Modi Avani C, Morita Diego A, Glauser Tracy A
Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Adherence and Self Management, MLC-3015, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
Pediatrics. 2008 Apr;121(4):e961-6. doi: 10.1542/peds.2007-1690. Epub 2008 Mar 3.
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").
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.
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.
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.
坚持抗癫痫药物治疗对癫痫药物治疗的有效性起着重要作用。本研究的目的是使用一种客观的依从性测量方法来：（1）记录新诊断癫痫儿童治疗第一个月的依从性模式；（2）研究依从性在人口统计学和癫痫相关变量方面的差异；（3）确定在门诊就诊前短时间内治疗依从性是否会提高（例如，“白大衣依从性”）。
研究对象包括35名新诊断癫痫儿童（平均年龄：7.2岁；34%为女性；66%为白人）及其照顾者。儿童被诊断为部分性癫痫（60%）、全身性癫痫（29%）或未分类癫痫（11%）。从首次服用抗癫痫药物开始，使用药物事件监测系统TrackCap对治疗依从性进行电子监测。计算1个月期间以及门诊预约前1天、3天和5天以及预约后3天的依从性。
新诊断癫痫儿童治疗第一个月的依从率为79.4%。父母已婚的儿童以及社会经济地位较高的儿童1个月的依从性较高，但与儿童的性别、年龄、癫痫类型、所开药物、癫痫发作频率或自癫痫发作开始后的时间长度无关。整个1个月期间的依从性与门诊就诊前1天、3天或5天以及就诊后3天的依从性没有差异。
新诊断癫痫儿童在抗癫痫药物治疗的第一个月依从性较差，令人担忧。几个人口统计学变量会影响治疗依从性，而与门诊就诊的时间接近程度则不会。需要进一步的研究来记录这种趋势是否会纵向持续，并确定依从性差的临床影响。
