Multidisciplinary management improves anxiety, depression, medication adherence, and quality of life among patients with epilepsy in eastern China: A prospective study

Case control study of access to medications during COVID-19 and longitudinal impact on health outcomes for primary care patients managing multiple chronic conditions

BACKGROUND

During coronavirus disease 2019 (COVID-19), people managing multiple chronic conditions (MCCs) experienced barriers to obtaining needed medications. The purposes of this paper are to (i) determine risk factors for difficulty obtaining medications during COVID-19, (ii) document reasons for the difficulty, and (iii) evaluate the impact on later physical and mental health outcomes.

METHOD

In a randomized controlled trial conducted in 2016-2021, 1969 adult primary care patients were surveyed about physical and mental health both before and during COVID-19. They reported their needs for medication during COVID-19 and any difficulty obtaining them. Reasons for difficulty accessing medications were tabulated descriptively. Logistic regression identified predictors of medication access difficulty. Multivariable linear regression modeled the relationship between access to medications and health outcomes, accounting for pre-COVID health.

RESULTS

In total 13% of participants experienced difficulty accessing needed medications. Compared to the larger sample, those participants were younger, had more MCCs, and had lower income. They were more often female, unmarried, and were facing insecurities in housing, food, or finances (all P < 0.004). Younger age and the presence of socioeconomic insecurity at baseline increased the odds of later difficulty accessing medications. Barriers to access included concerns about contracting COVID-19 (52%), physician or pharmacy inaccessibility (38%), and cost (26%). Adjusting for baseline health, difficulty accessing medications was associated with poorer health at follow up (P = 0.001).

CONCLUSION

People with socioeconomic disadvantages experienced a disproportionate impact of difficulty obtaining medications and poorer health outcomes due to COVID-19. They may be at greater risk in the event of future pandemics and other societal disruptions.

Nonadherence to antiseizure medications: what have we learned and what can be done next?

INTRODUCTION

Nonadherence to antiseizure medications (ASMs) is associated with increased mortality, morbidity, health care utilization, and costs.

AREAS COVERED

This article reviewed 18 randomized controlled trials published between Jan 2010 and Feb 2024 on Medication Adherence Enhancing Intervention (MAEI) for people with epilepsy. The adequacy of reporting intervention development process was assessed using the GUIDance for the rEporting of intervention Development (GUIDED). The adequacy of the intervention description was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. The interventions were categorized as educational (n = 7), behavioral (n = 5), or mixed (n = 6). The impact of MAEIs on adherence is mixed with majority of studies either reporting no difference between intervention and control groups (n = 6) or improvement in the intervention group (n = 7). The shortcomings in the reporting of MAEIs development, MAEIs description, and MAEIs impact measurement were discussed.

EXPERT OPINION

Future research needs to accomplish the following tasks: 1) develop and test valid epilepsy-specific self-report measures for assessing adherence; 2) optimize intervention design; and 3) increase transparency in reporting all stages of research.

The Role of Pharmacists' Interventions in Increasing Medication Adherence of Patients With Epilepsy: A Scoping Review

OBJECTIVES

Epilepsy is a chronic disease that requires long-term treatment and intervention from health workers. Medication adherence is a factor that influences the success of therapy for patients with epilepsy. Therefore, this study aimed to analyze the role of pharmacists in improving the clinical outcomes of epilepsy patients, focusing on medication adherence.

METHODS

A scoping literature search was conducted through the ScienceDirect, PubMed, and Google Scholar databases. The literature search included all original articles published in English until August 2023 for which the full text was available. This scoping review was carried out by a team consisting of pharmacists and neurologists following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews and the Joanna Briggs Institute guidelines, including 5 steps: identifying research questions, finding relevant articles, selecting articles, presenting data, and compiling the results.

