A prospective observational study to assess compliance and factors influencing compliance with antiepileptic drugs among patients with epilepsy


  • Paramjit Singh Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
  • Kanchan Gupta Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
  • Gagandeep Singh Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
  • Sandeep Kaushal Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India




Anti-epileptic drugs, Compliance, Epilepsy, MMAS, Pill-count, Seizures


Background: The primary treatment for epilepsy is Antiepileptic drug (AED) therapy. Non-compliance to AEDs can result in break-through seizure, emergency department visits, hospitalizations, fractures, head injuries and increased mortality. Thus, compliance to AEDs is crucial to be studied. Objective is to study compliance and factors influencing compliance with AEDs among patients with epilepsy.

Methods: This observational study was conducted in 105 patients with epilepsy on AED therapy in community in Ludhiana (Punjab) after approval from Institutional Ethics Committee. Demographic data and drug history was collected. Monthly follow up for 6 months was done by paying home visits and data regarding type, dose, frequency of administration of AED was recorded on a semi-structured performa. Pill count was done by recording number of pills dispensed and number of pills remaining with patient. Response to Morisky’s Medication Adherence Scale (MMAS) was also recorded. Results were correlated with patient demographics, type, frequency and number of AEDs.

Results: Out of 105 patients, 65 were males and 40 were females. Fifty-four patients were non-compliant with both pill-count and MMAS. Non-compliance was high in first month and decreased gradually. Poly-therapy, lower socio-economic status and multiple dosing regimens were most commonly associated with non-compliance.

Conclusions: Under-dosing was more common among non-compliers, which explains the high reporting of forgetfulness to take medicine in MMAS. Both pill count and MMAS are effective non-invasive tools to study compliance.


Lowenstein DH. Seizures and Epilepsy In: Braunwald E, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Longo DL, et al, eds. Harrison’s Principle of internal medicine. 20th ed. New York, NY: Mc Graw Hill; 2008:2498-2512.

Sander JW. Some aspect of prognosis in the epilepsies: A review. Epilepsia.1993;34(6): 1007-16. Sander JW. Some aspects of prognosis in the epilepsies: a review. Epilepsia. 1993 Nov;34(6):1007-16.

Chapman SC, Horne R, Eade R, Balestrini S, Rush J, Sisodiya SM. Applying a perceptions and practicalities approach to understanding nonadherence to antiepileptic drugs. Epilepsia. 2015 Sep;56(9):1398-407.

Jimmy B, Jose J. Patient Medication Adherence: Measures in Daily Practice. Oman Med J. 2011;26(3):155-59.

Eatock J, Baker GA. Managing patient adherence and quality of life in epilepsy. Neuropsychiatr Dis Treat. 2007;3(1):117-31.

Singh T, Sharma S , Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci. 2017;5(7):3264-7.

Lisk DR, Greene SH. Drug compliance and seizure control in epileptic children. Postgrad Med J. 1985 May 1;61(715):401-5.

González FL, Osorio XR, Rein AG, Martinez MC, Fernandez JS, Haba VV, Pedraza AD, Cerdá JM. Drug-resistant epilepsy: definition and treatment alternatives. Neurología. 2015 Sep 1;30(7):439-46.

Gurumurthy R, Chanda K, Sarma GR. An evaluation of factors affecting adherence to antiepileptic drugs in patients with epilepsy: a cross-sectional study. Singapore Med J. 2017 Feb;58(2):98-102.

Kalyani P, Goud MS. A Prospective Study to Measure Drug Compliance in Epilepsy Patients. Ind J Pharma Pract. 2017;10(3):207-15.

Saad ZA, Fatima A, Fatima N, Masroor K, Nikhat SRA. Prospective and observational study of use of anti-epileptic drugs in a tertiary care teaching hospital. J Drug Disc Therap. 2017;5(8):28-36.

Tan XC, Makmor-Bakry M, Lau CL, Tajarudin FW, Raymond AA. Factors affecting adherence to antiepileptic drugs therapy in Malaysia. Neurology Asia. 2015 Sep 1;20(3):235-41.

Jabbar MA, Al-Shammari SA. Determinants of Compliance in Saudi Epileptic Patients. Ann Saudi Med. 1993;13(1):1-5.

Hasiso TY, Desse TA. Adherence to Treatment and Factors Affecting Adherence of Epileptic Patients at Yirgalem General Hospital, Southern Ethiopia: A Prospective Cross-Sectional Study. PLoS. 2016;11(9):1-12.

Pasha MY, Bose D, Sushma M, Agadi JB. Assessment of factors influencing self-reported drug adherence to anti- epileptic drugs at a tertiary care hospital. Int J Res in Pharmacol Pharmacotherap. 2017;6(2):163-69.

Liu J, Liu Z, Ding H, Yang X. Adherence to treatment and influencing factors in a sample of Chinese epilepsy patients.Epileptic Disord. 2013;15(3):289-94.

Gomes MDM, Filho HDSM medication-taking behavior and drug self-regulation in people with epilepsy. Neuropsiquiatry. 1998;56(4):714-9.

Ferrari CMM, Cardoso de Sousa RM, Castro LHM. Factors associated with treatment non-adherence in patients with epilepsy in Brazil. Seizure. 2013;22:384-9.




How to Cite

Singh, P., Gupta, K., Singh, G., & Kaushal, S. (2019). A prospective observational study to assess compliance and factors influencing compliance with antiepileptic drugs among patients with epilepsy. International Journal of Basic & Clinical Pharmacology, 8(8), 1838–1843. https://doi.org/10.18203/2319-2003.ijbcp20193187



Original Research Articles