PRESCRIBING PATTERN OF ANTIEPILEPTIC DRUGS IN PEDIATRIC PATIENTS AT A TERTIARY CARE TEACHING HOSPITAL
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i2.46405Keywords:
Antiepileptic drugs, Pediatric patients, Adherence, Breakthrough seizuresAbstract
Objectives: Epilepsy is one of the common neurological conditions worldwide.
Methods: The observational, continuous, prospective, and single-center study was carried out to evaluate prescribing pattern of antiepileptic drugs (AEDs) in pediatric patients at a tertiary care teaching hospital of Gujarat for a total duration of 18 months. Patients were followed up monthly for the period of 3 months to evaluate seizure freedom, breakthrough seizure, and change in the AEDs, add-on therapy, treatment adherence and ADRs. Rationality was assessed for selection of drug and selection of the right dose according to recent guidelines.
Results: Majority of patients in the age group of 7–9 years with mean age of 6.83 ± 3.09 years. Male-to-female ratio was 1.3:1. Total 73 AEDs were prescribed to pediatric epilepsy patients after diagnosis. Thirty-seven (69.80%) patients were prescribed AED on visit as monotherapy and 16 (30.20%) patients were prescribed polytherapy. Sodium valproate (77.36%) was most commonly prescribed AED followed by levetiracetam and carbamazepine. Most of AEDs were prescribed according to NICE guideline and by generic name.
Conclusion: Conventional AEDs are still used as first line of treatment for pediatric epilepsy patients, although newer AEDs also frequently prescribed as add on or primary drug. Low birth weight, NICU admission, and non-compliance to treatment are associated with breakthrough seizures.
Downloads
References
Banerjee TK, Dutta S, Ray BK, Ghosal M, Hazra A, Chaudhuri A, et al. Epidemiology of epilepsy and its burden in Kolkata, India. Acta Neurol Scand 2015;132:203-11. doi: 10.1111/ane.12384, PMID 25689886
Luoni C, Bisulli F, Canevini MP, De Sarro G, Fattore C, Galimberti CA,et al. Determinants of health-related quality of life in pharmacoresistant epilepsy: Results from a large multicenter study of consecutively enrolled patients using validated quantitative assessments. Epilepsia 2011;52:2181-91.
Johannessen IS, Landmark CJ. Antiepileptic drug interactions-principles and clinical implications. Curr Neuropharmacol 2010;8:254-67.
Costa E, Giardini A, Savin M, Menditto E, Lehane E, Laosa O, et al. Interventional tools to improve medication adherence: Review of literature. Patient Preference Adherence 2015;9:1303-14. doi: 10.2147/ PPA.S87551, PMID 26396502
Ahmad N, Othaman NI, Islahudin F. Medication adherence and quality of life in epilepsy patients. Int J Pharm Pharm Sci 2013;5:401-4.
Hugarams. A Study on Drug Utilization Pattern of Antiepileptic Drugs in Rural Tertiary Care Teaching Hospital [Doctoral Dissertation]. Karnataka: Rajiv Gandhi University of Health Sciences.
Overview: Epilepsies: Diagnosis and Management: Guidance. National Institute for Health and Care Excellence. NICE. Available from: https:// www.nice.org.uk/guidance/cg137 [Last accessed on 2021 Nov 29].
Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kälviäinen R, et al. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2013;54:551-63. doi: 10.1111/ epi.12074, PMID 23350722
Marcdante KJ, Kliegman R, editors. Nelson. Pediatría Esencial. Netherlands: Elsevier; 2019.
Bhatt KM, Malhotra SD, Patel KP, Patel VJ. Drug utilization in pediatric neurology outpatient department: A prospective study at a tertiary care teaching hospital. J Basic Clin Pharm 2014;5:68-73. doi: 10.4103/0976-0105.139729, PMID 25278669
Panda BK, George RS, Parekh NV, Dharmadhikari A, Patil S. Evaluation and comparison of the utilization of anti-epileptic drugs in Indian paediatric patients with global usage data. J Pharm Health Serv Res 2019;10:365-71. doi: 10.1111/jphs.12315
Hasan SS, Bahari MB, Babar ZU, Ganesan V. Antiepileptic drug utilisation and seizure outcome among paediatric patients in a Malaysian public hospital. Singapore Med J 2010;51:21-7. PMID 20200771
Garfinkle J, Shevell MI. Cerebral palsy, developmental delay, and epilepsy after neonatal seizures. Pediatr Neurol 2011;44:88-96. doi: 10.1016/j.pediatrneurol.2010.09.001, PMID 21215907
Crump C, Sundquist K, Winkleby MA, Sundquist J. Preterm birth and risk of epilepsy in Swedish adults. Neurology 2011;77:1376-82. doi: 10.1212/WNL.0b013e318231528f, PMID 21968843
Lekshmi AA, Anjana A, Emmanuel SM, Sreelekshmi V, Selvin CS. Evaluation of prescribing pattern of antiepileptic drugs and assessment of quality of life of epileptic patients and the knowledge of their care givers. J Appl Pharm Sci 2017;7:152-6.
