Family Function Fosters Adherence in Young Epilepsy Patients

Parent and family factors can predict the 2-year adherence trajectories in young children with newly diagnosed epilepsy, according to the first study to identify these adherence predictors. Researchers used an evidence-based adherence assessment in young, recently diagnosed epilepsy patients.

The results indicate that parent and family functioning may play an even larger role in adherence in young epilepsy patients than seizure trajectories and side effects of antiepileptic drugs.

Previous research has shown that children with epilepsy have difficulties taking antiepileptic drugs as prescribed. Some of the reasons for non-adherence include poor seizure control, uninformed clinical decision-making, and increased health-care costs in adults, state the authors led by Kristin Loiselle of the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children's Hospital Medical Center.

“Prior cross-sectional studies have demonstrated that less disease knowledge, higher barriers to the medication regimen, poorer parent psychosocial status, and poorer family functioning negatively predict antiepileptic drug adherence,” they state, adding that these studies have methodological limitations.

Their analysis aimed to identify demographic, medical, and psychosocial predictors of previously established adherence trajectories among young children newly diagnosed with epilepsy at 2 different points in the course of epilepsy treatment.

The study is part of a large, prospective, longitudinal observational study of antiepileptic drug adherence and medical outcomes in youth with newly diagnosed epilepsy.

The study included 91 parents of children with epilepsy who completed questionnaires of psychosocial and family functioning at 1 month and 1 year following diagnosis. Chart review and questionnaires were used to collect medical variables and seizure outcomes. Previously established 2-year antiepileptic drug adherence trajectories ranged from severe early non-adherence, variable non-adherence, moderate non-adherence, and high adherence.

The results show that 1 month following diagnosis, the predictors of 2-year adherence trajectories included socioeconomic status, epilepsy knowledge, family problem-solving, and family communication. Significant predictors 1 year following diagnosis included socioeconomic status, parent fears and concerns, and parent life stress.

A novel finding was that better family communication and problem-solving skills were associated with more favorable 2-year adherence trajectories, above and beyond seizures and side effects.

“Our data highlight the critical role of parent and family functioning in adherence behaviors in pediatric epilepsy,” the authors state.

Family socioeconomic status emerged as an early and late predictor of 2-year adherence trajectories. “Although socioeconomic status is non-modifiable, clinicians should be aware that it is an important risk factor for non-adherence to AED (antiepileptic drug) therapy,” they state.

Knowledge about epilepsy, they note, plays a minor role in adherence behaviors relative to other parent and family factors.

Also, some parents lack the resources to administer medication due to the demands of their daily lives. “Parent-focused interventions to address fears, concerns, and life stress may be more critical later in the course of the child's epilepsy and could have a positive impact on adherence to epilepsy treatment and, ultimately, health-related quality of life,” they state.

Based on the results of the study, the authors recommend that targeted interventions at 1 month and 1 year after diagnosis be incorporated into clinical care.