Abstract

Treatment adherence is a critical component of epilepsy management. Antiepileptic drug side effects affect adherence and may result in the discontinuation of medication. This study aimed to investigate the association between antiepileptic drug side effects and medication adherence among Libyan patients with epilepsy while identifying predictors of adherence. A cross-sectional study was conducted at Tripoli University Hospital involving 200 adult epilepsy patients. Adherence was assessed via a self-report tool dichotomized as adherent/ non-adherent if patients stopped medication due to side effects. Side effects were evaluated using the Side Effects of Antiepileptic Drugs questionnaire. Logistic regression analyzed predictors of adherence, including antiepileptic drug use, therapy regimen, and side-effect profiles, with p<0.05 declared association. The overall adherence rate was 87.0%. Higher adherence was observed in older age groups, 95.8% in patients aged 51-60, 89.4% in married patients, and 91.0% in university-educated patients. Patients on monotherapy and those seizure-free in the preceding month demonstrated better adherence (88.4% and 93.0%, respectively). Valproate users had notably low adherence (52.6%) while carbamazepine and phenytoin users showed higher adherence (89.7% and 91.7%, respectively). Cognitive complaints significantly reduced adherence (76.1% vs. 79.6%), as did aggressive behavior (58.3% adherence). Logistic regression identified two independent predictors: patients on old-generation antiepileptic drugs had 2.7 times higher adherence (AOR=2.702, 95% CI: 1.168-6.249; p=0.02) while cognitive side effects reduced adherence by 86.4% (AOR=0.136, 95% CI: 0.031-0.596; p=0.008). Cognitive side effects predict non-adherence, necessitating routine monitoring. Paradoxically, older antiepileptic drugs correlated with better adherence. Integrating patient-reported metrics and addressing cognitive impacts could optimize epilepsy care, highlighting gaps in side-effect management and advocating personalized strategies in clinical settings.