WebMD Medical News
Laura J. Martin, MD
April 26, 2011 -- More than half of children with newly diagnosed epilepsy do not take their seizure medications as prescribed, a study shows.
The study is published in the Journal of the American Medical Association.
Nearly 60% of pediatric patients followed in the study were mildly, moderately, or severely non-adherent with therapy during the first six months of treatment.
Many took far less medication than prescribed, and the treatment-adherence pattern for the majority of patients was established during the first month of treatment.
Low socioeconomic status was the only variable examined that was associated with low treatment adherence.
About 325,000 children younger than age 15 in the U.S. have epileptic seizures. Antiseizure drugs are effective in most, but not all, children with epilepsy.
In adults, failure to take medications or not taking them as prescribed has been shown to be associated with worsening seizures and poorer outcomes.
In children, treatment adherence is determined by parents or other caregivers, but little is known about the influences that drive adherence and non-adherence.
“We have known that non-adherence is common in children, but we haven’t really known what the patterns of adherence are,” study researcher Avani C. Modi, PhD, of Cincinnati Children’s Hospital Medical Center, tells WebMD.
The study included 124 children with newly diagnosed epilepsy being evaluated at Cincinnati Children’s New Onset Seizure Clinic.
Parents or other caregivers were given medications in special bottles that electronically monitored when and how often the drugs were dispensed and they were asked to remove the medications from the bottle at the time they were given.
The adults were also questioned about issues that could affect medication adherence, such as family characteristics, patient seizure frequency, and medication side effects.
Over the course of the study several patterns of medication non-adherence emerged:
Modi says the patterns suggest that some parents or caregivers simply forget to give the medications while others are choosing not to give them.
She adds that caregivers may conclude the drugs aren’t needed or that their child does not have epilepsy when they miss doses without apparent consequences.
“Seizures can manifest in many different ways, including staring spells, arm jerks, and eye twitching,” she says. “These seizures may be missed or not recognized.”
Low socioeconomic status was a significant predictor of non-adherence to treatment.
The long-term impact of undertreatment is not as well understood for children with epilepsy as it is for adults.
Although more than a dozen antiseizure medications have been approved in less than two decades, about 30% of adults and children with epilepsy have poor seizure control, Modi says.
‘When seizures continue despite treatment, the clinician often doesn’t know if it is because the drugs aren’t working or because patients aren't taking them,” Mayo Clinic Arizona neurologist and Epilepsy Foundation spokesman Joseph I. Sirven, MD, tells WebMD. “If it is the former, patients need to be treated very aggressively. But if they are just not taking the drugs, that is an entirely different issue.”
SOURCES:Modi, A.C. The Journal of the American Medical Association, April 27, 2011; vol 305: pp 1669-1676.Avani C. Modi, PhD, assistant professor, divisions of behavioral medicine and clinical psychology, Cincinnati Children’s Hospital Medical Center.Joseph Sirven, MD, professor and chairman, department of neurology, Mayo Clinic Arizona; chair, professional advisory board, Epilepsy Foundation.News release, Cincinnati Children’s Hospital.News release, JAMA Media.
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