PRESCRIPTION PATTERNS AND RATIONAL USE OF ANTI-SEIZURE MEDICATIONS IN PAEDIATRIC EPILEPSY: A PROSPECTIVE OBSERVATIONAL STUDY FROM A SOUTH INDIAN TERTIARY CARE HOSPITAL
DOI:
https://doi.org/10.22159/ijpps.2026v18i7.58620Keywords:
Anti-seizure medications, Drug utilisation, Paediatric epilepsy, Prescribing indicators, Rational drug use, WHO/INRUDAbstract
Objective: To study the prescribing pattern of anti-seizure medications (ASMs) and evaluate for adherence to World Health Organisation/International Network for Rational Use of Drugs (WHO/INRUD) prescribing indicators and also evaluate if the dose was appropriate in a cohort of children with epilepsy at a tertiary care centre in South India.
Methods: A seven-month (February–August 2024) prospective observational study was performed at the Department of Paediatrics, a tertiary care hospital in Erode, Tamil Nadu. Consecutive paediatric patients with International League Against Epilepsy (ILAE) 2017–confirmed epilepsy on ASM therapy were enrolled. The quality of prescribing was assessed using 21 WHO/INRUD indicators across four domains: prescribing, patient care, facility, and complementary. The appropriateness of the dosing was compared to the British National Formulary for Children (BNF-C) reference ranges.
Results: In a cohort of 173 patients (mean age 7.2 ± 4.7 years; male 57.2%; rural residency 67.6%), 248 ASM prescriptions were analysed. Generalised tonic–clonic seizures were most common (39.3%), and the predominant aetiology was idiopathic/genetic (56.6%). Monotherapy was used in 61.8% of cases, with Sodium Valproate (27.4%) and Levetiracetam (19.4%) being the most prescribed drugs. Of the 21 WHO/INRUD indicators evaluated, the following exceeded target benchmarks: number of monotherapy prescriptions and correct dose (89.5%), documented diagnosis (98.8%), TDM (76.3%), and patient knowledge levels concerning treatment (85.0%). Continued deficiencies were observed for generic prescribing (73.0% v 100% goal), National List of Essential Medicines (NLEM) adherence (66.1%), availability of drugs recommended to treat key diseases (68.8%) and affordability (72.8% v >80%). The cumulative under-dosing rate (6.5%) was higher than the over-dosing rate (4.0%). Comorbidities were found in 40.5% of patients.
Conclusion: This analysis shows that ASM prescribing is not so incompatible with the monotherapy and dosage recommendations from previous guidelines, but persistent deficiencies in generic prescribing, formulary adherence and drug affordability remain. Recommendations include targeted interventions, such as including medicines on an essential medicines list, using electronic prescribing, and strengthening the supply chain.
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References
1. GBD 2021 Epilepsy Collaborators. Global, regional, and national burden of epilepsy, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Public Health 2025; 10(3):e203–27. doi: 10.1016/S2468-2667(24)00302-5
2. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58(4):522–30. doi: 10.1111/epi.13670
3. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58(4):512–21. doi: 10.1111/epi.13709
4. World Health Organization. Epilepsy: key facts [Internet]. Geneva: WHO; 2024 [cited 2025 Jun 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/epilepsy
5. Perucca E, Brodie MJ, Kwan P, Tomson T. 30 years of second-generation antiseizure medications: impact and future perspectives. Lancet Neurol 2020; 19(6):544–56. doi: 10.1016/S1474-4422(20)30036-2
6. Amudhan S, Gururaj G, Satishchandra P. Epilepsy in India I: epidemiology and public health. Ann Indian Acad Neurol 2015; 18(3):263–7. doi: 10.4103/0972-2327.160093
