Medication Adherence and Seizure Control in Children with Epilepsy: A Systematic Review

Fadhilatul Fatihah Firdaus; Atika Wahyu Puspitasari; Nadia Farhanah Syafhan

doi:10.37311/jsscr.v8i2.37180

Medication Adherence and Seizure Control in Children with Epilepsy: A Systematic Review

Fadhilatul Fatihah Firdaus, Atika Wahyu Puspitasari, Nadia Farhanah Syafhan

Abstract

Medication adherence is crucial for achieving seizure control in pediatric epilepsy, yet non-adherence remains a persistent challenge in clinical practice. This review evaluated the association between medication adherence and seizure control in children with epilepsy. A systematic review was conducted on online databases at Scopus, ScienceDirect, and PubMed for original articles published between 2015 to 2025. Keywords included “medication adherence”, “compliance”, “epilepsy”, “seizure”, “anticonvulsant”, “anti-seizure”, “seizure-free”, “seizure control”, and “treatment outcome”. A total of eight studies were included, comprising five cross-sectional and three retrospective cohort studies. Medication adherence rates ranged from 48.5% to 91.64% across different measurement methods. All studies demonstrated statistically significant associations (p<0.05) between adherence and seizure outcomes. Six studies showed adherence was associated with seizure control, while two examined seizure control as a factor associated with adherence, suggesting a possible bidirectional relationship. Good medication adherence was associated with 2 – 5-fold higher odds of favorable seizure outcomes (AOR: 2.19-4.91). Available evidence consistently indicates an association between medication adherence and seizure control in children with epilepsy, though causal conclusions are limited given the predominantly cross-sectional study designs included. Notably, seven of eight studies were conducted in Ethiopia, which may limit generalizability to other geographic and healthcare settings. Systematic adherence assessment and targeted interventions should be prioritized as integral components of comprehensive epilepsy care to improve seizure outcomes in children.

Keywords

Anti-seizure medications ; Children; MMAS-8; MPR; Pediatric epilepsy; Treatment adherence

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References

I. E. Scheffer, S. Berkovic, G. Capovilla, M. B. Connolly, J. French, L. Guilhoto, et al., “ILAEclassification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology,” Epilepsia, vol. 58, no. 4, pp. 512–521, Apr. 2017, [Online]. Available: https://doi.org/10.1111/epi.13709.

G. Biset, N. Abebaw, N. A. Gebeyehu, N. Estifanos, E. Birrie, and K. D. Tegegne, “Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: a systematic review and meta-analysis,” BMC Public Health, vol. 24, no. 1, p. 771, Dec. 2024, [Online]. Available: https://doi.org/10.1186/S12889-024-18236-Z.

Z. Su, J. Lu, Y. Shi, B. Qi, and Z. Guo, “Global, regional, and national children and adolescent epilepsy burden, 1990–2021: an analysis based on the global burden of disease study 2021,” Ann. Med., vol. 57, no. 1, Dec. 2025, [Online]. Available: https://doi.org/10.1080/07853890.2025.2534087.

Z. Zhou, S. Chen, Y. Gao, and G. Li, “Global, regional and national burden of epilepsy in adolescents aged 10–19 years from 1990 to 2021: An analysis for the Global Burden of Disease Study 2021,” Epilepsia Open, vol. 10, no. 6, p. 1918, Dec. 2025, [Online]. Available: https://doi.org/10.1002/EPI4.70176.

S. M. Samosir, P. I. Gunawan, R. Noviandi, and L. Q. B. Setiawati, “Childhood Epilepsy Management in Indonesia: Challenge and Current Condition,” International Journal of Integrated Medical Research. Accessed: Jul. 02, 2025. [Online]. Available: https://www.ijoimr.com/index.php/ijoimr/article/view/ijoimr192/89

Johns Hopkins Medicine, “Seizures and Epilepsy in Children | Johns Hopkins Medicine.” Accessed: Jan. 02, 2026. [Online]. Available: https://www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/seizures-and-epilepsy-in-children

WHO, “Epilepsy:A Public Health Imperative.” Accessed: Jul. 01, 2025. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/epilepsy

M. A. Adisu, A. B. Zemariam, Y. A. Derso, B. M. Wereta, M. A. Kassa, T. A. Kitaw, and T. E. Habtie, “Global patterns and predictors of anti-seizure medication adherence in pediatric epilepsy: A systematic review and meta-analysis,” Epilepsy & Behavior, vol. 172, p. 110544, Nov. 2025, [Online]. Available: https://doi.org/10.1016/j.yebeh.2025.110544.

