title: Identifying the barriers to antiepileptic drug adherence among adults with epilepsy.
abstract: OBJECTIVE
  To identify the barriers to antiepileptic drug (AED) adherence among adults with epilepsy (AWE). The impact of AED non-adherence on quality of life (QoL) was also examined.
  
  
  METHODS
  Systematic design (SR) study. A search strategy was undertaken with no time limits, for articles published in English, in MEDLINE, CINANL, PsycINFO, EMBASE, Cochrane databases and grey literature sources. Eligibility criteria included participants with epilepsy over 18 years, who were prescribed AEDs. Adherence had to be defined and adherence assessment measurements identified. A screening process was undertaken to select eligible studies. Eight studies met the inclusion criteria and were included in a quantitative synthesis. Quality of evidence was conducted using the EBL critical appraisal checklist and assessing risk of bias within individual studies.
  
  
  RESULTS
  Across the included studies a high prevalence of non-adherence was identified. AED non-adherence was associated with specific beliefs about medications, being depressed or anxious, poor medication self-administration management, uncontrolled recent seizures, frequent medication dosage times, poor physician-patient relationship and perceived social support. Additionally, AED non-adherence impacted negatively on QoL as a result of poor seizure control.
  
  
  CONCLUSIONS
  Although included studies were of good quality, risk of biases reduced the generalisability of results. Findings suggested that comprehensive adherence assessments should routinely be performed. Recommendations for future research include the use of longitudinal research designs and a follow up SR to include the 16-18-year-old population.
authors.affiliation: Sligo University Hospital, Sligo, Ireland. Electronic address: geraldineorourke-meehan@hotmail.com.
authors.forename: Geraldine
authors.initials: G
authors.lastname: O' Rourke
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address: Juliejordanobrien@rcsi.ie.
authors.forename: Julie Jordan
authors.initials: JJ
authors.lastname: O' Brien
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D004827:Epilepsy / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D010817:Physician-Patient Relations; D011788:Quality of Life
chemical_list: D000927:Anticonvulsants
keywords: Adherence; Adults with epilepsy; Antiepileptic drug; Barriers