Factors Affecting Non Compliance to Medication in Epileptic Patients
Medication Noncompliance in Epilepsy
DOI:
https://doi.org/10.54393/pjhs.v6i5.2679Keywords:
Epilepsy, Non Compliance, Poor Seizure Control, Cost ReductionAbstract
Non-compliance with antiepileptic medications is a significant concern, leading to poor seizure control, increased hospitalization, and higher healthcare costs. Objective: To identify factors contributing to non-compliance among epileptic patients. Methods: A cross-sectional study was conducted at Akhtar Saeed Trust Hospital, Lahore, from July 2023 to March 2024, including 200 epileptic patients aged 18-60 years identified as non-compliant using the Morisky Medication Adherence Scale (MMAS-4) Patients with psychiatric illnesses, hearing problems, or those pregnant/lactating were excluded. Data on demographics and contributing factors (e.g., high costs, forgetfulness, unemployment) were collected via structured proformas. Statistical analysis using SPSS version 25.0 included descriptive statistics and stratified analyses to explore relationships between factors and demographics, with significance at p < 0.05. Results: Of 200 patients, 67.5% were male. High cost (57.5%) was the leading factor, followed by forgetfulness (55.0%), prolonged treatment duration (32.5%), unemployment (29.5%), and medication complexity (16.5%). Monthly household income significantly influenced these factors; high costs and prolonged treatment duration were predominant in low-income groups (p < 0.001). Forgetfulness was uniformly reported across socio-economic strata (p = 0.094). Conclusions: High medication costs and forgetfulness are primary contributors to non-compliance among epileptic patients. Strategies like cost reduction, simplified regimens, and reminder interventions are essential to enhance adherence and improve clinical outcomes.
References
Beghi E. The epidemiology of epilepsy. Neuroepidemiology. 2020 Dec; 54(2): 185-91. doi: 10.1159/000503831. DOI: https://doi.org/10.1159/000503831
Siddiqui F, Sultan T, Mustafa S, Siddiqui S, Ali S, Malik A et al. Epilepsy in Pakistan: national guidelines for clinicians. Pakistan Journal of Neurological Sciences (PJNS). 2015 Jan; 10(3): 47-62.
Kim KT, Kim DW, Yang KI, Lee ST, Byun JI, Seo JG et al. Drug Committee of Korean Epilepsy Society. Refining general principles of antiepileptic drug treatments for epilepsy. Journal of Clinical Neurology (Seoul, Korea). 2020 May; 16(3): 383. doi: 10.3988/jcn.2020.16.3.383. DOI: https://doi.org/10.3988/jcn.2020.16.3.383
Zafar A, Shahid R, Nazish S, Aljaafari D, Alkhamis FA, Alsalman S et al. Nonadherence to antiepileptic medications: Still a major issue to be addressed in the management of epilepsy. Journal of Neurosciences in Rural Practice. 2019 Jan; 10(1): 106. doi: 10.4103/jnrp.jnrp_136_18. DOI: https://doi.org/10.4103/jnrp.jnrp_136_18
Sabaté E. Adherence to long-term therapies: evidence for action. World Health Organization; 2003.
