Definitions

Non-compliance occurs when you don’t fill the first prescription or stop refilling prescriptions.
Partial compliance occurs when you take less than the prescribed amount of medication.
Dose Timing is taking each dose within an appropriate time interval (such as 2 or 3 times a day, spaced evenly apart).

DID THE DRUG FAIL, OR DID YOU FAIL TO TAKE THE DRUG?

We often talk about having tried several medications without success, but don’t explain the probable reason for drug failure. Most often, medications are changed because of excessive side effects, or lack of improvement in seizure control. Sometimes, you play a part if you did not take the medication as regularly as prescribed. The doctor will assume that you followed the prescription unless you say you missed doses. If you omit doses on purpose because of side effects, you should be telling your doctor and asking about a dose reduction, instead of skipping some doses. If adding a second drug did not improve seizures, don’t stop without telling your doctor. Doctors appreciate honesty about these situations, but neither you nor the doctor knows about doses you forgot to take. This is the hidden problem that can be addressed by creating your personalized MedSkills© program.

If you are supposed to take your medication at 7 AM, does your pattern look like A or B?

Pattern A: Some doses taken at 7 AM, but many taken later in the day or skipped.

Pattern B: Almost all doses taken close to 7 AM, except later on weekends.

Score yourself:

If you scored less than "10", what are the main reasons you miss doses?

• Too many side effects
• Doesn't control my seizures
• Too many times a day
• Too many pills a day
• Get mixed up about my pill schedule
• Forget sometimes
• Forget mainly on weekends/vacations
• No specific schedule to take meds
• Pills cost too much, so I "stretch" the amount
• Other ________________________

Most people say their main reasons for missing doses are forgetfulness and lack of organization of dosing schedules. People who take very little or no medication often don’t believe they have epilepsy or don’t really have to take medication. Some people test their need for medication by purposefully omitting doses, while others simply are forgetful about daily dosing. These patients may be lulled into feeling they don’t need the medication because there were no immediate consequences to missed doses. Unfortunately, the consequences often occur sooner or later after discontinuing treatment (e.g., having a seizure after missing several doses or stopping medication). That’s not to say that missing one dose definitely will lead to a seizure. Some people can go several days without medication and not have a seizure, but others have seizures even when taking every dose every day. It’s a gamble for you to try to determine whether missing a few doses will result in a seizure. The most cautious approach to self-management is to work out the best dose of the medication for you that does not cause excessive side effects and provides good seizure control, and take those doses every day.

Some medicines are easy to remember, for example, pain or nausea medicines, for which the return of the symptoms reminds you to take the pills. Missing seizure medicines, on the other hand, may just increase your chances of having a seizure, without having an immediate obvious effect. Remembering to take seizure medicines therefore requires effort and planning.

Yes, you want to try hard to take 100% of your seizure medication because you don’t want to take a chance on having a seizure. But that’s hard, for everyone. The real goal is to do the best you can so you can get the most from your medication: the best seizure control possible.

Continue to Your Role

Section Editor: Robert Fisher, M.D., Ph.D., author: Joyce Cramer
Last Reviewed: 11/15/08