SANTA CLARA, CA—Adolescents with epilepsy are suboptimally adherent to antiepileptic drugs (AEDs), according to research presented at the 37th National Meeting of the Child Neurology Society. The development of a disease management program focused on educational goals could help improve adherence, reported Raj D. Sheth, MD, Division Chief of Pediatric Neurology at Nemours Children’s Clinic in Jacksonville, Florida.
Dr. Sheth and colleagues assessed 153 adolescents (mean age, 15) with epilepsy and their caregivers in two cross-sectional online surveys between April and December 2007. All participants were taking AEDs during the study and were considered nonadherent if they stopped taking or missed an AED within the past month.
Thirty-five percent of adolescents were nonadherent. Caregivers reported that they were primarily responsible for ensuring that AEDs were taken as prescribed (adolescents, 87%; caregivers, 88%), and adolescents said that they shared this responsibility (adolescents, 60%; caregivers, 55%). Caregivers were more likely to report that they, or another family member, were responsible for administering medication. Forgetfulness or not having pills was reported as the primary reason for nonadherence by 70% of adolescents and 66% of caregivers.
Seizure was the most frequently reported adverse event (adolescents, 39%; caregivers, 42%). School absence, emergency department visits, and hospitalization were also reported. In both groups, 15% answered that they were only somewhat or not at all confident in their knowledge of how to take AEDs as prescribed.
The physician-patient relationship is the most obvious way to decrease rates of nonadherence, said Dr. Sheth. “If [the patients] feel very comfortable with the physician, they tend to voice more opinions and tell you what they are really doing with their medication,” he told Neurology Reviews. Sometimes, phrasing a question differently can lead to more truthful answers. “For instance, in my practice, I don’t ask, ‘Did you miss taking your medication?’ Instead, I ask, ‘How many times a week do you miss your medication?’” Asking for a specific answer is more effective.
Dr. Sheth also stated that it is important to keep the relationship nonjudgmental. Asking the parent or caregiver to leave the room during follow-up often results in more truthful answers about alcohol and drug use, as well as adherence.
Dr. Sheth added that although a disease management program should focus on both adolescents and their caregivers, its primary goal should be one of graduated transition, allowing adolescents, as they demonstrate increasing responsibility, to eventually manage their epilepsy on their own and gain independence as they become young adults.
—Laura Sassano