RESULTS

The literature search yielded 10 studies that discussed pharmacist interventions for patients with epilepsy. Five articles described educational interventions involving drug-related counseling with pharmacists. Two articles focused on similar pharmacist interventions through patient education, both verbal and written. Three articles discussed an epilepsy review service, a multidisciplinary intervention program involving pharmacists and other health workers, and a mixed intervention combining education and training with therapy-based behavioral interventions.

CONCLUSIONS

Pharmacist interventions have been shown to be effective in improving medication adherence in patients with epilepsy. Furthermore, these interventions play a crucial role in improving other therapeutic outcomes, including patients' knowledge of self-management, perceptions of illness, the efficacy of antiepileptic drugs in controlling seizures, and overall quality of life.

Health-related quality of life and medication adherence of people living with epilepsy in Pakistan: A cross-sectional study

INTRODUCTION

The primary purpose of this study was to determine adherence and health-related quality of life (HRQoL) in PWE. Secondary aims were to assess association between adherence and HRQoL and determine predictors of HRQoL in PWE in Pakistan.

METHODS

A descriptive cross-sectional study was conducted among PWE receiving treatment from two tertiary care hospitals of Pakistan. The HRQoL and adherence were assessed with Urdu versions of Quality of Life in Epilepsy-31 (QOLIE-31), and Medication Adherence Rating Scale (MARS). Relationship between HRQoL and adherence was assessed by Pearson's product-moment correlation coefficient. Forced entry multiple linear models were used to determine relationship of independent variables with HRQoL.

RESULTS

219 PWE with a mean (±standard deviation) age, 34.18 (± 13.710) years, participated in this study. The overall weighted mean HRQoL score was (51.60 ± 17.10), and mean score for adherence was 6.17 (± 2.31). There was significant association between adherence and HRQoL in PWE (Pearson's correlation = 0.820-0.930; p ≤ .0001). Multiple linear regression found adherence (B = 16.8; p ≤ .0001), male gender (B = 10.0; p = .001), employment status (employed: B = 7.50; p = .030), level of education (Tertiary: B = 0.910; p = .010), duration of epilepsy (>10 years: B = -0.700; p ≤ .0001), and age (≥46 years: B = -0.680; p ≤ .0001), and ASM therapy (polypharmacy: B = 0.430; p = .010) as independent predictors of HRQoL in PWE from Pakistan.

CONCLUSIONS

The findings suggest PWE from our center have suboptimal adherence which affects HRQoL. Independent factors such as male gender, employment status and duration of epilepsy are predictors of HRQoL.

Adherence to epilepsy quality indicators in a tertiary referral center

BACKGROUND

Quality indicators play an important role in healthcare quality and patient safety. The aim of this study is to identify specific clinical pharmacy interventions to improve adherence to quality indicators and minimize risks among patients with epilepsy.

MATERIAL AND METHODS

A prospective, two-phase, observational study was conducted in a neurology outpatient clinic of a tertiary university hospital. In the first phase of the study, the rate of adherence to the quality indicators was evaluated with a checklist containing the quality indicators. In the second phase of the study, an expert panel meeting was convened to identify clinical pharmacist interventions to reduce the risks associated with non-adherence. The Fine-Kinney method was used to prioritize risks, and adherence rates with each quality improvement indicator (QI) were calculated.

RESULTS

The study found that adherence rates were highest for QIs involving estimating the number and type of seizures, providing medical treatment or referring patients with evidence of mood disorders to mental healthcare, and co-managing prenatal care for women with epilepsy. The most non-adherence rates were found in QIs involving quality-of-life assessment, daily folate supplementation, and addressing the decreased effectiveness of oral contraception. The annual review of information about educational issues was also poorly provided. An expert panel decided to integrate a clinical pharmacist into the outpatient clinic to improve medication adherence, side-effect assessment, drug interaction assessment, patient education, lifestyle-modification education, depression/suicide-related behavior screening, quality-of-life assessment, and effectiveness evaluation of oral contraceptives for female patients using enzyme-inducing ASM.