G. G. Kahsay, K. Gidey, and A. B. Berha, “Treatment outcomes, medication adherence and predictors among patients with epilepsy in Mekelle City Hospitals, Ethiopia: a multicentre observational cross-sectional study,” BMJ Open, vol. 15, no. 6, p. e097067, Jun. 2025, [Online]. Available: https://doi.org/10.1136/bmjopen-2024-097067.

K. Godara, N. Phakey, D. Garg, S. Sharma, and R. R. Das, “Interventions to Improve Medication Adherence in Children With Epilepsy: A Systematic Review,” Cureus, vol. 16, no. 2, p. e54680, Feb. 2024, [Online]. Available: https://doi.org/10.7759/CUREUS.54680.

R. R. Ramsey, N. Zhang, and A. C. Modi, “The Stability and Influence of Barriers to Medication Adherence on Seizure Outcomes and Adherence in Children With Epilepsy Over 2 Years,” J. Pediatr. Psychol., vol. 43, no. 2, p. 122, Mar. 2017, [Online]. Available: https://doi.org/10.1093/JPEPSY/JSX090.

L. M. V. R. Moura, D. Y. Mendez, J. De Jesus, R. A. Andrade, J. S. Weissman, B. G. Vickrey, and D. B. Hoch, “Association of adherence to epilepsy quality standards with seizure control,” Epilepsy Res., vol. 117, pp. 35–41, Nov. 2015, [Online]. Available: https://doi.org/10.1016/j.eplepsyres.2015.08.008.

M. Saleye, H. Abdirahman, T. Assabe, and T. Libe, “Treatment outcomes and associated factors among children with epilepsy attending the pediatric follow-up clinic at Hiwot Fana Comprehensive Specialized Hospital,” BMC Pediatr., Dec. 2025, [Online]. Available: https://doi.org/10.1186/s12887-025-06446-2.

T. Alene, G. Engidaye, T. Birhane, and S. Gedamu, “Epilepsy Treatment Outcome and Its Predictors Among Children Who Had Chronic Follow Up at Dessie Comprehensive Specialized Hospital,” Patient Relat. Outcome Meas., vol. Volume 15, pp. 71–80, Feb. 2024, [Online]. Available: https://doi.org/10.2147/PROM.S431242.

H. Mohammed, K. Lemnuro, T. Mekonnen, and T. Melaku, “Adherence to anti-seizure medications and associated factors among children with epilepsy at tertiary Hospital in Southwest Ethiopia: a cross-sectional study,” BMC Neurol., vol. 22, no. 1, p. 310, Aug. 2022, [Online]. Available: https://doi.org/10.1186/s12883-022-02842-8.

S. A. Dima and M. S. Shibeshi, “Antiepileptic drug adherence in children in southern Ethiopia: A cross sectional study,” PLoS One, vol. 17, no. 2, p. e0263821, Feb. 2022, [Online]. Available: https://doi.org/10.1371/journal.pone.0263821.

H. D. Adal, K. Alemu, and E. A. Muche, “Seizure control status and associated factors among pediatric epileptic patients at a neurologic outpatient clinic in Ethiopia,” PLoS One, vol. 16, no. 11, p. e0259079, Nov. 2021, [Online]. Available: https://doi.org/10.1371/journal.pone.0259079.

Y. Lee, Y. Ah, Y. J. Choi, Y. S. Cho, K. J. Kim, and J. Lee, “Antiepileptic drug adherence and persistence in children with epilepsy attending a large tertiary care children’s hospital,” Epileptic Disorders, vol. 18, no. 4, pp. 408–417, Dec. 2016, [Online]. Available: https://doi.org/10.1684/epd.2016.0871.

M. Nasir, E. Abebaw, M. Ahmed, and D. Ketema, “Clinical Characteristics, Treatment Outcome and Associated Factors of Epilepsy Among Children at Hospitals of North-West Ethiopia,” Pediatric Health Med. Ther., vol. Volume 14, pp. 385–404, Oct. 2023, [Online]. Available: https://doi.org/10.2147/PHMT.S436022.

A. Beyene, A. F. Ayalew, G. Mulat, A. Simachew Kassa, and T. Birhan, “The treatment outcomes of epilepsy and its root causes in children attending at the University of Gondar teaching hospital: A retrospective cohort study, 2018,” PLoS One, vol. 15, no. 3, p. e0230187, Mar. 2020, [Online]. Available: https://doi.org/10.1371/journal.pone.0230187.

