title: Adherence to antiepileptic medicines in children: a multiple-methods assessment involving dried blood spot sampling.
abstract: OBJECTIVE
  To evaluate adherence to prescribed antiepileptic drugs (AEDs) in children with epilepsy using a combination of adherence-assessment methods.
  
  
  METHODS
  A total of 100 children with epilepsy (≤17 years old) were recruited. Medication adherence was determined via parental and child self-reporting (≥9 years old), medication refill data from general practitioner (GP) prescribing records, and via AED concentrations in dried blood spot (DBS) samples obtained from children at the clinic and via self- or parental-led sampling in children's own homes. The latter were assessed using population pharmacokinetic modeling. Patients were deemed nonadherent if any of these measures were indicative of nonadherence with the prescribed treatment. In addition, beliefs about medicines, parental confidence in seizure management, and the presence of depressed mood in parents were evaluated to examine their association with nonadherence in the participating children.
  
  
  RESULTS
  The overall rate of nonadherence in children with epilepsy was 33%. Logistic regression analysis indicated that children with generalized epilepsy (vs. focal epilepsy) were more likely (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.37-15.81) to be classified as nonadherent as were children whose parents have depressed mood (OR 3.6, 95% CI 1.16-11.41).
  
  
  CONCLUSIONS
  This is the first study to apply the novel methodology of determining adherence via AED concentrations in clinic and home DBS samples. The present findings show that the latter, with further development, could be a useful approach to adherence assessment when combined with other measures including parent and child self-reporting. Seizure type and parental depressed mood were strongly predictive of nonadherence.
authors: Clinical and Practice Research Group, School of Pharmacy, Medical Biology Centre, Queen's University Belfast, Belfast, United Kingdom.
authors: Noraida Mohamed
authors: NM
authors: Shah
authors: Ahmed F
authors: AF
authors: Hawwa
authors: Jeff S
authors: JS
authors: Millership
authors: Paul S
authors: PS
authors: Collier
authors: Paul
authors: P
authors: Ho
authors: Mui Ling
authors: ML
authors: Tan
authors: Deirdre
authors: D
authors: Peake
authors: Sandya
authors: S
authors: Tirupathi
authors: Janice
authors: J
authors: Bothwell
authors: Nicola
authors: N
authors: Bailie
authors: Charles
authors: C
authors: Shepherd
authors: John
authors: J
authors: Craig
authors: James C
authors: JC
authors: McElnay
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000097:blood / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000523:psychology; D004827:Epilepsy / Q000188:drug therapy* / Q000523:psychology; D004829:Epilepsy, Generalized / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010290:Parents; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D057566:Self Report; D016903:Drug Monitoring
chemical_list: D000927:Anticonvulsants