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Observational Study
. 2014 Nov 25;83(22):2085-90.
doi: 10.1212/WNL.0000000000001023. Epub 2014 Oct 29.

Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes

Avani C Modi  1 , Yelena P Wu  2 , Joseph R Rausch  2 , James L Peugh  2 , Tracy A Glauser  2
Affiliations
Observational Study

Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes

Avani C Modi et al. Neurology. .

Abstract

Objective: The aim of the study was to determine sociodemographic, biological epilepsy-specific, and adherence predictors of long-term pediatric seizure outcomes.

Methods: This study is a prospective, longitudinal, observational study of antiepileptic drug (AED) adherence and seizure outcomes in children with newly diagnosed epilepsy. Patients were recruited from April 2006 to March 2009 and followed for 2 years. Objective, electronic monitors were used to assess AED adherence. Medical chart reviews assessed medical variables and seizure outcomes.

Results: Participants (n = 109) were 7.3 ± 2.9 years of age, and 62% male. Four adherence trajectory groups were identified: severe early nonadherence (n = 10), variable nonadherence (n = 16), moderate nonadherence (n = 40), and high adherence (n = 43). Two seizure probability trajectory groups were identified: high seizure (n = 28) and low seizure probability (n = 81). Participants with recognizable syndromes were less likely to be a member of the high seizure probability group (b = -2.372; odds ratio [OR] = 0.093; 95% confidence interval [CI]OR = 0.015, 0.595); those with the presence of epileptiform discharges on EEG were more likely to be in the high seizure probability group (b = 1.649; OR = 5.203; 95% CIOR = 1.422, 19.037). Adherence trajectory group status was a significant predictor of seizure trajectory group status (partial max-rescaled R(2) = 0.13).

Conclusions: Adherence trajectories and 2 biological epilepsy-specific variables explain a similar proportion of the variability in longitudinal seizure outcomes. The relationship between AED nonadherence and seizure outcomes is not linear. Early adherence interventions could change the course of seizure outcomes, particularly if variability in adherence was minimized postdiagnosis.

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Figures

Figure 1
Figure 1. Adherence group trajectories
Observed data trajectories are represented by dashed lines and model-based trajectories are represented by solid lines.
Figure 2
Figure 2. Seizure probability group trajectories
Observed data trajectories are represented by dashed lines and model-based trajectories are represented by solid lines.
Figure 3
Figure 3. Conditional probability of adherence group given seizure group
The omnibus χ2 null hypothesis test for no association between seizure and adherence trajectories was statistically significant (p < 0.05).
See this image and copyright information in PMC

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