Clear communication with the patient provides the basis for an effective patient-physician partnership, and noncompliance often results from a failure in communication. But even when the physician has given clear instructions and stressed the importance of following the medication regimen, noncompliance is the most common reason for incomplete seizure control or variable side effects.

Factors that increase noncompliance

Up to half of patients with epilepsy may not take their antiepileptic drugs (AEDs) as directed, and over half of the patients seen in emergency rooms because of recurrent seizures are noncompliant. Both patient-related and iatrogenic factors may be responsible.

Patient-related factors that increase noncompliance are:

• denial of the diagnosis of epilepsy
• limited financial means to pay for medication
• difficulty tolerating side effects
• frequent seizures
• memory impairment

Iatrogenic factors include:

• long intervals between visits to the physician
• complicated medication regimens

Signs of noncompliance

Noncompliance should be suspected if there is:

• an unexpected increase in the number or severity of seizures
• subtherapeutic or supratherapeutic AED serum levels
• a change in medical reimbursement systems

Monitoring AED levels will help determine compliance. However, patients who are compliant with the regimen also may have low or variable serum levels if:

• their AEDs have been improperly stored
• they take generic medications from different manufacturers
• their weight changes significantly

Adapted from: Schachter SC. Treatment of seizures. In: Schachter SC, Schomer DL, eds. The comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 61-74. With permission from Elsevier (www.elsevier.com).
Reviewed and revised December 2003 by Steven C. Schachter, MD, Harvard Medical School