Medication Adherence and Quality of Life in Epilepsy: The Potential Role of Seizure Severity in the Association Between Them

Background/Objectives: Epilepsy is a long-term condition that affects the brain and has a big impact on a person’s daily life, especially in areas where people do not have a lot of money or access to good healthcare. This study aimed to evaluate the relationship between medication adherence and QoL and to assess the role of seizure severity in the association between them among patients with epilepsy. Methods: A cross-sectional study of 1100 adult patients with epilepsy was conducted using registry data and structured interviews. The main outcomes that were assessed are quality of life (QoL), medication adherence, and seizure severity. Results: Reduced QoL was observed in 62% of patients. Low medication adherence was significantly associated with reduced QoL (OR = 4.33 [3.24–5.79] unadjusted; 3.90 [3.07–5.80] fully adjusted). Seizure severity was also associated with reduced QoL (OR = 1.62, p = 0.002; OR = 2.05, p < 0.001). Cognitive impairment showed the strongest association with reduced QoL, with ORs of 14.6 for mild and 80.8 for moderate-severe impairment in unadjusted models, remaining significant after adjustment. Medication adherence was significantly associated with seizure severity (OR = 1.18, p = 0.002), and attenuation of its effect after adjustment suggests that these variables are interrelated, although causality cannot be determined in this study. Additional factors associated with reduced QoL included lower education, longer disease duration, polytherapy, structural brain abnormalities, and comorbidities. Conclusions: Reduced QoL in epilepsy is strongly influenced by cognitive impairment and medication nonadherence, with seizure severity potentially contributing to this association, although causality cannot be inferred. These findings support integrated care strategies targeting adherence, cognition, and seizure control to improve patient outcomes.