Abstracts

Rationale: Many patients with epilepsy are treated successfully with antiepileptic drug (AED) monotherapy. Patients who do not achieve seizure control may need polytherapy to achieve better or complete seizure control. These patients have to incorporate a complex medication administration routine to their day-to-day lives. The Epilepsy medication and treatment complexity Index (EMTCI ) is a validated tool designed to address therapeutic complexity in adult patients with epilepsy. We studied the influence of AED treatment complexity on treatment adherence and quality of life of individuals with epilepsy.Methods: Prospective, transversal study of individuals with epilepsy in outpatient care. 385 patients, aged 18 years or older, literate, independent in daily living activities, without active psychiatric disease. Treatment adherence and quality of life were assessed with the Morisky test and the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Association tests were performed for treatment adherence and quality of life and gender, age, race/ethnic background, marital status, family income, occupation, family support, epilepsy syndrome, seizure control, access to medication and AED treatment complexity, measured by the EMTCI, followed by logistic regression for adherence and multiple linear regression for quality of life. Results: Average age was 39.7+/-12.6 yrs, 53.5% were women, 79.5% had symptomatic focal epilepsy, 71.1% were on multiple AEDs, 79% presented at least one seizure in the preceding six months and treatment duration was 21.5+/-13.2 yrs. Therapeutic regimen complexity (EMTCI) ranged from 2.0 to 44(average 14.7 +/- 8.0). 60.5% of participants had medium, and 5.7% low adherence. Mean QOLIE-31 was 64.2 +/- 18.2, with lowest averages seen in seizure worry (53.2+/-31.4), and medication effect (61.3+/-32.6). Highest scores were on social function. On multivariate logistic regression analysis, women with controlled seizures were less likely to display non-adherence. One-year increase in age decreased non-adherence by 3%. Probability of non-adherence was 6% higher for each one point increase in EMTCI. Better quality of life was associated with perception of seizure control and employment status. Patients with worse quality of life received more support from family or friends and were more often of African ancestry. Conclusions: Patients with refractory epilepsy need more complex therapeutic regimens to control seizures, which, paradoxically, may decrease adherence and efficacy of the medication, creating a vicious circle. The challenge for appropriate management of difficult-to-control epilepsy is, therefore, to adjust the medication regimen minimizing therapeutic complexity. EMTCI may provide important information to minimize treatment complexity in medically refractory epilepsy, even when more medication has to be added to the therapeutic regimen.