A Narrative Study on Antiepileptic Medication Adherence Among Patients with Epilepsy

Medication adherence is an important determinant of treatment effectiveness in epilepsy, yet it is often overlooked when persistent seizures are evaluated. This narrative review summarizes evidence on adherence to antiseizure medications (ASMs), focusing on how adherence is measured, the factors associated with missed or discontinued doses, and the clinical implications of poor adherence. Sixteen selected studies from 11 countries were considered, covering different populations, healthcare settings, study designs, and adherence measures. Reported adherence varied substantially between studies, reflecting differences in patient characteristics, measurement methods, and adherence thresholds. Common barriers included forgetfulness, treatment complexity and polytherapy, adverse effects, negative beliefs about medicines, financial constraints, stigma, and gaps in communication or follow-up. Objective approaches such as pharmacy refill measures and electronic monitoring can provide more detailed information on medication-taking behaviour, whereas self-report tools remain practical but are vulnerable to recall and social desirability bias. Persistent seizures should not automatically be interpreted as drug-resistant epilepsy before adherence has been assessed. A patient-centred approach should combine adherence assessment with education, management of adverse effects, treatment simplification when clinically appropriate, and regular follow-up. Future studies should use more consistent adherence definitions and evaluate feasible interventions across different healthcare settings, particularly in resource-constrained environments.