Abstract

STUDY OF ANTI-EPILEPTIC THERAPY IN PEDIATRIC PATIENTS IN A SECONDARY CARE HOSPITAL

Ramjan Shaik*, Ayesha Akhil, Shobha Rani R Hiremath, Usha HN

ABSTRACT

& Objectives: Epilepsy is a chronic disorder, characterized by recurrent seizures. It is one of the most common and challenging neurologic disorders affecting children. Over 10 million children worldwide are believed to have epilepsy. Children with seizure disorders require prolonged antiepileptic drug (AED) therapy for atleast two seizure-free years. Knowledge of the available as well as newer AEDs should enable the practitioner to choose the best drug or drugs for individual patients. Although various modalities exist to treat pediatric-onset seizures, seizures in 25% of children who are diagnosed as having epilepsy remain refractory to available therapies. The ultimate goal of patient management is to choose the therapeutic option that provides the best chance of improving the patient’s quality of life. Therefore, the present study was undertaken to get an overview of the current trends in prescribing patterns of anti-epileptic drugs (AEDs) in the treatment of epilepsy in pediatrics department, St. Martha’s Hospital, Bangalore. Methodology: A nine month prospective study was carried out in St. Martha’s Hospital, Bangalore after obtaining Ethical Committee Clearance. Patient’s data was collected from the out-patient cards and in-patient case sheets who were prescribed with anti-epileptic drugs. Results: Out of 110 patients during the study period, 66% were male and maximum number of patients 45(41%) were in the age group of 1-12 months. With respect to pharmacotherapy, 54 (49.1%) patients were subjected to acute management, 2 (1.8%) patients were given prophylactic treatment and the remaining 54(49.1%) patients were grouped under long-term therapy. Under acute management, Lorazepam (98.2%) was prescribed in maximum number of patients. Clobazam was given as prophylactic therapy in 2(1.8%) patients. For the long-term management of seizures, monotherapy was seen in maximum number of patients (70.3%) followed by dual therapy (22.3%) and polytherapy (7.4%). Details of monotherapy revealed that phenobarbitone was prescribed for maxumim number of patients (50%) followed by phenytoin (39.5%) and valproate (5.3%). Newer anti-epileptic drugs like levetiracetam and topiramate were also prescribed as a part of combination therapy. During the study period, a total of 3(2.7%) adverse drug reactions (ADRs) were reported. All the 3 ADRs were due to the same drug i.e. phenytoin. Conclusion: Among the different approaches of treatment, monotherapy was found to be the most preferred choice of treatment. Most of the patients (60%) attended the follow-up and majority of them (95.5%) were found to be seizure free after the follow-up session indicating patient compliance. The prescription pattern at St. Martha’s Hospital was found to be in accordance with the prescribing guidelines for epilepsy in pediatrics.

Keywords: Prescription Pattern, Epilepsy, Seizures, AEDs.