Abstracts

Self-discontinuation (SD) of AEDs is a subject that has received little attention. Most studies focus on noncompliance in situations, such as pregnancy or medication withdrawal after epilepsy surgery. There are no data on SD of AEDs due to lack of affordability. This study aimed to identify disease-related and socioeconomic factors associated with SD of AEDs due to its cost in a population of patients with refractory epilepsy. We studied a group of 338 patients with refractory epilepsy admitted to the Cleveland Clinic Foundation Adult Epilepsy Monitoring Unit. Patients were asked to volunteer information regarding SD of AEDs due to cost. Seizure severity, type of therapy, health care utilization, income, major daily activity and coverage for payment was compared between the group admitting to SD of AEDs due to cost (SD group) and those who did not (control group). Fourty patients who did not provide adequate information were excluded. Chi square, t-test and regression analysis were used in the statistical analysis. The sample was comprised of 298 epileptic patients (52.7% female) between 15-73 years of age (mean=36.14 years; +/-11.36). 34 patients (11.4%) had paroxysmal non-epileptic seizures (PNES) in addition to epilepsy. Only 28 patients (9.4%) admitted to SD due to cost. This group had more seizures with loss of bladder control [18 patients (66.7%) vs. 92 patients (40.6%); p=0.004] and more accidents during seizures [22 patients (81.5%) vs. 169 patients (65.3%); p=0.001] than the control group. Postictally, patients in the SD group had more restrictions for activities of daily living [19 patients (67.9%) vs. 115 patients (44.2%); p=0.014] than the control group. SD group had more hospital admissions within the prior year [14 patients (53.8%) vs. 96 patients (36.9%); p=0.05] and was more likely to be disabled [8 patients (29.6%) vs. 40 patients (14.9%); p=0.048] than the control group. SD patients were less likely to have private insurance to pay for AEDs [8/28 patients (28.6%) vs. 162/270 patients (60%); Standardized Coefficient B (SB)=-0.17; Unstandardized Coefficient B (UB)=-0.10; Standard Error (SE)=0.04; p=0.012] and was more likely to be supported by drug assistance programs [6 patients (21.4%) vs. 12 patients (4.5%); SB=0.19; UB=0.23; SE=0.73; p=0.002]. No differences between the groups was found in age, gender, age of seizure onset, duration of epilepsy, seizure frequency, presence of other chronic diseases, type of AED therapy, number of AEDs, gross monthly cost of AEDs or source of income. 9.4% of the patients with refractory epilepsy admitted to SD of AEDs due to cost. This group had more severe epilepsy (as expressed by accidents, health care utilization and life restrictions) and socio-economic disadvantages (as expressed by more disability and less coverage for treatment). We suspect that this number is an underestimate since some patients may fail to disclose noncompliance to their physicians.