title: Treatment non-adherence as a trigger for status epilepticus: An observational, retrospective study based on therapeutic drug monitoring.
abstract: OBJECTIVE
  To investigate the role of non-adherence to antiepileptic drug treatment as a trigger for status epilepticus (SE).
  
  
  METHODS
  124 consecutive admissions for SE in patients with established epilepsy were studied. Those who had had therapeutic drug monitoring at admission were identified. Non-adherence was defined as a serum concentration/dose ratio at admission of <75% of the patient's own trough control value.
  
  
  RESULTS
  In 64 cases serum concentration/dose ratios at admission were available for comparison with morning trough values. Treatment non-adherence was identified in a total of 24 (38%), 50% in children, 32% in patients 16-59 years and in 44% above 60. Missed medication had been reported in only two of these patients. No cases with confirmed non-adherence had a fatal outcome (p=0.05). No significant differences between non-adherent and adherent admissions concerning demographic factors or epilepsy and SE characteristics were found.
  
  
  CONCLUSIONS
  Antiepileptic drug non-adherence is a common cause of SE across all ages, but is not always identified due to the first history-based information often being elusive. Prompt and reliable recognition of non-adherence is imperative for correct management. This is the first study to demonstrate the extent of non-adherence by therapeutic drug monitoring in SE.
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: ingridanne.lie@gmail.com.
authors.forename: Ingrid Anne
authors.initials: IA
authors.lastname: Lie
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: ingvildhoggen@gmail.com.
authors.forename: Ingvild
authors.initials: I
authors.lastname: Hoggen
authors.affiliation: Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway. Electronic address: christian.samsonsen@stolav.no.
authors.forename: Christian
authors.initials: C
authors.lastname: Samsonsen
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway. Electronic address: eylert.brodtkorb@ntnu.no.
authors.forename: Eylert
authors.initials: E
authors.lastname: Brodtkorb
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000097:blood / Q000627:therapeutic use*; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000097:blood* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Adherence; Status epilepticus; Therapeutic drug monitoring