Impact of neurology staff’s adherence to management guidelines on seizure freedom in epilepsy patients

Aim: This study aimed to assess the relationship between clinician adherence to International League Against Epilepsy (ILAE) management guidelines and seizure freedom in adult patients with epilepsy at a Mexican tertiary care center. Methods: This retrospective cross-sectional study analyzed 404 adult outpatients with epilepsy from an institutional database (January–October 2013). Data were collected on demographic characteristics, seizure types, diagnostic workup completeness, treatment regimens, weight-adjusted dosing, self-reported adherence, and seizure freedom (defined as being seizure-free for at least 3 months). Statistical analysis included chi-squared tests (χ2) for categorical variables and multivariate logistic regression to identify independent predictors of seizure freedom. Results: Of 404 patients analyzed (58.7% female, mean age 33 ± 13 years), 49.3% achieved seizure freedom. Generalized seizures (including primary and secondarily generalized seizures) were most common (66%), followed by focal seizures (30%). Diagnostic studies included an electroencephalogram in 80% and a magnetic resonance imaging scan in 75% of patients. Monotherapy was used in 50.7%, polytherapy in 44.6%, with weight-adjusted dosing achieved in 92%. Self-reported treatment adherence was 81%. Factors significantly associated with seizure freedom included treatment adherence (51.4% vs. 27.3% in non-adherent patients, χ2 = 13.56, p < 0.001), monotherapy vs. polytherapy (71.7% vs. 62.9%, χ2 = 46.07, p < 0.001), and adequate weight-adjusted dosing (44.9% vs. 32.3%, χ2 = 5.97, p = 0.01). Conclusions: Adherence to ILAE management guidelines, particularly regarding monotherapy selection, weight-adjusted dosing, and treatment adherence, was significantly associated with improved seizure freedom rates. These findings underscore the importance of implementing evidence-based epilepsy management protocols systematically in clinical practice.