review · Epilepsy & Behavior
BACKGROUND: Epilepsy is a chronic neurologic disorder that affects around 50 million individuals worldwide, disproportionately affecting children and young adults. Anti-seizure medication is vital to control seizures, yet adherence remains a key public health concern. While there are scattered individual studies addressing these issues, there is no summary of evidence. This systematic review and meta-analysis will give an estimate of global adherence prevalence, regional variations and determinants, and offer suggestions on improving medication adherence in this vulnerable population. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews for studies reporting on the adherence of anti-seizure medication among children and adolescents. We employed random-effects model to calculate pooled estimates. Additionally, heterogeneity, publication bias and sensitivity analysis was performed. RESULTS: The final analysis consisted of 41 studies on a sample of 13,747. The pooled prevalence of adherence to anti-seizure medication in children and adolescents with epilepsy was estimated to be 63.96% (95% CI: 59.36%-68.57%). Independent predictors of medication adherence in the study were: children and adolescents of mothers with highest educational levels (AOR: 2.07, 95% CI: 1.01-3.14), recently diagnosed children and adolescents with epilepsy (AOR: 2.20, 95% CI: 1.25-3.16), parents with annual healthcare costs of over $7,000 (AOR: 0.53, 95% CI: 0.30-0.76), and patients on monotherapy (AOR: 3.03, 95% CI: 2.47-3.60). CONCLUSION: This meta-analysis found that there was a suboptimal rate of adherence to anti-seizure medication in children and adolescents. Predictors were maternal education, time since diagnosis, cost, and polypharmacy. The findings confirm the necessity of intervention into socioeconomic status and treatment complexity to improve adherence.
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DOI: 10.1016/j.yebeh.2025.110544
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