CONCLUSION

The study shows that medication adherence, assessment of side effects, drug interactions, and patient education are inadequately provided by neurologists in patients with epilepsy. Clinical pharmacists have a crucial role in reducing potential risks of non-adherence with quality indicators. By integrating clinical pharmacy services into routine epilepsy care processes, the quality of care can be improved. Future studies should focus on implementing these interventions and evaluating their impact on patient outcomes.

Intervention of pharmacist included in multidisciplinary team to reduce adverse drug event: a qualitative systematic review

BACKGROUND

Preventable harm in healthcare is a growing public health challenge. In addition to the economic costs of safety failures, adverse drug events (ADE) may lead to complication or even death. Multidisciplinary care team involving a pharmacist appears to be an adequate response to prevention of adverse drug event. This qualitative systematic review aims to identify and describe multidisciplinary planned team-based care involving at least one pharmacist to limit or prevent adverse drug events in the adult patients.

METHODS

To determine the type of interprofessional collaboration to prevent adverse drug event in which a pharmacist was involved, we conducted a qualitative systematic review of the literature of randomized controlled trials. Two independent reviewers screened trials in three databases: Medline, Web of Science, ScienceDirect. Prospective studies of at least three different health professionals' interventions, one of whom was a pharmacist in the last five years were included. Two reviewers performed data extraction and quality appraisal independently. We used TIDieR checklist to appraise articles quality.

RESULTS

In total 803 citations were retrieved, 34 were analysed and 16 full-text articles were reviewed. Only 3 studies published an implementation evaluation. More than half of the interventions (62%) targeted elderly patients including 6 whom lived in nursing homes. Studies outcomes were heterogeneous, and we did not perform a statistical analysis of the impact of these interventions. Most teams are composed of a physician/pharmacist/nurse trio (94%; 100%; 88%). Half of the teams were composed of the primary care physician. Other professionals were included such as physical therapists (25%), social worker (19%), occupational therapists (12%), and community health educator (6%). Multidisciplinary medication review was the most common intervention and was generally structured in four steps: data collection and baseline assessment, appraisal report by health professionals, a multidisciplinary medication review meeting and a patient follow-up.

CONCLUSIONS

The most common multidisciplinary intervention to prevent ADE in the adult population is the multidisciplinary drug review meeting at least the physician/pharmacist/nurse trio. Interventions target mostly elderly people in nursing homes, although complex chronic patients could benefit from this type of assessment.

TRIAL REGISTRATION

PROSPERO registration: CRD42022334685.

Exploring the association between epilepsy and depression: A systematic review and meta-analysis

OBJECTIVE

This study offers meta-analytic data on the potential association between epilepsy and depression especially for the prevalence of depression in epilepsy or vice versa.

METHODS

The relevant studies were searched and identified from nine electronic databases. Studies that mentioned the prevalence and/or incidence of epilepsy and depression were included. Hand searches were also included. The search language was English and the search time was through May 2022. Where feasible, random-effects models were used to generate pooled estimates.

RESULTS

After screening electronic databases and other resources, 48 studies from 6,234 citations were included in this meta-analysis. The period prevalence of epilepsy ranged from 1% to 6% in patients with depression. In population-based settings, the pooled period prevalence of depression in patients with epilepsy was 27% (95% CI, 23-31) and 34% in clinical settings (95% CI, 30-39). Twenty studies reported that seizure frequency, low income, unemployment of the patients, perception of stigma, anxiety, being female, unmarried status, disease course, worse quality of life, higher disability scores, and focal-impaired awareness seizures were risk factors for depression.

CONCLUSION

Our study found that epilepsy was associated with an increased risk of depression. Depression was associated with the severity of epilepsy.

