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

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 (p0.05) 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.