Non-adherence to anticonvulsants linked to worse long-term seizure freedom in children.

Early pediatric antiepileptic drug nonadherence is related to lower long-term seizure freedom

1. Avani C. Modi, PhD, 
2. Joseph R. Rausch, PhD and 
3. Tracy A. Glauser, MD

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1. Correspondence to Dr. Modi: avani.modi@cchmc.org

1. Published online before print January 24, 2014, doi: 10.1212/WNL.0000000000000147Neurology 10.1212/WNL.0000000000000147

• Abstract
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ABSTRACT

Objective: To examine the relationship between previously identified nonadherence trajectories during the first 6 months of antiepileptic drug (AED) therapy and long-term seizure-free rates (defined as ≥1 year of seizure freedom at the 4 years postdiagnosis milestone) in a cohort of children with newly diagnosed epilepsy.

Methods: A prospective longitudinal observational study of AED adherence and seizure freedom in a consecutive cohort of 124 children (ages 2–12 years) with newly diagnosed epilepsy was conducted. The association between previously identified AED adherence trajectories (i.e., near-perfect adherence [e.g., average adherence = 96.8%] vs nonadherent) and seizure freedom for ≥1 year at the 4 years postdiagnosis milestone was determined.

Results: Children who exhibited nonadherence to AED therapy in the first 6 months of treatment were 3.24 times more likely not to have achieved ≥1 year of seizure freedom at the 4 years postdiagnosis milestone compared to children in the near-perfect adherence group (χ² = 5.13; p = 0.02). Specifically, at the 4 years postdiagnosis milestone, only 12% of children in the near-perfect adherence group were continuing to experience seizures compared to 31% of children in the nonadherent group.

Conclusions: Children with epilepsy who achieved near-perfect adherence during the first 6 months of therapy experienced a higher rate of seizure freedom 4 years postdiagnosis compared with those children who demonstrated early nonadherence. This suggests that adherence intervention early in the course of treatment could play a role in improving long-term seizure freedom rates in children with epilepsy.

• Received June 3, 2013.
• Accepted in final form November 6, 2013.