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From JAMA |

Failure to Take Antiepileptic Drugs as Prescribed:  A Socioeconomic Issue After All

Pradeep N. Modur, MD, MS
Arch Neurol. 2011;68(10):1320-1322. doi:10.1001/archneurol.2011.224.
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Epilepsy is a chronic illness that affects 1% of the population. It is characterized by the occurrence of recurrent, unprovoked seizures. At present, therapy with antiepileptic drugs (AEDs) remains the cornerstone of treatment for epilepsy. The currently available AEDs are anticonvulsant rather than antiepileptogenic in nature, in that they control the seizures symptomatically without modifying the underlying disease process. Because the seizures are largely unpredictable in timing and severity, adequate treatment of epilepsy entails regular administration of AEDs for an indefinite period of time. Such a treatment strategy, simply by virtue of its nature, is fraught with problems of nonadherence to the prescribed regimen. Many patients are dismayed by the fact that there are no reliable or readily identifiable markers to indicate that strict adherence to the prescribed regimen will indeed prevent future seizures. Thus, it is not surprising to encounter nonadherence among patients with epilepsy, whether suspected by the clinicians or reported by the patients themselves. Recent studies have shown the rate of nonadherence to AEDs in adult patients to be in the range of 26% to 41%.1,2 Although occasional unintentional nonadherence to AEDs (eg, forgetting to take the medication once in a while) is acceptable, the consequences of chronic nonadherence (intentional or unintentional) are not necessarily trivial. As documented in the literature, nonadherence to AEDs is associated with significantly increased risk of seizures, morbidity (eg, injuries), mortality, emergency department visits, and hospital admissions, all of which can contribute to a higher overall cost of health care.13

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