Published online March 3, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e961-e966 (doi:10.1542/peds.2007-1690)
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ARTICLE

One-Month Adherence in Children With New-Onset Epilepsy: White-Coat Compliance Does Not Occur

Avani C. Modi, PhDa, Diego A. Morita, MDb and Tracy A. Glauser, MDb

a Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology
b Department of Pediatrics, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

OBJECTIVES. Adherence to antiepileptic drug therapy plays an important role in the effectiveness of pharmacologic treatment of epilepsy. The purpose of this study was to use an objective measure of adherence to (1) document patterns of adherence for the first month of therapy for children with new-onset epilepsy, (2) examine differences in adherence by demographic and epilepsy variables, and (3) determine whether treatment adherence improves for a short time before a clinic visit (eg, "white-coat compliance").

METHODS. Participants included 35 children with new-onset epilepsy (mean age: 7.2 years; 34% female; 66% white) and their caregivers. Children had a diagnosis of partial (60%), generalized (29%), or unclassified (11%) epilepsy. Adherence to treatment was electronically monitored with Medication Event Monitoring System TrackCap, starting with the first antiepileptic drug dose. Adherence was calculated across a 1-month period and for the 1, 3, and 5 days before and 3 days after the clinic appointment.

RESULTS. Adherence for the first month of treatment in children with new-onset epilepsy was 79.4%. One-month adherence was higher in children of married parents and those with higher socioeconomic status but did not correlate with child's gender, age, epilepsy type, prescribed medication, seizure frequency, or length of time since seizure onset. Adherence across the entire 1-month period was not different from adherence for the 1, 3, or 5 days before or 3 days after the clinic visit.

CONCLUSIONS. Poor adherence seen for children with new-onset epilepsy during the first month of antiepileptic drug therapy is a cause for concern. Several demographic variables influence adherence to treatment, whereas the proximity to a clinic visit does not. Additional studies are needed to document whether this trend continues longitudinally and determine the clinical impact of poor adherence.

Key Words: compliance • pediatric • electronic monitoring • seizures • longitudinal design • MEMS TrackCaps

Abbreviations: AED—antiepileptic drug • MEMS—Medication Event Monitoring System • SES—socioeconomic status • NS—not significant • TDM—therapeutic drug monitoring

Accepted Sep 27, 2007.


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