Detecting Reasons for Nonadherence to Medication in Adults with Epilepsy: A Review of Self-Report Measures and Key Predictors

This review presents individual reasons for self-reported nonadherence in people with epilepsy (PWE). A literature search was performed on the PubMed/Medline and Scopus databases for studies published up to March 2022. Thirty-six studies were included using the following inclusion criteria: original studies on adults with epilepsy, use of subjective self-report adherence measurement methods, and publication in English. Data were extracted using a standardized data extraction table, including the year of publication, authors, cohort size, study design, adherence measurement method, and self-reported reasons for nonadherence. Self-reported reasons for nonadherence were grouped following the WHO model with the five dimensions of nonadherence. In addition, study characteristics and sociodemographic information are reported. Of the 36 included studies, 81% were observational. The average nonadherence rate was nearly 50%. Across all studies, patient-associated, therapy-associated, and circumstance-related factors were the most frequently reported dimensions of nonadherence. These factors include forgetfulness, presence of side-effects, and history of seizures. Regarding healthcare system factors, financial problems were the most reported reason for nonadherence. Stigmatization and quality of life were the most frequently cited factors influencing nonadherence in the disease- and circumstance-related dimensions. The results suggest that interventions for improving adherence should incorporate all dimensions of nonadherence.

Prevalence and risk factors for depression and anxiety in adult patients with epilepsy: Caregivers' anxiety and place of residence do mater

OBJECTIVES

This study was aimed to assess the prevalence of anxiety and depression and the possible contributions of the caregiver's anxiety and depression, disease status, and socio-demographic characteristics to psychopathological comorbidities among adult patients with epilepsy.

METHODS

A total of 262 participants (131 adult patient-caregiver pairs) were enrolled in this study. The Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A) were applied to evaluate the depression and anxiety status among adult patients with epilepsy and their caregivers, respectively. We collected caregivers' anxiety and depression, patients' sociodemographic characteristic data, and disease status as independent variables using stepwise multiple linear regression analysis that were correlated to the degree of anxiety and depression among these adult patients with epilepsy.

RESULTS

Among adult patients with epilepsy, 46 (35.11%) subjects showed anxiety symptoms (HAM-A scores > 6), and 48 (36.64%) had depression symptoms (HAM-D scores > 6). Caregivers' anxiety levels and place of residence were significant independent predictors of both anxiety and depression levels among adult patients with epilepsy.

CONCLUSIONS

Adult patients with epilepsy are at a high risk of suffering from anxiety and depression. Caregivers' anxiety and place of residence are definite independent predictors for anxiety and depression severity among adult patients with epilepsy. Therefore, clinicians should be careful in closely monitoring the psychological status of adult patients with epilepsy and their caregivers. Furthermore, the government and medical institutions should increase educational awareness about epilepsy and its cure, especially among adult patients with epilepsy who live in rural areas and consider offering a multidisciplinary management program to improve these patients' psychological status.

Excessive Daytime Sleepiness and Sleep Quality and their Impact on Health-Related Quality of Life in People with Epilepsy: A study from Pakistan

BACKGROUND

Epilepsy is one of the most common but manageable neurological disorder. The relation between epilepsy, sleep, and health-related quality of life (HRQoL) in culturally distinct environment of Pakistan remains unclear. The purpose of this study was to determine prevalence and predictors of excessive daytime sleepiness (EDS), poor sleep quality (SQ), and to analyze their association with HRQoL in people with epilepsy (PWE).

METHODS

A study was conducted among PWE attending two tertiary care hospitals of Islamabad and Rawalpindi, Pakistan. The EDS, SQ, and HRQoL were evaluated by Urdu versions of Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Quality of Life in Epilepsy-31 (QOLIE-31).

