Medication Adherence and Lifestyle Burden in Adults with Generalized Epilepsy Receiving Monotherapy or Polytherapy

This is the authors' abstract. We don't add key points for this paper.

Objective: Medication adherence is a major determinant of seizure control in epilepsy.This study aimed to compare adherence between patients receiving antiseizure medication monotherapy and polytherapy, identify item-level non-adherence behaviors that differ between groups, and evaluate whether a structured lifestyle checklist provides additional explanatory value beyond treatment complexity.Methods: This cross-sectional outpatient study included 200 adults with generalized epilepsy, comprising 100 patients treated with monotherapy and 100 treated with polytherapy.Adherence was assessed using a reverse-coded 8-item Morisky Medication Adherence Scale (MMAS-8), with higher total scores indicating worse adherence.The dataset also included age, monthly seizure frequency, adverse-effect status, daily drug count, and an 8-item lifestyle checklist.Group comparisons, Spearman correlation analyses, and two multivariable linear regression models with HC3 robust standard errors were used.Results: Polytherapy was associated with worse reverse-coded adherence compared with monotherapy [median 3.0 (interquartile range 2.0-3.0) vs. 2.0 (1.0-2.0);p<0.001].The most prominent item-level differences were forgetting medication while away from home (35% vs. 8%, p<0.001) and difficulty remembering medication (34% vs. 8%, p<0.001).Lifestyle burden was higher in the polytherapy group and was correlated with worse adherence (Spearman r=0.666, p<0.001).In the extended model, polytherapy [β=0.487,95% confidence interval (CI) 0.244-0.730,p<0.001] and lifestyle checklist total score (β=0.434 per point, 95% CI 0.338-0.531,p<0.001) were independently associated with poorer adherence.Conclusion: Polytherapy and greater lifestyle burden were associated with poorer self-reported medication adherence.Because the MMAS-8 has not been specifically validated in a Turkish epilepsy population and the 8-item lifestyle checklist has not undergone formal psychometric validation, these findings should be interpreted cautiously and regarded as exploratory and hypothesis-generating.