Abstracts

Rationale: Adherence to medical regimens for pediatric conditions averages approximately 50% and, except for complete non-adherence, is difficult to detect objectively. No studies have examined the impact of non-adherence on seizure frequency and subsequent antiepileptic drug (AED) adjustments in children with new onset epilepsy. The purpose of the current study was to document the frequency of seizures and subsequent AED dosage increases occurring when patients are non-adherent to their prescribed treatment regimen. Methods: Participants included 25 children with new-onset epilepsy (Mean age = 6.88 years; 76% males, 72% Caucasian, 72% partial epilepsy/28% generalized). Each participant was given a MicroElectronic Monitoring System (MEMS) TrackCap to assess adherence to their AED (68% carbamazepine, 32% valproic acid). Treating healthcare providers were blinded to the electronic adherence data and assessed the need for drug dosage changes based on detailed clinical history. AED dosage increases, number of seizures prior to the increase, and adherence prior to the dosage increase were recorded.Results: Results indicated that 56% of the 25 participants had an increase in their AED after reaching the maintenance dose. Patients with partial epilepsy had more dosage increases than those with generalized epilepsy (χ2 (1) = 6.9, p < .01). Of the 25 participants, 71% of those with a dosage increase had imperfect adherence (adherence < 100%). Adherence in the week prior to the AED dosage increase was 82.6% and the mean number of seizures in the week prior was 0.38. In the week prior to the AED dosage increase, 1-week adherence was inversely related to the number of seizures that occurred that week (r = -0.56, p < .05). Conclusions: This data suggest that in children with new onset epilepsy imperfect adherence is associated with recurrent seizures and subsequent “avoidable” AED dosage increases. Objectively identifying poor adherence to AED regimen is important to help clinicians better decide when a behavioral intervention to improve adherence rather than an AED dosage increase is warranted. Funded by the Center for the Promotion of Adherence and Self-Management, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center