RESULTS

The study included 200 PWE and 51 healthy controls with mean (SD) ages of 33.1 ± 13.9, 32.9 ± 10.9, and a disease duration of 5.01 ± 6.17, respectively. The majority of the respondents (n = 130, 65%) had poor seizure control, and most of these (n = 88, 68%) were on combination antiepileptic drug (AED) therapy. In comparison to controls, a higher number of PWE had EDS by ESS (score ≥ 11, 10% vs. 40%, p-value 0.00), and poor SQ by PSQI (score > 5, 9% vs. 71%, p-value 0.00). A multiple logistic regression analysis reveals that the factors significantly associated with EDS were: female gender; increasing age; seizure control; duration of epilepsy; and combination AED therapy. A second multiple binary logistic regression analysis suggests that factors significantly associated with poor SQ were: increasing age; female gender; poor seizure control; and combination therapy. The Hierarchical multivariate analysis suggests that poor seizure control, EDS, and poor SQ were significant predictors of low HRQoL.

CONCLUSION

The findings suggest high prevalence of EDS and poor SQ in PWE in Pakistan. A significant negative association exists between sleep complaints and HRQoL. During routine clinical consultations, awareness about sleep hygiene practices must be provided to enhance HRQoL.

Managing depression and anxiety in patients with epilepsy in eastern China: A survey of epilepsy health professionals in Zhejiang Province

OBJECTIVE

We aimed to evaluate the assessment and management of epilepsy with anxiety and depression, and their clinical practice based on a survey.

METHODS

A cross-sectional survey of epilepsy health professionals was undertaken in Zhejiang Province using the modified International League Against Epilepsy (ILAE) Psychology Task Force questionnaire. We recorded the characteristics of participants and the practice of screening, referral, and treatment for depression and anxiety disorders. A total of 146 participants joined in the survey, of which 76.0% were neurologists, and 69 participants were the member of the Zhejiang Association Against Epilepsy (ZAAE).

RESULTS

This survey revealed that almost all participants (87.7%) agreed that screening for depression and anxiety in patients with epilepsy (PWEs) was very important; however, the frequency of screening was very low (41.1% of participants screened less than 10% of patients, and 34.2% participants screened between 10% and 30% of patients). A higher frequency of screening was reported in the member group and compared with that in the non-member group (P = 0.025). The main barrier to screening was the lack of time during clinic visits: 81.5% participants included screening questions as part of their clinical review. When anxiety/depression was diagnosed, the next step should be to refer patients to a psychiatrist (78.1%). No standardized procedures and lack of mental health specialists trained to assess and/or manage PWEs, were the main barriers to follow-up assessment and management. Lack of appropriately trained mental health specialists was also the main barrier to psychological treatment for depression and anxiety.

CONCLUSION

This survey highlighted that epilepsy healthcare professionals in Zhejiang province agreed on the importance of screening for psychiatric comorbidities in PWEs; however, the screening and management were actually insufficient. Certain barriers to screening, referral, and treatment were presented and improvements were recommended.

Challenges of patients with epilepsy and measures for improving epilepsy care in western China: A qualitative study

OBJECTIVE

The aim of this qualitative study was to explore the challenges that patients with epilepsy (PWEs) face and the opportunities or areas where changes in nursing care may improve epilepsy care in western China.

METHODS

Semi-structured interviews with open-ended questions based on a review of the literature were conducted at the epilepsy center of a tertiary hospital in western China. A total of 18 PWEs, 18 caregivers and 11 neurology nurses were interviewed by using purposive sampling. The data were transcribed verbatim, and a content analysis was used to conduct the framework analysis.

RESULTS

Three key themes were identified, namely, the impact of epilepsy, barriers to epilepsy management, and measures in nursing care for improving epilepsy care. Psychological stress, the side effects of drugs and accidental injury related to seizures were reported to be the main negative impacts on patients. Limited knowledge about epilepsy, poor adherence to therapy, and a lack of effective communication between patients and medical staff were the major barriers to epilepsy management. Strengthening health education, assessing the frequency and type of seizures, screening for psychological disorders and mental intervention, and maintaining continuity of care were identified as crucial measures for nurses to improve epilepsy care.