Hasiso TY and Desse TA. Adherence to treatment and factors affecting adherence of epileptic patients at Yirgalem General Hospital, Southern Ethiopia: a prospective cross-sectional study. PLOS One. 2016 Sep; 11(9): e0163040. doi: 10.1371/journal.pone.0163040. DOI: https://doi.org/10.1371/journal.pone.0163040
Teh KX, Henien NP, Wong LS, Wong ZK, Raja Ismail RZ, Achok HN et al. A cross-sectional study on the rate of non-adherence to anti-seizure medications and factors associated with non-adherence among patients with epilepsy. PLOS One. 2020 Jul; 15(7): e0235674. doi: 10.1371/journal.pone.0235674. DOI: https://doi.org/10.1371/journal.pone.0235674
Mendorf S, Prell T, Schönenberg A. Detecting reasons for nonadherence to medication in adults with epilepsy: a review of self-report measures and key predictors. Journal of Clinical Medicine. 2022 Jul; 11(15): 4308. doi: 10.3390/jcm11154308. DOI: https://doi.org/10.3390/jcm11154308
Ernawati I and Islamiyah WR. How to improve clinical outcome of epileptic seizure control based on medication adherence? A literature review. Open access Macedonian journal of medical sciences. 2018 Jun; 6(6): 1174. doi: 10.3889/oamjms.2018.235. DOI: https://doi.org/10.3889/oamjms.2018.235
Gilani A, Nawaz KH, Hassan Z, Yousaf MA, Hashmat A, Arif S. Frequency And Factors Of Non-Compliance Among Epileptic Patients. Pakistan Armed Forces Medical Journal. 2021 Jun; 30(3): 929. doi: 10.51253/pafmj.v71i3.3127. DOI: https://doi.org/10.51253/pafmj.v71i3.3127
Abebaw N, Girma N, Yasin M. Non-adherence to anti-epileptic drugs and associated factors among epileptic patients in Dessie Town Public Hospitals, Northeast Ethiopia. Journal of Epilepsy Research. 2021 Jun; 11(1): 39. doi: 10.14581/jer.21006. DOI: https://doi.org/10.14581/jer.21006
Chowdhury S, Phani AK, Das P, Ahammed Z, Kayasthagir PK, Hassanuzzaman M. Adherence to antiepileptic drugs and seizure control among patients with epilepsy. Chattagram Maa-O-Shishu Hospital Medical College Journal. 2020 Aug; 19(1): 68-73. doi: 10.3329/cmoshmcj.v19i1.48808. DOI: https://doi.org/10.3329/cmoshmcj.v19i1.48808
Gosain K and Samanta T. Understanding the role of stigma and misconceptions in the experience of epilepsy in India: findings from a mixed-methods study. Frontiers in Sociology. 2022 May; 7: 790145. doi: 10.3389/fsoc.2022.790145. DOI: https://doi.org/10.3389/fsoc.2022.790145
Akbar Malik M, Rafique A, Virk AO. Empowerment of primary health care in an Outreach resource-limited district in Punjab: A strategy for improving adherence to Antiepileptic drug treatment in children with Epilepsy. Pakistan Journal of Neurological Sciences (PJNS). 2019 Feb; 14(4): 6-12.
Awan SA, Khawaja I, Babar M, Khan F, Awan SA. Prevalence of non-adherence to antiepileptic drugs in patients with epilepsy presenting to emergency with fits. Cureus. 2022 Jul; 14(7). doi: 10.7759/cureus.27072. DOI: https://doi.org/10.7759/cureus.27072
Morisky DE, Ang A, Krousel‐Wood M, Ward HJ. Retracted: predictive validity of a medication adherence measure in an outpatient setting. The Journal of Clinical Hypertension. 2008 May; 10(5): 348-54. doi: 10.1111/j.1751-7176.2008.07572.x. DOI: https://doi.org/10.1111/j.1751-7176.2008.07572.x
Saleem F, Hassali MA, Akmal S, Morisky DE, Atif M, Al-Qazaz HK et al. Translation and validation study of Morisky Medication Adherence Scale (MMAS): the Urdu version for facilitating person-centered healthcare in Pakistan. International Journal of Person Centered Medicine. 2012 Sep; 2(3): 384-90.
