Compliance during treatment of epilepsy.

Noncompliance is a major factor in suboptimal control of epileptic seizures. As many as one-third to one-half of persons with epilepsy may be noncompliant. Noncompliance negates the usefulness of the advances made in the diagnosis and treatment of epilepsy and is perhaps the single most important factor in increasing the costs of care for people with epilepsy. Although the issue of noncompliance is very complex, realization that it is a multidimensional problem and varies from patient to patient should help individualize its evaluation and approach. Noncompliance can be described by three dimensions: behavior, extent, and intentionality. The simplest methods for determining noncompliance are measurements of the antiepileptic drug concentration and patient interview. Calculation of a coefficient of variation for serial anticonvulsant drug levels may be more descriptive, however. Education and devices to simplify dosing are the primary strategies for improving compliance.