title: Nonadherence to treatment causing acute hospitalizations in people with epilepsy: an observational, prospective study.
abstract: The aim was to assess the clinical relevance of antiepileptic drug (AED) nonadherence by means of therapeutic drug concentration monitoring (TDM). Two hundred eighty-two consecutive patients with epilepsy acutely admitted to hospital for seizures were included. Nonadherence was defined as having a serum concentration/dose ratio at admission of <75% of the patient's own control value (probable nonadherence: 50-75%; definite: <50%). Nonadherence was identified in 39% of patients (definite 24%; probable 15%). It was significantly more common in patients with generalized seizures compared to those with focal onset seizures, and in patients <30 years compared to older patients. When specifically asked, 44% of nonadherent patients claimed regular intake. Nonadherence is a major cause of seizure breakthrough in patients with epilepsy, particularly in young adults. Many patients seem to be unaware of missed drug intake. Prompt measurements of AED serum concentrations should be available as part of the emergency care for patients acutely hospitalized for seizures to permit this issue to be thoroughly addressed prior to discharge.
authors.affiliation: Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway.
authors.forename: Christian
authors.initials: C
authors.lastname: Samsonsen
authors.forename: Arne
authors.initials: A
authors.lastname: Reimers
authors.forename: Geir
authors.initials: G
authors.lastname: Bråthen
authors.forename: Grethe
authors.initials: G
authors.lastname: Helde
authors.forename: Eylert
authors.initials: E
authors.lastname: Brodtkorb
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D016903:Drug Monitoring; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Adherence; Seizure; Therapeutic drug monitoring