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Background: Epilepsy is a major public health problem affecting 70 million people worldwide. 90% of global people with epilepsy are living in low-income countries. Due to the lack of clear guidelines for treatment selection and the difficulty of individualizing care in low-income countries, achieving seizure control can be challenging. In Ethiopia, the prevalence of uncontrolled seizures ranges from 18.6% to 82.4%, and medication nonadherence is one of the contributing factors.
Objective: The objective of this study was to assess the association between uncontrolled seizures and Non-adherence to antiseizure medications(ASMs).
Methods: A hospital-based age-matched case-control study was conducted among epileptic patients at the neurologic clinic of Eka Kotebe General Hospital and Amanuel Mental Specialized Hospital. Cases were defined as patients who reported at least one seizure episode within the last 12 months, while controls were those who had no seizure episodes during the same period from October 2024 to March 2025. A total of 68 cases and 136 controls were involved in the study, with a matching ratio of 1:2. Data was anayzed using Stata. Bivariate and multivariate logistic regression analyses were used to examine the relationship between the dependent and independent variables. Statistical significance was declared at a p-value less than 0.05.
Results: Non-adherance to Antiseizure medication (ASM) was significantly associated with uncontrolled seizures (AOR = 4.67, 95% CI: 1.42–15.36, p = 0.011). History of cigarette smoking was another important factor, with smokers having higher odds of uncontrolled seizures (AOR = 7.63, 95% CI: 1.73–33, p = 0.007). Patients on polytherapy were also more likely to have uncontrolled seizures compared to those on monotherapy (AOR = 3.07, 95% CI: 1.36–6.94, p = 0.007). Moreover, participants with a negative overall belief about medications (BMQ) were significantly more likely to experience uncontrolled seizures (AOR = 7.75, 95% CI: 1.9–30.82, p = 0.004).
Conclusion and Recommendations: This study found that uncontrolled seizures among individuals on antiseizure medications (ASMs) were strongly associated with non-adherence, history of cigarette smoking, polytherapy, and negative beliefs about medications, with non-adherence emerging as the most significant predictor. To enhance outcomes, the study recommends strengthening ASMs adherence through education, reminders, and counseling, addressing misconceptions about ASMs, and regularly assessing and supporting patients in reducing substance use, alongside promoting consistent clinic follow-up. |
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