| Description: |
The epilepsy treatment gap (ETG) and poor adherence to antiseizure medications (ASMs) remain major challenges in low- and middle-income countries (LMICs). This study assessed adherence, evaluated the effectiveness of short messaging service (SMS) reminders, and investigated ASM-related adverse drug reactions (ADRs) in epilepsy patients from Kilifi and Nairobi, Kenya. A cohort of 1,692 people with epilepsy was assessed for medication adherence, with 38% having drug level data. In Kilifi, a randomised controlled trial (RCT) involving 1,038 participants tested SMS interventions (text, audio, both) versus control. Drug levels were measured at baseline, three, six and twelve months and a third of these were available at the time of analysis. At baseline, adherence was low—overall gap was 68% (71% in Nairobi, 65% in Kilifi). Factors associated with poor adherence included active epilepsy (aOR=1.80), ASM polytherapy (aOR=3.1), and low quality of life (β=-0.007). The SMS intervention in Kilifi reduced non-adherence over time. ASM levels below the quantification limit decreased from 34% at baseline to 29% at follow-up. Suboptimal levels dropped from 64% to 57%. However, overall incidence rate of non-adherence showed no significant difference across intervention groups. Proportion of secondary outcomes improved: daily seizures fell from 22% to 3%, severe disability from 33% to 16%, and negative beliefs from 29% to 20%. SMS reminders reduced the incidence rate of poor quality of life in those with adequate ASM levels but increased incidence rate of severe disability in those with low/suboptimal levels. ADRs affected 68% of 138 participants with mainly psychiatric (59%) and movement symptoms (51%) reported. Risk factors associated with ADR included polytherapy (aOR=2.3) and phenobarbital use. Psychiatric comorbidities were associated with polytherapy use, including depression (aOR=2.9) and psychosis (aOR=1.9). Electrolyte imbalances were found in 19.4% of 1,495 participants, notably hypomagnesaemia (associated with CBZ use) ... |