Haider S, Shabbir S, Tariq M, Nayeem A, Shafique H, Sahitia S. Socioeconomic Determinants of Access to Primary Healthcare in Rural Population of Sindh, Pakistan: Primary Healthcare Access in Rural Sindh: A Socioeconomic Analysis. Pakistan Journal of Health Sciences. 2025 Mar; 6(3): 223-8. doi: 10.54393/pjhs.v6i3.2755. DOI: https://doi.org/10.54393/pjhs.v6i3.2755
da Mota Gomes M, Navarro T, Keepanasseril A, Jeffery R, Haynes RB. Increasing adherence to treatment in epilepsy: what do the strongest trials show?. Acta Neurologica Scandinavica. 2017 Mar; 135(3): 266-72. doi: 10.1111/ane.12668. DOI: https://doi.org/10.1111/ane.12668
Hauser WA and Hesdorffer DC. Epidemiology of epilepsy. InNeuroepidemiology 2019 Jun: 97-120. doi: 10.1201/9780429277276-7. DOI: https://doi.org/10.1201/9780429277276-7
Lezaic N, Roussy J, Masson H, Jetté N, Keezer MR. Epilepsy in the elderly: unique challenges in an increasingly prevalent population. Epilepsy & Behavior. 2020 Jan; 102: 106724. doi: 10.1016/j.yebeh.2019.106724. DOI: https://doi.org/10.1016/j.yebeh.2019.106724
Govil N, Chahal S, Gupta N, Kaloti AS, Nadda A, Singh P. Factors associated with poor antiepileptic drugs adherence in below poverty line persons with epilepsy: a cross-sectional study. Journal of Neurosciences in Rural Practice. 2021 Jan; 12(1): 95. doi: 10.1055/s-0040-1721200. DOI: https://doi.org/10.1055/s-0040-1721200
Pironi V, Ciccone O, Beghi E, Paragua‐Zuellig H, Patel AA, Giussani G et al. ILAE Task Force on Access to Treatment. Survey on the worldwide availability and affordability of antiseizure medications: report of the ILAE task force on access to treatment. Epilepsia. 2022 Feb; 63(2): 335-51. doi: 10.1111/epi.17155. DOI: https://doi.org/10.1111/epi.17155
Permatananda PA, Apsari PI, Harkitasari S. Medication adherence and quality of life among epilepsy patients: A cross sectional study. International Journal of Research-Granthaalayah. 2019 Mar; 7(3): 1-0. doi: 10.29121/granthaalayah.v7.i3.2019.937. DOI: https://doi.org/10.29121/granthaalayah.v7.i3.2019.937
Alrukban NA, Alotaibi SA, Alanizy LN, Saleh A, Alsfouk BA. Non-Adherence to Antiseizure Medications: Rate and Predictors in Saudi Arabia. Medicina. 2024 Oct; 60(10): 1649. doi: 10.3390/medicina60101649. DOI: https://doi.org/10.3390/medicina60101649
Shumet S, Wondie M, Ayano G, Asfaw H, Kassew T, Mesafint G. Antiepileptic drug adherence and its Associated factors among Epilepsy patients on follow-ups at Amanuel Mental Specialized Hospital, Ethiopia. Ethiopian Journal of Health Sciences. 2022 Sep; 32(5): 913-22. doi: 10.4314/ejhs.v32i5.6. DOI: https://doi.org/10.4314/ejhs.v32i5.6
Kindem IA. Medication adherence and home-monitoring among kidney transplanted adolescents and young adults in Norway. 2023 May.
Abd Wahab ES, Al Omar M, Altabakha MM. Adherence to antiepileptic drugs among patients attending the neuro spinal hospital in the United Arab Emirates. Journal of Pharmacy and Bioallied Sciences. 2020 Oct; 12(4): 499-507. doi: 10.4103/JPBS.JPBS_367_19. DOI: https://doi.org/10.4103/JPBS.JPBS_367_19
Mahmoud, M.R., Alenazi, H.A., Almutairi, M.S., Alblowi, B.S., Abdelaziz, O.G., Abdelhady, H.M et al. Measuring of Non-Adherence of Epilepsy Patients to their Medication and its Relationship to their Beliefs about the Disease, and the Frequency of Seizures: A Comparative Study between Epilepsy Patients in Saudi Arabia and Egypt. Pakistan Journal of Medical & Health Sciences. 2022; 16(06): 479-479. doi: 10.53350/pjmhs22166479. DOI: https://doi.org/10.53350/pjmhs22166479
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments
