COMMENTARY

Pros and Cons of Extended-Release Antiepileptic Drugs

Andrew N. Wilner, MD

Disclosures

February 17, 2016

In This Article

Addressing Adherence

Seizures may result in physical, psychological, and social repercussions. One might assume that people with epilepsy would adhere rigorously to their medication regimens in order to prevent these deleterious outcomes. However, epilepsy patients, like patients with other illnesses, do not always take their medications as prescribed.[1]

Furthermore, an inverse relationship exists between the number of doses prescribed per day and adherence: The more frequently medication must be taken, the less likely it is the patient will consume all doses. Many patients fail to achieve 100% adherence even with once-a-day dosing.[2] Although 100% medication adherence does not guarantee seizure control, lack of adherence, not surprisingly, may result in increased seizure frequency.[2]

More than 25 years ago, Cramer and colleagues[1] used a medication event monitoring system to measure adherence in several groups of people with epilepsy. The system records the time that the medication bottle is opened on a computer chip contained within the cap. The results can then be printed and analyzed when the patient returns for follow-up.

Even though patients had consented to the study and knew they were being monitored, only 76% of doses were taken as prescribed. Adherence was 87% for once-a-day medications, 81% for twice-daily medications, 77% for medications taken three times daily, and only 39% for those taken four times daily.

Other adherence studies have revealed similar results.[3] These findings provide a clear rationale for clinicians to limit the number of daily medication doses for each patient in order to optimize adherence.

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