L. A. Anghel, A. M. Farcas, and R. N. Oprean, “An overview of the common methods used to measure treatment adherence,” Med. Pharm. Rep., vol. 92, no. 2, p. 117, 2019, [Online]. Available: https://doi.org/10.15386/MPR-1201.

S. Basu, S. Garg, N. Sharma, and M. Meghachandra Singh, “Improving the assessment of medication adherence: Challenges and considerations with a focus on low-resource settings,” Tzu Chi Med. J., vol. 31, no. 2, pp. 73–80, Apr. 2019, [Online]. Available: https://doi.org/10.4103/TCMJ.TCMJ_177_18.

M. Taha, S. Hanif, G. Dickson, J. Todd, D. Fyfe, S. MacBride-Stewart, R. Hassett, A. Marshall, and C. Heath, “Utilisation of specialist epilepsy services and antiseizure medication adherence rates in a cohort of people with epilepsy (PWE) accessing emergency care,” Seizure: European Journal of Epilepsy, vol. 115, pp. 59–61, Feb. 2024, [Online]. Available: https://doi.org/10.1016/j.seizure.2023.12.019.

Y. Babu, T. Sheleme, B. Sefera, F. Bekele, and W. Olika, “Magnitude of uncontrolled seizures and associated factors among people with epilepsy. Data from a major teaching hospital in Southwest Ethiopia,” Epilepsy & Behavior, vol. 140, p. 109089, Mar. 2023, [Online]. Available: https://doi.org/10.1016/j.yebeh.2023.109089.

D. Zena, A. Tadesse, N. Bekele, S. Yaregal, N. Sualih, and E. Worku, “Seizure control and its associated factors among epileptic patients at Neurology Clinic, University of Gondar hospital, Northwest Ethiopia,” SAGE Open Med., vol. 10, Jan. 2022, [Online]. Available: https://doi.org/10.1177/20503121221100612.

M. Ahmed, M. Nasir, S. Yalew, F. Getahun, and F. Getahun, “Assessment of Treatment Outcome and Its Associated Factors among Adult Epileptic Patients in Public Hospitals in the Southern Ethiopia: A Multi-center Cross-sectional Study,” Ethiop. J. Health Sci., vol. 33, no. 2, pp. 327–336, Apr. 2023, [Online]. Available: https://doi.org/10.4314/ejhs.v33i2.18.

NICE, “Overview | Epilepsies in children, young people and adults | Guidance | NICE.” Accessed: Jun. 23, 2025. [Online]. Available: https://www.nice.org.uk/guidance/ng217

M. W. Suryoputri, N. E. Endriastuti, and D. L. Ilma, “Effects of Antiepileptic Drug Levels on Clinical Outcomes in Pediatric Patients Using Pharmacokinetics Approach,” Indonesian Journal of Clinical Pharmacy, vol. 10, no. 4, pp. 272–288, Dec. 2021, [Online]. Available: https://doi.org/10.15416/ijcp.2021.10.4.272.

A. M. Albsoul-Younes, A. T. Masri, L. F. Gharaibeh, A. A. Murtaja, and A. A. Al-Qudah, “Frequency of antiepileptic drugs and response change in pediatric patients receiving 2 or more antiepileptic drugs,” Neurosciences, vol. 25, no. 4, pp. 269–275, Aug. 2020, [Online]. Available: https://doi.org/10.17712/nsj.2020.4.20190113.

I. Ernawati, N. Munif Yasin, I. Setyopranoto, and Z. Ikawati, “The Role of Pharmacists’ Interventions in Increasing Medication Adherence of Patients With Epilepsy: A Scoping Review,” Journal of Preventive Medicine and Public Health, vol. 57, no. 3, pp. 212–222, May 2024, [Online]. Available: https://doi.org/10.3961/jpmph.23.592.

E. A. A. Kyeremaa, S. Scott, C. Smith, C. Lawthom, A. Stewart, M. Alorabi, and D. Wright, “Barriers and enablers to antiseizure medication adherence in children with Epilepsy: A systematic review using meta-ethnography,” Seizure: European Journal of Epilepsy, vol. 130, pp. 115–134, Aug. 2025, [Online]. Available: https://doi.org/10.1016/j.seizure.2025.06.016.

A. C. Modi, K. A. Mann, L. Urso, and J. Peugh, “Preliminary feasibility and efficacy of text messaging and application-based adherence interventions in adolescents with epilepsy,” Epilepsy & Behavior, vol. 63, pp. 46–49, Oct. 2016, [Online]. Available: https://doi.org/10.1016/j.yebeh.2016.07.036.

DOI: https://doi.org/10.37311/jsscr.v8i2.37180

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