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Table of Contents    
Year : 2020  |  Volume : 68  |  Issue : 5  |  Page : 1257-1258

A Bitter Pill To Swallow – Drug Compliance and Adherence In Epilepsy

Apollo Super Speciality Hospitals, Bangalore, Karnataka, India

Date of Web Publication27-Oct-2020

Correspondence Address:
Dr. P Satishchandra
Department of Neurology, Apollo Institute of Neurosciences, Jayanagar, Bangalore, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.294828

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How to cite this article:
Vishwanathan L G, Satishchandra P. A Bitter Pill To Swallow – Drug Compliance and Adherence In Epilepsy. Neurol India 2020;68:1257-8

How to cite this URL:
Vishwanathan L G, Satishchandra P. A Bitter Pill To Swallow – Drug Compliance and Adherence In Epilepsy. Neurol India [serial online] 2020 [cited 2021 Aug 4];68:1257-8. Available from:

Epilepsy is a chronic neurological disorder and imposes an immense burden on health care facilities throughout the world. The mainstay of treatment remains medical for a majority of cases and the duration of treatment spans at least a few years, if not life-long. Due to various social, economic and medical factors, drug adherence is compromised in a significant number of patients living with epilepsy. At the outset, it is essential to highlight the difference between compliance and adherence. Compliance is a passive patient behavior, wherein he/she is expected to carry out orders issued by the treating doctor. The extent to which these recommendations are followed measures compliance. When the patient plays a more proactive role which results in lifestyle changes and change in the behavior to carry out recommendations that have been agreed upon with the physician, it is described as adherence. If the history of drug default is not forthcoming, a vicious cycle of increased pill burden and drug non-adherence would set in motion.

In the current issue, the paper titled “Adherence to the antiepileptic regime: A cross-sectional survey”[1] aims to assess the drug adherence and factors that are associated with adherence to drug regimens. The authors sampled 100 patients with epilepsy cross-sectionally. A third of these patients had lesser than primary education or were unemployed. Drug adherence was assessed using the Morisky medication adherence scale (MMAS). It was found that 71% of cases were not adherent to treatment. The authors also observed that patients on monotherapy and fewer doses of medications were more adherent to treatment compared to those on polytherapy. Higher frequency of seizures also predicted worse adherence.

Lack of drug compliance and adherence poses challenges to epilepsy treatment and is one of the major causes of pseudo-refractoriness.[2] In a study from rural south India, less than 16% patients who had poor drug compliance achieved seizure remission at the end of 4 years.[3] Poor adherence to treatment is also associated with reduced quality of life and productivity. In a cross-sectional study (n = 408), it was found that poor adherence also resulted in seizure-related job loss and a higher risk of motor vehicle-related accidents. The main factors that contributed to poor adherence were forgetfulness, adverse effects of the AEDs and costs of medical treatment of epilepsy.[4] Methods of assessing drug adherence may be subjective and/or objective, but either of these techniques is free of shortcomings.

Nevertheless, using multiple ways to track adherence may lead to better outcomes. A randomized controlled trial using the Medication Event Monitoring System (MEMS) showed that using objective methods of tracking drug adherence improves patient's adherence.[5] Apart from recurrence of seizures, lapses in medication intake increase the risk of developing serious consequences namely status epilepticus and rarely, sudden unexpected death (SUDEP). Certain behavior noted in patients such as Low necessity beliefs and high concerns regarding adverse effects are some of the main reasons as to why patients may skip doses or altogether stop treatment.[6] In the current era of smartphones and gadgets, many patients may be able to seek the help of daily alarms and reminders to ensure regular intake of the prescribed medications. Communication between patient and doctor is very critical to achieve good adherence. Patients who have more trust in their doctors have been observed to be more adherent to medical advice.[5] If non-adherence is recurrent, then one could take the assistance of psychiatry social workers (PSWs) or clinical psychologists to delineate the cause for poor adherence and customize interventions accordingly (personal observation).

The heterogeneity that exists in medication behavior of the people living with epilepsy (PWE) is very vast and complex. Hence more research is needed to assess drug adherence to antiepileptic drugs. Predicting poor adherence to treatment and thereby enforcing preemptive action to avoid its consequences is ideal, but such a solution is still lacking. A comprehensive approach is needed to tackle this multifaceted problem of drug adherence that almost every physician would have faced in their practice.

  References Top

Das AM, Ramamoorthy L, Narayan SK, Wadvekar V. Adherence to antiepileptic regime: A cross-sectional survey. Neurol India [Ahead of Print].  Back to cited text no. 1
Brodtkorb E, Samsonsen C, Sund JK, Bråthen G, Helde G, Reimers A. Treatment non-adherence in pseudo-refractory epilepsy. Epilepsy Research 2016;122:1-6.  Back to cited text no. 2
Mani K, Rangan G, Srinivas H, Sridharan V, Subbakrishna D. Epilepsy control with phenobarbital or phenytoin in rural south India: the Yelandur study. The Lancet 2001;357:1316-20.  Back to cited text no. 3
Hovinga CA, Asato MR, Manjunath R, Wheless JW, Phelps SJ, Sheth RD, et al. Association of non-adherence to antiepileptic drugs and seizures, quality of life, and productivity: Survey of patients with epilepsy and physicians. Epilepsy & Behavior 2008;13:316-22.  Back to cited text no. 4
Brown I, Sheeran P, Reuber M. Enhancing antiepileptic drug adherence: A randomized controlled trial. Epilepsy & Behavior 2009;16:634-9.  Back to cited text no. 5
Chapman SCE, Horne R, Chater A, Hukins D, Smithson WH. Patients' perspectives on antiepileptic medication: Relationships between beliefs about medicines and adherence among patients with epilepsy in UK primary care. Epilepsy & Behavior 2014;31:312-20.  Back to cited text no. 6


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