Uninformed clinical decisions resulting from lack of adherence assessment in children with new-onset epilepsy

This study examined the relationship between nonadherence to antiepileptic drug (AED) therapy and clinical decision making in a cohort of 112 children with newly diagnosed epilepsy. Antiepileptic drug adherence was monitored using electronic monitoring over the first six months of therapy. The primary outcome measure was rate of uninformed clinical decisions as defined by the number of participants with AED dosage or drug changes to address continued seizures who demonstrated nonadherence prior to the seizure. Among the 52 (47%) participants who had an AED change for continued seizures, 30 (27% of the overall cohort) had imperfect medication adherence prior to their seizures. A quarter of the children with new-onset epilepsy had uninformed medication changes because adherence was not rigorously assessed in clinical practice. The results highlight the importance of routinely assessing medication adherence in this population.

► Nonadherence and clinical decision making have been understudied in pediatrics. ► 25% of children had uninformed drug changes due to lack of adherence assessment. ► Integrating adherence data into clinical decision making is critical in epilepsy.