Adherence and quality of life in patients with epilepsy in Cyprus
Authors: Petrides M , Peletidi A , Nena E , Konstantinidis T , Kontogiorgis C 
Published: November 2024

Abstract

Introduction
Epilepsy affects about 50 million people globally1. Patients often struggle with medication adherence due to forgetfulness, side effects, or lack of understanding, yet consistent use is vital for reducing seizures and improving quality of life2. Community pharmacists can improve outcomes by educating patients, aiding adherence, and clarifying drug effects and interactions, beyond just dispensing prescriptions.

Aim
The study aimed to assess epileptic patients’ adherence and quality of life in Cyprus.

Methods
This quantitative study, conducted from September 2022 to October 2023, received ethical approval from the Cyprus National Ethics Committee. Data were collected via phone calls using tools translated into Greek to assess adherence among epileptic patients. These tools included the MMAS-8 Morisky, with 8 items (7 Yes/No questions and 1 Likert 5-Point question), and the Readiness for Change scale, featuring a 0-10 ruler and 3 open-ended questions. The MARS-5, with 5 Likert 5-Point questions, and the QOLIE-31 were also used, along with demographic data collection. Inclusion criteria were patients over 18 with epilepsy, on antiepileptic therapy, and Greek-speaking. Of the 151 patients in the registry, 16 were excluded by the Neurologist of the Limassol's General Hospital due to factors like communication issues, recent stroke, quadriplegia, brain paralysis, mental retardation, and Down syndrome. Statistical analysis was performed using SPSS V28.

Results
In total, 85 epileptic patients participated in the study (out of the 135 patients- response rate 62.96%). The study's demographics included 47 males (55.3%) and 38 females (44.7%), with 18 participants aged 18-34 (21.2%), 46 participants aged 35-64 (54.1%), and 21 participants over 65 (24.7%). Additionally, the age of epilepsy onset was categorised as follows: 39 participants (45.9%) had an onset before 18 years of age, and 46 participants (54.1%) had an onset at 18 years of age or older. The Morisky MMAS-8 results showed 47 participants (55.3%) with high compliance, 26 (30.6%) with medium, and 12 (14.1%) with low compliance. The MARS-5 results indicated 79 participants (92.9%) had high compliance (≥20), while 6 (7.1%) had low compliance (&lt;20). The readiness for change ruler had a mean score of 9.48 (SD = 0.16). Specifically, the distribution of scores was as follows: 1 participant (1.2%) scored 2, 4 participants (4.7%) scored 5, 2 participants (2.4%) scored 7, 4 participants (4.7%) scored 8, 2 participants (2.4%) scored 9, and 72 participants (84.7%) scored 10. The overall quality of life (QoL) score averaged 75.3 (SD = 2.16).

Discussion/Conclusion
This study is the first comprehensive assessment of adherence and quality of life among epileptic patients in Cyprus. Some patients did not participate due to lack of time and interest. Using the Morisky MMAS-8 and MARS-5 scales, over half showed high medication compliance, but a significant portion had medium to low compliance, indicating a need for targeted interventions. The findings underscore the critical role of community pharmacists in supporting adherence and enhancing quality of life through education, counseling, and personalized care. This study provides a foundation for future research and interventions to improve epilepsy management in Cyprus.

References
1. Koshy S. Role of pharmacists in the management of patients with epilepsy. Int J Pharm Pract 2012;20:65–8.
2. Bacci JL, Zaraa S, Stergachis A, Simic G, White HS. Community pharmacists’ role in caring for people living with epilepsy: A scoping review. Epilepsy & Behavior 2021;117:107850.