CONCLUSIONS

This study highlights the challenges among PWEs and opportunities for improving the quality of epilepsy care in western China. Limited knowledge and poor drug adherence are the main barriers to epilepsy management, which might be improved by more health education and continuing care provided by nurses. Assessing seizures, screening for psychological disorders and providing appropriate psychological care would help improve epilepsy care.

New Strategies to Improve Patient Adherence to Medications for Noncommunicable Diseases During and After the COVID-19 Era Identified via a Literature Review

Noncommunicable diseases (NCDs) place a huge burden on healthcare systems and society as a whole. Relatively early in the coronavirus disease 2019 (COVID-19) pandemic, clinicians became aware that in individuals infected with COVID-19, those with preexisting NCDs such as diabetes mellitus and cardiovascular disease (CVD) were at a greater risk of poor outcomes and mortality than those without. The importance of adherence to medications and lifestyle changes to control and prevent NCDs has been a major focus for many years, but with limited success - the proportion of patients adherent and persistent to their medications remains very low. There are many facets to adherence and persistence. Recent evidence suggests that a patient-centric approach is important, and ensuring that a patient is both motivated and empowered is critical to improving adherence/persistence. The COVID-19 pandemic has brought many changes to the way in which patients with NCDs are managed, with telemedicine and ehealth becoming more common. Changes have also occurred in the way in which patients can gain access to medications during the pandemic. The potential for these changes forms the basis of improving the management of patients with NCDs both during and after the pandemic. Over the coming months, a huge amount of work will be put into initiatives to promote adherence to COVID-19 vaccination programs. Those at highest risk of severe COVID-19, such as people aged 80 years and older, are likely to receive the vaccine first in some parts of world. Finally, social determinants of health are critical elements that can impact not just the likelihood of having an NCD or becoming infected with COVID-19, but also access to healthcare, and a patient's adherence and persistence with their treatments.

Psychiatric comorbidities in adult patients with epilepsy (A systematic review)

The co-occurrence of epilepsy and psychiatric disorders is long known. The scope of this systematic review was to describe the prevalence of specific interictal psychiatric disorders in patients with epilepsy and to assess possible associations between psychiatric disorders and other sociodemographic or clinical characteristics of epilepsy patients. MEDLINE and ScienceDirect were searched for original articles published between January 2015 and February 2021 describing studies that involved epilepsy patients with psychiatric comorbidities. We identified 13 studies with heterogenous methodology and reporting. Prevalence of any psychiatric disorder observed was up to 51% in idiopathic generalized epilepsy (IGE), up to 43.1% in temporal lobe epilepsy (TLE) and up to 43.3% in a general population of patients with epilepsy. The most frequent psychiatric comorbidities associated with epilepsy included mood/affective disorders (up to 40% for lifetime occurrence and up to 23% for current occurrence), anxiety disorders (up to 30.8% for lifetime occurrence and up to 15.6% for current occurrence), personality disorders [up to 11% in juvenile myoclonic epilepsy (JME)] and psychotic disorders (up to 4% of epilepsy patients). In focal epilepsy, depressive disorders might be associated with specific brain imaging findings and with cognitive impairment. Anxiety disorders are associated with a higher frequency of generalized tonico-clonic seizure (GTCS) and with worse social functioning. Psychotic disorders were found to be associated with longer duration of epilepsy. Childhood maltreatment experiences were found to be a powerful predictor for the occurrence of psychiatric comorbidities in epilepsy patients, while data regarding association of other epilepsy characteristics with the presence of psychiatric disorders is conflicting.

