Abstracts

Rationale: People with epilepsy (PWE) tend to have poorer quality of life as a result of recurrent seizures and other factors (e.g., depression). Psychological stress is a frequently self-reported seizure trigger. Stress may also be associated with seizures by reducing adherence to antiepileptic drugs (AEDs), but few studies have examined this relationship. We tested the hypothesis that greater daily stress would be associated with poorer AED adherence using diary data from a diverse sample of PWE who participated in a pilot study testing a smartphone-based self-management intervention. Methods: English or Spanish-speaking adults with epilepsy who self-reported suboptimal AED adherence were recruited from epilepsy clinics at NYU Medical Center and Bellevue Hospital Center. Participants were randomized to one of three arms: 1) use of a smartphone application that delivered epilepsy self-management support and allowed subjects to log seizures, stress, and AED taking daily for 3 months; 2) the smartphone application plus phone-delivered motivational interviewing; 3) usual care. We analyzed diary data from participants who used the smartphone diary for at least two weeks (N=16); because no group differences were found, the two smartphone study arms were combined for this analysis. Subject-level averages of diary-reported AED adherence, stress and seizures were calculated and Pearson correlations were used to examine their associations. Multivariable linear regression was used to test the association between self-reported stress and AED adherence, controlling for age, sex, ethnicity, depressive symptoms and number of days of diary completion.  Results: The mean age was 40.4 ± 12.6 years, 68.8% of participants were female, 43.8% were Hispanic, 18.8% were married, and 31.3% were working for pay. The majority of participants reported having had a seizure in the last 30 days (81.3%). Average AED adherence was high (97.9%), but 50% of participants reported missed doses during the study period. Poorer adherence was strongly associated with more frequent diary-reported seizures (r=-0.62, p=.01). In the multivariable regression model, higher average daily stress was associated with lower average adherence (p=.020) independent of age, sex, ethnicity, depressive symptoms and number of days of diary completion. None of these covariates were associated with adherence. Conclusions: Our results suggest that participants experiencing higher levels of daily stress report poorer AED adherence. This association was independent of diary adherence, increasing our confidence in the finding despite likely under-reporting of missed AED doses in diary studies. Non-adherence to AEDs contributes to poor seizure control and is an important intervention target to improve epilepsy outcomes. Future studies should examine the temporal associations between stress, AED adherence and seizures. If replicated, our findings suggest that stress management may be a promising approach to improving self-management and health outcomes in PWE. Funding: UCB Pharma