7. Megiddo I, Colson A, Chisholm D, Dua T, Nandi A, Laxminarayan R. Health and economic benefits of public financing of epilepsy treatment in India: an agent-based simulation model. Epilepsia 2016; 57(3):464–74. doi: 10.1111/epi.13294
8. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med 2000; 342(5):314–8. doi: 10.1056/NEJM200002033420503
9. World Health Organization. How to investigate drug use in health facilities: selected drug use indicators. Geneva: WHO; 1993. Report No.: WHO/DAP/93.1
10. Khoshdel Z, Tomas S, Jafari M. Drug utilization study of antiepileptic drugs in the pediatric department, tertiary care hospital, Bangalore, India. J Family Med Prim Care 2022; 11(6):2393–8. doi: 10.4103/jfmpc.jfmpc_1591_21
11. Balagura G, Iapadre G, Verrotti A, Striano P. Moving beyond sodium valproate: choosing the right anti-epileptic drug in children. Expert Opin Pharmacother 2019; 20(12):1449–56. doi: 10.1080/14656566.2019.1617277
12. Yildirim M, Bektas O, Akinci Goktas O, Yuksel MF, Sahin S, Tiras Teber S. Levetiracetam monotherapy in children with epilepsy: experience from a tertiary pediatric neurology center. Epilepsy Behav 2021; 116:107745. doi: 10.1016/j.yebeh.2020.107745
13. Magar YB, Hiray RS, Ghongane BB. Utilization pattern of antiepileptic drugs and their adverse effects in a tertiary healthcare and teaching hospital. Int J Basic Clin Pharmacol 2019; 8(1):39–46. doi: 10.18203/2319-2003.ijbcp20185182
14. Jhaj R, Banerjee A, Kshirsagar NA, Sadasivam B, Chandy SJ, Bright HR, et al. Use of drugs not listed in the National List of Essential Medicines: findings from a prescription analysis by the ICMR–Rational Use of Medicines Centres Network in tertiary care hospitals across India. Indian J Pharmacol 2022; 54(6):407–16. doi: 10.4103/ijp.ijp_472_22
15. Czornyj L, Caceres Guido P, Bramuglia G, Rodino A, Feria-Romero I, Lazarowski A. High incidence of persistent subtherapeutic levels of the most common AEDs in children with epilepsy receiving polytherapy. Epilepsy Res 2018; 148:107–14. doi: 10.1016/j.eplepsyres.2018.10.005
16. Srivastava K, Agarwal E, Rajadhyaksha S, Deshmukh R, Kulkarni V, Doke P, et al. Significant treatment gap and co-morbidities identified in an epidemiological survey of pediatric epilepsy in rural suburbs of India. Seizure 2021; 91:417–24. doi: 10.1016/j.seizure.2021.07.026
17. Record EJ, Bumbut A, Shih S, Merwin S, Kroner B, Gaillard WD. Risk factors, etiologies, and comorbidities in urban pediatric epilepsy. Epilepsy Behav 2021; 115:107716. doi: 10.1016/j.yebeh.2020.107716
18. Cho YS, Ah YM, Jung AH, Kim KJ, Lee JY. Trends in antiepileptic drug prescriptions for childhood epilepsy at a tertiary children’s hospital in Korea, 2001–2012. Paediatr Drugs 2015; 17(6):487–96. doi: 10.1007/s40272-015-0148-y
19. Singh K, Setia RK, Sharma S, Bansal N, Bansal RK, Chaudhary A, et al. Antiepileptic drug prices, availability and affordability in a resource-limited setting. Ann Indian Acad Neurol 2020; 23(5):674–80. doi: 10.4103/aian.AIAN_453_19
20. Paediatric Formulary Committee. BNF for Children 2023–2024. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2023
21. Kaur P, Kaur A, Singh J, Singh H. Prescription pattern of antiepileptic drugs in children with epilepsy: a cross-sectional study. Asian J Pharm Clin Res 2023; 16(5):99–103. doi: 10.22159/ajpcr.2023.v16i5.47359
22. Das M, Sehgal VK, Singh H. Adverse drug reactions of anti-epileptic drugs in pediatric age group in a tertiary care teaching hospital: a cross-sectional study. Asian J Pharm Clin Res 2022; 15(3):4–7. doi: 10.22159/ajpcr.2022.v15i3.43740
23. Pal A. Drug utilization pattern of antiepileptic drugs: a pharmacoepidemiologic and pharmacovigilance study in a tertiary teaching hospital in India. Asian J Pharm Clin Res 2011; 4(1):96–9.
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