The Quality of Life in Patients with Epilepsy in the Context of Sleep Problems and Sexual Satisfaction

Epilepsy influences the quality of patient functioning in almost all aspects of life. This study aimed to assess the quality of difficulties with sleep initiation and those concerning sexual function, and to assess whether sleep disorders are associated with selected aspects of sexual function and quality of life. The study involved completing a quality-of-life questionnaire for persons with epilepsy: a QOLIE-31 questionnaire, and the present authors' questionnaire, including 20 questions. A total of 170 questionnaires were completed by 89 men and 81 women. Sleep problems of various frequency were reported by 98 participants (57.6%). Only 41% of patients were definitely satisfied with their sex life. The respondents who declared dissatisfaction with their sex life more often reported difficulties with sleep initiation (χ2 = 10.20; p ≤ 0.001). Moreover, those who claimed that epilepsy might contribute to sex life problems more commonly declared dissatisfaction with their sex life (χ2 = 20.01; p ≤ 0.001) and more frequently, reported difficulties with sleep initiation (χ2 = 6.30; p ≤ 0.012). The issues should constitute the constant element of medical history taking, as improvement in these areas of functioning may promote better quality of life in patients with epilepsy.

Strategies for improving adherence to antiepileptic drug treatment in people with epilepsy

BACKGROUND

Poor adherence to antiepileptic medication is associated with increased mortality, morbidity and healthcare costs. In this review, we focus on interventions designed and tested in randomised controlled trials (RCTs) and quasi-RCTs to assist people with adherence to antiepileptic medication. This is an update of a Cochrane review first published in 2011, and last updated in 2017.

OBJECTIVES

To determine the effectiveness of interventions aimed at improving adherence to antiepileptic medication in adults and children with epilepsy.

SEARCH METHODS

For the latest update, we searched the following databases on 18 February 2020: Cochrane Register of Studies (CRS Web), MEDLINE, CINAHL Plus and PsycINFO. CRS Web includes RCTs or quasi-RCTs from PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP), CENTRAL, and the Specialized Registers of Cochrane Review Groups including Epilepsy. We also searched the reference lists of relevant articles.

SELECTION CRITERIA

RCTs and quasi-RCTs of adherence-enhancing interventions aimed at people with a clinical diagnosis of epilepsy (as defined in individual studies), of any age and treated with antiepileptic drugs in a primary care, outpatient or other community setting.

DATA COLLECTION AND ANALYSIS

All review authors independently assessed lists of potentially relevant citations and abstracts. At least two review authors independently extracted data and performed a quality assessment of each study according to the Cochrane tool for assessing risk of bias. We graded the level of evidence for each outcome according to GRADE. The studies differed widely according to the type of intervention and measures of adherence; therefore combining data was not appropriate.

MAIN RESULTS

We included 20 studies reporting data on 2832 participants. Thirteen studies targeted adults with epilepsy, one study included participants of all ages, one study included participants older than two years, one recruited pediatric patients aged between 1 month to 15 years, one study targeted caregivers of children with epilepsy, one targeted adolescents and caregivers, and two studies targeted families of children with epilepsy. We identified three ongoing studies. Follow-up time was generally short in most studies, ranging from 1 to 12 months. The studies examined three main types of interventions: educational interventions, behavioural interventions and mixed interventions. All but three studies compared treatment with usual care or 'no intervention'. Due to heterogeneity between studies in terms of interventions, methods used to measure adherence and the way the studies were reported, we did not pool the results and these findings were inappropriate to be included in a meta-analysis. Education and counselling of participants with epilepsy had mixed success (moderate-certainty evidence). Behavioural interventions such as the use of intensive reminders provided more favourable effects on adherence (moderate-certainty evidence). The effect on adherence to antiepileptic drugs described by studies of mixed interventions showed improved adherence in the intervention groups compared to the control groups (high-certainty evidence). Eleven studies described seizure frequency or seizure severity or both, with four of them, reporting improved adherence and decreased seizure frequency in the intervention groups (moderate-certainty evidence). Findings related to self-efficacy and quality of life were mixed, with no clear pattern across types of intervention.

AUTHORS' CONCLUSIONS

Behavioural interventions such as intensive reminders and the use of mixed interventions demonstrate some positive results, however, we need more reliable evidence on their efficacy, derived from carefully-designed RCTs before we can draw a firm conclusion. None of the newly included studies have provided additional information that would lead to significant changes in our conclusions.