Sociocultural, medical, family environment, and cognitive factors predictive of adherence to treatment of epilepsy were analysed in 119 children, age 4 to 14 years, enrolled in a longitudinal study at the first visit to the seizure clinic, Los Angeles Children’s Hospital, CA. A foreign language, most commonly Spanish, was spoken in the home in 45% of families. Families with less parental education, non-English speaking recent immigrants with lower incomes and highly stressful lives, were more likely to keep appointments and to comply with treatment schedules than those with cultural and socioeconomic advantages. Cognitive functioning (IQ) was positively correlated with adequate drug levels. Seizure frequency and severity were not correlated with treatment adherence. Behavioral comorbidity was associated with poor adherence to medication and attendance. Parental report of medication adherence was minimally correlated with adherence based on drug levels. Adherence measures were statistically independent of each other, emphasizing the need to use multiple predictive factors. 
COMMENT. Contrary to expectations, the most striking positive measure of adherence to therapy and attendance of patients with epilepsy in this study was an acculturative risk factor among non-English speaking recent immigrants with lower incomes and highly stressful lives. Seizure severity was not associated with adherence outcome. One factor not addressed in this study was the physician’s fluency with foreign language or need for clinic interpreters that might detract from patient communication. In my early years at Children’s Memorial Hospital, Chicago, in the 1960’s, one of my fellows in training, Dr Winston Ortiz, later of Ponce, Puerto Rico, was adept at obtaining compliance with epilepsy treatment from Spanish-speaking parents at our Seizure Clinic. His clinical acumen, fluency with the language, and gentle but commanding persuasion engendered trust and faithful adherence to treatment regimens and appointment schedules. The rapport between physician and patient is perhaps the most important predictive factor of compliance and success of epilepsy management. In recent years we physicians have also become dependent on the support and expertise of nurse practitioners who strengthen the physician-patient relationship and contribute to treatment compliance and effectiveness.