Abstracts

Rationale: Sixty percent of children with epilepsy demonstrate non-adherence to their antiepileptic drug treatment (AED), which can result in poor short and long-term seizure control. The study aim was to examine the preliminary efficacy of a family-tailored problem-solving intervention (Supporting Treatment Adherence Regimens; STAR) to improve adherence in children with new-onset epilepsy using an enrichment, randomized controlled clinical trial design (e.g., only those with poor adherence would be randomized). It was hypothesized that participants in the STAR intervention group would demonstrate significant improvements in adherence from baseline to post intervention (8-week period) compared to the treatment as usual group and maintain these effects over time. A secondary aim was to assess changes in targeted mechanisms (e.g. epilepsy knowledge, problem solving skills, adherence barriers) and assess treatment feasibility and acceptability for participants who received the STAR intervention.Methods: Fifty families participated in this study (Mage= 7.6±3.0; 80% Caucasian; Epilepsy Diagnosis: 42% idiopathic localization related, 24% idiopathic generalized, 28% unclassified; AED: 32% carbamazepine, 30% valproate, 24% levetiracetam; 14% other). Families completed baseline questionnaires and were given an electronic monitor (i.e., MEMS TrackCap) to observe AED adherence. If adherence was <95% during the one-month run-in or two subsequent visits (every 3 months), families were randomized (STAR: n=11; TAU: n=12; Near-Perfect Adherence Group: n=21; Withdrew/Lost to follow-up: n=6). The STAR intervention included education and problem-solving sessions. All children were monitored over the same time period (i.e. 4-month follow-up period).Results: Significant group differences were noted during active treatment. Specifically, after initiation of the problem solving sessions (Sessions 2-4), group differences in adherence were found (SESSION 2-3: TAU=-0.5 vs STAR=15.8, p =.053; Session 3-4; TAU=-12.0 vs STAR=18.1, p < .01; Session 4-2Week Follow-up; TAU=-9.7 vs STAR=15.3, p < .05). Significant changes in epilepsy knowledge and management of the condition were also noted for the STAR intervention group. Finally, caregivers reported that they liked the individualized format, used the problem-solving skills learned, valued the feedback from the MEMS TrackCap, and felt the intervention was beneficial to their family.Conclusions: Children who received the STAR intervention exhibited improved adherence compared to children in the TAU group during active treatment. Overall families expressed that they benefited from the STAR sessions. Future studies should include a larger sample size and booster intervention sessions to maintain treatment effects over time.