Abstracts

Rationale: Non-adherence to antiepileptic drugs (AEDs) is a significant problem in pediatric epilepsy, with 60% of patients demonstrating some level of non-adherence. A recent meta-analysis of text-messaging interventions to improve adherence indicated 18 of 29 studies demonstrated some benefit; however, only three of these were pediatric focused and none were in epilepsy. Thus, the overall aim of the current study was to pilot test the feasibility, acceptability and preliminary efficacy of text-messaging and application-based reminder systems, with and without parental support, for adolescents with epilepsy. It was hypothesized that all text/app-based systems would improve adherence but those with parental involvement would result in greater adherence improvements. Methods: Twenty-five adolescents (mean age=15.7; 52% males) and caregivers were recruited and randomized to one of five interventions for one-month: 1) adolescent text only, 2) adolescent and caregiver text plus communication, 3) adolescent application only, 4) adolescent and caregiver application plus communication, and 5) epilepsy application for adolescents only. Primary caregivers and adolescents completed questionnaires at baseline, post-treatment, and 1-month follow-up. The primary outcome measure was electronically-monitored adherence (e.g., MEMS TrackCaps, SimpleMed boxes). Results: Analyses revealed that that compared to the control group (i.e. Group 5: Epilepsy tool kit application created by the National Society for Epilepsy), Group 2 (Teen and parents receive text message) had significantly higher adherence at the beginning of the intervention(?_01=23.97;p < .05), while Group 1 (Teen only text message) demonstrated a trend toward significantly higher adherence at the beginning of the intervention (?_00=18.98;p=.075). Further, teens and parents receiving text messaging (Group 2)(?_11=-0.78;p=.09) or an adherence application (Group 4)(?_12=-1.39;p=.10) both demonstrated a trend toward a linear decrease in adherence over time, due to ceiling effects. No significant effects on intercept, linear slope, and quadratic change variances were found; however, there was a trend favoring parental involvement (d = 0.40) and text versus application (d = 0.40). Adolescents perceived the texts and applications to be easy to navigate, lacking glitches, helpful for taking their epilepsy medication, useful for epilepsy management and beneficial in general. Parents also reported that they perceived the texts and applications to be easy to navigate, helpful for taking medications, lacking glitches, and useful for managing epilepsy. Conclusions: Overall, results indicated that text and application-based reminder systems are acceptable and feasible for adolescents with epilepsy and their caregivers over a short period of time. Effect sizes also suggest that text messaging may yield greater changes in adherence compared to applications and that caregiver involvement may be beneficial. These data highlight that technology-focused adherence interventions are feasible but should likely be targeted to those with demonstrated non-adherence in future clinical trials. Funding: This research was supported by the Fifth Third Bank/Charlotte R. Schmidlapp Women Scholars Program awarded to the first author.