Rationale:
Up to 60% of patients with epilepsy show poor concordance with anti-seizure medications (ASMs), 1 with negative implications for seizure control and associated increased risk of morbidity and mortality. 2 There is little data regarding the impact of newer generation (especially once daily) ASMs on concordance.3 Potential relationships between patients’ perceptions of seizures and concordance are unclear. Patients’ perspectives regarding how to improve concordance are poorly described.
There are many ways of assessing concordance, from pill-box analysis to questionnaires. Anonymised questionnaires enable a breadth of areas to be explored, without observer bias.
The aims are:
To identify the proportion of adult patients who feel concordance with their ASMs is poor.
To identify whether patients’ perceptions of seizures influence concordance.
To identify potential factors which patients feel may improve concordance.
To ascertain whether patients recall discussions about concordance with healthcare professionals (HCPs) and whether this is associated with improved concordance.
Methods:
Outpatients attending a tertiary epilepsy clinic were asked to complete anonymised questionnaires. The carers of those with intellectual disability (ID) were asked to complete questionnaires on their behalf.
:
Ninety-two patients’ responses were analyzed over a four month period. Thirty one patients (with ID) had carer input. 33% of all patients thought their concordance was poor- 50% of these experienced generalized tonic-clonic seizures. 65% had experienced sleep-related seizures. There was a trend towards improved concordance in those with ID and carer input and those prescribed monotherapy. Those with perceived non-disabling seizures were significantly more likely to express concordance than those with disabling seizures (p= 0.034).
A trend towards perceived concordance was seen in those patients who could recall discussions about concordance with HCPs. The most common response from patients regarding how to improve concordance was a request to minimize the number of times ASMs needed to be taken.
:
There is an association between monotherapy and perceived concordance. The inverse association between disabling seizures and perceived concordance may be explained by the trend for those with disabling seizures to be prescribed poly-therapy. Patients’ perceptions of their seizures do not appear to influence concordance. Strategies focussing on minimising the number of times ASMs are administered and early repeated discussions with HCPs may help to improve concordance.
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