Factors Associated With Antiseizure Medication Adherence in Patients With Epilepsy: A Systematic Review

Abstract

Introduction Epilepsy is one of the most common chronic neurological disorders worldwide, and adherence to antiseizure medication (ASM) therapy is essential for seizure control and improved quality of life. Poor adherence has been associated with increased morbidity, mortality, and healthcare burden. This systematic review aimed to examine factors associated with ASM adherence among patients with epilepsy across different sociocultural and clinical settings.Methods Systematic searches were conducted in PubMed, Scopus, Web of Science, and Google Scholar databases. A total of 5736 records were identified and screened according to the PRISMA 2020 guidelines. After applying predefined eligibility criteria and assessing methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists, 41 quantitative studies were included in the final synthesis.Results Most studies reported moderate levels of ASM adherence. Factors associated with nonadherence were categorized according to the five World Health Organization (WHO) dimensions of adherence. The most frequently reported barriers included forgetfulness, complex medication regimens (particularly polytherapy), and adverse drug effects. Psychosocial factors such as depression, anxiety, negative medication beliefs, and perceived stigma were consistently associated with lower adherence. In addition, socioeconomic barriers including low income and high medication costs were frequently associated with poor adherence, particularly in low- and middle-income countries.Conclusion ASM adherence in epilepsy is associated with a complex interaction of biological, psychosocial, cultural, and economic factors. Major barriers include forgetfulness, treatment complexity, adverse effects, mental health problems, stigma, and financial difficulties. Improving adherence may require multidimensional interventions, including individualized patient education, psychosocial support, simplified treatment regimens, and strengthened healthcare policies targeting both patient- and system-level barriers.