psychological cause, rather than primarily being a disease of the brain. Other factors for AED non-adherence were forgetfulness, specific beliefs about medications, depression, uncontrolled recent seizures, and frequent medication dosage.ConclusionThe review found a high prevalence of CAM use and non-adherence to AEDs among epilepsy patients. However, a limited number of studies have investigated the association between CAM usage and AED adherence. Future studies may wish to explore the influence of CAM use on AED medication adherence.

A cross-sectional study on the rate of non-adherence to anti-seizure medications and factors associated with non-adherence among patients with epilepsy

“…Similar to the patient and disease-related dimensions, we did not find statistically significant associations with adherence for any of the therapy-related factors. This differs from other studies which highlighted significant associations between complicated treatment regimen and ASM adverse effects with poor medication adherence [6,19,25,33]. A possible reason for the discrepancies in our findings may be attributed to our inadequate sample size.…”

“…Patient-related factors such as treatment control, concern, understanding and identity were not found to be statistically different. However, previous studies have shown that patient understanding and perceived lack of benefit of ASM therapy were significant predictors of non-adherence [6,19,37]. This contradiction is possibly attributed to the education level of our patients and the high scores in patients' illness perception which is similar in both the adherent and non-adherent groups in our study.…”

“…The prevalence of non-adherence to ASM therapy varies widely in different regions, ranging from 26% to as high as 79% [6,19]. Objective methods in assessing adherence include pill counts, electronic drug monitoring system, rate of prescription refills, directly observed therapy and monitoring of drug concentrations in body fluids.…”

“…Subjective methods include patient self-reporting and patient kept-diary [6,20,21]. There is no "gold-standard" test for measuring adherence [16] and the most commonly used method is patient self-reporting [6,19] through the administration of a questionnaire or structured interview. There have been several studies in middle-income countries like Malaysia that evaluated the prevalence and factors associated with ASM non-adherence.…”

Attitudes underlying reliance on complementary and alternative medicine

“…In 1998, Astin found that dissatisfaction with and distrust in biomedicine was a significant predictor in alternative, but not in complementary use (Astin, 1998). In the latter group, patient characteristics such as "holistic thinking" and "spirituality" (Astin, 1998) were significant predictors, alongside psychosocial etiology as a naive theory of illness causation (Farrukh, Makmor-Bakry, Hatah, & Tan, 2018). According to Hunt, employing CAM as an alternative to (as opposed to complementing) biomedicine reached 30% among all British CAM users in 2010 (Hunt et al, 2010).…”