Variable Adherence Has Significant Impact On Seizure Outcomes
A two-year collaborative study provides solid scientific backing to the age-old parents’ admonition: “It’s important to take your medicine.”
Avani Modi, PhD, director of the Center for Adherence and co-director of the New Onset Seizure Clinic, led a research team including colleagues from the divisions of Neurology and Behavioral Medicine and Clinical Psychology, who tracked drug adherence and seizure outcomes in children with epilepsy for two years. Findings appeared online Oct. 29, 2014 in Neurology.
The study used electronic monitoring devices to track adherence patterns and seizure patterns in 109 children. The researchers found that patients fell into four distinct adherence groups: severe early non-adherence (9 percent), variable non-adherence (15 percent), moderate non-adherence (37 percent) and high adherence (39 percent). Children with epilepsy also fell into two distinct seizure groups: high or low seizure probability. Overall, children whose adherence patterns changed significantly over two years had the worse seizure outcomes.
Children in the variable non-adherence group tended to be more likely to be in the high seizure probability group, even after accounting for important medical characteristics such as seizure type and brain abnormalities. Their drug adherence started at 71 percent, dropped to 32 percent and then improved to 58 percent by the end of the study – a variability rate that put them at high risk for ongoing seizures.
“What was previously unrecognized,” Modi says, “is that monitoring and addressing drug adherence is a highly important, modifiable variable that can impact long-term seizure outcome.”
This new understanding of the role of drug adherence “empowers the family to really contribute to the child’s outcome in a way that no one previously understood,” says co-author Tracy Glauser, MD, director of the Comprehensive Epilepsy Center at Cincinnati Children’s.
“Now,” Modi says, “we can say with more confidence to families, ‘Our job is to give you the best medications and treatments for your child’s particular epilepsy diagnosis, and your job is to take the medications.’ ”
