Factors associated with poor adherence to antiepileptic treatment

Abstract

Background: Epilepsy requires continuous antiepileptic treatment for adequate seizure control and reduction of morbidity and mortality. However, poor therapeutic adherence remains frequent and represents an important determinant of clinical instability, seizure recurrence, preventable hospitalizations, and an increased risk of sudden death related to epilepsy. It is a multifactorial phenomenon influenced by sociodemographic aspects, therapeutic complexity, psychiatric comorbidities, and healthcare access barriers. In the Brazilian context, the integrated understanding of these determinants remains limited. Objective: To analyze the factors associated with poor adherence to treatment with antiepileptic drugs, as well as their impacts on seizure control, epilepsy progression, and clinical outcomes, investigating how insufficient adherence influences patients’ quality of life and prognosis. Methods: A systematic review was conducted, with studies identified in the PubMed database between 2010 and 2026 analyzed in pairs. The following search strategy was used: (“EPILEPSY”) AND (“ADHERENCE”) AND (“NON-ADHERENCE”) AND (“TREATMENT”). Articles not published in English and those that did not address the clinical prediction of the tests were excluded. After analyzing 72 studies, only 2 articles met the inclusion criteria and were selected, reflecting the scarcity of research on the topic during the analyzed period. Results: The analyzed studies showed that poor adherence to antiepileptic treatment is associated with multiple factors, including low educational level, difficulties in accessing healthcare services, complex therapeutic regimens, and the occurrence of adverse effects. In addition, psychiatric comorbidities such as depression and anxiety also contribute to lower treatment adherence. These factors may compromise therapeutic continuity and favor poor seizure control. As a consequence, there is a higher frequency of epileptic seizures, increased hospitalizations, and worse quality of life, as well as a higher risk of sudden death related to epilepsy. Therefore, the early identification of determinants of non-adherence is essential for the implementation of strategies that promote better disease control. Conclusion: The present review demonstrated that poor adherence to antiepileptic treatment is associated with socioeconomic factors, psychiatric comorbidities, and barriers to accessing healthcare services, contributing to a higher frequency of epileptic seizures, increased hospitalizations, and a greater risk of sudden death related to epilepsy. In this context, the early identification of the determinants of non-adherence becomes essential for the development of intervention strategies that promote seizure control, improve quality of life, and reduce patient morbidity and mortality.