LETTER TO THE EDITOR - The Adherence to Anti-seizure Medications in Adolescents is Complex and Requires Consideration of All Influencing Factors

Sep 29, 2026

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Letter to the editor responding to an observational cross-sectional study on adherence to anti-seizure medications among Filipino adolescents. The correspondence highlights key limitations: reliance on self-administered surveys without verification of response accuracy or seizure information, lack of measured and correlated serum ASM levels, and low instrument sensitivity and specificity of the Morisky-Green-Levine scale. It also notes that COVID-19–era access constraints may affect adherence and that adult-based adherence literature may not transfer to adolescents, recommending serum level monitoring to strengthen conclusions.

LanguageEnglish

CategoryHealthcare

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Pages2

Reading Time5 min

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Letter to the editor: Adherence to anti-seizure medications in adolescents

Key concerns about self-reported adherence

Missing serum level measurements and scale limitations

COVID-19 period and adult literature relevance

LETTER TO THE EDITOR The Adherence to Anti-seizure Medications in Adolescents is Complex and Requires Consideration of All Influencing Factors* Josef Finsterer, MD, PhD Neurology Department, Neurology and Neurophysiology Center, Vienna, Austria Keywords: epilepsy, anti-seizure medications, seizures, adherence, adolescents We read with interest the article by Gaspi et al. on an observational cross-sectional study of adherence to antiseizure medications (ASMs) among Filipino adolescents aged 10 to 19 years, based on a self-report survey conducted between February and July 2023.1 Of the 51 patients included, 20% were non-adherent, 35% were moderately adherent, and 45% were highly adherent according to the 4-point scale developed by Morisky, Green, and Levine (MGLS) .1 The availability of an unemployed primary caregiver was associated with a 7-fold higher likelihood of moderate to high adherence, while regular use of at least three different ASMs was associated with a 0.3 lower likelihood of moderate to high adherence.1 The study is noteworthy, but some points require discussion. *In response to the article “Anti-seizure medication adherence among adolescents with epilepsy in a tertiary hospital in the Philippines” by Gaspi et al., published in Acta Medica Philippina 2025 Jun 30;59(8):35-44. eISSN 2094-9278 (Online) Published: November 28, 2025 [https://doi.org/10.47895/amp.v59i18.13799](https://doi.org/10.47895/amp.v59i18.13799) [Copyright: The Author](Copyright: The Author)([s](s)) 2025 Corresponding author: Josef Finsterer, MD, PhD Neurology Department Neurology and Neurophysiology Center Postfach 20 1180 Vienna, Austria [Email: fifigs1@yahoo.de](Email: fifigs1@yahoo.de) ORCiD: [https://orcid.org/0000-0003-2839-7305](https://orcid.org/0000-0003-2839-7305) The first point is that assessing ASM adherence through a self-administered survey may be flawed due to several disadvantages.2 It is difficult for the researcher to verify whether the responses regarding adherence are accurate and whether the information about the type and frequency of seizures is truthful. Furthermore, the questionnaire may miss individual aspects of adherence. The second point is that the serum levels of the ASM taken by the patients included in the study were not measured and correlated with the responses to the questionnaire.1 In order to assess whether the responses to the questionnaire were reliable or not, it would have been useful to at least measure the serum levels of those ASMs for which serum levels are routinely available. The third point is that the Morisky-Green-Levine scale itself has several drawbacks.3 The sensitivity of the instrument is low, but the specificity is even lower. Since the reliability and consistency of the test is low, the Morisky-Green-Levine scale should be used in conjunction with other scales to compare their reliability and assess which is most appropriate for the objectives of a study.3,4 The fourth point is that the study period also included the time of the COVID-19 pandemic. Since access toASMs may have been limited during lockdowns, it would be interesting to know whether adherence differed before and during the pandemic. The fifth point is that the paper cites and discusses a series of articles on adherence to ASM therapy in adult patients.1 Since adherence to therapy can vary depending on age, particularly between pediatric and adult patients, the inclusion of data on adults should be avoided so as not to confuse the reader. In summary, this interesting study has limitations that affect the results and their interpretation. Taking these limitations into account could strengthen the conclusionsand reinforce the message of the study. All open questions must be clarified before readers can uncritically accept the study's conclusions. To monitor adherence to ASM therapy in adolescents, measuring serum levels of ASMs may be more useful than using questionnaires, as the reliabilit

FAQs

Why may self-administered surveys for ASM adherence be problematic?

Self-report surveys make it difficult to verify whether adherence responses and seizure type/frequency information are accurate. The questionnaire may also overlook individual adherence factors.

What does the letter suggest about serum levels of anti-seizure medications?

The study did not measure or correlate serum ASM levels with questionnaire responses. The author suggests measuring serum levels for ASMs where routine serum testing is available to improve reliability.

What drawbacks of the Morisky-Green-Levine scale are discussed?

The letter states the instrument has low sensitivity and even lower specificity. It argues that the scale should be used alongside other measures to compare reliability and suitability for study objectives.

Sep 29, 2026

Upload by jayni