Adherence to antiepileptic drugs in patients from José de San Martín Hospital

ORELLANA LUCAS; PACHA MARIA SOL; ERNST GLENDA; LAGGER IGNACIO; MARTINEZ OSCAR

Houston

Congreso; 70th American Epilepsy Society Annual Meeting,; 2016

American Epilepsy Society

Rationale: Most patients with epilepsy control effectively their illness using antiepileptic drugs (AED). Non-adherence is a relevant factor which ranges from 30-50%. Our purpose is to investigate factors associated with treatment non-adherence in a sample of Argentine patients. Methods: We did a retrospective review of clinical data from patients with Epilepsy evaluated from January 2009 to December 2015 in José de San Martín University Hospital from Buenos Aires-Argentina. Inclusion criteria: a diagnosis of epilepsy documented in medical files, 20 ≥ years of age, therapy with at least one AED, no change in AED in the last six months. We classified patients using the Morisky Medication Adherence Scale in those with Low adherence (0-1 pts) and those with Medium and High Adherence (2-4 pts). We analyzed in both groups: Sex; Age (20-39 years, 40-59 years and 60≥ years); type of seizures (focal aware, focal with impaired awareness, focal to bilateral tonic-clonic and generalized tonic-clonic); Drug resistant epilepsy and History of: Post-traumatic epilepsy (PTE), febrile seizures (FS) and sleep privation/stress (SPS). Results: We analyzed 627 patients who met all study inclusion criteria. This group comprised of 52% females and 48% males; age ranged between 20 and 94 years old (average of 40,23+/-17,32). There was 58% aged 20-39 years, 26% with 40-59 years and 16% with 60≥ years. We observed that 14.19% had low adherence while 85.81% had medium/high adherence to AED. In the low adherence group,.44,94% were males and 55,06% were females. We also found that: 57,30% aged 20-39 years, 29,21% were 40-59 years and 13.49% were 60≥ years. Other findings included: 12.36% of AED resistant patients; 20.22% who suffered from SPS, 13,49% with history of PTE and 6.74% with FS during childhood. In relation to the type of seizures we observed: focal aware seizures in 2,26%, focal with impaired awareness in 7,86%, focal to bilateral tonic-clonic seizures in 51,68% and generalized tonic-clonic seizures in 38,20 %. When comparing the low adherence group to the medium/high adherence one and analyzing them in terms of age and sex we found: A) 66,67% had low-adherence and 12.82% had medium/high adherence. In women we found similar results; B) A higher frequency of focal aware seizures in both sexes from the medium/high adherence group also related to age; C) Regarding drug resistance that in the moderate/high male adherent group, there was 17,31% aged 20-39 years old, 27,28% with 39-59 years and 5,12%% aged 60 ≥ years old. In the group of low adherents we only found 4.77% drug-resistance. Conclusions: We found 14,.19% of AED Low-adherents contrasting with most published reports. This could be related to the definition method of adherence used. Age and sex in low adherents was similar to other studies. Men aged 60 ≥ years with PTE showed less adherence to AED treatment than those without it. Cognitive impairment could be related to this. Moreover, we found major adherence in AED resistant males which seems not to be related with age. Further prospective studies, including socioeconomic factors, will be necessary to analyze adherence in epilepsy patients