Tan WW, Kong ST, Chan DW, Ho PC. A retrospective study on the usage of antiepileptic drugs in Asian children from 2000 to 2009 in the largest pediatric hospital in Singapore. Pharmacoepidemiol Drug Saf 2012;21:1074-80. doi: 10.1002/pds.3293, PMID 22674757
George J, Jose J, Kulkarni DA, Pol RR, Shalavadi MH, Mangannavar CV. Evaluation of drug utilization and analysis of anti-epileptic drugs at tertiary care teaching hospital. Indian J Pharm Pract 2016;9:189-94. doi: 10.5530/ijopp.9.3.10
Khattri S, Hussain S, Yadav SS, Bajpai M, Sawlani KK. Assessment of Drug Prescribing Pattern Using WHO Indicators in Outpatient Departments of a Tertiary Care Teaching Hospital in North India. In: Proceedings for Annual Meeting of the Japanese Pharmacological Society. Proceedings of the for Annual Meeting of the Japanese Pharmacological Society WCP2018 (The 18th World Congress of Basic and Clinical Pharmacology); 2018. p. PO3-12. doi: 10.1254/jpssuppl. WCP2018.0_PO3-12-20
Hafeez H, Akbar J, Munir AB, Qamar-uz-Zaman M, Faiz S, Abbas SM, et al. Evaluation of rational drug use among pediatrics by using WHO core drug use indicators in selected hospitals of Pakistan. Int J Pharm Res 2020;1: ???.
May TW, Berkenfeld R, Dennig D, Scheid B, Hausfeld H, Walther S, et al. Patients’ perspectives on management and barriers of regular antiepileptic drug intake. Epilepsy Behav 2018;79:162-8. doi: 10.1016/j. yebeh.2017.11.039, PMID 29291547
Panda PK, Dawman L, Panda P, Sharawat IK. Feasibility and effectiveness of teleconsultation in children with epilepsy amidst the ongoing COVID-19 pandemic in a resource-limited country. Seizure 2020;81:29-35. doi: 10.1016/j.seizure.2020.07.013, PMID 32712376
Kaddumukasa M, Matovu S, Katabira E. The frequency and precipitating factors for breakthrough seizures among patients with epilepsy in Uganda. BMC Neurol. 2013;13(1):1-7.
Afifi L, Al-Kattan M, Mostafa ED, Shamloul R. Assessment of precipitating factors of breakthrough seizures in epileptic patients. Egypt J Neurol Psychiatry Neurosurg 2015;52:165. doi: 10.4103/1110- 1083.162002
Modi AC, Rausch JR, Glauser TA. Patterns of nonadherence to antiepileptic drug therapy in children with newly diagnosed epilepsy. JAMA 2011;305:1669-76. doi: 10.1001/jama.2011.506, PMID 21521848
Chauhan S, Prasad PL, Khurana B, Gahalaut P. Self-reported medication adherence to antiepileptic drugs and treatment satisfaction among paediatric patients having epilepsy: A cross sectional study from the Indian subcontinent. Sri Lanka J Child Health 2018;47:129-36. doi: 10.4038/sljch.v47i2.8478
Dwajani S, Adarsh E, Nirmala KS, Sahajananda H. Sociodemographic, rationale drug use of antiepileptic drugs among pediatric patients with epilepsy: A prospective study at a tertiary Care Hospital. J Neurosci Rural Pract 2019;10:474-8. doi: 10.1055/s-0039-1698280, PMID 31602154
Published
How to Cite
Issue
Section
Copyright (c) 2022 Megha Shah, Panchal Kaushal ,Chetna Desai
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.
